Study On Aural Rehabilitation With Cochlear Implant And Standardization Of Mandarin Sentence Lists For Children Speech Perception Assessment

The first single-channel cochlear implant was manufactured and successful used in clinic in 1970. Further, Melbourne University in Australia invented the first multiple-channel cochlear implant in 1980's. During the 30 years continuing developed, cochlear implant was more and more perfect. Nowadays, cochlear implant was the credible measure to help the rehabilitation of severe to profound sensorineural deafness. However, how to objectively evaluate the effect after the CI is still being disputed. In present report, we aim at discussing the rehabilitation effect of cochlear implant as well as the development of mandarin sentence materials for Chinesespeech audiometry. Our study includes four parts as following.Part one: Comparison of the effect of different type of electrodescochlear implantees' aural rehabilitationIn this decade, the technique of cochlear implant has acquired drastic improvement. Some companies have empoldered some new productions. Our country introduced this technique into clinic in 1995. There are some types of electrodes can be selected in market. We observed Australia Nucleus (straight and contour electrodes), Austria Medel and America Advanced Bionics' cochlear implantees, to compare the mapping results and the aural/oral rehabilitation effect, in order to explore whether have different effect from different type of electrodes cochlear implantees. Our study showed there were some discrimination in threshold-levels, comfortable-levels and dynamic range in different type of manufacture: America Advanced Bionics 90K had the lowest threshold-levels, but Austria Medel C40+ had the highest comfortable-levels and widest dynamic range. There was no discrimination in CAP and SIR in different type of electrodes. All patients implanted different type of electrodes can acquire benefits in some degree. A large part of implantees can communicate freely with others after rehabilitation training and express with fluent language. Part two: Study of aural rehabilitation in post-lingual deafened patientswith multi-channel cochlear implantNowadays, multi-channel cochlear implant has positive effect both in post-lingual deafened patients and pre-lingual deafened patients. But it was universally acknowledge that post-lingual deafened patients with cochlear implant can arrive at good auditory level more quickly than pre-lingual deafened patients. Our aim in this study is to seek a convenient and effective method through subjective psychophysical measurements and CAP /SIR assessment. Follow part one study, the discrimination of threshold levels, comfortable levels and dynamic range between post-lingual and pre-lingual deafened patients in same electrodes was compared. There was no statistic difference in warble tone, T-levels, C-levels and dynamic range after 6 months implant (P>0.05) , but the score of CAP and SIR in post-lingual deafened patients were more prominent.Part three: Using electrically evoked stapedius responses for evaluationof the effect of cochlear implantCochlear implant is a high-tech biomedicine device. Successful surgery, good condition device and mapping after surgery are all crucial factors for implantees. We always meet some trouble when measured threshold and maximum comfortable level through subjective psychophysical measurements, especially mapping for children or infants. So the credible objective methods to assess the cochlear device and auditory nerve center are necessary. We observed 108 electrode arrays in 36 implantees, and found the incidence of the electrically evoked stapedius responses was 69.44 %. There was no significant difference between ESR threshold and maximum comfortable level in statistics. There was significant relationship between ESR threshold and maximum comfortable level. ESR can objective assess the construction of auditory conduct function and good condition device in surgery immediately. But it may also be affected by the abnormity of tympanic membrane, tympanic cavity, ossicular chain, or any portion in reflex arc. So the failure evoked of ESR neither reflex acoustic nerve obstacle nor device's out of the way. Whereas, ESR is the significant sign to indicate the electrodes' successful implant. CI Surgeon should pay attention to those who can not evoke the ESRT during operation. ESRT has great significance in mapping the fitting of speech processor as the complement of subjective methods.Part Foue: Standardization of Mandarin sentence lists for children speech perception assessment in babble noise and primary application incochlear implanteesAs the development of otology and audiology, especially the abroad application of hearing aid and hearing implant such as cochlear implant in clinic. Audiologists have realized the urgency of the exploration of mandarin materials for Chinese speech audiometry. Our study of this part aim at exploring a suit of mandarin material for Chinese speech audiometry in babble noise to evaluate the speech recognition, distinguish the different hearing implant and mapping strategy, following up the effect of restore and modify the project of rehabilitation. Finally, we developed a suit of materials during the process of compilation, recording, validation and modifiability. This suit of materials contains 27 lists (9 sentences, 50 keywords, per each one). Through the test, we found out cochlear implantees' performance in babble noise were weaker than normal hearing children even though the same hearing ages experiences. The cochlear implantees' in equal level of warble tone had different scores in the speech audiometry and the different rehabilitate effect existed individually.