Lailach Susen, Lenz Alexander, Zahnert Thomas, Neudert Marcus
Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Sächsisches Cochlear Implant Centrum, Universitätsklinikum Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
HNO. 2023 Sep;71(9):583-591. doi: 10.1007/s00106-023-01341-7. Epub 2023 Aug 4.
Patients with a cochlear implant (CI) should be evaluated for a new speech processor every 6 years. The aim of this analysis was to assess the subjective and audiological benefit of upgrades.
Speech understanding and subjective benefit were analyzed in 99 patients with the old and the new speech processor after 4 weeks of wearing. Speech understanding was assessed using the Freiburg monosyllabic test in quiet (FBE) at 65 dB and 80 dB, and the Oldenburg Sentence Test (OLSA) at 65 dB noise with adaptive speech sound level. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was used to assess subjective hearing impairment, and the Audio Processor Satisfaction Questionnaire (APSQ) was used to assess subjective satisfaction.
The speech processor upgrade resulted in a significant improvement of speech understanding in quiet at 65 dB (mean difference 8.9 ± 25.9 percentage points, p < 0.001) and 80 dB (mean difference 8.1 ± 29.7 percentage points, p < 0.001) and in noise (mean difference 3.2 ± 10.7 dB signal-to-noise ratio [S/N], p = 0.006). Using the APHAB, a significant improvement (mean difference 0.07 ± 0.16, p < 0.001) in hearing impairment was demonstrated in all listening situations. The APSQ showed significantly higher patient satisfaction with the new speech processor (mean difference 0.42 ± 1.26, p = 0.006). A comparative assessment of the benefit based on subjective and speech audiometric results identified a proportion of patients (35-42%) who subjectively benefited from the upgrade but had no measurable benefit based on speech audiometry.
There was a significant improvement in audiologically measurable and subjectively reflected speech understanding and patient satisfaction after the upgrade. In patients with only a small improvement in audiologically measurable speech understanding, the subjective benefit should also be assessed with validated measurement instruments in order to justify an upgrade to the payers in the health sector.
人工耳蜗植入（CI）患者应每6年评估是否需要更换新的言语处理器。本分析的目的是评估升级后的主观和听力学益处。
对99例佩戴新旧言语处理器4周后的患者进行言语理解和主观益处分析。使用弗莱堡单音节测试在安静环境下65dB和80dB时评估言语理解能力，以及在65dB噪声环境下使用奥尔登堡句子测试（OLSA）并采用自适应语音声级评估。使用助听器益处简表（APHAB）评估主观听力障碍，使用音频处理器满意度问卷（APSQ）评估主观满意度。
言语处理器升级后，在安静环境下65dB（平均差异8.9±25.9个百分点，p<0.001）和80dB（平均差异8.1±29.7个百分点，p<0.001）以及噪声环境下（平均差异3.2±10.7dB信噪比[S/N]，p=0.006）的言语理解能力均有显著改善。使用APHAB，在所有聆听情况下听力障碍均有显著改善（平均差异0.07±0.16，p<0.001）。APSQ显示患者对新言语处理器的满意度显著更高（平均差异0.42±1.26，p=0.006）。基于主观和言语测听结果对益处进行的比较评估发现，有一部分患者（35%-42%）主观上从升级中受益，但基于言语测听没有可测量的益处。
升级后，在听力学可测量和主观反映的言语理解以及患者满意度方面均有显著改善。对于听力学可测量的言语理解改善较小的患者，也应使用经过验证的测量工具评估主观益处，以便向卫生部门的支付方证明升级的合理性。
