Evaluation of the Optimized Pitch and Language Strategy in Cochlear Implant Recipients

Outcomes Using the Optimized Pitch and Language Strategy Versus the Advanced Combination Encoder Strategy in Mandarin-Speaking Cochlear Implant Recipients

OBJECTIVES

The experimental Optimized Pitch and Language (OPAL) strategy enhances coding of fundamental frequency (F0) information in the temporal envelope of electrical signals delivered to channels of a cochlear implant (CI). Previous studies with OPAL have explored performance on speech and lexical tone perception in Mandarin- and English-speaking CI recipients. However, it was not clear which cues to lexical tone (primary and/or secondary) were used by the Mandarin CI listeners. The primary aim of the present study was to investigate whether OPAL provides improved recognition of Mandarin lexical tones in both quiet and noisy environments compared with the Advanced Combination Encoder (ACE) strategy. A secondary aim was to investigate whether, and to what extent, removal of secondary (duration and intensity envelope) cues to lexical tone affected Mandarin tone perception.

DESIGN

Thirty-two CI recipients with an average age of 24 (range 7 to 57) years were enrolled in the study. All recipients had at least 1 year of experience using ACE. Each subject attended two testing sessions, the first to measure baseline performance, and the second to evaluate the effect of strategy after provision of some take-home experience using OPAL. A minimum take-home duration of approximately 4 weeks was prescribed in which subjects were requested to use OPAL as much as possible but were allowed to also use ACE when needed. The evaluation tests included recognition of Mandarin lexical tones in quiet and in noise (signal to noise ratio [SNR] +5 dB) using naturally produced tones and duration/intensity envelope normalized versions of the tones; Mandarin sentence in adaptive noise; Mandarin monosyllabic and disyllabic word in quiet; a subset of Speech, Spatial, and Qualities of hearing questionnaire (SSQ, speech hearing scale); and subjective preference for strategy in quiet and noise.

RESULTS

For both the natural and normalized lexical tone tests, mean scores for OPAL were significantly higher than ACE in quiet by 2.7 and 2.9%-points, respectively, and in noise by 7.4 and 7.2%-points, respectively. Monosyllabic word recognition in quiet using OPAL was significantly higher than ACE by approximately 7.5% points. Average SSQ ratings for OPAL were significantly higher than ACE by approximately 0.5 points on a 10-point scale. In quiet conditions, 14 subjects preferred OPAL, 7 expressed a preference for ACE, and 9 reported no preference. Compared with quiet, in noisy situations, there was a stronger preference for OPAL (19 recipients), a similar preference for ACE (7 recipients), while fewer expressed no preference. Average daily take-home use of ACE and OPAL was 4.9 and 7.1 hr, respectively.

CONCLUSIONS

For Mandarin-speaking CI recipients, OPAL provided significant improvements to lexical tone perception for natural and normalized tones in quiet and noise, monosyllabic word recognition in quiet, and subjective ratings of speech intelligibility. Subjects accessed both primary and secondary cues to lexical tone for perception in quiet and noise conditions. The benefits of lexical tone recognition were attributed to enhanced F0 rate cues encoded by OPAL, especially in a noisy environment. The OPAL strategy was well accepted by many of the Mandarin-speaking CI recipients.

Effect of reducing electrical stimulation rate on hearing performance of Nucleus® cochlear implant recipients

OBJECTIVE

To evaluate whether a 500 pulses per second per channel (pps/ch) rate would provide non-inferior hearing performance compared to the 900 pps/ch rate in the Advanced Combination Encoder (ACE™) sound coding strategy.

DESIGN

A repeated measures single-subject design was employed, wherein each subject served as their own control. All except one subject used 900 pps/ch at enrolment. After three weeks of using the alternative rate program, both programs were loaded into the sound processor for two more weeks of take-home use. Subjective performance, preference, words in quiet, sentences in babble, music quality, and fundamental frequency (F0) discrimination were assessed using a balanced design.

STUDY SAMPLE

Data from 18 subjects were analysed, with complete datasets available for 17 subjects.

RESULTS

Non-inferior performance on all clinical measures was shown for the lower rate program. Subjects' preference ratings were comparable for the programs, with 53% reporting no difference overall. When a preference was expressed, the 900 pps/ch condition was preferred more often.

CONCLUSION

Reducing the stimulation rate from 900 pps/ch to 500 pps/ch did not compromise the hearing outcomes evaluated in this study. A lower pulse rate in future cochlear implants could reduce power consumption, allowing for smaller batteries and processors.

EEG-based assessment of temporal fine structure and envelope effect in mandarin syllable and tone perception

In recent years, speech perception research has benefited from low-frequency rhythm entrainment tracking of the speech envelope. However, speech perception is still controversial regarding the role of speech envelope and temporal fine structure, especially in Mandarin. This study aimed to discuss the dependence of Mandarin syllables and tones perception on the speech envelope and the temporal fine structure. We recorded the electroencephalogram (EEG) of the subjects under three acoustic conditions using the sound chimerism analysis, including (i) the original speech, (ii) the speech envelope and the sinusoidal modulation, and (iii) the fine structure of time and the modulation of the non-speech (white noise) sound envelope. We found that syllable perception mainly depended on the speech envelope, while tone perception depended on the temporal fine structure. The delta bands were prominent, and the parietal and prefrontal lobes were the main activated brain areas, regardless of whether syllable or tone perception was involved. Finally, we decoded the spatiotemporal features of Mandarin perception from the microstate sequence. The spatiotemporal feature sequence of the EEG caused by speech material was found to be specific, suggesting a new perspective for the subsequent auditory brain-computer interface. These results provided a new scheme for the coding strategy of new hearing aids for native Mandarin speakers.

HIGHLIGHTS

Pitch perception with the temporal limits encoder for cochlear implants

The temporal-limits-encoder (TLE) strategy has been proposed to enhance the representation of temporal fine structure (TFS) in cochlear implants (CIs), which is vital for many aspects of sound perception but is typically discarded by most modern CI strategies. TLE works by computing an envelope modulator that is within the temporal pitch limits of CI electric hearing. This paper examines the TFS information encoded by TLE and evaluates the salience and usefulness of this information in CI users. Two experiments were conducted to compare pitch perception performance of TLE versus the widely-used Advanced Combinational Encoder (ACE) strategy. Experiment 1 investigated whether TLE processing improved pitch discrimination compared to ACE. Experiment 2 parametrically examined the effect of changing the lower frequency limit of the TLE modulator on pitch ranking. In both experiments, F0 difference limens were measured with synthetic harmonic complex tones using an adaptive procedure. Signal analysis of the outputs of TLE and ACE strategies showed that TLE introduces important temporal pitch cues that are not available with ACE. Results showed an improvement in pitch discrimination with TLE when the acoustic input had a lower F0 frequency. No significant effect of lower frequency limit was observed for pitch ranking, though a lower limit did tend to provide better outcomes. These results suggest that the envelope modulation introduced by TLE can improve pitch perception for CI listeners.

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.

Combination and Comparison of Sound Coding Strategies Using Cochlear Implant Simulation With Mandarin Speech

Three cochlear implant (CI) sound coding strategies were combined in the same signal processing path and compared for speech intelligibility with vocoded Mandarin sentences. The three CI coding strategies, biologically-inspired hearing aid algorithm (BioAid), envelope enhancement (EE), and fundamental frequency modulation (F0mod), were combined with the advanced combination encoder (ACE) strategy. Hence, four singular coding strategies and four combinational coding strategies were derived. Mandarin sentences with speech-shape noise were processed using these coding strategies. Speech understanding of vocoded Mandarin sentences was evaluated using short-time objective intelligibility (STOI) and subjective sentence recognition tests with normal-hearing listeners. For signal-to-noise ratios at 5 dB or above, the EE strategy had slightly higher average scores in both STOI and listening tests compared to ACE. The addition of EE to BioAid slightly increased the mean scores for BioAid+EE, which was the combination strategy with the highest scores in both objective and subjective speech intelligibility. The benefits of BioAid, F0mod, and the four combinational coding strategies were not observed in CI simulation. The findings of this study may be useful for the future design of coding strategies and related studies with Mandarin.

Effect of Increased Daily Cochlear Implant Use on Auditory Perception in Adults

Purpose Despite the recommendation for cochlear implant (CI) processor use during all waking hours, variability in average daily wear time remains high. Previous work has shown that objective wear time is significantly correlated with speech recognition outcomes. We aimed to investigate the causal link between daily wear time and speech recognition outcomes and assess one potential underlying mechanism, spectral processing, driving the causal link. We hypothesized that increased CI use would result in improved speech recognition via improved spectral processing. Method Twenty adult CI recipients completed two study visits. The baseline visit included auditory perception testing (speech recognition and spectral processing measures), questionnaire administration, and documentation of data logging from the CI software. Participants watched an educational video, and they were informed of the compensation schedule. Participants were then asked to increase their daily CI use over a 4-week period during everyday life. Baseline measures were reassessed following the 4-week period. Results Seventeen out of 20 participants increased their daily CI use. On average, participants' speech recognition improved by 3.0, 2.4, and 7.0 percentage points per hour of increased average daily CI use for consonant-nucleus-consonant words, AzBio sentences, and AzBio sentences in noise, respectively. Questionnaire scores were similar between visits. Spectral processing showed significant improvement and accounted for a small amount of variance in the change in speech recognition values. Conclusions Improved consistency of processor use over a 4-week period yielded significant improvements in speech recognition scores. Though a significant factor, spectral processing is likely not the only mechanism driving improvement in speech recognition; further research is warranted.

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.

Melodic interval perception with acoustic and electric hearing in bimodal and single-sided deaf cochlear implant listeners

Two notes sounded sequentially elicit melodic intervals and contours that form the basis of melody. Many previous studies have characterized pitch perception in cochlear implant (CI) users to be poor which may be due to the limited spectro-temporal resolution and/or spectral warping with electric hearing compared to acoustic hearing (AH). Poor pitch perception in CIs has been shown to distort melodic interval perception. To characterize this interval distortion, we recruited CI users with either normal (single sided deafness, SSD) or limited (bimodal) AH in the non-implanted ear. The contralateral AH allowed for a stable reference with which to compare melodic interval perception in the CI ear, within the same listener. Melodic interval perception was compared across acoustic and electric hearing in 9 CI listeners (4 bimodal and 5 SSD). Participants were asked to rank the size of a probe interval presented to the CI ear to a reference interval presented to the contralateral AH ear using a method of constant stimuli. Ipsilateral interval ranking was also measured within the AH ear to ensure that listeners understood the task and that interval ranking was stable and accurate within AH. Stimuli were delivered to the AH ear via headphones and to the CI ear via direct audio input (DAI) to participants' clinical processors. During testing, a reference and probe interval was presented and participants indicated which was larger. Ten comparisons for each reference-probe combination were presented. Psychometric functions were fit to the data to determine the probe interval size that matched the reference interval. Across all AH reference intervals, the mean matched CI interval was 1.74 times larger than the AH reference. However, there was great inter-subject variability. For some participants, CI interval distortion varied across different reference AH intervals; for others, CI interval distortion was constant. Within the AH ear, ipsilateral interval ranking was accurate, ensuring that participants understood the task. No significant differences in the patterns of results were observed between bimodal and SSD CI users. The present data show that much larger intervals were needed with the CI to match contralateral AH reference intervals. As such, input melodic patterns are likely to be perceived as frequency compressed and/or warped with electric hearing, with less variation among notes in the pattern. The high inter-subject variability in CI interval distortion suggests that CI signal processing should be optimized for individual CI users.

Place and Temporal Cues in Cochlear Implant Pitch and Melody Perception

The present study compared pitch and melody perception using cochlear place of excitation and temporal cues in six adult nucleus cochlear implant (CI) recipients. The stimuli were synthesized tones presented through a loudspeaker, and recipients used the Advanced Combinational Encoder (ACE) sound coding strategy on their own sound processors. Three types of tones were used, denoted H3, H4, and P5. H3 tones were harmonic tones with fundamental frequencies in the range C3-C4 (131-262 Hz), providing temporal pitch cues alone. H4 tones were harmonic tones with fundamental frequencies in the range C4-C5 (262-523 Hz), providing a mixture of temporal and place cues. P5 tones were pure tones with fundamental frequencies in the range C5-C6 (523-1046 Hz), providing place pitch cues alone. Four experimental procedures were used: pitch discrimination, pitch ranking, backward modified melodies, and warped modified melodies. In each trial of the modified melodies tests, subjects heard a familiar melody and a version with modified pitch (in randomized order), and had to select the unmodified melody. In all four procedures, many scores were much lower than would be expected for normal hearing listeners, implying that the strength of the perceived pitch was weak. Discrimination and ranking with H3 and P5 tones was poor for two-semitone intervals, but near perfect for intervals of five semitones and larger. H4 tones provided the lowest group mean scores in all four procedures, with some pitch reversals observed in pitch ranking. Group mean scores for P5 tones (place cues alone) were at least as high as those for H3 tones (temporal cues alone). The relatively good scores on the melody tasks with P5 tones were surprising, given the lack of temporal cues, raising the possibility of musical pitch using place cues alone. However, the alternative possibility that the CI recipients perceived the place cues as brightness, rather than musical pitch per se, cannot be excluded. These findings show that pitch perception models need to incorporate neural place representations alongside temporal cues if they are to predict pitch and melody perception in the absence of temporal cues.