单侧聋患者人工耳蜗植入术后听觉效果及双耳信号匹配的研究

Cochlear implant (CI) is an important method for patients with unilateral deafness to regain binaural hearing. Patients with unilateral deafness can benefit from binaural hearing, improve their acoustic source localization ability and speech recognition ability in noise environment. At present, it is believed that the integration of the two interear electrical signals and acoustic signals after cochlear implantation in SSD patients may be the key to the binaural benefit. This project is based on sound after cochlear implantation in patients with CI side, and study the nature of electrical signals, it is concluded that the best match of SSD patients binaural sound signal, and is applied to the SSD patients with postoperative cochlear debugging, naked ears and adopt the binaural sound signal patterns before and after the best of both ears auditory advantage (sound source localization and noise under the call of a speech recognition ability), and the law of change over time, the SSD CI patients with postoperative hearing effect, reveal the acoustic signals matching in the important value of SSD patients with auditory rehabilitation process, thus provide a basis for the realization of individualized precision of SSD patients treatment.

人工耳蜗植入（cochlear implant，CI）是单侧聋患者重新获得双耳听觉（binaural hearing）的重要手段。单侧聋患者CI术后可受益于双耳听觉，改善其声源定位能力及噪声环境中的言语识别能力。目前认为SSD患者人工耳蜗植入术后双耳间电信号与声信号的匹配（match）整合情况可能是术后是否能获得更大双耳优势（binaural benefit）的关键。本项目拟通过对人工耳蜗植入术后患者CI侧声、电信号的性质研究，得出SSD患者双耳声电信号的最佳匹配方式，并将其应用于SSD患者术后人工耳蜗的调试，比较裸耳及采用双耳声电信号最佳匹配模式前后的双耳听觉优势（声源定位能力与噪声呼下的言语识别能力）的差异，及其随时间变化的规律，研究SSD患者CI术后的听觉效果，揭示声电信号匹配在SSD患者听觉康复过程中的重要意义，从而为实现SSD患者的个体化精准治疗提供依据。

目前国际上已有研究证明人工耳蜗植入（cochlear implant，CI）是单侧聋患者重新获得双耳听觉（binaural hearing）的重要手段。单侧聋患者CI术后可受益于双耳听觉，改善其声源定位能力及噪声环境中的言语识别能力，同时主观感受耳鸣减轻生活质量改善。.目前认为SSD患者人工耳蜗植入术后双耳间电信号与声信号的匹配（match）整合情况可能是术后是否能获得更大双耳优势（binaural benefit）的关键。.本项目入组40例单侧听力损失患者，通过长期规律随访，研究患者术后耳鸣、生活质量、声源定位和言语识别的改善情况。研究结果与既往研究结果相似，汉语普通话单侧聋患者人工耳蜗术后主客观获益明显，且随耳蜗术后康复时间延长双耳听觉获益越多。在稳态噪声环境中，CI有助于消除头影效应的影响改善言语识别。在竞争性言语噪声环境中，人工耳蜗植入有助于SSD和AHL患者利用空间和/或性别线索识别空间竞争性言语。单侧聋和不对称性听力损失人工耳蜗使用者可从对称放置的掩蔽声提供的空间线索中获益。研究中发现部分患者出现双耳声电信号失匹配的现象，但是通过调机参数的修改，可以使双耳听觉的获益最大化。同时在保证言语识别能力的基础上，可以进一步改善音乐感知和旋律的变化。研究结果有助于今后进一步探究听觉中枢对双耳信号整合的能力、双耳听觉的原理以及单侧听力损失患者听觉植入的最佳时机。