低频残余听力保留患者声电联合刺激短期效果观察

Short-term observation of electrical acoustic stimulation in patients with low frequency residual hearing after cochlear implant

目的分析低频残余听力(low-frequency residual hearing,LFRH)保留的人工耳蜗(cochlear implant,CI)植入患者使用声电联合刺激(electrical acoustic stimulation,EAS)后,其言语、声调识别以及音乐感知的改善情况。方法选取2017年1月至2020年10月行单侧CI手术且有LFRH保留的汉语普通话患者共12例,男8例、女4例,语后聋5例、语前聋7例,植入时中位年龄12岁(3~62岁);患者术前均有残余听力,及时佩戴助听器且康复效果良好,CI电刺激使用时间(37.0±16.2)个月。患者植入侧术后125 Hz和250 Hz纯音听阈均≤80 dB HL,使用EAS设备后,进行为期2个月的临床跟踪性研究。分别于EAS使用前、使用即刻、使用后2个月进行效果评估,包括言语识别率、声调识别和音乐测试。使用SPSS 23.0软件进行统计学分析。结果共10例患者完成2个月临床随访和效果评估,EAS使用即刻相比使用前,扬扬格词识别率明显下降[(71.7±4.3)%比(79.6±3.1)%,P=0.018]。EAS使用2个月后相比使用前、使用即刻,噪声环境中句子、噪声环境中声调识别率得分均显著提高,噪声环境中句子识别阈均显著改善(P值均<0.05)。使用EAS 2个月后的音高分辨能力较使用前显著提升(P=0.042),节奏分辨能力较使用前(P=0.021)和使用即刻(P=0.017)均显著提高。其余测试结果差异均无统计学意义(P值均>0.05)。结论EAS提供的低频声学信息以及声电刺激模式可为CI植入者在噪声下的言语、声调识别和音乐感知提供丰富的听觉线索,短时间内即可促进已接受长期电刺激CI患者复杂聆听能力的提高,综合改善其听觉水平。

Objective To analyze the effects of electrical acoustic stimulation(EAS)on speech and tone recognition as well as music perception in children with low-frequency residual hearing(LFRH)after cochlear implant(CI).Methods A total of twelve Mandarin patients with LFRH who underwent unilateral CI from January 2017 to October 2020 were recruited,including 8 males and 4 females.There were 5 cases of pre-lingual deafness and 7 cases of post-lingual deafness.The median age at implantation was 12 years old(3-62 years).All patients had residual hearing(RH)before surgery,wore hearing aid(HA)timely,had an effective rehabilitation and the duration of use of electrical stimulation was 37.0±16.2 months.On the implanted side,the thresholds of 125 Hz and 250 Hz were less than and equal to 80 dB HL after implantation.A two-month follow-up clinical study was conducted with the EAS devices.The EAS effects were evaluated before,immediately after and 2 months after upgrade,including speech recognition rate,tone recognition and music tests.SPSS 23.0 software was used for statistical analysis.Results A total of ten patients completed a two-month clinical follow-up and efficiency evaluation.Compared to the electrical stimulation,the recognition rate of spondee word significantly decreased after the immediate use of EAS(71.7±4.3 vs 79.6±3.1,P=0.018).Compared to the electrical stimulation as well as immediate use of EAS,the results of sentence in noise,tone in noise,and SRT of sentence in noise were all significantly improved at 2 months after use of EAS(P<0.05).The pitch discrimination was significantly improved at 2 months after the use of EAS compared with that before the use of EAS(P=0.042).Compared with before(P=0.021)and immediately(P=0.017)use of EAS,the ability of rhythm resolution was significantly improved.There were no significant differences in other test results(P>0.05).Conclusion s The low-frequency acoustic information provided by EAS as well as the electrical-acoustic stimulation mode can provide rich auditory cues of speech perception in noise,tone recognition in noise,and musical discrimination for CI subjects.It can promote the improvement of complex listening ability of CI patients undergoing long-term electrical stimulation in a short time and comprehensively improve their hearing capacities.