Free field frequency discrimination abilities of cochlear implant users

The Acoustic Change Complex Compared to Hearing Performance in Unilaterally and Bilaterally Deaf Cochlear Implant Users

OBJECTIVES

Clinical measures evaluating hearing performance in cochlear implant (CI) users depend on attention and linguistic skills, which limits the evaluation of auditory perception in some patients. The acoustic change complex (ACC), a cortical auditory evoked potential to a sound change, might yield useful objective measures to assess hearing performance and could provide insight in cortical auditory processing. The aim of this study is to examine the ACC in response to frequency changes as an objective measure for hearing performance in CI users.

DESIGN

Thirteen bilaterally deaf and six single-sided deaf subjects were included, all having used a unilateral CI for at least 1 year. Speech perception was tested with a consonant-vowel-consonant test (+10 dB signal-to-noise ratio) and a digits-in-noise test. Frequency discrimination thresholds were measured at two reference frequencies, using a 3-interval, 2-alternative forced-choice, adaptive staircase procedure. The two reference frequencies were selected using each participant's frequency allocation table and were centered in the frequency band of an electrode that included 500 or 2000 Hz, corresponding to the apical electrode or the middle electrode, respectively. The ACC was evoked with pure tones of the same two reference frequencies with varying frequency increases: within the frequency band of the middle or the apical electrode (+0.25 electrode step), and steps to the center frequency of the first (+1), second (+2), and third (+3) adjacent electrodes.

RESULTS

Reproducible ACCs were recorded in 17 out of 19 subjects. Most successful recordings were obtained with the largest frequency change (+3 electrode step). Larger frequency changes resulted in shorter N1 latencies and larger N1-P2 amplitudes. In both unilaterally and bilaterally deaf subjects, the N1 latency and N1-P2 amplitude of the CI ears correlated to speech perception as well as frequency discrimination, that is, short latencies and large amplitudes were indicative of better speech perception and better frequency discrimination. No significant differences in ACC latencies or amplitudes were found between the CI ears of the unilaterally and bilaterally deaf subjects, but the CI ears of the unilaterally deaf subjects showed substantially longer latencies and smaller amplitudes than their contralateral normal-hearing ears.

CONCLUSIONS

The ACC latency and amplitude evoked by tone frequency changes correlate well to frequency discrimination and speech perception capabilities of CI users. For patients unable to reliably perform behavioral tasks, the ACC could be of added value in assessing hearing performance.

Combining Place and Rate of Stimulation Improves Frequency Discrimination in Cochlear Implant Users

In the auditory system, frequency is represented as tonotopic and temporal response properties of the auditory nerve. While these response properties are inextricably linked in normal hearing, cochlear implants can separately excite tonotopic location and temporal synchrony using different electrodes and stimulation rates, respectively. This separation allows for the investigation of the contributions of tonotopic and temporal cues for frequency discrimination. The present study examines frequency discrimination in adult cochlear implant users as conveyed by electrode position and stimulation rate, separately and combined. The working hypothesis is that frequency discrimination is better provided by place and rate cues combined compared to either cue alone. This hypothesis was tested in two experiments. In the first experiment, frequency discrimination needed for melodic contour identification was measured for frequencies near 100, 200, and 400 Hz using frequency allocation modeled after clinical processors. In the second experiment, frequency discrimination for pitch ranking was measured for frequencies between 100 and 1600 Hz using an experimental frequency allocation designed to provide better access to place cues. The results of both experiments indicate that frequency discrimination is better with place and rate cues combined than with either cue alone. These results clarify how signal processing for cochlear implants could better encode frequency into place and rate of electrical stimulation. Further, the results provide insight into the contributions of place and rate cues for pitch.

Computer-based musical interval training program for Cochlear implant users and listeners with no known hearing loss

A musical interval is the difference in pitch between two sounds. The way that musical intervals are used in melodies relative to the tonal center of a key can strongly affect the emotion conveyed by the melody. The present study examines musical interval identification in people with no known hearing loss and in cochlear implant users. Pitch resolution varies widely among cochlear implant users with average resolution an order of magnitude worse than in normal hearing. The present study considers the effect of training on musical interval identification and tests for correlations between low-level psychophysics and higher-level musical abilities. The overarching hypothesis is that cochlear implant users are limited in their ability to identify musical intervals both by low-level access to frequency cues for pitch as well as higher-level mapping of the novel encoding of pitch that implants provide. Participants completed a 2-week, online interval identification training. The benchmark tests considered before and after interval identification training were pure tone detection thresholds, pure tone frequency discrimination, fundamental frequency discrimination, tonal and rhythm comparisons, and interval identification. The results indicate strong correlations between measures of pitch resolution with interval identification; however, only a small effect of training on interval identification was observed for the cochlear implant users. Discussion focuses on improving access to pitch cues for cochlear implant users and on improving auditory training for musical intervals.

The Acoustic Change Complex in Response to Frequency Changes and Its Correlation to Cochlear Implant Speech Outcomes

One of the biggest challenges that face cochlear implant (CI) users is the highly variable hearing outcomes of implantation across patients. Since speech perception requires the detection of various dynamic changes in acoustic features (e.g., frequency, intensity, timing) in speech sounds, it is critical to examine the ability to detect the within-stimulus acoustic changes in CI users. The primary objective of this study was to examine the auditory event-related potential (ERP) evoked by the within-stimulus frequency changes (F-changes), one type of the acoustic change complex (ACC), in adult CI users, and its correlation to speech outcomes. Twenty-one adult CI users (29 individual CI ears) were tested with psychoacoustic frequency change detection tasks, speech tests including the Consonant-Nucleus-Consonant (CNC) word recognition, Arizona Biomedical Sentence Recognition in quiet and noise (AzBio-Q and AzBio-N), and the Digit-in-Noise (DIN) tests, and electroencephalographic (EEG) recordings. The stimuli for the psychoacoustic tests and EEG recordings were pure tones at three different base frequencies (0.25, 1, and 4 kHz) that contained a F-change at the midpoint of the tone. Results showed that the frequency change detection threshold (FCDT), ACC N1' latency, and P2' latency did not differ across frequencies (p > 0.05). ACC N1'-P2 amplitude was significantly larger for 0.25 kHz than for other base frequencies (p < 0.05). The mean N1' latency across three base frequencies was negatively correlated with CNC word recognition (r = -0.40, p < 0.05) and CNC phoneme (r = -0.40, p < 0.05), and positively correlated with mean FCDT (r = 0.46, p < 0.05). The P2' latency was positively correlated with DIN (r = 0.47, p < 0.05) and mean FCDT (r = 0.47, p < 0.05). There was no statistically significant correlation between N1'-P2' amplitude and speech outcomes (all ps > 0.05). Results of this study indicated that variability in CI speech outcomes assessed with the CNC, AzBio-Q, and DIN tests can be partially explained (approximately 16-21%) by the variability of cortical sensory encoding of F-changes reflected by the ACC.

Pure tone discrimination with cochlear implants and filter-band spread

For many cochlear implant (CI) users, frequency discrimination is still challenging. We studied the effect of frequency differences relative to the electrode frequency bands on pure tone discrimination. A single-center, prospective, controlled, psychoacoustic exploratory study was conducted in a tertiary university referral center. Thirty-four patients with Cochlear Ltd. and MED-EL CIs and 19 age-matched normal-hearing control subjects were included. Two sinusoidal tones were presented with varying frequency differences. The reference tone frequency was chosen according to the center frequency of basal or apical electrodes. Discrimination abilities were psychophysically measured in a three-interval, two-alternative, forced-choice procedure (3I-2AFC) for various CI electrodes. Hit rates were measured, particularly with respect to discrimination abilities at the corner frequency of the electrode frequency-bands. The mean rate of correct decision concerning pitch difference was about 60% for CI users and about 90% for the normal-hearing control group. In CI users, the difference limen was two semitones, while normal-hearing participants detected the difference of one semitone. No influence of the corner frequency of the CI electrodes was found. In CI users, pure tone discrimination seems to be independent of tone positions relative to the corner frequency of the electrode frequency-band. Differences of 2 semitones can be distinguished within one electrode.

Using haptic stimulation to enhance auditory perception in hearing-impaired listeners

INTRODUCTION

Hearing-assistive devices, such as hearing aids and cochlear implants, transform the lives of hearing-impaired people. However, users often struggle to locate and segregate sounds. This leads to impaired threat detection and an inability to understand speech in noisy environments. Recent evidence suggests that segregation and localization can be improved by providing missing sound-information through haptic stimulation.

AREAS COVERED

This article reviews the evidence that haptic stimulation can effectively provide sound information. It then discusses the research and development required for this approach to be implemented in a clinically viable device. This includes discussion of what sound information should be provided and how that information can be extracted and delivered.

EXPERT OPINION

Although this research area has only recently emerged, it builds on a significant body of work showing that sound information can be effectively transferred through haptic stimulation. Current evidence suggests that haptic stimulation is highly effective at providing missing sound-information to cochlear implant users. However, a great deal of work remains to implement this approach in an effective wearable device. If successful, such a device could offer an inexpensive, noninvasive means of improving educational, work, and social experiences for hearing-impaired individuals, including those without access to hearing-assistive devices.

Frequency change detection and speech perception in cochlear implant users

Dynamic frequency changes in sound provide critical cues for speech perception. Most previous studies examining frequency discrimination in cochlear implant (CI) users have employed behavioral tasks in which target and reference tones (differing in frequency) are presented statically in separate time intervals. Participants are required to identify the target frequency by comparing stimuli across these time intervals. However, perceiving dynamic frequency changes in speech requires detection of within-interval frequency change. This study explored the relationship between detection of within-interval frequency changes and speech perception performance of CI users. Frequency change detection thresholds (FCDTs) were measured in 20 adult CI users using a 3-alternative forced-choice (3AFC) procedure. Stimuli were 1-sec pure tones (base frequencies at 0.25, 1, 4 kHz) with frequency changes occurring 0.5 s after the tone onset. Speech tests were 1) Consonant-Nucleus-Consonant (CNC) monosyllabic word recognition, 2) Arizona Biomedical Sentence Recognition (AzBio) in Quiet, 3) AzBio in Noise (AzBio-N, +10 dB signal-to-noise/SNR ratio), and 4) Digits-in-noise (DIN). Participants' subjective satisfaction with the CI was obtained. Results showed that correlations between FCDTs and speech perception were all statistically significant. The satisfaction level of CI use was not related to FCDTs, after controlling for major demographic factors. DIN speech reception thresholds were significantly correlated to AzBio-N scores. The current findings suggest that the ability to detect within-interval frequency changes may play an important role in speech perception performance of CI users. FCDT and DIN can serve as simple and rapid tests that require no or minimal linguistic background for the prediction of CI speech outcomes.

Harmony Perception in Prelingually Deaf, Juvenile Cochlear Implant Users

Prelingually deaf children listening through cochlear implants (CIs) face severe limitations on their experience of music, since the hearing device degrades relevant details of the acoustic input. An important parameter of music is harmony, which conveys emotional as well as syntactic information. The present study addresses musical harmony in three psychoacoustic experiments in young, prelingually deaf CI listeners and normal-hearing (NH) peers. The discrimination and preference of typical musical chords were studied, as well as cadence sequences conveying musical syntax. The ability to discriminate chords depended on the hearing age of the CI listeners, and was less accurate than for the NH peers. The groups did not differ with respect to the preference of certain chord types. NH listeners were able to categorize cadences, and performance improved with age at testing. In contrast, CI listeners were largely unable to categorize cadences. This dissociation is in accordance with data found in postlingually deafened adults. Consequently, while musical harmony is available to a limited degree to CI listeners, they are unable to use harmony to interpret musical syntax.

Cortical Processing of Frequency Changes Reflected by the Acoustic Change Complex in Adult Cochlear Implant Users

The purpose of this study was to examine neural substrates of frequency change detection in cochlear implant (CI) recipients using the acoustic change complex (ACC), a type of cortical auditory evoked potential elicited by acoustic changes in an ongoing stimulus. A psychoacoustic test and electroencephalographic recording were administered in 12 postlingually deafened adult CI users. The stimuli were pure tones containing different magnitudes of upward frequency changes. Results showed that the frequency change detection threshold (FCDT) was 3.79% in the CI users, with a large variability. The ACC N1' latency was significantly correlated with the FCDT and the clinically collected speech perception score. The results suggested that the ACC evoked by frequency changes can serve as a useful objective tool in assessing frequency change detection capability and predicting speech perception performance in CI users.

Discrimination of Stochastic Frequency Modulation by Cochlear Implant Users

BACKGROUND

Past work has shown that low-rate frequency modulation (FM) may help preserve signal coherence, aid segmentation at word and syllable boundaries, and benefit speech intelligibility in the presence of a masker.

PURPOSE

This study evaluated whether difficulties in speech perception by cochlear implant (CI) users relate to a deficit in the ability to discriminate among stochastic low-rate patterns of FM.

RESEARCH DESIGN

RESEARCH DESIGN

This is a correlational study assessing the association between the ability to discriminate stochastic patterns of low-rate FM and the intelligibility of speech in noise.

STUDY SAMPLE

Thirteen postlingually deafened adult CI users participated in this study.

DATA COLLECTION AND ANALYSIS

Using modulators derived from 5-Hz lowpass noise applied to a 1-kHz carrier, thresholds were measured in terms of frequency excursion both in quiet and with a speech-babble masker present, stimulus duration, and signal-to-noise ratio in the presence of a speech-babble masker. Speech perception ability was assessed in the presence of the same speech-babble masker. Relationships were evaluated with Pearson product-moment correlation analysis with correction for family-wise error, and commonality analysis to determine the unique and common contributions across psychoacoustic variables to the association with speech ability.

RESULTS

Significant correlations were obtained between masked speech intelligibility and three metrics of FM discrimination involving either signal-to-noise ratio or stimulus duration, with shared variance among the three measures accounting for much of the effect. Compared to past results from young normal-hearing adults and older adults with either normal hearing or a mild-to-moderate hearing loss, mean FM discrimination thresholds obtained from CI users were higher in all conditions.

CONCLUSIONS

The ability to process the pattern of frequency excursions of stochastic FM may, in part, have a common basis with speech perception in noise. Discrimination of differences in the temporally distributed place coding of the stimulus could serve as this common basis for CI users.

Adult Cochlear Implant Users Are Able to Discriminate Basic Tonal Features in Musical Patterns: Evidence From Event-related Potentials

OBJECTIVE

Measurement of electrophysiological correlates of discrimination abilities of basic musical features in pre- and postlingually deafened adult cochlear implant (CI) users.

STUDY DESIGN

Electroencephalographic study. Comparison between CI users and matched normal hearing controls.

PATIENTS

Thirty-six hearing impaired adults using a cochlear implant for 4 to 15 months. Profound hearing impairment was acquired either before (N = 12) or after language acquisition (N = 17). Seven patients suffered from a single-sided deafness.

METHODS

Presentation of auditory stimuli consisting of musical four tone standard patterns and deviant patterns varying with regard to tone pitch, timbre, intensity, and rhythm of two different degrees. Analysis of electrophysiological, event-related mismatch responses.

RESULTS

Cochlear implant users elicited significant mismatch responses on most deviant features. Comparison to controls revealed significantly smaller mismatch negativity amplitudes. Except for one parameter (pitch) there were no reliable differences between pre- and postlingually deafened CI users.

CONCLUSION

Despite a highly reduced complexity of neural auditory stimulation by the cochlear implant device in comparison to the physiological cochlear input, CI users exhibit cortical discriminatory responses to relatively subtle basic tonal alterations.

Correlations Between Pitch and Phoneme Perception in Cochlear Implant Users and Their Normal Hearing Peers

This study examined correlations between pitch and phoneme perception for nine cochlear implant users and nine normal hearing listeners. Pure tone frequency discrimination thresholds were measured for frequencies of 500, 1000, and 2000 Hz. Complex tone fundamental frequency (F0) discrimination thresholds were measured for F0s of 110, 220, and 440 Hz. The effects of amplitude and frequency roving were measured under the rationale that individuals who are robust to such perturbations would perform better on phoneme perception measures. Phoneme identification was measured using consonant and vowel materials in quiet, in stationary speech-shaped noise (SSN), in spectrally notched SSN, and in temporally gated SSN. Cochlear implant pure tone frequency discrimination thresholds ranged between 1.5 and 9.9 %, while cochlear implant complex tone F0 discrimination thresholds ranged between 2.6 and 28.5 %. On average, cochlear implant users had 5.3 dB of masking release for consonants and 8.4 dB of masking release for vowels when measured in temporally gated SSN compared to stationary SSN. Correlations with phoneme identification measures were generally higher for complex tone discrimination measures than for pure tone discrimination measures. Correlations with phoneme identification measures were also generally higher for pitch perception measures that included amplitude and frequency roving. The strongest correlations were observed for measures of complex tone F0 discrimination with phoneme identification in temporally gated SSN. The results of this study suggest that musical training or signal processing strategies that improve F0 discrimination should improve consonant identification in fluctuating noise.

Time course of auditory streaming: do CI users differ from normal-hearing listeners?

In a complex acoustical environment, the auditory system decides which stimulus components originate from the same source by forming auditory streams, where temporally non-overlapping stimulus portions are considered to originate from one source if their stimulus characteristics are similar. The mechanisms underlying streaming are commonly studied by alternating sequences of A and B signals which are often tones with different frequencies. For similar frequencies, they are grouped into one stream. Otherwise, they are considered to belong to different streams. The present study investigates streaming in cochlear implant (CI) users, where hearing is restored by electrical stimulation of the auditory nerve. CI users listened to 30-s long sequences of alternating A and B harmonic complexes at four different fundamental frequency separations, ranging from 2 to 14 semitones. They had to indicate as promptly as possible after sequence onset, if they perceived one stream or two streams and, in addition, any changes of the percept throughout the rest of the sequence. The conventional view is that the initial percept is always that of a single stream which may after some time change to a percept of two streams. This general build-up hypothesis has recently been challenged on the basis of a new analysis of data of normal-hearing listeners. Using the same experimental paradigm and analysis, the present study found that the results of CI users agree with those of the normal-hearing listeners: (i) the probability of the first decision to be a one-stream percept decreased and that of a two-stream percept increased as Δf increased, and (ii) a build-up was only found for 6 semitones. Only the time elapsed before the listeners made their first decision of the percept was prolonged as compared to normal-hearing listeners. The similarity in the data of the CI user and the normal-hearing listeners indicates that the quality of stream formation is similar in these groups of listeners.

Qualitative case studies of five cochlear implant recipients' experience with music

Cochlear implantation has revolutionized the management of those who suffer from severe-to-profound hearing loss because many patients now achieve excellent speech understanding with objective testing. Nevertheless, speech understanding in noisy conditions and music appreciation remain significant challenges to cochlear implant (CI) users. Music appreciation is an extremely complex experience that is difficult to quantify through a conventional outcome study. This paper aims at documenting the experience of five CI patients with regard to music appreciation using qualitative techniques. This information was obtained through a semi-structured interview process. The interviews were then transcribed and analysed using a constant comparative method of qualitative description. The results together with medical case records were used to identify emerging themes. The common themes that evolved were: musical background, the experience of receiving the implant, current experience with music, attention, musical prediction ability, internal hearing, hedonic vs. critical listening, determination, and timbre perception. By documenting their experiences in this manner, novel insights into the patient perspective are provided that are unique to the literature. These descriptions will aid clinicians and researchers who work in the area of cochlear implantation to better understand the needs of their patients.

A comparison of the speech recognition and pitch ranking abilities of children using a unilateral cochlear implant, bimodal stimulation or bilateral hearing aids

OBJECTIVE

The present study compared the speech recognition and pitch ranking abilities of normally hearing children (n=15) to children using a cochlear implant (CI) alone (n=8), bilateral hearing aids (HAs) (n=6), or bimodal stimulation (BMS) (n=9). It was hypothesised that users of BMS would score higher on tasks of speech and pitch perception than children using a CI alone, but not children using HAs.

METHODS

Participants were assessed on tasks of monosyllabic word recognition in quiet, sentence recognition in quiet and noise (10 dB signal-to-noise ratio), and a pitch ranking task using pairs of sung vowels one, half, and a quarter of an octave apart.

RESULTS

There were no significant differences between the mean percentage-correct scores of the four participant groups for either words in quiet or sentences in quiet and noise. However, the proportion of bimodal users who scored >80% correct (80%) was significantly greater than the proportion of high-scoring unilateral CI (25%) or bilateral HA users (17%). Contrary to expectations, there was also no significant difference between the pitch ranking scores of users of BMS and users of a CI alone for all three interval sizes (p<0.05, RM-ANOVA). However participants using only acoustic hearing (i.e. the NH and HA groups) scored significantly higher than participants using electrical stimulation (i.e. the CI and BMS groups) on the pitch ranking task (p<0.05; RM-ANOVA).

CONCLUSIONS

Contrary to findings in postlingually deafened adults, we found no significant bimodal advantage for pitch perception in prelingually deafened children. However, the performance of children using electrical stimulation was significantly poorer than children using only acoustic stimulation. Further research is required to investigate the contribution of the non-implanted ears of users of BMS to pitch perception, and the effect of hearing loss on the development of pitch perception in children.

Musical pitch and lexical tone perception with cochlear implants

OBJECTIVE

The purpose of the present study was to test the hypothesis that cochlear implant (CI) users' music perception is correlated with their lexical tone perception, and the two types of perception share similar mechanisms in electric hearing.

DESIGN

A lexical tone perception test and a pitch interval discrimination test were administered to a group of CI users and a group of normal-hearing (NH) listeners. SAMPLE STUDY: Nineteen adult CI users and 10 NH listeners who are native-Mandarin-Chinese speakers participated in the study.

RESULT

Tone-perception performance of the CI group was, on average, 58.3% correct (± 19.78% correct), and performance of the NH group was near perfect. The CI group had a mean threshold of 5.66 semitones (± 5.57 semitones) in pitch discrimination as compared to the threshold of 0.44 semitone from the NH group. There was a strong correlation between the CI users' tone-perception performance and their pitch discrimination threshold (r = -0.75, p < 0.001).

CONCLUSION

Musical and lexical pitch perceptions are strongly correlated with each other and they might share similar mechanisms in electric hearing.

Audiological outcome of the pull-back technique in cochlear implantees

OBJECTIVES/HYPOTHESIS

The distance of the cochlear implant electrode contacts to the modiolus can be reduced by a surgical technique called "pull-back." This procedure changes the location of the fully inserted electrode array by moving the electrode out of the cochlea until the first silicon ring is visible in the cochleostomy. This leads to a more focused stimulation, which in turn could possibly improve hearing performance. The objective of the present study was to investigate the influence of the pull-back technique on frequency difference limens (FDL) and speech perception.

STUDY DESIGN

Double-blind trial.

METHODS

Twelve pull-back and 12 matched controls (matched by age, gender, duration of deafness, and duration of implant use) were used. Twenty-four patients were implanted with the Nucleus-24 Contour Advance array. In 12 patients the pull-back technique was used and in 12 matched controls a standard insertion technique was applied. Twelve months after the initial stimulation speech perception, spread of neuronal excitation (SOE) at electrodes 5, 10, and 15; and FDLs at 1, 2, and 4 kHz were measured.

RESULTS

There was no significant difference of speech perception performance between the two groups. However, the mean FDL for the 4 kHz reference tone was significantly lower in the pull-back group compared to the controls. The SOE was significantly reduced at basal, middle, and apical electrodes in the electrode pull-back group.

CONCLUSIONS

The pull-back technique seems to have its greatest effect on perimodiolar position in the basal regions of the cochlea. Therefore, it is most likely to observe improved FDL in the 4 kHz region. Current speech recognition tests do not reflect the lower FDL.

Perceptual fusion of polyphonic pitch in cochlear implant users

In music, multiple pitches often occur simultaneously, an essential feature of harmony. In the present study, the authors assessed the ability of cochlear implant (CI) users to perceive polyphonic pitch. Acoustically presented stimuli consisted of one, two, or three superposed tones with different fundamental frequencies (f(0)). The normal hearing control group obtained significantly higher mean scores than the CI group. CI users performed near chance levels in recognizing two- and three-pitch stimuli, and demonstrated perceptual fusion of multiple pitches as single-pitch units. These results suggest that limitations in polyphonic pitch perception may significantly impair music perception in CI users.