双模式助听临床调试流程探讨

Clinical Fitting Process for Bimodal Hearing

近年来,双耳双模式助听越来越受到临床上的认可和使用。由于人工耳蜗与助听器的工作机制不同,患者双耳在感知声音的时间、强度和频率存在差异。在双模助听者中,两种助听装置会在声音传递上存在时间延迟差异;调试上两者的放大响度不均衡,会引起患者听起来两耳声音明显大小不一的抱怨;两者在各频率上的补偿效果不统一等,都会进而影响患者的听觉体验和双模佩戴的优势体现。所以,临床上的精细调试尤为重要。对语后聋患者进行双模式验配,以先适应使用人工耳蜗为主,再进行助听器的调适,由于患者表述能力强,听力师可以根据患者需求最大化给予双模式的精细调试;对于儿童语前聋患儿双模式验配,由于患儿有学习语言的时间压力,以最快的时间适应双模式设备有利于让患儿尽早进入言语训练及双侧听觉训练阶段,建议在人工耳蜗开机时即采用双模式佩戴。

In recent years,bimodal fitting has been increasingly accepted and utilized in the clinic.Because of the differences in working mechanisms of cochlear implants and hearing aids,a patient’s binaural perception of sound is different in time,intensity and frequency.For patients using bimodal hearing,there is a time delay difference in sound transmission between the two devices.If amplification gains of the two devices are not properly balanced during bimodal fitting,binaural sound loudness can be noticeably different for the patient.In addition,unbalanced compensation across frequencies can compromise a patient’s auditory experience and bimodal benefits.Therefore,accurate fitting is particularly important.For post-lingually deaf patients,bimodal fitting is mainly to adapt to using the cochlear implant with adjustment of the hearing aid.The audiologist can administer bimodal fine fitting according to the patient’s needs when they can express himself.Because children are in rapid development of language capability,for the children with pre-lingual deafness,adapting to bimodal devices in the shortest time possible is conducive to enabling them to receive speech rehabilitation and binaural auditory training as soon as possible.It is recommended to start wearing bimodal devices once the cochlear implant is turned on.