全数字助听器临床效果评价
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摘要
目的 1、用啭音和滤波复合音对同一助听器声场测试的结果有无差别?对于全数字助听器，哪一种测试信号更适合于声场数量评估且与听觉功能评估结果相关性好?2、传统模拟助听器和全数字助听器用两种信号测试结果差值是否相同?3、经过一段时间的康复训练，听力障碍儿童语音分辨能力有无显著性提高?是否配戴全数字助听器的儿童这种能力提高幅度配戴传统模拟助听器儿童的高?
方法 对2002年9月1日-2003年1月在深圳市特殊需要儿童早期干预中心听觉言语康复训练班、家长学校亲子班就读的30名2-7岁智力正常的听力障碍儿童(其中10人配戴传统模拟助听器，10人配戴全数字助听器，10人学期初为传统模拟助听器，后变为全数字助听器)。对其进行如下研究：1)听觉数量评估：选取啭音和滤波复合音作为测试音分别进行声场测试，测试信号由扬声器给出，频率范围为250—4000Hz，声音强度为40—115dBHL。裸耳听力均由多频稳态诱发电位测试系统测试所得。通过单因素方差分析，分析三组用不同的测试信号进行声场测试的结果有无不同。2)听觉功能评估：测试音为言语声，在本底噪声存在的情况下由扬声器给出，强度控制在70±2dBHL，内容包括声母识别、韵母识别。3)频谱分析：利用听觉言语康复计算机系统的专业工具语图分析仪及滤波器，对听力障碍儿童发出的不同语音进行频谱分析。步骤1-3在学期末重复进行一次。4)统计分析方法：测试所得数据用SPSS10.0统计软件包进行分析，对受试者年龄、性别、听力障碍发生时间、程度、初始验配时间在三组间的分布有无显著性差异用Kruskal-Wallis Test法进行
山西医科大学
硕创卜学位卡仑文
秩和检验，对在实际测试过程中三因素对听觉功能评估结果的影响进行
多元回归分析，三组学期初、学期末的啡音、滤波复合音声场测试结果、
听觉功能评估计量资料比较分析进行单因素方差分析。对听觉数量评估
与听觉功能评估间结果的相关性进行直线相关分析。
结果用嗽音和滤波复合音对传统模拟助听器进行声场测试，结果无显
著性差异，对全数字助听器则差异显著。对于全数字助听器，滤波复合
音测试结果与听觉功能评估结果相关性好，且全数字组儿童语音识别能
力提高幅度传统组大，传统变全数字组儿童语音识别能力提高幅度也较
传统组大。
结论对于全数字助听器，先前应用于传统模拟助听器的声场啡音测试
结果仅供参考，而滤波复合音对于全数字助听器来说是一种较好的能够
反映实际聆听效果的声场测试信号。与传统模拟助听器比较，全数字助
听器能够获得较好的语音识别能力，对于处于学语关键期的幼儿，应该
作为首次验配助听器时的首选。
Objective The aim of this study is to investigate 1) whether it has significant difference between the sound field assessment of the same hearing aid by giving FM tones and filtered compound sound, and for digital hearing aid , the result of field assessment with which sound has good correlation with hearing function assessment ;2) whether it has significant difference between the result of these two sound field assessment on analogy hearing aid and digital hearing aid; and 3) whether the use of analogy hearing aids and digital hearing aids leads to different benefits in speech recognition abilities for children with hearing loss. Method Thirty 2-7 years old children with bilateral hearing aids (severe to profound) were included in the study. They take audition and speech study in Shenzhen Early Intervention Central for Children with Special Needs from April. 2002 to Jan, 2003. All children used two hearing aids behind the ear(ten used digital hearing aids, ten used analogy hearing aids, and ten used analogy
hearing aids at the beginning of term but then change to digital hearing aid). On each child, we took these research as follow:
1. hearing assessment: the unaided hearing was estimated by Multi-frequency Stable State Evoked Potential System, and the aided hearing was estimated in sound field by giving FM tones and then filtered compound sound ,which delivered through a loundspeaker 40-115dBHL over the range 500 to 4000Hz.
2. Hearing function evaluation: The purpose of this study was to examine children' s speech recognition abilities for Shengmu and Yunmu, It was presented in background noise when the children used analogy or digital hearing aid. The speech signal was delivered through a loudspeaker located at 70?dBHL .
3.Each child's voice was taken Speech spectrum analysis by Speech analysis meter and filter of Audio and Speech Rehabilitation System.
1-3 were repeated in the end of the term.
4. Statistical analysis was done by SPSS 10. 0. Gave the result of hearing level assessment and hearing function evaluation ANOVA among these three groups. Took Kruskal-Wallis Test to analysis the distribution of age, sex, hearing loss degree, occurring time and the time of initial worn hearing aid, and then linear regression given on the last three factors and hearing function evaluation result. Correlation analysis was given on aided hearing level and speech recognition abilities.
Results Significant difference were found between the result of aided hearing level assessment by FM tones and filtered compound sound. Function evaluation shows that the speech recognition ability of children with digital hearing aids is higher than that of which worn analogy hearing aids. It has strong correlation between the result of sound field assessment with that of function evaluation for children worn digital hearing aids. Conclusions The single subject research can be used in evaluation on benefit of rehabilitation for special needs children if the marker we choose to evaluation is valid and repeatable enough. The results of this investigation suggest that filtered compound sound with special frequency is good signal to assess the children's aided hearing level especially who worn
digital hearing aids. Wearing digital hearing aids can get higher speech recognition ability than wearing analogy hearing aids for children with hearing loss. To get satisfactory effect on early intervention for child with hearing loss, wearing digital hearing aids is the best choice.
方法 对2002年9月1日-2003年1月在深圳市特殊需要儿童早期干预中心听觉言语康复训练班、家长学校亲子班就读的30名2-7岁智力正常的听力障碍儿童(其中10人配戴传统模拟助听器，10人配戴全数字助听器，10人学期初为传统模拟助听器，后变为全数字助听器)。对其进行如下研究：1)听觉数量评估：选取啭音和滤波复合音作为测试音分别进行声场测试，测试信号由扬声器给出，频率范围为250—4000Hz，声音强度为40—115dBHL。裸耳听力均由多频稳态诱发电位测试系统测试所得。通过单因素方差分析，分析三组用不同的测试信号进行声场测试的结果有无不同。2)听觉功能评估：测试音为言语声，在本底噪声存在的情况下由扬声器给出，强度控制在70±2dBHL，内容包括声母识别、韵母识别。3)频谱分析：利用听觉言语康复计算机系统的专业工具语图分析仪及滤波器，对听力障碍儿童发出的不同语音进行频谱分析。步骤1-3在学期末重复进行一次。4)统计分析方法：测试所得数据用SPSS10.0统计软件包进行分析，对受试者年龄、性别、听力障碍发生时间、程度、初始验配时间在三组间的分布有无显著性差异用Kruskal-Wallis Test法进行
山西医科大学
硕创卜学位卡仑文
秩和检验，对在实际测试过程中三因素对听觉功能评估结果的影响进行
多元回归分析，三组学期初、学期末的啡音、滤波复合音声场测试结果、
听觉功能评估计量资料比较分析进行单因素方差分析。对听觉数量评估
与听觉功能评估间结果的相关性进行直线相关分析。
结果用嗽音和滤波复合音对传统模拟助听器进行声场测试，结果无显
著性差异，对全数字助听器则差异显著。对于全数字助听器，滤波复合
音测试结果与听觉功能评估结果相关性好，且全数字组儿童语音识别能
力提高幅度传统组大，传统变全数字组儿童语音识别能力提高幅度也较
传统组大。
结论对于全数字助听器，先前应用于传统模拟助听器的声场啡音测试
结果仅供参考，而滤波复合音对于全数字助听器来说是一种较好的能够
反映实际聆听效果的声场测试信号。与传统模拟助听器比较，全数字助
听器能够获得较好的语音识别能力，对于处于学语关键期的幼儿，应该
作为首次验配助听器时的首选。
Objective The aim of this study is to investigate 1) whether it has significant difference between the sound field assessment of the same hearing aid by giving FM tones and filtered compound sound, and for digital hearing aid , the result of field assessment with which sound has good correlation with hearing function assessment ;2) whether it has significant difference between the result of these two sound field assessment on analogy hearing aid and digital hearing aid; and 3) whether the use of analogy hearing aids and digital hearing aids leads to different benefits in speech recognition abilities for children with hearing loss. Method Thirty 2-7 years old children with bilateral hearing aids (severe to profound) were included in the study. They take audition and speech study in Shenzhen Early Intervention Central for Children with Special Needs from April. 2002 to Jan, 2003. All children used two hearing aids behind the ear(ten used digital hearing aids, ten used analogy hearing aids, and ten used analogy
hearing aids at the beginning of term but then change to digital hearing aid). On each child, we took these research as follow:
1. hearing assessment: the unaided hearing was estimated by Multi-frequency Stable State Evoked Potential System, and the aided hearing was estimated in sound field by giving FM tones and then filtered compound sound ,which delivered through a loundspeaker 40-115dBHL over the range 500 to 4000Hz.
2. Hearing function evaluation: The purpose of this study was to examine children' s speech recognition abilities for Shengmu and Yunmu, It was presented in background noise when the children used analogy or digital hearing aid. The speech signal was delivered through a loudspeaker located at 70?dBHL .
3.Each child's voice was taken Speech spectrum analysis by Speech analysis meter and filter of Audio and Speech Rehabilitation System.
1-3 were repeated in the end of the term.
4. Statistical analysis was done by SPSS 10. 0. Gave the result of hearing level assessment and hearing function evaluation ANOVA among these three groups. Took Kruskal-Wallis Test to analysis the distribution of age, sex, hearing loss degree, occurring time and the time of initial worn hearing aid, and then linear regression given on the last three factors and hearing function evaluation result. Correlation analysis was given on aided hearing level and speech recognition abilities.
Results Significant difference were found between the result of aided hearing level assessment by FM tones and filtered compound sound. Function evaluation shows that the speech recognition ability of children with digital hearing aids is higher than that of which worn analogy hearing aids. It has strong correlation between the result of sound field assessment with that of function evaluation for children worn digital hearing aids. Conclusions The single subject research can be used in evaluation on benefit of rehabilitation for special needs children if the marker we choose to evaluation is valid and repeatable enough. The results of this investigation suggest that filtered compound sound with special frequency is good signal to assess the children's aided hearing level especially who worn
digital hearing aids. Wearing digital hearing aids can get higher speech recognition ability than wearing analogy hearing aids for children with hearing loss. To get satisfactory effect on early intervention for child with hearing loss, wearing digital hearing aids is the best choice.
引文
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2 张华．新一代助听器．听力学及言语疾病杂志，2002，10(3)：192-194
3 陈湘宁，陈光冶．数字化助听器的若干技术发展．电声技术，2001，8：27-29
4 张华．数字式助听器的发展与展望．国外医学耳鼻咽喉科学分册，2001，25(6)：333-335
5 侯文生，彭承琳，郑俊．数字式助昕器技术进展．中国医疗器械杂志，1998，22(1)：31-34
6 严洪，洪峰．数字信号处理芯片的发展和应用．航天医学与医学工程，1999，12(1)：76-78
7 潭云松．助听器的基本原理与应用．中国康复医学理论与实践，1996，2(4)：176-178
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