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感音神经性聋患者在使用骨导助听器和同侧残余听力时的电声互作用的心理声学和电生理学研究

Psychoacoustic and electrophysiological electric-acoustic interaction effects in cochlear implant users with ipsilateral residual hearing.

机构信息

Department of Otorhinolaryngology, Hannover Medical School, Hanover, Germany.

Department of Otorhinolaryngology, Hannover Medical School, Hanover, Germany; Cluster of Excellence 'Hearing4All', Hanover, Germany.

出版信息

Hear Res. 2020 Feb;386:107873. doi: 10.1016/j.heares.2019.107873. Epub 2019 Dec 18.

Abstract

Cochlear implant users with ipsilateral residual hearing combine acoustic and electric hearing in one ear, this is called electric-acoustic stimulation (EAS). In EAS users, masking can be shown for electric probes in the presence of acoustic maskers and vice versa. Masking effects in acoustic hearing are generally attributed to nonlinearities of the basilar membrane and hair cell adaptation effects. However, similar masking patterns are observed more centrally in electric hearing. Consequently, there is no consensus so far on the level of interaction between the two modalities. Animal studies have shown that electric-acoustic interaction effects can result in reduced physiological responses in the cochlear nerve and the inferior colliculus. In CI users with residual hearing, it has recently become feasible to record intracochlear potentials with a high spatial resolution via the implanted electrode array. An investigation of the electrophysiological effects during combined electric-acoustic stimulation in humans might be used to assess peripheral mechanisms of masking. Seventeen MED-EL Flex electrode users with ipsilateral residual hearing participated in both a behavioral and a physiological electric-acoustic masking experiment. Psychoacoustic methods were used to measure the changes in behavioral thresholds due to the presence of a masker of the opposing modality. Subjects were stimulated electrically with unmodulated pulse trains using a research interface and acoustically with pure tones delivered via headphones. Auditory response telemetry was used to obtain objective electrophysiological changes of electrically evoked compound action potential and electrocochleography for electric, acoustic and combined electric-acoustic presentation in the same subjects. Behavioral thresholds of probe tones, either electric or acoustic, were significantly elevated in the presence of acoustic or electric maskers, respectively. 15 subjects showed significant electric threshold elevation with acoustic masking that did not depend on the electric-acoustic frequency difference (EAFD), a measure for the proximity of stimulation sites in the cochlea. Electric masking showed significant threshold elevation in eleven subjects, which depended significantly on EAFD. In the electrophysiological masking experiment, reduced responses to electric and acoustic stimulation with additional stimulation of the opposing modality were observed. Results showed a similar asymmetry as the psychoacoustic masking experiment. Response reduction was smaller than threshold elevation, especially for electric masking. Some subjects showed reduced responses to acoustic stimulation with electric masking, especially for small EAFD. The reduction of electrically evoked responses was significant in some subjects. No correlation was observed between psychoacoustic and electrophysiological masking results. From present study, it can be concluded that both electric and acoustic stimulation mask each other when presented simultaneously. Electrophysiological measurements indicate that masking effects are already to some extent present in the periphery.

摘要

人工耳蜗植入用户在一只耳朵中同时结合了声学和电刺激,这被称为电声刺激(EAS)。在 EAS 用户中,当存在声学掩蔽器时,可以观察到电探针的掩蔽,反之亦然。在声学听力中,掩蔽效应通常归因于基底膜的非线性和毛细胞适应效应。然而,在电听力中更集中地观察到类似的掩蔽模式。因此,迄今为止,对于两种模态之间的相互作用水平尚无共识。动物研究表明,电声相互作用效应可能导致耳蜗神经和下丘中的生理反应降低。在具有残余听力的 CI 用户中,最近已经可以通过植入的电极阵列以高空间分辨率记录耳蜗内电位。在人类中进行联合电声刺激的电生理效应研究可能用于评估掩蔽的外围机制。17 名具有同侧残余听力的 MED-EL Flex 电极用户参与了行为和生理电声掩蔽实验。使用心理物理方法测量由于对侧模态掩蔽器的存在而导致行为阈值变化。受试者使用研究接口以未调制的脉冲串进行电刺激,并通过耳机以纯音进行声学刺激。听觉反应遥测用于获得同一受试者的电刺激、声学刺激和联合电声刺激的电诱发复合动作电位和电描记图的客观电生理变化。在存在声学或电掩蔽器的情况下,探针的电或声学阈值均显著升高。15 名受试者在存在声学掩蔽时表现出与电刺激无关的显著电阈值升高,这与耳蜗中刺激部位的接近程度(EAFD)有关。11 名受试者的电掩蔽表现出显著的阈值升高,这与 EAFD 显著相关。在电生理掩蔽实验中,观察到随着对侧模态的额外刺激,电和声学刺激的反应降低。结果显示出与心理物理掩蔽实验相似的不对称性。反应减少小于阈值升高,尤其是对于电掩蔽。一些受试者在电掩蔽时对声学刺激的反应减少,尤其是对于小的 EAFD。在一些受试者中,电诱发反应的减少是显著的。在心理物理和电生理掩蔽结果之间未观察到相关性。从本研究可以得出结论,当同时呈现电刺激和声学刺激时,两者会相互掩蔽。电生理测量表明,掩蔽效应在一定程度上已经存在于外围。

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