人工耳蜗植入者汉语声调前注意加工及与耳蜗植入相关的耳蜗电刺激的研究
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摘要
目的:1与正常的听觉系统相比,人工耳蜗系统仍然提供不了完整的信息,特别是音调(乐音)信息,所以人工耳蜗植入者对汉语声调识别不很理想。事件相关电位(event related potentials,ERP)能够提供大脑皮层水平对声音刺激加工的信息,失匹配负波(mismatch negativity,MMN)是一种对刺激信号的前注意加工的事件相关电位,是大脑在对刺激尚未有意识注意前的加工阶段,是一个自动察觉和加工过程。本实验应用事件相关电位中的失匹配负波作为研究指标,比较语前聋人工耳蜗植入者和正常人对汉语声调识别时听觉中枢前注意加工的区别。同时比较两种范式的失匹配负波(oddball和control)的作用。2本文将介绍在人工耳蜗植入术中测试人工耳蜗电极串中每一个电极放电时引起面神经刺激症状的电流阈值,寻找出规律性,探讨产生这种规律的原因。3本文还探讨鼓岬电刺激在声刺激测试无反应或反应不好的人工耳蜗植入者选择中的应用。
方法:1耳蜗植入者选在北京协和医院耳鼻喉科进行手术的植入者,声音刺激材料为汉语四声调字,每个声调25个,共100个汉字,另外还有一种纯音,组成四个不同刺激组合,一个control block和三个oddball block。事件相关电位采用NeuroScan公司生产的EEG放大器,电极帽,采集分析软件Scan4.3进行,得出人工耳蜗植入者和正常人的两种MMN:oddball-MMN和control-MMN。2面神经反应阈值是在术中用人工耳蜗神经反应遥测设备(NRT)及面神经监测仪,记录不同强度的电刺激的面神经反应阈值,并进行分析,探寻不同电极刺激时面神经反应阈值变化的规律。3鼓岬电刺激选择1995年～2007年在北京协和医院植入人工耳蜗的鼓岬电刺激的患者进行分析,对这些对声刺激反应不佳的人工耳蜗植入者,在鼓岬电刺激指导下进行了人工耳蜗植入的患者术后效果进行总结,对鼓岬电刺激的意义作出评价。
结果:1人工耳蜗植入者和正常人均能得到明显的MMN。oddball MMN:正常人和人工耳蜗植入者的oddball-MMN均含有两个负波,人工耳蜗植入者oddballMMN的第一个负波与正常人相比潜伏期明显提前,人工耳蜗植入者oddball MMN第二个负波的潜伏期与正常人相比也有提前的现象,但不如第一个负波差异显著性大。control MMN:正常人control MMN的第一个负波缺失;人工耳蜗植入者control-MMN的第一个负波仍然存在;正常人对三种声调加工的control MMN(相当于第二个负波)振幅具有显著的差异,而人工耳蜗植入者三种声调的control-MMN第二个负波振幅差异不具显著性。2面神经反应阈值:通过增加或是减少电刺激的强度,所有的人工耳蜗植入者都能够测试到面神经对人工耳蜗不同电极的电刺激反应阈,从我们的实验可以看到三种类型的反应阈变化趋势:(1)渐降型。(2)前段渐降,后段平稳,有一个明显的拐点。(3)前段渐降,后段平稳,有一个明显的拐点,但全程有波动。3鼓岬电刺激:声刺激测试效果不佳的患者均成功在鼓岬电刺激结果的指导下进行了人工耳蜗植入,术中、术后NRT测试均有反应,行为测听效果满意。
结论:1人工耳蜗植入者和正常人都能够得到明显的对声调差异进行加工的MMN,证明人工耳蜗植入者和正常人都能够在前注意阶段对汉语声调进行加工。但从对总平均的波形观察和对统计结果的分析来看,人工耳蜗植入者的波形不规则,对声调之间的辨别统计分析没有明显的差异,说明人工耳蜗植入者与正常人相比对声调信息的加工困难,加工能力下降。在正常人中,因为control MMN与oddball MMN相比排除了声调物理属性差异对MMN的影响,真正反映以记忆为基础前注意加工,能够对声调的不同进行区分,说明在研究汉语声调的前注意加工时,control范式比oddball范式更加具有灵敏性,更能客观评价中枢前注意加工过程,避免了oddball造成的错估,更具有实用价值。2人工耳蜗电极由末端到顶端放电时,面神经电刺激反应阈值有减低的趋势,并且减低的方式有所不同,说明人工耳蜗电极在蜗管内时,顶端电极离面神经更近,直电极在蜗管内行进不规则。3声刺激测试反应不好,但能够合作的人工耳蜗植入者植入耳的选择,鼓岬电刺激能够提供有意义的参考。
Objective:1 Compared to normal auditory system,cochlear implant can not provide enough information,especially tonal information,so tonal discrimination is not so good in cochlear implant recipients.ERP can offer processing information to acoustic stimulation in cerebral cortex, MMN is an event related potentials of preattentive processing to stimulation signal,is Cerebullar processing of stimulation before attention,is a course of automatic detection and processing. Using mismatch negativity(MMN) of event related potentials(ERPs) as an index in our experiment,compared differences of pre-attentive auditory processing of Chinese tones between prelingual cochlear implant(CI) recipients and matched controls.At the same time,we compared the functions of two kinds of MMN.2 tested the threshold for cochlear implant electrodes stimulating the facial nerve,and investigate the change and the regularity of the change.3 To report and discuss the use of promontory stimulation test in cochlear implant candidates with poor response to acoustic stimulation test.
Methods:1 cochlear implant recipients are those who were operated at Department of Otolaryngology and Head Neck Surgery of Peking Union Medical College Hospital.Auditory materials included four Chinese tones and a pure tone,we used 25 group of Chinese character as these,100 Chinese characters totally,made up four stimulation blocks,a control block and three oddball blocks.event related potentials were recorded and analyzed by a NeuroScan SynAmps EEG amplifier and Acquire software Scan4.3.Oddball MMNs and control MMNs of CI users and normal subjects were obtained by different subtracting,there were two kinds of MMNs obtained in cochlear implant recipients and normal subjects,oddball MMN and control MMN.2 Used the neural response telemetry(NRT) equipment of cochlear implant and facial nerve monitor to record the threshod for the response of facial nerve to different intensive electric stimulation.Through analysis,try to find the changing regularity according to different intensive electric stimulation.3 Selected twelve recipients of cochlear implant performed and mapped in PUMCH from 1995 to 2007,who adopted promontory stimulation test.We summarized the postoperative results of these cochlear implant recipients who performed poorly in acoustic stimulation and were operated under the direction of promontory stimulation test,and discussed the role of promontory stimulation test in cochlear implantation.
Result:1 Obvious MMNs could be obtained from Cochlear implant recipients and normal subjects.Oddball MMN:oddball MMNs of normal person and cochlear implant recipients all had two negative waves,Latency of the first wave of oddball MMN was shorter in Cochlear implant recipients than in normal subjects,latency of the second wave was also shorter in Cochlear implant recipients than normal subjects,but the difference was not as significant as the first wave. Control MMN:in control paradigm,the first negative wave disappeared in normal subjects;In control MMNs of cochlear implant recipients,changes of the first wave are not as significant as normal subjects.In normal subjects,there were significant differences for the amplitudes of control MMN(corresponding to the second wave) about three Chinese tones block,but there were no difference in cochlear implant recipients.2 through increasing or decreasing the intension of electric stimuli,the threshold of facial nerve for electric stimuli could be obtained from all electrodes of all cochlear implant recipients,there were three kinds of variation trends of threshold:(1) Decreasing type.(2) Decreasing in anterior segment,stable in posterior segment, there is a obvious knee point.(3) Decreasing in anterior segment,stable in posterior segment, there is a obvious knee point too,but fluctuating in whole range.3 According to the results of promontory stimulation test,patients who had poorly acoustic stimulation tests were performed of cochlear implantion successfully;intraoperation and postoperation NRT test could be proceeded well;postoperative speech perception tests were satisfying.
Conclusion:1 There were evident MMN in processing different Chinese tones in CI users and normal person,this indicated that CI users and normal person both can process Chinese tones in preattentive period.But from the waveforms of grand average and the results of statistical analysis, we could find the waveforms of CI users are irregular,and there were not significant differences in processing different Chinese tones in statistical analysis.Compared to normal person,the processing of CI users was more difficult than that of normal person,and the ability of processing in CI users was decreased.In normal subjects,compared to oddball MMN,control MMN eliminated the effect of acoustic physical characteristics,could reflect the real memory-based pre-attentive processing,it could reflect the differences in processing different Chinese tones.In experiments of preattentive process for Chinese tones,control paradigm is more sensitive than oddball paradigm,is more objective in evaluating the function of preattentive process,because it avoids the misestimation of the MMN as oddball paradigm,we believe control MMN is more valuable in practice.2 From the end to the tip of cochlear implant electrodes,there is decreasing trend of the facial nerve response thresholds to electric stimulation,but the decreasing styles are different.This can indicated that tip electrodes are closer to facial nerve,and the courses of straight electrodes in cochlear ducts are more irregular.3 cochlear implant candidates with poor response to acoustic stimulation test can get benefit from promontory stimulation test.
方法:1耳蜗植入者选在北京协和医院耳鼻喉科进行手术的植入者,声音刺激材料为汉语四声调字,每个声调25个,共100个汉字,另外还有一种纯音,组成四个不同刺激组合,一个control block和三个oddball block。事件相关电位采用NeuroScan公司生产的EEG放大器,电极帽,采集分析软件Scan4.3进行,得出人工耳蜗植入者和正常人的两种MMN:oddball-MMN和control-MMN。2面神经反应阈值是在术中用人工耳蜗神经反应遥测设备(NRT)及面神经监测仪,记录不同强度的电刺激的面神经反应阈值,并进行分析,探寻不同电极刺激时面神经反应阈值变化的规律。3鼓岬电刺激选择1995年～2007年在北京协和医院植入人工耳蜗的鼓岬电刺激的患者进行分析,对这些对声刺激反应不佳的人工耳蜗植入者,在鼓岬电刺激指导下进行了人工耳蜗植入的患者术后效果进行总结,对鼓岬电刺激的意义作出评价。
结果:1人工耳蜗植入者和正常人均能得到明显的MMN。oddball MMN:正常人和人工耳蜗植入者的oddball-MMN均含有两个负波,人工耳蜗植入者oddballMMN的第一个负波与正常人相比潜伏期明显提前,人工耳蜗植入者oddball MMN第二个负波的潜伏期与正常人相比也有提前的现象,但不如第一个负波差异显著性大。control MMN:正常人control MMN的第一个负波缺失;人工耳蜗植入者control-MMN的第一个负波仍然存在;正常人对三种声调加工的control MMN(相当于第二个负波)振幅具有显著的差异,而人工耳蜗植入者三种声调的control-MMN第二个负波振幅差异不具显著性。2面神经反应阈值:通过增加或是减少电刺激的强度,所有的人工耳蜗植入者都能够测试到面神经对人工耳蜗不同电极的电刺激反应阈,从我们的实验可以看到三种类型的反应阈变化趋势:(1)渐降型。(2)前段渐降,后段平稳,有一个明显的拐点。(3)前段渐降,后段平稳,有一个明显的拐点,但全程有波动。3鼓岬电刺激:声刺激测试效果不佳的患者均成功在鼓岬电刺激结果的指导下进行了人工耳蜗植入,术中、术后NRT测试均有反应,行为测听效果满意。
结论:1人工耳蜗植入者和正常人都能够得到明显的对声调差异进行加工的MMN,证明人工耳蜗植入者和正常人都能够在前注意阶段对汉语声调进行加工。但从对总平均的波形观察和对统计结果的分析来看,人工耳蜗植入者的波形不规则,对声调之间的辨别统计分析没有明显的差异,说明人工耳蜗植入者与正常人相比对声调信息的加工困难,加工能力下降。在正常人中,因为control MMN与oddball MMN相比排除了声调物理属性差异对MMN的影响,真正反映以记忆为基础前注意加工,能够对声调的不同进行区分,说明在研究汉语声调的前注意加工时,control范式比oddball范式更加具有灵敏性,更能客观评价中枢前注意加工过程,避免了oddball造成的错估,更具有实用价值。2人工耳蜗电极由末端到顶端放电时,面神经电刺激反应阈值有减低的趋势,并且减低的方式有所不同,说明人工耳蜗电极在蜗管内时,顶端电极离面神经更近,直电极在蜗管内行进不规则。3声刺激测试反应不好,但能够合作的人工耳蜗植入者植入耳的选择,鼓岬电刺激能够提供有意义的参考。
Objective:1 Compared to normal auditory system,cochlear implant can not provide enough information,especially tonal information,so tonal discrimination is not so good in cochlear implant recipients.ERP can offer processing information to acoustic stimulation in cerebral cortex, MMN is an event related potentials of preattentive processing to stimulation signal,is Cerebullar processing of stimulation before attention,is a course of automatic detection and processing. Using mismatch negativity(MMN) of event related potentials(ERPs) as an index in our experiment,compared differences of pre-attentive auditory processing of Chinese tones between prelingual cochlear implant(CI) recipients and matched controls.At the same time,we compared the functions of two kinds of MMN.2 tested the threshold for cochlear implant electrodes stimulating the facial nerve,and investigate the change and the regularity of the change.3 To report and discuss the use of promontory stimulation test in cochlear implant candidates with poor response to acoustic stimulation test.
Methods:1 cochlear implant recipients are those who were operated at Department of Otolaryngology and Head Neck Surgery of Peking Union Medical College Hospital.Auditory materials included four Chinese tones and a pure tone,we used 25 group of Chinese character as these,100 Chinese characters totally,made up four stimulation blocks,a control block and three oddball blocks.event related potentials were recorded and analyzed by a NeuroScan SynAmps EEG amplifier and Acquire software Scan4.3.Oddball MMNs and control MMNs of CI users and normal subjects were obtained by different subtracting,there were two kinds of MMNs obtained in cochlear implant recipients and normal subjects,oddball MMN and control MMN.2 Used the neural response telemetry(NRT) equipment of cochlear implant and facial nerve monitor to record the threshod for the response of facial nerve to different intensive electric stimulation.Through analysis,try to find the changing regularity according to different intensive electric stimulation.3 Selected twelve recipients of cochlear implant performed and mapped in PUMCH from 1995 to 2007,who adopted promontory stimulation test.We summarized the postoperative results of these cochlear implant recipients who performed poorly in acoustic stimulation and were operated under the direction of promontory stimulation test,and discussed the role of promontory stimulation test in cochlear implantation.
Result:1 Obvious MMNs could be obtained from Cochlear implant recipients and normal subjects.Oddball MMN:oddball MMNs of normal person and cochlear implant recipients all had two negative waves,Latency of the first wave of oddball MMN was shorter in Cochlear implant recipients than in normal subjects,latency of the second wave was also shorter in Cochlear implant recipients than normal subjects,but the difference was not as significant as the first wave. Control MMN:in control paradigm,the first negative wave disappeared in normal subjects;In control MMNs of cochlear implant recipients,changes of the first wave are not as significant as normal subjects.In normal subjects,there were significant differences for the amplitudes of control MMN(corresponding to the second wave) about three Chinese tones block,but there were no difference in cochlear implant recipients.2 through increasing or decreasing the intension of electric stimuli,the threshold of facial nerve for electric stimuli could be obtained from all electrodes of all cochlear implant recipients,there were three kinds of variation trends of threshold:(1) Decreasing type.(2) Decreasing in anterior segment,stable in posterior segment, there is a obvious knee point.(3) Decreasing in anterior segment,stable in posterior segment, there is a obvious knee point too,but fluctuating in whole range.3 According to the results of promontory stimulation test,patients who had poorly acoustic stimulation tests were performed of cochlear implantion successfully;intraoperation and postoperation NRT test could be proceeded well;postoperative speech perception tests were satisfying.
Conclusion:1 There were evident MMN in processing different Chinese tones in CI users and normal person,this indicated that CI users and normal person both can process Chinese tones in preattentive period.But from the waveforms of grand average and the results of statistical analysis, we could find the waveforms of CI users are irregular,and there were not significant differences in processing different Chinese tones in statistical analysis.Compared to normal person,the processing of CI users was more difficult than that of normal person,and the ability of processing in CI users was decreased.In normal subjects,compared to oddball MMN,control MMN eliminated the effect of acoustic physical characteristics,could reflect the real memory-based pre-attentive processing,it could reflect the differences in processing different Chinese tones.In experiments of preattentive process for Chinese tones,control paradigm is more sensitive than oddball paradigm,is more objective in evaluating the function of preattentive process,because it avoids the misestimation of the MMN as oddball paradigm,we believe control MMN is more valuable in practice.2 From the end to the tip of cochlear implant electrodes,there is decreasing trend of the facial nerve response thresholds to electric stimulation,but the decreasing styles are different.This can indicated that tip electrodes are closer to facial nerve,and the courses of straight electrodes in cochlear ducts are more irregular.3 cochlear implant candidates with poor response to acoustic stimulation test can get benefit from promontory stimulation test.
引文
Matthias Wittfoth , Angelika Wolf , Joachim Muller and Anja Hahne Music perception in cochlear implant users: an event-related potential study Stefan Koelsch, Clinical Neurophysiology Volume 115, Issue 4, April 2004, Pages 966-972
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Limb CJ.Cochlear implant-mediated perception of music.Curr Opin Otolaryngol Head Neck Surg.2006 Oct;14(5):337-40.
Vongpaisal T,Trehub SE,Schellenberg EG.Song recognition by children and adolescents with cochlear implants.J Speech Lang Hear Res.2006Oct;49(5):1091-103.
Huang TS,Wang NM,Liu SY Nucleus 22-channel cochlear mini-system implantations in Mandarin-speaking patients,Am J Otol.1996 Jan;17(1):46-52.
Huang TS,Wang NM,Liu SY.Tone perception of Mandarin-speaking postlingually deaf implantees using the Nucleus 22-Channel Cochlear Mini System.Ann Otol Rhinol Laryngol Suppl.1995 Sep;166:294-8.
Peng SC,Tomblin JB,Cheung H,Lin YS,Wang LS.Perception and production of mandarin tones in prelingually deaf children with cochlear implants.Ear Hear.2004Jun;25(3):251-64.
Wei CG,Cao K,Zeng FG.Mandarin tone recognition in cochlear-implant subjects.Hear Res.2004 Nov;197(1-2):87-95.
Xu L,Li Y,Hao J,Chen X,Xue SA,Han D.Tone production in Mandarin-speaking children with cochlear implants:a preliminary study.Acta Otolaryngol.2004May;124(4):363-7.
赵伦主编,ERP实验教程。天津社会科学出版社,2004。
Giard, M. H., Perrin, F., Pernier, J., & Bouchet, P. Brain generators implicated in the processing of auditory stimulus deviance: a topographic event-related potential study. Psychophysiology, 1990 Nov;27(6):627-40.
Levanen, S., Ahonen, A., Hari, R., McEvoy, L., & Sams, M. Deviant auditory stimuli activate human left and right auditory cortex differently. Cerebral Cortex, 1996 Mar-Apr;6(2): 288-96.
Naatanen R, Winkler I. The concept of auditory stimulus representation in cognitive neuroscience. Psychol Bull. 1999 Nov; 125(6): 826-59.
Naatanen, R. Mismatch negativity outside strong attentional focus: A commentary on woldorff et al.(1991). Psychophysiology, 1991; 28: 478-84.
woldorff M et al. The effects of channel-selective attention on the mismatch negativity wave elicited by deviant tones. Psychophysiology, 1991; 28; 30-42.
Singh S, Liasis A, Rajput K, Towell A, Luxon L. Event-related potentials in pediatric cochlear implant patients. Ear Hear. 2004 Dec;25(6):598-610.
KrausN, MiccoAG, Koch DB, McGeeT, Carrell T, Sharma A, Wiet RJ, Weingarten CZ. The mismatch negativity cortical evoked potential elicited by speech in cochlear-implant users. Hear Res. 1993 Feb;65(1-2): 118-24.
Groenen P, Snik A, van den Broek P. On the clinical relevance of mismatch negativity: results from subjects with normal hearing and cochlear implant users. Audiol Neurootol. 1996 Mar-Apr;1(2):112-24.
Koelsch S, Wittfoth M, Wolf A, Muller J, Hahne A. Music perception in cochlear implant users: an event-related potential study. Clin Neurophysiol. 2004 Apr;115(4):966-72.
Kelly AS, Purdy SC, Thorne PR.Electrophysiological and speech perception measures of auditory processing in experienced adult cochlear implant users. Clin Neurophysiol. 2005 Jun;116(6): 1235-46. Epub 2005 Apr 26.
Meng X, Sai X, Wang C, Wang J, Sha S, Zhou X. Auditory and speech processing and reading development in Chinese school children: behavioural and ERP evidence. Dyslexia. 2005 Nov; 11 (4):292-310.
Chandrasekaran B, Gandour JT, Krishnan A.Neuroplasticity in the processing of pitch dimensions: A multidimensional scaling analysis of the mismatch negativity. Restor Neurol Neurosci. 2007;25(3-4): 195-210.
Naatanen, R., Gaillard, A. and Mantysalo, S., Early selective attention reinterpreted. Acta Psychol 1978 Jul;42(4):313-29.
Korpilahti P, Krause CM, Holopainen I, Lang AH. Early and late mismatch negativity elicited by words and speech-like stimuli in children. Brain Lang. 2001 Mar;76(3):332-9.
Naatanen, R., Tervaniemi, M. Sussman, E. Paavilainen P. and Winkler I., 'Primitive intelligence' in the auditory cortex, Trends Neurosci. 24 (2001), pp. 283-288.
Ponton, C. W., & Don, M. (1995). The mismatch negativity in cochlear implant users. Ear and Hearing, 1995 Feb;16(1):131-46.
Ponton, C. W., Eggermont, J. J., Don, M., Waring, M. D., Kwong, B., Cunningham, J. et al. Maturation of the mismatch negativity: effects of profound deafness and cochlear implant use. Audiology & Neuro - otology, 2000 May-Aug;5(3-4): 167-85.
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