Binaural speech intelligibility in noise for hearing-impaired listeners

The effect of multimicrophone noise reduction systems on sound source localization by users of binaural hearing aids

This paper evaluates the influence of three multimicrophone noise reduction algorithms on the ability to localize sound sources. Two recently developed noise reduction techniques for binaural hearing aids were evaluated, namely, the binaural multichannel Wiener filter (MWF) and the binaural multichannel Wiener filter with partial noise estimate (MWF-N), together with a dual-monaural adaptive directional microphone (ADM), which is a widely used noise reduction approach in commercial hearing aids. The influence of the different algorithms on perceived sound source localization and their noise reduction performance was evaluated. It is shown that noise reduction algorithms can have a large influence on localization and that (a) the ADM only preserves localization in the forward direction over azimuths where limited or no noise reduction is obtained; (b) the MWF preserves localization of the target speech component but may distort localization of the noise component. The latter is dependent on signal-to-noise ratio and masking effects; (c) the MWF-N enables correct localization of both the speech and the noise components; (d) the statistical Wiener filter approach introduces a better combination of sound source localization and noise reduction performance than the ADM approach.

Perceptual Benefit and Functional Outcomes for Children Using Sequential Bilateral Cochlear Implants

OBJECTIVE

To evaluate the additional perceptual benefit provided to children through the use of two cochlear implants in comparison to one after 6 to 13 mo experience with sequential bilateral implants.

DESIGN

A second cochlear implant was received by 11 children. The principal selection criteria were being age 4 to 15 yr with a bilateral profound hearing loss and being a consistent user of a first implant with a commitment to use of a second implant. Horizontal localization was assessed by using pink noise bursts presented from a 180 degrees , eight-loudspeaker array. Speech perception was assessed by using a four-alternative forced-choice spondee test, with speech presented from in front and adaptive background noise presented from 90 degrees to the left or right. Both tests were completed in the first implant alone and bilateral conditions. A questionnaire measured the pre- to postoperative change in the parent's ratings of the child's performance in specific listening situations. Items were related to speech perception, spatial hearing, or other qualities of hearing. Regular parental reports of device use, attitude and performance were collected. Most subjects were assessed at 6 mo after surgery, with two assessed at 13 mo.

RESULTS

The 11 subjects demonstrated a great range of outcomes. For one subject, only anecdotal data were collected. Speech perception testing indicated that when noise was presented ipsilateral to the first implant, 8 of 10 subjects showed a benefit in the bilateral condition. None of the nine subjects tested showed a benefit when noise was contralateral to the first implant. Generally, there was no benefit to localization in the bilateral condition. For eight subjects, postoperative performance ratings were generally higher than preoperative ratings, particularly in the spatial hearing section. Anecdotal reports indicated that most subjects had a negative attitude toward, and gained limited experience with, the second implant alone. The subjects developed a range of speech perception skills, from detection to conversation level. Regarding the use of bilateral implants, attitudes were more positive and device use was consistent for eight subjects, and six parents reported some evidence of improved performance in daily life.

CONCLUSIONS

Children over age 4 yr may gain significant additional benefit from a second implant, including improved speech perception in some noise contexts and functional advantages in daily life. There is, however, no evidence from this study to suggest that binaural listening skills, including localization, will develop during the first 6 mo. Furthermore, some children who may be committed users of a first implant may not adapt to or benefit from a second implant during the first 6 mo of device use. Although the factors influencing benefit cannot be clearly identified, limited preoperative auditory experience with the second ear, a delay of years between implants, relatively advanced age, and lack of second-implant-alone experience do not preclude benefit. Continued evaluation of these and additional subjects will clarify the factors that do contribute to benefit. Such information will be vital in helping families of implanted children to make an informed decision regarding a second implant.

Auditory Evoked Potentials in the Detection of Interaural Intensity Differences in Children and Adults

OBJECTIVE

The goal of the current study was to identify neurophysiological indices of binaural processing in children with no history of hearing loss or listening problems. The results will guide our efforts to diagnose children for whom impaired binaural processing may contribute to difficulty understanding speech in adverse listening environments. Our main aim was to document the cortical auditory evoked potentials (AEPs) in response to interaural intensity differences (IIDs) in children. It is well known, however, that the morphology of AEPs is substantially different in children and adults. Comparison of AEPs in response to IIDs between children and adults allowed us to evaluate age-related differences in the AEP waveform of binaural processing.

DESIGN

Nine children (ages 7 yr 0 mo to 9 yr 4 mo) and 11 adults (23 to 34 yr) with normal hearing and no known or suspected neurological or academic problems listened to click stimuli under earphones. Click trains consisted of broadband noise of 1-msec duration with a click rate of 100 Hz. In the experimental condition (IID-present) 50-msec intervals containing an interaural intensity difference of 20 dB were introduced periodically in the continuous stream of otherwise diotic click trains. The diotic trains alternated in intensity between 50 and 70 dB peSPL. In the baseline condition (IID-absent), the same continuous diotic click stream utilized in the IID-present condition was presented with no IID. Finally, for comparison with existing literature on AEPs in children and adults, we presented monaural click trains of 50-msec duration, like those used in the IID stimulus (but with no continuous stream) to the left ear at 70 dB peSPL, with an interstimulus interval of 750 msec. Stimuli were presented in separate blocks for each stimulus type and AEPs were recorded in a passive listening condition.

RESULTS

A prominent AEP activation was present in both age groups for the IID-present condition; the IID-absent condition did not evoke substantial AEPs. Adult waveform characteristics of the AEPs to monaural clicks and IID-present around 100 and 200 msec were comparable to previous reports. The children demonstrated the expected AEP activation patterns in response to monaural clicks (i.e., positivity around 100 msec, followed by prominent negativity around 250 msec); however their AEP waveforms to IIDs were mainly comprised of a prolonged positivity around 200 to 250 msec after stimulus onset. A two-step temporal-spatial Principal Component Analysis (PCA) was used to evaluate the temporal (time) and spatial (electrode location) composition of the AEP waveforms in children and adults in response to IID-present and IID-absent conditions. Separate repeated-measures ANOVAs with factor scores as the dependent variable were conducted for each temporal factor (TF) representing the waveform deflections around 100, 200 and 250 msec (i.e., TF110, TF200, and TF255) at the frontocentral spatial factor (SF1). Significantly greater negative activation was observed in adults than in children in response to IID-present for TF110. The IID-present condition evoked a significantly greater waveform inflection for TF200 in both age groups than IID-absent. A positive going activation for TF255 was observed in the IID-present condition in children but not in adults.

CONCLUSIONS

This study compared obligatory AEPs in response to binaural processing of IIDs in children and adults with normal hearing. The morphology of the AEP waveform in children was different for monaural clicks and IID-present stimuli. The difference between AEPs for monaural clicks and IID-present did not occur in adults. It is likely that polarity reversal of the AEPs in response to the IID accounts for the observed AEP morphology in children.

Spatial Unmasking and Binaural Advantage for Children with Normal Hearing, a Cochlear Implant and a Hearing Aid, and Bilateral Implants

The aims of this study were to: (1) determine if spatial unmasking existed and differed for children with normal hearing, a hearing aid and a cochlear implant (CIHA), and bilateral implants (BICI); (2) determine if binaural advantage and headshadow effect differed between children with CIHA and BICI. Results indicated that most of the CIHA and BICI children demonstrated spatial unmasking, though to a lesser degree than children with normal hearing. Results also indicated that the children with BICI demonstrated greater headshadow effect than those with CIHA. The CIHA and BICI children also differed in binaural advantage, which could be due to the differences in headshadow effect and in detection abilities with the hearing aid versus the second implant.

MED-EL Cochlear implants: state of the art and a glimpse into the future

Cochlear implantation is an accepted treatment method for adults and children with severe to profound hearing loss. Confidence in technology has led to changes in individuals who can receive a cochlear implant and changes in expected benefit with a cochlear implant. This article describes the research and development activities at MED-EL, which make possible the implementation of new speech-coding strategies as well as the application of acoustic and electric stimulation via a combined speech processor in MED-EL devices. Research on benefits from bilateral cochlear implantation and electric-acoustic stimulation are also reviewed. Finally, the potential of drug delivery systems is considered as a way to improve cochlear implant outcomes, and results from preliminary evaluations of a hybrid cochlear implant system with drug delivery capabilities are reported.

Prediction of speech intelligibility in spatial noise and reverberation for normal-hearing and hearing-impaired listeners

Binaural speech intelligibility of individual listeners under realistic conditions was predicted using a model consisting of a gammatone filter bank, an independent equalization-cancellation (EC) process in each frequency band, a gammatone resynthesis, and the speech intelligibility index (SII). Hearing loss was simulated by adding uncorrelated masking noises (according to the pure-tone audiogram) to the ear channels. Speech intelligibility measurements were carried out with 8 normal-hearing and 15 hearing-impaired listeners, collecting speech reception threshold (SRT) data for three different room acoustic conditions (anechoic, office room, cafeteria hall) and eight directions of a single noise source (speech in front). Artificial EC processing errors derived from binaural masking level difference data using pure tones were incorporated into the model. Except for an adjustment of the SII-to-intelligibility mapping function, no model parameter was fitted to the SRT data of this study. The overall correlation coefficient between predicted and observed SRTs was 0.95. The dependence of the SRT of an individual listener on the noise direction and on room acoustics was predicted with a median correlation coefficient of 0.91. The effect of individual hearing impairment was predicted with a median correlation coefficient of 0.95. However, for mild hearing losses the release from masking was overestimated.

Comparing Monotic and Diotic Selective Auditory Attention Abilities in Children

Purpose

Some researchers have assessed ear-specific performance of auditory processing ability using speech recognition tasks with normative data based on diotic administration. The present study investigated whether monotic and diotic administrations yield similar results using the Selective Auditory Attention Test.

Method

Seventy-two typically achieving children were tested both monotically and diotically in a counterbalanced, repeated measures design.

Results

Results revealed that diotic scores were significantly higher than monotic scores, with no significant difference between right and left ears.

Conclusion

Collecting ear-specific normative data is recommended over extrapolating from norms using a diotic speech recognition test. Because a binaural advantage may be found when listening under challenging conditions, the strategy of occluding one ear in children with (central) auditory processing disorder ([C]APD) should be reconsidered.

Speech perception for adults who use hearing aids in conjunction with cochlear implants in opposite ears

This study aimed to (a) investigate the effect of using a hearing aid in conjunction with a cochlear implant in opposite ears on speech perception in quiet and in noise, (b) identify the speech information obtained from a hearing aid that is additive to the information obtained from a cochlear implant, and (c) explore the relationship between aided thresholds in the nonimplanted ear and speech perception benefit from wearing a hearing aid in conjunction with a cochlear implant in opposite ears. Fourteen adults who used the Nucleus 24 cochlear implant system in 1 ear participated in the study. All participants had either used a hearing aid in the nonimplanted ear for at least 75% of waking hours after cochlear implantation, and/or, hearing loss less than 90 dB HL in the low frequencies in the nonimplanted ear. Speech perception was evaluated in 3 conditions: cochlear implant alone (CI), hearing aid alone (HA), and cochlear implant in conjunction with hearing aid in opposite ears (CIHA). Three speech perception tests were used: consonant-vowel nucleus-consonant (CNC) words in quiet, City University of New York style (CUNY) sentences in coincident signal and noise, and spondees in coincidental and spatially separated signal and noise. Information transmission analyses were performed on the CNC responses. Of the 14 participants tested, 6 showed significant bimodal benefit on open-set speech perception measures and 5 showed benefit on close-set spondees. However, 2 participants showed poorer speech perception with CIHA than CI in at least 1 of the speech perception tests. Results of information transmission analyses showed that bimodal benefit (performance with CIHA minus that with CI) in quiet arises from improved perception of the low frequency components in speech. Results showed that participants with poorer aided thresholds in the mid-to-high frequencies demonstrated greater bimodal benefit. It is possible that the mid-to-high frequency information provided by the hearing aids may be conflicting with the cochlear implants.

Horizontal localization with bilateral hearing aids: without is better than with

This paper studies the effect of bilateral hearing aids on directional hearing in the frontal horizontal plane. Localization tests evaluated bilateral hearing aid users using different stimuli and different noise scenarios. Normal hearing subjects were used as a reference. The main research questions raised in this paper are: (i) How do bilateral hearing aid users perform on a localization task, relative to normal hearing subjects? (ii) Do bilateral hearing aids preserve localization cues, and (iii) Is there an influence of state of the art noise reduction algorithms, more in particular an adaptive directional microphone configuration, on localization performance? The hearing aid users were tested without and with their hearing aids, using both a standard omnidirectional microphone configuration and an adaptive directional microphone configuration. The following main conclusions are drawn. (i) Bilateral hearing aid users perform worse than normal hearing subjects in a localization task, although more than one-half of the subjects reach normal hearing performance when tested unaided. For both groups, localization performance drops significantly when acoustical scenarios become more complex. (ii) Bilateral, i.e., independently operating hearing aids do not preserve localization cues. (iii) Overall, adaptive directional noise reduction can have an additional and significant negative impact on localization performance.

Evaluation of Bilaterally Implanted Adult Subjects with the Nucleus 24 Cochlear Implant System

OBJECTIVE

To evaluate the speech perception benefits of bilateral implantation for subjects who already have one implant.

STUDY DESIGN

Repeated measures.

PATIENTS

Thirty adult cochlear implant users who received their second implant from 1 to 7 years with a mean of 3 years after their first device. Ages ranged from 29 to 82 years with a mean of 57 years.

SETTING

Tertiary referral centers across the United Kingdom.

MAIN OUTCOME MEASURES

Monosyllabic consonant-nucleus-consonant words and City University of New York sentences in quiet with coincident speech and noise and with the noise spatially separated from the speech by +/-90 degrees .

RESULTS

At 9 months, results showed the second ear in noise was 13.9 +/- 5.9% worse than the first ear (p < 0.001); a significant binaural advantage of 12.6 +/- 5.4% (p < 0.001) over the first ear alone for speech and noise from the front; a 21 +/- 6% (p < 0.001) binaural advantage over the first ear alone when noise was ipsilateral to the first ear; no binaural advantage when noise was contralateral to the first ear.

CONCLUSIONS

There is a significant bilateral advantage of adding a second ear for this group. We were unable to predict when the second ear would be the better performing ear, and by implanting both ears, we guarantee implanting the better ear. Sequential implantation with long delays between ears has resulted in poor second ear performance for some subjects and has limited the degree of bilateral benefit that can be obtained by these users. The dual microphone does not provide equivalent benefit to bilateral implants.

Amplitude-Mapping Effects on Speech Intelligibility With Unilateral and Bilateral Cochlear Implants

OBJECTIVE

A study was conducted examining the effects of amplitude-mapping adjustments on speech intelligibility with bilateral cochlear implant users, for both unilateral and bilateral device use. The main motivation for this study was the consideration that bilateral loudness summation may result in sounds becoming too loud if no adjustments are made to standard monaural amplitude-mapping functions (maps) when used bilaterally. In that case, reductions of the stimulation levels may be needed. The objective was to assess the impact of such adjustments on speech intelligibility in noise and in quiet.

DESIGN

Four different maps were compared in eight bilateral users of the Nucleus 24 system. Each map variation was taken home for 1 week and used bilaterally. After each week, the map used was tested both unilaterally and bilaterally using an adaptive speech-in-noise test and bilaterally for low-level speech in quiet. For the tests in noise, both speech and noise were presented from the same loudspeaker placed directly in front of the listener (S0N0). One of the maps evaluated was a standard clinical map, fitted as if only one ear were to be used. The three other maps used stimulation levels that were reduced more near the maximal stimulation levels, near thresholds, or else by a similar amount over the entire dynamic range.

RESULTS

The data showed a modest but statistically significant decrease in performance when stimulation levels were lowered. This was true both in noise and in quiet. For level reductions corresponding to binaural loudness summation effects, the performance decrease was on the order of 1 to 2 dB. Altering the slope of the map had relatively little effect on performance. Comparison of unilateral with bilateral performance using the same map (i.e., no compensation for bilateral loudness summation) and with speech and noise both presented from in front of the listeners showed a modest but statistically significant improvement in the bilateral condition.

CONCLUSIONS

Using higher stimulation levels in amplitude-mapping functions can improve both monaural and binaural speech perception performance in quiet and in noise, even when the slope of the acoustic to electrical amplitude-mapping function is held constant (i.e., when the electrical signal-to-noise ratio remains constant). The results in noise can be understood if we assume that the relation between electrical stimulation levels and loudness grows faster at higher stimulation levels. When comparing the monaural better ear with binaural performance in noise (S0N0) by using the same map, that is to say, when no adjustments were made in the bilateral condition for bilateral loudness summation, an average signal-to-noise ratio benefit of 1.4 dB was found in the bilateral condition. These findings indicate that when fitting bilateral devices clinically, although binaural performance may decrease slightly if levels need to be reduced to compensate for binaural loudness summation, the binaural S0N0 advantage over the better ear will offset this. Consequently, performance with both ears after adjustment is likely to remain at least as good as for the better ear alone without level adjustment, even in the S0N0 condition where binaural advantages are minimized.

The effect of spatial separation on informational masking of speech in normal-hearing and hearing-impaired listeners

The ability to understand speech in a multi-source environment containing informational masking may depend on the perceptual arrangement of signal and masker objects in space. In normal-hearing listeners, Arbogast et al. [J. Acoust. Soc. Am. 112, 2086-2098 (2002)] found an 18-dB spatial release from a primarily informational masker, compared to 7 dB for a primarily energetic masker. This article extends the earlier work to include the study of listeners with sensorineural hearing loss. Listeners performed closed-set speech recognition in two spatial conditions: 0 degrees and 90 degrees separation between signal and masker. Three maskers were tested: (1) the different-band sentence masker was designed to be primarily informational; (2) the different-band noise masker was a control for the different-band sentence; and (3) the same-band noise masker was designed to be primarily energetic. The spatial release from the different-band sentence was larger than for the other maskers, but was smaller (10 dB) for the hearing-impaired group than for the normal-hearing group (15 dB). The smaller benefit for the hearing-impaired listeners can be partially explained by masker sensation level. However, the results suggest that hearing-impaired listeners can use the perceptual effect of spatial separation to improve speech recognition in the presence of a primarily informational masker.

Evaluation of Selected Auditory Tests in School-Age Children Suspected of Auditory Processing Disorders

OBJECTIVE

To compare the auditory function of normal-hearing children attending mainstream schools who were referred for an auditory evaluation because of listening/hearing problems (suspected auditory processing disorders [susAPD]) with that of normal-hearing control children.

DESIGN

Sixty-five children with a normal standard audiometric evaluation, ages 6-14 yr (32 of whom were referred for susAPD, with the rest age-matched control children), completed a battery of four auditory tests: a dichotic test of competing sentences; a simple discrimination of short tone pairs differing in fundamental frequency at varying interstimulus intervals (TDT); a discrimination task using consonant cluster minimal pairs of real words (CCMP), and an adaptive threshold task for detecting a brief tone presented either simultaneously with a masker (simultaneous masking) or immediately preceding it (backward masking). Regression analyses, including age as a covariate, were performed to determine the extent to which the performance of the two groups differed on each task. Age-corrected z-scores were calculated to evaluate the effectiveness of the complete battery in discriminating the groups.

RESULTS

The performance of the susAPD group was significantly poorer than the control group on all but the masking tasks, which failed to differentiate the two groups. The CCMP discriminated the groups most effectively, as it yielded the lowest number of control children with abnormal scores, and performance in both groups was independent of age. By contrast, the proportion of control children who performed poorly on the competing sentences test was unacceptably high. Together, the CCMP (verbal) and TDT (nonverbal) tasks detected impaired listening skills in 56% of the children who were referred to the clinic, compared with 6% of the control children. Performance on the two tasks was not correlated.

CONCLUSIONS

Two of the four tests evaluated, the CCMP and TDT, proved effective in differentiating the two groups of children of this study. The application of both tests increased the proportion of susAPD children who performed poorly compared with the application of each test alone, while reducing the proportion of control subjects who performed poorly. The findings highlight the importance of carrying out a complete auditory evaluation in children referred for medical attention, even if their standard audiometric evaluation is unremarkable.

Sensitivity to Interaural Level and Envelope Time Differences of Two Bilateral Cochlear Implant Listeners Using Clinical Sound Processors

OBJECTIVES

To assess the sensitivity of two bilateral cochlear implant users to interaural level and time differences (ILDs and ITDs) for various signals presented through the auxiliary inputs of clinical sound processors that discard fine timing information and only preserve envelope cues.

DESIGN

In a lateralization discrimination experiment, the just noticeable difference (JND) for ILDs and envelope ITDs was measured by means of an adaptive 2-AFC method. Different stimuli were used, including click trains at varying repetition rates, a speech fragment, and noise bursts. For one cochlear implant listener and one stimulus, the sensitivity to envelope ITDs was also determined with the method of constant stimuli. The dependency of ILD-JNDs on the interaural place difference was studied with stimulation at single electrode pairs by using sinusoidal input signals in combination with appropriate single-channel processor fittings. In a lateralization position experiment, subjects were required to use a visual pointer on a computer screen to indicate in-the-head positions for blocks of stimuli containing either ILD or ITD cues. All stimuli were loudness balanced (before applying ILD) and fed directly into the auxiliary inputs of the BTE processors (TEMPO+, Med-El Corp.). The automatic gain control and the processors' microphones were deactivated.

RESULTS

Both cochlear implant listeners were highly sensitive to ILDs in all broadband stimuli used; JNDs approached those of normal-hearing listeners. Pitch-matched single electrode pairs showed significantly lower ILD-JNDs than pitch-mismatched electrode pairs. Envelope ITD-JNDs of cochlear implant listeners obtained with the adaptive method were substantially higher and showed a higher test-retest variability than waveform ITD-JNDs of normal-hearing control listeners and envelope ITD-JNDs of normal-hearing listeners reported in the literature for comparable signals. The envelope ITD-JNDs for the click trains were significantly lower than for the speech token or the noise bursts. The best envelope ITD-JND measured was ca. 250 mus for the click train at 100 cycles per sec. Direct measurement of the psychometric function for envelope ITD by the method of constant stimuli showed discrimination above chance level down to 150 micros. The lateralization position experiment showed that both ILDs and envelope ITDs can lead to monotonic changes in lateral percept.

CONCLUSIONS

The two cochlear implant users tested showed strong effects of ILDs in various broadband stimuli with respect to JNDs as well as lateralization position. The high dependency of ILD-JNDs on the interaural pitch difference suggests the potential importance of pitch-matched assignment of electrodes in the two ears by the speech processors. Envelope ITDs appear to be more ambiguous cues than ILDs, as reflected by the higher and more variable JNDs compared with normal-hearing listeners. The envelope ITD-JNDs of cochlear implant listeners depended on the stimulus.

Head Shadow, Squelch, and Summation Effects in Bilateral Users of the MED-EL COMBI 40/40+ Cochlear Implant

OBJECTIVE

The aim of the study was to investigate the impact of bilateral cochlear implant use on speech perception in noise in bilateral users of the MED-EL COMBI 40/40+ cochlear implants.

DESIGN

Speech reception thresholds were measured in 21 subjects using the Oldenburg sentence test. Speech was always presented from the front. Noise was either presented from the front, from the left side, or from the right side. Each condition was measured for unilateral and bilateral implant use.

RESULTS

For three subjects, the test was too difficult to be administered. The 18 subjects from whom a complete data set could be obtained showed a significant head shadow effect and summation effect for all test conditions, whereas the squelch effect was significant for noise from the left side only. Average effect sizes were significant for all effects and amounted to 6.8 dB for the head shadow effect, 0.9 dB for the squelch effect, and 2.1 dB for the summation effect. Effect sizes were not correlated with duration of deafness.

CONCLUSIONS

Bilateral cochlear implant users can at least qualitatively benefit from the effects that are known from normal-hearing subjects, that is, head shadow, summation, and squelch effect. Bilateral cochlear implantation also reduces the performance gap between cochlear implant users and normal-hearing subjects.

Speech perception, localization, and lateralization with bilateral cochlear implants

Five bilateral cochlear implant users were tested for their localization abilities and speech understanding in noise, for both monaural and binaural listening conditions. They also participated in lateralization tasks to assess the impact of variations in interaural time delays (ITDs) and interaural level differences (ILDs) for electrical pulse trains under direct computer control. The localization task used pink noise bursts presented from an eight-loudspeaker array spanning an arc of approximately 108 degrees in front of the listeners at ear level (0-degree elevation). Subjects showed large benefits from bilateral device use compared to either side alone. Typical root-mean-square (rms) averaged errors across all eight loudspeakers in the array were about 10 degrees for bilateral device use and ranged from 20 degrees to 60 degrees using either ear alone. Speech reception thresholds (SRTs) were measured for sentences presented from directly in front of the listeners (0 degrees) in spectrally matching speech-weighted noise at either 0 degrees, +90 degrees or -90 degrees for four subjects out of five tested who could perform the task. For noise to either side, bilateral device use showed a substantial benefit over unilateral device use when noise was ipsilateral to the unilateral device. This was primarily because of monaural head-shadow effects, which resulted in robust SRT improvements (P<0.001) of about 4 to 5 dB when ipsilateral and contralateral noise positions were compared. The additional benefit of using both ears compared to the shadowed ear (i.e., binaural unmasking) was only 1 or 2 dB and less robust (P = 0.04). Results from the lateralization studies showed consistently good sensitivity to ILDs; better than the smallest level adjustment available in the implants (0.17 dB) for some subjects. Sensitivity to ITDs was moderate on the other hand, typically of the order of 100 micros. ITD sensitivity deteriorated rapidly when stimulation rates for unmodulated pulse-trains increased above a few hundred Hz but at 800 pps showed sensitivity comparable to 50-pps pulse-trains when a 50-Hz modulation was applied. In our opinion, these results clearly demonstrate important benefits are available from bilateral implantation, both for localizing sounds (in quiet) and for listening in noise when signal and noise sources are spatially separated. The data do indicate, however, that effects of interaural timing cues are weaker than those from interaural level cues and according to our psychophysical findings rely on the availability of low-rate information below a few hundred Hz.

Spectral contributions to the benefit from spatial separation of speech and noise

Speech recognition in noise improves when speech and noise sources are separated in space. This benefit has two components whose effects are strongest in different frequency regions: (1) interaural level differences (e.g., head shadow), which are largest at higher frequencies, and (2) interaural time differences, which have their greatest contribution at lower frequencies. Binaural interactions enhance the separation of signals from noise through the use of these interaural differences. Here, the benefit attributable to spatial separation was measured as a function of the low- and high-pass cutoff frequency of speech and noise. Listeners were younger adults with normal hearing, older adults with normal hearing, and older adults with hearing loss. Binaural thresholds for narrowband noises were measured in quiet and in a speech-shaped masker as a function of masker low-pass cutoff frequency. Speech levels corresponding to 50% correct recognition of sentences from the Hearing in Noise Test (HINT) were measured in a 65-dB SPL speech-shaped noise. Thresholds for narrowband noises and for speech were measured with two loudspeaker configurations: (1) signals and speech-shaped noise at 0 degrees azimuth (in front of the listener) and (2) signals at 0 degrees azimuth and speech-shaped noise at 90 degrees azimuth (at the listener's side). The criterion measure was spatial separation benefit, or the difference in thresholds for the two conditions. Benefit of spatial separation for unfiltered speech averaged 6.1 dB for younger listeners with normal hearing, 4.9 dB for older listeners with normal hearing, and 2.7 dB for older listeners with hearing loss. Benefit was differentially affected by low-pass and high-pass filtering, suggesting a trade-off of the contributions of higher frequency interaural level differences and lower frequency interaural timing cues. As expected, older listeners with hearing loss benefited little from the improved signal-to-noise ratios in the higher frequencies resulting from head shadow, but showed some benefit from lower frequency cues. Spatial benefit for older listeners with normal hearing was reduced relative to benefit for younger listeners. This result may be related to older listeners' elevated thresholds at frequencies above 6.0 kHz.

Sound-direction identification, interaural time delay discrimination, and speech intelligibility advantages in noise for a bilateral cochlear implant user

OBJECTIVES

To characterize some of the benefits available from using two cochlear implants compared with just one, sound-direction identification (ID) abilities, sensitivity to interaural time delays (ITDs) and speech intelligibility in noise were measured for a bilateral multi-channel cochlear implant user.

METHODS

Sound-direction ID in the horizontal plane was tested with a bilateral cochlear implant user. The subject was tested both unilaterally and bilaterally using two independent behind-the-ear ESPRIT (Cochlear Ltd.) processors, as well as bilaterally using custom research processors. Pink noise bursts were presented using an 11-loudspeaker array spanning the subject's frontal 180 degrees arc in an anechoic room. After each burst, the subject was asked to identify which loudspeaker had produced the sound. No explicit training, and no feedback were given. Presentation levels were nominally at 70 dB SPL, except for a repeat experiment using the clinical devices where the presentation levels were reduced to 60 dB SPL to avoid activation of the devices' automatic gain control (AGC) circuits. Overall presentation levels were randomly varied by +/- 3 dB. For the research processor, a "low-update-rate" and a "high-update-rate" strategy were tested. Direct measurements of ITD just noticeable differences (JNDs) were made using a 3 AFC paradigm targeting 70% correct performance on the psychometric function. Stimuli included simple, low-rate electrical pulse trains as well as high-rate pulse trains modulated at 100 Hz. Speech data comparing monaural and binaural performance in noise were also collected with both low, and high update-rate strategies on the research processors. Open-set sentences were presented from directly in front of the subject and competing multi-talker babble noise was presented from the same loudspeaker, or from a loudspeaker placed 90 degrees to the left or right of the subject.

RESULTS

For the sound-direction ID task, monaural performance using the clinical devices showed large mean absolute errors of 81 degrees and 73 degrees, with standard deviations (averaged across all 11 loud-speakers) of 10 degrees and 17 degrees, for left and right ears, respectively. Fore bilateral device use at a presentation level of 70 dB SPL, the mean error improved to about 16 degrees with an average standard deviation of 18 degrees. When the presentation level was decreased to 60 dB SPL to avoid activation of the automatic gain control (AGC) circuits in the clinical processors, the mean response error improved further to 8 degrees with a standard deviation of 13 degrees. Further tests with the custom research processors, which had a higher stimulation rate and did not include AGCs, showed comparable response errors: around 8 or 9 degrees and a standard deviation of about 11 degrees for both update rates. The best ITD JNDs measured for this subject were between 350 to 400 microsec for simple low-rate pulse trains. Speech results showed a substantial headshadow advantage for bilateral device use when speech and noise were spatially separated, but little evidence of binaural unmasking. For spatially coincident speech and noise, listening with both ears showed similar results to listening with either side alone when loudness summation was compensated for. No significant differences were observed between binaural results for high and low update-rates in any test configuration. Only for monaural listening in one test configuration did the high rate show a small significant improvement over the low rate.

CONCLUSION

Results show that even if interaural time delay cues are not well coded or perceived, bilateral implants can offer important advantages, both for speech in noise as well as for sound-direction identification.

Sensitivity of auditory cortical neurons to locations of signals and competing noise sources

The present study examined cortical parallels to psychophysical signal detection and sound localization in the presence of background noise. The activity of single units or of small clusters of units was recorded in cortical area A2 of chloralose-anesthetized cats. Signals were 80-ms click trains that varied in location in the horizontal plane around the animal. Maskers were continuous broadband noises. In the focal masker condition, a single masker source was tested at various azimuths. In the diffuse masker condition, uncorrelated noise was presented from two speakers at +/-90 degrees lateral to the animal. For about 2/3 of units ("type A"), the presence of the masker generally reduced neural sensitivity to signals, and the effects of the masker depended on the relative locations of signal and masker sources. For the remaining 1/3 of units ("type B"), the masker reduced spike rates at low signal levels but often augmented spike rates at higher signal levels. Increases in spike rates of type B units were most common for signal sources in front of the ear contralateral to the recording site but tended to be independent of masker source location. For type A units, masker effects could be modeled as a shift toward higher levels of spike-rate- and spike-latency-versus-level functions. For a focal masker, the shift size decreased with increasing separation of signal and masker. That result resembled psychophysical spatial unmasking, i.e., improved signal detection by spatial separation of the signal from the noise source. For the diffuse masker condition, the shift size generally was constant across signal locations. For type A units, we examined the effects of maskers on cortical signaling of sound-source location, using an artificial-neural-network (ANN) algorithm. First, an ANN was trained to estimate the signal location in the quiet condition by recognizing the spike patterns of single units. Then we tested ANN responses for spike patterns recorded under various masker conditions. Addition of a masker generally altered spike patterns and disrupted ANN identification of signal location. That disruption was smaller, however, for signal and masker configurations in which the masker did not severely reduce units' spike rates. That result compared well with the psychophysical observation that listeners maintain good localization performance as long as signals are clearly audible.

The impact of head angle on monaural and binaural performance with directional and omnidirectional hearing aids

OBJECTIVE

To evaluate the impact of head turn and monaural and binaural fittings on the sentence reception thresholds of hearing-impaired listeners wearing directional and omnidirectional hearing aids.

DESIGN

Sentence reception thresholds were measured for 20 listeners fit monaurally and binaurally with behind-the-ear hearing aids set in both directional and omnidirectional modes. All listeners exhibited symmetrical, sloping, sensorineural hearing loss. The aided performance across these four fittings was evaluated for three different head and body angles. The three angles reflected body turns of 0 degrees, 15 degrees, and 30 degrees as measured relative to the primary sound source, with 0 degrees denoting the listener directly facing the sound source. Listeners were instructed to keep their heads in a fixed horizontal position and turn their heads and bodies to face visual targets at the three test angles. Sentences from the Hearing in Noise Test presented with a background of five, spatially separated, uncorrelated samples of cafeteria noise served as test material. All testing was performed in a moderately reverberant (Rt = 631 msec) "living room" environment.

RESULTS

Participants generally performed significantly better when fit with directional versus omnidirectional hearing aids, and when fit binaurally versus monaurally across test conditions. The measured "binaural advantage" was reduced with increasing head angle. Participants performed significantly better with a 30 degree head angle than when directly facing the primary speaker. This "head turn advantage" was most prominent for monaural (versus binaural) conditions. Binaural and head turn advantages were not significantly different across directional and omnidirectional modes.

CONCLUSIONS

These data provide additional support for the use of directional hearing aids and binaural amplification to improve speech intelligibility in noisy environments. The magnitude of these advantages was similar to that reported in previous investigations. The data also showed that hearing aid wearers achieved significantly better speech intelligibility in noise by turning their heads and bodies to a position in which they were not directly facing the sound source. This head turn advantage was in good agreement with the increase in Directivity Index with head turn and reflected the fact that hearing aids are generally most sensitive to sounds arriving from angles other than directly in front of the hearing aid wearer. Although these data suggest that many monaural hearing aid wearers may significantly improve speech intelligibility in noise through the use of head turn, the interaction between this advantage and the potential loss of visual cues with head turn is unknown.

Nonsense-syllable recognition in noise using monaural and binaural listening strategies

Using a binaurally equipped KEMAR manikin, syllables of the CUNY Nonsense Syllable Test were recorded in sound field at 0-degree azimuth against a background of cafeteria noise at 270-degrees azimuth, at several signal-to-noise (S/N) ratios. The combination of inputs recorded at each ear was delivered to ten normal-hearing (NH) and eight sensorineurally hearing impaired (HI) listeners through insert ear phones to produce five experimental listening conditions: (1) binaural head shadow (HS), in which ear presentation was analogous to the original stimulus recording, (2) binaural favorable (BF), in which the noise-shadowed (right-ear) recording was presented to both ears, (3) monaural favorable (MF), in which the noise-shadowed recording was presented only to the right ear, (4) monoaural unfavorable (MU), in which the noise-unshadowed (left ear) recording was presented only to the left ear, and (5) simulated monoaural aided (SMA), in which the noise-shadowed recording was presented to the right ear and the noise-unshadowed recording--attenuated by 20 dB relative to the HS condition--was presented to the left ear. All main effects (subject type, listening condition, and S/N ratio) were statistically significant. Normal listeners showed 3.3- and 3.2-dB advantages, respectively, due to head-shadow and binaural squelch, over hearing-impaired listeners. Some hearing-impaired listeners performed better under the SMA or BF conditions than under the HS condition. Potential digital signal processing strategies designed to optimize speech understanding under binaurally aided listening conditions are discussed.

Release from masking due to spatial separation of sources in the identification of nonspeech auditory patterns

A nonspeech pattern identification task was used to study the role of spatial separation of sources on auditory masking in multisource listening environments. The six frequency patterns forming the signal set were comprised of sequences of eight 60-ms tone bursts. Bursts of masking sounds were played synchronously with the signals. The main variables in the study were (1) the difference in spatial separation in the horizontal plane between signals and maskers and (2) the nature of the masking produced by the maskers. Spatial separation of signal and masker ranged from 0-180 degrees. The maskers were of two types: (1) a sequence of eight 60-ms bursts of Gaussian noise intended to produce predominantly peripherally based "energetic masking" and (2) a sequence of eight 60-ms bursts of eight-tone complexes intended to produce primarily centrally based "informational masking." The results indicated that identification performance improved with increasing separation of signal and masker. The amount of improvement depended upon the type of masker and the center frequency of the signal patterns. Much larger improvements were found for spatial separation of the signal and informational masker than for the signal and energetic masker. This was particularly apparent when the acoustical advantage of the signal-to-noise ratio in the more favorable of the two ears (the ear nearest the signal) was taken into account. The results were interpreted as evidence for an important role of binaural hearing in reducing sound source or message uncertainty and may contribute toward solving the "cocktail party problem."

Auditory localization, detection of spatial separateness, and speech hearing in noise by hearing impaired listeners

In two groups, one with sensorineural and the other with conductive-mixed hearing loss, measures were made of single-source localization and speech intelligibility in both spatially separate and nonseparate noise. There was also a test for detecting when two sounds came from the same location or from separate ones. Localization test results confirmed earlier findings, namely, disruption of vertical plane ability generally, and a further, particular disturbance to horizontal plane localization in the conductive-mixed group. Compared with a normal control group, there were only slight signs of benefit from separation of speech and noise in the region lateral to the listener, and virtually none in the frontal region. The new test, spatial separateness, had elements in common with both of the other tests, and links were observed from localization to separateness detection, and from separateness to benefit from separation of speech and noise. Localization was also related to speech hearing in nonspatially separated noise.

Calbindin D-28k immunoreactivity in the medial nucleus of the trapezoid body declines with age in C57BL/6, but not CBA/CaJ, mice

This study compared calbindin D-28k immunoreactivity in the medial nucleus of the trapezoid body (MNTB) in young (3-4 month old) and old (24-26 month old) CBA/CaJ mice, and young (3-4 month old), middle-aged (6.5-8.5 month old), and old (24-29 month old) C57BL/6 mice. C57BL/6 mice exhibit progressively more severe peripheral (sensorineural) hearing loss between 4 and 12 months of age, whereas CBA/CaJ mice show little change in peripheral sensitivity until very late in life. We obtained auditory brainstem response audiograms on all subject mice. Old CBA mice were selected for study whose audiograms matched those of young CBA and C57 controls. Middle-aged C57 mice showed elevated thresholds indicative of peripheral degeneration. Brain sections were reacted with anti-calbindin D-28k (CB). Staining patterns in Nissl and anti-CB material were characterized and cells were counted. We found no significant change in the number of CB+ cells or the total number of cells in the MNTB of old CBA mice compared to young controls. However, the mean number of CB+ cells decreased by 11% in middle-aged, and by 14.8% in old C57 mice. Since the decline in C57 mice was significant by 6.5-8.5 months of age, the decrease could be the consequence of a loss of input from the cochlear nucleus where cell numbers are known to decline by this age in this strain. The total number of neurons in MNTB assessed from Nissl material showed a more modest 7.1% decline with age in C57 mice, implying that the greater loss of CB immunoreactive cells with age cannot be completely attributed to a reduction in the total number of cells.

Age-related and gender-related changes in monaural speech recognition

Previous studies of older listeners suggest age-related declines in speech recognition. However, the interpretation of these results is not straightforward because auditory thresholds, which account for the largest proportion of the variance in speech-recognition scores, also vary considerably with age. Here, effects of age, gender, and auditory thresholds on several measures of speech recognition were assessed for a large sample of individuals enrolled in a longitudinal study of age-related hearing loss. Participants ranged in age from 55-84 years. They were evaluated with a battery of conventional audiometric measures and speech-recognition materials, including NU-6 monosyllabic words, Synthetic Sentence Identification sentences, and high-context and low-context sentences from the Speech Perception in Noise test. Two analyses were conducted to assure that changes in speech-recognition scores with age were examined independently of age-related changes in auditory thresholds. In the first analysis, no significant differences in speech recognition were observed for individuals in three age groups (55-64, 65-74, 75-84 years) who were selected so that average puretone thresholds for the groups were within 5 dB. In the second analysis, using partial correlations to adjust both score and age for their association with average thresholds, significant declines with age were observed for males in maximum word recognition, maximum synthetic sentence identification, and keyword recognition in high-context sentences. For females, no significant changes in speech recognition with age were observed for any test.

New computerized Finnish speech in noise test and binaural hearing

Aided and unaided binaural versus monaural recognition of speech has been studied with more or less laborious methods when speech and noise sources are spatially separated. The efficacy of the new Finnish speech in noise test to show binaural advantage was evaluated in free field conditions. Thirteen subjects with normal hearing were tested measuring speech recognition thresholds in noise (SRTN) in anechoic chambre with different situations of spatial separation of speech and noise sources monaurally and binaurally. The noise source was fixed above the head (treating both ears similarly) and equidistant speech was delivered at different azimuths. SRTNs with mixed speech and noise without spatial separation served as normalizing reference. Differencies in SRTNs consistently followed the changing head and pinna shadow effects on the speech-to-noise ratio with a smaller binaural advantage. This new test seems to give quite economically the same results as those of previous more sophisticated investigations on speech recognition in free field situations.

Perceptual consequences of cochlear hearing loss and their implications for the design of hearing aids

This paper provides an overview of changes in the perception of sound that result from cochlear damage. It starts with a brief introduction to the physiology of the cochlea, emphasizing the role of the "active mechanism" and describing how cochlear function is altered by cochlear damage. Then the effects of cochlear damage on various aspects of perception are described, including absolute sensitivity, frequency selectivity, loudness perception and intensity discrimination, temporal resolution, temporal integration, pitch perception and frequency discrimination, and sound localization and other aspects of binaural and spatial hearing. The possible role of each of these aspects of auditory perception in the ability to understand speech in quiet and in noise is discussed and evaluated. It is concluded that, for losses up to about 45 dB, audibility is the single most important factor. However, for greater losses, poor discrimination of suprathreshold (audible) stimuli is also of major importance. The final section of the paper describes applications of the findings to hearing aid design. It is concluded that linear amplification can be of only limited benefit in compensating for the effects of cochlear damage. Hearing aids incorporating compression can help to compensate for the effects of reduced dynamic range. Digital signal processing to enhance spectral contrast may be of some help in compensating for the effects of reduced frequency selectivity.

Responses of inferior colliculus neurons in C57BL/6J mice with and without sensorineural hearing loss: effects of changing the azimuthal location of a continuous noise masker on responses to contralateral tones

Extracellular recordings were obtained from inferior colliculus neurons of young adult (2-month-old) C57 mice with normal hearing and middle-aged (6-month-old) C57 mice with sensorineural hearing loss as they responded to best frequency (BF) tones (signal) in the presence of a continuous background noise (masker). Rate/level functions were obtained for the signal alone, noise bursts alone, and the signal in continuous noise as a function of masker location. For both groups of mice, thresholds for BF tones were significantly elevated in the presence of noise at all three noise locations. Separating the signal and masker sources significantly improved masked tone thresholds of 2-month-old mice but not hearing-impaired mice. The decreased ability of middle-aged mice to benefit from separation of the signal and masker sources may reflect alterations in binaural processing as a result of sensorineural hearing loss.

Binaural cues and consonant perception in reverberation and noise

Although a binaural advantage for understanding speech in adverse listening conditions has long been recognized, little is known about how binaural hearing influences consonant error patterns. The goal of the present study was to examine differences in consonant perception when stimuli distorted by noise and/or reverberation were presented using monaural, binaural, and diotic presentation modes. Results showed significant differences in error patterns among the three listening conditions (noise, reverberation, and reverberation + noise). Differences among the three presentation modes (monaural, binaural, and diotic) were subtle, as were interactions among presentation modes and listening conditions.

Bilateral Digital Hearing Aids for Binaural Hearing

The rehabilitation of binaural hearing performance in hearing impaired listeners has received relatively little attention to date. Both localization ability and speech-understanding-in noise are affected in the impaired listener. When localization performance is tested in impaired ears with conventional hearing aid fittings it is found to be worse than the unaided condition. Advances in electronic design now permit speculation about the implementation of complex digital filters within the confines of an in-the-ear hearing aid. We have begun exploring strategies to enhance the localization performance of impaired listeners with bilateral digital signal processing. We are examining three strategies in bilateral hearing aid design to improve localization performance in hearing impaired listeners, namely 1) more accurate fitting of individual ear losses, 2) equalization of the effect of the hearing aid itself on the acoustics within the ear canal, and 3) binaural fitting strategies which in effect modify individual ear fittings to enhance localization performance. The results of early psychophysical testing suggests that localization performance can be improved with these strategies.

A clinical test for the assessment of binaural speech perception in noise

The present paper describes a clinical test for the assessment of speech perception in noise. The test was designed to separate the effects of several relevant monaural and binaural cues. Results show that the performance of individual hearing-impaired listeners deviates significantly from normal for at least 2 of the following aspects: (1) perception of speech in steady-state noise; (2) relative binaural advantage due to directional cues; (3) relative advantage due to masker fluctuations. In contrast, both the hearing loss for reverberated speech and the relative binaural advantage due to interaural signal decorrelation, caused by reverberation, were essentially normal for almost all hearing impaired.