基于精细解剖的拟合减少双耳位置失配并改善言语结局，并有初步证据表明可降低聆听努力

文献信息

中文摘要

目的： 本研究提出一种基于解剖的拟合精细方法（rfABF），旨在减少双耳电极阵列植入不对称（两耳间常与耳蜗覆盖不完全相关）的双侧人工耳蜗（CI）使用者的双耳位置失配。
设计： 前瞻性单中心概念验证研究，比较rfABF与常规临床拟合（CBF）。ABF映射采用两种算法推导方法制备：一种缩放电极间频谱间距（zipped），另一种转置临床频率与音调拓扑频率之间的比值（transposed）。随后根据使用者反馈对这些映射进行精细调整，直至获得自然的音质。评估包括安静与噪声下的言语感知、声源定位、主观音质评分（HISQUI19），以及使用瞳孔测量法评估的聆听努力。
研究样本： 九名经验丰富的成年双侧CI使用者，其电极阵列植入深度和/或电极阵列类型存在双耳不对称。
结果： rfABF使双侧言语理解在安静条件下显著改善（CBF：77.5% ± 8.1%；rfABF：83.1% ± 8.0%；p = 0.025），并在S0N0（信号与噪声均来自前方）和S0Ncontra（信号来自前方、噪声来自对侧耳）两种噪声配置下均显著改善。rfABF使双耳刺激位置失配从平均33.8° ± 27.3°大幅降至6.4° ± 4.2°。探索性、描述性瞳孔测量表明，部分参与者的聆听努力降低，表现为事件相关瞳孔扩张（ERPD）波幅降低，尤其是在言语可懂度得以保持或改善的病例中。
结论： rfABF显示出临床潜力，可改善电极阵列植入不对称的双侧CI使用者的言语理解并促进其获取双耳线索，并有初步证据表明可降低聆听努力。

英文摘要

OBJECTIVE: This study proposes a refined approach to anatomy-based fitting (rfABF) that aims to reduce interaural place mismatch in bilateral cochlear implant (CI) users with asymmetric electrode array insertions between ears, a condition frequently associated with incomplete cochlear coverage.
DESIGN: Prospective monocenter proof-of-concept study comparing rfABF with conventional clinically based fitting (CBF). ABF maps were prepared using two algorithmically derived methods: one scaling inter-electrode spectral spacing (zipped), and another transposing the ratio between clinical and tonotopic frequencies (transposed). These maps were then refined based on user feedback until a natural sound quality was achieved. Assessments consisted of speech perception in quiet and noise, sound localization, subjective sound quality ratings (HISQUI19), and listening effort assessed using pupillometry.
STUDY SAMPLE: Nine experienced adult bilateral CI users with interaural asymmetry in electrode array insertion depth and/or electrode array type.
RESULTS: Bilateral speech understanding improved significantly with rfABF in quiet (CBF: 77.5% ± 8.1%; rfABF: 83.1% ± 8.0%; p = 0.025) and in noise under both S0N0 (signal and noise from front) and S0Ncontra (signal from front, noise from contralateral ear) configurations. Interaural place-of-stimulation mismatch was substantially reduced from a mean of 33.8° ± 27.3° to 6.4° ± 4.2° with rfABF. Exploratory, descriptive pupillometry indicated reduced listening effort in a subset of participants, reflected by lower event-related pupil dilation (ERPD) amplitudes, particularly in cases where speech intelligibility was preserved or improved.
CONCLUSIONS: rfABF shows clinical potential to improve speech understanding and facilitate access to binaural cues in bilateral CI users with asymmetric electrode array insertions, with preliminary evidence for reduced listening effort.