Effect of cochlear implantation on speech recognition under different listening modes in children
-
摘要: 目的 通过测试人工耳蜗植入(CI)儿童不同聆听模式的助听听阈及安静与噪声环境下的言语识别率，对比双侧CI、双耳双模式及单侧CI之间的差异，分析并探索不同聆听模式的效果与优势。方法 选取2012—2021年行双侧CI、双耳双模式及单侧CI的重度或极重度感音神经性听力损失儿童67例为研究对象，其中单侧CI 23例(单侧CI组)，双模式(一侧CI对侧佩戴助听器)25例(双模式组)，双侧CI 19例(双侧CI组)。分别测试三组患儿在250~4000 Hz的助听听阈，以及在安静及噪声环境下的双音节词及短句的言语识别率。结果 双侧CI组、双模式组及单侧CI组助听听阈结果经ANOVA比较组间差异无统计学意义(P>0.05)。分别经组内配对t检验，三组在安静及噪声环境下的双音节词、短句的言语识别率差异有统计学意义(P < 0.05)。三组在安静环境下的双音节词及短句的言语识别率差异无统计学意义(P>0.05)，在噪声环境下差异有统计学意义(P < 0.05)。经进一步多重线性回归分析显示，双模式组与双侧CI组在安静及噪声环境下的双音节词及短句识别率差异无统计学意义(β=-0.567，P>0.05；β=-0.643，P>0.05)；双模式组与单侧CI组在噪声环境下的双音节词及短句识别率差异有统计学意义(β=-0.124，P < 0.05)，但在安静环境下差异无统计学意义(β=-0.671，P>0.05)；双侧CI组与单侧CI组在噪声环境下的双音节词及短句识别率差异有统计学意义(β=-0.226，P < 0.05)，但在安静环境下差异无统计学意义(β=-0.341，P>0.05)。结论 一线临床人员及患儿家长应及时为听障儿童提供完整、准确的听力学评估，尽早实现双耳聆听。若患儿对侧耳无残余听力且佩戴助听器后言语识别能力仍不理想，应尽早开展对侧耳CI植入以实现双耳听觉；如果对侧耳尚有残余听力，且佩戴助听器后言语理解能力尚佳，可以优先尝试双耳双模式。不论是选择双耳双模式助听还是双侧CI助听，都要注重个性化、精细化、系统化的调试，并且及时为患儿进行听觉评估。Abstract: Objective To investigate speech recognition among children with a unilateral cochlear implant(CI), bilateral CI, and bimodal hearing and identify the benefits of binaural hearing.Methods A total of 67 children with severe sensorineural hearing loss who received bilateral CI, bimodal hearing, and unilateral CI from 2012 to 2021 were recruited, including 23 cases with unilateral CI, 25 cases of bimodal hearing, and 19 cases of bilateral CI. The aided hearing threshold at 250-4000 Hz and speech recognition performance of two-syllable words and short sentences in quiet and noisy environments were tested, respectively.Results There was no significant difference in the hearing threshold results of the bilateral CI group, the bimodal hearing group, and the unilateral CI group by ANOVA(P>0.05). According to the paired t-test within the group, the speech recognition of disyllabic words and short sentences in quiet and noisy environments were significantly different among the three groups(P < 0.05). There was no significant difference in the speech recognition rates of disyllabic words and short sentences among the three groups in a quiet environment(P>0.05), but there was a statistically significant difference in a noisy environment(P < 0.05). Additional multiple linear regression analysis showed no significant difference in the recognition rates of disyllabic words and short sentences between the bimodal group and the bilateral CI group in quiet and noisy environments(β=-0.567, P>0.05; β=-0.643, P>0.05). There was a statistically significant difference in speech recognition of disyllabic words and short sentences between the bimodal group and the unilateral CI group in the noise environment(β=-0.124, P < 0.05), but the difference was not statistically significant in a quiet environment(β=-0.671, P>0.05); there was a statistically significant difference in the recognition rate of disyllabic words and short sentences between the bilateral CI group and the unilateral CI group in the noise environment(β=-0.226, P < 0.05), but the difference was not statistically significant in a quiet environment(β=-0.341, P>0.05).Conclusion Clinicians and guardians are encouraged to provide the most comprehensive audiological evaluation for children with hearing loss. Bilateral CI and bimodal hearing have demonstrated enormous advantages over unilateral CI regarding speech recognition in noise. Bimodal hearing deems a strong recommendation if the contralateral ear has sufficient speech recognition capability. Bilateral CI should be warranted if hearing aids deemed to be ineffective.
-
Key words:
- child /
- hearing loss, sensorineural /
- cochlear implantation /
- binaural listening /
- bimodal fitting /
- speech recognition
-
-
表 1 三组患儿基本资料比较
组别 例数 性别/例 CI年龄/月 家庭教育水平 CI后测试言语的间隔时间/月 男 女 高中 大学 单侧CI组 23 11 12 21.3±5.2 3 20 8.3±2.2 双模式组 25 16 9 23.4±4.4 6 19 10.6±1.8 双侧CI组 19 10 9 25.1±3.1 2 17 9.1±3.3 t值 0.78 0.63 0.87 0.59 P值 >0.05 >0.05 >0.05 >0.05 
下载: 导出CSV
表 2 三种聆听模式下的双耳助听听阈
dB HL，X±S 组别 250 Hz 500 Hz 1000 Hz 2000 Hz 4000 Hz 双侧CI组 25.66±6.12 27.18±5.27 26.33±6.19 28.15±7.79 31.92±6.89 双模式组 26.67±8.03 29.77±4.57 32.71±6.89 34.45±5.79 41.43±5.74 单侧CI组 27.12±5.64 22.05±6.33 23.19±5.88 25.27±6.59 28.16±6.18 F值 3.63 4.12 2.54 3.76 4.33 P值 >0.05 >0.05 >0.05 >0.05 >0.05
下载: 导出CSV
表 3 三组在安静和噪声环境下的言语识别率比较
%，X±S 组别 安静环境下 噪声环境下 双音节词识别率 短句识别率 双音节词识别率 短句识别率 双侧CI组 87.43±6.72 94.66±3.11 62.38±5.881) 81.33±6.792) 双模式组 83.34±7.67 96.78±2.89 71.34±6.231) 95.67±5.992) 单侧CI组 78.56±7.82 95.03±2.36 57.17±6.481) 78.54±4.882) F值 2.33 4.51 3.67 6.10 P值 >0.05 >0.05 < 0.05 < 0.05 与安静环境下双音节词识别率比较，1)P < 0.05；与安静环境下短句识别率比较，2)P < 0.05。
下载: 导出CSV
-
[1] 戴朴, 郗昕, 孙喜斌, 等. 人工耳蜗植入工作指南(2013)修订解读[J]. 中华耳鼻咽喉头颈外科杂志, 2014, 49(2): 96-102. doi: 10.3760/cma.j.issn.1673-0860.2014.02.002
[2] 李玲, 叶放蕾, 王乐, 等. 语前聋患儿一侧人工耳蜗植入对侧佩戴助听器聆听效果分析[J]. 听力学及言语疾病杂志, 2016, 24(3): 273-276. doi: 10.3969/j.issn.1006-7299.2016.03.013
[3] Mok M, Grayden D, Dowell RC, et al. Speech perception for adults who use hearing aids in conjunction with cochlear implants in opposite ears[J]. J Speech Lang Hear Res, 2006, 49(2): 338-351. doi: 10.1044/1092-4388(2006/027)
[4] Chang YS, Hong SH, Kim EY, et al. Benefit and predictive factors for speech perception outcomes in pediatric bilateral cochlear implant recipients[J]. Braz J Otorhinolaryngol, 2019, 85(5): 571-577. doi: 10.1016/j.bjorl.2018.04.009
[5] Willis S, Xu K, Thomas M, et al. Bilateral and bimodal cochlear implant listeners can segregate competing speech using talker sex cues, but not spatial cues[J]. JASA Express Lett, 2021, 1(1): 014401. doi: 10.1121/10.0003049
[6] Holtmann LC, Janosi A, Bagus H, et al. Aligning Hearing Aid and Cochlear Implant Improves Hearing Outcome in Bimodal Cochlear Implant Users[J]. Otol Neurotol, 2020, 41(10): 1350-1356. doi: 10.1097/MAO.0000000000002796
[7] Brumer N, Elkins E, Hillyer J, et al. Relationships Between Health-Related Quality of Life and Speech Perception in Bimodal and Bilateral Cochlear Implant Users[J]. Front Psychol, 2022, 13: 859722. doi: 10.3389/fpsyg.2022.859722
[8] 徐静, 冯帅, 李巍, 等. 双模式和双侧人工耳蜗植入术后双耳聆听效果分析[J]. 中华耳科学杂志, 2020, 18(5): 886-890. doi: 10.3969/j.issn.1672-2922.2020.05.015
[9] 李琳, 文开学, 赵惠芳. 儿童人工耳蜗术后听觉言语发育状况及影响因素分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2021, 29(1): 18-21, 42. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJH202101005.htm
[10] 杨烨, 高珺岩, 钱晓云, 等. 人工耳蜗植入手术对患儿及其家庭的长远助益研究[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(1): 42-47. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201801009.htm
[11] 王智超, 黄琦, 陈兵, 等. 人工耳蜗术后耳鸣疗效及耳鸣改变模式分析[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(11): 966-971. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2020.11.002
[12] Obuchi C, Shiroma M, Ogane S, et al. Binaural integration abilities in bilateral cochlear implant user[J]. J Otol, 2015, 10(4): 150-153. doi: 10.1016/j.joto.2016.02.001
[13] Forli F, Bruschini L, Franciosi B, et al. Sequential bilateral cochlear implant: long-term speech perception results in children first implanted at an early age[J]. Eur Arch Otorhinolaryngol, 2022.
[14] Mohammad Azmi HH, Goh BS, Abdullah A, et al. The outcomes of bilateral cochlear implant users in Universiti Kebangsaan Malaysia[J]. Acta Otolaryngol, 2020, 140(10): 838-844. doi: 10.1080/00016489.2020.1775887
[15] de Graaff F, Eikelboom RH, Sucher C, et al. Binaural summation, binaural unmasking and fluctuating masker benefit in bimodal and bilateral adult cochlear implant users[J]. Cochlear Implants Int, 2021, 22(5): 245-256. doi: 10.1080/14670100.2021.1894686
[16] 李刚, 陶勇, 孟照莉, 等. 同龄接受助听器或人工耳蜗干预的极重度聋患儿早期语前听能发育规律的对比研究[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(1): 41-44. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.1001-1781.2020.01.010
[17] 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. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2020.11.010
[18] Zedan A, Jürgens T, Williges B, et al. Speech Intelligibility and Spatial Release From Masking Improvements Using Spatial Noise Reduction Algorithms in Bimodal Cochlear Implant Users[J]. Trends Hear, 2021, 25: 23312165211005931.
-