对侧于人工耳蜗的颞上回听觉和视觉言语诱发激活可预测言语识别结果。

文献信息

中文摘要

目的： 人工耳蜗植入者的言语识别结果差异很大，但仅凭患者病史因素无法很好地解释这种差异。耳聋和人工耳蜗开机后的神经可塑性重组会影响新植入者适应电听觉的方式。在本研究中，我们评估言语识别结果与皮层语言处理区刺激诱发激活之间的关联。
设计： 招募了43名新植入的语后聋成人人工耳蜗植入者（17名女性，植入时平均年龄：58.5岁，标准差：14.4岁）进行纵向研究。参与者参加了两次研究访视：第一次在设备开机后1个月内进行，第二次在设备开机后1年进行。每次访视时，我们评估了噪声下的言语识别结果，并使用功能性近红外光谱在被动聆听任务中评估皮层激活，任务中通过听觉或视觉言语（唇读）条件讲述一个故事。
结果： 我们发现，1年时的言语理解结果与1个月时对听觉和视觉言语的颞上回激活之间存在一致的负相关。这些关联在1年时测量的激活中未观察到。亚组回归分析显示，这些相关性最一致地见于对侧于人工耳蜗的颞上回。1个月时对侧于植入物的颞上回激活也解释了1年时言语结果中超出临床因素之外的额外方差。然而，纵向分析显示，在植入使用第一年内，受试者内激活变化与言语理解结果变化之间没有关联。
结论： 我们的证据强调，成人发病耳聋后发生的神经可塑性变化在人工耳蜗植入者开机后如何适应其设备方面起着重要作用。设备开机后1个月内进行的神经影像学测量与1年时言语识别结果之间的关系，可能有助于对植入者进行分诊，以改善植入者的临床管理。

英文摘要

OBJECTIVES: Speech recognition outcomes vary widely in cochlear implant recipients, but the reasons for this variability are not well explained by patient history factors alone. Neuroplastic reorganization after both deafness and cochlear implant switch-on can affect how new recipients adapt to electrical hearing. In this study, we evaluate the associations between speech recognition outcomes and stimulus-evoked activation of cortical language processing areas.
DESIGN: Forty-three newly implanted post-lingually deaf adult cochlear implant recipients (17 female, mean age at implantation: 58.5 yr, SD: 14.4 yr) were recruited for the longitudinal study. Participants attended two research visits: the first conducted within 1 mo of device switch-on, and the second conducted 1 yr after device switch-on. At each visit, we evaluated speech recognition outcomes in noise and cortical activation using functional near-infrared spectroscopy during a passive listening task, during which a story was told in either an auditory- or visual-speech (lipreading) condition.
RESULTS: We found consistent negative correlations between speech understanding outcomes at 1 yr and activation of the superior temporal gyrus at 1 mo in response to both auditory and visual speech. These associations were not observed for activation measured at 1 yr. Subgroup regression analysis revealed that these correlations were most consistently seen in the superior temporal gyrus contralateral to the cochlear implant. Activation in the superior temporal gyrus contralateral to the implant at 1 mo also explained additional variance in speech outcomes at 1 yr beyond clinical factors alone. However, longitudinal analysis showed no association between within-subject changes in activation and changes in speech understanding outcomes within this first year of implant use.
CONCLUSIONS: Our evidence highlights that neuroplastic changes which occur following adult-onset deafness play an important role in how cochlear implant recipients adapt to their devices after switch-on. The relationship between neuroimaging measures made within 1 mo after device switch-on and speech recognition outcomes at 1 yr can potentially enable triaging of recipients to improve clinical management of implant recipients.