Zusammenfassung
Patienten mit ausreichendem Tieftongehör nach Kochleaimplantation können elektrisch erzeugte Reizmuster und akustische Reize derart integrieren, dass sich die Wahrnehmung von Sprache, v. a. im Störgeräusch, und die Musikabbildung deutlich verbessern, was auf eine Übertragung der „Feinstruktur“ des Signals durch genauere Abbildung der Grundfrequenz (F0) über den akustischen Reiz zurückgeführt wird. Prinzipbedingt erfolgt die Abbildung von Tonhöhen oder Melodiekonturen mit bisher verwendeten Kochleaimplantaten (CI) nur grob; Tonhöhenunterschiede werden erst bei sehr großen Intervallen erkannt. Man nimmt an, dass die durch den akustischen Informationskanal übertragene Tonhöheninformation den CI-Träger in die Lage versetzt, sicherer zwischen Sprach- und Störsignal zu unterscheiden. Die Verfolgung eines einzelnen Sprechers in einem Gewirr aus verschiedenen Stimmen gelingt besser, wenn als Trennungsmerkmal die Grundfrequenzkontur der Stimme zur Verfügung steht. Eine besondere Herausforderung besteht in der Schonung der Hörfunktion im zu operierenden Ohr. Die Entwicklung besonders flexibler und dünner Elektrodenträger sowie die Anwendung einer das Innenohr minimal traumatisierenden Operationstechnik ermöglichen bei fast allen Patienten einen weitgehenden Hörerhalt.
Abstract
After cochlear implantation, individuals with sufficient residual hearing in the lower frequency region are able to successfully combine acoustic and electrical stimulation patterns to improve speech perception, especially in noise, and to improve music appraisal as well. These improvements occur through enhanced transmission of fine structure information by more accurate mapping of the fundamental frequency contour through acoustic hearing. In current cochlear implant systems, the transfer of frequency and melodic contour is very coarse, and the correct detection of pitch contour requires large frequency differences. It is assumed that the acoustically transferred part of the signal enables the cochlear implant recipient to better segregate between speech signals and interfering sounds. The detection and following of a speech signal emitted by a single talker in a multitalker babble situation is improved when fundamental frequencies as grouping cues are present. The preservation of hearing in the implanted ear must be considered a major surgical challenge. The development of very flexible and soft electrode carriers in combination with surgical approaches that minimally traumatize the inner ear enable hearing preservation in nearly all cases.
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Danksagung
Die Autoren bedanken sich bei Herrn Dipl.-Ing. Tobias Rader für die Aufbereitung der Abbildungen und die Einstellung der http://www-Seiten mit den EAS-Demonstrationen sowie bei den Herstellern MED-EL (Innsbruck) und Cochlear (Hannover) für die Bereitstellung der Abbildungen.
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Baumann, U., Helbig, S. Hören mit kombinierter elektrischer und akustischer Stimulation. HNO 57, 542–550 (2009). https://doi.org/10.1007/s00106-009-1923-2
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DOI: https://doi.org/10.1007/s00106-009-1923-2