Neural Predictors of Speech Perception Outcomes in Adults with Cochlear Implants

人工耳蜗植入成人言语感知结果的神经预测因子

YINGYING WANG Show email (2019-07-01 to 2022-06-30) $460,356

Project ID: R21DC018110 (NIDCD)

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Abstract

Cochlear implants (CIs) have benefited more than 324,200 individuals worldwide who are deaf or severely hard of hearing since 1984. Although CIs can significantly improve auditory speech perception, leading to better quality of life for severe-to-profoundly deaf individuals, the success rate is highly variable and speech perception outcomes (SPOs) differ widely across CI users. Many factors can contribute to this wide variability, such as age of implantation, duration of deafness, level of preoperative usable residual hearing, pre-CI hearing aid use, and the design of CI electrodes. However, these factors explain only about 10-20% of the variance. Therefore, a large portion of the variance in post-surgical SPOs remains unclear and unpredictable, leading to great difficulty in determining who will benefit from a CI. The goal of this project is to identify the brain-based factors that determine the variability in SPOs in order to characterize the factors leading to successful SPOs. Functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS) will be used to measure brain activity, and diffusion weighted imaging (DWI) will be used to measure white matter integrity prior to implantation; these measures will be contrasted with a group of normal hearing controls. After implantation, only fNIRS (which is fully compatible with a CI) will be used to measure changes in activity together with changes in speech perception at three- and six-month follow-up visits after the activation of the CI. The central hypothesis, formulated on the promising predictive powers of brain-based measures, is that pre-surgical neural markers predict SPOs following implantation. If this hypothesis is correct, pre-surgical brain imaging scans might be introduced in the evaluation process of CI candidacy. The long-term goal is to implement an imaging-guided process to determine pre-surgical CI candidacy and assist in post-surgical aural rehabilitation. The specific aims are to: 1) identify differences in activity and white matter integrity between adults with post-lingual sensorineural hearing loss (SNHL) and age- and gender-matched normal hearing controls; 2) determine neural markers that predict SPOs; and 3) identify changes in brain activity, specifically cross-modal reorganization in the post-lingual SNHL group, following implantation. By achieving these aims, the PI will gather data essential to developing a treatment protocol that involves brain imaging data to best guide clinical practices in adults and children, which will be proposed in a subsequent R01. Ultimately, the results of this research will reveal those neural factors important in predicting better SPOs in CI users and will lead to improved prognosis. The knowledge gained from this work will also shed light on opposing theoretical frameworks that account for the relationship between functional changes and SPOs in CI users. The foundational information established under this award will provide the framework for future research proposals aiming to collect imaging data in CI candidates for all ages in clinical practices. This study directly addresses Priority Areas 2 and 3 in Hearing and Balance Research of the latest NIDCD Strategic Plan.

自1984年以来，人工耳蜗植入物（CIs）使全世界超过324,200名耳聋或严重听力障碍的人受益。虽然CI可显着改善听觉言语感，从而提高严重至深度聋人的生活质量，但成功率变化很大，语言感知结果（SPO）在CI用户中差异很大。许多因素可能导致这种广泛的变异，例如植入年龄，耳聋持续时间，术前可用残余听力水平，CI前助听器使用以及CI电极的设计。然而，这些因素仅解释了约10-20％的方差。因此，手术后SPO的很大一部分差异仍然不明确且不可预测，导致很难确定谁将从CI中受益。该项目的目标是确定决定SPO变异性的基于大脑的因素，以便确定导致SPO成功的因素。功能磁共振成像（fMRI）和功能性近红外光谱（fNIRS）将用于测量大脑活动，扩散加权成像（DWI）将用于测量植入前的白质完整性;这些措施将与一组正常的听力控制措施形成对比。植入后，只有fNIRS（与CI完全相容）将用于测量CI活化后三个月和六个月随访时的活动变化以及语音感知的变化。基于大脑测量的有希望的预测能力制定的中心假设是术前神经标记物预测植入后的SPO。如果这个假设是正确的，可以在CI候选资格的评估过程中引入术前脑成像扫描。长期目标是实施成像引导过程，以确定术前CI候选资格并协助手术后听觉康复。具体目标是：1）识别具有舌下感觉神经性听力损失（SNHL）和年龄和性别匹配的正常听力控制的成人之间的活动和白质完整性的差异; 2）确定预测SPO的神经标记物; 3）在植入后识别大脑活动的变化，特别是语言后SNHL组中的跨模式重组。通过实现这些目标，PI将收集必要的数据，以开发涉及脑成像数据的治疗方案，以最好地指导成人和儿童的临床实践，这将在随后的R01中提出。最终，这项研究的结果将揭示那些预测CI用户中更好的SPO的重要神经因素，并将改善预后。从这项工作中获得的知识也将阐明反对理论框架，这些理论框架解释了CI用户中功能变化与SPO之间的关系。根据该奖项建立的基础信息将为未来的研究提案提供框架，旨在收集临床实践中所有年龄段的CI候选人的成像数据。本研究直接针对最新NIDCD战略计划的听力和平衡研究中的优先领域2和3。