Compensation effect of hearing aid on speech recognition in noise in patients with unilateral hearing loss
-
摘要: 目的 探究单侧听力损失患者在噪声环境中的言语识别表现，考察助听器对不同程度单侧听力损失患者噪声言语识别的补偿效果。方法 纳入25例单侧听力损失患者，依据受试者听力水平将其中14例单侧中度、中重度听力损失者设为中-中重度组，另11例单侧重度、极重度听力损失者设为重-极重度组。以15例听力正常的健康受试者作为对照组。在声场中测试单侧听力损失患者佩戴耳背式助听器(BTE)和未佩戴BTE助听器在噪声环境中的言语识别阈值，以及固定信噪比(SNR)为0 dB和-5 dB时的言语识别率。采用单因素方差分析考察单侧听力损失受试者与正常人的差异显著性，配对样本t检验分析单侧听力损失受试者使用助听器的补偿效果。结果 两组单侧听力损失受试者相较对照组在噪声环境中的言语识别阈值均显著升高(P < 0.01)，两组间差异不显著，固定SNR环境中的言语识别率均显著降低(P < 0.01)，且两组间不存在显著差异；佩戴BTE助听器时两组受试者言语识别阈值显著下降(P < 0.01)，言语识别率均有显著改善(P < 0.01)。结论 单侧听力损失达到中度以上的患者在噪声环境中的言语识别能力即表现出显著下降，患耳佩戴耳背式助听器对其噪声环境中的言语识别能力有较好的补偿效果。Abstract: Objective The aim of this study was to investigate the speech recognition in noise in patients with unilateral hearing loss(UHL), and explore the compensation effect of behind-the-ear(BTE) hearing aid on speech recognition in patients with varied degrees of UHL.Methods Twenty-five participants with UHL were divided into two groups according to the degree of hearing loss: one group included subjects with unilateral moderate and moderately severe hearing loss and another one included subjects with unilateral severe and profound hearing loss. Fifteen healthy subjects with normal hearing were enrolled as the control group. The speech recognition thresholds and speech recognition scores at fixed signal noise ratio(SNR) in UHL participants with and without BTE hearing aid were tested in the sound field and compared with those in the control group. One-way ANOVA was used to examine the significance of the difference between UHL participants and control group, and paired t-test was used to analyze the compensation effect of hearing aid on speech recognition in noise in UHL participants.Results The speech recognition thresholds were significantly higher in both UHL groups(P < 0.01) compared with the control group, there was no significant difference between two UHL groups. And the speech recognition scores were significantly lower when the SNR was fixed(P < 0.01), and there were no significant differences between two UHL groups. When fitting BTE hearing aid, the speech recognition thresholds of the two groups significantly decreased(P < 0.01), and the speech recognition scores significantly improved(P < 0.01).Conclusion Patients with above moderate UHL presented a significant decrease in performance of speech recognition in noise, and fitting BTE hearing aid on the affected ear had a positive compensation effect.
-
Key words:
- unilateral hearing loss /
- hearing aid /
- noise /
- speech recognition score
-
-
表 1 各组受试者噪声中言语测试描述性结果
X ±S 组别 SRT/dB SRS(0 dB) SRS(-5 dB) 助听SRT 助听SRS(0 dB) 助听SRS(-5 dB) 对照组 -3.64 ±1.41 97.00±2.20 65.80±1.78 - - - 试验组 中-中重度组 -0.27±1.10 88.14±6.00 39.14±2.32 -1.63±1.33 91.57±5.77 51.00±8.84 重-极重度组 -0.07 ±1.71 80.73±8.34 37.73±3.05 -1.66±1.67 89.09±6.79 50.82±13.00 
下载: 导出CSV
表 2 噪声环境中对照组与各受试组助听前言语识别情况多重比较
均值差 P SE. 95% CI 下限 上限 SRT/dB 对照组和中-中重度组 -3.373 < 0.001 0.468 -4.568 -2.179 对照组和重-极重度组 -3.566 < 0.001 0.630 -5.214 -1.917 中-中重度组和重-极重度组 -0.192 0.984 0.593 -1.770 1.386 SNR=0 dB 对照组和中-中重度组 0.089 < 0.001 0.017 0.043 0.134 对照组和重-极重度组 0.163 < 0.001 0.025 0.090 0.235 中-中重度组和重-极重度组 0.074 0.068 0.030 -0.005 0.153 SNR=-5 dB 对照组和中-中重度组 0.267 < 0.001 0.029 0.192 0.341 对照组和重-极重度组 0.281 < 0.001 0.035 0.187 0.375 中-中重度组和重-极重度组 0.014 0.977 0.038 -0.086 0.114
下载: 导出CSV
表 3 助听前后噪声环境中言语识别阈值比较
dB SRT Mean SE. P t 95% CI 下限 上限 中-中重度组 -1.360 0.185 < 0.001 -7.348 -1.760 -0.960 重-极重度组 -1.587 0.557 < 0.001 -9.441 -1.962 -1.213
下载: 导出CSV
表 4 噪声环境中各组助听前后言语识别率比较
SRT Mean SE. P t 95% CI 下限 上限 SNR=0 dB 重-极重度组 8.364 0.036 0.001 4.427 4.155 12.573 SNR=-5 dB 中-中重度组 11.500 0.105 0.001 4.101 5.441 17.559 重-极重度组 13.091 0.081 < 0.001 5.301 7.588 18.594
下载: 导出CSV
-
[1] World Health Orgnization. World Report on Hearing[J/OL]2021.
[2] Mertens G, De Bodt M, Van de Heyning P. Evaluation of Long-Term Cochlear Implant Use in Subjects With Acquired Unilateral Profound Hearing Loss: Focus on Binaural Auditory Outcomes[J]. Ear Hear, 2017, 38(1): 117-125. doi: 10.1097/AUD.0000000000000359
[3] Snapp HA, Ausili SA. Hearing with One Ear: Consequences and Treatments for Profound Unilateral Hearing Loss[J]. J Clin Med, 2020, 9(4): 1010-1022. doi: 10.3390/jcm9041010
[4] 刘锦峰, 原晶晶, 周沫, 等. 单侧听力损失及单侧聋的声源定位能力康复现状[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(5): 472-476, 480. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202105023.htm
[5] Mondelli MF, Dos Santos Mde M, José MR. Speech perception in noise in unilateral hearing loss[J]. Braz J Otorhinolaryngol, 2016, 82(4): 427-432. doi: 10.1016/j.bjorl.2015.08.019
[6] Asp F, Reinfeldt S. Effects of Simulated and Profound Unilateral Sensorineural Hearing Loss on Recognition of Speech in Competing Speech[J]. Ear Hear, 2020, 41(2): 411-419. doi: 10.1097/AUD.0000000000000764
[7] 乔宇斐, 郝文洋, 商莹莹, 等. 单侧耳聋病程对声源定位及噪声下言语识别的影响[J]. 听力学及言语疾病杂志, 2019, 27(2): 134-139. doi: 10.3969/j.issn.1006-7299.2019.02.006
[8] Dwyer NY, Firszt JB, Reeder RM. Effects of unilateral input and mode of hearing in the better ear: self-reported performance using the speech, spatial and qualities of hearing scale[J]. Ear Hear, 2014, 35(1): 126-136. doi: 10.1097/AUD.0b013e3182a3648b
[9] 夏清清, 李佳楠, 杨仕明. 单侧聋的听觉原理、临床表现及干预策略[J]. 中华耳科学杂志, 2020, 18(1): 139-145. doi: 10.3969/j.issn.1672-2922.2020.01.024
[10] Bishop CE, Eby TL. The current status of audiologic rehabilitation for profound unilateral sensorineural hearing loss[J]. Laryngoscope, 2010, 120(3): 552-556. doi: 10.1002/lary.20735
[11] Fogels J, Jönsson R, Sadeghi A, et al. Single-Sided Deafness-Outcomes of Three Interventions for Profound Unilateral Sensorineural Hearing Loss: A Randomized Clinical Trial[J]. Otol Neurotol, 2020, 41(6): 736-744. doi: 10.1097/MAO.0000000000002633
[12] Snapp HA, Hoffer ME, Liu X, et al. Effectiveness in Rehabilitation of Current Wireless CROS Technology in Experienced Bone-Anchored Implant Users[J]. Otol Neurotol, 2017, 38(10): 1397-1404. doi: 10.1097/MAO.0000000000001614
[13] 陈彪, 李永新. 单侧聋患者人工助听技术治疗研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(5): 478-480. http://www.cnki.com.cn/Article/CJFDTotal-LCEH202005025.htm
[14] 郗昕. 成人单侧聋和不对称性听力损失干预方式的评估框架[J]. 中国听力语言康复科学杂志, 2018, 16(6): 401-406. doi: 10.3969/j.issn.1672-4933.2018.06.001
[15] Wong LL, Soli SD, Liu S, et al. Development of the Mandarin Hearing in Noise Test(MHINT)[J]. Ear Hear, 2007, 28(2 Suppl): 70S-74S.
[16] 陈建勇, 张华, 彭璐, 等. 可接受噪声级与噪声下言语测试在老年性聋助听器验配效果评估中的应用[J]. 中华耳科学杂志, 2015, 13(4): 583-588. doi: 10.3969/j.issn.1672-2922.2015.04.004
[17] Keidser G, Dillon H, Flax M, et al. The NAL-NL2 Prescription Procedure[J]. Audiol Res, 2011, 1(1): 88-90.
[18] Bernstein J, Schuchman GI, Rivera AL. Head Shadow and Binaural Squelch for Unilaterally Deaf Cochlear Implantees[J]. Otol Neurotol, 2017, 38(7): e195-e202. doi: 10.1097/MAO.0000000000001469
[19] 孙进, 孙文浩, 陈向平, 等. 单侧轻中度传导性听力损失对言语识别能力影响的临床观察[J]. 中国听力语言康复科学杂志, 2021, 19(5): 340-343. doi: 10.3969/j.issn.1672-4933.2021.05.005
[20] Lopez-Poveda EA, Eustaquio-Martín A, San-Victoriano FM. Binaural pre-processing for contralateral sound field attenuation and improved speech-in-noise recognition[J]. Hear Res, 2022, 418: 108469. doi: 10.1016/j.heares.2022.108469
[21] Lieu JE, Tye-Murray N, Karzon RK, et al. Unilateral hearing loss is associated with worse speech-language scores in children[J]. Pediatrics, 2010, 125(6): e1348-e1355. doi: 10.1542/peds.2009-2448
[22] Ehrmann-Mueller D, Kurz A, Kuehn H, et al. Usefulness of cochlear implantation in children with single sided deafness[J]. Int J Pediatr Otorhinolaryngol, 2020, 130: 109808. doi: 10.1016/j.ijporl.2019.109808
[23] 张静平, 王巍, 王悦, 等. 语后聋成人人工耳蜗植入患者术后生活质量和言语识别能力评估[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(11): 1002-1004. http://www.cnki.com.cn/Article/CJFDTotal-LCEH202011010.htm
-