使用人工耳蜗恢复听力后神经和行为系统的纵向适应

文献信息

中文摘要

背景： 人工耳蜗（CI）可恢复重度至极重度听力损失患者的听力，但植入后行为与神经适应如何展开仍不清楚，尤其是在连续言语处理过程中。大多数关于植入后可塑性的纵向研究使用了简单的听觉刺激，限制了对复杂环境中连续言语处理的理解。方法：我们随访了19名新植入人工耳蜗的成年用户，分别在激活时以及激活后3、6和12个月进行随访。每次随访时，参与者完成了安静和噪声下的言语识别测试、空间三位数字测试、听力相关生活质量测量，以及在具有生态效度的连续言语选择性注意任务（伴有竞争性干扰）中进行的脑电图检查。神经分析聚焦于对任务相关和任务无关言语包络的时间响应函数以及头皮场拓扑的变化。结果：言语识别随时间改善，空间分离获益在6个月时出现。任务相关言语的神经追踪比任务无关言语的神经追踪更强且出现更早，头皮拓扑在各次随访间显著变化。更强的任务相关神经追踪与更好的言语识别、更好的空间聆听和更高的生活质量相关。最大的行为和神经增益出现在激活后早期，并在约6个月时趋于平稳。结论：这些发现提供了植入后适应的功能相关解释，并确立了纵向连续言语神经追踪作为研究感觉恢复后康复的有用框架。

英文摘要

Cochlear implants (CIs) restore hearing in people with severe-to-profound hearing loss, but how behavioral and neural adaptations unfold after implantation remains unclear, particularly during continuous speech processing. Most longitudinal studies of postimplant plasticity have used simple auditory stimuli, limiting insight into continuous-speech processing in complex environments. We followed 19 newly implanted adult CI users at activation and at 3, 6, and 12 mo after activation. At each session, participants completed speech recognition testing in quiet and noise, a spatial triple-digit test, hearing-related quality-of-life measures, and electroencephalography during an ecologically valid continuous-speech selective-attention task with competing distractors. Neural analyses focused on temporal response functions to task-relevant and task-irrelevant speech envelopes and changes in scalp field topography. Speech recognition improved over time, and spatial-separation benefits emerged by 6 mo. Neural tracking of task-relevant speech was stronger and emerged earlier than tracking of task-irrelevant speech, and scalp topographies changed significantly across sessions. Stronger task-relevant neural tracking was associated with better speech recognition, better spatial listening, and higher quality of life. The largest behavioral and neural gains occurred early after activation and plateaued by approximately 6 mo. These findings provide a functionally relevant account of postimplant adaptation and establish longitudinal continuous-speech neural tracking as a useful framework for studying rehabilitation after sensory restoration.