{"id":28127,"date":"2024-10-24T08:00:53","date_gmt":"2024-10-24T06:00:53","guid":{"rendered":"https:\/\/lifelonghearing.com\/?p=28127"},"modified":"2025-04-24T12:21:42","modified_gmt":"2025-04-24T12:21:42","slug":"zvuk-kochlearnych-implantatov","status":"publish","type":"post","link":"https:\/\/lifelonghearing.com\/sk\/zvuk-kochlearnych-implantatov\/","title":{"rendered":"Zvuk kochle\u00e1rnych implant\u00e1tov: ani Mickey Mouse, ani robotick\u00fd hlas!"},"content":{"rendered":"

Ako bude znie\u0165 m\u00f4j kochle\u00e1rny implant\u00e1t?<\/h1><\/div>

Od prvej kochle\u00e1rnej implant\u00e1cie v roku 1977 sa technol\u00f3gia KI vyv\u00edjala a spolu s \u0148ou aj porozumenie re\u010di a kvalita zvuku s KI. S\u00fa\u010dasn\u00e9 \u0161t\u00fadie simuluj\u00fa zvuk kochle\u00e1rnych implant\u00e1tov.<\/strong><\/p>\n<\/div>

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

Odborn\u00edci z praxe vedia, \u017ee v\u00e4\u010d\u0161ina z\u00e1ujemcov o KI m\u00e1 dve hlavn\u00e9 ot\u00e1zky: \u201eAko dobre budem po\u010du\u0165?\u201c a \u201eAko to bude znie\u0165?\u201c [1]<\/a> Odpove\u010f na ot\u00e1zku dosiahnute\u013enej zrozumite\u013enosti re\u010di nie je jednoduch\u00e1. Existuje pr\u00edli\u0161 ve\u013ea faktorov, ktor\u00e9 na \u0148u vpl\u00fdvaj\u00fa. M\u00f4\u017eeme v\u0161ak zrozumite\u013enos\u0165 re\u010di aspo\u0148 zmera\u0165 a n\u00e1sledne ju vyjadri\u0165 v \u010d\u00edseln\u00fdch hodnot\u00e1ch. M\u00f4\u017eeme ju len pop\u00edsa\u0165 \u2013 viac \u010di menej kvetnat\u00fdmi slovami alebo ju porovna\u0165 so zn\u00e1mymi zvukov\u00fdmi obrazmi. Renomovan\u00fd v\u00fdvojov\u00fd psychol\u00f3g Michael F. Dorman, emeritn\u00fd profesor lingvistiky, sluchov\u00fdch a re\u010dov\u00fdch vied, sa t\u00fdmito n\u00e1ro\u010dn\u00fdmi ot\u00e1zkami z vedeck\u00e9ho h\u013eadiska zaober\u00e1 u\u017e nieko\u013eko desa\u0165ro\u010d\u00ed. Najprv sk\u00famal v r\u00f4znych v\u00fdskumn\u00fdch skupin\u00e1ch vplyv r\u00f4znych technick\u00fdch faktorov na porozumenie re\u010di s kochle\u00e1rnym implant\u00e1tom. Vysvet\u013euje mo\u017enosti, ktor\u00e9 teraz vyu\u017e\u00edva pri sk\u00faman\u00ed zvuku kochle\u00e1rnych implant\u00e1tov: \u201eJednostranne nepo\u010duj\u00faci pacienti s KI otvorili v\u00fdskumn\u00edkom okno na zodpovedanie ot\u00e1zky, ktor\u00fa si kladie takmer ka\u017ed\u00fd kandid\u00e1t na KI: \u201eAko bude m\u00f4j KI znie\u0165?\u201c.\u201c[2]<\/a>V\u00fdsledky jeho aktu\u00e1lnych \u0161t\u00fadi\u00ed [3]<\/a> [4]<\/a>s\u00fa povzbudiv\u00e9: u pou\u017e\u00edvate\u013eov KI s kr\u00e1tkymi elektr\u00f3dami znie KI vy\u0161\u0161ie ako prirodzen\u00fd sluch. Pre niektor\u00fdch u\u017e\u00edvate\u013eov KI s dlh\u00fdmi elektr\u00f3dami v\u0161ak KI znie takmer alebo dokonca \u00faplne rovnako ako prirodzen\u00fd sluch, zatia\u013e \u010do in\u00ed vn\u00edmaj\u00fa zvuk KI ako viac \u010di menej tlmen\u00fd, niekedy tie\u017e menej zrete\u013en\u00fd ako prirodzen\u00fd sluch v druhom uchu.[5]<\/a><\/p>\n

\u201eH\u013ead\u00e1 sa Mickey Mouse\u201c \u2013 popis alebo porovnanie zvukov\u00fdch obrazov<\/h2>\n

Jednou z priekopn\u00ed\u010dok t\u00fdchto porovn\u00e1vac\u00edch \u0161t\u00fadi\u00ed bola Sandra Prentissov\u00e1 so svojimi vedeck\u00fdmi kolegami v USA. Pracovali s pou\u017e\u00edvate\u013eom KI, u ktor\u00e9ho pokr\u00fdva KI elektr\u00f3da takmer cel\u00e9 dva z\u00e1vity slim\u00e1ka, pri\u010dom jeho zvy\u0161kov\u00fd sluch bol po implant\u00e1cii zachovan\u00fd takmer bez zmeny vo v\u0161etk\u00fdch v\u00fd\u0161kach. Pred desiatimi rokmi po\u017eiadal vedeck\u00fd t\u00edm tohto pou\u017e\u00edvate\u013ea v r\u00e1mci pr\u00edpadovej \u0161t\u00fadie, aby porovnal vn\u00edmanie v\u00fd\u0161ok t\u00f3nov s KI s vn\u00edman\u00edm prirodzen\u00e9ho zvy\u0161kov\u00e9ho sluchu v tom istom uchu. V\u00fdsledky potvrdili priradenie jednotliv\u00fdch v\u00fd\u0161ok ku konkr\u00e9tnym miestam v slim\u00e1kovi, a teda v\u00fdznamnos\u0165 dlh\u00fdch elektr\u00f3d. Pri n\u00edzkofrekven\u010dn\u00fdch zvukoch sa tie\u017e uk\u00e1zal vplyv \u010dasov\u00e9ho rozl\u00ed\u0161enia na vn\u00edmanie v\u00fd\u0161ky t\u00f3nu, \u010d\u00edm sa potvrdila \u00fa\u010dinnos\u0165 tzv. k\u00f3dovania jemnej \u0161trukt\u00fary. T\u00e1to pr\u00edpadov\u00e1 \u0161t\u00fadia neposkytuje v\u0161ak \u017eiadne inform\u00e1cie o zvukovom obraze.<\/p>\n

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Weller a jeho kolegovia ukazuj\u00fa: pou\u017e\u00edvatelia KI, ktor\u00ed maj\u00fa elektr\u00f3dy zaveden\u00e9 pod uhlom viac ako 630 stup\u0148ov, vykazuj\u00fa najlep\u0161ie porozumenie re\u010di, zatia\u013e \u010do t\u00ed, ktor\u00ed maj\u00fa elektr\u00f3dy zaveden\u00e9 pod uhlom menej ako 360 stup\u0148ov, vykazuj\u00fa v\u00fdrazne hor\u0161ie porozumenie re\u010di. \u00a9adaptovan\u00e9 od Weller et al. 2023<\/p><\/div>\n

Touto ot\u00e1zkou sa zaoberal americk\u00fd vedec Michael F. Dorman spolu s \u010fal\u0161\u00edmi vedeck\u00fdmi kolegami v nieko\u013ek\u00fdch \u0161t\u00fadi\u00e1ch s jednostranne implantovan\u00fdmi pou\u017e\u00edvate\u013emi KI s norm\u00e1lnym, prirodzen\u00fdm sluchom na druhej strane. Implant\u00e1cie KI u pacientov s jednostrannou hluchotou boli prv\u00fdkr\u00e1t vykonan\u00e9 v roku 2003 v r\u00e1mci jednej eur\u00f3pskej \u0161t\u00fadie a dnes s\u00fa be\u017en\u00e9 v mnoh\u00fdch krajin\u00e1ch, vr\u00e1tane Rak\u00faska [6]<\/a>. Spo\u010diatku niektor\u00ed odborn\u00edci pochybovali o tom, \u010di je umelo generovan\u00fd zvukov\u00fd vnem KI kompatibiln\u00fd s prirodzen\u00fdm zvukov\u00fdm vnemom na druhej strane. Dorman a jeho kolegovia v\u0161ak po\u017eiadali t\u00fdchto pou\u017e\u00edvate\u013eov bimod\u00e1lnych KI, aby presne porovnali zvukov\u00fd vnem KI s prirodzen\u00fdm sluchom na druhej strane. Ako akustick\u00fd sign\u00e1l pou\u017eili nieko\u013eko kr\u00e1tkych viet, ktor\u00e9 potom technicky spracovali pre prirodzene po\u010duj\u00face ucho, a\u017e k\u00fdm \u00fa\u010dastn\u00edci \u0161t\u00fadie nepop\u00edsali zvuk rovnako ako nespracovan\u00fd zvuk KI. V \u00favode jednej z v\u00fdsledn\u00fdch publik\u00e1ci\u00ed vedci p\u00ed\u0161u, \u017ee od takto vyvinut\u00fdch simul\u00e1ci\u00ed o\u010dak\u00e1vali zvuky Mickey Mousa alebo robotov. Pr\u00e1ve tieto predstavy dodnes niektor\u00ed \u013eudia pou\u017e\u00edvaj\u00fa na opis zvuku kochle\u00e1rneho implant\u00e1tu, ke\u010f sa na\u0148 zauj\u00edmaj\u00faci \u013eudia p\u00fdtaj\u00fa. Zvuk modern\u00fdch KI je v\u0161ak zrejme ove\u013ea prirodzenej\u0161\u00ed, ne\u017e sa doteraz predpokladalo! Pod\u013ea Dormana bol re\u010dov\u00fd sign\u00e1l simula\u010dn\u00fdch zvukov preva\u017ene mierne tlmen\u00fd [7]<\/a> [8]<\/a>. Niektor\u00ed \u00fa\u010dastn\u00edci \u0161t\u00fadie dokonca hodnotili zvuk KI ako \u00faplne toto\u017en\u00fd s prirodzen\u00fdm zvukom v druhom uchu \u2013 to bol konkr\u00e9tne pr\u00edpad niektor\u00fdch pou\u017e\u00edvate\u013eov implant\u00e1tov MED-EL s dlh\u00fdmi elektr\u00f3dami.<\/p>\n

Simul\u00e1cia ukazuje: Modern\u00e9 KI znej\u00fa prirodzene!<\/h2>\n

Vedci vyvinuli r\u00f4zne simul\u00e1cie, ktor\u00e9 umo\u017e\u0148uj\u00fa pochopi\u0165 \u00fa\u010dinky technick\u00fdch parametrov. V\u017edy v\u0161ak i\u0161lo iba o porovnanie: dlh\u00e9 a kr\u00e1tke elektr\u00f3dy, viac alebo menej frekven\u010dn\u00fdch p\u00e1siem, s inform\u00e1ciami o jemnej \u0161trukt\u00fare alebo bez nej. Toto s\u00fa d\u00f4le\u017eit\u00e9 inform\u00e1cie nielen pre v\u00fdvojov\u00e9 t\u00edmy: kandid\u00e1ti na KI m\u00f4\u017eu tieto simul\u00e1cie vyu\u017ei\u0165 v zmysle rozhodnutia, ktor\u00fdm vlastnostiam KI chc\u00fa venova\u0165 osobitn\u00fa pozornos\u0165. Tieto simul\u00e1cie v\u0161ak nem\u00f4\u017eu poskytn\u00fa\u0165 predsta<\/p>\n

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Zatia\u013e \u010do elektr\u00f3dy MED-EL FLEX24 sa pou\u017e\u00edvaj\u00fa v syst\u00e9moch EAS pre osoby, ktor\u00e9 e\u0161te st\u00e1le po\u010duj\u00fa n\u00edzke t\u00f3ny prirodzen\u00fdm sluchom, najdlh\u0161ie elektr\u00f3dy od niektor\u00fdch in\u00fdch poskytovate\u013eov s\u00fa dokonca krat\u0161ie aj pre kandid\u00e1tov s hlbokou stratou sluchu. [11]<\/p><\/div>vu o skuto\u010dnom zvuku kochle\u00e1rneho implant\u00e1tu! Nov\u00e9 simul\u00e1cie odborn\u00edka na KI Michaela F. Dormana a jeho kolegov maj\u00fa za cie\u013e presne toto. Vo svojich vysvetleniach tie\u017e poukazuj\u00fa na to, \u017ee prirodzen\u00fd zvukov\u00fd dojem by nemal by\u0165 zjednodu\u0161ene stoto\u017e\u0148ovan\u00fd s optim\u00e1lnym porozumen\u00edm re\u010di. Aj so s\u00fa\u010dasnou technol\u00f3giou KI je st\u00e1le nutn\u00e1 adapt\u00e1cia na KI. Optim\u00e1lne vyu\u017eitie kochle\u00e1rnych implant\u00e1tov zais\u0165uje sluchov\u00e1 rehabilit\u00e1cia. Spracovanie sluchu v mozgu si m\u00f4\u017ee zvykn\u00fa\u0165 na menej optim\u00e1lny zvuk KI, ale \u010dasto to trv\u00e1 nieko\u013eko rokov[9]<\/a>, \u010do je \u010fal\u0161\u00edm z\u00e1verom Dormanovho v\u00fdskumu. Av\u0161ak v\u00fdsledky \u0161t\u00fadie s\u00fa p\u00f4sobiv\u00e9: v s\u00fa\u010dasnosti m\u00f4\u017eu kandid\u00e1ti KI o\u010dak\u00e1va\u0165 takmer prirodzen\u00fa kvalitu zvuku s individu\u00e1lne nastavenou d\u013a\u017ekou KI elektr\u00f3dy!<\/p>\n<\/div>

D\u013a\u017eka elektr\u00f3d: ako technick\u00e9 vlastnosti ovplyv\u0148uj\u00fa zvuk<\/strong><\/p>\n

Vedci r\u00fdchlo vyvinuli zvukov\u00e9 pr\u00edklady, ktor\u00e9 \u013eu\u010fom s norm\u00e1lnym sluchom pomohli predstavi\u0165 si vplyv jednotliv\u00fdch technick\u00fdch prvkov kochle\u00e1rnych implant\u00e1tov, najm\u00e4 vplyv d\u013a\u017eky elektr\u00f3d. \u013dudsk\u00e9 vn\u00fatorn\u00e9 ucho pou\u017e\u00edva \u201ek\u00f3dovanie miesta\u201c: r\u00f4zne v\u00fd\u0161ky t\u00f3nov s\u00fa priraden\u00e9 ur\u010dit\u00fdm miestam v kochlei (slim\u00e1kovi). S kochle\u00e1rnym implant\u00e1tom s\u00fa po\u010dute\u013en\u00e9 presne tie zvukov\u00e9 intervaly, ktor\u00fdch ekvivalent dosiahne elektr\u00f3dy KI v slim\u00e1kovi. Preto je obzvl\u00e1\u0161\u0165 d\u00f4le\u017eit\u00e9, aby d\u013a\u017eka elektr\u00f3dy \u010do najviac zodpovedala d\u013a\u017eke kochley. Pre kandid\u00e1tov KI alebo pou\u017e\u00edvate\u013eov s typick\u00fdm slim\u00e1kom pon\u00faka rak\u00fasky v\u00fdrobca MED-EL ako jedin\u00fd elektr\u00f3dy, ktor\u00e9 s\u00fa so svojou d\u013a\u017ekou 32 milimetrov dostato\u010dne dlh\u00e9, aby dosiahli miesta pre vysok\u00e9 aj n\u00edzke t\u00f3ny. Napr\u00edklad elektr\u00f3da dlh\u00e1 len 24 milimetrov ponech\u00e1va v typickej kochlei nedosiahnut\u00e9 viac ako tri okt\u00e1vy frekven\u010dn\u00e9ho rozsahu! Aby boli napriek tomu po\u010dute\u013en\u00e9 v\u0161etky v\u00fd\u0161ky, pou\u017e\u00edvaj\u00fa v\u00fdrobcovia triky zvan\u00e9 frekven\u010dn\u00fd posun a frekven\u010dn\u00e1 kompresia. Pri frekven\u010dnom posune je zvuk s frekvenciou 70 hertzov stimulovan\u00fd tam, kde p\u00f4vodne znel ako 590 hertzov. Na margo toho znie v\u0161etko vy\u0161\u0161ie, a je to zn\u00e1me ako efekt Mickey Mousa. V\u010faka dodato\u010dnej frekven\u010dnej kompresii sa sedem okt\u00e1v po\u010dute\u013en\u00e9ho zvuku stla\u010d\u00ed do \u0161tyroch okt\u00e1v. Keby sa to malo zopakova\u0165 na klav\u00edri, klav\u00edr by znel nielen nepr\u00edjemne vysoko, ale aj ve\u013emi rozladene \u2013 mus\u00edme teda predpoklada\u0165, \u017ee tento efekt sa dosiahne aj pomocou KI.<\/p>\n

Krat\u0161ia elektr\u00f3da navy\u0161e neovplyv\u0148uje iba zvuk, ale zhor\u0161uje i porozumenie re\u010di. To preuk\u00e1zali viacer\u00ed vedci \u2013 naposledy Tobias Weller a jeho kolegovia z Univerzitnej nemocnice v Hannoveri. Uv\u00e1dzaj\u00fa, \u017ee \u201epr\u00ednos [kochle\u00e1rneho implant\u00e1tu] je v\u00fdrazne vy\u0161\u0161\u00ed pri uhle zavedenia [elektr\u00f3dy] 540\u00b0 - 630\u00b0 ne\u017e pri uhle zavedenia men\u0161om ako 360\u00b0, hoci po 630\u00b0 nedoch\u00e1dza k v\u00fdrazn\u00e9mu poklesu.\u201c [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
\n[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
\n[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.
\n[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.
\n[5]<\/a> Dorman MF, 2020
\n[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
\n[7]<\/a> Dorman MF 2020
\n[8]<\/a> Dorman MF 2019
\n[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
\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> Quellen: Elektroden-Einf\u00fchrwinkel laut Studien siehe blog.medel.pro; Flex34 approximiert.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"

Ako bude znie\u0165 m\u00f4j kochle\u00e1rny implant\u00e1t? Od prvej kochle\u00e1rnej implant\u00e1cie v roku 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":[418],"tags":[],"class_list":["post-28127","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-veda-sk"],"yoast_head":"\nZvuk kochle\u00e1rnych implant\u00e1tov: ani Mickey Mouse, ani robotick\u00fd hlas! - Slovak<\/title>\n<meta name=\"description\" content=\"Od prvej kochle\u00e1rnej implant\u00e1cie v roku 1977 sa technol\u00f3gia KI vyv\u00edjala a spolu s \u0148ou aj porozumenie re\u010di a kvalita zvuku s KI. S\u00fa\u010dasn\u00e9 \u0161t\u00fadie simuluj\u00fa zvuk kochle\u00e1rnych implant\u00e1tov.\" \/>\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\/sk\/zvuk-kochlearnych-implantatov\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Zvuk kochle\u00e1rnych implant\u00e1tov: ani Mickey Mouse, ani robotick\u00fd hlas! - Slovak\" \/>\n<meta property=\"og:description\" content=\"Od prvej kochle\u00e1rnej implant\u00e1cie v roku 1977 sa technol\u00f3gia KI vyv\u00edjala a spolu s \u0148ou aj porozumenie re\u010di a kvalita zvuku s KI. 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