用于耳蜗阵列离散区域频谱-时间处理的新型心理声学测量：一项概念验证研究。

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中文摘要

引言： 尽管人工耳蜗植入（CI）总体上取得了成功，但术后耳蜗内已知病理生理过程对听力结局的影响仍知之甚少。既往研究提示，电极-耳蜗界面和神经感觉靶点的耳蜗内局部差异可能导致部分CI用户结局不佳。研究强调需要确定最佳的耳蜗生物标志物和行为学测量，以增强对结局不佳的CI用户的诊断和治疗策略。本概念验证研究引入了一种频谱-时间处理测量的新型改良方法，旨在探索其与电生理测量和言语感知的关联。
方法： 从澳大利亚一家大型非营利性CI诊所招募了18名成年CI植入者，使用24、400、500和600系列Cochlear Ltd设备。参与者完成了频谱波纹STRIPES测试的“分区”改良版（secSTRIPES）和双极跨阻抗（4PI）。原始STRIPES刺激经过带通滤波用于secSTRIPES，靶向电极阵列的离散高频（基底）和低频（顶端）区域。采用线性混合模型方法确定局部阻抗测量与secSTRIPES评分之间是否存在任何关系。使用简单线性回归研究受试者内相关性以及与常规言语理解测量的关联。
结果： 数据表明受试者内分区变异性，18名参与者中有13名的secSTRIPES评分存在有意义的差异（评分差异>1）。大多数参与者（72%）在基底secSTRIPES测试中得分更差。在控制年龄和阻抗后，对于14名双侧听力损失的CI用户，这种分区偏倚显著（p=0.005）。4PI与secSTRIPES评分之间没有统计学显著关系，但结果提示局部阻抗与频谱-时间处理之间可能存在正趋势。secSTRIPES与言语评分之间的关联也不显著，但观察到言语与顶端STRIPES评分之间存在正趋势。
结论： 这项首次描述STRIPES测试分区改良版的初步研究，为secSTRIPES作为电极阵列局部区域听力能力的心理声学测量提供了充分的概念验证。虽然由于样本量的限制，结果必须谨慎解释，但初步发现揭示了处理性能的耳蜗内变异性，值得进一步研究。经过正式验证后，secSTRIPES可能有助于未来研究探索分区偏倚如何影响CI用户的整体处理，并作为耳蜗生物标志物指导干预以改善CI性能。

英文摘要

INTRODUCTION: Despite the general success of cochlear implantation (CI), the impact of known pathophysiological processes occurring within the cochlea after surgery on hearing outcomes are poorly understood. Previous studies suggested localised intracochlear variations in the electrode-cochlear interface and neurosensory targets may be contributing to poor outcomes for some CI users. Research has highlighted the need to define optimal cochlear biomarkers and behavioural measures to enhance diagnostic and therapeutic approaches for CI users with poor outcomes. The current proof of concept study introduces a novel adaptation of a measure of spectral-temporal processing and aimed to explore its association with electrophysiological measures and speech perception.
METHODS: 18 adult CI implant users with 24, 400, 500 and 600 series Cochlear Ltd devices were recruited from a large not-for-profit CI clinic in Australia. Participants completed a "sectional" adaptation of the spectral ripple STRIPES test (secSTRIPES) and bipolar transimpedances (4PI). Original STRIPES stimuli were band-pass filtered for secSTRIPES, targeting discrete high frequency (basal) and low frequency (apical) sections of the electrode array. A linear mixed model approach was used to determine if any relationship existed between localised impedance measures and secSTRIPES scores. Simple linear regression was used to investigate within-subject correlations and the association with conventional measures of speech understanding.
RESULTS: Data indicated within-subject sectional variability, with a meaningful difference in secSTRIPES scores for 13 of 18 participants (scores different by >1). Most participants (72%) scored worse on the basal secSTRIPES test. This sectional bias was significant when controlling for age and impedances for 14 CI users with bilateral hearing loss (p= 0.005). There was no statistically significant relationship between 4PI and secSTRIPES scores, however the results suggested there may be positive trend between localised impedance and spectral-temporal processing. The association of secSTRIPES and speech scores was also non-significant, however positive trends between speech and apical STRIPES scores were observed.
CONCLUSIONS: This pilot study, the first to describe the sectional adaptation of the STRIPES test, provides sufficient proof of concept for secSTRIPES as a psychoacoustic measure of listening ability in localised sections of the electrode array. While results must be interpreted cautiously due to limitations of the sample size, preliminary findings reveal intracochlear variability in processing performance which warrants further investigation. Following formal validation, secSTRIPES may be beneficial for future research to explore how sectional biases influence overall processing for CI users and as a cochlear biomarker to guide interventions to improve CI performance.