A Music-Related Quality of Life Measure to Guide Music Rehabilitation for Adult Cochlear Implant Users

Adults With Cochlear Implants: Residual Hearing, Musical Perception, and Temporal Skills

PURPOSE

The main purpose of the study is to investigate whether the presence of residual hearing before cochlear implantation has an effect on temporal pattern recognition skills and musical perception in adults.

METHOD

The study included adults with cochlear implants who were between the ages of 20 and 45 years. Adults with cochlear implants were divided into two groups: absent (n = 20) and available (n = 20) groups according to residual hearing before implantation. Frequency Pattern and Duration Pattern tests were applied to evaluate temporal pattern recognition, and the "Music-Related Quality of Life Questionnaire" was applied to evaluate musical perceptions.

RESULTS

There were no statistically significant differences between the groups in terms of cochlear-implanted hearing thresholds and speech recognition scores, musical perception, and musical activities, according to their residual hearing. On the other hand, the frequency and duration pattern recognition skills were statistically significantly better in adults with residual hearing. Also, statistically significant correlations were obtained in terms of temporal skills and musical perception subskills.

CONCLUSIONS

The presence of residual hearing before cochlear implantation may affect temporal auditory processing skills. It is concluded that the integration of cochlear implants may affect temporal processing skills in adults as well as quality of life. It is recommended that experts be aware of this issue and pay attention to residual hearing.

Meludia platform as a tool to evaluate music perception in pediatric and adult cochlear implant users

PURPOSE

Music perception is one of the greatest challenges for cochlear implant (CI) users. The aims of this study were: (i) to evaluate the music perception of CI users using the online Meludia music training program as music testing platform, (ii) to compare performance among three age groups, and (iii) to compare CI users with their normal hearing (NH) peers.

METHODS

138 individuals participated, divided between children (6-10 y), adolescents (11-16 y), and adults (≥ 17 y). Five music perception tasks were evaluated: Rhythm, Spatialization, Stable/unstable, Melody, and Density. We also administered the music related quality of life (MuRQoL) questionnaire for adults, and a music questionnaire for pediatric population (6-16 y) (MuQPP).

RESULTS

A significantly higher percentage of the adolescent CI users completed the five tasks compared to the other age groups. Both pediatric and adolescent CI users had similar performance to their NH peers in most categories. On the MuRQoL, adult NH listeners reported more music exposure than CI users (3.8 ± 0.6 vs 3.0 ± 0.6, p < 0.01), but both groups reported similar levels of perceived music importance (3.4 ± 0.7 vs 3.2 ± 1.1, p = 0.340). On the MuQPP, pediatric CI users who scored highly on music perception also had higher reported questionnaire scores (54.2 ± 12.9 vs 40.9 ± 12.1, p = 0.009).

CONCLUSIONS

Meludia can be used to evaluate music perception and to use for music training in CI users of all ages. Adolescents had the highest performance in most musical tasks. Pediatric CI users were more similar to their NH peers. The importance of music in adult CI users was comparable to their NH peers.

Objective and Subjective Assessment of Music Perception and Musical Experiences in Young Cochlear Implant Users

For many individuals, music has a significant impact on the quality and enjoyability of life. Cochlear implant (CI) users must cope with the constraints that the CI imposes on music perception. Here, we assessed the musical experiences of young CI users and age-matched controls with normal hearing (NH). CI users and NH peers were divided into subgroups according to age: children and adolescents. Participants were tested on their ability to recognize vocal and instrumental music and instruments. A music questionnaire for pediatric populations (MuQPP) was also used. CI users and NH peers identified a similar percentage of vocal music. CI users were significantly worse at recognizing instruments (p < 0.05) and instrumental music (p < 0.05). CI users scored similarly to NH peers on the MuQPP, except for the musical frequency domain, where CI users in the children subgroup scored higher than their NH peers (p = 0.009). For CI users in the children subgroup, the identification of instrumental music was positively correlated with music importance (p = 0.029). Young CI users have significant deficits in some aspects of music perception (instrumental music and instrument identification) but have similar scores to NH peers in terms of interest in music, frequency of music exposure, and importance of music.

The Impact of Musical Rehabilitation on Complex Sound Perception in Cochlear Implant Users: A Systematic Review

OBJECTIVE

Musical rehabilitation has been used in clinical and nonclinical contexts to improve postimplantation auditory processing in implanted individuals. This systematic review aimed to evaluate the efficacy of music rehabilitation in controlled experimental and quasi-experimental studies on cochlear implant (CI) user speech and music perception.

DATABASES REVIEWED

PubMed/MEDLINE, EMBASE, Web of Science, PsycARTICLES, and PsycINFO databases through July 2022.

METHODS

Controlled experimental trials and prospective studies were included if they compared pretest and posttest data and excluded hearing aid-only users. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were then used to extract data from 11 included studies with a total of 206 pediatric and adult participants. Interventions included group music therapy, melodic contour identification training, auditory-motor instruction, or structured digital music training. Studies used heterogeneous outcome measures evaluating speech and music perception. Risk of bias was assessed using the National Heart, Lung, and Blood Institute Quality Assessment Tool.

RESULTS

A total of 735 studies were screened, and 11 met the inclusion criteria. Six trials reported both speech and music outcomes, whereas five reported only music perception outcomes after the intervention relative to control. For music perception outcomes, significant findings included improvements in melodic contour identification (five studies, p < 0.05), timbre recognition (three studies, p < 0.05), and song appraisal (three studies, p < 0.05) in their respective trials. For speech prosody outcomes, only vocal emotion identification demonstrated significant improvements (two studies, p < 0.05).

CONCLUSION

Music rehabilitation improves performance on multiple measures of music perception, as well as tone-based characteristics of speech (i.e., emotional prosody). This suggests that rehabilitation may facilitate improvements in the discrimination of spectrally complex signals.

Development and validation of BATUTA: a test to evaluate the musical perception of people with hearing impairment

PURPOSE

To describe the development and validation of a test, called BATUTA, that assesses the musical perception of people with hearing impairment that are hearing aid (HA) users. BATUTA is a computerized test with 35 subtests, divided into the rhythm, pitch, and timbre modules, and the participants must answer whether the sound samples and/or parts of the songs, presented in pairs, are the same or not.

METHODS

The BATUTA creation process consisted of four stages: test development, submission to the expert committee for content validation; pilot application with 51 normal hearing participants and retest to validate reliability. The process was based on several recommendations for the development and validation of musical assessment instruments. A deep investigation of the guidelines related to sound samples used, musical attributes evaluated, testing environment and the most appropriate response method was undertaken to ensure dependability.

RESULTS

The Content Validity Index (CVI) and expert agreement rates, when analyzed with the committee's recommendations, resulted in corrections and new audio recordings to ensure compliance to the test. The pilot test scores indicated internal consistency and the retest confirmed the reliability of BATUTA.

CONCLUSION

The results demonstrated the viability of BATUTA to assess the musical perception of people with hearing impairment that are HA users.

Musical Mistuning Perception and Appraisal in Cochlear Implant Recipients

OBJECTIVE

Music is a very crucial art form that can evoke emotions, and the harmonious presence of the human voice in music is an impactful part of this process. As a result, vocals have had some significant effects on contemporary music. The mechanism behind the cochlear implant (CI) recipients perceiving different aspects of music is clear; however, how well they perceive vocal tuning within music it is not well known. Hence, this study evaluated the mistuning perception of CI recipients and compared their performance with normal-hearing (NH) listeners.

STUDY DESIGN, SETTING, AND PATIENTS

A total of 16 CI users (7 cisgender men, 9 cisgender women) and 16 sex-matched NH controls with an average age of 30.2 (±10.9; range, 19-53) years and 23.5 (±6.1; range, 20-37) years, respectively, were enrolled in this study. We evaluated the mistuning ability using the mistuning perception test (MPT) and assessed self-perceived music perception and engagement using the music-related quality-of-life questionnaire. Test performance was measured and reported on the item-response theory metric with a z score ranging from -4 to +4.

RESULTS

A significant difference in the MPT scores was found between NH and CI recipients, whereas a significant correlation was noted between the music-related quality-of-life questionnaire-frequency subscale and MPT scores. No significant correlations were found between age, CI age, and CI usage duration and MPT performance.

CONCLUSIONS

This study revealed that musical mistuning perception is a limitation for CI recipients, similar to previously evaluated aspects of music perception. Hence, it is important to consider this aspect in the assessment of music perception, enjoyment, and music-based auditory interventions in CI recipients, as vocals are paramount in music perception and recreation. The MPT is a convenient and accessible tool for mistuning assessment in CI and hearing-aid users.

Application of Patient Reported Outcome Measures in Cochlear Implant Patients: Implications for the Design of Specific Rehabilitation Programs

INTRODUCTION

Cochlear implants (CI) have been developed to enable satisfying verbal communication, while music perception has remained in the background in both the research and technological development, thus making CI users dissatisfied by the experience of listening to music. Indications for clinicians to test and train music abilities are at a preliminary stage compared to the existing and well-established hearing and speech rehabilitation programs. The main aim of the present study was to test the utility of the application of two different patient reporting outcome (PRO) measures in a group of CI users. A secondary objective was to identify items capable of driving the indication and design specific music rehabilitation programs for CI patients.

MATERIALS AND METHODS

A consecutive series of 73 CI patients referred to the Audiology Unit, University of Padova, was enrolled from November 2021 to May 2022 and evaluated with the audiological battery test and PRO measures: Musica e Qualità della Vita (MUSQUAV) and Nijmegen Cochlear Implant Questionnaire (NCIQ) Italian version.

RESULTS

The reliability analysis showed good consistency between the different PRO measures (Cronbach's alpha = 0.873). After accounting for the epidemiological and clinical variables, the PRO measures showed a correlation with audiological outcomes in only one case (rho = -0.304; adj. p = 0.039) for NCIQ-T with the CI-pure tone average. A willingness for musical rehabilitation was present in 63% of patients (Rehab Factor, mean value of 0.791 ± 0.675).

CONCLUSIONS

We support the role of the application of MUSQUAV and NCIQ to improve the clinical and audiological evaluation of CI patients. Moreover, we proposed a derivative item, called the rehab factor, which could be used in clinical practice and future studies to clarify the indication and priority of specific music rehabilitation programs.

The music-related quality of life: Italian validation of MuRQoL into MUSQUAV questionnaire and preliminary data from a cohort of postlingually deafened cochlear implant users

PURPOSE

Cochlear implant (CI) users do not receive much of the auditory information necessary for an accurate perception of music. This usually entails a dissatisfaction with the music they hear, so that their quality of life may potentially be affected. The main aim of this paper was to translate and validate into Italian an instrument to evaluate these aspects-The Music-Related Quality of Life Questionnaire (MuRQoL)-to help the work of clinicians and therapists.

METHODS

The translation of the MuRQoL into "Questionario Musica e Qualità della Vita" (MUSQUAV) was done according to the international guidelines. The translated questionnaire was administered to normal hearing (NH) and CI users adults. Exploratory factor analysis, confirmatory factor analysis and known group method were used to confirm construct validity and applicability of MUSQUAV.

RESULTS

We retrieved 225 results. The MUSQUAV questionnaire was acceptable according to the goodness-of-fit indices. The correlation between the items, evaluated using Cronbach's α coefficient, indicates a good internal consistency (> 0.80). The non-parametric Mann-Whitney test showed significant differences in the distinct populations tested.

CONCLUSIONS

The MUSQUAV questionnaire is a valid, low-cost and rapid instrument for professional workers in the audiological field, especially useful in the assessment of the patients' perception and musical engagement.

Guidelines for Best Practice in the Audiological Management of Adults Using Bimodal Hearing Configurations

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.

Self-reported music perception is related to quality of life and self-reported hearing abilities in cochlear implant users

OBJECTIVES

To investigate the relationship between self-reported music perception and appreciation and (1) quality of life (QoL), and (2) self-assessed hearing ability in 98 post-lingually deafened cochlear implant (CI) users with a wide age range.

METHODS

Participants filled three questionnaires: (1) the Dutch Musical Background Questionnaire (DMBQ), which measures the music listening habits, the quality of the sound of music and the self-assessed perception of elements of music; (2) the Nijmegen Cochlear Implant Questionnaire (NCIQ), which measures health-related QoL; (3) the Speech, Spatial and Qualities (SSQ) of hearing scale, which measures self-assessed hearing ability. Additionally, speech perception was behaviorally measured with a phoneme-in-word identification.

RESULTS

A decline in music listening habits and a low rating of the quality of music after implantation are reported in DMBQ. A significant relationship is found between the music measures and the NCIQ and SSQ; no significant relationships are observed between the DMBQ and speech perception scores.

CONCLUSIONS

The findings suggest some relationship between CI users' self-reported music perception ability and QoL and self-reported hearing ability. While the causal relationship is not currently evaluated, the findings may imply that music training programs and/or device improvements that improve music perception may improve QoL and hearing ability.

Musical Perception Assessment of People With Hearing Impairment: A Systematic Review and Meta-Analysis

Purpose People with hearing impairment (HI) face numerous challenges that can be minimized with the use of hearing aids and cochlear implants. Despite technological advances in these assistive hearing devices, musical perception remains difficult for these people. Tests and protocols developed to assess the musical perception of this audience were the target of this systematic review, whose objective was to investigate how assessments of musical perception in people with HI are carried out. Method Searches for primary articles were carried out in the PubMed/MEDLINE, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature, and ASHAWire databases. Search results were managed using EndNote X9 software, and analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement. Results The 16 cross-sectional included studies analyzed music perception data from people with HI compared to a control group of participants with normal hearing. Among these, four studies were selected to be included in a meta-analysis, performed with timbre and melody. Variability was observed in the tests and between the levels of auditory perception skills analyzed in relation to the components of music. With respect to the tests, sound stimuli generated by synthesizers were the most used stimuli; with the exception of timbre evaluation, the most frequent test environment was a booth with sound attenuation, and the average intensity for presenting sound stimuli was 70 dB SPL. The most evaluated sound component was pitch, followed by rhythm and timbre, with a pattern of responses based on adaptive and psychoacoustic methods. Conclusions The heterogeneity of the musical parameters and the auditory abilities evaluated by the tests is a fact that can compromise evidence found in this area of study. It is worth considering the quality of samples that were recorded with real musical instruments and digitized afterward, in comparison with synthesized samples that do not seem to accurately represent real instruments. The need to minimize semantic parallelism that involves the auditory skills and elements of music involved in the assessment of musical perception is highlighted.

Participation of Acoustic and Electric Hearing in Perceiving Musical Sounds

Introduction: The objective of our study was to evaluate musical perception and its relation to the quality of life in patients with bimodal binaural auditory stimulation.

Materials and Methods: Nineteen adult patients with a cochlear implant (CI) for minimum 6 months, and moderate to severe contralateral hearing loss with a hearing aid (HA), and 21 normal hearing adults were included in this prospective, cross-sectional study. Pure-tone and speech audiometry, musical test evaluating sound perception characteristics and musical listening abilities, Munich questionnaire for musical habits, and the APHAB questionnaire were recoded. Performance in musical perception test with HA, CI, and HA + CI, and potential correlations between music test, audiometry and questionnaires were investigated.

Results: Bimodal stimulation improved musical perception in several features (sound brightness, roughness, and clarity) in comparison to unimodal hearing, but CI did not add to HA performances in texture, polyphony or musical emotion and even appeared to interfere negatively in pitch perception with HA. Musical perception performances (sound clarity, instrument recognition) appeared to be correlated to hearing-related quality of life (APHAB RV and EC subdomains) but not with speech performances suggesting that the exploration of musical perception complements speech understanding evaluation to better describe every-day life hearing handicap.

Conclusion: Testing musical sound perception provides important information on hearing performances as a complement to speech audiometry and appears to be related to hearing-related quality of life.

Assessment of music experience after cochlear implantation: A review of current tools and their utilization

Objective

To provide an overview of the current available music assessment tools after cochlear implantation (CI); to report on the utilization of music assessments in the literature; to propose potential future directions in music assessment after CI.

Methods

A thorough search was performed in PubMed, Embase, and The Cochrane Library through October 31, 2020. MeSH search terms, keywords, and phrases included “cochlear implant,” “cochlear prosthesis,” “auditory prosthesis,” “music,” “music assessment,” “music questionnaire,” “music perception,” “music enjoyment, and “music experience.” Potentially relevant studies were reviewed for inclusion, with particular focus on assessments developed specifically for the cochlear implant population and intended for widespread use.

Results/conclusions

Six hundred and forty-three studies were screened for relevance to assessment of music experience among cochlear implantees. Eighty-one studies ultimately met criteria for inclusion. There are multiple validated tools for assessment of music experience after cochlear implantation, each of which provide slightly differing insights into the patients’ subjective and/or objective post-activation experience. However, no single assessment tool has been adopted into widespread use and thus, much of the literature pertaining to this topic evaluates outcomes non-uniformly, including single-use assessments designed specifically for the study at hand. The lack of a widely accepted universal tool for assessment of music limits our collective understanding the contributory and mitigating factors applicable to current music experience of cochlear implantees, and limits our ability to uniformly evaluate the success of new implant technologies or music training paradigms.

Translation and validation of the music-related quality of life questionnaire for adults with cochlear implant in Turkish language

PURPOSE

It is important to assess the impact of music on cochlear implant (CI) users' quality of life. The aim of this study was to adapt and validate the music-related quality of life questionnaire into the Turkish language for adult CI users.

METHODS

161 CI users and 162 normal-hearing adults were included in the study. The final Turkish version of the questionnaire was prepared and evaluated for validity and reliability. The internal consistency of the questionnaire and test-retest reliability were evaluated by Cronbach's α and ICC index. Factor analysis and 'know-group' method was used to determine the construct validity.

RESULTS

Sampling adequacy for execution of factor analysis was confirmed by the results of Kaiser-Meyer-Olkin (= 0.91) and Bartlett test (p < 0.05). 2 factors for each scale were identified from exploratory factor analysis. Confirmatory factor analysis confirmed the questionnaire met the criteria standards for adequacy of fit. The reliability coefficient was determined at least 0.80. Correlation between items indicated excellent (> .80) internal consistency.

CONCLUSION

The Turkish version of the questionnaire has good validity and reliability and can be used to investigate the relationship between music and quality of life and as a diagnostic tool in identifying individuals who need music support and to guide and evaluate music rehabilitation.

Development of the Basic Auditory Skills Evaluation Battery for Online Testing of Cochlear Implant Listeners

Purpose Cochlear implant (CI) performance varies considerably across individuals and across domains of auditory function, but clinical testing is typically restricted to speech intelligibility. The goals of this study were (a) to develop a basic auditory skills evaluation battery of tests for comprehensive assessment of ecologically relevant aspects of auditory perception and (b) to compare CI listeners' performance on the battery when tested in the laboratory by an audiologist or independently at home. Method The battery included 17 tests to evaluate (a) basic spectrotemporal processing, (b) processing of music and environmental sounds, and (c) speech perception in both quiet and background noise. The battery was administered online to three groups of adult listeners: two groups of postlingual CI listeners and a group of older normal-hearing (ONH) listeners of similar age. The ONH group and one CI group were tested in a laboratory by an audiologist, whereas the other CI group self-tested independently at home following online instructions. Results Results indicated a wide range in the performance of CI but not ONH listeners. Significant differences were not found between the two CI groups on any test, whereas on all but two tests, CI listeners' performance was lower than that of the ONH participants. Principal component analysis revealed that four components accounted for 82% of the variance in measured results, with component loading indicating that the test battery successfully captures differences across dimensions of auditory perception. Conclusions These results provide initial support for the use of the basic auditory skills evaluation battery for comprehensive online assessment of auditory skills in adult CI listeners.

The CI MuMuFe - A New MMN Paradigm for Measuring Music Discrimination in Electric Hearing

Cochlear implants (CIs) allow good perception of speech while music listening is unsatisfactory, leading to reduced music enjoyment. Hence, a number of ongoing efforts aim to improve music perception with a CI. Regardless of the nature of these efforts, effect measurements must be valid and reliable. While auditory skills are typically examined by behavioral methods, recording of the mismatch negativity (MMN) response, using electroencephalography (EEG), has recently been applied successfully as a supplementary objective measure. Eleven adult CI users and 14 normally hearing (NH) controls took part in the present study. To measure their detailed discrimination of fundamental features of music we applied a new multifeature MMN-paradigm which presented four music deviants at four levels of magnitude, incorporating a novel "no-standard" approach to be tested with CI users for the first time. A supplementary test measured behavioral discrimination of the same deviants and levels. The MMN-paradigm elicited significant MMN responses to all levels of deviants in both groups. Furthermore, the CI-users' MMN amplitudes and latencies were not significantly different from those of NH controls. Both groups showed MMN strength that was in overall alignment with the deviation magnitude. In CI users, however, discrimination of pitch levels remained undifferentiated. On average, CI users' behavioral performance was significantly below that of the NH group, mainly due to poor pitch discrimination. Although no significant effects were found, CI users' behavioral results tended to be in accordance with deviation magnitude, most prominently manifested in discrimination of the rhythm deviant. In summary, the study indicates that CI users may be able to discriminate subtle changes in basic musical features both in terms of automatic neural responses and of attended behavioral detection. Despite high complexity, the new CI MuMuFe paradigm and the "no-standard" approach provided reliable results, suggesting that it may serve as a relevant tool in future CI research. For clinical use, future studies should investigate the possibility of applying the paradigm with the purpose of assessing discrimination skills not only at the group level but also at the individual level.