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Dolhopiatenko H, Nogueira W. Selective attention decoding in bimodal cochlear implant users. Front Neurosci 2023; 16:1057605. [PMID: 36711138 PMCID: PMC9874229 DOI: 10.3389/fnins.2022.1057605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
The growing group of cochlear implant (CI) users includes subjects with preserved acoustic hearing on the opposite side to the CI. The use of both listening sides results in improved speech perception in comparison to listening with one side alone. However, large variability in the measured benefit is observed. It is possible that this variability is associated with the integration of speech across electric and acoustic stimulation modalities. However, there is a lack of established methods to assess speech integration between electric and acoustic stimulation and consequently to adequately program the devices. Moreover, existing methods do not provide information about the underlying physiological mechanisms of this integration or are based on simple stimuli that are difficult to relate to speech integration. Electroencephalography (EEG) to continuous speech is promising as an objective measure of speech perception, however, its application in CIs is challenging because it is influenced by the electrical artifact introduced by these devices. For this reason, the main goal of this work is to investigate a possible electrophysiological measure of speech integration between electric and acoustic stimulation in bimodal CI users. For this purpose, a selective attention decoding paradigm has been designed and validated in bimodal CI users. The current study included behavioral and electrophysiological measures. The behavioral measure consisted of a speech understanding test, where subjects repeated words to a target speaker in the presence of a competing voice listening with the CI side (CIS) only, with the acoustic side (AS) only or with both listening sides (CIS+AS). Electrophysiological measures included cortical auditory evoked potentials (CAEPs) and selective attention decoding through EEG. CAEPs were recorded to broadband stimuli to confirm the feasibility to record cortical responses with CIS only, AS only, and CIS+AS listening modes. In the selective attention decoding paradigm a co-located target and a competing speech stream were presented to the subjects using the three listening modes (CIS only, AS only, and CIS+AS). The main hypothesis of the current study is that selective attention can be decoded in CI users despite the presence of CI electrical artifact. If selective attention decoding improves combining electric and acoustic stimulation with respect to electric stimulation alone, the hypothesis can be confirmed. No significant difference in behavioral speech understanding performance when listening with CIS+AS and AS only was found, mainly due to the ceiling effect observed with these two listening modes. The main finding of the current study is the possibility to decode selective attention in CI users even if continuous artifact is present. Moreover, an amplitude reduction of the forward transfer response function (TRF) of selective attention decoding was observed when listening with CIS+AS compared to AS only. Further studies to validate selective attention decoding as an electrophysiological measure of electric acoustic speech integration are required.
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A Study of Event-Related Potentials During Monaural and Bilateral Hearing in Single-Sided Deaf Cochlear Implant Users. Ear Hear 2023:00003446-990000000-00102. [PMID: 36706105 DOI: 10.1097/aud.0000000000001326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Single-sided deafness (SSD) is characterized by a profoundly deaf ear and normal hearing in the contralateral ear. A cochlear implant (CI) is the only method to restore functional hearing in a profoundly deaf ear. In a previous study, we identified that the cortical processing of a CI signal differs from the normal-hearing ear (NHE) when directly compared using an auditory oddball paradigm consisting of pure tones. However, exactly how the brain integrates the electrical and acoustic signal is not well investigated. This study aims to understand how the provision of the CI in combination with the NHE may improve SSD CI users' ability to discriminate and evaluate auditory stimuli. DESIGN Electroencephalography from 10 SSD-CI participants (4 participated in the previous pure-tone study) were recorded during a semantic acoustic oddball task, where they were required to discriminate between odd and even numbers. Stimuli were presented in four hearing conditions: directly through the CI, directly to the NHE, or in free field with the CI switched on and off. We examined task-performance (response time and accuracy) and measured N1, P2, N2N4, and P3b event-related brain potentials (ERPs) linked to the detection, discrimination, and evaluation of task relevant stimuli. Sound localization and speech in noise comprehension was also examined. RESULTS In direct presentation, task performance was superior during NHE compared with CI (shorter and less varied reaction times [~720 versus ~842 msec], higher target accuracy [~93 versus ~70%]) and early neural responses (N1 and P2) were enhanced for NHE suggesting greater signal saliency. However, the size of N2N4 and P3b target-standard effects did not differ significantly between NHE and CI. In free field, target accuracy was similarly high with the CI (FF-On) and without the CI (FF-Off) (~95%), with some evidence of CI interference during FF-On (more variable and slightly but significantly delayed reaction times [~737 versus ~709 msec]). Early neural responses and late effects were also greater during FF-On. Performance on sound localization and speech in noise comprehension (S CI N NHE configuration only) was significantly greater during FF-On. CONCLUSIONS Both behavioral and neural responses in the semantic oddball task were sensitive to CI in both direct and free-field presentations. Direct conditions revealed that participants could perform the task with the CI alone, although performance was suboptimal and early neural responses were reduced when compared with the NHE. For free-field, the addition of the CI was associated with enhanced early and late neural responses, but this did not result in improved task performance. Enhanced neural responses show that the additional input from the CI is modulating relevant perceptual and cognitive processes, but the benefit of binaural hearing on behavior may not be realized in simple oddball tasks which can be adequately performed with the NHE. Future studies interested in binaural hearing should examine performance under noisy conditions and/or use spatial cues to allow headroom for the measurement of binaural benefit.
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Távora-Vieira D, Wedekind A. Single-Sided Deafness: Emotional and Social Handicap, Impact on Health Status and Quality of Life, Functional Hearing, and the Effects of Cochlear Implantation. Otol Neurotol 2022; 43:1116-1124. [PMID: 36351222 DOI: 10.1097/mao.0000000000003725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the functional and subjective outcomes in individuals with single-sided deafness (SSD) treated with a cochlear implant (CI). METHODS Eighty-one adult CI users with SSD participated in this study. Functional assessments consisted of speech in noise testing and localization. Subjective assessments consisted of the Speech Spatial Quality of Hearing Scale, the Tinnitus Reaction Questionnaire, the Abbreviated Profile of Hearing Aid Benefit questionnaire, the Hearing Handicap Inventory for Adults questionnaire, and the Glasgow Health Status Inventory and the Glasgow Benefit Inventory questionnaires. RESULTS SSD has remarkable consequences on quality of life (QoL) and imposes a substantial emotional and social handicap on the individuals. Self-reported QoL improved after CI with tinnitus intrusion significantly reduced as early as 3 months post-CI. A significant improvement was seen in all speech understanding in noise configurations. Localization ability significantly improved with CI on. CONCLUSION Our findings demonstrate that SSD reduces social and psychological QoL and imposes a remarkable level of handicap as per general and specific self-assessments tool. CI provided a significant improvement in function including speech understanding in noise and localization ability, as well as improved QoL and reduced tinnitus significantly in both the early and long terms.
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Steinmetzger K, Meinhardt B, Praetorius M, Andermann M, Rupp A. A direct comparison of voice pitch processing in acoustic and electric hearing. Neuroimage Clin 2022; 36:103188. [PMID: 36113196 PMCID: PMC9483634 DOI: 10.1016/j.nicl.2022.103188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022]
Abstract
In single-sided deafness patients fitted with a cochlear implant (CI) in the affected ear and preserved normal hearing in the other ear, acoustic and electric hearing can be directly compared without the need for an external control group. Although poor pitch perception is a crucial limitation when listening through CIs, it remains unclear how exactly the cortical processing of pitch information differs between acoustic and electric hearing. Hence, we separately presented both ears of 20 of these patients with vowel sequences in which the pitch contours were either repetitive or variable, while simultaneously recording functional near-infrared spectroscopy (fNIRS) and EEG data. Overall, the results showed smaller and delayed auditory cortex activity in electric hearing, particularly for the P2 event-related potential component, which appears to reflect the processing of voice pitch information. Both the fNIRS data and EEG source reconstructions furthermore showed that vowel sequences with variable pitch contours evoked additional activity in posterior right auditory cortex in electric but not acoustic hearing. This surprising discrepancy demonstrates, firstly, that the acoustic detail transmitted by CIs is sufficient to distinguish between speech sounds that only vary regarding their pitch information. Secondly, the absence of a condition difference when stimulating the normal-hearing ears suggests a saturation of cortical activity levels following unilateral deafness. Taken together, these results provide strong evidence in favour of using CIs in this patient group.
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Affiliation(s)
- Kurt Steinmetzger
- Section of Biomagnetism, Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany,Corresponding author.
| | - Bastian Meinhardt
- Section of Biomagnetism, Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Mark Praetorius
- Section of Otology and Neurootology, ENT Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Martin Andermann
- Section of Biomagnetism, Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - André Rupp
- Section of Biomagnetism, Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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Weglage A, Müller V, Layer N, Abdel-Latif KHA, Lang-Roth R, Walger M, Sandmann P. Side-of-Implantation Effect on Functional Asymmetry in the Auditory Cortex of Single-Sided Deaf Cochlear-Implant Users. Brain Topogr 2022; 35:431-452. [PMID: 35668310 PMCID: PMC9334411 DOI: 10.1007/s10548-022-00902-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/10/2022] [Indexed: 11/25/2022]
Abstract
Cochlear implants (CIs) allow to restore the hearing function in profoundly deaf individuals. Due to the degradation of the stimulus by CI signal processing, implanted individuals with single-sided deafness (SSD) have the specific challenge that the input highly differs between their ears. The present study compared normal-hearing (NH) listeners (N = 10) and left- and right-ear implanted SSD CI users (N = 10 left, N = 9 right), to evaluate cortical speech processing between CI- and NH-ears and to explore for side-of-implantation effects. The participants performed a two-deviant oddball task, separately with the left and the right ear. Auditory event-related potentials (ERPs) in response to syllables were compared between proficient and non-proficient CI users, as well as between CI and NH ears. The effect of the side of implantation was analysed on the sensor and the source level. CI proficiency could be distinguished based on the ERP amplitudes of the N1 and the P3b. Moreover, syllable processing via the CI ear, when compared to the NH ear, resulted in attenuated and delayed ERPs. In addition, the left-ear implanted SSD CI users revealed an enhanced functional asymmetry in the auditory cortex than right-ear implanted SSD CI users, regardless of whether the syllables were perceived via the CI or the NH ear. Our findings reveal that speech-discrimination proficiency in SSD CI users can be assessed by N1 and P3b ERPs. The results contribute to a better understanding of the rehabilitation success in SSD CI users by showing that cortical speech processing in SSD CI users is affected by CI-related stimulus degradation and experience-related functional changes in the auditory cortex.
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Affiliation(s)
- Anna Weglage
- Faculty of Medicine and University Hospital Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, Audiology and Pediatric Audiology, Cochlear Implant Center, University of Cologne, Cologne, Germany.
| | - Verena Müller
- Faculty of Medicine and University Hospital Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, Audiology and Pediatric Audiology, Cochlear Implant Center, University of Cologne, Cologne, Germany
| | - Natalie Layer
- Faculty of Medicine and University Hospital Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, Audiology and Pediatric Audiology, Cochlear Implant Center, University of Cologne, Cologne, Germany
| | - Khaled H A Abdel-Latif
- Jean-Uhrmacher-Institute for Clinical ENT Research, University of Cologne, Cologne, Germany
| | - Ruth Lang-Roth
- Faculty of Medicine and University Hospital Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, Audiology and Pediatric Audiology, Cochlear Implant Center, University of Cologne, Cologne, Germany
| | - Martin Walger
- Faculty of Medicine and University Hospital Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, Audiology and Pediatric Audiology, Cochlear Implant Center, University of Cologne, Cologne, Germany
- Jean-Uhrmacher-Institute for Clinical ENT Research, University of Cologne, Cologne, Germany
| | - Pascale Sandmann
- Faculty of Medicine and University Hospital Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, Audiology and Pediatric Audiology, Cochlear Implant Center, University of Cologne, Cologne, Germany
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Tao DD, Zhang YM, Liu H, Zhang W, Xu M, Galvin JJ, Zhang D, Liu JS. The P300 Auditory Event-Related Potential May Predict Segregation of Competing Speech by Bimodal Cochlear Implant Listeners. Front Neurosci 2022; 16:888596. [PMID: 35757527 PMCID: PMC9226716 DOI: 10.3389/fnins.2022.888596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Compared to normal-hearing (NH) listeners, cochlear implant (CI) listeners have greater difficulty segregating competing speech. Neurophysiological studies have largely investigated the neural foundations for CI listeners' speech recognition in quiet, mainly using the P300 component of event-related potentials (ERPs). P300 is closely related to cognitive processes involving auditory discrimination, selective attention, and working memory. Different from speech perception in quiet, little is known about the neurophysiological foundations for segregation of competing speech by CI listeners. In this study, ERPs were measured for a 1 vs. 2 kHz contrast in 11 Mandarin-speaking bimodal CI listeners and 11 NH listeners. Speech reception thresholds (SRTs) for a male target talker were measured in steady noise or with a male or female masker. Results showed that P300 amplitudes were significantly larger and latencies were significantly shorter for the NH than for the CI group. Similarly, SRTs were significantly better for the NH than for the CI group. Across all participants, P300 amplitude was significantly correlated with SRTs in steady noise (r = -0.65, p = 0.001) and with the competing male (r = -0.62, p = 0.002) and female maskers (r = -0.60, p = 0.003). Within the CI group, there was a significant correlation between P300 amplitude and SRTs with the male masker (r = -0.78, p = 0.005), which produced the most informational masking. The results suggest that P300 amplitude may be a clinically useful neural correlate of central auditory processing capabilities (e.g., susceptibility to informational masking) in bimodal CI patients.
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Affiliation(s)
- Duo-Duo Tao
- Department of Ear, Nose, and Throat, Shaanxi Provincial People's Hospital, Xi'An, China
| | - Yun-Mei Zhang
- Department of Ear, Nose, and Throat, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hui Liu
- Department of Ear, Nose, and Throat, Shaanxi Provincial People's Hospital, Xi'An, China
| | - Wen Zhang
- Department of Ear, Nose, and Throat, Shaanxi Provincial People's Hospital, Xi'An, China
| | - Min Xu
- Department of Ear, Nose, and Throat, Shaanxi Provincial People's Hospital, Xi'An, China
| | - John J Galvin
- House Institute Foundation, Los Angeles, CA, United States
| | - Dan Zhang
- Department of Ear, Nose, and Throat, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ji-Sheng Liu
- Department of Ear, Nose, and Throat, The First Affiliated Hospital of Soochow University, Suzhou, China
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Falcón Benítez N, Falcón González JC, Ramos Macías Á, Borkoski Barreiro S, Ramos de Miguel Á. Cochlear Implants in Single-Sided Deafness. Comparison Between Children and Adult Populations With Post-lingually Acquired Severe to Profound Hearing Loss. Front Neurol 2021; 12:760831. [PMID: 34803893 PMCID: PMC8599284 DOI: 10.3389/fneur.2021.760831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To determine audiological and clinical results of cochlear implantation (CI) comparing two populations with single-sided deafness (SSD): post-lingually deaf children between 6 and 12 years of age, and post-lingually deaf adults, in order to evaluate the effect of CI in different age groups. Design: Retrospective case review. Setting: Tertiary clinic. Patients and Method: Twenty-three children and twenty-one adult patients that were candidates for CI with single-side deafness were included. In all cases we evaluate: Speech perception thresholds; disyllabic words test (65 dB SPL) were performed in the modalities S0-SCI-SNH and Auditory Lateralization Test. The Speech, Spatial, and Qualities of Hearing Scale (SSQ) questionnaire was also used. All results were obtained after 12 months of CI activation. Results: In children, the most common etiology was idiopathic sensory-neural hearing loss. They showed positive results in the Auditory Lateralization Test. In the Speech Test, word recognition in noise improved from 2% preoperatively to 61.1% at a mean follow-up of 1 year (S0 condition) in children [test with signal in CI side 60% and signal normal hearing side (plugged) 31%]. The processor was used for >12 h in all cases. With respect to the SSQ questionnaire, parents were more satisfied within the postoperative period than within the preoperative period. For adults, the most common etiology was idiopathic sudden sensorineural hearing loss (SNHL). Positive results in the Auditory Lateralization Test were found. With respect to the Speech Test in quiet conditions: Word recognition in noise improved from 5.7% preoperatively to 71.8% at a mean follow-up of 1 year [test with signal in CI side 68% and signal normal hearing side (plugged) 41%]. The processor was used for >12 h. In the SSQ questionnaire, the post-operative results showed a beneficial effect of the CI. No adverse events were reported during the study period. No differences were found between children and adults in all tests in this study. Conclusions: Cochlear implantation in post-lingually deaf adults and children with SSD can achieve a speech perception outcome comparable with CI in conventional candidates. Improvements in spatial hearing were also observed. Careful patient selection and counseling regarding potential benefits are important to optimize outcomes.
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Affiliation(s)
- Nadia Falcón Benítez
- Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Juan Carlos Falcón González
- Department of Otolaryngology, Head and Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas, Spain
| | - Ángel Ramos Macías
- Department of Otolaryngology, Head and Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas, Spain
| | - Silvia Borkoski Barreiro
- Department of Otolaryngology, Head and Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas, Spain
| | - Ángel Ramos de Miguel
- Hearing and Balance Laboratory, Las Palmas de Gran Canaria University Institute of Intelligent System and Numeric Application in Engineering, Las Palmas, Spain
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