Initial independent results with the Clarion cochlear implant

A Novel Pathological Voice Identification Technique through Simulated Cochlear Implant Processing Systems

This paper presents a pathological voice identification system employing signal processing techniques through cochlear implant models. The fundamentals of the biological process for speech perception are investigated to develop this technique. Two cochlear implant models are considered in this work: one uses a conventional bank of bandpass filters, and the other one uses a bank of optimized gammatone filters. The critical center frequencies of those filters are selected to mimic the human cochlear vibration patterns caused by audio signals. The proposed system processes the speech samples and applies a CNN for final pathological voice identification. The results show that the two proposed models adopting bandpass and gammatone filterbanks can discriminate the pathological voices from healthy ones, resulting in F1 scores of 77.6% and 78.7%, respectively, with speech samples. The obtained results of this work are also compared with those of other related published works.

Consonant and Vowel Identification in Cochlear Implant Users Measured by Nonsense Words: A Systematic Review and Meta-Analysis

PURPOSE

The purpose of this systematic review and meta-analysis was to establish a baseline of the vowel and consonant identification scores in prelingually and postlingually deaf users of multichannel cochlear implants (CIs) tested with consonant-vowel-consonant and vowel-consonant-vowel nonsense syllables.

METHOD

Six electronic databases were searched for peer-reviewed articles reporting consonant and vowel identification scores in CI users measured by nonsense words. Relevant studies were independently assessed and screened by 2 reviewers. Consonant and vowel identification scores were presented in forest plots and compared between studies in a meta-analysis.

RESULTS

Forty-seven articles with 50 studies, including 647 participants, thereof 581 postlingually deaf and 66 prelingually deaf, met the inclusion criteria of this study. The mean performance on vowel identification tasks for the postlingually deaf CI users was 76.8% (N = 5), which was higher than the mean performance for the prelingually deaf CI users (67.7%; N = 1). The mean performance on consonant identification tasks for the postlingually deaf CI users was higher (58.4%; N = 44) than for the prelingually deaf CI users (46.7%; N = 6). The most common consonant confusions were found between those with same manner of articulation (/k/ as /t/, /m/ as /n/, and /p/ as /t/).

CONCLUSIONS

The mean performance on consonant identification tasks for the prelingually and postlingually deaf CI users was found. There were no statistically significant differences between the scores for prelingually and postlingually deaf CI users. The consonants that were incorrectly identified were typically confused with other consonants with the same acoustic properties, namely, voicing, duration, nasality, and silent gaps. A univariate metaregression model, although not statistically significant, indicated that duration of implant use in postlingually deaf adults predict a substantial portion of their consonant identification ability. As there is no ceiling effect, a nonsense syllable identification test may be a useful addition to the standard test battery in audiology clinics when assessing the speech perception of CI users.

Cognitive Predictors of Improvements in Adults’ Spoken Word Recognition Six Months after Cochlear Implant Activation

This study investigated whether cognitive measures obtained prior to cochlear implant surgery activation could predict improvements in spoken word recognition in adult cochlear implant recipients 6 months after activation. In addition to noncognitive factors identified by previous studies (i.e. younger age, shorter duration of hearing loss), the present results indicated that improvement in spoken word recognition was associated with higher verbal learning scores and better verbal working memory. Contrary to expectation, neither general cognitive ability nor processing speed was significantly correlated with outcome at 6 months. Multiple regression analyses revealed that a combination of verbal learning scores and lip-reading skill accounted for nearly 72% of the individual differences in improvement in spoken word recognition (i.e. the variance in spoken word recognition scores at 6 months that remained unexplained after controlling for baseline spoken word recognition scores). These findings have relevance for research on auditory processing with cochlear implants as well as implications for clinical interventions.

Efficacy of a cochlear implant simultaneous analog stimulation strategy coupled with a monopolar electrode configuration

OBJECTIVES

The present study was performed to evaluate the efficacy and clinical feasibility of using monopolar stimulation with the Clarion Simultaneous Analog Stimulation (SAS) strategy in patients with cochlear implants.

METHODS

Speech recognition by 10 Clarion cochlear implant users was evaluated by means of 4 different speech processing strategy/electrode configuration combinations; ie, SAS and Continuous Interleaved Sampling (CIS) strategies were each used with monopolar (MP) and bipolar (BP) electrode configurations. The test measures included consonants, vowels, consonant-nucleus-consonant words, and Hearing in Noise Test sentences with a +10 dB signal-to-noise ratio. Additionally, subjective judgments of sound quality were obtained for each strategy/configuration combination.

RESULTS

All subjects but 1 demonstrated open-set speech recognition with the SAS/MP combination. The group mean Hearing in Noise Test sentence score for the SAS/MP combination was 31.6% (range, 0% to 92%) correct, as compared to 25.0%, 46.7%, and 37.8% correct for the CIS/BP, CIS/MP, and SAS/BP combinations, respectively. Intersubject variability was high, and there were no significant differences in mean speech recognition scores or mean preference ratings among the 4 strategy/configuration combinations tested. Individually, the best speech recognition performance was with the subject's everyday strategy/configuration combination in 72% of the applicable cases. If the everyday strategy was excluded from the analysis, the subjects performed best with the SAS/MP combination in 37.5% of the remaining cases.

CONCLUSIONS

The SAS processing strategy with an MP electrode configuration gave reasonable speech recognition in most subjects, even though subjects had minimal previous experience with this strategy/configuration combination. The SAS/MP combination might be particularly appropriate for patients for whom a full dynamic range of electrical hearing could not be achieved with a BP configuration.

Neuronal responses in cat primary auditory cortex to electrical cochlear stimulation: IV. Activation pattern for sinusoidal stimulation

Patterns of threshold distributions for single-cycle sinusoidal electrical stimulation and single pulse electrical stimulation were compared in primary auditory cortex of the adult cat. Furthermore, the effects of auditory deprivation on these distributions were evaluated and compared across three groups of adult cats. Threshold distributions for single and multiple unit responses from the middle cortical layers were obtained on the ectosylvian gyrus in an acutely implanted animal; 2 wk after deafening and implantation (short-term group); and neonatally deafened animals implanted following 2-5 yr of deafness (long-term group). For all three cases, we observed similar patterns of circumscribed regions of low response thresholds in the region of primary auditory cortex (AI). A dorsal and a ventral region of low response thresholds were found separated by a narrow, anterior-posterior strip of elevated thresholds. The ventral low-threshold regions in the short-term group were cochleotopically arranged. By contrast, the dorsal region in the short-term animals and both low-threshold regions in long-term deafened animals maintained only weak cochleotopicity. Analysis of the spatial extent of the low-threshold regions revealed that the activated area for sinusoidal stimulation was smaller and more circumscribed than for pulsatile stimulation for both dorsal and ventral AI. The width of the high-threshold ridge that separated the dorsal and ventral low-threshold regions was greater for sinusoidal stimulation. Sinusoidal and pulsatile threshold behavior differed significantly for electrode configurations with low and high minimum thresholds. Differences in threshold behavior and cortical response distributions between the sinusoidal and pulsatile stimulation suggest that stimulus shape plays a significant role in the activation of cortical activity. Differences in the activation pattern for short-term and long-term deafness reflect deafness-induced reorganizational changes based on factors such as differences in excitatory and inhibitory balance that are affected by the stimulation parameters.

Patterns of phoneme perception errors by listeners with cochlear implants as a function of overall speech perception ability

Many studies have noted great variability in speech perception ability among postlingually deafened adults with cochlear implants. This study examined phoneme misperceptions for 30 cochlear implant listeners using either the Nucleus-22 or Clarion version 1.2 device to examine whether listeners with better overall speech perception differed qualitatively from poorer listeners in their perception of vowel and consonant features. In the first analysis, simple regressions were used to predict the mean percent-correct scores for consonants and vowels for the better group of listeners from those of the poorer group. A strong relationship between the two groups was found for consonant identification, and a weak, nonsignificant relationship was found for vowel identification. In the second analysis, it was found that less information was transmitted for consonant and vowel features to the poorer listeners than to the better listeners; however, the pattern of information transmission was similar across groups. Taken together, results suggest that the performance difference between the two groups is primarily quantitative. The results underscore the importance of examining individuals' perception of individual phoneme features when attempting to relate speech perception to other predictor variables.

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.

The effect of long-term deafness on speech recognition in postlingually deafened adult CLARION cochlear implant users

Research suggests that duration of deafness prior to cochlear implantation affects postoperative speech recognition in adults. Duration of deafness usually is defined as the number of years between the onset of profound deafness and implantation. The purpose of this study was to examine the effects of duration of deafness--expressed as percentage of life with deafness--independent of age at implantation on postoperative speech recognition in adult postlingually deafened CLARION Multi-Strategy Cochlear Implant users. Speech recognition tests (CID sentences and NU6 words) were administered to 202 consecutively implanted adults preoperatively and at 3 and 6 months after initial device fitting. Patients implanted at a younger age and those with smaller percentages of their lives with deafness achieved the highest levels of short-term postoperative speech recognition. Patients who had been deaf for > or =60% of their lives demonstrated a slower rate of speech recognition improvement than those with shorter durations of deafness, but still continued to improve with increased implant experience.

Gap detection by early-deafened cochlear-implant subjects

Two studies investigating gap-detection thresholds were conducted with cochlear-implant subjects whose onset of profound hearing loss was very early in life. The Cochlear Limited multiple-electrode prosthesis was used. The first study investigated the effects of pulse rate (200, 500, and 1000 pulses/s) and stimulus duration (500 and 1000 ms) on gap thresholds in 15 subjects. Average gap thresholds were 1.8 to 32.1 ms. There was essentially no effect of pulse rate and for almost all subjects, no effect of stimulus duration. For two subjects, performance was poorer for the 1000-ms stimulus duration. The second study investigated the relationships between gap thresholds, subject variables, and speech-perception scores. Data from the first study were combined with those from previous studies [Busby et al., Audiology 31, 95-111 (1992); Tong et al., J. Acoust. Soc. Am. 84, 951-962 (1988)], providing data from 27 subjects. A significant negative correlation was found between age at onset of deafness and gap thresholds and most variability in gap thresholds was for the congenitally deaf subjects. Significant negative correlations were found between gap thresholds and word scores for open-set Bamford-Kowal-Bench (BKB) sentences in the auditory-visual condition and lipreading enhancement scores for the same test.

The recognition of sentences in noise by normal-hearing listeners using simulations of cochlear-implant signal processors with 6-20 channels

Sentences were processed through simulations of cochlear-implant signal processors with 6, 8, 12, 16, and 20 channels and were presented to normal-hearing listeners at +2 db S/N and at -2 db S/N. The signal-processing operations included bandpass filtering, rectification, and smoothing of the signal in each band, estimation of the rms energy of the signal in each band (computed every 4 ms), and generation of sinusoids with frequencies equal to the center frequencies of the bands and amplitudes equal to the rms levels in each band. The sinusoids were summed and presented to listeners for identification. At issue was the number of channels necessary to reach maximum performance on tests of sentence understanding. At +2 dB S/N, the performance maximum was reached with 12 channels of stimulation. At -2 dB S/N, the performance maximum was reached with 20 channels of stimulation. These results, in combination with the outcome that in quiet, asymptotic performance is reached with five channels of stimulation, demonstrate that more channels are needed in noise than in quiet to reach a high level of sentence understanding and that, as the S/N becomes poorer, more channels are needed to achieve a given level of performance.

The identification of consonants and vowels by cochlear implant patients using a 6-channel continuous interleaved sampling processor and by normal-hearing subjects using simulations of processors with two to nine channels

OBJECTIVE

To compare the vowel and consonant identification ability of cochlear implant patients using a 6-channel continuous interleaved sampling (CIS) processor and of normal-hearing subjects using simulations of processors with two to nine channels.

DESIGN

Subjects, 10 normal-hearing listeners and seven cochlear implant patients, were presented synthetic vowels in /bVt/ context, natural vowels produced by men, women, and girls in /hVd/ context, and consonants in /aCa/ context for identification. Stimuli for the normal-hearing subjects were pre-processed through simulations of implant processors with two to nine channels and were output as the sum of sinusoids at the center frequencies of the analysis filters.

RESULTS

Five implant patients' scores fell within the range of normal performance with a 6-channel processor when the patients were tested with synthetic vowels. Four patients' scores fell within the range of normal with a 6-channel processor when the patients were tested with multitalker vowels. Five patients' scores fell within the range of normal for a 6-channel processor for the consonant feature "place of articulation."

CONCLUSION

Signal processing technology for cochlear implants has matured sufficiently to allow some patients who use CIS processors and a small number of monopolar electrodes to achieve scores on tests of speech identification that are within the range of scores established by normal-hearing subjects listening to speech processed through a small number of channels.

Nucleus 22 cochlear implantation results in postmeningitic deafness

Cochlear implant surgery was performed on 13 patients with postmeningitic deafness (seven adults, six children). Two adults and two children (30.8%) had severe labyrinthitis ossificans requiring radical "drill-out." Five of 13 (38.5%) had some bone growth requiring partial drill-out, and four of 13 (30.8%) had normal insertion with no drill-out. Hearing results for patients with no bone growth were similar to nonmeningitic patients; three of four (75%) had open-set speech recognition. Performance of patients with total drill-out was poor; "auditory only" performance was limited to detection and pattern perception of speech, and no patients had open-set speech recognition. Results for patients with partial drill-out were similar to results in patients with no bone growth. Labyrinthitis ossificans not only presents surgical challenges to cochlear implantation but may also adversely affect hearing outcome.