A within-subject comparison of adult patients using the Nucleus F0F1F2 and F0F1F2B3B4B5 speech processing strategies

Vowel confusion patterns in adults during initial 4 years of implant use

This study investigated adult cochlear implant users' (n = 39) vowel recognition and confusions by an open-set syllable test during 4 years of implant use, in a prospective repeated-measures design. Subjects' responses were coded for phoneme errors and estimated by the generalized mixed model. Improvement in overall vowel recognition was highest during the first 6 months, showing statistically significant change until 4 years, especially for the mediocre performers. The best performers improved statistically significantly until 18 months. The poorest performers improved until 12 months and exhibited more vowel confusions. No differences were found in overall vowel recognition between Nucleus24M/24R and Med-ElC40+ device users (matched comparison), but certain vowels showed statistically significant differences. Vowel confusions between adjacent vowels were evident, probably due to the implant users' inability to discriminate formant frequencies. Vowel confusions were also dominated by vowels whose average F1 and/or F2 frequencies were higher than the target vowel, indicating a basalward shift in the confusions.

Comparison of Continuous Interleaved Sampling and Simultaneous Analog Stimulation Speech Processing Strategies in Newly Implanted Adults with a Clarion 1.2 Cochlear Implant

OBJECTIVE

This study consisted of a within-subjects comparison of speech recognition and patient preference when subjects used two different cochlear implant speech processing strategies with a Clarion 1.2 (enhanced bipolar) device: Simultaneous Analog Stimulation (SAS), and Continuous Interleaved Sampling (CIS). These two strategies used two different electrode configurations: the SAS strategy used bipolar stimulation, whereas the CIS strategy used monopolar stimulation.

STUDY DESIGN

This was a multicenter study that used a within-subjects balanced crossover design. Experience with the two strategies was replicated in each subject using an ABAB design. Order of strategy use was balanced across all subjects.

SETTING

The study was carried out at several cochlear implant centers affiliated with tertiary medical centers.

PATIENTS

Subjects consisted of 25 postlingually deafened adults who received a Clarion cochlear implant.

INTERVENTIONS

Total involvement by each subject was 14 weeks. Speech perception testing and sound quality assessments were performed after use with each strategy.

MAIN OUTCOME MEASURES

Primary outcome measures include speech perception data and patient responses to questionnaires regarding speech and sound quality.

RESULTS

Analyses revealed that performance did not differ significantly by the strategy encountered first as relative to the strategy encountered second and that the order in which a strategy was used did not appear to affect subjects' eventual preference for a particular strategy. Although speech recognition scores tended to be higher for CIS for most of the test measures at most of the test intervals, the analysis of variance to evaluate differences in strategy did not reveal a significant effect of strategy. Further analysis of scores obtained at the replication interval, however, revealed that scores obtained with CIS were significantly higher than scores obtained with SAS on the Hearing in Noise Test sentences in quiet and noise. In addition, significantly more patients indicated a final preference for the CIS strategy than for the SAS strategy. Importantly, both the analysis evaluating order and the analysis evaluating strategy revealed significant effects of evaluation period, indicating that time/experience with the implant had a significant effect on scores for each strategy, regardless of the order in which it was used (first or second).

CONCLUSIONS

This study demonstrates that important learning occurs during the first several weeks of cochlear implant use, making it difficult to adequately compare performance with different speech processing strategies. However, the finding that patients often prefer the strategy they understand speech the best with supports the clinical practice of letting adult patients select their preferred strategy without formally evaluating speech perception with each available strategy.

Phoneme recognition and confusions with multichannel cochlear implants: consonants

The aim of this study was to investigate how postlingually severely or profoundly hearing-impaired adults relearn to recognize consonants after receiving multichannel cochlear implants. Consonant recognition of 19 Finnish-speaking subjects was studied for a minimum of 6 months and a maximum of 24 months using an open-set nonsense-syllable test in a prospective repeated-measure design. Responses were coded for phoneme errors, and proportions of correct responses and 95% confidence intervals were calculated for recognition and confusions. Two years after the switch-on, the mean recognition of consonants was 71% (95% confidence interval = 68-73%). The manner of articulation was easier to classify than the place of articulation, and the consonants [s], [r], [k], [t], [p], [n], and [j] were easier to recognize than [h], [m], [l], and [v]. Adaptation to electrical hearing with a multichannel cochlear implant was successful, but consonants with alveolar, palatal, or velar transitions (high F2) were better recognized than consonants with labial transitions (low F2). The locus of the F2 transitions of the consonants with better recognition was at the frequencies 1.5-2 kHz, whereas the locus of the F2 transitions of the consonants with poorer recognition was at 1.2-1.4 kHz. A tendency to confuse consonants with the closest consonant with higher F2 transition was also noted.

Role of the efferent medial olivocochlear system in contralateral masking and binaural interactions: an electrophysiological study in guinea pigs

Contralateral broadband noise (BBN) elevates ipsilateral auditory thresholds (central masking) and reduces the amplitude of ipsilateral brainstem auditory evoked potentials (BAEPs). Binaural interactions are complex psychophysical phenomena, but binaural interaction components are easily extracted from BAEPs to monaural versus binaural click stimulation. However, contralateral, or binaural, acoustical stimulation is known to activate simultaneously the crossed and uncrossed medial olivocochlear (MOC) efferent systems and decrease activity in both cochleas. Particularly, contralateral BBN stimulation suppresses in part ipsilateral peripheral activity. What is the role of such contralaterally induced peripheral suppression in the overall changes in central BAEPs observed during contralateral masking or binaural stimulation? Compound action potentials (CAPs) of the auditory nerve and BAEPs were recorded simultaneously in awake guinea pigs from electrodes chronically implanted on the round window of the cochlea and the surface of the brain. Peripheral and central measures of contralateral masking and binaural interactions were obtained from responses to monaural or binaural clicks, with or without contralateral BBN, recorded before, during, and after the reversible blockade of the MOC function following a single intramuscular injection of gentamicin. Contralateral BBN effectively reduced the amplitudes of CAP and of all BAEP peaks. CAP to ipsilateral click did not, however, change significantly from monaural to binaural click stimulation; still, normal binaural interaction components developed in the BAEPs. When the medial efferent function was blocked by gentamicin, the normal contralateral BBN suppression of CAP and of the earliest BAEP peak was lost; however, the later BAEP peaks were suppressed by contralateral BBN as before gentamicin, and the central binaural interaction components were unchanged. In these experimental conditions, the MOC efferent system seems to play little role in centrally recorded contralateral masking and binaural interactions.

Place-pitch sensitivity and its relation to consonant recognition by cochlear implant listeners using the MPEAK and SPEAK speech processing strategies

Two related studies investigated the relationship between place-pitch sensitivity and consonant recognition in cochlear implant listeners using the Nucleus MPEAK and SPEAK speech processing strategies. Average place-pitch sensitivity across the electrode array was evaluated as a function of electrode separation, using a psychophysical electrode pitch-ranking task. Consonant recognition was assessed by analyzing error matrices obtained with a standard consonant confusion procedure to obtain relative transmitted information (RTI) measures for three features: stimulus (RTI stim), envelope (RTI env[plc]), and place-of-articulation (RTI plc[env]). The first experiment evaluated consonant recognition performance with MPEAK and SPEAK in the same subjects. Subjects were experienced users of the MPEAK strategy who used the SPEAK strategy on a daily basis for one month and were tested with both processors. It was hypothesized that subjects with good place-pitch sensitivity would demonstrate better consonant place-cue perception with SPEAK than with MPEAK, by virtue of their ability to make use of SPEAK's enhanced representation of spectral speech cues. Surprisingly, all but one subject demonstrated poor consonant place-cue performance with both MPEAK and SPEAK even though most subjects demonstrated good or excellent place-pitch sensitivity. Consistent with this, no systematic relationship between place-pitch sensitivity and consonant place-cue performance was observed. Subjects' poor place-cue perception with SPEAK was subsequently attributed to the relatively short period of experience that they were given with the SPEAK strategy. The second study reexamined the relationship between place-pitch sensitivity and consonant recognition in a group of experienced SPEAK users. For these subjects, a positive relationship was observed between place-pitch sensitivity and consonant place-cue performance, supporting the hypothesis that good place-pitch sensitivity facilitates subjects' use of spectral cues to consonant identity. A strong, linear relationship was also observed between measures of envelope- and place-cue extraction, with place-cue performance increasing as a constant proportion (approximately 0.8) of envelope-cue performance. To the extent that the envelope-cue measure reflects subjects' abilities to resolve amplitude fluctuations in the speech envelope, this finding suggests that both envelope- and place-cue perception depend strongly on subjects' envelope-processing abilities. Related to this, the data suggest that good place-cue perception depends both on envelope-processing abilities and place-pitch sensitivity, and that either factor may limit place-cue perception in a given cochlear implant listener. Data from both experiments indicate that subjects with small electric dynamic ranges (< 8 dB for 125-Hz, 205-microsecond/ph pulse trains) are more likely to demonstrate poor electrode pitch-ranking skills and poor consonant recognition performance than subjects with larger electric dynamic ranges.

Speech perception performance in experienced cochlear-implant patients receiving the SPEAK processing strategy in the Nucleus Spectra-22 cochlear implant

Sixteen experienced cochlear implant patients with a wide range of speech-perception abilities received the SPEAK processing strategy in the Nucleus Spectra-22 cochlear implant. Speech perception was assessed in quiet and in noise with SPEAK and with the patients' previous strategies (for most, Multipeak) at the study onset, as well as after using SPEAK for 6 months. Comparisons were made within and across the two test sessions to elucidate possible learning effects. Patients were also asked to rate the strategies on seven speech recognition and sound quality scales. After 6 months' experience with SPEAK, patients showed significantly improved mean performance on a range of speech recognition measures in quiet and noise. When mean subjective ratings were compared over time there were no significant differences noted between strategies. However, many individuals rated the SPEAK strategy better for two or more of the seven subjective measures. Ratings for "appreciation of music" and "quality of my own voice" in particular were generally higher for SPEAK. Improvements were realized by patients with a wide range of speech perception abilities, including those with little or no open-set speech recognition.

Performance over time of adult patients using the Ineraid or nucleus cochlear implant

This study examined the average and individual performance over time of 49 adult cochlear implant subjects. Subjects were randomly assigned to receive either the Ineraid cochlear implant, with analog processing, or the Nucleus cochlear implant, with feature-extraction processing. All subjects had postlingual profound bilateral sensorineural hearing loss and received no significant benefit from hearing aids before implantation. Group data were examined in two ways. First, only subjects who had complete data over the test period were examined. Second, an analysis of all available data was carried out by mixed linear-model analysis. In this analysis, to account for missed follow-ups at the planned intervals, data consisting of the observations closest in time to the planned test times were modeled by natural splines with knots at the planned follow-up times. Contrasts between all pairs of planned follow-up times for each device were tested, as were contrasts between devices at each planned follow-up time. Results indicated little difference between the performance of the Ineraid and Nucleus subjects in their level of performance or their rate of learning. Postimplantation performance was typically superior to preimplantation performance within 9 months, and continued to improve up to 18-30 months depending on the speech perception measure. In some subjects, improvements in speech perception measures were observed up to four or five years postimplantation. There was also evidence that three subjects had a decrement in overall speech perception performance, although their postimplantation scores were always higher than their preimplantation scores. In at least one subjects this was likely a result of age-related cognition decrements.

Perception of rhythmic and sequential pitch patterns by normally hearing adults and adult cochlear implant users

OBJECTIVE

This study compares the musical perception of 17 adult recipients of the Nucleus cochlear implant using two different formant extraction processing strategies (F0F1F2 and MPEAK).

DESIGN

Over a 12 mo period, participants were alternately switched between two strategies every 3 mo. Performance was evaluated using three measures of rhythmic and sequential pitch perception.

RESULTS

Three individuals performed significantly better with the MPEAK strategy on one particular rhythm task, 11 participants performed better with the MPEAK strategy on another rhythm task, and no significant differences were found between the two strategies on a sequential pitch pattern task.

CONCLUSIONS

Neither strategy seems clearly superior for perception of either sequential pitch or rhythmic patterns.

Initial independent results with the Clarion cochlear implant

OBJECTIVE

This paper reports some preliminary findings from patients, implanted at the University of Iowa, using the Advanced Bionics Clarion cochlear implant (version 1.0). We compared the performance of patients using both simultaneous analog and nonsimultaneous pulsatile processing strategies. The performance of Clarion patients was also compared with a group of patients who were using either the feature-extraction Nucleus cochlear implant or the compressed-analog Ineraid cochlear implant.

DESIGN

One aim was to compare the analog and pulsatile stimulation in 19 patients using the Clarion implant. This aim could be accomplished only partially because of difficulties encountered in adequately fitting patients with the analog strategy. A second aim was to compare the Clarion users' performance with feature-extraction Nucleus and compressed-analog Ineraid patients. Comparisons were made with all patients having 9 mo experience postimplantation.

RESULTS

Subjects performed better using the pulsatile mode compared with the analog mode. All subjects chose to use the pulsatile strategy after the first 3 mo of the study. Results comparing performance at 9 mo with our compressed-analog Ineraid and feature-extraction Nucleus patients indicated, in general, better average performance for the Clarion users.

CONCLUSIONS

We conclude that the pulsatile version of the Clarion cochlear implant typically produces superior performance to the analog version of that device at this stage in its development. After 9 mo of experience, users of the Clarion implant are performing better than are users of the feature-extraction Nucleus and compressed-analog Ineraid cochlear implants with comparable amounts of experience.