{"id":28127,"date":"2024-10-24T08:00:53","date_gmt":"2024-10-24T06:00:53","guid":{"rendered":"https:\/\/lifelonghearing.com\/?p=28127"},"modified":"2025-04-17T04:25:42","modified_gmt":"2025-04-17T04:25:42","slug":"zvuk-kochlearnich-implantatu-ani-mickey-mouse-ani-roboticky-hlas","status":"publish","type":"post","link":"https:\/\/lifelonghearing.com\/cs\/zvuk-kochlearnich-implantatu-ani-mickey-mouse-ani-roboticky-hlas\/","title":{"rendered":"Zvuk kochle\u00e1rn\u00edch implant\u00e1t\u016f: ani Mickey Mouse, ani robotick\u00fd hlas!"},"content":{"rendered":"

Jak bude m\u016fj kochle\u00e1rn\u00ed implant\u00e1t zn\u00edt?<\/h1><\/div>

Od prvn\u00ed kochle\u00e1rn\u00ed implantace v roce 1977 se technologie CI vyv\u00edjela a spolu s n\u00ed i porozum\u011bn\u00ed \u0159e\u010di a kvalita zvuku s CI. Sou\u010dasn\u00e9 studie simuluj\u00ed zvuk kochle\u00e1rn\u00edch implant\u00e1t\u016f.<\/strong><\/p>\n<\/div>

<\/span><\/div><\/div><\/div><\/div><\/div>

\"Odborn\u00edci z praxe v\u011bd\u00ed, \u017ee v\u011bt\u0161ina z\u00e1jemc\u016f o CI m\u00e1 dv\u011b hlavn\u00ed ot\u00e1zky: \u201eJak dob\u0159e budu sly\u0161et?\u201c a \u201eJak to bude zn\u00edt?\u201c. [1]<\/a> Odpov\u011b\u010f na ot\u00e1zku dosa\u017eiteln\u00e9 srozumitelnosti \u0159e\u010di nen\u00ed snadn\u00e1. Existuje p\u0159\u00edli\u0161 mnoho ovliv\u0148uj\u00edc\u00edch faktor\u016f, kter\u00e9 hraj\u00ed roli. M\u016f\u017eeme v\u0161ak srozumitelnost \u0159e\u010di alespo\u0148 zm\u011b\u0159it a n\u00e1sledn\u011b ji vyj\u00e1d\u0159it v \u010d\u00edseln\u00fdch hodnot\u00e1ch. M\u016f\u017eeme ji pouze popsat v\u00edce \u010di m\u00e9n\u011b kv\u011btnat\u00fdmi slovy nebo ji porovnat se zn\u00e1m\u00fdmi zvukov\u00fdmi obrazy. Renomovan\u00fd v\u00fdvojov\u00fd psycholog Michael F. Dorman, emeritn\u00ed profesor lingvistiky, sluchov\u00fdch a \u0159e\u010dov\u00fdch v\u011bd, se t\u011bmito n\u00e1ro\u010dn\u00fdmi ot\u00e1zkami z v\u011bdeck\u00e9ho hlediska zab\u00fdv\u00e1 ji\u017e n\u011bkolik desetilet\u00ed. Nejprve zkoumal v r\u016fzn\u00fdch v\u00fdzkumn\u00fdch skupin\u00e1ch vliv r\u016fzn\u00fdch technick\u00fdch faktor\u016f na porozum\u011bn\u00ed \u0159e\u010di s kochle\u00e1rn\u00edm implant\u00e1tem. Vysv\u011btluje mo\u017enosti, kter\u00e9 nyn\u00ed vyu\u017e\u00edv\u00e1 p\u0159i zkoum\u00e1n\u00ed zvuku kochle\u00e1rn\u00edch implant\u00e1t\u016f: \u201eJednostrann\u011b nesly\u0161\u00edc\u00ed pacienti s CI otev\u0159eli v\u00fdzkumn\u00edk\u016fm okno pro odpov\u011b\u010f na ot\u00e1zku, kterou si klade t\u00e9m\u011b\u0159 ka\u017ed\u00fd kandid\u00e1t na CI: \u201eJak bude m\u016fj CI zn\u00edt?\u201c[2]<\/a><\/p>\n

V\u00fdsledky jeho aktu\u00e1ln\u00edch studi\u00ed [3]<\/a> [4]<\/a>jsou pozvbudiv\u00e9: u u\u017eivatel\u016f CI s kr\u00e1tk\u00fdmi elektrodami zn\u00ed CI v\u00edce vysoko ne\u017e p\u0159irozen\u00fd sluch. Pro n\u011bkter\u00e9 u\u017eivatele CI s dlouh\u00fdmi elektrodami v\u0161ak CI zn\u00ed t\u00e9m\u011b\u0159 nebo dokonce zcela stejn\u011b jako p\u0159irozen\u00fd sluch, zat\u00edmco jin\u00ed vn\u00edmaj\u00ed zvuk CI jako v\u00edce \u010di m\u00e9n\u011b tlumen\u00fd, n\u011bkdy tak\u00e9 m\u00e9n\u011b z\u0159eteln\u00fd ne\u017e p\u0159irozen\u00fd sluch v druh\u00e9m uchu.[5]<\/a><\/p>\n

\u201eHled\u00e1 se Mickey Mouse\u201c - popis nebo porovn\u00e1n\u00ed zvukov\u00fdch obraz\u016f<\/h2>\n

Jednou z pr\u016fkopnic t\u011bchto srovn\u00e1vac\u00edch studi\u00ed byla Sandra Prentissov\u00e1 se sv\u00fdmi v\u011bdeck\u00fdmi kolegy v USA. Pracovali s u\u017eivatelem CI, u n\u011bho\u017e CI elektroda pokr\u00fdv\u00e1 t\u00e9m\u011b\u0159 cel\u00e9 dva z\u00e1vity hlem\u00fd\u017ed\u011b, p\u0159i\u010dem\u017e jeho zbytkov\u00fd sluch byl po implantaci zachov\u00e1n t\u00e9m\u011b\u0159 beze zm\u011bny ve v\u0161ech v\u00fd\u0161k\u00e1ch. P\u0159ed deseti lety po\u017e\u00e1dal v\u011bdeck\u00fd t\u00fdm v r\u00e1mci p\u0159\u00edpadov\u00e9 studie tohoto u\u017eivatele, aby porovnal vn\u00edm\u00e1n\u00ed v\u00fd\u0161ek t\u00f3n\u016f s CI s vn\u00edm\u00e1n\u00edm p\u0159irozen\u00e9ho zbytkov\u00e9ho sluchu v t\u00e9m\u017ee uchu. V\u00fdsledky potvrdily p\u0159i\u0159azen\u00ed jednotliv\u00fdch v\u00fd\u0161ek ke konkr\u00e9tn\u00edm m\u00edst\u016fm v hlem\u00fd\u017edi, a tedy v\u00fdznam dlouh\u00fdch elektrod<\/a>. U n\u00edzkofrekven\u010dn\u00edch zvuk\u016f se tak\u00e9 uk\u00e1zal vliv \u010dasov\u00e9ho rozli\u0161en\u00ed na vn\u00edm\u00e1n\u00ed v\u00fd\u0161ky t\u00f3nu, \u010d\u00edm\u017e se potvrdila \u00fa\u010dinnost tzv. k\u00f3dov\u00e1n\u00ed jemn\u00e9 struktury<\/a>. k\u00f3dov\u00e1n\u00ed jemn\u00e9 struktury. Tato p\u0159\u00edpadov\u00e1 studie v\u0161ak neposkytuje \u017e\u00e1dn\u00e9 informace o zvukov\u00e9m obrazu.<\/p>\n

\"\"

Weller a jeho kolegov\u00e9 ukazuj\u00ed: U\u017eivatel\u00e9 CI, kte\u0159\u00ed maj\u00ed elektrody zavedeny pod \u00fahlem v\u00edce ne\u017e 630 stup\u0148\u016f, vykazuj\u00ed nejlep\u0161\u00ed porozum\u011bn\u00ed \u0159e\u010di, zat\u00edmco ti, kte\u0159\u00ed maj\u00ed elektrody zavedeny pod \u00fahlem m\u00e9n\u011b ne\u017e 360 stup\u0148\u016f, vykazuj\u00ed v\u00fdrazn\u011b hor\u0161\u00ed porozum\u011bn\u00ed \u0159e\u010di. \u00a9adaptiert von Weller et al. 2023<\/p><\/div>\n

Touto ot\u00e1zkou se pak zab\u00fdval americk\u00fd v\u011bdec Michael F. Dorman spolu s dal\u0161\u00edmi kolegy v\u011bdci v n\u011bkolika studi\u00edch s jednostrann\u011b implantovan\u00fdmi u\u017eivateli CI s norm\u00e1ln\u00edm, p\u0159irozen\u00fdm sluchem na druh\u00e9 stran\u011b. Implantace CI u pacient\u016f s jednostrannou hluchotou byly poprv\u00e9 provedeny v roce 2003 v r\u00e1mci jedn\u00e9 evropsk\u00e9 studie a dnes jsou rutinn\u00ed v mnoha zem\u00edch, v\u010detn\u011b Rakouska [6]<\/a>. Zpo\u010d\u00e1tku n\u011bkte\u0159\u00ed odborn\u00edci pochybovali o tom, zda je um\u011ble generovan\u00fd zvukov\u00fd vjem CI kompatibiln\u00ed s p\u0159irozen\u00fdm zvukov\u00fdm vjemem na druh\u00e9 stran\u011b. Dorman a jeho kolegov\u00e9 v\u0161ak po\u017e\u00e1dali takov\u00e9 u\u017eivatele bimod\u00e1ln\u00edch CI, aby p\u0159esn\u011b porovnali zvukov\u00fd vjem CI s p\u0159irozen\u00fdm sluchem na druh\u00e9 stran\u011b. Jako akustick\u00fd sign\u00e1l pou\u017eili n\u011bkolik kr\u00e1tk\u00fdch v\u011bt. Ty pak technicky zpracov\u00e1vali pro p\u0159irozen\u011b sly\u0161\u00edc\u00ed ucho, dokud \u00fa\u010dastn\u00edci studie nepopsali zvuk stejn\u011b jako nezpracovan\u00fd zvuk CI. V \u00favodu jedn\u00e9 z v\u00fdsledn\u00fdch publikac\u00ed v\u011bdci p\u00ed\u0161\u00ed, \u017ee od takto vyvinut\u00fdch simulac\u00ed o\u010dek\u00e1vali zvuky Mickey Mouse nebo robot\u016f. Pr\u00e1v\u011b tyto p\u0159edstavy dodnes n\u011bkte\u0159\u00ed lid\u00e9 pou\u017e\u00edvaj\u00ed k popisu zvuku kochle\u00e1rn\u00edho implant\u00e1tu, kdy\u017e se jich na n\u011bj z\u00e1jemci nebo z\u00e1jemkyn\u011b ptaj\u00ed. Zvuk modern\u00edch CI je v\u0161ak z\u0159ejm\u011b mnohem p\u0159irozen\u011bj\u0161\u00ed, ne\u017e se d\u0159\u00edve p\u0159edpokl\u00e1dalo! Podle Dormana byl \u0159e\u010dov\u00fd sign\u00e1l simula\u010dn\u00edch zvuk\u016f p\u0159ev\u00e1\u017en\u011b m\u00edrn\u011b tlumen\u00fd [7]<\/a> [8]<\/a>. N\u011bkte\u0159\u00ed \u00fa\u010dastn\u00edci studie dokonce hodnotili zvuk CI jako zcela toto\u017en\u00fd s p\u0159irozen\u00fdm zvukem v druh\u00e9m uchu - to byl konkr\u00e9tn\u011b p\u0159\u00edpad n\u011bkter\u00fdch u\u017eivatel\u016f implant\u00e1t\u016f MED-EL s dlouh\u00fdmi elektrodami.<\/p>\n

Simulace ukazuje: Modern\u00ed CI zn\u00ed p\u0159irozen\u011b!<\/h2>\n

V\u011bdci vyvinuli r\u016fzn\u00e9 simulace, kter\u00e9 umo\u017e\u0148uj\u00ed pochopit \u00fa\u010dinky technick\u00fdch parametr\u016f. V\u017edy se v\u0161ak jednalo pouze o srovn\u00e1n\u00ed: dlouh\u00e9 a kr\u00e1tk\u00e9 elektrody, v\u00edce \u010di m\u00e9n\u011b frekven\u010dn\u00edch p\u00e1sem, s informac\u00ed o jemn\u00e9 struktu\u0159e nebo bez n\u00ed. To jsou d\u016fle\u017eit\u00e9 informace nejen pro v\u00fdvojov\u00e9 t\u00fdmy: Kandid\u00e1ti na CI mohou tyto simulace vyu\u017e\u00edt k rozhodnut\u00ed, kter\u00fdm vlastnostem CI cht\u011bj\u00ed v\u011bnovat zvl\u00e1\u0161tn\u00ed pozornost. Tyto simulace v\u0161ak nemohou poskytnout p\u0159edstavu o skute\u010dn\u00e9m zvuku kochle\u00e1rn\u00edho implant\u00e1tu! Nov\u00e9 simulace odborn\u00edka na CI Michaela F. Dormana a jeho koleg\u016f maj\u00ed za c\u00edl pr\u00e1v\u011b toto. Ve sv\u00fdch vysv\u011btlen\u00edch tak\u00e9 poukazuj\u00ed na to,<\/p>\n

\"\"

Zat\u00edmco elektrody MED-EL FLEX24 se pou\u017e\u00edvaj\u00ed v syst\u00e9mech EAS pro osoby, kter\u00e9 je\u0161t\u011b sly\u0161\u00ed n\u00edzk\u00e9 t\u00f3ny p\u0159irozen\u00fdm sluchem, nejdel\u0161\u00ed elektrody od n\u011bkter\u00fdch jin\u00fdch poskytovatel\u016f jsou je\u0161t\u011b krat\u0161\u00ed ne\u017e u kandid\u00e1t\u016f s hlubokou ztr\u00e1tou sluchu. [11]<\/a><\/p><\/div>\u017ee p\u0159irozen\u00fd zvukov\u00fd dojem by nem\u011bl b\u00fdt jednodu\u0161e ztoto\u017e\u0148ov\u00e1n s optim\u00e1ln\u00edm porozum\u011bn\u00edm \u0159e\u010di. I se sou\u010dasnou technologi\u00ed CI je st\u00e1le nutn\u00e1 adaptace na CI. Optim\u00e1ln\u00ed vyu\u017eit\u00ed kochle\u00e1rn\u00edch implant\u00e1t\u016f zaji\u0161\u0165uje sluchov\u00e1 rehabilitace. Zpracov\u00e1n\u00ed sluchu v mozku si m\u016f\u017ee zvyknout na m\u00e9n\u011b optim\u00e1ln\u00ed zvuk CI, ale \u010dasto to trv\u00e1 n\u011bkolik let[9]<\/a>, co\u017e je dal\u0161\u00ed z\u00e1v\u011br Dormanova v\u00fdzkumu. Nicm\u00e9n\u011b v\u00fdsledky studie jsou p\u016fsobiv\u00e9: dnes mohou kandid\u00e1ti CI o\u010dek\u00e1vat t\u00e9m\u011b\u0159 p\u0159irozenou kvalitu zvuku s individu\u00e1ln\u011b nastavenou d\u00e9lkou CI elektrody!<\/p>\n<\/div>

D\u00e9lka elektrod: jak technick\u00e9 vlastnosti ovliv\u0148uj\u00ed zvuk<\/strong><\/p>\n

V\u011bdci rychle vyvinuli zvukov\u00e9 p\u0159\u00edklady, kter\u00e9 lidem s norm\u00e1ln\u00edm sluchem pomohly p\u0159edstavit si vliv jednotliv\u00fdch technick\u00fdch prvk\u016f kochle\u00e1rn\u00edch implant\u00e1t\u016f, zejm\u00e9na vliv d\u00e9lky elektrod. Lidsk\u00e9 vnit\u0159n\u00ed ucho pou\u017e\u00edv\u00e1 \u201ek\u00f3dov\u00e1n\u00ed m\u00edsta\u201c: r\u016fzn\u00e9 v\u00fd\u0161ky t\u00f3n\u016f jsou p\u0159i\u0159azeny ur\u010dit\u00fdm m\u00edst\u016fm v hlem\u00fd\u017edi. S kochle\u00e1rn\u00edm implant\u00e1tem jsou sly\u0161iteln\u00e9 p\u0159esn\u011b ty zvukov\u00e9 intervaly, jejich\u017e ekvivalent dos\u00e1hne elektrody CI v hlem\u00fd\u017edi. Proto je obzvl\u00e1\u0161t\u011b d\u016fle\u017eit\u00e9, aby d\u00e9lka elektrody co nejv\u00edce odpov\u00eddala d\u00e9lce hlem\u00fd\u017ed\u011b. Pro kandid\u00e1ty CI nebo u\u017eivatele s typick\u00fdm hlem\u00fd\u017ed\u011bm nab\u00edz\u00ed rakousk\u00fd v\u00fdrobce MED-EL jako jedin\u00fd elektrody, kter\u00e9 jsou se svou d\u00e9lkou 32 milimetr\u016f dostate\u010dn\u011b dlouh\u00e9, aby dos\u00e1hly stejn\u011b do m\u00edst pro vysok\u00e9 i n\u00edzk\u00e9 t\u00f3ny. Nap\u0159\u00edklad elektroda dlouh\u00e1 pouh\u00fdch 24 milimetr\u016f ponech\u00e1v\u00e1 v\u00edce ne\u017e t\u0159i okt\u00e1vy frekven\u010dn\u00edho rozsahu v typick\u00e9m hlem\u00fd\u017edi nedosa\u017een\u00e9! Aby byly navzdory tomu sly\u0161iteln\u00e9 v\u0161echny v\u00fd\u0161ky, pou\u017e\u00edvaj\u00ed v\u00fdrobci triky zvan\u00e9 frekven\u010dn\u00ed posun a frekven\u010dn\u00ed komprese. P\u0159i frekven\u010dn\u00edm posunu je zvuk o frekvenci 70 hertz\u016f stimulov\u00e1n tam, kde p\u016fvodn\u011b zazn\u00edvalo 590 hertz\u016f. D\u00edky tomu zn\u00ed v\u0161e v\u00edce vysoko, co\u017e je zn\u00e1m\u00e9 jako efekt Mickey Mouse. D\u00edky dodate\u010dn\u00e9 frekven\u010dn\u00ed kompresi se sedm okt\u00e1v sly\u0161iteln\u00e9ho zvuku stla\u010d\u00ed do \u010dty\u0159 okt\u00e1v. Kdyby se to m\u011blo zopakovat na klav\u00edru, zn\u011bl by klav\u00edr nejen nep\u0159\u00edjemn\u011b vysoko, ale tak\u00e9 velmi rozlad\u011bn\u011b - mus\u00edme tedy p\u0159edpokl\u00e1dat, \u017ee tohoto efektu se dos\u00e1hne i pomoc\u00ed CI.
\nKrat\u0161\u00ed elektroda nav\u00edc neovliv\u0148uje pouze zvuk, ale zhor\u0161uje tak\u00e9 porozum\u011bn\u00ed \u0159e\u010di. To prok\u00e1zala \u0159ada v\u011bdc\u016f - naposledy Tobias Weller a jeho kolegov\u00e9 z Univerzitn\u00ed nemocnice v Hannoveru. Ti uv\u00e1d\u011bj\u00ed, \u017ee \u201ep\u0159\u00ednos [of a cochlear implant]je v\u00fdrazn\u011b vy\u0161\u0161\u00ed p\u0159i \u00fahlu zaveden\u00ed [of the electrode] 540\u00b0 - 630\u00b0 ne\u017e p\u0159i \u00fahlu zaveden\u00ed men\u0161\u00edm ne\u017e 360\u00b0, a\u010dkoli po 630\u00b0 nedoch\u00e1z\u00ed k v\u00fdrazn\u00e9mu poklesu\u201c.
\n[10]<\/a><\/p>\n<\/div><\/div><\/div><\/div>

\n

[1]<\/a> Dorman MF, Natale SC, Baxter L, et al. Approximations to the Voice of a Cochlear Implant: Explorations With Single-Sided Deaf Listeners. Trends in Hearing. 2020;24. doi:10.1177\/2331216520920079 [2]<\/a> Zeitler DM, Dorman MF, Cochlear Implantation for Single-Sided Deafness: A New Treatment Paradigm. J Neurol Surg B Skull Base 2019; 80(02): 178-186. doi: 10.1055\/s-0038-1677482 [3]<\/a> Dorman MF, Natale SC, Butts AM, Zeitler DM, Carlson ML. The sound quality of cochlear implants: Studies with singlesided deaf patients. Otol Neurotol. 2017 Sep;38(8):e268-e273. doi: 10.1097\/MAO.0000000000001449. [4]<\/a> Dorman MF, Natale SC, Zeitler DM, Baxter L, Noble JH. Looking for Mickey Mouse\u2122 But Finding a Munchkin: The Perceptual Effects of Frequency Upshifts for Single-Sided Deaf, Cochlear Implant Patients. J Speech Lang Hear Res. 2019 Sep 20;62(9):3493-3499. doi: 10.1044\/2019_JSLHR-H-18-0389. Epub 2019 Aug 15. [5]<\/a> Dorman MF, 2020 [6]<\/a> Prentiss S, Staecker H, Wolford B. Ipsilateral acoustic electric pitch matching: a case study of cochlear implantation in an up-sloping hearing loss with preserved hearing across multiple frequencies. Cochlear Implants Int. 2014;15(3):161-165. doi:10.1179\/1754762814Y.0000000066 [7]<\/a> Dorman MF 2020 [8]<\/a> Dorman MF 2019 [9]<\/a> Dorman MF, Natale SC, Noble JH and Zeitler DM (2022) Upward Shifts in the Internal Representation of Frequency Can Persist Over a 3-Year Period for Cochlear Implant Patients Fit With a Relatively Short Electrode Array. Front. Hum. Neurosci. 16:863891. doi: 10.3389\/fnhum.2022.863891<\/p>\n

[10]<\/a> \u201e9 Gr\u00fcnde f\u00fcr die Relevanz der CI-Elektrode\u201c, https:\/\/blog.medel.pro\/de\/chirurgie\/relevanz-der-ci-elektrode\/
\n[11]<\/a> Zdroje: Elektroden-Einf\u00fchrwinkel laut Studien siehe blog.medel.pro; Flex34 approximiert.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"

Jak bude m\u016fj kochle\u00e1rn\u00ed implant\u00e1t zn\u00edt? Od prvn\u00ed kochle\u00e1rn\u00ed implantace v roce 1977<\/p>\n","protected":false},"author":4,"featured_media":31618,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[470],"tags":[],"class_list":["post-28127","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-veda"],"yoast_head":"\nZvuk kochle\u00e1rn\u00edch implant\u00e1t\u016f: ani Mickey Mouse, ani robotick\u00fd hlas!<\/title>\n<meta name=\"description\" content=\"Od prvn\u00ed kochle\u00e1rn\u00ed implantace v roce 1977 se technologie CI vyv\u00edjela a spolu s n\u00ed i porozum\u011bn\u00ed \u0159e\u010di a kvalita zvuku s CI. Sou\u010dasn\u00e9 studie simuluj\u00ed zvuk kochle\u00e1rn\u00edch implant\u00e1t\u016f.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/lifelonghearing.com\/cs\/zvuk-kochlearnich-implantatu-ani-mickey-mouse-ani-roboticky-hlas\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Zvuk kochle\u00e1rn\u00edch implant\u00e1t\u016f: ani Mickey Mouse, ani robotick\u00fd hlas!\" \/>\n<meta property=\"og:description\" content=\"Od prvn\u00ed kochle\u00e1rn\u00ed implantace v roce 1977 se technologie CI vyv\u00edjela a spolu s n\u00ed i porozum\u011bn\u00ed \u0159e\u010di a kvalita zvuku s CI. 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