传统气导与骨导助听器在单侧感音神经性听力损失患者中的功能结局

文献信息

中文摘要

目的： 探讨佩戴传统助听器（HAs）的单侧感音神经性听力损失（USNHL）患者在多人交谈环境中的言语表现、对听力和空间能力的主观满意度，以及影响结局的因素。
方法： 回顾性纳入32名以普通话为母语的USNHL个体。根据个体适合性为患者验配气导（AC）或骨导（BC）助听器。气导助听器验配按NAL-NL2（成人）或DSL v5（儿童）处方目标进行真耳测量（REM）。在初次验配时，在代表双耳静噪效应、总和效应和头影效应的三种空间配置下，评估多人交谈条件下的噪声中言语感知。采用中文版言语、空间与听觉质量量表（C-SSQ12）评估主观表现。6个月随访评估包括言语感知测试、再次施测C-SSQ12以及总体满意度调查。
结果： 在初次助听器验配时比较助听与未助听条件，在S0N0、S0NSSD或SSSDNNH配置下均未观察到言语识别阈（SRT）的显著差异（分别为p=0.5983、p=0.1008、p=0.9375）。在6个月随访时（n=12），与基线相比未检测到言语感知的显著改善（所有配置p>0.05）。然而，关于C-SSQ12结局（n=26），评估空间定位的问题（第6题和第7题）得分在6个月时较基线显著改善（分别为r=-0.5691，p=0.004和r=-0.6674，p<0.001），而音乐感知问题（第10题）得分下降（r=-0.5254，p=0.007）。根据Cohen标准，效应量均为大效应。在初次验配时，观察到听力损失持续时间与SSSDNNH下SRT变化呈负相关（r=-0.3549，p=0.0463），较差耳纯音平均听阈（PTA）与S0NSSD下∆SRT呈负相关（r=-0.4057，p=0.0212）。助听前言语与所有三种条件下的ΔSRT均呈负相关（p均<0.05）。较差耳PTA与6个月时C-SSQ12总分改善呈正相关（r=0.4743，p=0.0144）。
结论： 在6个月的适应期内，佩戴传统助听器的USNHL患者仅在两项主观空间感知能力条目上表现出有限改善，而大多数主观领域及所有双耳噪声中言语表现的客观指标均未显示显著获益。听力损失持续时间、助听前言语和较差耳PTA是初次助听器验配时影响短期言语结局的因素。较差耳PTA也影响6个月随访时主观言语、空间与听觉质量表现。

英文摘要

PURPOSE: To explore speech performance in multi-talker environments, subjective satisfaction with hearing and spatial ability, and factors influencing outcomes in patients with unilateral sensorineural hearing loss (USNHL) fitted with conventional hearing aids (HAs).
METHODS: A total of 32 native Mandarin-speaking individuals with USNHL were retrospectively enrolled. Patients were fitted with either air-conduction (AC) or bone-conduction (BC) HAs based on individual suitability. Real-ear measurements (REM) were performed for AC HA fitting according to NAL-NL2 (adults) or DSL v5 (pediatric) prescriptive targets. At the initial fitting session, speech perception in noise was assessed under multi-talker conditions across three spatial configurations representing binaural squelch, summation, and head shadow effects. The Chinese version of the Speech, Spatial and Qualities of Hearing Scale (C-SSQ12) was administered to evaluate subjective performance. Follow-up assessments at 6 months included speech perception testing, re-administration of the C-SSQ12, and an overall satisfaction survey.
RESULTS: Comparing aided and unaided conditions at the initial HA fitting, no significant differences in speech recognition threshold (SRT) were observed under S0N0, S0NSSD, or SSSDNNH configurations (p = 0.5983,p = 0.1008, p = 0.9375, respectively). At 6-month follow-up (n = 12), no significant improvements in speech perception were detected compared to baseline (p > 0.05 for all configurations). However, regarding C-SSQ12 outcomes (n = 26), scores for questions assessing spatial localization (Questions 6 and 7) showed significant improvements at 6 months compared to baseline (r=-0.5691, p = 0.004 and r=-0.6674, p < 0.001, respectively), while the score for music perception (Question 10) declined (r=-0.5254, p = 0.007). The effect sizes were all large according to Cohen's standards. At initial fitting, a negative correlation was observed between hearing loss duration and SRT variation under SSSDNNH (r =-0.3549, p = 0.0463), and a negative correlation was found between worse ear pure-tone average (PTA) and ∆SRT under S0NSSD (r=-0.4057, p = 0.0212). Pre-aided speech was correlated negatively with ΔSRTs under all three conditions (p all < 0.05). The worse ear PTA was positively correlated with improvement in total C-SSQ12 score at 6 months (r = 0.4743, p = 0.0144).
CONCLUSION: Within a 6-month adaptation period, patients with USNHL fitted with conventional HAs demonstrated limited improvements in only two items of subjective spatial perception abilities, while the majority of subjective domains and all objective measures of binaural speech-in-noise performance showed no significant benefit. Hearing loss duration, pre-aided speech, and worse ear PTA emerged as factors influencing short-term speech outcomes at initial HA fitting. The worse ear PTA also influenced subjective speech, spatial, and qualities of hearing performance at 6-month follow-up.