听障儿童双耳双模式言语识别能力比较研究

发布时间：2018-09-18 12:09

【摘要】：双耳双模式即听障患者单耳植入人工耳蜗后,对侧耳配戴助听器的助听模式。我国听障儿童人工耳蜗术后双耳双模式的配戴率较低。本研究从临床问题出发,通过与单侧人工耳蜗的比较,研究以汉语为母语的听障儿童在人工耳蜗植入术后言语识别的双耳双模式优势及其影响因素,并对双耳双模式是否存在干扰的问题进行探讨。在回顾国内外双耳双模式相关研究的基础上,本研究的主体分为四个部分：第一部分为双耳双模式听觉能力发展跟踪研究；第二部分为双耳双模式噪声下言语识别能力比较研究；第三部分为双耳双模式听觉定向能力研究；第四部分为双耳双模式事件相关电位研究。具体方法和结果如下：第一部分将149名被试按不同助听模式分为两组,比较不同助听模式的听觉能力及其发展的趋势。结果显示,双耳双模式组在声调、言语可懂度、连续语音以及选择性听取方面相比单侧人工耳蜗组都存在优势,发展更快,提示术后应尽早验配助听器。并且听障儿童术后康复6个月以后,双音节词、短句以及韵母识别训练以巩固为主,强化训练的重点应放在声母、声调识别和选择性听取能力三方面。第二部分从噪声下言语识别阈的角度,采用封闭项和开放项两种测试对39名被试在不同助听模式状态下进行进一步的评估。结果表明,听障儿童在双耳双模式状态下,噪声下的言语识别能力比单侧人工耳蜗状态时存在显著的优势。同时影响因素方面,双耳双模式优势会随着配戴时间的延长而不断提高,建议联合配戴6个月以上以取得理想的效果；只要非植入耳有可用的中低频听力,就应该双耳双模式验配,并结合测试结果和临床实践经验,非植入耳助听器补偿效果越好,双耳双模式优势越大；术前的助听器经验有利于术后双耳双模式优势的发挥；并且随着康复训练时间的增加,双耳双模式也能逐渐发挥出更大的优势。第三部分探讨了16名听障儿童在不同助听模式状态下的听觉定向能力。结果显示,听觉定向能力是其日常生活中的难点,使用双耳双模式后,在声源位于左右时,体现出了一定优势,随着角度的减小,双耳强度差和时间差线索减弱,双耳双模式的听觉定向优势也随之减小。同时,将人工耳蜗麦克风置于错误位置会影响听觉定向能力,并且术前的助听器经验也可能会影响其听觉定向能力的发展。第四部分采用平衡设计范式的事件相关电位测试考察不同助听模式的人工耳蜗植入儿童以及健听儿童言语声的皮层听觉诱发电位特征,应用独立成分分析法(ICA)矫正人工耳蜗伪迹。结果显示,听障儿童和健听儿童的皮层听觉诱发电位的潜伏期差异不显著,说明通过植入人工耳蜗和验配助听器,听障儿童重建了听觉通路,听觉皮层接收到声音信号的时间和健听儿童无差异；在双耳双模式状态下皮层听觉诱发电位的波幅相比单侧人工耳蜗状态时显著增大,以客观测试证明了双耳双模式优势的存在；并且不同助听模式P1成分波幅的差值和噪声下言语识别阈差值呈中度相关,两者可联合作为评估双耳双模式优势的主客观综合指标；最后学龄前健听儿童已发展出辅音分辨的自动加工机制,但尚未发展出声调分辨的自动加工机制。本研究的意义与创新点在于：(1)明确了以汉语为母语的听障儿童在人工耳蜗植入术后言语识别各个维度的双耳双模式优势及其影响因素,并提出了相关临床建议,为康复师的训练策略及手术医生对患者植入耳的选择提供了参考。(2)在研究方法上,对双耳双模式的言语识别能力进行了纵向跟踪与横向比较相结合；宏观趋势与微观分析相结合；主观听觉行为测试与客观事件相关电位测试相结合的综合评估,构建了双耳双模式言语识别能力的综合评估模式。(3)首次将言语声刺激用于双耳双模式的事件相关电位研究,并探索将平衡设计及独立成分分析等新范式和新方法应用于人工耳蜗植入儿童皮层听觉诱发电位测试。
[Abstract]:Two-ear and two-ear model is the hearing-aid model for hearing-impaired children after cochlear implantation in one ear and wearing hearing aids in the other ear. The advantages and influencing factors of binaural and bimodal speech recognition after speech recognition are discussed.
On the basis of reviewing the relevant studies on binaural and bimodal auditory abilities at home and abroad, the main body of this study is divided into four parts: the first part is a follow-up study on the development of binaural and bimodal auditory abilities; the second part is a comparative study on speech recognition ability under binaural and bimodal noise; the third part is a study on binaural and bimodal auditory orientation ability; the fourth part It is divided into two - mode two - event ERP. The specific methods and results are as follows:
In the first part, 149 subjects were divided into two groups according to different hearing aids, and the auditory ability and development trend of different hearing aids were compared. After 6 months of rehabilitation, the training of disyllabic words, short sentences and vowels recognition was mainly consolidation. The emphasis of intensive training should be on consonants, tone recognition and selective listening ability.
In the second part, 39 hearing-impaired children were further evaluated under different hearing-aid modes by using the closed-term and open-term tests from the perspective of speech recognition threshold under noise. The results showed that the speech recognition ability of hearing-impaired children under noise was significantly superior to that under unilateral cochlear implant. As for the influencing factors, the advantages of binaural and bimodal hearing aids will increase with the extension of wearing time. It is suggested to wear the binaural and bimodal hearing aids for more than 6 months to achieve the desired results. As long as the non-implanted ears have available low and medium frequency hearing, the binaural and bimodal hearing aids should be tested and matched. The better, the greater the advantages of binaural bimodal; preoperative hearing aid experience is conducive to postoperative binaural bimodal advantage; and with the increase of rehabilitation training time, binaural bimodal can gradually play a greater advantage.
The third part discusses the auditory Orienteering ability of 16 hearing-impaired children under different hearing aids. The results show that auditory Orienteering ability is a difficult point in their daily life. After using binaural and binaural mode, when the sound source is left and right, it shows a certain advantage. With the decrease of angle, the clues of binaural intensity difference and time difference weaken, and binaural and binaural intensity difference weakens. At the same time, putting the cochlear microphone in the wrong position will affect the auditory orientation ability, and the preoperative hearing aid experience may also affect the development of auditory orientation ability.
In the fourth part, the auditory evoked potentials of cochlear implant children and hearing-impaired children with different hearing aids were measured by event-related potentials test with balanced design paradigm, and the artifacts were corrected by independent component analysis (ICA). There was no significant difference in latency between the two groups, indicating that hearing impaired children reconstructed the auditory pathway by implanting cochlear implants and testing hearing aids, and the time when the auditory cortex received the sound signal was no different from that of healthy children. It is proved that there is a binaural bimodal advantage, and there is a moderate correlation between the difference of amplitude of P1 component in different hearing aids and the difference of speech recognition threshold in noisy environment. The automatic processing mechanism of tone discrimination has been developed.
The significance and innovations of this study are as follows: (1) To clarify the advantages and influencing factors of bimodal speech recognition in each dimension of Chinese-speaking hearing-impaired children after cochlear implantation, and to put forward relevant clinical suggestions for the rehabilitation training strategy and the choice of implanted ears by surgeons. (2) On the research method, the binaural and bimodal speech recognition abilities were tracked vertically and compared horizontally; macro-trend and micro-analysis were combined; subjective auditory behavior test and objective event-related potential test were combined to evaluate the binaural and bimodal speech recognition abilities. Secondly, speech sound stimulation was applied to the study of bimodal event-related potentials, and new paradigms and methods such as balance design and independent component analysis were explored to test cortical auditory evoked potentials in children with cochlear implants.
【学位授予单位】：华东师范大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R764

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