Speech understanding in noise with the Roger Pen, Naida CI Q70 processor, and integrated Roger 17 receiver in a multi-talker network

The Efficacy of Wireless Auditory Training in Unilateral Hearing Loss Rehabilitation

PURPOSE

The purpose of this study was to evaluate the efficacy of auditory training (AT) in patients with unilateral hearing loss (UHL) using hearing aids (HAs), comparing traditional methods with a new approach involving a wireless remote microphone.

METHODS

The study included 96 participants, divided into two groups, with ages ranging from 42 to 64 years, comprising both male and female subjects. A clinical trial including consecutive moderate UHL patients was performed at our institution. For the study group, a Roger Pen was used during AT with patients inside a sound-attenuating cabin. Controls followed conventional sessions. Professional speech and language pathologists performed the rehabilitation. Audiological outcomes were measured, including word recognition at signal-to-noise ratios (SNRs) of 0 dB, +5 dB, and +10 dB, to determine the effectiveness of the training. Measurements also included the Speech, Spatial, and Qualities of Hearing Scale to assess perceived auditory abilities.

RESULTS

A total of 46 and 50 UHL patients were randomly included in the study and control groups, respectively. No differences were found in terms of sex, age, presence of tinnitus, duration of hearing loss, pure tone average, and speech-in-noise perception without an HA. Following HA fitting and AT, a notable enhancement in the ability to identify speech in noisy environments was observed in the study group. This improvement was significant at SNRs of +5 and +10. When comparing the ability to identify speech in noise using HAs across both groups, it was observed that hearing capabilities post-wireless AT showed a significant improvement at an SNR of +5. Only the study group had a significant improvement in the total Speech, Spatial, and Qualities of Hearing Scale score after the training.

CONCLUSIONS

In our group of UHL patients, we found significantly better speech-in-noise perception when HA fitting was followed by wireless AT. Wireless AT may facilitate usage of HAs, leading to binaural hearing in UHL patients. Our findings suggest that future interventions might benefit from incorporating wireless technology in AT programs.

Effect of Hearing Device Use on Speech-in-Noise Performance in Children with Severe-to-Profound Unilateral Hearing Loss

OBJECTIVES

Limited evidence exists for the use of rerouting devices in children with severe-to-profound unilateral sensorineural hearing loss. Many laboratory studies to date have evaluated hearing-in-noise performance in specific target-masker spatial configurations within a small group of participants and with only a subset of available hearing devices. In the present study, the efficacy of all major types of nonsurgical devices was evaluated within a larger group of pediatric subjects on a challenging speech-in-noise recognition task.

DESIGN

Children (7-18 years) with unaided severe-to-profound unilateral hearing loss (UHL' n = 36) or bilateral normal hearing (NH, n = 36) participated in the present study. The signal-to-noise ratio (SNR) required for 50% speech understanding (SNR-50) was measured using BKB sentences in the presence of proprietary restaurant noise (R-SPACE BSIN-R) in the R-SPACE Sound System. Subjects listened under 2 target/masker spatial configurations. The target signal was directed toward subjects' NH or hearing-impaired ear (45º azimuth), while the interfering restaurant noise masker was presented from the remaining 7 loudspeakers encircling the subject, spaced every 45º. Head position was fixed during testing. The presentation level of target sentences and masking noise varied over time to estimate the SNR-50 (dB). The following devices were tested in all participants with severe-to-profound UHL: air conduction (AC) contralateral routing of signal (CROS), bone conduction (BC) CROS fitted on a headband with and without the use of remote microphone (RM), and an ear-level RM hearing assistance technology (HAT) system.

RESULTS

As a group, participants with severe-to-profound UHL performed best when the target signal was directed toward their NH ear. Across listening conditions, there was an average 8.5 dB improvement in SNR-50 by simply orienting the NH ear toward the target signal. When unaided, participants with severe-to-profound UHL performed as well as participants with NH when the target signal was directed toward the NH ear. Performance was negatively affected by AC CROS when the target signal was directed toward the NH ear, whereas no statistically significant change in performance was observed when using BC CROS. When the target signal was directed toward participants' hearing-impaired ear, all tested devices improved SNR-50 compared with the unaided condition, with small improvements (1-2 dB) observed with CROS devices and the largest improvement (9 dB) gained with the personal ear-level RM HAT system. No added benefit nor decrement was observed when RM was added to BC CROS using a 50/50 mixing ratio when the target was directed toward the impaired ear.

CONCLUSIONS

In a challenging listening environment with diffuse restaurant noise, SNR-50 was most improved in the study sample when using a personal ear-level RM HAT system. Although tested rerouting devices offered measurable improvement in performance (1-2 dB in SNR-50) when the target was directed to the impaired ear, benefit may be offset by a detriment in performance in the opposing condition. Findings continue to support use of RM HAT for children with severe-to-profound UHL in adverse listening environments, when there is one primary talker of interest, to ensure advantageous SNRs.

A Qualitative Investigation of Clients, Significant Others, and Clinicians' Experiences of Using Wireless Microphone Systems to Manage Hearing Impairment

This study aimed to explore the perceptions and experiences of adults with hearing impairment (HI), their significant others (SOs), and clinicians regarding the use and provision of wireless microphone systems (WMS). A qualitative descriptive methodology was used, with a total of 43 participants across three groups: (1) 23 adults with HI who used WMS; (2) 7 SOs of adults who used WMS; and (3) 13 clinicians who provided WMSs to adults with HI. Participants completed an individual semi-structured in-depth interview to explore their experiences, with the data analysed using thematic analysis. The analysis revealed five themes encompassing the perceptions and experiences of WMSs: (1) with experience and clear expectations, users believe that WMS can make a difference; (2) the trial and decision-making process is important; (3) clients' experiences using WMS; (4) issues with WMS and technology; and (5) users require ongoing training and support to use WMS. These findings highlight the complexities of providing and using WMS with adults with HI. However, clients, SOs, and clinicians all reported that, with appropriate experience, expectations, training, and support, WMS can make a real difference in listening and communicating in different situations. There is also an opportunity to involve SOs more throughout the rehabilitation process.

Remote Microphone Systems for Cochlear Implant Recipients in Small Group Settings

Purpose Cochlear implant (CI) recipients often experience speech recognition difficulty in noise in small group settings with multiple talkers. In traditional remote microphones systems, one talker wears a remote microphone that wirelessly delivers speech to the CI processor. This system will not transmit signals from multiple talkers in a small group. However, remote microphone systems with multiple microphones allowing for adaptive beamforming may be beneficial for small group situations with multiple talkers. Specifically, a remote microphone with an adaptive multiple-microphone beamformer may be placed in the center of the small group, and the beam (i.e., polar lobe) may be automatically steered toward the direction associated with the most favorable speech-to-noise ratio. The signal from the remote microphone can then be wirelessly delivered to the CI sound processor. Alternately, each of the talkers in a small group may use a remote microphone that is part of a multi-talker network that wirelessly delivers the remote microphone signal to the CI sound processor. The purpose of this study was to compare the potential benefit of an adaptive multiple-microphone beamformer remote microphone system and a multi-talker network remote microphone system.

Method Twenty recipients, ages 12 to 84 years, with Advanced Bionics CIs completed sentence-recognition-in-noise tasks while seated at a desk surrounded by three loudspeakers at 0, 90, and 270 degrees. These speakers randomly presented the target speech while competing noise was presented from four loudspeakers located in the corners of the room. Testing was completed in three conditions: 1) CI alone, 2) Remote microphone system with an adaptive multiple-microphone beamformer, and 3) and a multi-talker network remote microphone system each with five different signal levels (15 total conditions).

Results Significant differences were found across all signal levels and technology conditions. Relative to the CI alone, sentence recognition improvements ranged from 14–23 percentage points with the adaptive multiple-microphone beamformer and 27–47 percentage points with the multi-talker network with superior performance for the latter remote microphone system.

Conclusions Both remote microphone systems significantly improved speech recognition in noise of CI recipients when listening in small group settings, but the multi-talker network provided superior performance.

A subjective and objective evaluation of a codec for the electrical stimulation patterns of cochlear implants

Wireless transmission of audio from or to signal processors of cochlear implants (CIs) is used to improve speech understanding of CI users. This transmission requires wireless communication to exchange the necessary data. Because they are battery powered devices, energy consumption needs to be kept low in CIs, therefore making bitrate reduction of the audio signals necessary. Additionally, low latency is essential. Previously, a codec for the electrodograms of CIs, called the Electrocodec, was proposed. In this work, a subjective evaluation of the Electrocodec is presented, which investigates the impact of the codec on monaural speech performance. The Electrocodec is evaluated with respect to speech recognition and quality in ten CI users and compared to the Opus audio codec. Opus is a low latency and low bitrate audio codec that best met the CI requirements in terms of bandwidth, bitrate, and latency. Achieving equal speech recognition and quality as Opus, the Electrocodec achieves lower mean bitrates than Opus. Actual rates vary from 24.3 up to 53.5 kbit/s, depending on the codec settings. While Opus has a minimum algorithmic latency of 5 ms, the Electrocodec has an algorithmic latency of 0 ms.

Speech Recognition in Noise in Single-Sided Deaf Cochlear Implant Children on Using Adaptive Digital Microphone Technology

BACKGROUND

 Previous research demonstrated benefits of adaptive digital microphone technologies (ADMTs) in adults with single-sided deafness (SSD) having a cochlear implant (CI). Children with SSD are especially affected by background noise because of their noise exposure in kindergarten and school.

PURPOSE

 This article aims to evaluate possible effects of ADMT on speech recognition in background noise in children with SSD who use a CI.

STUDY SAMPLE

 Ten children between 5 and 11 years of age were included.

DATA COLLECTION AND ANALYSIS

 Speech recognition in noise was assessed for one frontal distant and two lateral speakers. The speech stimulus was presented at a speech level of 65 dB(A) and noise at a level of 55 dB(A). For the presentation condition with one frontal speaker, four listening conditions were assessed: (1) normal-hearing (NH) ear and CI turned off; (2) NH ear and CI; (3) NH ear and CI with ADMT; and (4) NH ear with ADMT and CI. Listening conditions (2) to (4) were also tested for each lateral speaker. The frontal speaker was positioned directly in front of the participant, whereas the lateral speakers were positioned at angles of 90 degrees and -90 degrees to the participant's head.

RESULTS

 Children with SSD who use a CI significantly benefit from the application of ADMT in speech recognition in noise for frontal distant and for lateral speakers. Speech recognition improved significantly with ADMT at the CI and the NH ears.

CONCLUSION

 Application of ADMT significantly improves speech recognition in noise in children with SSD who use a CI and can therefore be highly recommended. The decision of whether to apply ADMT at the CI NH ear or bilaterally should be made for each child individually.

The Benefit of Remote and On-Ear Directional Microphone Technology Persists in the Presence of Visual Information

BACKGROUND

 Both the Roger remote microphone and on-ear, adaptive beamforming technologies (e.g., Phonak UltraZoom) have been shown to improve speech understanding in noise for cochlear implant (CI) listeners when tested in audio-only (A-only) test environments.

PURPOSE

 Our aim was to determine if adult and pediatric CI recipients benefited from these technologies in a more common environment-one in which both audio and visual cues were available and when overall performance was high.

STUDY SAMPLE

 Ten adult CI listeners (Experiment 1) and seven pediatric CI listeners (Experiment 2) were tested.

DESIGN

 Adults were tested in quiet and in two levels of noise (level 1 and level 2) in A-only and audio-visual (AV) environments. There were four device conditions: (1) an ear canal-level, omnidirectional microphone (T-mic) in quiet, (2) the T-mic in noise, (3) an adaptive directional mic (UltraZoom) in noise, and (4) a wireless, remote mic (Roger Pen) in noise. Pediatric listeners were tested in quiet and in level 1 noise in A-only and AV environments. The test conditions were: (1) a behind-the-ear level omnidirectional mic (processor mic) in quiet, (2) the processor mic in noise, (3) the T-mic in noise, and (4) the Roger Pen in noise.

DATA COLLECTION AND ANALYSES

 In each test condition, sentence understanding was assessed (percent correct) and ease of listening ratings were obtained. The sentence understanding data were entered into repeated-measures analyses of variance.

RESULTS

 For both adult and pediatric listeners in the AV test conditions in level 1 noise, performance with the Roger Pen was significantly higher than with the T-mic. For both populations, performance in level 1 noise with the Roger Pen approached the level of baseline performance in quiet. Ease of listening in noise was rated higher in the Roger Pen conditions than in the T-mic or processor mic conditions in both A-only and AV test conditions.

CONCLUSION

 The Roger remote mic and on-ear directional mic technologies benefit both speech understanding and ease of listening in a realistic laboratory test environment and are likely do the same in real-world listening environments.

Benefits in Speech Recognition in Noise with Remote Wireless Microphones in Group Settings

BACKGROUND

Although hearing aids (HAs) and cochlear implants (CIs) can provide significant benefits to persons with hearing loss, users frequently report difficulty hearing in noisy environments, particularly when there are multiple talkers. Little is known about the benefits provided by currently available wireless microphones in multitalker situations.

PURPOSE

The purpose of this study was to compare the benefits received in speech recognition in noise by adults with hearing loss when using two different wireless microphone types in a simulated group setting.

RESEARCH DESIGN

A quasi-experimental, repeated-measures design was used where performance in a control condition, HA/CI alone, was compared with performance in two wireless microphone intervention conditions.

STUDY SAMPLE

Participants included ten listeners, aged 20-92 years, with bilateral sensorineural hearing loss who were experienced HA or CI users.

INTERVENTION

The two wireless microphones by Phonak, Roger Pen, and Roger Select used the same digital modulation protocol to transmit the signal to compatible receivers. However, the Roger Pen operated in a fixed omnidirectional mode, whereas the Roger Select operated in an adaptive directional mode.

DATA COLLECTION AND ANALYSIS

Participants were asked to repeat Hearing in Noise Test sentences presented in restaurant noise in three conditions: HA/CI alone, HA/CI with a Roger Pen, or HA/CI with a Roger Select microphone placed in the center of a round table. Sentences were presented from one of five loudspeakers equally spaced with the participant, while restaurant noise was presented on each side at four signal-to-noise ratios (SNRs), including +5, 0, -5, and -10 dB. A two-way, repeated-measures analysis of variance was performed with main effects of listening condition and noise level.

RESULTS

Significantly  greater speech recognition performance was achieved with the wireless microphones than with listening with just the HA or CI. Furthermore, at the -5- and -10-dB SNR conditions, the Roger Select resulted in significantly better performance than the Roger Pen microphone.

CONCLUSIONS

The results suggest that the Roger Select microphone can provide significant benefits in speech recognition in noise over the use of HA/CI alone (61%) and also significant benefits over the use of a Roger Pen (16%) in a simulated group dining experience.

Guidelines for Best Practice in the Audiological Management of Adults with Severe and Profound Hearing Loss

Individuals with severe to profound hearing loss are likely to present with complex listening needs that require evidence-based solutions. This document is intended to inform the practice of hearing care professionals who are involved in the audiological management of adults with a severe to profound degree of hearing loss and will highlight the special considerations and practices required to optimize outcomes for these individuals.

Effect of Microphone Location and Beamforming Technology on Speech Recognition in Pediatric Cochlear Implant Recipients

BACKGROUND

Despite improvements in cochlear implant (CI) technology, pediatric CI recipients continue to have more difficulty understanding speech than their typically hearing peers in background noise. A variety of strategies have been evaluated to help mitigate this disparity, such as signal processing, remote microphone technology, and microphone placement. Previous studies regarding microphone placement used speech processors that are now dated, and most studies investigating the improvement of speech recognition in background noise included adult listeners only.

PURPOSE

The purpose of the present study was to investigate the effects of microphone location and beamforming technology on speech understanding for pediatric CI recipients in noise.

RESEARCH DESIGN

A prospective, repeated-measures, within-participant design was used to compare performance across listening conditions.

STUDY SAMPLE

A total of nine children (aged 6.6 to 15.3 years) with at least one Advanced Bionics CI were recruited for this study.

DATA COLLECTION AND ANALYSIS

The Basic English Lexicon Sentences and AzBio Sentences were presented at 0o azimuth at 65-dB SPL in +5 signal-to-noise ratio noise presented from seven speakers using the R-SPACE system (Advanced Bionics, Valencia, CA). Performance was compared across three omnidirectional microphone configurations (processor microphone, T-Mic 2, and processor + T-Mic 2) and two directional microphone configurations (UltraZoom and auto UltraZoom). The two youngest participants were not tested in the directional microphone configurations.

RESULTS

No significant differences were found between the various omnidirectional microphone configurations. UltraZoom provided significant benefit over all omnidirectional microphone configurations (T-Mic 2, p = 0.004, processor microphone, p < 0.001, and processor microphone + T-Mic 2, p = 0.018) but was not significantly different from auto UltraZoom (p = 0.176).

CONCLUSIONS

All omnidirectional microphone configurations yielded similar performance, suggesting that a child's listening performance in noise will not be compromised by choosing the microphone configuration best suited for the child. UltraZoom (adaptive beamformer) yielded higher performance than all omnidirectional microphones in moderate background noise for adolescents aged 9 to 15 years. The implications of these data suggest that for older children who are able to reliably use manual controls, UltraZoom will yield significantly higher performance in background noise when the target is in front of the listener.

Speech polar plots for different directionality settings of SONNET cochlear implant processor

Objectives: The newest CI processor from MED-EL company, the SONNET, has two new directional microphone settings. Besides the Omnidirectional microphone mode, it has the possibility to switch to Natural or Adaptive directionality. Both new modes favour perception of sound coming from a front-facing direction compared to sounds from sources at alternate azimuths. Natural directionality mimics the pinna effect of the normal external ear. Design: We undertook to verify the effect of these options in vivo by means of clinical audiological tests. Speech reception thresholds were successively measured for a variety of speech presentation azimuths while keeping the noise azimuths constant. Complete 'Speech Reception Threshold (SRT)-Polar-Plots' were obtained from these data for the Omnidirectional and Natural directionality modes of the SONNET. In addition, one 'SRT-point' was also measured in the 'Adaptive' mode for speech coming from 45° azimuth. Study sample: A group of 13 adult CI recipients participated. Only one of these subjects had previous experience with the SONNET processor. Results: Complete 'SRT-Polar-Plots' could be measured in Natural and Omnidirectional modes in CI recipients within an acceptable timeframe. The pinna-following directionality for Natural mode could be confirmed. Median SRT in noise for speech coming from the 45° azimuth speaker was -5.6 dB SNR for Omnidirectional, -9.1 dB SNR for Natural and -12.8 dB SNR for Adaptive microphone. Natural and Adaptive significantly improved performance compared to Omnidirectional mode at this optimal azimuth of 45° with a median improvement in SRT of 3.5 and 7.2 dB respectively. Conclusions: A novel audiological method, 'SRT-Polar-Plot', was developed and described. Significant directionality benefits for Natural and Adaptive mode were confirmed in vivo using this technique.

Effect of Hearing Aid Directionality and Remote Microphone on Speech Intelligibility in Complex Listening Situations

Remote microphones (RMs) have been developed to support hearing aid (HA) users in understanding distant talkers. In traditional clinical applications, a drawback of these systems is the deteriorated speech intelligibility in the near field. This study investigates advantages and disadvantages of clinical RM usage and the effects of different directionality settings of the HAs in complex listening situations in the laboratory. Speech intelligibility was investigated in 15 experienced severely hearing impaired participants in a noisy environment using a dual-task test paradigm where the tasks were presented from either a near field or a far field loudspeaker. Primary and secondary tasks were presented simultaneously so attention had to be shared on both tasks. In a second experiment, two speech intelligibility tests were presented from either the near field or the far field loudspeaker. The tests were interleaved to simulate a complex listening situation with shifting attention. Directional HA microphones yielded better performance than omnidirectional microphones (both combined with a RM) in near field when analyzing both tasks of the dual-task experiment separately. Furthermore, the integrated dual-task test results showed better performance with directional HA microphones compared with the omnidirectional setting (both cases in combination with a RM). These findings were confirmed by the results of the interleaved speech intelligibility test.

A directional remote-microphone for bimodal cochlear implant recipients

To evaluate whether speech recognition in noise differs according to whether a wireless remote microphone is connected to just the cochlear implant (CI) or to both the CI and to the hearing aid (HA) in bimodal CI users. The second aim was to evaluate the additional benefit of the directional microphone mode compared with the omnidirectional microphone mode of the wireless microphone. This prospective study measured Speech Recognition Thresholds (SRT) in babble noise in a 'within-subjects repeated measures design' for different listening conditions. Eighteen postlingually deafened adult bimodal CI users. No difference in speech recognition in noise in the bimodal listening condition was found between the wireless microphone connected to the CI only and to both the CI and the HA. An improvement of 4.1 dB was found for switching from the omnidirectional microphone mode to the directional mode in the CI only condition. The use of a wireless microphone improved speech recognition in noise for bimodal CI users. The use of the directional microphone mode led to a substantial additional improvement of speech perception in noise for situations with one target signal.

Dietrich M, Dorman MF. Speech Understanding in Noise for Adults With Cochlear Implants: Effects of Hearing Configuration, Source Location Certainty, and Head Movement

Purpose

The primary purpose of this study was to assess speech understanding in quiet and in diffuse noise for adult cochlear implant (CI) recipients utilizing bimodal hearing or bilateral CIs. Our primary hypothesis was that bilateral CI recipients would demonstrate less effect of source azimuth in the bilateral CI condition due to symmetric interaural head shadow.

Method

Sentence recognition was assessed for adult bilateral (n = 25) CI users and bimodal listeners (n = 12) in three conditions: (1) source location certainty regarding fixed target azimuth, (2) source location uncertainty regarding roving target azimuth, and (3) Condition 2 repeated, allowing listeners to turn their heads, as needed.

Results

(a) Bilateral CI users exhibited relatively similar performance regardless of source azimuth in the bilateral CI condition; (b) bimodal listeners exhibited higher performance for speech directed to the better hearing ear even in the bimodal condition; (c) the unilateral, better ear condition yielded higher performance for speech presented to the better ear versus speech to the front or to the poorer ear; (d) source location certainty did not affect speech understanding performance; and (e) head turns did not improve performance. The results confirmed our hypothesis that bilateral CI users exhibited less effect of source azimuth than bimodal listeners. That is, they exhibited similar performance for speech recognition irrespective of source azimuth, whereas bimodal listeners exhibited significantly poorer performance with speech originating from the poorer hearing ear (typically the nonimplanted ear).

Conclusions

Bilateral CI users overcame ear and source location effects observed for the bimodal listeners. Bilateral CI users have access to head shadow on both sides, whereas bimodal listeners generally have interaural asymmetry in both speech understanding and audible bandwidth limiting the head shadow benefit obtained from the poorer ear (generally the nonimplanted ear). In summary, we found that, in conditions with source location uncertainty and increased ecological validity, bilateral CI performance was superior to bimodal listening.

Evaluation of speech reception threshold in noise in young Cochlear™ Nucleus® system 6 implant recipients using two different digital remote microphone technologies and a speech enhancement sound processing algorithm

OBJECTIVE

Children affected by hearing loss can experience difficulties in challenging and noisy environments even when deafness is corrected by Cochlear implant (CI) devices. These patients have a selective attention deficit in multiple listening conditions. At present, the most effective ways to improve the performance of speech recognition in noise consists of providing CI processors with noise reduction algorithms and of providing patients with bilateral CIs. The aim of this study was to compare speech performances in noise, across increasing noise levels, in CI recipients using two kinds of wireless remote-microphone radio systems that use digital radio frequency transmission: the Roger Inspiro accessory and the Cochlear Wireless Mini Microphone accessory.

METHODS

Eleven Nucleus Cochlear CP910 CI young user subjects were studied. The signal/noise ratio, at a speech reception threshold (SRT) value of 50%, was measured in different conditions for each patient: with CI only, with the Roger or with the MiniMic accessory. The effect of the application of the SNR-noise reduction algorithm in each of these conditions was also assessed. The tests were performed with the subject positioned in front of the main speaker, at a distance of 2.5 m. Another two speakers were positioned at 3.50 m. The main speaker at 65 dB issued disyllabic words. Babble noise signal was delivered through the other speakers, with variable intensity.

RESULTS

The use of both wireless remote microphones improved the SRT results. Both systems improved gain of speech performances. The gain was higher with the Mini Mic system (SRT = -4.76) than the Roger system (SRT = -3.01). The addition of the NR algorithm did not statistically further improve the results.

CONCLUSION

There is significant improvement in speech recognition results with both wireless digital remote microphone accessories, in particular with the Mini Mic system when used with the CP910 processor. The use of a remote microphone accessory surpasses the benefit of application of NR algorithm.