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Nyirjesy SC, Lewis JH, Hallak D, Conroy S, Moberly AC, Tamati TN. Evaluating Listening Effort in Unilateral, Bimodal, and Bilateral Cochlear Implant Users. Otolaryngol Head Neck Surg 2024; 170:1147-1157. [PMID: 38104319 DOI: 10.1002/ohn.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/24/2023] [Accepted: 11/24/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Evaluate listening effort (LE) in unilateral, bilateral, and bimodal cochlear implant (CI) users. Establish an easy-to-implement task of LE that could be useful for clinical decision making. STUDY DESIGN Prospective cohort study. SETTING Tertiary neurotology center. METHODS The Sentence Final Word Identification and Recall Task, an established measure of LE, was modified to include challenging listening conditions (multitalker babble, gender, and emotional variation; test), in addition to single-talker sentences (control). Participants listened to lists of sentences in each condition and recalled the last word of each sentence. LE was quantified by percentage of words correctly recalled and was compared across conditions, across CI groups, and within subjects (best aided vs monaural). RESULTS A total of 24 adults between the ages of 37 and 82 years enrolled, including 4 unilateral CI users (CI), 10 bilateral CI users (CICI), and 10 bimodal CI users (CIHA). Task condition impacted LE (P < .001), but hearing configuration and listener group did not (P = .90). Working memory capacity and contralateral hearing contributed to individual performance. CONCLUSION This study adds to the growing body of literature on LE in challenging listening conditions for CI users and demonstrates feasibility of a simple behavioral task that could be implemented clinically to assess LE. This study also highlights the potential benefits of bimodal hearing and individual hearing and cognitive factors in understanding individual differences in performance, which will be evaluated through further research.
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Affiliation(s)
- Sarah C Nyirjesy
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Jessica H Lewis
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
- Department of Speech and Hearing Science, The Ohio State University, Columbus, Ohio, USA
| | - Diana Hallak
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Sara Conroy
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Aaron C Moberly
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Terrin N Tamati
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Dourado RPB, Caldas FF, Cardoso CC, Santos DCD, Bahmad F. Benefits of Bimodal Stimulation to Speech Perception in Noise and Silence. Int Arch Otorhinolaryngol 2023; 27:e645-e653. [PMID: 37876694 PMCID: PMC10593532 DOI: 10.1055/s-0043-1761169] [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: 07/25/2022] [Accepted: 09/26/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Understanding all the benefits of bimodality with self-assessment questionnaires on the effect of hearing on quality of life is still necessary. Objective To present whether bimodality still offers hearing benefits to the population who uses acoustic stimulation associated with electrical stimulation. Methods The present study included 13 participants aged between 16 and 80 years old who were users of cochlear implants from Cochlear Corporation and hearing aids. All patients underwent the Hearing in Noise Test, and their visual analog scale score was obtained. Four-tone means were collected, and the participants answered the Speech, Spatial and Hearing Qualities questionnaire. Results Bimodal users had an average sentence recognition rate of 76.0% in silence and 67.6% in fixed noise, and the signal-to-noise ratio in adaptive noise was +2.89dB. In addition, a lower level of difficulty was observed in the test using the visual analog scale. The domain with the highest average was auditory qualities (6.50), followed by spatial hearing (6.26) and hearing for speech (5.81). Individuals with an average between 50 and 70 dB of hearing level showed better sentence recognition in silence and noise. Conclusion Bimodal stimulation showed benefits for users with different degrees of hearing loss; however, individuals who presented greater hearing residue had better performance in speech recognition with noise and in silence in addition to a good perception of hearing quality.
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Affiliation(s)
- Rayssa Pacheco Brito Dourado
- Health Sciences Postgraduate Program in Ciências da Saúde, Campus Universitário Darcy Ribeiro, Universidade de Brasília, Brasília, DF, Brazil
| | | | | | - Danielle Cristovão dos Santos
- Faculdade de Ciências da Saúde, Universidade de Brasília, Brasilia, DF, Brazil
- Centro de Reabilitação da Audição e Fala, Instituto Brasiliense de Otorrino, Asa Norte, Brasília, DF, Brazil
| | - Fayez Bahmad
- Health Science School, Universidade de Brasilia, Brasilia, DF, Brazil
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Holder JT, Holcomb MA, Snapp H, Labadie RF, Vroegop J, Rocca C, Elgandy MS, Dunn C, Gifford RH. Guidelines for Best Practice in the Audiological Management of Adults Using Bimodal Hearing Configurations. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e011. [PMID: 36274668 PMCID: PMC9581116 DOI: 10.1097/ono.0000000000000011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Clinics are treating a growing number of patients with greater amounts of residual hearing. These patients often benefit from a bimodal hearing configuration in which acoustic input from a hearing aid on 1 ear is combined with electrical stimulation from a cochlear implant on the other ear. The current guidelines aim to review the literature and provide best practice recommendations for the evaluation and treatment of individuals with bilateral sensorineural hearing loss who may benefit from bimodal hearing configurations. Specifically, the guidelines review: benefits of bimodal listening, preoperative and postoperative cochlear implant evaluation and programming, bimodal hearing aid fitting, contralateral routing of signal considerations, bimodal treatment for tinnitus, and aural rehabilitation recommendations.
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Affiliation(s)
| | | | | | | | | | - Christine Rocca
- Guy’s and St. Thomas’ Hearing Implant Centre, London, United Kingdom
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Tao DD, Liu JS, Zhou N. Acoustic analysis of tone production in Mandarin-speaking bimodal cochlear implant users. JASA EXPRESS LETTERS 2022; 2:055201. [PMID: 36154063 DOI: 10.1121/10.0010376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The benefit of using a hearing aid with a cochlear implant (bimodal hearing) has been demonstrated for tone perception under certain conditions. The present study evaluated bimodal effects for tone production by comparing performance between a bimodal and a unimodal implant group. Results showed that acoustic differentiation of tones produced by the bimodal group was better than the unimodal implant group, and performance was dependent on the subject's acoustic thresholds but not related to implant experience or age at implantation. The findings support the use of amplified acoustic hearing in conjunction with the implant for better development of pitch production.
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Affiliation(s)
- Duo-Duo Tao
- Department of Ear, Nose, and Throat, Shaanxi Provincial People's Hospital, Xi'an 710068, China
| | - Ji-Sheng Liu
- Department of Ear, Nose, and Throat, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ning Zhou
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, North Carolina 27834, USA , ,
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Brown KD, Dillon MT, Park LR. Benefits of Cochlear Implantation in Childhood Unilateral Hearing Loss (CUHL Trial). Laryngoscope 2021; 132 Suppl 6:S1-S18. [PMID: 34542181 PMCID: PMC9293149 DOI: 10.1002/lary.29853] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/29/2021] [Accepted: 08/22/2021] [Indexed: 11/12/2022]
Abstract
Objectives/Hypotheses Children with unilateral sensory hearing loss (UHL) struggle to understand speech in noise and locate the origin of sound and have reduced quality of hearing. This clinical trial will determine the benefits of cochlear implantation in children with UHL. Study Design Prospective clinical trial. Methods Twenty children with at least moderate to profound sensory hearing loss and poor speech perception (word score <30%) in one ear and normal hearing in the contralateral ear participated in a Food and Drug Administration‐approved clinical trial. Subjects were evaluated for speech perception in quiet, speech perception in noise, sound localization, and subjective benefits after implantation. Results CNC word score perception in quiet significantly improved (1% to 50%, P < .0001) by 12 months after activation. Speech perception in noise by BKB‐SIN significantly improved in all three noise configurations; there was a 3.6 dB advantage in head shadow (P < .0001), a 1.6 dB advantage in summation (P = .003), and a 2.5 dB advantage in squelch (P = .0001). Localization improved by 26° at 9 months (P < .0001). Speech, Spatial, and Qualities (SSQ) demonstrated significant improvements in speech (5.2 to 7.4, P = .0012), qualities of hearing (5.9 to 7.5, P = .0056), and spatial hearing (2.7 to 6.6, P < .0001). SSQ subscales associated with binaural hearing were significantly improved, as was listening effort (P = .0082). Subjects demonstrated a non‐significant improvement in fatigue. Conclusions This study demonstrates that children with UHL significantly benefit from cochlear implantation. Level of Evidence Level 3 Laryngoscope, 132:S1–S18, 2022
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Affiliation(s)
- Kevin D Brown
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Margaret T Dillon
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Lisa R Park
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
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King K, Dillon MT, O'Connell BP, Brown KD, Park LR. Spatial Release From Masking in Bimodal and Bilateral Pediatric Cochlear Implant Recipients. Am J Audiol 2021; 30:67-75. [PMID: 33259722 DOI: 10.1044/2020_aja-20-00051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Traditional clinical measures of cochlear implant (CI) recipient performance may not fully evaluate the benefit of bimodal listening (hearing aid contralateral to a CI). The clinical assessment of spatial release from masking (SRM) may be a sensitive measure of the benefit of listening with bimodal stimulation. This study compared the SRM of pediatric bimodal and bilateral CI listeners using a clinically feasible method, and investigated variables that may contribute to speech recognition performance with spatially separated maskers. Method Forty pediatric bimodal (N = 20) and bilateral CI (N = 20) participants were assessed in their best aided listening condition on sentence recognition in a four-talker masker. Testing was completed with target and masker colocated at 0° azimuth, and with the masker directed at 90° to either ear. SRM was calculated as the difference in performance between the colocated and each 90° condition. A two-way mixed-methods analysis of variance was used to compare performance between groups in the three masker conditions. Multiple regression analyses were conducted to investigate potential predictors for SRM asymmetry including hearing history, unaided thresholds, word recognition, duration of device use, and acoustic bandwidth. Results Both groups demonstrated SRM, with significantly better recognition in each 90° condition as compared to the colocated condition. The groups did not differ significantly in SRM. The multiple regression analyses did not reveal any significant predictors of SRM asymmetry. Conclusions Bimodal and bilateral CI listeners demonstrated similar amounts of SRM. While no specific variables predicted SRM asymmetry in bimodal listeners, pediatric bimodal and bilateral CI recipients should expect similar amounts of SRM regardless of the side of the masker. SRM asymmetry in pediatric bimodal listeners may signal a need for consideration of a second CI.
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Affiliation(s)
- Kaylene King
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Margaret T. Dillon
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Brendan P. O'Connell
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Kevin D. Brown
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Lisa R. Park
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill
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Abstract
OBJECTIVE To assess the benefits of bimodal listening (i.e., addition of contralateral hearing aid) for cochlear implant (CI) users on real-world tasks involving high-talker variability speech materials, environmental sounds, and self-reported quality of life (quality of hearing) in listeners' own best-aided conditions. STUDY DESIGN Cross-sectional study between groups. SETTING Outpatient hearing clinic. PATIENTS Fifty experienced adult CI users divided into groups based on normal daily listening conditions (i.e., best-aided conditions): unilateral CI (CI), unilateral CI with contralateral HA (bimodal listening; CIHA), or bilateral CI (CICI). INTERVENTION Task-specific measures of speech recognition with low (Harvard Standard Sentences) and high (Perceptually Robust English Sentence Test Open-set corpus) talker variability, environmental sound recognition (Familiar Environmental Sounds Test-Identification), and hearing-related quality of life (Nijmegen Cochlear Implant Questionnaire). MAIN OUTCOME MEASURES Test group differences among CI, CIHA, and CICI conditions. RESULTS No group effect was observed for speech recognition with low or high-talker variability, or hearing-related quality of life. Bimodal listeners demonstrated a benefit in environmental sound recognition compared with unilateral CI listeners, with a trend of greater benefit than the bilateral CI group. There was also a visual trend for benefit on high-talker variability speech recognition. CONCLUSIONS Findings provide evidence that bimodal listeners demonstrate stronger environmental sound recognition compared with unilateral CI listeners, and support the idea that there are additional advantages to bimodal listening after implantation other than speech recognition measures, which are at risk of being lost if considering bilateral implantation.
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Spirrov D, Kludt E, Verschueren E, Büchner A, Francart T. Effect of (Mis)Matched Compression Speed on Speech Recognition in Bimodal Listeners. Trends Hear 2020; 24:2331216520948974. [PMID: 32865486 PMCID: PMC7466877 DOI: 10.1177/2331216520948974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Automatic gain control (AGC) compresses the wide dynamic range of sounds to the narrow dynamic range of hearing-impaired listeners. Setting AGC parameters (time constants and knee points) is an important part of the fitting of hearing devices. These parameters do not only influence overall loudness elicited by the hearing devices but can also affect the recognition of speech in noise. We investigated whether matching knee points and time constants of the AGC between the cochlear implant and the hearing aid of bimodal listeners would improve speech recognition in noise. We recruited 18 bimodal listeners and provided them all with the same cochlear-implant processor and hearing aid. We compared the matched AGCs with the default device settings with mismatched AGCs. As a baseline, we also included a condition with the mismatched AGCs of the participants' own devices. We tested speech recognition in quiet and in noise presented from different directions. The time constants affected outcomes in the monaural testing condition with the cochlear implant alone. There were no specific binaural performance differences between the two AGC settings. Therefore, the performance was mostly dependent on the monaural cochlear implant alone condition.
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Affiliation(s)
| | | | | | | | - Tom Francart
- ExpORL, Department of Neurosciences, KU Leuven, Belgium
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9
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Varadarajan VV, Sydlowski SA, Li MM, Anne S, Adunka OF. Evolving Criteria for Adult and Pediatric Cochlear Implantation. EAR, NOSE & THROAT JOURNAL 2020; 100:31-37. [PMID: 32804575 DOI: 10.1177/0145561320947258] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The indications for cochlear implantation have gradually expanded as advancements in technology have evolved, resulting in improved audiologic outcomes for both adult and children. There remains a significant underutilization of cochlear implant technology in the United States, and recognition of the potential benefits of cochlear implantation for non-traditional indications is critical for encouraging the evolution of candidacy criteria. Adult cochlear implantation candidacy has progressed from patients with bilateral profound sensorineural hearing loss (SNHL) to include patients with greater degrees of residual hearing, single-sided deafness and asymmetric hearing, and atypical etiologies of hearing loss (eg, vestibular schwannoma, Ménière's disease, and otosclerosis). Indications for pediatric cochlear implantation have similarly evolved from children with bilateral severe to profound SNHL to implanting children at a younger age, including those with residual hearing, asymmetric hearing loss, inner ear malformations, as well as cochlear nerve deficiency. In this editorial, the literature investigating cochlear implantation for nontraditional indications is reviewed with an aim to use the best available evidence to encourage the evolution of candidacy criteria.
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Affiliation(s)
- Varun V Varadarajan
- Department of Otolaryngology-Head and Neck Surgery, 2647The Ohio State University, Columbus, OH, USA
| | | | - Michael M Li
- Department of Otolaryngology-Head and Neck Surgery, 2647The Ohio State University, Columbus, OH, USA
| | - Samantha Anne
- Head and Neck Institute, 443553Cleveland Clinic, Cleveland, OH, USA
| | - Oliver F Adunka
- Department of Otolaryngology-Head and Neck Surgery, 2647The Ohio State University, Columbus, OH, USA
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10
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Speech Perception Changes in the Acoustically Aided, Nonimplanted Ear after Cochlear Implantation: A Multicenter Study. J Clin Med 2020; 9:jcm9061758. [PMID: 32517138 PMCID: PMC7356938 DOI: 10.3390/jcm9061758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/23/2020] [Accepted: 06/02/2020] [Indexed: 11/17/2022] Open
Abstract
In recent years there has been an increasing percentage of cochlear implant (CI) users who have usable residual hearing in the contralateral, nonimplanted ear, typically aided by acoustic amplification. This raises the issue of the extent to which the signal presented through the cochlear implant may influence how listeners process information in the acoustically stimulated ear. This multicenter retrospective study examined pre- to postoperative changes in speech perception in the nonimplanted ear, the implanted ear, and both together. Results in the latter two conditions showed the expected increases, but speech perception in the nonimplanted ear showed a modest yet meaningful decrease that could not be completely explained by changes in unaided thresholds, hearing aid malfunction, or several other demographic variables. Decreases in speech perception in the nonimplanted ear were more likely in individuals who had better levels of speech perception in the implanted ear, and in those who had better speech perception in the implanted than in the nonimplanted ear. This raises the possibility that, in some cases, bimodal listeners may rely on the higher quality signal provided by the implant and may disregard or even neglect the input provided by the nonimplanted ear.
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Music Is More Enjoyable With Two Ears, Even If One of Them Receives a Degraded Signal Provided By a Cochlear Implant. Ear Hear 2020; 41:476-490. [DOI: 10.1097/aud.0000000000000771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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12
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From Bimodal Hearing to Sequential Bilateral Cochlear Implantation in Children—A Within-Subject Comparison. Otol Neurotol 2020; 41:767-774. [DOI: 10.1097/mao.0000000000002644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pinheiro MMC, Welter PI, Estácio JC. The influence of the bimodal stimulation on the auditory ability of temporal ordering. REVISTA CEFAC 2020. [DOI: 10.1590/1982-0216/202022315419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to analyze temporal ordering auditory ability in unilateral cochlear implant users with bimodal stimulation. Methods: the study included 15 unilateral cochlear implant users, six with bimodal stimulation and nine with exclusive cochlear implant and a control group consisting of 15 hearing individuals. Both groups underwent the standard duration and the standard frequency tests for temporal ordering auditory ability analysis. In the inferential analysis of the data, the nonparametric statistical tests Mann-Whitney and Kruskal-Wallis were used (p<0,05). Results: there was a significant difference in the performance of the standard frequency test, and subjects with bimodal stimulation presented a better performance than those with exclusive cochlear implants. The standard frequency test was associated with education and speech therapy. On the other hand, in the standard duration test, there was a relation with the implanted ear. The most frequent errors were discrimination for both temporal tests. Conclusion: bimodal stimulation, education and speech therapy influenced the performance of the frequency pattern test, while the implanted side influenced the performance of the duration pattern test.
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Abstract
OBJECTIVE The objectives of this study were to assess the effectiveness of various measures of speech understanding in distinguishing performance differences between adult bimodal and bilateral cochlear implant (CI) recipients and to provide a preliminary evidence-based tool guiding clinical decisions regarding bilateral CI candidacy. DESIGN This study used a multiple-baseline, cross-sectional design investigating speech recognition performance for 85 experienced adult CI recipients (49 bimodal, 36 bilateral). Speech recognition was assessed in a standard clinical test environment with a single loudspeaker using the minimum speech test battery for adult CI recipients as well as with an R-SPACE 8-loudspeaker, sound-simulation system. All participants were tested in three listening conditions for each measure including each ear alone as well as in the bilateral/bimodal condition. In addition, we asked each bimodal listener to provide a yes/no answer to the question, "Do you think you need a second CI?" RESULTS This study yielded three primary findings: (1) there were no significant differences between bimodal and bilateral CI performance or binaural summation on clinical measures of speech recognition, (2) an adaptive speech recognition task in the R-SPACE system revealed significant differences in performance and binaural summation between bimodal and bilateral CI users, with bilateral CI users achieving significantly better performance and greater summation, and (3) the patient's answer to the question, "Do you think you need a second CI?" held high sensitivity (100% hit rate) for identifying likely bilateral CI candidates and moderately high specificity (77% correct rejection rate) for correctly identifying listeners best suited with a bimodal hearing configuration. CONCLUSIONS Clinics cannot rely on current clinical measures of speech understanding, with a single loudspeaker, to determine bilateral CI candidacy for adult bimodal listeners nor to accurately document bilateral benefit relative to a previous bimodal hearing configuration. Speech recognition in a complex listening environment, such as R-SPACE, is a sensitive and appropriate measure for determining bilateral CI candidacy and also likely for documenting bilateral benefit relative to a previous bimodal configuration. In the absence of an available R-SPACE system, asking the patient whether or not s/he thinks s/he needs a second CI is a highly sensitive measure, which may prove clinically useful.
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Davidson LS, Geers AE, Uchanski RM, Firszt JB. Effects of Early Acoustic Hearing on Speech Perception and Language for Pediatric Cochlear Implant Recipients. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3620-3637. [PMID: 31518517 PMCID: PMC6808345 DOI: 10.1044/2019_jslhr-h-18-0255] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/14/2018] [Accepted: 06/19/2019] [Indexed: 06/10/2023]
Abstract
Purpose The overall goal of the current study was to identify an optimal level and duration of acoustic experience that facilitates language development for pediatric cochlear implant (CI) recipients-specifically, to determine whether there is an optimal duration of hearing aid (HA) use and unaided threshold levels that should be considered before proceeding to bilateral CIs. Method A total of 117 pediatric CI recipients (ages 5-9 years) were given speech perception and standardized tests of receptive vocabulary and language. The speech perception battery included tests of segmental perception (e.g., word recognition in quiet and noise, and vowels and consonants in quiet) and of suprasegmental perception (e.g., talker and stress discrimination, and emotion identification). Hierarchical regression analyses were used to determine the effects of speech perception on language scores, and the effects of residual hearing level (unaided pure-tone average [PTA]) and duration of HA use on speech perception. Results A continuum of residual hearing levels and the length of HA use were represented by calculating the unaided PTA of the ear with the longest duration of HA use for each child. All children wore 2 devices: Some wore bimodal devices, while others received their 2nd CI either simultaneously or sequentially, representing a wide range of HA use (0.03-9.05 years). Regression analyses indicate that suprasegmental perception contributes unique variance to receptive language scores and that both segmental and suprasegmental skills each contribute independently to receptive vocabulary scores. Also, analyses revealed an optimal duration of HA use for each of 3 ranges of hearing loss severity (with mean PTAs of 73, 92, and 111 dB HL) that maximizes suprasegmental perception. Conclusions For children with the most profound losses, early bilateral CIs provide the greatest opportunity for developing good spoken language skills. For those with moderate-to-severe losses, however, a prescribed period of bimodal use may be more advantageous for developing good spoken language skills.
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Affiliation(s)
| | | | | | - Jill B. Firszt
- Washington University School of Medicine in St. Louis, MO
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16
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Yüksel M, Meredith MA, Rubinstein JT. Effects of Low Frequency Residual Hearing on Music Perception and Psychoacoustic Abilities in Pediatric Cochlear Implant Recipients. Front Neurosci 2019; 13:924. [PMID: 31551687 PMCID: PMC6733978 DOI: 10.3389/fnins.2019.00924] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/19/2019] [Indexed: 12/02/2022] Open
Abstract
Studies have demonstrated the benefits of low frequency residual hearing in music perception and for psychoacoustic abilities of adult cochlear implant (CI) users, but less is known about these effects in the pediatric group. Understanding the contribution of combined electric and acoustic stimulation in this group can help to gain a better perspective on decisions regarding bilateral implantation. We evaluated the performance of six unilaterally implanted children between 9 and 13 years of age with contralateral residual hearing using the Clinical Assessment of Music Perception (CAMP), spectral ripple discrimination (SRD), and temporal modulation transfer function (TMTF) tests and compared findings with previous research. Our study sample performed similarly to normal hearing subjects in pitch direction discrimination (0.81 semitones) and performed well above typical CI users in melody recognition (43.37%). The performance difference was less in timbre recognition (48.61%), SRD (1.47 ripple/octave), and TMTF for four modulation frequencies. These findings suggest that the combination of low frequency acoustic hearing with the broader frequency range of electric hearing can help to increase clinical CI benefit in pediatric users and decisions regarding second-side implantation should consider these factors.
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Affiliation(s)
- Mustafa Yüksel
- Audiology and Speech Disorders Program, Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - Margaret A Meredith
- Childhood Communication Center, Seattle Children's Hospital, Seattle, WA, United States
| | - Jay T Rubinstein
- Virginia Merrill Bloedel Hearing Research Center, Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, WA, United States
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Zhang F, Underwood G, McGuire K, Liang C, Moore DR, Fu QJ. Frequency change detection and speech perception in cochlear implant users. Hear Res 2019; 379:12-20. [PMID: 31035223 PMCID: PMC6571168 DOI: 10.1016/j.heares.2019.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/21/2019] [Accepted: 04/15/2019] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Fawen Zhang
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA.
| | - Gabrielle Underwood
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA
| | - Kelli McGuire
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA
| | - Chun Liang
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA; Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China
| | - David R Moore
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology, University of Cincinnati, Ohio, USA
| | - Qian-Jie Fu
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, USA
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Abstract
OBJECTIVES To investigate the possible advantage of the use of a dedicated bimodal hearing aid fitting formula, the Adaptive Phonak Digital Bimodal (APDB), compared with a frequently used standard hearing aid fitting formula, the NAL-NL2. We evaluated the effects of bimodal hearing aid fitting on provided hearing aid gain and on bimodal auditory functioning in a group of experienced bimodal cochlear implant (CI) users. A second aim of our study was to determine the effect of broadband loudness balancing on the prescribed gain of those two fitting formulas. DESIGN This prospective study used a crossover design in which two fitting methods were compared varying in basic prescription formula (NAL-NL2 or APDB fitting formula). The study consisted of a three-visit crossover design with 3 weeks between sessions. Nineteen postlingually deafened experienced bimodal CI users participated in this study. Auditory functioning was evaluated by a speech in quiet test, a speech in noise test, and a questionnaire on auditory performance. RESULTS Significant differences between the two fitting formulas were found for frequencies of 2000 Hz and above. For these frequencies, less gain was provided by the APDB fitting formula compared with NAL-NL2. For the APDB fitting formula, a higher compression ratio for frequencies of 1000 Hz and above was found compared with the NAL-NL2 fitting formula. Loudness balancing did not result in large deviations from the prescribed gain by the initial fitting formula. Bimodal benefit was found for speech perception in quiet and for speech perception in noise. No differences in auditory performance were found between the two fitting formulas for any of the auditory performance tests. CONCLUSIONS The results of this study show that CI users with residual hearing at the contralateral ear can benefit from bimodal stimulation, regardless of the fitting method that was applied. Although significant differences between the output and compression ratio of the NAL-NL2 and the APDB fitting formula existed, no differences in bimodal auditory performance were observed. Therefore, NAL-NL2 or the APDB fitting prescription both seem suited for bimodal fitting purposes. Additional loudness balancing has a marginal effect on the provided hearing aid output.
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Abstract
OBJECTIVES Bimodal hearing has shown to improve speech recognition in quiet and in noise and to improve sound localization compared with unilateral cochlear implant (CI) use alone. Fitting the CI and hearing aid (HA) separately has been described well, but HA fitting procedures for bimodal CI users are not well researched or widely accepted. The aim of the present study was to systematically review the literature on the effect of different HA fitting strategies on auditory performance in bimodal CI users. DESIGN Original articles, written in English, were identified through systematic searches in Medline (OvidSP), Embase, Web of Science, Scopus, CINAHL, Cochrane, PubMed publisher, and Google Scholar. The quality of the studies was assessed on five aspects: methodologic quality (with the methodological index for nonrandomized studies score), number of subjects, quality of the description of contralateral hearing loss, quality of HA verification, and direct comparison of HA fitting procedures based on auditory performance. RESULTS A total of 1665 records were retrieved, of which 17 were included for systematical reviews. Critical appraisal led to three high-quality studies, 10 medium-quality studies, and four low-quality studies. The results of the studies were structured according to four topics: frequency response, frequency translation/transposition, dynamic range compression, and loudness. In general, a bimodal benefit was found in most studies, using various strategies for the HA fitting. Using a standard prescription rule such as National Acoustics Laboratory formula-non-linear 1, National Acoustics Laboratory formula-non-linear 2, or desired sensation level is a good starting point in children and adults. CONCLUSIONS Although a bimodal benefit was found in most studies, there is no clear evidence how certain choices in HA fitting contribute to optimal bimodal performance. A generally accepted HA prescription rule is an essential part of most fitting procedures used in the studies. Current evidence suggests that frequency lowering or transposition is not beneficial. Individual fine tuning based on loudness or general preference is often applied, but its additional value for auditory performance should be investigated more thoroughly. Good quality comparative studies are needed to further develop evidence-based fitting procedures in case of bimodal listening.
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Results in Adult Cochlear Implant Recipients With Varied Asymmetric Hearing: A Prospective Longitudinal Study of Speech Recognition, Localization, and Participant Report. Ear Hear 2019; 39:845-862. [PMID: 29373326 DOI: 10.1097/aud.0000000000000548] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Asymmetric hearing with severe to profound hearing loss (SPHL) in one ear and better hearing in the other requires increased listening effort and is detrimental for understanding speech in noise and sound localization. Although a cochlear implant (CI) is the only treatment that can restore hearing to an ear with SPHL, current candidacy criteria often disallows this option for patients with asymmetric hearing. The present study aimed to evaluate longitudinal performance outcomes in a relatively large group of adults with asymmetric hearing who received a CI in the poor ear. DESIGN Forty-seven adults with postlingual hearing loss participated. Test materials included objective and subjective measures meant to elucidate communication challenges encountered by those with asymmetric hearing. Test intervals included preimplant and 6 and 12 months postimplant. Preimplant testing was completed in participants' everyday listening condition: bilateral hearing aids (HAs) n = 9, better ear HA n = 29, and no HA n = 9; postimplant, each ear was tested separately and in the bimodal condition. RESULTS Group mean longitudinal results in the bimodal condition postimplant compared with the preimplant everyday listening condition indicated significantly improved sentence scores at soft levels and in noise, improved localization, and higher ratings of communication function by 6 months postimplant. Group mean, 6-month postimplant results were significantly better in the bimodal condition compared with either ear alone. Audibility and speech recognition for the poor ear alone improved significantly with a CI compared with preimplant. Most participants had clinically meaningful benefit on most measures. Contributory factors reported for traditional CI candidates also impacted results for this population. In general, older participants had poorer bimodal speech recognition in noise and localization abilities than younger participants. Participants with early SPHL onset had better bimodal localization than those with later SPHL onset, and participants with longer SPHL duration had poorer CI alone speech understanding in noise but not in quiet. Better ear pure-tone average (PTA) correlated with all speech recognition measures in the bimodal condition. To understand the impact of better ear hearing on bimodal performance, participants were grouped by better ear PTA: group 1 PTA ≤40 dB HL (n = 19), group 2 PTA = 41 to 55 dB HL (n = 14), and group 3 PTA = 56 to 70 dB HL (n = 14). All groups showed bimodal benefit on speech recognition measures in quiet and in noise; however, only group 3 obtained benefit when noise was toward the CI ear. All groups showed improved localization and ratings of perceived communication. CONCLUSIONS Receiving a CI for the poor ear was an effective treatment for this population. Improved audibility and speech recognition were evident by 6 months postimplant. Improvements in sound localization and self-reports of communication benefit were significant and not related to better ear hearing. Participants with more hearing in the better ear (group 1) showed less bimodal benefit but greater bimodal performance for speech recognition than groups 2 and 3. Test batteries for this population should include quality of life measures, sound localization, and adaptive speech recognition measures with spatially separated noise to capture the hearing loss deficits and treatment benefits reported by this patient population.
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Vroegop JL, Dingemanse JG, van der Schroeff MP, Goedegebure A. Comparing the Effect of Different Hearing Aid Fitting Methods in Bimodal Cochlear Implant Users. Am J Audiol 2019; 28:1-10. [PMID: 30383163 DOI: 10.1044/2018_aja-18-0067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose The aim of the study was to investigate the effect of 3 hearing aid fitting procedures on provided gain of the hearing aid in bimodal cochlear implant users and their effect on bimodal benefit. Method This prospective study measured hearing aid gain and auditory performance in a cross-over design in which 3 hearing aid fitting methods were compared. Hearing aid fitting methods differed in initial gain prescription rule (NAL-NL2 and Audiogram+) and loudness balancing method (broadband vs. narrowband loudness balancing). Auditory functioning was evaluated by a speech-in-quiet test, a speech-in-noise test, and a sound localization test. Fourteen postlingually deafened adult bimodal cochlear implant users participated in the study. Results No differences in provided gain and in bimodal performance were found for the different hearing aid fittings. For all hearing aid fittings, a bimodal benefit was found for speech in noise and sound localization. Conclusion Our results confirm that cochlear implant users with residual hearing in the contralateral ear substantially benefit from bimodal stimulation. However, on average, no differences were found between different types of fitting methods, varying in prescription rule and loudness balancing method.
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Affiliation(s)
- Jantien L. Vroegop
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - J. Gertjan Dingemanse
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Marc P. van der Schroeff
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - André Goedegebure
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
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Tao DD, Liu JS, Yang ZD, Wilson BS, Zhou N. Bilaterally Combined Electric and Acoustic Hearing in Mandarin-Speaking Listeners: The Population With Poor Residual Hearing. Trends Hear 2019; 22:2331216518757892. [PMID: 29451107 PMCID: PMC5818091 DOI: 10.1177/2331216518757892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The hearing loss criterion for cochlear implant candidacy in mainland China is extremely stringent (bilateral severe to profound hearing loss), resulting in few patients with substantial residual hearing in the nonimplanted ear. The main objective of the current study was to examine the benefit of bimodal hearing in typical Mandarin-speaking implant users who have poorer residual hearing in the nonimplanted ear relative to those used in the English-speaking studies. Seventeen Mandarin-speaking bimodal users with pure-tone averages of ∼80 dB HL participated in the study. Sentence recognition in quiet and in noise as well as tone and word recognition in quiet were measured in monaural and bilateral conditions. There was no significant bimodal effect for word and sentence recognition in quiet. Small bimodal effects were observed for sentence recognition in noise (6%) and tone recognition (4%). The magnitude of both effects was correlated with unaided thresholds at frequencies near voice fundamental frequencies (F0s). A weak correlation between the bimodal effect for word recognition and unaided thresholds at frequencies higher than F0s was identified. These results were consistent with previous findings that showed more robust bimodal benefits for speech recognition tasks that require higher spectral resolution than speech recognition in quiet. The significant but small F0-related bimodal benefit was also consistent with the limited acoustic hearing in the nonimplanted ear of the current subject sample, who are representative of the bimodal users in mainland China. These results advocate for a more relaxed implant candidacy criterion to be used in mainland China.
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Affiliation(s)
- Duo-Duo Tao
- 1 Department of Ear, Nose, and Throat, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ji-Sheng Liu
- 1 Department of Ear, Nose, and Throat, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhen-Dong Yang
- 1 Department of Ear, Nose, and Throat, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Blake S Wilson
- 2 Departments of Surgery, Biomedical Engineering, and Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Ning Zhou
- 3 Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
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Devocht EMJ, Janssen AML, Chalupper J, Stokroos RJ, George ELJ. The Benefits of Bimodal Aiding on Extended Dimensions of Speech Perception: Intelligibility, Listening Effort, and Sound Quality. Trends Hear 2019; 21:2331216517727900. [PMID: 28874096 PMCID: PMC5604840 DOI: 10.1177/2331216517727900] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The benefits of combining a cochlear implant (CI) and a hearing aid (HA) in opposite ears on speech perception were examined in 15 adult unilateral CI recipients who regularly use a contralateral HA. A within-subjects design was carried out to assess speech intelligibility testing, listening effort ratings, and a sound quality questionnaire for the conditions CI alone, CIHA together, and HA alone when applicable. The primary outcome of bimodal benefit, defined as the difference between CIHA and CI, was statistically significant for speech intelligibility in quiet as well as for intelligibility in noise across tested spatial conditions. A reduction in effort on top of intelligibility at the highest tested signal-to-noise ratio was found. Moreover, the bimodal listening situation was rated to sound more voluminous, less tinny, and less unpleasant than CI alone. Listening effort and sound quality emerged as feasible and relevant measures to demonstrate bimodal benefit across a clinically representative range of bimodal users. These extended dimensions of speech perception can shed more light on the array of benefits provided by complementing a CI with a contralateral HA.
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Affiliation(s)
- Elke M J Devocht
- 1 Department of ENT/Audiology, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Center (MUMC+), The Netherlands
| | - A Miranda L Janssen
- 1 Department of ENT/Audiology, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Center (MUMC+), The Netherlands.,2 Department of Methodology and Statistics, School for Public Health and Primary Care (CAPHRI), Maastricht University (UM), The Netherlands
| | - Josef Chalupper
- 3 Advanced Bionics European Research Centre, Hannover, Germany
| | - Robert J Stokroos
- 1 Department of ENT/Audiology, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Center (MUMC+), The Netherlands
| | - Erwin L J George
- 1 Department of ENT/Audiology, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Center (MUMC+), The Netherlands
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Warren SE, Dunbar MN. Bimodal Hearing in Individuals with Severe-to-Profound Hearing Loss: Benefits, Challenges, and Management. Semin Hear 2018; 39:405-413. [PMID: 30374211 DOI: 10.1055/s-0038-1670706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Binaural hearing offers numerous advantages over monaural hearing. While bilateral implants are a successful treatment option for some patients, many individuals choose to achieve binaural hearing by using a cochlear implant with a contralateral hearing aid. Compared with monaural hearing, benefits of bimodal hearing include improved speech perception in quiet and in noise, improved localization, and more natural sound quality. Despite the advantages, there exist disadvantages to bimodal hearing, primarily related to binaural integration. Management of these devices can be challenging in that the hearing aid and cochlear implant may be managed by different clinicians. When fitting devices, strategies are recommended to optimize the integration of input from both devices. In managing bimodal devices, recommended outcomes measures include those that would reflect bimodal benefit, such as speech understanding in noise and spatial sound quality perception.
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Affiliation(s)
- Sarah E Warren
- School of Communication Sciences and Disorders, University of Memphis, Memphis, Tennessee.,Department of Audiology and Speech Pathology, Arkansas Children's Hospital, Little Rock, Arkansas
| | - M Noelle Dunbar
- Department of Otolaryngology/Head and Neck Surgery, Columbia University Medical Center, New York, New York
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Vroegop JL, Homans NC, Goedegebure A, van der Schroeff MP. A directional remote-microphone for bimodal cochlear implant recipients. Int J Audiol 2018; 57:858-863. [PMID: 30261771 DOI: 10.1080/14992027.2018.1508896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Jantien L Vroegop
- a ENT-Department , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Nienke C Homans
- a ENT-Department , Erasmus Medical Center , Rotterdam , The Netherlands
| | - André Goedegebure
- a ENT-Department , Erasmus Medical Center , Rotterdam , The Netherlands
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Wenrich KA, Davidson LS, Uchanski RM. Segmental and Suprasegmental Perception in Children Using Hearing Aids. J Am Acad Audiol 2018; 28:901-912. [PMID: 29130438 PMCID: PMC5726292 DOI: 10.3766/jaaa.16105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Suprasegmental perception (perception of stress, intonation, "how something is said" and "who says it") and segmental speech perception (perception of individual phonemes or perception of "what is said") are perceptual abilities that provide the foundation for the development of spoken language and effective communication. While there are numerous studies examining segmental perception in children with hearing aids (HAs), there are far fewer studies examining suprasegmental perception, especially for children with greater degrees of residual hearing. Examining the relation between acoustic hearing thresholds, and both segmental and suprasegmental perception for children with HAs, may ultimately enable better device recommendations (bilateral HAs, bimodal devices [one CI and one HA in opposite ears], bilateral CIs) for a particular degree of residual hearing. Examining both types of speech perception is important because segmental and suprasegmental cues are affected differentially by the type of hearing device(s) used (i.e., cochlear implant [CI] and/or HA). Additionally, suprathreshold measures, such as frequency resolution ability, may partially predict benefit from amplification and may assist audiologists in making hearing device recommendations. PURPOSE The purpose of this study is to explore the relationship between audibility (via hearing thresholds and speech intelligibility indices), and segmental and suprasegmental speech perception for children with HAs. A secondary goal is to explore the relationships among frequency resolution ability (via spectral modulation detection [SMD] measures), segmental and suprasegmental speech perception, and receptive language in these same children. RESEARCH DESIGN A prospective cross-sectional design. STUDY SAMPLE Twenty-three children, ages 4 yr 11 mo to 11 yr 11 mo, participated in the study. Participants were recruited from pediatric clinic populations, oral schools for the deaf, and mainstream schools. DATA COLLECTION AND ANALYSIS Audiological history and hearing device information were collected from participants and their families. Segmental and suprasegmental speech perception, SMD, and receptive vocabulary skills were assessed. Correlations were calculated to examine the significance (p < 0.05) of relations between audibility and outcome measures. RESULTS Measures of audibility and segmental speech perception are not significantly correlated, while low-frequency pure-tone average (unaided) is significantly correlated with suprasegmental speech perception. SMD is significantly correlated with all measures (measures of audibility, segmental and suprasegmental perception and vocabulary). Lastly, although age is not significantly correlated with measures of audibility, it is significantly correlated with all other outcome measures. CONCLUSIONS The absence of a significant correlation between audibility and segmental speech perception might be attributed to overall audibility being maximized through well-fit HAs. The significant correlation between low-frequency unaided audibility and suprasegmental measures is likely due to the strong, predominantly low-frequency nature of suprasegmental acoustic properties. Frequency resolution ability, via SMD performance, is significantly correlated with all outcomes and requires further investigation; its significant correlation with vocabulary suggests that linguistic ability may be partially related to frequency resolution ability. Last, all of the outcome measures are significantly correlated with age, suggestive of developmental effects.
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Affiliation(s)
- Kaitlyn A. Wenrich
- Program in Audiology and Communication Science, Washington University School of Medicine, St. Louis, MO
| | - Lisa S. Davidson
- Program in Audiology and Communication Science, Washington University School of Medicine, St. Louis, MO
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, MO
- Central Institute for the Deaf, St. Louis, MO
| | - Rosalie M. Uchanski
- Program in Audiology and Communication Science, Washington University School of Medicine, St. Louis, MO
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, MO
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Vroegop JL, Homans NC, Goedegebure A, Dingemanse JG, van Immerzeel T, van der Schroeff MP. The Effect of Binaural Beamforming Technology on Speech Intelligibility in Bimodal Cochlear Implant Recipients. Audiol Neurootol 2018; 23:32-38. [PMID: 29936510 DOI: 10.1159/000487749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/15/2018] [Indexed: 11/19/2022] Open
Abstract
Although the benefit of bimodal listening in cochlear implant users has been agreed on, speech comprehension remains a challenge in acoustically complex real-life environments due to reverberation and disturbing background noises. One way to additionally improve bimodal auditory performance is the use of directional microphones. The objective of this study was to investigate the effect of a binaural beamformer for bimodal cochlear implant (CI) users. This prospective study measured speech reception thresholds (SRT) in noise in a repeated-measures design that varied in listening modality for static and dynamic listening conditions. A significant improvement in SRT of 4.7 dB was found with the binaural beamformer switched on in the bimodal static listening condition. No significant improvement was found in the dynamic listening condition. We conclude that there is a clear additional advantage of the binaural beamformer in bimodal CI users for predictable/static listening conditions with frontal target speech and spatially separated noise sources.
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Gifford RH, Loiselle L, Natale S, Sheffield SW, Sunderhaus LW, S. Dietrich M, Dorman MF. Speech Understanding in Noise for Adults With Cochlear Implants: Effects of Hearing Configuration, Source Location Certainty, and Head Movement. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:1306-1321. [PMID: 29800361 PMCID: PMC6195075 DOI: 10.1044/2018_jslhr-h-16-0444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/04/2018] [Indexed: 05/11/2023]
Abstract
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.
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Affiliation(s)
| | - Louise Loiselle
- Arizona State University, Tempe, AZ
- MED-EL Corporation, Durham, NC
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Combined Electric and Acoustic Stimulation With Hearing Preservation: Effect of Cochlear Implant Low-Frequency Cutoff on Speech Understanding and Perceived Listening Difficulty. Ear Hear 2018; 38:539-553. [PMID: 28301392 DOI: 10.1097/aud.0000000000000418] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary objective of this study was to assess the effect of electric and acoustic overlap for speech understanding in typical listening conditions using semidiffuse noise. DESIGN This study used a within-subjects, repeated measures design including 11 experienced adult implant recipients (13 ears) with functional residual hearing in the implanted and nonimplanted ear. The aided acoustic bandwidth was fixed and the low-frequency cutoff for the cochlear implant (CI) was varied systematically. Assessments were completed in the R-SPACE sound-simulation system which includes a semidiffuse restaurant noise originating from eight loudspeakers placed circumferentially about the subject's head. AzBio sentences were presented at 67 dBA with signal to noise ratio varying between +10 and 0 dB determined individually to yield approximately 50 to 60% correct for the CI-alone condition with full CI bandwidth. Listening conditions for all subjects included CI alone, bimodal (CI + contralateral hearing aid), and bilateral-aided electric and acoustic stimulation (EAS; CI + bilateral hearing aid). Low-frequency cutoffs both below and above the original "clinical software recommendation" frequency were tested for all patients, in all conditions. Subjects estimated listening difficulty for all conditions using listener ratings based on a visual analog scale. RESULTS Three primary findings were that (1) there was statistically significant benefit of preserved acoustic hearing in the implanted ear for most overlap conditions, (2) the default clinical software recommendation rarely yielded the highest level of speech recognition (1 of 13 ears), and (3) greater EAS overlap than that provided by the clinical recommendation yielded significant improvements in speech understanding. CONCLUSIONS For standard-electrode CI recipients with preserved hearing, spectral overlap of acoustic and electric stimuli yielded significantly better speech understanding and less listening effort in a laboratory-based, restaurant-noise simulation. In conclusion, EAS patients may derive more benefit from greater acoustic and electric overlap than given in current software fitting recommendations, which are based solely on audiometric threshold. These data have larger scientific implications, as previous studies may not have assessed outcomes with optimized EAS parameters, thereby underestimating the benefit afforded by hearing preservation.
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Blankenship C, Zhang F, Keith R. Behavioral Measures of Temporal Processing and Speech Perception in Cochlear Implant Users. J Am Acad Audiol 2018; 27:701-713. [PMID: 27718347 DOI: 10.3766/jaaa.15026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although most cochlear implant (CI) users achieve improvements in speech perception, there is still a wide variability in speech perception outcomes. There is a growing body of literature that supports the relationship between individual differences in temporal processing and speech perception performance in CI users. Previous psychophysical studies have emphasized the importance of temporal acuity for overall speech perception performance. Measurement of gap detection thresholds (GDTs) is the most common measure currently used to assess temporal resolution. However, most GDT studies completed with CI participants used direct electrical stimulation not acoustic stimulation and they used psychoacoustic research paradigms that are not easy to administer clinically. Therefore, it is necessary to determine if the variance in GDTs assessed with clinical measures of temporal processing such as the Randomized Gap Detection Test (RGDT) can be used to explain the variability in speech perception performance. PURPOSE The primary goal of this study was to investigate the relationship between temporal processing and speech perception performance in CI users. RESEARCH DESIGN A correlational study investigating the relationship between behavioral GDTs (assessed with the RGDT or the Expanded Randomized Gap Detection Test) and commonly used speech perception measures (assessed with the Speech Recognition Test [SRT], Central Institute for the Deaf W-22 Word Recognition Test [W-22], Consonant-Nucleus-Consonant Test [CNC], Arizona Biomedical Sentence Recognition Test [AzBio], Bamford-Kowal-Bench Speech-in-Noise Test [BKB-SIN]). STUDY SAMPLE Twelve postlingually deafened adult CI users (24-83 yr) and ten normal-hearing (NH; 22-30 yr) adults participated in the study. DATA COLLECTION AND ANALYSIS The data were collected in a sound-attenuated test booth. After measuring pure-tone thresholds, GDTs and speech perception performance were measured. The difference in performance between-participant groups on the aforementioned tests, as well as the correlation between GDTs and speech perception performance was examined. The correlations between participants' biologic factors, performance on the RGDT and speech perception measures were also explored. RESULTS Although some CI participants performed as well as the NH listeners, the majority of the CI participants displayed temporal processing impairments (GDTs > 20 msec) and poorer speech perception performance than NH participants. A statistically significant difference was found between the NH and CI test groups in GDTs and some speech tests (SRT, W-22, and BKB-SIN). For the CI group, there were significant correlations between GDTs and some measures of speech perception (CNC Phoneme, AzBio, BKB-SIN); however, no significant correlations were found between biographic factors and GDTs or speech perception performance. CONCLUSIONS Results support the theory that the variability in temporal acuity in CI users contributes to the variability in speech performance. Results also indicate that it is reasonable to use the clinically available RGDT to identify CI users with temporal processing impairments for further appropriate rehabilitation.
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Affiliation(s)
- Chelsea Blankenship
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH
| | - Fawen Zhang
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH
| | - Robert Keith
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH
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The cochlear implant and possibilities for narrowing the remaining gaps between prosthetic and normal hearing. World J Otorhinolaryngol Head Neck Surg 2018; 3:200-210. [PMID: 29780963 PMCID: PMC5956133 DOI: 10.1016/j.wjorl.2017.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/26/2017] [Indexed: 11/21/2022] Open
Abstract
Background The cochlear implant has become the standard of care for severe or worse losses in hearing and indeed has produced the first substantial restoration of a lost or absent human sense using a medical intervention. However, the devices are not perfect and many efforts to narrow the remaining gaps between prosthetic and normal hearing are underway. Objective To assess the present status of cochlear implants and to describe possibilities for improving them. Results The present-day devices work well in quiet conditions for the great majority of users. However, not all users have high levels of speech reception in quiet and nearly all users struggle with speech reception in typically noisy acoustic environments. In addition, perception of sounds more complex than speech, such as most music, is generally poor unless residual hearing at low frequencies can be stimulated acoustically in conjunction with the electrical stimuli provided by the implant. Possibilities for improving the present devices include increasing the spatial specificity of neural excitation by reducing masking effects or with new stimulus modes; prudent pruning of interfering or otherwise detrimental electrodes from the stimulation map; a further relaxation in the criteria for implant candidacy, based on recent evidence from persons with high levels of residual hearing and to allow many more people to benefit from cochlear implants; and “top down” or “brain centric” approaches to implant designs and applications. Conclusions Progress in the development of the cochlear implant and related treatments has been remarkable but room remains for improvements. The future looks bright as there are multiple promising possibilities for improvements and many talented teams are pursuing them.
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Dorman MF, Gifford RH. Speech Understanding in Complex Listening Environments by Listeners Fit With Cochlear Implants. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:3019-3026. [PMID: 29049602 PMCID: PMC5945071 DOI: 10.1044/2017_jslhr-h-17-0035] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/11/2017] [Indexed: 05/11/2023]
Abstract
PURPOSE The aim of this article is to summarize recent published and unpublished research from our 2 laboratories on improving speech understanding in complex listening environments by listeners fit with cochlear implants (CIs). METHOD CI listeners were tested in 2 listening environments. One was a simulation of a restaurant with multiple, diffuse noise sources, and the other was a cocktail party with 2 spatially separated point sources of competing speech. At issue was the value of the following sources of information, or interventions, on speech understanding: (a) visual information, (b) adaptive beamformer microphones and remote microphones, (c) bimodal fittings, that is, a CI and contralateral low-frequency acoustic hearing, (d) hearing preservation fittings, that is, a CI with preserved low-frequency acoustic in the same ear plus low-frequency acoustic hearing in the contralateral ear, and (e) bilateral CIs. RESULTS A remote microphone provided the largest improvement in speech understanding. Visual information and adaptive beamformers ranked next, while bimodal fittings, bilateral fittings, and hearing preservation provided significant but less benefit than the other interventions or sources of information. Only bilateral CIs allowed listeners high levels of speech understanding when signals were roved over the frontal plane. CONCLUSIONS The evidence supports the use of bilateral CIs and hearing preservation surgery for best speech understanding in complex environments. These fittings, when combined with visual information and microphone technology, should lead to high levels of speech understanding by CI patients in complex listening environments. PRESENTATION VIDEO http://cred.pubs.asha.org/article.aspx?articleid=2601622.
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Affiliation(s)
- Michael F. Dorman
- Department of Speech and Hearing Science, Arizona State University, Tempe
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Cochlear Implantation in Cases of Unilateral Hearing Loss: Initial Localization Abilities. Ear Hear 2017; 38:611-619. [DOI: 10.1097/aud.0000000000000430] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Masking release with changing fundamental frequency: Electric acoustic stimulation resembles normal hearing subjects. Hear Res 2017; 350:226-234. [DOI: 10.1016/j.heares.2017.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/04/2017] [Accepted: 05/08/2017] [Indexed: 11/20/2022]
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Vroegop JL, Dingemanse JG, Homans NC, Goedegebure A. Evaluation of a wireless remote microphone in bimodal cochlear implant recipients. Int J Audiol 2017; 56:643-649. [DOI: 10.1080/14992027.2017.1308565] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Nienke C. Homans
- Department of ENT, Erasmus Medical Center, Rotterdam, the Netherlands
| | - André Goedegebure
- Department of ENT, Erasmus Medical Center, Rotterdam, the Netherlands
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Dorman MF, Liss J, Wang S, Berisha V, Ludwig C, Natale SC. Experiments on Auditory-Visual Perception of Sentences by Users of Unilateral, Bimodal, and Bilateral Cochlear Implants. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:1505-1519. [PMID: 27960006 PMCID: PMC5399766 DOI: 10.1044/2016_jslhr-h-15-0312] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 02/12/2016] [Accepted: 04/04/2016] [Indexed: 05/25/2023]
Abstract
PURPOSE Five experiments probed auditory-visual (AV) understanding of sentences by users of cochlear implants (CIs). METHOD Sentence material was presented in auditory (A), visual (V), and AV test conditions to listeners with normal hearing and CI users. RESULTS (a) Most CI users report that most of the time, they have access to both A and V information when listening to speech. (b) CI users did not achieve better scores on a task of speechreading than did listeners with normal hearing. (c) Sentences that are easy to speechread provided 12 percentage points more gain to speech understanding than did sentences that were difficult. (d) Ease of speechreading for sentences is related to phrase familiarity. (e) Users of bimodal CIs benefit from low-frequency acoustic hearing even when V cues are available, and a second CI adds to the benefit of a single CI when V cues are available. (f) V information facilitates lexical segmentation by improving the recognition of the number of syllables produced and the relative strength of these syllables. CONCLUSIONS Our data are consistent with the view that V information improves CI users' ability to identify syllables in the acoustic stream and to recognize their relative juxtaposed strengths. Enhanced syllable resolution allows better identification of word onsets, which, when combined with place-of-articulation information from visible consonants, improves lexical access.
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Affiliation(s)
- Michael F Dorman
- Department of Speech and Hearing Science, Arizona State University, Tempe
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Stilp C, Donaldson G, Oh S, Kong YY. Influences of noise-interruption and information-bearing acoustic changes on understanding simulated electric-acoustic speech. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2016; 140:3971. [PMID: 27908030 PMCID: PMC6909990 DOI: 10.1121/1.4967445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 08/18/2016] [Accepted: 10/28/2016] [Indexed: 06/06/2023]
Abstract
In simulations of electrical-acoustic stimulation (EAS), vocoded speech intelligibility is aided by preservation of low-frequency acoustic cues. However, the speech signal is often interrupted in everyday listening conditions, and effects of interruption on hybrid speech intelligibility are poorly understood. Additionally, listeners rely on information-bearing acoustic changes to understand full-spectrum speech (as measured by cochlea-scaled entropy [CSE]) and vocoded speech (CSECI), but how listeners utilize these informational changes to understand EAS speech is unclear. Here, normal-hearing participants heard noise-vocoded sentences with three to six spectral channels in two conditions: vocoder-only (80-8000 Hz) and simulated hybrid EAS (vocoded above 500 Hz; original acoustic signal below 500 Hz). In each sentence, four 80-ms intervals containing high-CSECI or low-CSECI acoustic changes were replaced with speech-shaped noise. As expected, performance improved with the preservation of low-frequency fine-structure cues (EAS). This improvement decreased for continuous EAS sentences as more spectral channels were added, but increased as more channels were added to noise-interrupted EAS sentences. Performance was impaired more when high-CSECI intervals were replaced by noise than when low-CSECI intervals were replaced, but this pattern did not differ across listening modes. Utilizing information-bearing acoustic changes to understand speech is predicted to generalize to cochlear implant users who receive EAS inputs.
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Affiliation(s)
- Christian Stilp
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky 40292, USA
| | - Gail Donaldson
- Department of Communication Sciences and Disorders, University of South Florida, PCD 1017, 4202 East Fowler Avenue, Tampa, Florida 33620, USA
| | - Soohee Oh
- Department of Communication Sciences and Disorders, University of South Florida, PCD 1017, 4202 East Fowler Avenue, Tampa, Florida 33620, USA
| | - Ying-Yee Kong
- Department of Communication Sciences and Disorders, Northeastern University, 226 Forsyth Building, 360 Huntington Avenue, Boston, Massachusetts 02115, USA
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Choi SJ, Lee JB, Bahng J, Lee WK, Park CH, Kim HJ, Lee JH. Effect of low frequency on speech performance with bimodal hearing in bilateral severe hearing loss. Laryngoscope 2016; 126:2817-2822. [PMID: 27075047 DOI: 10.1002/lary.26014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Unilateral cochlear implantation has emerged as a widely accepted procedure to treat severe to profound hearing loss, but many studies have reported benefits in terms of speech comprehension when listeners with residual low-frequency hearing in the nonimplanted ear use a hearing aid. STUDY DESIGN Retrospective study. METHODS In this study, we analyzed the speech performance and satisfaction of bimodal hearing according to the residual low-frequency hearing level in the nonimplanted ear. Based on low-frequency pure-tone audiometry (average of 250 Hz and 500 Hz) in the nonimplanted ear, we classified individuals into three groups as follows: group A (under 70 dB), group B (71-90 dB), and group C (over 91 dB). Listeners were tested using the Word Recognition Score, the Korea-Central Institute for Deaf sentence recognition test, and the Korean version of the Hearing Handicap Inventory for the Elderly questionnaire. RESULTS We observed a bimodal benefit when the residual low-frequency threshold was less than 70 dB HL and a greater satisfaction with bimodal hearing compared to cochlear implant alone, when the residual low-frequency threshold was less than 70 dB HL. CONCLUSIONS This study supports the benefits of bimodal hearing in listeners with bilateral severe to profound sensorineural hearing loss as standard clinical practice, when the residual low-frequency hearing threshold is under 70 dB in the nonimplanted ear. LEVEL OF EVIDENCE 4 Laryngoscope, 126:2817-2822, 2016.
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Affiliation(s)
- Seong Jun Choi
- Department of Otorhinolaryngology, College of Medicine, Konyang University, Daejon, South Korea
| | - Jong Bin Lee
- Department of Otorhinolaryngology, College of Medicine, Konyang University, Daejon, South Korea
| | - Junghwa Bahng
- Department of Audiology, Hallym University of Graduate Studies, Seoul, South Korea
| | - Won Ki Lee
- Department of Urology, College of Medicine, Hallym University, Chuncheon, South Korea
| | - Chan Hum Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Hyung-Jong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Chuncheon, Republic of Korea
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Dillon MT, Buss E, Adunka OF, Buchman CA, Pillsbury HC. Influence of Test Condition on Speech Perception With Electric-Acoustic Stimulation. Am J Audiol 2015; 24:520-8. [PMID: 26650652 DOI: 10.1044/2015_aja-15-0022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/05/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The goal of this work was to better understand speech perception for cochlear implant (CI) users with bilateral residual hearing, including consideration of effects related to listening conditions and test measures. Of interest was the role of acoustic hearing for speech perception in a complex background, the role of listening experience for CI-alone conditions, and whether performance with electric-acoustic stimulation (EAS) was improved by a contralateral hearing aid (HA). METHOD Eleven subjects provided data on Consonant-Nucleus-Consonant (CNC; Peterson & Lehiste, 1962) words in quiet, City University of New York (CUNY; Boothroyd, Hanin, & Hnath, 1985) sentences in steady noise, and Bamford-Kowal-Bench (Bench, Kowal, & Bamford, 1979) sentences in multitalker babble. Listening conditions included: CI with a full-frequency map, CI with a truncated-frequency map, EAS, and EAS+HA (EAS plus contralateral HA). Sounds were presented at 0° azimuth. RESULTS For CNC words and CUNY sentences, performance was better with the truncated-frequency than the full-frequency map, and performance with EAS was better than for either CI-alone condition. For Bench-Kowal-Bamford sentences, EAS+HA was better than EAS. CONCLUSIONS As demonstrated previously, performance was better in the EAS condition than either CI-alone condition. Better performance in the truncated-frequency than full-frequency CI-alone condition suggests that listening experience may be important. A contralateral HA improved performance over unilateral EAS under some conditions.
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Affiliation(s)
| | - Emily Buss
- University of North Carolina at Chapel Hill
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Wilson BS. Getting a decent (but sparse) signal to the brain for users of cochlear implants. Hear Res 2014; 322:24-38. [PMID: 25500178 DOI: 10.1016/j.heares.2014.11.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/19/2014] [Accepted: 11/24/2014] [Indexed: 11/27/2022]
Abstract
The challenge in getting a decent signal to the brain for users of cochlear implants (CIs) is described. A breakthrough occurred in 1989 that later enabled most users to understand conversational speech with their restored hearing alone. Subsequent developments included stimulation in addition to that provided with a unilateral CI, either with electrical stimulation on both sides or with acoustic stimulation in combination with a unilateral CI, the latter for persons with residual hearing at low frequencies in either or both ears. Both types of adjunctive stimulation produced further improvements in performance for substantial fractions of patients. Today, the CI and related hearing prostheses are the standard of care for profoundly deaf persons and ever-increasing indications are now allowing persons with less severe losses to benefit from these marvelous technologies. The steps in achieving the present levels of performance are traced, and some possibilities for further improvements are mentioned. This article is part of a Special Issue entitled <Lasker Award>.
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Affiliation(s)
- Blake S Wilson
- Duke Hearing Center, Duke University Health System, Durham, NC 27710, USA; Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA; Pratt School of Engineering, Duke University, Durham, NC 27708, USA; Department of Electrical and Computer Engineering, Duke University, Durham, NC 27708, USA; Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; School of Engineering, University of Warwick, Coventry CV4 8UW, UK.
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