Koklear İmplantlıların Konuşma Performansı Üzerinde FM Sistem
Transkript
Koklear İmplantlıların Konuşma Performansı Üzerinde FM Sistem
<HQL7ÕS'HUJLVL5-88 Orijinal makale .RNOHDUøPSODQWOÕODUÕQ .RQXúPD3HUIRUPDQVÕ Üzerinde FM Sistem Etkisi $VXPDQ$OQÕDoÕN(5'2ö$1 0DUPDUDhQLYHUVLWHVL2G\RORMLYH.RQXúPD%R]XNOXNODUÕ%LOLP'DOÕø67$1%8/ ÖZET Amaç: Gürültülü ortamlarda Frekans Modulasyonlu (FM) VLVWHP NXOODQÕPÕQÕQ NRNOHDU LPSODQW NXOODQDQ NLúLOHUGH NRQXúPDQÕQ DQODúÕOÕUOÕ÷Õ ]HULQH RODQ HWNLVLQLQ LQFHOHQPHVLDPDoODQPÕúWÕU Materyal ve Metot %X YDND oDOÕúPDVÕQGD VHVVL] RUWDPGD WHN KHFHOL NRQXúPD OLVWHVL LOH \DSÕODQ NRQXúPD WHVWLQH J|UH µL\L¶ µRUWD¶ YHµ N|W¶ NRQXúPD SHUIRUPDQVÕ RODQ o NRNOHDU LPSODQW NXOODQÕFÕVÕQGD )0 VLVWHPL NXOODQÕPÕQÕQHWNLOHULDUDúWÕUÕOPÕúWÕU6HVVL]YHJUOWORUWDPGD+]LúLWPHHúLNOHUL G% +/ YH WHN KHFHOL NRQXúPD WHVW VNRUODUÕ WHVSLW HGLOPLúWLU$\UÕFDJUOWORUWDPGD)0VLVWHPLOHLúLWPH HúLNOHULYHNRQXúPDWHVWOHULWHNUDUGH÷HUOHQGLULOPLúWLU Bulgular: Her üç vakada da gürültülü ortamda FM VLVWHPVL] LúLWPH HúLNOHULQGH YH NRQXúPD SerformansODUÕQGDVHVVL]RUWDPLOHNDUúÕODúWÕUÕOGÕ÷ÕQGDDQODPOÕGúú HOGH HGLOPLúWLU )0 VLVWHP LOH HOGH HGLOHQ LúLWPH HúLNOHUL YH NRQXúPD WHVW VNRUODUÕQÕQ VHVVL] RUWDP EXOJXODUÕ LOH EHQ]HUROGX÷XWHVSLWHGLOPLúWLU Sonuç: FM sistem ile gürültülü ortamlarda çevre gürülWVQQ \DQNÕODQPDQÕQ YH PHVDIH HWNLOHULQLQ D]DOPDVÕQDED÷OÕRODUDNNRNOHDULPSODQWNXOODQÕFÕODUÕQÕQ NRQXúXODQODUÕ DQODPD SHUIRUPDQVODUÕQGD DUWÕú VD÷ODnPDNWDGÕU %X GXUXP NRNOHDU LPSODQW NXOODQÕFÕODUÕQÕQ JQON \DúDP LoLQGH GH NRQXúXODnlDUÕ GDKD UDKDW DQODPD EDNÕPÕQGDQ )0 VLVWHPLQGHQ \DUDU VD÷OD\DELOHFHNOHULQL J|VWHUPHNtedir. ABSTRACT The effects of FM system on cochlear implant recipients’ speech performance Objective: This study aimed to examine the effects of Frequency Modulation (FM) system on cochlear implant recipients’ speech understanding in noisy environments. Material and Method: In this case study three cochlear implant users whose speech performance were evaluated ‘good’ ‘moderate’ and ‘bad’ according to their monosyllabic word discrimination score in a quiet condition were tested to show the effects of FM system in a noisy condition. Threshold level (in dB HL) at 250, 500, 1000, 2000, 4000, 6000 Hz. and open set monosyllabic word discrimination scores were determined in quiet and in noisy conditions in three cases. Moreover, these tests were also repeated with FM system in noisy condition. Results: In noisy condition without FM, a decrease was found in hearing threshold levels and word discrimination scores for all three subjects. With FM system in noisy condition, hearing thresholds and word discrimination scores again increased as in quiet setting. Conclusion: FM system provides better speech understanding in noisy conditions for cochlear implant users by reducing the effects of noise, reverberation and distance. It shows that cochlear implant users have an advantage of better speech understanding in daily life with FM system. Anahtar Kelimeler: FM sistem; gürültü; koklear implant Key Words: FM system; noise; cochlear implant *ø5øù Koklear implant, iç kulakta koklea LoLQH \HUOHúWLULOHQ HOHNWURWODU YDVÕWDVÕ LOH LúLWPH VLQLULQH LúLWVHO ELOJL\L J|QGHUPHN DPDFÕ LOH NDIDWDVÕ GHULVL DOWÕQD implante edilen elektronik bir alettir. 6LVWHPLQ GÕú NÕVPÕ NXODN DUNDVÕQD WDNÕODQ ELU VHV LúOHPFL YH NDID GHULVL DOWÕQGDNL DOÕFÕ\OD ELU PÕNQDWÕV YDVÕWDVÕ LOH LUWLEDWÕ VD÷OD\DQ LOHWLFL ERELQGHQ ROXúXU 6HV LúOHPFLVL ]HULQGHNL PLNURIRQODU oHYUHVHOVHVOHULWRSOD\DUDNLOHWLFLERELQWDUDIÕQGDQ NDID GHULVL DOWÕQGDNL DOÕFÕ\D J|QGHULU $OÕFÕ\a gelen VHVOHUL HOHNWULNVHO NRGODUD G|QúWUHUHN Lo NXODNtaki elektURWODUD LOHWLU øúLWPH VLQLULQH \DNÕQ olarak \HUOHúWLULOHQ HOHNWURWODUYDVÕWDVÕLOHROXúDQDNÕP <D]ÕúPDDGUHVL $VXPDQ$OQÕDoÕN(5'2ö$1 Ph.D 0DUPDUDhQLYHUVLWHVL2G\RORMLYH.RQXúPD%R]XNOXNODUÕ%LOLP'DOÕøVWDQEXO e-mail: [email protected] <D]ÕQÕQJHOGL÷LWDULK : 28.02.2012 <D\ÕQDNDEXOWDULKL : 07.09.2012 VLQLUGH DNVL\RQ SRWDQVL\HO ROXúWXUDUDN LúLWVHO ELOJL halinde beyine gönderilir. 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Sessiz ortamda NRQXúPD\ÕD\ÕUWHWPHSXDQÕROGX÷XLoLQµRUWD¶ GHUHFHGH NRQXúPD SHUIRUPDQVÕ RODQ NXOODQÕFÕ RODUDNGH÷HUOHQGLULOPLúWLU +HU ELU NXOODQÕFÕ LoLQ D\UÕ D\UÕ -500-10002000-4000-6000 Hz.’GH LúLWPH HúLNOHUL YH NRQXúPD\Õ D\ÕUWHWPHSXDQODUÕDúD÷ÕGDNLSURWRNROHJ|UH EHOLUOHQPLúWLU a.Sessiz ortamda sadece koklear implant ile b.Gürültülü ortamda sadece koklear implant ile c. Gürültülü ortamda koklear implant +FM sistem ile. *UOWúLGGHWVHYL\HVLWPWHVWOHUGHG%63/ úLGGHW VHYL\HVLQGH VDELW WXWXOPXúWXU øúLWPH HúLNOHULQLQWHVSLWHGLOPHVLQGHGDUEDQWJUOWNRQXúPD WHVWOHULQGH LVH JHQLú VSHNWUDO |]HOOL÷L ROGX÷X LoLQNRQXúPDJUOWVYHULOPLúWLU .RQXúPD X\DUDQODUÕ G% 63/ úLGGHW VHYL\HVLQGH YHULOPLúWLU .RQXúPD WHVWleri için Marmara hQLYHUVLWHVLWHNKHFHOLNRQXúPDOLVWHVLNXOODQÕOPÕúWÕU22. BULGULAR +HU ELU YDND LoLQ D\UÕ D\UÕ VHVVL] RUWDPGD gürültülü ortamda ve gürültülü ortamda FM sistem LOH HOGH HGLOHQ LúLWPH HúLNOHUL ùHNLO ùHNLO YH ùHNLO¶GHJ|VWHULOPLúWLU ùHNLO. Vaka 1. ‘kötü’ NRQXúPDSHUIRUPDQV ùHNLO9DNDµL\L¶NRQXúPDSHUIRUPDQVÕ ùHNLO 9DNDµRUWD¶GHUHFHGHNRQXúPDSHUIRUPDQVÕ .RQXúPD\Õ D\ÕUW HWPH SXDQODUÕ 9DND LoLQ sessiz ortamda %44, gürültülü ortamda sadece koklear implant ile %24; gürültülü ortamda koklear implant ve FM sistem ile %40; Vaka 2 için, sessiz ortamda %88; gürültülü ortamda sadece koklear implant ile %60; gürültülü ortamda koklear implant ve FM sistem ile %80; Vaka 3 için sessiz ortamda %60; gürültülü ortamda %40; gürültülü ortamda FM sistem ile %52 olarak EHOLUOHQPLúWLU+HUoYDNDGDGDJUOWORUWDPGD NRQXúPD SHUIRUPDQVODUÕQGD Gúú J|]OHQLUNHQ JUOWO RUWDPGD )0 VLVWHP LOH NRQXúPD SHUIRUPDQVODUÕQÕQVHVVL]RUWDPODEHQ]HUúHNLOGHL\LOHúWL÷L WHVSLW HGLOPLúWLU .RQXúPD\Õ D\ÕUW HWPH SXDQODUÕ YDNDODULoLQùHNLO¶GHJ|VWHULOPLúWLU ùHNLO ho D\UÕ YDNDGDQ HOGH HGLOHQ NRQXúPD\Õ D\ÕUW HWPHSXDQODUÕ 87 $$(UGR÷DQ 7$57,ù0$ )0 VLVWHP VHV GDOJDODUÕQÕ ELU YHULFL YDVÕWDVÕ LOH VHV ND\QD÷ÕQGDQ WRSOD\DUDN )0 PRGXODV\RQOX VLQ\DOOHU KDOLQGH GLQOH\LFLQLQ NXOODQGÕ÷Õ LúLWPH FLKD]Õ YH\D NRNOHDU LPSODQWD WDNÕODQ DOÕFÕ\D J|QGHULU Ortamda sabit bir gürültü olsa bile, ses, mesafe ve \DQNÕODQPDHWNLOHULRUWDGDQNDOGÕUÕODUDNGLQOH\LFL\H XODúPDNWDGÕU %X oDOÕúPDGD NRQXúPD SHUIRUPDQVÕ iyi, kötü ve orta derecede olan 3 koklear implant kullaQÕFÕVÕQÕQ JUOWO RUWDPGD )0 VLVWHPGHQ \DUDUODQPDGXUXPODUÕLQFHOHQPLúWLU %X oDOÕúPDGDNL YDNDODUGD VHVVL] RUWDPGD LúLWPH HúLNOHULYHNRQXúPD\ÕD\ÕUWHWPHSXDQODUÕQHNDGDU L\L ROXUVD ROVXQ JUOWO RUWDPGD LúLWPH HúLNOHULQGH N|WOHúPH NRQXúPD\Õ D\ÕUW HWPH SXDQODUÕQGD EHOLUOL ELU Gúú WHVSLW HGLOPLúWLU $QFDN D\QÕ JUOW úLGGHW VHYL\HVLQGH )0 VLVWHP NXOODQÕOGÕ÷Õ ]DPDQLúLWPHHúLNOHULQLQVHVVL]RUWDPLúLWPHHúLNOHUL VHYL\HVLQH \NVHOGL÷L NRQXúPD\Õ D\ÕUW HWPH SXDQODUÕQGD GD VHVVL] RUWDP SXDQODUÕ LOH RUDQWÕOÕ ELoLPGHEHOLUJLQG]HOPHROGX÷XEHOLUOHQPLúWLU)0 sistem ile koklear implant NXODQÕFÕODUÕ JUOWO RUWDPGD GD VHVVL] RUWDPGDNLQH EHQ]HU úHNLOGH SHUIRUPDQVJ|VWHUPLúOHUGLU )0 VLVWHP |]HOOLNOH VÕQÕI RUWDPÕ JLEL RUWDPODUGD sinyal-gürültü orDQÕQÕ FLKD]VÕ] GXUXPD J|UH -30 G% RUDQÕQGD23, konvaQVL\RQHO LúLWPH FLKD]ODUÕ LOH NDUúÕODúWÕUÕOGÕ÷ÕQGD-FLYDUÕQGDDUWÕUPDNWDGÕU24. Johnston ve ark.25 \ÕOÕQGD\DSWÕNODUÕoDOÕúPDGD LúLWVHO LúOHPOHPH ER]XNOX÷X RODQ oRFXNODUGD )0 VLVWHP NXOODQÕPÕQÕQ EX oRFXNODUÕQ NRQXúPD DOJÕVÕQGD YH DNDGHPLN SHUIRUPDQVODUÕQGD DUWÕúD VHEHSROGX÷XQXEHOLUWPLúOHUGLU Nillson ve ark.26 QRUPDO LúLWPH GXUXPXQGD sinyal-JUOWRUDQÕQGDKHUG%¶OLND]DOPDQÕQ, koQXúPDDOJÕVÕQGDRUDQÕQGDN|WOHúPH\HVHEHS ROGX÷XQXWHVSLWHWPLúOHUGLU Sessiz ortamlarda NRQXúPDSHUIRUPDQVÕoRNL\L RODQ LPSODQW NXOODQÕFÕODUÕQGD ELOH JUOW RUWDPGD NRQXúPD\Õ D\ÕUW HWPH EHFHULOHULQGH Gúú J|]OHQPHNWHGLU.RNOHDULPSODQWNXOODQÕFÕODUÕQÕQJUOWO RUWDPGD NRQXúXODQODUÕ DQODPDGD \DúDGÕNODUÕ ]RUOXNODUD NRQXúPD X\DUDQÕQ VSHNWUDO úLGGHW IUHkans) özelliklerinin gürültü sebebi ile bozulmaVÕQÕQ27 VHEHSROGX÷XGúQOPHNWHGLU )0 VLVWHP PLNURIRQX NRQXúPDFÕQÕQ D÷Õ] NÕVPÕQD oRN \DNÕQ FP¶GHQ GDKD NÕVD PHVDIHGH ROGX÷X LoLQ PHVDIH \DQNÕODQPD YH DUND SODQ gürültüsünün etkilerini çok aza indirmektedir. Bu oDOÕúPDGD GD NRNOHDU LPSODQW NXOODQDQ o NLúLQLQ FM sistem ile gürültülü ortamda, aynen sessiz ortamdakine benzer performans göstermeleri, sisWHPLQ KHP oRFXNODUGD KHP GH \HWLúNLQOHUGH JQlük hayat içinde her türlü gürültülü ortamda kullaQÕOPDVÕJHUHNOLOL÷LQLJ|VWHUPHNWHGLU. REFERANSLAR 1. Fryauf-Bertschy H, Tyler RS, Kelsay DM. Performance over time of congenitally deaf and postlingually deafened children using a mulitchannel cochlear implant. Journal of Speech and Hearing Research 1992;35:913–20. 2. Miyamoto RT, Osberger MJ, Robbins AM, Myres WA, Kessler K. Prelingually deafened children’s performance with the Nucleus multichannel cochlear implant. American Journal of Otology 1993;14(5):437–45. 3. Waltzman SB, Cohen N, Shapiro W. Effects of cochlear implantation on the young deaf child. Advances in Oto-Rhino-Laryngology 1995;50: 125–8. 4. Miyamoto RT, Svirsky M, Kirk KI, Robbins AM, Todd S, Riley A. Speech intelligibility of children with multichannel cochlear implants. Annals of Otology, Rhinology and Laryngology 1997;168:35–6. 5. Svirsky MA, Chute PM, Green J, Bollard P, Miyamoto R. Language development in children who are prelingually deaf who have used the SPEAK or CIS stimulation strategies since initial stimulation. Volta Review 2002;102:199–213. 6. Lutman ME, Tait DM. Early communicative behavior in young children receiving cochlear implants: factor analysis of turn-taking and gaze orientation. Annals of Otology, Rhinology and Laryngology 1995;166:397–9. 7. Gfeller K, Christ A, Knutson JF, Witt S, Murray KT, Tyler RS. Musical backgrounds, listening habits, and aesthetic enjoyment of adult cochlear implant recipients. Journal of the American Academy of Audiology 2000;11:390–406. 8. Schafer EC, Thibodeau LM. Speech recognition abilities of adults using CIs interfaced with FM systems. Journal of American Academy of Audiology 2004;15(10):678–91. 9. Wolfe J, Schafer EC. Optimizing the benefit of Auria sound processors coupled to personal FM systems with iConnect2 adaptors. Journal of American Academy of Audiology 2008;19(8):585-94. 10. Wouters J, Vanden Berghe J. Speech recognition in noise for cochlear implantees with a two-microphone monaural adaptive noise reduction system. Ear and Hearing 2001;22:420-30. 11. Finitzo-Hieber T, Tillman T. Room acoustics effects on monosyllabic word discrimination ability for normal and hearing-impaired children. Journal of Speech and Hearing Research 1978;21:440–58. 12. Hall JW III. New Handbook of Auditory Evoked Responses. New York: Allyn&Bacon; 2006. 13. Bradley J. Speech intelligibility studies in classrooms. Journal of the Acoustical Society of America 1986;80:846–54. 14. Crandell C. Classroom acoustics for hearing-impaired children. Journal of the Acoustical Society of America 1992;92:2470. 88 15. Finitzo-Hieber T. Classroom acoustics. in: Roeser R, editor. 2nd ed. Auditory disorders in school children. New York: Thieme-Stratton; 1988. p:221–3. 16. Kodaras M. Reverberation times of typical elementary school settings. Noise Control 1960;6:17–9. 17. Knecht HA, Nelson PB, Whitelaw GM, Feth LL. Background noise levels and reverberation times in unoccupied classrooms: predictions and measurements. American Journal of Audiology 2002;11: 65–71. 18. Crandell C, Bess F. Speech recognition of children in a “typical” classroom setting. Asha 1986; 82. 19. Crum D. The effects of noise, reverberation, and speaker-tolistener distance on speech understanding (Unpublished doctoral dissertation). Evanston, IL: Northwestern Univ. 1974. 20. Olsen W. Acoustics and amplification in classrooms for the hearing impaired. in: Bess FH, editor. Childhood deafness: Causation, assessment, and management. New York: Grune & Stratton, 1993. 21. Anderson KL, Goldstein H, Colodzin L, Iglehart F. Benefit of S/N enhancing devices to speech perception of children listening in a typical classroom with hearing aids or a CI. Journal of Educational Audiology 2005; 12:14–28. 22. $NúLW$0.RQXúPD\ÕD\ÕUWHWPHWHVWLLoLQL]RIRQLNNHOLPHOLVWHOHULQLQ ROXúWXUXOPDVÕ tH] øVWDQEXO 0DUPDUD hQLYHUVLWHVL 6D÷OÕN %LOLPOHUL (QVWLWV2G\RORMLYH.RQXúPD%R]XNOXNODUÕ%LOLP'DOÕ 23. McArdle R, Abrams HB, Chisolm TH. When hearing aids go bad: an FM success story. Journal of American Academy of Audiology 2005;16: 809–21. 24. Anderson K, Goldstein H. Speech perception benefits of FM and infrared devices to children with hearing aids in a typical classroom. Language Speech Hearing Services 2004;35:169–84. 25. Johnston KN, John AB, Kreisman NV, Hall JW III, Crandell CC. Multiple benefits of personal FM system use by children with auditory processing disorder (APD). International Journal of Audiolology 2009;48: 371–83. 26. Nillson M, Soli SD, Sullivan J. Development of the hearing in noise test for the measurement of speech reception thresholds in quiet and in noise. Journal of Acoustical Society of America 1994;95:1085–99. 27. Nelson PB, Jin SH, Carney AE, Nelson DA. Understanding speech in modulated interference: CI users and normal hearing listeners. Journal of Acoustical Society of America 2003;113(2):961–68.
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