Speech recognition with the nucleus 24 SPEAK, ACE, and CIS speech coding strategies in newly implanted adults

Consonant and vowel confusions in well-performing adult cochlear implant users, measured with a nonsense syllable repetition test

OBJECTIVE

The study's objective was to identify consonant and vowel confusions in cochlear implant (CI) users, using a nonsense syllable repetition test.

DESIGN

In this cross-sectional study, participants repeated recorded mono- and bisyllabic nonsense words and real-word monosyllables in an open-set design.

STUDY SAMPLE

Twenty-eight Norwegian-speaking, well-performing adult CI users (13 unilateral and 15 bilateral), using implants from Cochlear, Med-El and Advanced Bionics, and a reference group of 20 listeners with normal hearing participated.

RESULTS

For the CI users, consonants were confused more often than vowels (58% versus 71% correct). Voiced consonants were confused more often than unvoiced (54% versus 64% correct). Voiced stops were often repeated as unvoiced, whereas unvoiced stops were never repeated as voiced. The nasals were repeated correctly in one third of the cases and confused with other nasals in one third of the cases. The real-word monosyllable score was significantly higher than the nonsense syllable score (76% versus 63% correct).

CONCLUSIONS

The study revealed a general devoicing bias for the stops and a high confusion rate of nasals with other nasals, which suggests that the low-frequency coding in CIs is insufficient. Furthermore, the nonsense syllable test exposed more perception errors than the real word test.

Objective intelligibility measurement of reverberant vocoded speech for normal-hearing listeners: Towards facilitating the development of speech enhancement algorithms for cochlear implants

Cochlear implant (CI) recipients often struggle to understand speech in reverberant environments. Speech enhancement algorithms could restore speech perception for CI listeners by removing reverberant artifacts from the CI stimulation pattern. Listening studies, either with cochlear-implant recipients or normal-hearing (NH) listeners using a CI acoustic model, provide a benchmark for speech intelligibility improvements conferred by the enhancement algorithm but are costly and time consuming. To reduce the associated costs during algorithm development, speech intelligibility could be estimated offline using objective intelligibility measures. Previous evaluations of objective measures that considered CIs primarily assessed the combined impact of noise and reverberation and employed highly accurate enhancement algorithms. To facilitate the development of enhancement algorithms, we evaluate twelve objective measures in reverberant-only conditions characterized by a gradual reduction of reverberant artifacts, simulating the performance of an enhancement algorithm during development. Measures are validated against the performance of NH listeners using a CI acoustic model. To enhance compatibility with reverberant CI-processed signals, measure performance was assessed after modifying the reference signal and spectral filterbank. Measures leveraging the speech-to-reverberant ratio, cepstral distance and, after modifying the reference or filterbank, envelope correlation are strong predictors of intelligibility for reverberant CI-processed speech.

Incidence of Cochlear Implant Electrode Contacts in the Functional Acoustic Hearing Region and the Influence on Speech Recognition with Electric-Acoustic Stimulation

OBJECTIVES

To investigate the incidence of electrode contacts within the functional acoustic hearing region in cochlear implant (CI) recipients and to assess its influence on speech recognition for electric-acoustic stimulation (EAS) users.

STUDY DESIGN

Retrospective review.

SETTING

Tertiary referral center.

PATIENTS

One hundred five CI recipients with functional acoustic hearing preservation (≤80 dB HL at 250 Hz).

INTERVENTIONS

Cochlear implantation with a 24-, 28-, or 31.5-mm lateral wall electrode array.

MAIN OUTCOME MEASURES

Angular insertion depth (AID) of individual contacts was determined from imaging. Unaided acoustic thresholds and AID were used to calculate the proximity of contacts to the functional acoustic hearing region. The association between proximity values and speech recognition in quiet and noise for EAS users at 6 months postactivation was reviewed.

RESULTS

Sixty percent of cases had one or more contacts within the functional acoustic hearing region. Proximity was not significantly associated with speech recognition in quiet. Better performance in noise was observed for cases with close correspondence between the most apical contact and the upper edge of residual hearing, with poorer results for increasing proximity values in either the basal or apical direction ( r14 = 0.48, p = 0.043; r18 = -0.41, p = 0.045, respectively).

CONCLUSION

There was a high incidence of electrode contacts within the functional acoustic hearing region, which is not accounted for with default mapping procedures. The variability in outcomes across EAS users with default maps may be due in part to electric-on-acoustic interference, electric frequency-to-place mismatch, and/or failure to stimulate regions intermediate between the most apical electrode contact and the functional acoustic hearing region.

En route to sound coding strategies for optical cochlear implants

Hearing loss is the most common human sensory deficit. Severe-to-complete sensorineural hearing loss is often treated by electrical cochlear implants (eCIs) bypassing dysfunctional or lost hair cells by direct stimulation of the auditory nerve. The wide current spread from each intracochlear electrode array contact activates large sets of tonotopically organized neurons limiting spectral selectivity of sound coding. Despite many efforts, an increase in the number of independent eCI stimulation channels seems impossible to achieve. Light, which can be better confined in space than electric current may help optical cochlear implants (oCIs) to overcome eCI shortcomings. In this review, we present the current state of the optogenetic sound encoding. We highlight optical sound coding strategy development capitalizing on the optical stimulation that requires fine-grained, fast, and power-efficient real-time sound processing controlling dozens of microscale optical emitters as an emerging research area.

Familiar and unfamiliar speaker recognition assessment and system emulation for cochlear implant users

In the area of speech processing, human speaker identification under naturalistic environments is a challenging task, especially for hearing-impaired individuals with cochlear implants (CIs) or hearing aids (HAs). Motivated by the fact that electrodograms reflect direct CI stimulation of input audio, this study proposes a speaker identification (ID) investigation using two-dimensional electrodograms constructed from the responses of a CI auditory system to emulate CI speaker ID capabilities. Features are extracted from electrodograms through an identity vector (i-vector) framework to train and generate identity models for each speaker using a Gaussian mixture model-universal background model followed by probabilistic linear discriminant analysis. To validate the proposed system, perceptual speaker ID for 20 normal hearing (NH) and seven CI listeners was evaluated with a total of 41 different speakers and compared with the scores from the proposed system. A one-way analysis of variance showed that the proposed system can reliably predict the speaker ID capability of CI (F[1,10] = 0.18, p = 0.68) and NH (F[1,20] = 0, p = 0.98) listeners in naturalistic environments. The impact of speaker familiarity is also addressed, and the results show a reduced performance for speaker recognition by CI subjects using their CI processor, highlighting limitations of current speech processing strategies used in CIs/HAs.

Mild therapeutic hypothermia protects against inflammatory and proapoptotic processes in the rat model of cochlear implant trauma

OBJECTIVE

Mild therapeutic hypothermia (MTH) has been demonstrated to prevent residual hearing loss from surgical trauma associated with cochlear implant (CI) insertion. Here, we aimed to characterize the mechanisms of MTH-induced hearing preservation in CI in a well-established preclinical rodent model.

APPROACH

Rats were divided into four experimental conditions: MTH-treated and implanted cochleae, cochleae implanted under normothermic conditions, MTH only cochleae and un-operated cochleae (controls). Auditory brainstem responses (ABRs) were recorded at different time points (up to 84 days) to confirm long-term protection and safety of MTH locally applied to the cochlea for 20 min before and after implantation. Transcriptome sequencing profiling was performed on cochleae harvested 24 h post CI and MTH treatment to investigate the potential beneficial effects and underlying active gene expression pathways targeted by the temperature management.

RESULTS

MTH treatment preserved residual hearing up to 3 months following CI when compared to the normothermic CI group. In addition, MTH applied locally to the cochleae using our surgical approach was safe and did not affect hearing in the long-term. Results of RNA sequencing analysis highlight positive modulation of signaling pathways and gene expression associated with an activation of cellular inflammatory and immune responses against the mechanical damage caused by electrode insertion.

SIGNIFICANCE

These data suggest that multiple and possibly independent molecular pathways play a role in the protection of residual hearing provided by MTH against the trauma of cochlear implantation.

Effect of Electrode Insertion Angle on Cochlear Implantation Outcomes in Adult and Children Patients with Sensorineural Hearing Loss

Purpose

To determine the role played by electrode insertion angle in cochlear implantation (CI) outcomes in adult and children patients with sensorineural hearing loss (SNHL).

Methods

Adults (n = 10) and children (n = 19) with SNHL undergoing CI in a tertiary specialized hospital were retrospectively enrolled. The measurements were evaluated before and after CI surgery using sound field audiometry and speech recognition tests. Questionnaires were used to assess subjective benefits. Electrode insertion angles were determined using postoperative X-rays.

Results

Both adult and children patients showed significant improvements in hearing, speech performance, and audiology and speech-related quality of life after CI. The angular insertion depths of adult and children group were 323.70 ± 43.57° and 341.53 ± 57.07°, respectively, showing no significant difference. In the adult group, deeper insertion depths were found to be strongly linked to lower postoperative pure tone thresholds at 12 months and higher postoperative disyllabic Word Recognition and Sentence Recognition Scores at 6 months (all P < 0.05). In the children group, deeper insertion depth had a positive correlation with postoperative monosyllabic Word Recognition Scores 6 and 12 months after CI surgery (both P < 0.05). Multiple linear regression models were constructed to predict disyllabic Word Recognition Scores at 6 and 12 months postoperatively in the children group, in which insertion angle, duration of hearing loss, and preoperative questionnaire result were identified as dependent variables.

Conclusions

Greater angular insertion depths resulted in improved hearing and speech performances after CI. The benefits of greater angular insertion depths can be found in both adult and children patients and last for at least 12 months. Clinicians are expected to determine the optimal implantation direction during CI and ensure the insertion depth to improve the speech rehabilitation of patients.

Speech recognition as a function of the number of channels for Mid-Scala electrode array recipients

This study investigated the number of channels needed for maximum speech understanding and sound quality in 15 adult cochlear implant (CI) recipients with Advanced Bionics (AB) Mid-Scala electrode arrays completely within scala tympani. In experiment I, CI programs used a continuous interleaved sampling (CIS)-based strategy and 4-16 active electrodes. In experiment II, CI programs used an n-of-m strategy featuring 16 active electrodes with either 8- or 12-maxima. Speech understanding and sound quality measures were assessed. For CIS programs, participants demonstrated performance gains using up to 4-10 electrodes on speech measures and sound quality ratings. For n-of-m programs, there was no significant effect of maxima, suggesting 8-maxima is sufficient for this sample's maximum performance and sound quality. These results are largely consistent with previous studies using straight electrode arrays [e.g., Fishman, Shannon, and Slattery (1997). J. Speech Lang. Hear. Res. 40, 1201-1215; Friesen, Shannon, Baskent, and Wang (2001). J. Acoust. Soc. Am. 110, 1150-1163; Shannon, Cruz, and Galvin (2011). Audiol. Neurotol. 16, 113-123; Berg, Noble, Dawant, Dwyer, Labadie, and Gifford (2020). J. Acoust. Soc. Am. 147, 3646-3656] and in contrast with recent studies looking at cochlear precurved electrode arrays [e.g., Croghan, Duran, and Smith (2017). J. Acoust. Soc. Am. 142, EL537-EL543; Berg, Noble, Dawant, Dwuer, Labadie, and Gifford (2019b). J. Acoust. Soc. Am. 145, 1556-1564], which found continuous improvements up to 16 independent channels. These findings suggest that Mid-Scala electrode array recipients demonstrate similar channel independence to straight electrode arrays rather than other manufacturer's precurved electrode arrays.

Relative Weights of Temporal Envelope Cues in Different Frequency Regions for Mandarin Vowel, Consonant, and Lexical Tone Recognition

Objectives: Mandarin-speaking users of cochlear implants (CI) perform poorer than their English counterpart. This may be because present CI speech coding schemes are largely based on English. This study aims to evaluate the relative contributions of temporal envelope (E) cues to Mandarin phoneme (including vowel, and consonant) and lexical tone recognition to provide information for speech coding schemes specific to Mandarin.

Design: Eleven normal hearing subjects were studied using acoustic temporal E cues that were extracted from 30 continuous frequency bands between 80 and 7,562 Hz using the Hilbert transform and divided into five frequency regions. Percent-correct recognition scores were obtained with acoustic E cues presented in three, four, and five frequency regions and their relative weights calculated using the least-square approach.

Results: For stimuli with three, four, and five frequency regions, percent-correct scores for vowel recognition using E cues were 50.43–84.82%, 76.27–95.24%, and 96.58%, respectively; for consonant recognition 35.49–63.77%, 67.75–78.87%, and 87.87%; for lexical tone recognition 60.80–97.15%, 73.16–96.87%, and 96.73%. For frequency region 1 to frequency region 5, the mean weights in vowel recognition were 0.17, 0.31, 0.22, 0.18, and 0.12, respectively; in consonant recognition 0.10, 0.16, 0.18, 0.23, and 0.33; in lexical tone recognition 0.38, 0.18, 0.14, 0.16, and 0.14.

Conclusion: Regions that contributed most for vowel recognition was Region 2 (502–1,022 Hz) that contains first formant (F1) information; Region 5 (3,856–7,562 Hz) contributed most to consonant recognition; Region 1 (80–502 Hz) that contains fundamental frequency (F0) information contributed most to lexical tone recognition.

Cochlear Implant Research and Development in the Twenty-first Century: A Critical Update

Cochlear implants (CIs) are the world's most successful sensory prosthesis and have been the subject of intense research and development in recent decades. We critically review the progress in CI research, and its success in improving patient outcomes, from the turn of the century to the present day. The review focuses on the processing, stimulation, and audiological methods that have been used to try to improve speech perception by human CI listeners, and on fundamental new insights in the response of the auditory system to electrical stimulation. The introduction of directional microphones and of new noise reduction and pre-processing algorithms has produced robust and sometimes substantial improvements. Novel speech-processing algorithms, the use of current-focusing methods, and individualised (patient-by-patient) deactivation of subsets of electrodes have produced more modest improvements. We argue that incremental advances have and will continue to be made, that collectively these may substantially improve patient outcomes, but that the modest size of each individual advance will require greater attention to experimental design and power. We also briefly discuss the potential and limitations of promising technologies that are currently being developed in animal models, and suggest strategies for researchers to collectively maximise the potential of CIs to improve hearing in a wide range of listening situations.

Enhancement of interaural level differences for bilateral cochlear implant users

Bilateral cochlear implant (BiCI) users do not localize sounds as well as normal hearing (NH) listeners do. NH listeners rely on two binaural cues to localize sounds in the horizontal plane, namely interaural level differences (ILDs) and interaural time differences. BiCI systems, however, convey these cues poorly. In this work, we investigated two methods to improve the coding of ILDs in BiCIs. The first method enhances ILDs by applying an artificial current-versus-angle function to the clinical levels delivered by the basal electrodes of the CI contralateral to the target sound. The second method enhances ILDs by using bilaterally linked N-of-M band selection. Results indicate that the participants were able to discriminate the location of the sound more accurately at narrow azimuths when the ILD enhancement was applied, compared to when they were using natural ILDs. Also, the results show that linking the band selection had a positive effect on left/right discrimination accuracy at larger azimuths for three out of the 10 tested participants, when compared to unlinked band selection. Based on these results, we conclude that ILD enhancement besides linked N-of-M band selection can help some BiCI participants to discriminate sound sources on the frontal horizontal plane.

Effect of Stimulation Rate on Speech Understanding in Older Cochlear-Implant Users

OBJECTIVES

Cochlear implants (CIs) are considered a safe and effective intervention for more severe degrees of hearing loss in adults of all ages. Although older CI users ≥65 years of age can obtain large benefits in speech understanding from a CI, there is a growing body of literature suggesting that older CI users may not perform as well as younger CI users. One reason for this potential age-related limitation could be that default CI stimulation settings are not optimal for older CI users. The goal of this study was to determine whether improvements in speech understanding were possible when CI users were programmed with nondefault stimulation rates and to determine whether lower-than-default stimulation rates improved older CI users' speech understanding.

DESIGN

Sentence recognition was measured acutely using different stimulation rates in 37 CI users ranging in age from 22 to 87 years. Maps were created using rates of 500, 720, 900, and 1200 pulses per second (pps) for each subject. An additional map using a rate higher than 1200 pps was also created for individuals who used a higher rate in their clinical processors. Thus, the clinical rate of each subject was also tested, including non-default rates above 1200 pps for Cochlear users and higher rates consistent with the manufacturer defaults for subjects implanted with Advanced Bionics and Med-El devices. Speech understanding performance was evaluated at each stimulation rate using AzBio and Perceptually Robust English Sentence Test Open-set (PRESTO) sentence materials tested in quiet and in noise.

RESULTS

For Cochlear-brand users, speech understanding performance using non-default rates was slightly poorer when compared with the default rate (900 pps). However, this effect was offset somewhat by age, in which older subjects were able to maintain comparable performance using a 500-pps map compared with the default rate map when listening to the more difficult PRESTO sentence material. Advanced Bionics and Med-El users showed modest improvements in their overall performance using 720 pps compared with the default rate (>1200 pps). On the individual-subject level, 10 subjects (11 ears) showed a significant effect of stimulation rate, with 8 of those ears performing best with a lower-than-default rate.

CONCLUSIONS

Results suggest that default stimulation rates are likely sufficient for many CI users, but some CI users at any age can benefit from a lower-than-default rate. Future work that provides experience with novel rates in everyday life has the potential to identify more individuals whose performance could be improved with changes to stimulation rate.

Speech recognition as a function of the number of channels for an array with large inter-electrode distances

This study investigated the number of channels available to cochlear implant (CI) recipients for maximum speech understanding and sound quality for lateral wall electrode arrays-which result in large electrode-to-modiolus distances-featuring the greatest inter-electrode distances (2.1-2.4 mm), the longest active lengths (23.1-26.4 mm), and the fewest number of electrodes commercially available. Participants included ten post-lingually deafened adult CI recipients with MED-EL electrode arrays (FLEX28 and STANDARD) entirely within scala tympani. Electrode placement and scalar location were determined using computerized tomography. The number of channels was varied from 4 to 12 with equal spatial distribution across the array. A continuous interleaved sampling-based strategy was used. Speech recognition, sound quality ratings, and a closed-set vowel recognition task were measured acutely for each electrode condition. Participants did not demonstrate statistically significant differences beyond eight channels at the group level for almost all measures. However, several listeners showed considerable improvements from 8 to 12 channels for speech and sound quality measures. These results suggest that channel interaction caused by the greater electrode-to-modiolus distances of straight electrode arrays could be partially compensated for by a large inter-electrode distance or spacing.

Association of Patient-Related Factors With Adult Cochlear Implant Speech Recognition Outcomes: A Meta-analysis

Importance

Multiple studies have evaluated associations between post-cochlear implant (CI) speech recognition outcomes and patient-related factors. Current literature often appears equivocal or contradictory, so little is known about the factors that contribute to successful speech recognition outcomes with CIs.

Objective

To use a meta-analysis to pool data from the extant literature and provide an objective summary of existing evidence on associations of patient-related factors and CI speech recognition outcomes.

Data Sources

A literature search was performed using PubMed, Scopus, and CINAHL databases in January 2019 using the following search terms: cochlear implant or cochlear implants or cochlear implantation and speech recognition or word recognition or sentence recognition. Studies of postlingually deafened adult CI recipients that reported word or sentence recognition scores were included.

Study Selection

Inclusion criteria were postlingual adult CI recipients 18 years or older with word or sentence recognition scores at minimum 6-month postimplantation. Studies that included patients undergoing revision or reimplantation surgery were excluded.

Data Extraction and Synthesis

Following the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines, 1809 unique articles underwent review by abstract, and 121 articles underwent full-text review, resulting in 13 articles of 1095 patients for a meta-analysis of correlations. Random-effects model was used when the heterogeneity test yielded a low P value (P < .05).

Main Outcomes and Measures

The planned primary outcome was the pooled correlation values between postimplant speech recognition scores and patient-related factors.

Results

Of the 1095 patients included from the 13 studies, the mean age at implantation ranged from 51.2 to 63.7 years and the mean duration of hearing loss ranged from 9.5 to 31.8 years; for the 825 patients for whom sex was reported, 421 (51.0%) were women. A weak negative correlation was observed between age at implantation and postimplant sentence recognition in quiet (r = -0.31 [95% CI, -0.41 to -0.20]). Other correlations between patient-related factors and postimplant word or sentence recognition were statistically significant, but all correlations were absent to negligible (r = 0.02-0.27).

Conclusions and Relevance

Given that most associations were weak, negligible, or absent, patient-related factors often thought to affect CI speech recognition ability offer limited assistance in clinical decision-making in cochlear implantation. Additional research is needed to identify patient-related and other factors that predict CI outcomes, including speech recognition and other important variables related to success with CIs.

The Temporal Fine Structure of Background Noise Determines the Benefit of Bimodal Hearing for Recognizing Speech

Cochlear implant (CI) users have more difficulty understanding speech in temporally modulated noise than in steady-state (SS) noise. This is thought to be caused by the limited low-frequency information that CIs provide, as well as by the envelope coding in CIs that discards the temporal fine structure (TFS). Contralateral amplification with a hearing aid, referred to as bimodal hearing, can potentially provide CI users with TFS cues to complement the envelope cues provided by the CI signal. In this study, we investigated whether the use of a CI alone provides access to only envelope cues and whether acoustic amplification can provide additional access to TFS cues. To this end, we evaluated speech recognition in bimodal listeners, using SS noise and two amplitude-modulated noise types, namely babble noise and amplitude-modulated steady-state (AMSS) noise. We hypothesized that speech recognition in noise depends on the envelope of the noise, but not on its TFS when listening with a CI. Secondly, we hypothesized that the amount of benefit gained by the addition of a contralateral hearing aid depends on both the envelope and TFS of the noise. The two amplitude-modulated noise types decreased speech recognition more effectively than SS noise. Against expectations, however, we found that babble noise decreased speech recognition more effectively than AMSS noise in the CI-only condition. Therefore, we rejected our hypothesis that TFS is not available to CI users. In line with expectations, we found that the bimodal benefit was highest in babble noise. However, there was no significant difference between the bimodal benefit obtained in SS and AMSS noise. Our results suggest that a CI alone can provide TFS cues and that bimodal benefits in noise depend on TFS, but not on the envelope of the noise.

Precompensating for spread of excitation in a cochlear implant coding strategy

Cochlear implant users' limited ability to understand speech in noisy environments has been linked to the poor spatial resolution and the high degree of spectral smearing associated with the spread of neural excitation. A sound coding algorithm that aims to improve the spectro-temporal representation of the sound signal at the implanted ear by precompensating the electrical stimulation for the spread of excitation is presented in this study. The spread precompensation algorithm was integrated into the standard clinical advanced combination encoder (ACE) strategy and the resulting strategy was called SPACE. SPACE was evaluated acutely with a group of six implant users and was compared to their daily used ACE strategy in terms of preference rating and speech recognition in four-talker babble and stationary speech-shaped noise. While no significant differences in preference rating were observed, speech recognition in four-talker babble was improved by SPACE processing. Analysis of the group results revealed a significant improvement in mean speech reception threshold (SRT) over the ACE strategy of 1.4 dB in four-talker babble, whereas the difference of 0.9 dB in stationary noise did not reach statistical significance. Assessment of individual differences showed that four out of six listeners obtained significant SRT improvements with SPACE and that no subject scored significantly worse compared to ACE. The results suggest that the proposed sound coding strategy has the potential to improve speech perception for cochlear implant users in challenging listening situations.

The effect of a coding strategy that removes temporally masked pulses on speech perception by cochlear implant users

Speech recognition in noisy environments remains a challenge for cochlear implant (CI) recipients. Unwanted charge interactions between current pulses, both within and between electrode channels, are likely to impair performance. Here we investigate the effect of reducing the number of current pulses on speech perception. This was achieved by implementing a psychoacoustic temporal-masking model where current pulses in each channel were passed through a temporal integrator to identify and remove pulses that were less likely to be perceived by the recipient. The decision criterion of the temporal integrator was varied to control the percentage of pulses removed in each condition. In experiment 1, speech in quiet was processed with a standard Continuous Interleaved Sampling (CIS) strategy and with 25, 50 and 75% of pulses removed. In experiment 2, performance was measured for speech in noise with the CIS reference and with 50 and 75% of pulses removed. Speech intelligibility in quiet revealed no significant difference between reference and test conditions. For speech in noise, results showed a significant improvement of 2.4 dB when removing 50% of pulses and performance was not significantly different between the reference and when 75% of pulses were removed. Further, by reducing the overall amount of current pulses by 25, 50, and 75% but accounting for the increase in charge necessary to compensate for the decrease in loudness, estimated average power savings of 21.15, 40.95, and 63.45%, respectively, could be possible for this set of listeners. In conclusion, removing temporally masked pulses may improve speech perception in noise and result in substantial power savings.

Emerging approaches for restoration of hearing and vision

Impairments of vision and hearing are highly prevalent conditions limiting the quality of life and presenting a major socioeconomic burden. For long, retinal and cochlear disorders have remained intractable for causal therapies, with sensory rehabilitation limited to glasses, hearing aids, and electrical cochlear or retinal implants. Recently, the application of gene therapy and optogenetics to eye and ear has generated hope for a fundamental improvement of vision and hearing restoration. To date, one gene therapy for the restoration of vision has been approved and undergoing clinical trials will broaden its application including gene replacement, genome editing, and regenerative approaches. Moreover, optogenetics, i.e. controlling the activity of cells by light, offers a more general alternative strategy. Over little more than a decade, optogenetic approaches have been developed and applied to better understand the function of biological systems, while protein engineers have identified and designed new opsin variants with desired physiological features. Considering potential clinical applications of optogenetics, the spotlight is on the sensory systems. Multiple efforts have been undertaken to restore lost or hampered function in eye and ear. Optogenetic stimulation promises to overcome fundamental shortcomings of electrical stimulation, namely poor spatial resolution and cellular specificity, and accordingly to deliver more detailed sensory information. This review aims at providing a comprehensive reference on current gene therapeutic and optogenetic research relevant to the restoration of hearing and vision. We will introduce gene-therapeutic approaches and discuss the biotechnological and optoelectronic aspects of optogenetic hearing and vision restoration.

Neural Interface: Frontiers and Applications : Cochlear Implants

The theory and implementation of modern cochlear implant are presented in this chapter. Major signal processing strategies of cochlear implants are discussed in detail. Hardware implementation including wireless signal transmission circuit, integrated circuit design of implant circuit, and neural response measurement circuit are provided in the latter part of the chapter. Finally, new technologies that are likely to improve the performance of current cochlear implants are introduced.

A psychoacoustic application for the adjustment of electrical hearing thresholds in cochlear implant patients

Objective

Fitting cochlear implants, especially the precise determination of electrical hearing thresholds, is a time-consuming and complex task for patients as well as audiologists. Aim of the study was to develop a method that enables cochlear implant (CI) patients to determine their electrical hearing thresholds precisely and independently. Applicability and impact of this method on speech perception in noise at soft speech levels were evaluated.

Method

An adaptive psychoacoustic procedure for precise hearing threshold determination (precT) was implemented using MatLab (MathWorks) and a graphical user interface was created. Sound signals were calibrated with a CIC4-Implant-Decoder. Study design: A prospective study including 15 experienced adult cochlear implant users was conducted. Electrical hearing thresholds were determined using the automated precT procedure (auto-precT). Speech perception in noise at 50 dB SPL presentation levels was measured for three conditions: (P1) T-levels kept at the previously established T-levels; (P2) T-levels set to the hearing thresholds determined using auto-precT application; (P3) T-levels set 10 cu below the values determined with auto-precT.

Results

All subjects were able to perform the auto-precT application independently. T-levels were altered on average by an absolute value of 10.5 cu using auto-precT. Median speech reception thresholds were significantly improved from 2.5 dB SNR (P1) to 1.6 dB SNR (P2, p = 0.02). Speech perception was lowest using the globally lowered T-levels, median 2.9 dB SNR (P3, not significant compared to P1 and P2).

Conclusion

The applicability of the developed auto-precT application was confirmed in the present clinical study. Patients benefited from adjusting previously established T-levels to the threshold levels determined by the auto-precT application. The integration of the application in the clinical fitting routine as well as a remote fitting software approach is recommended. Furthermore, future possibilities of auto-precT include the implementation of the application on tablets or smart phones.

Quantifying Cochlear Implant Users' Ability for Speaker Identification using CI Auditory Stimuli

Speaker recognition is a biometric modality that uses underlying speech information to determine the identity of the speaker. Speaker Identification (SID) under noisy conditions is one of the challenging topics in the field of speech processing, specifically when it comes to individuals with cochlear implants (CI). This study analyzes and quantifies the ability of CI-users to perform speaker identification based on direct electric auditory stimuli. CI users employ a limited number of frequency bands (8 ∼ 22) and use electrodes to directly stimulate the Basilar Membrane/Cochlear in order to recognize the speech signal. The sparsity of electric stimulation within the CI frequency range is a prime reason for loss in human speech recognition, as well as SID performance. Therefore, it is assumed that CI-users might be unable to recognize and distinguish a speaker given dependent information such as formant frequencies, pitch etc. which are lost to un-simulated electrodes. To quantify this assumption, the input speech signal is processed using a CI Advanced Combined Encoder (ACE) signal processing strategy to construct the CI auditory electrodogram. The proposed study uses 50 speakers from each of three different databases for training the system using two different classifiers under quiet, and tested under both quiet and noisy conditions. The objective result shows that, the CI users can effectively identify a limited number of speakers. However, their performance decreases when more speakers are added in the system, as well as when noisy conditions are introduced. This information could therefore be used for improving CI-user signal processing techniques to improve human SID.

Human Frequency Following Responses to Vocoded Speech: Amplitude Modulation Versus Amplitude Plus Frequency Modulation

OBJECTIVES

The most commonly employed speech processing strategies in cochlear implants (CIs) only extract and encode amplitude modulation (AM) in a limited number of frequency channels. proposed a novel speech processing strategy that encodes both frequency modulation (FM) and AM to improve CI performance. Using behavioral tests, they reported better speech, speaker, and tone recognition with this novel strategy than with the AM-alone strategy. Here, we used the scalp-recorded human frequency following responses (FFRs) to examine the differences in the neural representation of vocoded speech sounds with AM alone and AM + FM as the spectral and temporal cues were varied. Specifically, we were interested in determining whether the addition of FM to AM improved the neural representation of envelope periodicity (FFRENV) and temporal fine structure (FFRTFS), as reflected in the temporal pattern of the phase-locked neural activity generating the FFR.

DESIGN

FFRs were recorded from 13 normal-hearing, adult listeners in response to the original unprocessed stimulus (a synthetic diphthong /au/ with a 110-Hz fundamental frequency or F0 and a 250-msec duration) and the 2-, 4-, 8- and 16-channel sine vocoded versions of /au/ with AM alone and AM + FM. Temporal waveforms, autocorrelation analyses, fast Fourier Transform, and stimulus-response spectral correlations were used to analyze both the strength and fidelity of the neural representation of envelope periodicity (F0) and TFS (formant structure).

RESULTS

The periodicity strength in the FFRENV decreased more for the AM stimuli than for the relatively resilient AM + FM stimuli as the number of channels was increased. Regardless of the number of channels, a clear spectral peak of FFRENV was consistently observed at the stimulus F0 for all the AM + FM stimuli but not for the AM stimuli. Neural representation as revealed by the spectral correlation of FFRTFS was better for the AM + FM stimuli when compared to the AM stimuli. Neural representation of the time-varying formant-related harmonics as revealed by the spectral correlation was also better for the AM + FM stimuli as compared to the AM stimuli.

CONCLUSIONS

These results are consistent with previously reported behavioral results and suggest that the AM + FM processing strategy elicited brainstem neural activity that better preserved periodicity, temporal fine structure, and time-varying spectral information than the AM processing strategy. The relatively more robust neural representation of AM + FM stimuli observed here likely contributes to the superior performance on speech, speaker, and tone recognition with the AM + FM processing strategy. Taken together, these results suggest that neural information preserved in the FFR may be used to evaluate signal processing strategies considered for CIs.

Endoscopic-Assisted Cochlear Implantation in Children with Malformed Ears

OBJECTIVE

Complex middle and inner ear malformations are considered an important limitation for cochlear implant (CI) with traditional microscopic techniques. The aim of the present study is to describe the results of the endoscopic-assisted CI procedure in children with malformed ears.

STUDY DESIGN

Case series with chart review of consecutive patients.

SETTING

Two tertiary referral centers: University Hospital of Verona and University Hospital of Modena, Italy.

SUBJECTS AND METHODS

In total, 25 children underwent endoscopic-assisted cochlear implantation between January 2013 and January 2018. The audiologic and neuroradiologic assessment showed profound hearing loss and malformation of the middle and inner ear in all children. A complete review of anatomic features, surgical results, and audiologic outcomes was performed. The surgical technique is described step-by-step, and the outcomes are detailed.

RESULTS

All patients (mean age, 3.6 years; range, 2.8-9 years) underwent a transattical/endoscopic-assisted CI procedure. All children showed varying degrees of auditory benefit, as measured by routine audiometry, speech perception tests, and Categories of Auditory Performance scores (mean, 6). No immediate or late postoperative complications were noted.

CONCLUSION

The endoscopic-assisted approach proved to be successful in cochlear implantation. The direct visualization and magnification allow (1) exploration of the tympanic cavity; (2) confirmation of all anatomic features, with strict control of the course of the facial nerve, round window area, and inner ear; and (3) performance of the cochleostomy with adequate insertion of the array.

Systematic Review of Auditory Training in Pediatric Cochlear Implant Recipients

Objective The purpose of this systematic review is to evaluate the published research in auditory training (AT) for pediatric cochlear implant (CI) recipients. This review investigates whether AT in children with CIs leads to improvements in speech and language development, cognition, and/or quality of life and whether improvements, if any, remain over time post AT intervention. Method A systematic search of 7 databases identified 96 review articles published up until January 2017, 9 of which met the inclusion criteria. Data were extracted and independently assessed for risk of bias and quality of study against a PICOS (participants, intervention, control, outcomes, and study) framework. Results All studies reported improvements in trained AT tasks, including speech discrimination/identification and working memory. Retention of improvements over time was found whenever it was assessed. Transfer of learning was measured in 4 of 6 studies, which assessed generalization. Quality of life was not assessed. Overall, evidence for the included studies was deemed to be of low quality. Conclusion Benefits of AT were illustrated through the improvement in trained tasks, and this was observed in all reviewed studies. Transfer of improvement to other domains and also retention of benefits post AT were evident when assessed, although rarely done. However, higher quality evidence to further examine outcomes of AT in pediatric CI recipients is needed.

Hearing in Noise: The Importance of Coding Strategies—Normal-Hearing Subjects and Cochlear Implant Users

Two schemes are mainly used for coding sounds in cochlear implants: Fixed-Channel and Channel-Picking. This study aims to determine the speech audiometry scores in noise of people using either type of sound coding scheme. Twenty normal-hearing and 45 cochlear implant subjects participated in this experiment. Both populations were tested by using dissyllabic words mixed with cocktail-party noise. A cochlear implant simulator was used to test the normal-hearing subjects. This simulator separated the sound into 20 spectral channels and the eight most energetic were selected to simulate the Channel-Picking strategy. For normal-hearing subjects, we noticed higher scores with the Fixed-Channel strategy than with the Channel-Picking strategy in the mid-range signal-to-noise ratios (0 to +6 dB). For cochlear implant users, no differences were found between the two coding schemes but we could see a slight advantage for the Fixed-Channel strategies over the Channel-Picking strategies. For both populations, a difference was observed for the signal-to-noise ratios at 50% of the maximum recognition plateau in favour of the Fixed-Channel strategy. To conclude, in the most common signal-to-noise ratio conditions, a Fixed-Channel coding strategy may lead to better recognition percentages than a Channel-Picking strategy. Further studies are indicated to confirm this.

Objective Identification of Simulated Cochlear Implant Settings in Normal-Hearing Listeners Via Auditory Cortical Evoked Potentials

OBJECTIVES

Providing cochlear implant (CI) patients the optimal signal processing settings during mapping sessions is critical for facilitating their speech perception. Here, we aimed to evaluate whether auditory cortical event-related potentials (ERPs) could be used to objectively determine optimal CI parameters.

DESIGN

While recording neuroelectric potentials, we presented a set of acoustically vocoded consonants (aKa, aSHa, and aNa) to normal-hearing listeners (n = 12) that simulated speech tokens processed through four different combinations of CI stimulation rate and number of spectral maxima. Parameter settings were selected to feature relatively fast/slow stimulation rates and high/low number of maxima; 1800 pps/20 maxima, 1800/8, 500/20 and 500/8.

RESULTS

Speech identification and reaction times did not differ with changes in either the number of maxima or stimulation rate indicating ceiling behavioral performance. Similarly, we found that conventional univariate analysis (analysis of variance) of N1 and P2 amplitude/latency failed to reveal strong modulations across CI-processed speech conditions. In contrast, multivariate discriminant analysis based on a combination of neural measures was used to create "neural confusion matrices" and identified a unique parameter set (1800/8) that maximally differentiated speech tokens at the neural level. This finding was corroborated by information transfer analysis which confirmed these settings optimally transmitted information in listeners' neural and perceptual responses.

CONCLUSIONS

Translated to actual implant patients, our findings suggest that scalp-recorded ERPs might be useful in determining optimal signal processing settings from among a closed set of parameter options and aid in the objective fitting of CI devices.

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.

Long-term outcomes of cochlear implantation in patients with high-frequency hearing loss

OBJECTIVE

To demonstrate the long-term benefits of implantation in patients with high-frequency sensorineural hearing loss, this report provides 5-year follow-up on a group of implant recipients who were subjects of the Cochlear™ Nucleus^® Hybrid™ L24 Implant System pivotal clinical study.

METHODS

The results of three related clinical studies were compiled to provide outcome data after 1, 3, and 5 years of implant use in a group of subjects who presented with preoperative high-frequency hearing loss and were implanted with a Nucleus Hybrid L24 (Cochlear Ltd., Sydney, Australia) cochlear implant. A subset of the 50 adult subjects (N = 32) who participated in the Hybrid L24 pivotal Investigational Device Exemption (IDE) completed comprehensive evaluations at 12 months postactivation, 3 years postactivation, and then as part of a postapproval study at 5 years postactivation. Testing included audiometric, speech perception, and subjective satisfaction measures.

RESULTS

Mean unilateral speech perception performance was significantly improved at all postoperative intervals compared to preoperative best-aided results and has remained stable to 5 years postactivation. Ninety-four percent of subjects had measurable hearing, and 72% continued to use electric-acoustic stimulation in the implanted ear after 5 years of implant use. Subjective satisfaction results support objective performance improvements.

CONCLUSION

Results demonstrate long-term success of patients with high-frequency hearing loss following Hybrid L24 (Cochlear) cochlear implantation. Benefits include speech perception abilities significantly better than those in the preoperative best-aided condition, with additional benefit in those using electric-acoustic stimulation in the implanted ear.

LEVEL OF EVIDENCE

2b. Laryngoscope, 1939-1945, 2018.

Evaluation of a revised indication for determining adult cochlear implant candidacy

OBJECTIVE

To evaluate the use of monosyllabic word recognition versus sentence recognition to determine candidacy and long-term benefit for cochlear implantation.

STUDY DESIGN

Prospective multi-center single-subject design.

METHODS

A total of 21 adults aged 18 years and older with bilateral moderate to profound sensorineural hearing loss and low monosyllabic word scores received unilateral cochlear implantation. The consonant-nucleus-consonant (CNC) word test was the central measure of pre- and postoperative performance. Additional speech understanding tests included the Hearing in Noise Test sentences in quiet and AzBio sentences in +5 dB signal-to-noise ratio (SNR). Quality of life (QoL) was measured using the Abbreviated Profile of Hearing Aid Benefit and Health Utilities Index.

RESULTS

Performance on sentence recognition reached the ceiling of the test after only 3 months of implant use. In contrast, none of the participants in this study reached a score of 80% on CNC word recognition, even at the 12-month postoperative test interval. Measures of QoL related to hearing were also significantly improved following implantation.

CONCLUSION

Results of this study demonstrate that monosyllabic words are appropriate for determining preoperative candidate and measuring long-term postoperative speech recognition performance.

LEVEL OF EVIDENCE

2c. Laryngoscope, 127:2368-2374, 2017.

Investigating the use of a Gammatone filterbank for a cochlear implant coding strategy

•

A Gammatone filterbank has the potential to better resolve the harmonics of complex tones.

•

A total delay of a Gammatone filterbank can be made smaller compared to an FFT filterbank with the same frequency resolution at low frequencies.

•

Melody contour identification improved with longer frame size or higher frequency resolution.

Background

Contemporary speech processing strategies in cochlear implants (CIs) such as the Advanced Combination Encoder (ACE) use a standard Fast Fourier Transform (FFT) filterbank to extract envelopes. The assignment of the FFT bins to approximate the frequency resolution of the basilar membrane is only partly based on physiology, especially since the bins are distributed linearly below 1000 Hz and logarithmically above 1000 Hz.

New method

A Gammatone filterbank which provides a closer approximation to the bandwidths of filters in the human auditory system could replace the standard FFT filterbank in the ACE strategy. An infinite impulse response (IIR) all-pole design of the Gammatone filterbank was compared to the FFT filterbank with 128, 256 and 512 points resolutions and the effect of the frequency boundaries of the filters was also investigated.

Results

Melodic contour identification (MCI) and just noticeable difference (JND) experiments, both involving synthetic clarinet notes in octaves 3 and 4, were conducted with 6 normal hearing (NH) participants using noise vocoded stimuli; and 10 CI recipients just performed the MCI experiment. The MCI results for both NH and CI subjects, showed a significant effect of the filterbank on the percentage correct responses of the participants.

Comparison with existing methods

The Gammatone filterbank can better resolve the harmonics of tested synthetic clarinet notes which led to better performances in the MCI experiment.

Conclusions

The total delay of the Gammatone filterbank can be made smaller than the delay of the FFT filterbank with the same frequency resolution at low frequencies.

Relationships Among Peripheral and Central Electrophysiological Measures of Spatial and Spectral Selectivity and Speech Perception in Cochlear Implant Users

OBJECTIVES

The ability to perceive speech is related to the listener's ability to differentiate among frequencies (i.e., spectral resolution). Cochlear implant (CI) users exhibit variable speech-perception and spectral-resolution abilities, which can be attributed in part to the extent of electrode interactions at the periphery (i.e., spatial selectivity). However, electrophysiological measures of peripheral spatial selectivity have not been found to correlate with speech perception. The purpose of this study was to evaluate auditory processing at the periphery and cortex using both simple and spectrally complex stimuli to better understand the stages of neural processing underlying speech perception. The hypotheses were that (1) by more completely characterizing peripheral excitation patterns than in previous studies, significant correlations with measures of spectral selectivity and speech perception would be observed, (2) adding information about processing at a level central to the auditory nerve would account for additional variability in speech perception, and (3) responses elicited with spectrally complex stimuli would be more strongly correlated with speech perception than responses elicited with spectrally simple stimuli.

DESIGN

Eleven adult CI users participated. Three experimental processor programs (MAPs) were created to vary the likelihood of electrode interactions within each participant. For each MAP, a subset of 7 of 22 intracochlear electrodes was activated: adjacent (MAP 1), every other (MAP 2), or every third (MAP 3). Peripheral spatial selectivity was assessed using the electrically evoked compound action potential (ECAP) to obtain channel-interaction functions for all activated electrodes (13 functions total). Central processing was assessed by eliciting the auditory change complex with both spatial (electrode pairs) and spectral (rippled noise) stimulus changes. Speech-perception measures included vowel discrimination and the Bamford-Kowal-Bench Speech-in-Noise test. Spatial and spectral selectivity and speech perception were expected to be poorest with MAP 1 (closest electrode spacing) and best with MAP 3 (widest electrode spacing). Relationships among the electrophysiological and speech-perception measures were evaluated using mixed-model and simple linear regression analyses.

RESULTS

All electrophysiological measures were significantly correlated with each other and with speech scores for the mixed-model analysis, which takes into account multiple measures per person (i.e., experimental MAPs). The ECAP measures were the best predictor. In the simple linear regression analysis on MAP 3 data, only the cortical measures were significantly correlated with speech scores; spectral auditory change complex amplitude was the strongest predictor.

CONCLUSIONS

The results suggest that both peripheral and central electrophysiological measures of spatial and spectral selectivity provide valuable information about speech perception. Clinically, it is often desirable to optimize performance for individual CI users. These results suggest that ECAP measures may be most useful for within-subject applications when multiple measures are performed to make decisions about processor options. They also suggest that if the goal is to compare performance across individuals based on a single measure, then processing central to the auditory nerve (specifically, cortical measures of discriminability) should be considered.

Perception of consonants in reverberation and noise by adults fitted with bimodal devices

PURPOSE

The purpose of this study was to evaluate the contribution of a contralateral hearing aid to the perception of consonants, in terms of voicing, manner, and place-of-articulation cues in reverberation and noise by adult cochlear implantees aided by bimodal fittings.

METHOD

Eight postlingually deafened adult cochlear implant (CI) listeners with a fully inserted CI in 1 ear and low-frequency hearing in the other ear were tested on consonant perception. They were presented with consonant stimuli processed in the following experimental conditions: 1 quiet condition, 2 different reverberation times (0.3 s and 1.0 s), and the combination of 2 reverberation times with a single signal-to-noise ratio (5 dB).

RESULTS

Consonant perception improved significantly when listening in combination with a contralateral hearing aid as opposed to listening with a CI alone in 0.3 s and 1.0 s of reverberation. Significantly higher scores were also noted when noise was added to 0.3 s of reverberation.

CONCLUSIONS

A considerable benefit was noted from the additional acoustic information in conditions of reverberation and reverberation plus noise. The bimodal benefit observed was more pronounced for voicing and manner of articulation than for place of articulation.

Biomedical studies on temporal bones of the first multi-channel cochlear implant patient at the University of Melbourne

OBJECTIVE

To analyse the temporal bones and implant of the first University of Melbourne's (UOM) patient (MC-1) to receive the multi-channel cochlear prosthesis.

METHODS

The left cochlea was implanted with the prototype multi-channel cochlear prosthesis on 1 August 1978, and the Cochlear versions CI-22 and CI-24 on 22 June 1983 and 10 November 1998, respectively. MC-1 died in 2007.

RESULTS

Plain X-rays of the temporal bones showed that after the CI-22 had been explanted seven electrode bands remained in situ. Micro-CT scans also revealed a partially united fracture transecting the left implanted and right control cochleae. Histology indicated a total loss of the organ of Corti on both sides, and a tear of the left basilar membrane. In addition, there was a dense fibrous capsule with heterotopic bone surrounding one proximal band of the CI-22 array that restricted its removal. This pathology was associated with dark particulate material within macrophages, probably due to the release of platinum from the electrode bands. Scanning electron microscopy (SEM) showed possible corrosion of platinum and surface roughening. Three-dimensional reconstruction of the cochlear histology demonstrated the position of the electrode tracts (C1-22 and CI-24) in relation to the spiral ganglion, which showed 85-90% loss of ganglion cells.

DISCUSSION AND CONCLUSIONS

This study confirms our first histopathological findings that our first free-fitting banded electrode array produced moderate trauma to the cochlea when inserted around the scala tympani of the basal turn. The difficulty in extraction was most likely due to one band being surrounded by an unusually large amount of fibrous tissue and bone, with an electrode band caught due to surface irregularities. Some surface corrosion and a small degree of platinum deposition in the tissue may also help explain the outcome for this long-term cochlear implantation.

Factors affecting open-set word recognition in adults with cochlear implants

OBJECTIVE

A great deal of variability exists in the speech-recognition abilities of postlingually deaf adult cochlear implant (CI) recipients. A number of previous studies have shown that duration of deafness is a primary factor affecting CI outcomes; however, there is little agreement regarding other factors that may affect performance. The objective of the present study was to determine the source of variability in CI outcomes by examining three main factors, biographic/audiologic information, electrode position within the cochlea, and cognitive abilities in a group of newly implanted CI recipients.

DESIGN

Participants were 114 postlingually deaf adults with either the Cochlear or Advanced Bionics CI systems. Biographic/audiologic information, aided sentence-recognition scores, a high resolution temporal bone CT scan and cognitive measures were obtained before implantation. Monosyllabic word recognition scores were obtained during numerous test intervals from 2 weeks to 2 years after initial activation of the CI. Electrode position within the cochlea was determined by three-dimensional reconstruction of pre- and postimplant CT scans. Participants' word scores over 2 years were fit with a logistic curve to predict word score as a function of time and to highlight 4-word recognition metrics (CNC initial score, CNC final score, rise time to 90% of CNC final score, and CNC difference score).

RESULTS

Participants were divided into six outcome groups based on the percentile ranking of their CNC final score, that is, participants in the bottom 10% were in group 1; those in the top 10% were in group 6. Across outcome groups, significant relationships from low to high performance were identified. Biographic/audiologic factors of age at implantation, duration of hearing loss, duration of hearing aid use, and duration of severe-to-profound hearing loss were significantly and inversely related to performance as were frequency modulated tone, sound-field threshold levels obtained with the CI. That is, the higher-performing outcome groups were younger in age at the time of implantation, had shorter duration of severe-to-profound hearing loss, and had lower CI sound-field threshold levels. Significant inverse relationships across outcome groups were also observed for electrode position, specifically the percentage of electrodes in scala vestibuli as opposed to scala tympani and depth of insertion of the electrode array. In addition, positioning of electrode arrays closer to the modiolar wall was positively correlated with outcome. Cognitive ability was significantly and positively related to outcome; however, age at implantation and cognition were highly correlated. After controlling for age, cognition was no longer a factor affecting outcomes.

CONCLUSION

There are a number of factors that limit CI outcomes. They can act singularly or collectively to restrict an individual's performance and to varying degrees. The highest performing CI recipients are those with the least number of limiting factors. Knowledge of when and how these factors affect performance can favorably influence counseling, device fitting, and rehabilitation for individual patients and can contribute to improved device design and application.

Perception of vowels and prosody by cochlear implant recipients in noise

The aim of the present study was to compare the ability of cochlear implant (CI) recipients to recognise speech prosody in the presence of speech-weighted noise to their ability to recognise vowels in the same test paradigm and listening condition. All test materials were recorded from four different speakers (two male, two female). Two prosody recognition tasks were developed, both using single words as stimuli. The first task involved a question/statement distinction, while the second task required listeners to make a judgement about the speaker's attitude. Vowel recognition tests were conducted using vowel pairs selected on the basis of specific acoustic cues (frequencies of the first two formants and duration). Ten CI users and ten normal-hearing controls were tested in both quiet and an adaptive noise condition, using a two-alternative forced-choice test paradigm for all the tests. Results indicated that vowel recognition was significantly better than prosody recognition in both listener groups in both quiet and noise, and that question/statement discrimination was the most difficult task for CI listeners in noise. Data from acoustic analyses were used to interpret differences in performance on different tasks and with different speakers.

LEARNING OUTCOMES

As a result of this activity, readers will be able to (1) describe suitable methods for comparing vowel and prosody perception in noise, (2) compare performance on vowel and prosody perception tasks in quiet in normal-hearing listeners and cochlear implant recipients, (3) compare performance on vowel and prosody perception tasks in noise in normal-hearing listeners and cochlear implant recipients and (4) relate performance on prosody tasks in quiet to performance on these tasks in noise.

Using temporal modulation sensitivity to select stimulation sites for processor MAPs in cochlear implant listeners

Previous studies in our laboratory showed that temporal acuity as assessed by modulation detection thresholds (MDTs) varied across activation sites and that this site-to-site variability was subject specific. Using two 10-channel MAPs, the previous experiments showed that processor MAPs that had better across-site mean (ASM) MDTs yielded better speech recognition than MAPs with poorer ASM MDTs tested in the same subject. The current study extends our earlier work on developing more optimal-fitting strategies to test the feasibility of using a site-selection approach in the clinical domain. This study examined the hypothesis that revising the clinical speech processor MAP for cochlear implant (CI) recipients by turning off selected sites that have poorer temporal acuity and reallocating frequencies to the remaining electrodes would lead to improved speech recognition. Twelve CI recipients participated in the experiments. We found that site selection procedure based on MDTs in the presence of a masker resulted in improved performance on consonant recognition and recognition of sentences in noise. In contrast, vowel recognition was poorer with the experimental MAP than with the clinical MAP, possibly due to reduced spectral resolution when sites were removed from the experimental MAP. Overall, these results suggest a promising path for improving recipient outcomes using personalized processor-fitting strategies based on a psychophysical measure of temporal acuity.

Reverberation suppression in cochlear implants using a blind channel-selection strategy

Reverberation severely degrades speech intelligibility for cochlear implant (CI) users. The ideal reverberant mask (IRM), a binary mask for reverberation suppression which is computed using signal-to-reverberant ratio, was found to yield substantial intelligibility gains for CI users even in highly reverberant environments (e.g., T60 = 1.0 s). Motivated by the intelligibility improvements obtained from IRM, a monaural blind channel-selection criterion for reverberation suppression is proposed. The proposed channel-selection strategy is blind, meaning that prior knowledge of neither the room impulse response nor the anechoic signal is required. By the use of a residual signal obtained from linear prediction analysis of the reverberant signal, the residual-to-reverberant ratio (RRR) of individual frequency channels was employed as the channel-selection criterion. In each frame, the channels with RRR less than an adaptive threshold were retained while the rest were zeroed out. Performance of the proposed strategy was evaluated via intelligibility listening tests conducted with CI users in simulated rooms with two reverberation times of 0.6 and 0.8 s. The results indicate significant intelligibility improvements in both reverberant conditions (over 30 and 40 percentage points in T60 = 0.6 and 0.8 s, respectively). The improvement is comparable to that obtained with the IRM strategy.

Single and multiple microphone noise reduction strategies in cochlear implants

To restore hearing sensation, cochlear implants deliver electrical pulses to the auditory nerve by relying on sophisticated signal processing algorithms that convert acoustic inputs to electrical stimuli. Although individuals fitted with cochlear implants perform well in quiet, in the presence of background noise, the speech intelligibility of cochlear implant listeners is more susceptible to background noise than that of normal hearing listeners. Traditionally, to increase performance in noise, single-microphone noise reduction strategies have been used. More recently, a number of approaches have suggested that speech intelligibility in noise can be improved further by making use of two or more microphones, instead. Processing strategies based on multiple microphones can better exploit the spatial diversity of speech and noise because such strategies rely mostly on spatial information about the relative position of competing sound sources. In this article, we identify and elucidate the most significant theoretical aspects that underpin single- and multi-microphone noise reduction strategies for cochlear implants. More analytically, we focus on strategies of both types that have been shown to be promising for use in current-generation implant devices. We present data from past and more recent studies, and furthermore we outline the direction that future research in the area of noise reduction for cochlear implants could follow.

Comparison of Mandarin tone and speech perception between advanced combination encoder and continuous interleaved sampling speech-processing strategies in children

OBJECTIVE

This study was performed to compare cochlear implant (CI) users' performance in Mandarin speech and tone perception between 2 types of speech-processing strategies-advanced combination encoder (ACE) and continuous interleaved sampling (CIS)-under quiet and noisy conditions.

METHODS

This study involved 10 congenitally deaf children (age range, 5.7-15.3 years; mean, 9.2 years) who received the Nucleus 24-channel CI system cochlear device (CI24R; Cochlear Ltd, Lane Cove NSW, Australia). The subjects used ACE since switching on their CI devices. Speech and tone perception tests were administered under quiet and noisy (+5 dB signal-to-noise ratio) conditions with ACE and CIS strategies 20 minutes and 2 weeks apart.

RESULTS

Regardless of the strategy used, subjects showed significantly higher scores in speech perception than in tone recognition. Under noisy conditions, subjects had significantly higher tone identification scores with the CIS than the ACE strategy (P = .038). There was no significant difference in speech identification score between the strategies. Subjects showed significant higher tone identification and speech perception scores under quiet than noisy (+5 dB signal-to-noise ratio) conditions. Subjectively, 6 subjects preferred the ACE strategy, and the remaining 4 preferred the CIS strategy. The strategy preference of the subjects was related to speech perception performance rather than tone identification. A significant correlation was observed between tone identification and speech recognition, regardless of whether speech was evaluated by consonants (r = 0.669, P < .001), vowels (r = 0.426, P = .001), or sentences (r = 0.294, P = .023).

CONCLUSION

There are only 4 patterns of tone in Mandarin, which is far fewer than the number of speech sounds. However, tone identification is poorer than speech perception. The CIS speech-processing strategy may improve tone identification under noisy conditions. Before improved speech strategies to code acoustic characteristics of tone can be developed, it would be worthwhile to try both CIS and ACE for CI users and to select the most suitable speech-processing strategy according to the subjective preference and objective performance.