RU2325142C1 - Method of tuning speech processor of cochlear implantation system - Google Patents

Abstract

FIELD: medicine; othorhinolaryngology.

SUBSTANCE: to achieve this, the patient is stimulated by electric signals sent to all electrodes of the implant. The speech processor is tuned gradually by changing the stimulus value in all 12-22 channels of the cochlear implantation system. At the same time, the stapedial reflex is registered in response to excessive signal level. Then comfort levels are set for each channel in the speech processor implantation program. Once the reflex limen is reached in some channel, measuring the reflex level in this channel stops. During further tuning the stimulation level of other channels is gradually increased.

EFFECT: less time needed to tune the speech processor of the cochlear implantation system.

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Description

The invention relates to medicine, namely to otorhinolaryngology. Currently, cochlear implantation is the most effective method of hearing rehabilitation for patients with severe sensorineural hearing loss, mainly children of younger age groups (Daikhes N.A., Korvyakov V.C., Pashkov A.V. et al. Cochlear implantation at the Federal State Clinical Center for Otorhinolaryngology // All-Russian Scientific -practical conference with international participation "Modern aspects and prospects of development of otorhinolaryngology": Materials of Conf. - M., 2005 - P.32.). Optimal tuning of the speech processor is a prerequisite for successful user perception of the cochlear implant (Skinner MW, Holden LK, Holden TA Parameters selection to optimize speech recognition with Nucleus implant // Otolaryngol. Head Neck Surg. - 1997. - Vol. 117, - No. 3. - Vol 1. - P.188-195; Petrov S.M. Initial information on tuning the speech processor of a cochlear implant // West Otorhinolar. - 2002. - No. 4. - P.18-20).

To achieve the level of adjustment at which it is possible to carry out effective rehabilitation measures, at the initial stages of adjustment, you can be satisfied with the definition of settings of a comfortable level, since, based on their values, you can tentatively set perception thresholds. In the vast majority of patients with clear subjective assessments of threshold and comfort levels, the dynamic range of current perception is in the range of 15-20 dB.

Different cochlear implantation systems (depending on the manufacturer) have a different number of auditory nerve stimulation channels. For successful sound perception, it is necessary to establish optimal comfort indicators on each individual channel.

Children of younger age groups, as a rule, are not able to accurately demonstrate the feeling of discomfort from excessive stimulation of the auditory nerve, and therefore it is necessary to use objective methods to determine stimulation levels not exceeding the levels of auditory discomfort (Petrov SM, Schukina AA MCL, stapedius reflex thresholds and white noise band perception in implanted adults with postlingual deafness // XXVIII International Congress of Audiology. - Innsbruck. - Austria. - 2006. - 3-7 September. - Abstract book. - p.72).

The most widespread method of determining levels close to comfortable is the method of recording the stapedial reflex - an involuntary contraction of the stirrup muscle in response to excessive stimulation. The patient is gradually increased in intensity of stimulation of the auditory nerve until the onset of reflex contraction of the stirrup muscle. Then, the testing procedure is repeated for another channel, starting with the minimum stimulus values. Registration of this phenomenon is carried out by means of a tympanometer - a device for determining the pressure gradient in the external auditory canal.

The closest solution is the classical method of impedance measurement, the so-called acoustic impedance measurement, which was developed by O. Metz in 1946 (Metz O. The acoustic impedance measured on normal and patological ears // Acta otolaryngol. - 1946. - Suppl. 63. - p.1-254.). The method is based on the registration of acoustic impedance (impedance) of the middle ear, depending on the air pressure in the external auditory canal, expressed in mm of water. This method is ubiquitous in the clinic in the form of tympanometry and registration of the acoustic reflex (Hoheisel H., Walch R. Psychiatr. Neurol. Med. Psychol. - 1953 - 5 (5) - P.194-200). The registration of the stapedial reflex, as a rule, is carried out at four frequencies with a predetermined intensity of the suprathreshold stimulus.

The above methods have their drawbacks.

For the method of registering the reflex threshold for each individual channel, this is:

1) the need for the patient to withstand the entire research procedure for each individual channel completely;

2) for each channel, the study must begin with a minimum level of stimulation;

3) a significant duration of the study conducted on each of the 12 channels.

For the acoustic impedance method, these are:

1) the use of only four frequencies for research;

2) presentation of a stimulus with a predetermined intensity, excluding a step-by-step determination of discomfort.

To eliminate the disadvantages of the above methods, a method for adjusting the parameters of the speech processor of a cochlear implantation system is proposed.

The purpose of the invention is the optimization of the tuning process of the speech processor of the cochlear implantation system.

The method is as follows: registration of the stapedi reflex is carried out during sequential stimulation of all tunable channels of the implant in an amount from 12 to 22 in one session. Upon reaching a reflex threshold on any channel, i.e. comfort, the determination of the level of reflex in this channel is stopped. With further research, the level of stimulation of the remaining channels is gradually raised (shift). Thus, the comfort parameters of all the tested channels are set in a time slightly exceeding the setting of one channel.

Positive effect: tuning of the speech processor in patients with a cochlear implantation system is carried out for a time significantly less than tuning each channel individually while maintaining the same measurement accuracy.

An example of a specific implementation No. 1. Patient Kartoeva F., medical history No. 18171/333, 4 years. In the postoperative period, the patient was psychologically difficult to undergo the procedure for tuning the speech processor, as a result of which it was possible to configure no more than two channels per day, if necessary, configure 22 channels of the system. The processor was tuned during sequential stimulation of all channels with an increase in the stimulus level. At the same time, stapedial reflex was determined. Using the proposed algorithm made it possible to adjust the comfort parameters of all channels in one go.

An example of a specific implementation No. 2. Patient Sidorova D., medical history No. 16539/139, 3 years. During the first turn on of the speech processor, the patient was negatively tuned, which made it possible to tune no more than two or three channels per day, if necessary, configure 22 channels of the system. The processor was tuned during sequential stimulation of all channels with an increase in the overall stimulus level. Upon reaching the threshold of reflex (i.e. comfort), the increase in the level of stimulation on this channel ceased. At the same time, a stapedial reflex was determined. Using the proposed algorithm made it possible to configure the comfort parameters of all channels in one go.

Information sources

1. Daikhes N.A., Korvyakov B.C., Pashkov A.V. et al. Cochlear implantation at the Federal State Clinical Center for Otorhinolaryngology // All-Russian Scientific and Practical Conference with International Participation "Modern Aspects and Prospects for the Development of Otorhinolaryngology": Materials Conf. - M., 2005 - P.32.

2. Petrov S.M. Initial information on tuning the speech processor of a cochlear implant // Tomsk State University Journal. otorhinolar. - 2002. - No. 4. - S.18-20.

3. Hoheisel H., Walch R. Psychiatr. Neurol. Med. Psychol. - 1953 - 5 (5) - P.194-200.

4. Metz O. The acoustic impedance measured on normal and patological ears // Acta otolaryngol. - 1946. - Suppl. 63. - p.1-254.

5. Petrov S.M., Schukina A.A. MCL, stapedius reflex thresholds and white noise band perception in implanted adults with postlingual deafness // XXVIII International Congress of Audiology. - Innsbruck. - Austria. - 2006. - 3-7 September. - Abstract book. - p.72.

6. Skinner M.W., Holden L.K., Holden T.A. Parameters selection to optimize speech recognition with Nucleus implant // Otolaryngol. Head Neck Surg. - 1997. - Vol. 117, - No. 3. - Vol 1. - P.188-195.

Claims (1)

The method of adjusting the parameters of the speech processor of the cochlear implantation system by stimulating the patient with electric signals supplied to all the implant electrodes, registering the thresholds of the stapedi reflex and then setting comfort levels for each channel in the implant speech processor program, characterized in that the speech processor is adjusted sequentially, changing the value stimulus for all channels of the cochlear implantation system from 12 to 22 channels with simultaneous registration of the stapes a dial reflex in response to an excessive level of the stimulus, and upon reaching the reflex threshold on any channel, that is, comfort, the determination of the reflex level in this channel is stopped, and with further tuning the level of stimulation of the remaining channels is gradually raised.