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Creff G, Lambert C, Coudert P, Pean V, Laurent S, Godey B. Comparison of Tonotopic and Default Frequency Fitting for Speech Understanding in Noise in New Cochlear Implantees: A Prospective, Randomized, Double-Blind, Cross-Over Study. Ear Hear 2024; 45:35-52. [PMID: 37823850 DOI: 10.1097/aud.0000000000001423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
OBJECTIVES While cochlear implants (CIs) have provided benefits for speech recognition in quiet for subjects with severe-to-profound hearing loss, speech recognition in noise remains challenging. A body of evidence suggests that reducing frequency-to-place mismatch may positively affect speech perception. Thus, a fitting method based on a tonotopic map may improve speech perception results in quiet and noise. The aim of our study was to assess the impact of a tonotopic map on speech perception in noise and quiet in new CI users. DESIGN A prospective, randomized, double-blind, two-period cross-over study in 26 new CI users was performed over a 6-month period. New CI users older than 18 years with bilateral severe-to-profound sensorineural hearing loss or complete hearing loss for less than 5 years were selected in the University Hospital Centre of Rennes in France. An anatomical tonotopic map was created using postoperative flat-panel computed tomography and a reconstruction software based on the Greenwood function. Each participant was randomized to receive a conventional map followed by a tonotopic map or vice versa. Each setting was maintained for 6 weeks, at the end of which participants performed speech perception tasks. The primary outcome measure was speech recognition in noise. Participants were allocated to sequences by block randomization of size two with a ratio 1:1 (CONSORT Guidelines). Participants and those assessing the outcomes were blinded to the intervention. RESULTS Thirteen participants were randomized to each sequence. Two of the 26 participants recruited (one in each sequence) had to be excluded due to the COVID-19 pandemic. Twenty-four participants were analyzed. Speech recognition in noise was significantly better with the tonotopic fitting at all signal-to-noise ratio (SNR) levels tested [SNR = +9 dB, p = 0.002, mean effect (ME) = 12.1%, 95% confidence interval (95% CI) = 4.9 to 19.2, standardized effect size (SES) = 0.71; SNR = +6 dB, p < 0.001, ME = 16.3%, 95% CI = 9.8 to 22.7, SES = 1.07; SNR = +3 dB, p < 0.001 ME = 13.8%, 95% CI = 6.9 to 20.6, SES = 0.84; SNR = 0 dB, p = 0.003, ME = 10.8%, 95% CI = 4.1 to 17.6, SES = 0.68]. Neither period nor interaction effects were observed for any signal level. Speech recognition in quiet ( p = 0.66) and tonal audiometry ( p = 0.203) did not significantly differ between the two settings. 92% of the participants kept the tonotopy-based map after the study period. No correlation was found between speech-in-noise perception and age, duration of hearing deprivation, angular insertion depth, or position or width of the frequency filters allocated to the electrodes. CONCLUSION For new CI users, tonotopic fitting appears to be more efficient than the default frequency fitting because it allows for better speech recognition in noise without compromising understanding in quiet.
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Affiliation(s)
- Gwenaelle Creff
- Department of Otolaryngology-Head and Neck Surgery (HNS), University Hospital, Rennes, France
- MediCIS, LTSI (Image and Signal Processing Laboratory), INSERM, U1099, Rennes, France
| | - Cassandre Lambert
- Department of Otolaryngology-Head and Neck Surgery (HNS), University Hospital, Rennes, France
| | - Paul Coudert
- Department of Otolaryngology-Head and Neck Surgery (HNS), University Hospital, Rennes, France
| | | | | | - Benoit Godey
- Department of Otolaryngology-Head and Neck Surgery (HNS), University Hospital, Rennes, France
- MediCIS, LTSI (Image and Signal Processing Laboratory), INSERM, U1099, Rennes, France
- Hearing Aid Academy, Javene, France
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2
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The Augmented Cochlear Implant: a Convergence of Drugs and Cochlear Implantation for the Treatment of Hearing Loss. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00426-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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St. Peter M, Brough DE, Lawrence A, Nelson-Brantley J, Huang P, Harre J, Warnecke A, Staecker H. Improving Control of Gene Therapy-Based Neurotrophin Delivery for Inner Ear Applications. Front Bioeng Biotechnol 2022; 10:892969. [PMID: 35721868 PMCID: PMC9204055 DOI: 10.3389/fbioe.2022.892969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Survival and integrity of the spiral ganglion is vital for hearing in background noise and for optimal functioning of cochlear implants. Numerous studies have demonstrated that supplementation of supraphysiologic levels of the neurotrophins BDNF and NT-3 by pumps or gene therapy strategies supports spiral ganglion survival. The endogenous physiological levels of growth factors within the inner ear, although difficult to determine, are likely extremely low within the normal inner ear. Thus, novel approaches for the long-term low-level delivery of neurotrophins may be advantageous. Objectives: This study aimed to evaluate the long-term effects of gene therapy-based low-level neurotrophin supplementation on spiral ganglion survival. Using an adenovirus serotype 28-derived adenovector delivery system, the herpes latency promoter, a weak, long expressing promoter system, has been used to deliver the BDNF or NTF3 genes to the inner ear after neomycin-induced ototoxic injury in mice. Results: Treatment of the adult mouse inner ear with neomycin resulted in acute and chronic changes in endogenous neurotrophic factor gene expression and led to a degeneration of spiral ganglion cells. Increased survival of spiral ganglion cells after adenoviral delivery of BDNF or NTF3 to the inner ear was observed. Expression of BDNF and NT-3 could be demonstrated in the damaged organ of Corti after gene delivery. Hearing loss due to overexpression of neurotrophins in the normal hearing ear was avoided when using this novel vector–promoter combination. Conclusion: Combining supporting cell-specific gene delivery via the adenovirus serotype 28 vector with a low-strength long expressing promoter potentially can provide long-term neurotrophin delivery to the damaged inner ear.
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Affiliation(s)
| | | | - Anna Lawrence
- Department of Otolaryngology, University of Kansas School of Medicine, Kansas City, KS, United States
| | | | - Peixin Huang
- Department of Otolaryngology, University of Kansas School of Medicine, Kansas City, KS, United States
| | - Jennifer Harre
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Athanasia Warnecke
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Hinrich Staecker
- Department of Otolaryngology, University of Kansas School of Medicine, Kansas City, KS, United States
- *Correspondence: Hinrich Staecker,
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Wichova H, Shew M, Nelson-Brantley J, Warnecke A, Prentiss S, Staecker H. MicroRNA Profiling in the Perilymph of Cochlear Implant Patients: Identifying Markers that Correlate to Audiological Outcomes. J Am Acad Audiol 2022; 32:627-635. [PMID: 35609590 DOI: 10.1055/s-0041-1742234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
HYPOTHESIS MicroRNA (miRNA) expression profiles from human perilymph correlate to post cochlear implantation (CI) hearing outcomes. BACKGROUND The high inter-individual variability in speech perception among cochlear implant recipients is still poorly understood. MiRNA expression in perilymph can be used to characterize the molecular processes underlying inner ear disease and to predict performance with a cochlear implant. METHODS Perilymph collected during CI from 17 patients was analyzed using microarrays. MiRNAs were identified and multivariable analysis using consonant-nucleus-consonant testing at 6 and 18 months post implant activation was performed. Variables analyzed included age, gender, preoperative pure tone average (PTA), and preoperative speech discrimination (word recognition [WR]). Gene ontology analysis was performed to identify potential functional implications of changes in the identified miRNAs. RESULTS Distinct miRNA profiles correlated to preoperative PTA and WR. Patients classified as poor performers showed downregulation of six miRNAs that potentially regulate pathways related to neuronal function and cell survival. CONCLUSION Individual miRNA profiles can be identified in microvolumes of perilymph. Distinct non-coding RNA expression profiles correlate to preoperative hearing and postoperative cochlear implant outcomes.
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Affiliation(s)
| | - Matthew Shew
- Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Jennifer Nelson-Brantley
- Department of Anatomy and Cell Biology, School of Medicine, University of Kanas, Kansas City, Kansas
| | - Athanasia Warnecke
- Department of Otolaryngology Head and Neck Surgery, Hannover Medical School, Hannover, Germany
| | - Sandra Prentiss
- Department of Otolaryngology Head and Neck Surgery, University of Miami School of Medicine, Miami, Florida
| | - Hinrich Staecker
- Department of Otolaryngology Head and Neck Surgery, University of Kansas School of Medicine, Kansas City Kansas
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Jaekel BN, Weinstein S, Newman RS, Goupell MJ. Impacts of signal processing factors on perceptual restoration in cochlear-implant users. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 151:2898. [PMID: 35649892 PMCID: PMC9054268 DOI: 10.1121/10.0010258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Cochlear-implant (CI) users have previously demonstrated perceptual restoration, or successful repair of noise-interrupted speech, using the interrupted sentences paradigm [Bhargava, Gaudrain, and Başkent (2014). "Top-down restoration of speech in cochlear-implant users," Hear. Res. 309, 113-123]. The perceptual restoration effect was defined experimentally as higher speech understanding scores with noise-burst interrupted sentences compared to silent-gap interrupted sentences. For the perceptual restoration illusion to occur, it is often necessary for the masking or interrupting noise bursts to have a higher intensity than the adjacent speech signal to be perceived as a plausible masker. Thus, signal processing factors like noise reduction algorithms and automatic gain control could have a negative impact on speech repair in this population. Surprisingly, evidence that participants with cochlear implants experienced the perceptual restoration illusion was not observed across the two planned experiments. A separate experiment, which aimed to provide a close replication of previous work on perceptual restoration in CI users, also found no consistent evidence of perceptual restoration, contrasting the original study's previously reported findings. Typical speech repair of interrupted sentences was not observed in the present work's sample of CI users, and signal-processing factors did not appear to affect speech repair.
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Affiliation(s)
- Brittany N Jaekel
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland 20742, USA
| | - Sarah Weinstein
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland 20742, USA
| | - Rochelle S Newman
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland 20742, USA
| | - Matthew J Goupell
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland 20742, USA
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Wille I, Harre J, Oehmichen S, Lindemann M, Menzel H, Ehlert N, Lenarz T, Warnecke A, Behrens P. Development of Neuronal Guidance Fibers for Stimulating Electrodes: Basic Construction and Delivery of a Growth Factor. Front Bioeng Biotechnol 2022; 10:776890. [PMID: 35141211 PMCID: PMC8819688 DOI: 10.3389/fbioe.2022.776890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/05/2022] [Indexed: 12/03/2022] Open
Abstract
State-of-the-art treatment for sensorineural hearing loss is based on electrical stimulation of residual spiral ganglion neurons (SGNs) with cochlear implants (CIs). Due to the anatomical gap between the electrode contacts of the CI and the residual afferent fibers of the SGNs, spatial spreading of the stimulation signal hampers focused neuronal stimulation. Also, the efficiency of a CI is limited because SGNs degenerate over time due to loss of trophic support. A promising option to close the anatomical gap is to install fibers as artificial nerve guidance structures on the surface of the implant and install on these fibers drug delivery systems releasing neuroprotective agents. Here, we describe the first steps in this direction. In the present study, suture yarns made of biodegradable polymers (polyglycolide/poly-ε-caprolactone) serve as the basic fiber material. In addition to the unmodified fiber, also fibers modified with amine groups were employed. Cell culture investigations with NIH 3T3 fibroblasts attested good cytocompatibility to both types of fibers. The fibers were then coated with the extracellular matrix component heparan sulfate (HS) as a biomimetic of the extracellular matrix. HS is known to bind, stabilize, modulate, and sustainably release growth factors. Here, we loaded the HS-carrying fibers with the brain-derived neurotrophic factor (BDNF) which is known to act neuroprotectively. Release of this neurotrophic factor from the fibers was followed over a period of 110 days. Cell culture investigations with spiral ganglion cells, using the supernatants from the release studies, showed that the BDNF delivered from the fibers drastically increased the survival rate of SGNs in vitro. Thus, biodegradable polymer fibers with attached HS and loaded with BDNF are suitable for the protection and support of SGNs. Moreover, they present a promising base material for the further development towards a future neuronal guiding scaffold.
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Affiliation(s)
- Inga Wille
- Institut für Anorganische Chemie, Leibniz Universität Hannover, Hannover, Germany
- Cluster of Excellence Hearing4all, Hannover, Germany
| | - Jennifer Harre
- Cluster of Excellence Hearing4all, Hannover, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Hannover, Germany
| | - Sarah Oehmichen
- Institut für Technische Chemie, Technische Universität Braunschweig, Braunschweig, Germany
| | - Maren Lindemann
- Institut für Technische Chemie, Technische Universität Braunschweig, Braunschweig, Germany
| | - Henning Menzel
- Institut für Technische Chemie, Technische Universität Braunschweig, Braunschweig, Germany
| | - Nina Ehlert
- Institut für Anorganische Chemie, Leibniz Universität Hannover, Hannover, Germany
- Cluster of Excellence Hearing4all, Hannover, Germany
| | - Thomas Lenarz
- Cluster of Excellence Hearing4all, Hannover, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Hannover, Germany
| | - Athanasia Warnecke
- Cluster of Excellence Hearing4all, Hannover, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Hannover, Germany
| | - Peter Behrens
- Institut für Anorganische Chemie, Leibniz Universität Hannover, Hannover, Germany
- Cluster of Excellence Hearing4all, Hannover, Germany
- Cluster of Excellence PhoenixD, Hannover, Germany
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Lopez-Poveda EA, Eustaquio-Martín A, Fumero MJ, Gorospe JM, Polo López R, Gutiérrez Revilla MA, Schatzer R, Nopp P, Stohl JS. Speech-in-Noise Recognition With More Realistic Implementations of a Binaural Cochlear-Implant Sound Coding Strategy Inspired by the Medial Olivocochlear Reflex. Ear Hear 2021; 41:1492-1510. [PMID: 33136626 PMCID: PMC7722463 DOI: 10.1097/aud.0000000000000880] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/24/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Cochlear implant (CI) users continue to struggle understanding speech in noisy environments with current clinical devices. We have previously shown that this outcome can be improved by using binaural sound processors inspired by the medial olivocochlear (MOC) reflex, which involve dynamic (contralaterally controlled) rather than fixed compressive acoustic-to-electric maps. The present study aimed at investigating the potential additional benefits of using more realistic implementations of MOC processing. DESIGN Eight users of bilateral CIs and two users of unilateral CIs participated in the study. Speech reception thresholds (SRTs) for sentences in competition with steady state noise were measured in unilateral and bilateral listening modes. Stimuli were processed through two independently functioning sound processors (one per ear) with fixed compression, the current clinical standard (STD); the originally proposed MOC strategy with fast contralateral control of compression (MOC1); a MOC strategy with slower control of compression (MOC2); and a slower MOC strategy with comparatively greater contralateral inhibition in the lower-frequency than in the higher-frequency channels (MOC3). Performance with the four strategies was compared for multiple simulated spatial configurations of the speech and noise sources. Based on a previously published technical evaluation of these strategies, we hypothesized that SRTs would be overall better (lower) with the MOC3 strategy than with any of the other tested strategies. In addition, we hypothesized that the MOC3 strategy would be advantageous over the STD strategy in listening conditions and spatial configurations where the MOC1 strategy was not. RESULTS In unilateral listening and when the implant ear had the worse acoustic signal-to-noise ratio, the mean SRT was 4 dB worse for the MOC1 than for the STD strategy (as expected), but it became equal or better for the MOC2 or MOC3 strategies than for the STD strategy. In bilateral listening, mean SRTs were 1.6 dB better for the MOC3 strategy than for the STD strategy across all spatial configurations tested, including a condition with speech and noise sources colocated at front where the MOC1 strategy was slightly disadvantageous relative to the STD strategy. All strategies produced significantly better SRTs for spatially separated than for colocated speech and noise sources. A statistically significant binaural advantage (i.e., better mean SRTs across spatial configurations and participants in bilateral than in unilateral listening) was found for the MOC2 and MOC3 strategies but not for the STD or MOC1 strategies. CONCLUSIONS Overall, performance was best with the MOC3 strategy, which maintained the benefits of the originally proposed MOC1 strategy over the STD strategy for spatially separated speech and noise sources and extended those benefits to additional spatial configurations. In addition, the MOC3 strategy provided a significant binaural advantage, which did not occur with the STD or the original MOC1 strategies.
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Affiliation(s)
- Enrique A. Lopez-Poveda
- Laboratorio de Audición Computacional y Psicoacústica, Instituto de Neurociencias de Castilla y León, Universidad de Salamanca, Salamanca, Spain
- Grupo de Audiología, Instituto de Investigación Biomédica de Salamanca, Universidad de Salamanca, Salamanca, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Almudena Eustaquio-Martín
- Laboratorio de Audición Computacional y Psicoacústica, Instituto de Neurociencias de Castilla y León, Universidad de Salamanca, Salamanca, Spain
- Grupo de Audiología, Instituto de Investigación Biomédica de Salamanca, Universidad de Salamanca, Salamanca, Spain
| | - Milagros J. Fumero
- Laboratorio de Audición Computacional y Psicoacústica, Instituto de Neurociencias de Castilla y León, Universidad de Salamanca, Salamanca, Spain
- Grupo de Audiología, Instituto de Investigación Biomédica de Salamanca, Universidad de Salamanca, Salamanca, Spain
| | - José M. Gorospe
- Laboratorio de Audición Computacional y Psicoacústica, Instituto de Neurociencias de Castilla y León, Universidad de Salamanca, Salamanca, Spain
- Grupo de Audiología, Instituto de Investigación Biomédica de Salamanca, Universidad de Salamanca, Salamanca, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad de Salamanca, Salamanca, Spain
- Unidad de Foniatría, Logopedia y Audiología, Servicio de Otorrinolaringología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Rubén Polo López
- Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Joshua S. Stohl
- North American Research Laboratory, MED-EL Corporation, Durham, North Carolina, USA
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Fletcher MD, Verschuur CA. Electro-Haptic Stimulation: A New Approach for Improving Cochlear-Implant Listening. Front Neurosci 2021; 15:581414. [PMID: 34177440 PMCID: PMC8219940 DOI: 10.3389/fnins.2021.581414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/29/2021] [Indexed: 12/12/2022] Open
Abstract
Cochlear implants (CIs) have been remarkably successful at restoring speech perception for severely to profoundly deaf individuals. Despite their success, several limitations remain, particularly in CI users' ability to understand speech in noisy environments, locate sound sources, and enjoy music. A new multimodal approach has been proposed that uses haptic stimulation to provide sound information that is poorly transmitted by the implant. This augmenting of the electrical CI signal with haptic stimulation (electro-haptic stimulation; EHS) has been shown to improve speech-in-noise performance and sound localization in CI users. There is also evidence that it could enhance music perception. We review the evidence of EHS enhancement of CI listening and discuss key areas where further research is required. These include understanding the neural basis of EHS enhancement, understanding the effectiveness of EHS across different clinical populations, and the optimization of signal-processing strategies. We also discuss the significant potential for a new generation of haptic neuroprosthetic devices to aid those who cannot access hearing-assistive technology, either because of biomedical or healthcare-access issues. While significant further research and development is required, we conclude that EHS represents a promising new approach that could, in the near future, offer a non-invasive, inexpensive means of substantially improving clinical outcomes for hearing-impaired individuals.
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Affiliation(s)
- Mark D. Fletcher
- Faculty of Engineering and Physical Sciences, University of Southampton Auditory Implant Service, University of Southampton, Southampton, United Kingdom
- Faculty of Engineering and Physical Sciences, Institute of Sound and Vibration Research, University of Southampton, Southampton, United Kingdom
| | - Carl A. Verschuur
- Faculty of Engineering and Physical Sciences, University of Southampton Auditory Implant Service, University of Southampton, Southampton, United Kingdom
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Turton L, Souza P, Thibodeau L, Hickson L, Gifford R, Bird J, Stropahl M, Gailey L, Fulton B, Scarinci N, Ekberg K, Timmer B. Guidelines for Best Practice in the Audiological Management of Adults with Severe and Profound Hearing Loss. Semin Hear 2020; 41:141-246. [PMID: 33364673 PMCID: PMC7744249 DOI: 10.1055/s-0040-1714744] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Individuals with severe to profound hearing loss are likely to present with complex listening needs that require evidence-based solutions. This document is intended to inform the practice of hearing care professionals who are involved in the audiological management of adults with a severe to profound degree of hearing loss and will highlight the special considerations and practices required to optimize outcomes for these individuals.
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Affiliation(s)
- Laura Turton
- Department of Audiology, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom
| | - Pamela Souza
- Communication Sciences and Disorders and Knowles Hearing Center, Northwestern University, Evanston, Illinois
| | - Linda Thibodeau
- University of Texas at Dallas, Callier Center for Communication Disorders, Dallas, Texas
| | - Louise Hickson
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - René Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Judith Bird
- Cambridge University Hospital NHS Foundation Trust, United Kingdom
| | - Maren Stropahl
- Department of Science and Technology, Sonova AG, Stäfa, Switzerland
| | | | | | - Nerina Scarinci
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Katie Ekberg
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Barbra Timmer
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
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