Adaptation by normal listeners to upward spectral shifts of speech: implications for cochlear implants

How to vocode: Using channel vocoders for cochlear-implant research

The channel vocoder has become a useful tool to understand the impact of specific forms of auditory degradation-particularly the spectral and temporal degradation that reflect cochlear-implant processing. Vocoders have many parameters that allow researchers to answer questions about cochlear-implant processing in ways that overcome some logistical complications of controlling for factors in individual cochlear implant users. However, there is such a large variety in the implementation of vocoders that the term "vocoder" is not specific enough to describe the signal processing used in these experiments. Misunderstanding vocoder parameters can result in experimental confounds or unexpected stimulus distortions. This paper highlights the signal processing parameters that should be specified when describing vocoder construction. The paper also provides guidance on how to determine vocoder parameters within perception experiments, given the experimenter's goals and research questions, to avoid common signal processing mistakes. Throughout, we will assume that experimenters are interested in vocoders with the specific goal of better understanding cochlear implants.

Cochlear-Implant Simulated Signal Degradation Exacerbates Listening Effort in Older Listeners

OBJECTIVES

Individuals with cochlear implants (CIs) often report that listening requires high levels of effort. Listening effort can increase with decreasing spectral resolution, which occurs when listening with a CI, and can also increase with age. What is not clear is whether these factors interact; older CI listeners potentially experience even higher listening effort with greater signal degradation than younger CI listeners. This study used pupillometry as a physiological index of listening effort to examine whether age, spectral resolution, and their interaction affect listening effort in a simulation of CI listening.

DESIGN

Fifteen younger normal-hearing listeners (ages 18 to 31 years) and 15 older normal-hearing listeners (ages 65 to 75 years) participated in this experiment; they had normal hearing thresholds from 0.25 to 4 kHz. Participants repeated sentences presented in quiet that were either unprocessed or vocoded, simulating CI listening. Stimuli frequency spectra were limited to below 4 kHz (to control for effects of age-related high-frequency hearing loss), and spectral resolution was decreased by decreasing the number of vocoder channels, with 32-, 16-, and 8-channel conditions. Behavioral speech recognition scores and pupil dilation were recorded during this task. In addition, cognitive measures of working memory and processing speed were obtained to examine if individual differences in these measures predicted changes in pupil dilation.

RESULTS

For trials where the sentence was recalled correctly, there was a significant interaction between age and spectral resolution, with significantly greater pupil dilation in the older normal-hearing listeners for the 8- and 32-channel vocoded conditions. Cognitive measures did not predict pupil dilation.

CONCLUSIONS

There was a significant interaction between age and spectral resolution, such that older listeners appear to exert relatively higher listening effort than younger listeners when the signal is highly degraded, with the largest effects observed in the eight-channel condition. The clinical implication is that older listeners may be at higher risk for increased listening effort with a CI.

Effects of training length on adaptation to noise-vocoded speech

Listeners show rapid perceptual learning of acoustically degraded speech, though the amount of exposure required to maximize speech adaptation is unspecified. The current work used a single-session design to examine the length of auditory training on perceptual learning for normal hearing listeners exposed to eight-channel noise-vocoded speech. Participants completed short, medium, or long training using a two-alternative forced choice sentence identification task with feedback. To assess learning and generalization, a 40-trial pre-test and post-test transcription task was administered using trained and novel sentences. Training results showed all groups performed near ceiling with no reliable differences. For test data, we evaluated changes in transcription accuracy using separate linear mixed models for trained or novel sentences. In both models, we observed a significant improvement in transcription at post-test relative to pre-test. Critically, the three training groups did not differ in the magnitude of improvement following training. Subsequent Bayes factors analysis evaluating the test by group interaction provided strong evidence in support of the null hypothesis. For these stimuli and procedure, results suggest increased training does not necessarily maximize learning outcomes; both passive and trained experience likely supported adaptation. Findings may contribute to rehabilitation recommendations for listeners adapting to degraded speech signals.

Intracranial electrophysiology of spectrally degraded speech in the human cortex

Introduction

Cochlear implants (CIs) are the treatment of choice for severe to profound hearing loss. Variability in CI outcomes remains despite advances in technology and is attributed in part to differences in cortical processing. Studying these differences in CI users is technically challenging. Spectrally degraded stimuli presented to normal-hearing individuals approximate input to the central auditory system in CI users. This study used intracranial electroencephalography (iEEG) to investigate cortical processing of spectrally degraded speech.

Methods

Participants were adult neurosurgical epilepsy patients. Stimuli were utterances /aba/ and /ada/, spectrally degraded using a noise vocoder (1-4 bands) or presented without vocoding. The stimuli were presented in a two-alternative forced choice task. Cortical activity was recorded using depth and subdural iEEG electrodes. Electrode coverage included auditory core in posteromedial Heschl's gyrus (HGPM), superior temporal gyrus (STG), ventral and dorsal auditory-related areas, and prefrontal and sensorimotor cortex. Analysis focused on high gamma (70-150 Hz) power augmentation and alpha (8-14 Hz) suppression.

Results

Chance task performance occurred with 1-2 spectral bands and was near-ceiling for clear stimuli. Performance was variable with 3-4 bands, permitting identification of good and poor performers. There was no relationship between task performance and participants demographic, audiometric, neuropsychological, or clinical profiles. Several response patterns were identified based on magnitude and differences between stimulus conditions. HGPM responded strongly to all stimuli. A preference for clear speech emerged within non-core auditory cortex. Good performers typically had strong responses to all stimuli along the dorsal stream, including posterior STG, supramarginal, and precentral gyrus; a minority of sites in STG and supramarginal gyrus had a preference for vocoded stimuli. In poor performers, responses were typically restricted to clear speech. Alpha suppression was more pronounced in good performers. In contrast, poor performers exhibited a greater involvement of posterior middle temporal gyrus when listening to clear speech.

Discussion

Responses to noise-vocoded speech provide insights into potential factors underlying CI outcome variability. The results emphasize differences in the balance of neural processing along the dorsal and ventral stream between good and poor performers, identify specific cortical regions that may have diagnostic and prognostic utility, and suggest potential targets for neuromodulation-based CI rehabilitation strategies.

Influence of the Frequency-to-Place Function on Recognition with Place-Based Cochlear Implant Maps

OBJECTIVE

Comparison of acute speech recognition for cochlear implant (CI) alone and electric-acoustic stimulation (EAS) users listening with default maps or place-based maps using either a spiral ganglion (SG) or a new Synchrotron Radiation-Artificial Intelligence (SR-AI) frequency-to-place function.

METHODS

Thirteen adult CI-alone or EAS users completed a task of speech recognition at initial device activation with maps that differed in the electric filter frequency assignments. The three map conditions were: (1) maps with the default filter settings (default map), (2) place-based maps with filters aligned to cochlear SG tonotopicity using the SG function (SG place-based map), and (3) place-based maps with filters aligned to cochlear Organ of Corti (OC) tonotopicity using the SR-AI function (SR-AI place-based map). Speech recognition was evaluated using a vowel recognition task. Performance was scored as the percent correct for formant 1 recognition due to the rationale that the maps would deviate the most in the estimated cochlear place frequency for low frequencies.

RESULTS

On average, participants had better performance with the OC SR-AI place-based map as compared to the SG place-based map and the default map. A larger performance benefit was observed for EAS users than for CI-alone users.

CONCLUSION

These pilot data suggest that EAS and CI-alone users may experience better performance with a patient-centered mapping approach that accounts for the variability in cochlear morphology (OC SR-AI frequency-to-place function) in the individualization of the electric filter frequencies (place-based mapping procedure).

LEVEL OF EVIDENCE

3 Laryngoscope, 133:3540-3547, 2023.

Rhythmic modulation of prediction errors: A top-down gating role for the beta-range in speech processing

Natural speech perception requires processing the ongoing acoustic input while keeping in mind the preceding one and predicting the next. This complex computational problem could be handled by a dynamic multi-timescale hierarchical inferential process that coordinates the information flow up and down the language network hierarchy. Using a predictive coding computational model (Precoss-β) that identifies online individual syllables from continuous speech, we address the advantage of a rhythmic modulation of up and down information flows, and whether beta oscillations could be optimal for this. In the model, and consistent with experimental data, theta and low-gamma neural frequency scales ensure syllable-tracking and phoneme-level speech encoding, respectively, while the beta rhythm is associated with inferential processes. We show that a rhythmic alternation of bottom-up and top-down processing regimes improves syllable recognition, and that optimal efficacy is reached when the alternation of bottom-up and top-down regimes, via oscillating prediction error precisions, is in the beta range (around 20-30 Hz). These results not only demonstrate the advantage of a rhythmic alternation of up- and down-going information, but also that the low-beta range is optimal given sensory analysis at theta and low-gamma scales. While specific to speech processing, the notion of alternating bottom-up and top-down processes with frequency multiplexing might generalize to other cognitive architectures.

Comparison of Two Place-Based Mapping Procedures on Masked Sentence Recognition as a Function of Electrode Array Angular Insertion Depth and Presence of Acoustic Low-Frequency Information: A Simulation Study

INTRODUCTION

Cochlear implant (CI) and electric-acoustic stimulation (EAS) users may experience better performance with maps that align the electric filter frequencies to the cochlear place frequencies, known as place-based maps, than with maps that present spectrally shifted information. Individual place-based mapping procedures differ in the frequency content that is aligned to cochlear tonotopicity versus discarded or spectrally shifted. The performance benefit with different place-based maps may vary due to individual differences in angular insertion depth (AID) of the electrode array and whether functional acoustic low-frequency information is available in the implanted ear. The present study compared masked speech recognition with two types of place-based maps as a function of AID and presence of acoustic low-frequency information.

METHODS

Sixty adults with normal hearing listened acutely to CI or EAS simulations of two types of place-based maps for one of three cases of electrode arrays at shallow AIDs. The strict place-based (Strict-PB) map aligned the low- and mid-frequency information to cochlear tonotopicity and discarded information below the frequency associated with the most apical electrode contact. The alternative place-based map (LFshift-PB) aligned the mid-frequency information to cochlear tonotopicity and provided more of the speech spectrum by compressing low-frequency information on the apical electrode contacts (i.e., <1 kHz). Three actual cases of a 12-channel, 24-mm electrode array were simulated by assigning the carrier frequency for an individual channel as the cochlear place frequency of the associated electrode contact. The AID and cochlear place frequency for the most apical electrode contact were 460° and 498 Hz for case 1, 389° and 728 Hz for case 2, and 335° and 987 Hz for case 3, respectively.

RESULTS

Generally, better performance was observed with the Strict-PB maps for cases 1 and 2, where mismatches were 2-4 octaves for the most apical channel with the LFshift-PB map. Similar performance was observed between maps for case 3. For the CI simulations, performance with the Strict-PB map declined with decreases in AID, while performance with the LFshift-PB map remained stable across cases. For the EAS simulations, performance with the Strict-PB map remained stable across cases, while performance with the LFshift-PB map improved with decreases in AID.

CONCLUSIONS

Listeners demonstrated differences with the Strict-PB versus LFshift-PB maps as a function of AID and whether acoustic low-frequency information was available (CI vs. EAS). These data support the use of the Strict-PB mapping procedure for AIDs ≥335°, though further study including time for acclimatization in CI and EAS users is warranted.

Influence of Electric Frequency-to-Place Mismatches on the Early Speech Recognition Outcomes for Electric-Acoustic Stimulation Users

PURPOSE

Cochlear implant (CI) recipients with hearing preservation experience significant improvements in speech recognition with electric-acoustic stimulation (EAS) as compared to with a CI alone, although outcomes across EAS users vary. The individual differences in performance may be due in part to default mapping procedures, which result in electric frequency-to-place mismatches for the majority of EAS users. This study assessed the influence of electric mismatches on the early speech recognition for EAS users.

METHOD

Twenty-one participants were randomized at EAS activation to listen exclusively with a default or place-based map. For both groups, the unaided thresholds determined the acoustic cutoff frequency (i.e., > 65 dB HL). For default maps, the electric filter frequencies were assigned to avoid spectral gaps in frequency information but created varying magnitudes of mismatches. For place-based maps, the electric filter frequencies were assigned to avoid frequency-to-place mismatches. Recognition of consonant-nucleus-consonant words and vowels was assessed at activation and 1, 3, and 6 months postactivation.

RESULTS

For participants with default maps, electric mismatch at 1500 Hz ranged from 2 to -12.0 semitones (Mdn = -5 semitones). Poorer performance was observed for those with larger magnitudes of electric mismatch. This effect was observed through 6 months of EAS listening experience.

CONCLUSIONS

The present sample of EAS users experienced better initial performance when electric mismatches were small or eliminated. These data suggest the utility of methods that reduce electric mismatches, such as place-based mapping procedures. Investigation is ongoing to determine whether these differences persist with long-term EAS use.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22096523.

The 100 Most-Cited Manuscripts in Hearing Implants: A Bibliometrics Analysis

The aim of the study was to characterise the most frequently cited articles on the topic of hearing implants. A systematic search was carried out using the Thomson Reuters Web of Science Core Collection database. Eligibility criteria restricted the results to primary studies and reviews published from 1970 to 2022 in English dealing primarily with hearing implants. Data including the authors, year of publication, journal, country of origin, number of citations and average number of citations per year were extracted, as well as the impact factors and five-year impact factor of journals publishing the articles. The top 100 papers were published across 23 journals and were cited 23,139 times. The most-cited and influential article describes the first use of the continuous interleaved sampling (CIS) strategy utilised in all modern cochlear implants. More than half of the studies on the list were produced by authors from the United States, and the Ear and Hearing journal had both the greatest number of articles and the greatest number of total citations. To conclude, this research serves as a guide to the most influential articles on the topic of hearing implants, although bibliometric analyses mainly focus on citations. The most-cited article was an influential description of CIS.

Perceptual Learning of Noise-Vocoded Speech Under Divided Attention

Speech perception performance for degraded speech can improve with practice or exposure. Such perceptual learning is thought to be reliant on attention and theoretical accounts like the predictive coding framework suggest a key role for attention in supporting learning. However, it is unclear whether speech perceptual learning requires undivided attention. We evaluated the role of divided attention in speech perceptual learning in two online experiments (N = 336). Experiment 1 tested the reliance of perceptual learning on undivided attention. Participants completed a speech recognition task where they repeated forty noise-vocoded sentences in a between-group design. Participants performed the speech task alone or concurrently with a domain-general visual task (dual task) at one of three difficulty levels. We observed perceptual learning under divided attention for all four groups, moderated by dual-task difficulty. Listeners in easy and intermediate visual conditions improved as much as the single-task group. Those who completed the most challenging visual task showed faster learning and achieved similar ending performance compared to the single-task group. Experiment 2 tested whether learning relies on domain-specific or domain-general processes. Participants completed a single speech task or performed this task together with a dual task aiming to recruit domain-specific (lexical or phonological), or domain-general (visual) processes. All secondary task conditions produced patterns and amount of learning comparable to the single speech task. Our results demonstrate that the impact of divided attention on perceptual learning is not strictly dependent on domain-general or domain-specific processes and speech perceptual learning persists under divided attention.

The recognition of time-compressed speech as a function of age in listeners with cochlear implants or normal hearing

Speech recognition is diminished when a listener has an auditory temporal processing deficit. Such deficits occur in listeners over 65 years old with normal hearing (NH) and with age-related hearing loss, but their source is still unclear. These deficits may be especially apparent when speech occurs at a rapid rate and when a listener is mostly reliant on temporal information to recognize speech, such as when listening with a cochlear implant (CI) or to vocoded speech (a CI simulation). Assessment of the auditory temporal processing abilities of adults with CIs across a wide range of ages should better reveal central or cognitive sources of age-related deficits with rapid speech because CI stimulation bypasses much of the cochlear encoding that is affected by age-related peripheral hearing loss. This study used time-compressed speech at four different degrees of time compression (0, 20, 40, and 60%) to challenge the auditory temporal processing abilities of younger, middle-aged, and older listeners with CIs or with NH. Listeners with NH were presented vocoded speech at four degrees of spectral resolution (unprocessed, 16, 8, and 4 channels). Results showed an interaction between age and degree of time compression. The reduction in speech recognition associated with faster rates of speech was greater for older adults than younger adults. The performance of the middle-aged listeners was more similar to that of the older listeners than to that of the younger listeners, especially at higher degrees of time compression. A measure of cognitive processing speed did not predict the effects of time compression. These results suggest that central auditory changes related to the aging process are at least partially responsible for the auditory temporal processing deficits seen in older listeners, rather than solely peripheral age-related changes.

American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Adult Cochlear Implantation for Single-Sided Deafness

The indications for cochlear implantation have expanded to include individuals with profound sensorineural hearing loss in the impaired ear and normal hearing (NH) in the contralateral ear, known as single-sided deafness (SSD). There are additional considerations for the clinical assessment and management of adult cochlear implant candidates and recipients with SSD as compared to conventional cochlear implant candidates with bilateral moderate to profound sensorineural hearing loss. The present report reviews the current evidence relevant to the assessment and management of adults with SSD. A systematic review was also conducted on published studies that investigated outcomes of cochlear implant use on measures of speech recognition in quiet and noise, sound source localization, tinnitus perception, and quality of life for this patient population. Expert consensus and systematic review of the current literature were combined to provide guidance for the clinical assessment and management of adults with SSD.

Effect of Place-Based Versus Default Mapping Procedures on Masked Speech Recognition: Simulations of Cochlear Implant Alone and Electric-Acoustic Stimulation

PURPOSE

Cochlear implant (CI) recipients demonstrate variable speech recognition when listening with a CI-alone or electric-acoustic stimulation (EAS) device, which may be due in part to electric frequency-to-place mismatches created by the default mapping procedures. Performance may be improved if the filter frequencies are aligned with the cochlear place frequencies, known as place-based mapping. Performance with default maps versus an experimental place-based map was compared for participants with normal hearing when listening to CI-alone or EAS simulations to observe potential outcomes prior to initiating an investigation with CI recipients.

METHOD

A noise vocoder simulated CI-alone and EAS devices, mapped with default or place-based procedures. The simulations were based on an actual 24-mm electrode array recipient, whose insertion angles for each electrode contact were used to estimate the respective cochlear place frequency. The default maps used the filter frequencies assigned by the clinical software. The filter frequencies for the place-based maps aligned with the cochlear place frequencies for individual contacts in the low- to mid-frequency cochlear region. For the EAS simulations, low-frequency acoustic information was filtered to simulate aided low-frequency audibility. Performance was evaluated for the AzBio sentences presented in a 10-talker masker at +5 dB signal-to-noise ratio (SNR), +10 dB SNR, and asymptote.

RESULTS

Performance was better with the place-based maps as compared with the default maps for both CI-alone and EAS simulations. For instance, median performance at +10 dB SNR for the CI-alone simulation was 57% correct for the place-based map and 20% for the default map. For the EAS simulation, those values were 59% and 37% correct. Adding acoustic low-frequency information resulted in a similar benefit for both maps.

CONCLUSIONS

Reducing frequency-to-place mismatches, such as with the experimental place-based mapping procedure, produces a greater benefit in speech recognition than maximizing bandwidth for CI-alone and EAS simulations. Ongoing work is evaluating the initial and long-term performance benefits in CI-alone and EAS users.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19529053.

Degradation levels of continuous speech affect neural speech tracking and alpha power differently

Making sense of a poor auditory signal can pose a challenge. Previous attempts to quantify speech intelligibility in neural terms have usually focused on one of two measures, namely low-frequency speech-brain synchronization or alpha power modulations. However, reports have been mixed concerning the modulation of these measures, an issue aggravated by the fact that they have normally been studied separately. We present two MEG studies analyzing both measures. In study 1, participants listened to unimodal auditory speech with three different levels of degradation (original, 7-channel and 3-channel vocoding). Intelligibility declined with declining clarity, but speech was still intelligible to some extent even for the lowest clarity level (3-channel vocoding). Low-frequency (1-7 Hz) speech tracking suggested a U-shaped relationship with strongest effects for the medium-degraded speech (7-channel) in bilateral auditory and left frontal regions. To follow up on this finding, we implemented three additional vocoding levels (5-channel, 2-channel and 1-channel) in a second MEG study. Using this wider range of degradation, the speech-brain synchronization showed a similar pattern as in study 1, but further showed that when speech becomes unintelligible, synchronization declines again. The relationship differed for alpha power, which continued to decrease across vocoding levels reaching a floor effect for 5-channel vocoding. Predicting subjective intelligibility based on models either combining both measures or each measure alone showed superiority of the combined model. Our findings underline that speech tracking and alpha power are modified differently by the degree of degradation of continuous speech but together contribute to the subjective speech understanding.

Effects of experience on recognition of speech produced with a face mask

Over the past two years, face masks have been a critical tool for preventing the spread of COVID-19. While previous studies have examined the effects of masks on speech recognition, much of this work was conducted early in the pandemic. Given that human listeners are able to adapt to a wide variety of novel contexts in speech perception, an open question concerns the extent to which listeners have adapted to masked speech during the pandemic. In order to evaluate this, we replicated Toscano and Toscano (PLOS ONE 16(2):e0246842, 2021), looking at the effects of several types of face masks on speech recognition in different levels of multi-talker babble noise. We also examined the effects of listeners' self-reported frequency of encounters with masked speech and the effects of the implementation of public mask mandates on speech recognition. Overall, we found that listeners' performance in the current experiment (with data collected in 2021) was similar to that of listeners in Toscano and Toscano (with data collected in 2020) and that performance did not differ based on mask experience. These findings suggest that listeners may have already adapted to masked speech by the time data were collected in 2020, are unable to adapt to masked speech, require additional context to be able to adapt, or that talkers also changed their productions over time. Implications for theories of perceptual learning in speech are discussed.

The time course of adaptation to distorted speech

When confronted with unfamiliar or novel forms of speech, listeners' word recognition performance is known to improve with exposure, but data are lacking on the fine-grained time course of adaptation. The current study aims to fill this gap by investigating the time course of adaptation to several different types of distorted speech. Keyword scores as a function of sentence position in a block of 30 sentences were measured in response to eight forms of distorted speech. Listeners recognised twice as many words in the final sentence compared to the initial sentence with around half of the gain appearing in the first three sentences, followed by gradual gains over the rest of the block. Rapid adaptation was apparent for most of the eight distortion types tested with differences mainly in the gradual phase. Adaptation to sine-wave speech improved if listeners had heard other types of distortion prior to exposure, but no similar facilitation occurred for the other types of distortion. Rapid adaptation is unlikely to be due to procedural learning since listeners had been familiarised with the task and sentence format through exposure to undistorted speech. The mechanisms that underlie rapid adaptation are currently unclear.

Reducing interaural tonotopic mismatch preserves binaural unmasking in cochlear implant simulations of single-sided deafness

Binaural unmasking, a key feature of normal binaural hearing, can refer to the improved intelligibility of masked speech by adding masking that facilitates perceived separation of target and masker. A question relevant for cochlear implant users with single-sided deafness (SSD-CI) is whether binaural unmasking can still be achieved if the additional masking is spectrally degraded and shifted. CIs restore some aspects of binaural hearing to these listeners, although binaural unmasking remains limited. Notably, these listeners may experience a mismatch between the frequency information perceived through the CI and that perceived by their normal hearing ear. Employing acoustic simulations of SSD-CI with normal hearing listeners, the present study confirms a previous simulation study that binaural unmasking is severely limited when interaural frequency mismatch between the input frequency range and simulated place of stimulation exceeds 1-2 mm. The present study also shows that binaural unmasking is largely retained when the input frequency range is adjusted to match simulated place of stimulation, even at the expense of removing low-frequency information. This result bears implications for the mechanisms driving the type of binaural unmasking of the present study and for mapping the frequency range of the CI speech processor in SSD-CI users.

Estimating the reduced benefit of infant-directed speech in cochlear implant-related speech processing

Caregivers modify their speech when talking to infants, a specific type of speech known as infant-directed speech (IDS). This speaking style facilitates language learning compared to adult-directed speech (ADS) in infants with normal hearing (NH). While infants with NH and those with cochlear implants (CIs) prefer listening to IDS over ADS, it is yet unknown how CI processing may affect the acoustic distinctiveness between ADS and IDS, as well as the degree of intelligibility of these. This study analyzed speech of seven female adult talkers to model the effects of simulated CI processing on (1) acoustic distinctiveness between ADS and IDS, (2) estimates of intelligibility of caregivers' speech in ADS and IDS, and (3) individual differences in caregivers' ADS-to-IDS modification and estimated speech intelligibility. Results suggest that CI processing is substantially detrimental to the acoustic distinctiveness between ADS and IDS, as well as to the intelligibility benefit derived from ADS-to-IDS modifications. Moreover, the observed variability across individual talkers in acoustic implementation of ADS-to-IDS modification and the estimated speech intelligibility was significantly reduced due to CI processing. The findings are discussed in the context of the link between IDS and language learning in infants with CIs.

Influence of electrode to cochlear duct length ratio on post-operative speech understanding outcomes

OBJECTIVE

To assess whether the pre-operative electrode to cochlear duct length ratio (ECDLR), is associated with post-operative speech recognition outcomes.

STUDY DESIGN

A retrospective chart review study.

SETTING

Tertiary referral center.

PATIENTS

The study included sixty-one adult CI recipients with a pre-operative computed tomography scan and a speech recognition test 12 months after implantation.

INTERVENTIONS

The average of two raters' cochlear duct length (CDL) measurements and the length of the recipient's cochlear implant electrode array formed the basis for the electrode-to-cochlear duct length ratio (ECLDR). Speech recognition tests were compared as a function of ECDLR and electrode array length itself.

MAIN OUTCOME MEASURES

The relationship between ECDLR and percent correct on speech recognition tests.

RESULTS

A second order polynomial regression relating ECDLR to percent correct on the CNC words speech recognition test was statistically significant, as was a fourth order polynomial regression for the AzBio Quiet test. In contrast, there was no statistically significant relationship between speech recognition scores and electrode array length.

CONCLUSIONS

ECDLR values can be statistically associated to speech-recognition outcomes. However, these ECDLR values cannot be predicted by the electrode length alone, and must include a measure of CDL.

Eye Gaze and Perceptual Adaptation to Audiovisual Degraded Speech

Purpose Visual cues from a speaker's face may benefit perceptual adaptation to degraded speech, but current evidence is limited. We aimed to replicate results from previous studies to establish the extent to which visual speech cues can lead to greater adaptation over time, extending existing results to a real-time adaptation paradigm (i.e., without a separate training period). A second aim was to investigate whether eye gaze patterns toward the speaker's mouth were related to better perception, hypothesizing that listeners who looked more at the speaker's mouth would show greater adaptation. Method A group of listeners (n = 30) was presented with 90 noise-vocoded sentences in audiovisual format, whereas a control group (n = 29) was presented with the audio signal only. Recognition accuracy was measured throughout and eye tracking was used to measure fixations toward the speaker's eyes and mouth in the audiovisual group. Results Previous studies were partially replicated: The audiovisual group had better recognition throughout and adapted slightly more rapidly, but both groups showed an equal amount of improvement overall. Longer fixations on the speaker's mouth in the audiovisual group were related to better overall accuracy. An exploratory analysis further demonstrated that the duration of fixations to the speaker's mouth decreased over time. Conclusions The results suggest that visual cues may not benefit adaptation to degraded speech as much as previously thought. Longer fixations on a speaker's mouth may play a role in successfully decoding visual speech cues; however, this will need to be confirmed in future research to fully understand how patterns of eye gaze are related to audiovisual speech recognition. All materials, data, and code are available at https://osf.io/2wqkf/.

Semantic Predictability Facilitates Comprehension of Degraded Speech in a Graded Manner

Previous studies have shown that at moderate levels of spectral degradation, semantic predictability facilitates language comprehension. It is argued that when speech is degraded, listeners have narrowed expectations about the sentence endings; i.e., semantic prediction may be limited to only most highly predictable sentence completions. The main objectives of this study were to (i) examine whether listeners form narrowed expectations or whether they form predictions across a wide range of probable sentence endings, (ii) assess whether the facilitatory effect of semantic predictability is modulated by perceptual adaptation to degraded speech, and (iii) use and establish a sensitive metric for the measurement of language comprehension. For this, we created 360 German Subject-Verb-Object sentences that varied in semantic predictability of a sentence-final target word in a graded manner (high, medium, and low) and levels of spectral degradation (1, 4, 6, and 8 channels noise-vocoding). These sentences were presented auditorily to two groups: One group (n =48) performed a listening task in an unpredictable channel context in which the degraded speech levels were randomized, while the other group (n =50) performed the task in a predictable channel context in which the degraded speech levels were blocked. The results showed that at 4 channels noise-vocoding, response accuracy was higher in high-predictability sentences than in the medium-predictability sentences, which in turn was higher than in the low-predictability sentences. This suggests that, in contrast to the narrowed expectations view, comprehension of moderately degraded speech, ranging from low- to high- including medium-predictability sentences, is facilitated in a graded manner; listeners probabilistically preactivate upcoming words from a wide range of semantic space, not limiting only to highly probable sentence endings. Additionally, in both channel contexts, we did not observe learning effects; i.e., response accuracy did not increase over the course of experiment, and response accuracy was higher in the predictable than in the unpredictable channel context. We speculate from these observations that when there is no trial-by-trial variation of the levels of speech degradation, listeners adapt to speech quality at a long timescale; however, when there is a trial-by-trial variation of the high-level semantic feature (e.g., sentence predictability), listeners do not adapt to low-level perceptual property (e.g., speech quality) at a short timescale.

Auditory memory for random time patterns in cochlear implant listeners

Learning about new sounds is essential for cochlear-implant and normal-hearing listeners alike, with the additional challenge for implant listeners that spectral resolution is severely degraded. Here, a task measuring the rapid learning of slow or fast stochastic temporal sequences [Kang, Agus, and Pressnitzer (2017). J. Acoust. Soc. Am. 142, 2219-2232] was performed by cochlear-implant (N = 10) and normal-hearing (N = 9) listeners, using electric or acoustic pulse sequences, respectively. Rapid perceptual learning was observed for both groups, with highly similar characteristics. Moreover, for cochlear-implant listeners, an additional condition tested ultra-fast electric pulse sequences that would be impossible to represent temporally when presented acoustically. This condition also demonstrated learning. Overall, the results suggest that cochlear-implant listeners have access to the neural plasticity mechanisms needed for the rapid perceptual learning of complex temporal sequences.

The Relevance of the Availability of Visual Speech Cues During Adaptation to Noise-Vocoded Speech

Purpose This study first aimed to establish whether viewing specific parts of the speaker's face (eyes or mouth), compared to viewing the whole face, affected adaptation to distorted noise-vocoded sentences. Second, this study also aimed to replicate results on processing of distorted speech from lab-based experiments in an online setup. Method We monitored recognition accuracy online while participants were listening to noise-vocoded sentences. We first established if participants were able to perceive and adapt to audiovisual four-band noise-vocoded sentences when the entire moving face was visible (AV Full). Four further groups were then tested: a group in which participants viewed the moving lower part of the speaker's face (AV Mouth), a group in which participants only see the moving upper part of the face (AV Eyes), a group in which participants could not see the moving lower or upper face (AV Blocked), and a group in which participants saw an image of a still face (AV Still). Results Participants repeated around 40% of the key words correctly and adapted during the experiment, but only when the moving mouth was visible. In contrast, performance was at floor level, and no adaptation took place, in conditions when the moving mouth was occluded. Conclusions The results show the importance of being able to observe relevant visual speech information from the speaker's mouth region, but not the eyes/upper face region, when listening and adapting to distorted sentences online. Second, the results also demonstrated that it is feasible to run speech perception and adaptation studies online, but that not all findings reported for lab studies replicate. Supplemental Material https://doi.org/10.23641/asha.14810523.

Effects of Spectral Resolution and Frequency Mismatch on Speech Understanding and Spatial Release From Masking in Simulated Bilateral Cochlear Implants

OBJECTIVES

Due to interaural frequency mismatch, bilateral cochlear-implant (CI) users may be less able to take advantage of binaural cues that normal-hearing (NH) listeners use for spatial hearing, such as interaural time differences and interaural level differences. As such, bilateral CI users have difficulty segregating competing speech even when the target and competing talkers are spatially separated. The goal of this study was to evaluate the effects of spectral resolution, tonotopic mismatch (the frequency mismatch between the acoustic center frequency assigned to CI electrode within an implanted ear relative to the expected spiral ganglion characteristic frequency), and interaural mismatch (differences in the degree of tonotopic mismatch in each ear) on speech understanding and spatial release from masking (SRM) in the presence of competing talkers in NH subjects listening to bilateral vocoder simulations.

DESIGN

During testing, both target and masker speech were presented in five-word sentences that had the same syntax but were not necessarily meaningful. The sentences were composed of five categories in fixed order (Name, Verb, Number, Color, and Clothes), each of which had 10 items, such that multiple sentences could be generated by randomly selecting a word from each category. Speech reception thresholds (SRTs) for the target sentence presented in competing speech maskers were measured. The target speech was delivered to both ears and the two speech maskers were delivered to (1) both ears (diotic masker), or (2) different ears (dichotic masker: one delivered to the left ear and the other delivered to the right ear). Stimuli included the unprocessed speech and four 16-channel sine-vocoder simulations with different interaural mismatch (0, 1, and 2 mm). SRM was calculated as the difference between the diotic and dichotic listening conditions.

RESULTS

With unprocessed speech, SRTs were 0.3 and -18.0 dB for the diotic and dichotic maskers, respectively. For the spectrally degraded speech with mild tonotopic mismatch and no interaural mismatch, SRTs were 5.6 and -2.0 dB for the diotic and dichotic maskers, respectively. When the tonotopic mismatch increased in both ears, SRTs worsened to 8.9 and 2.4 dB for the diotic and dichotic maskers, respectively. When the two ears had different tonotopic mismatch (e.g., there was interaural mismatch), the performance drop in SRTs was much larger for the dichotic than for the diotic masker. The largest SRM was observed with unprocessed speech (18.3 dB). With the CI simulations, SRM was significantly reduced to 7.6 dB even with mild tonotopic mismatch but no interaural mismatch; SRM was further reduced with increasing interaural mismatch.

CONCLUSIONS

The results demonstrate that frequency resolution, tonotopic mismatch, and interaural mismatch have differential effects on speech understanding and SRM in simulation of bilateral CIs. Minimizing interaural mismatch may be critical to optimize binaural benefits and improve CI performance for competing speech, a typical listening environment. SRM (the difference in SRTs between diotic and dichotic maskers) may be a useful clinical tool to assess interaural frequency mismatch in bilateral CI users and to evaluate the benefits of optimization methods that minimize interaural mismatch.

Unilateral Acoustic Degradation Delays Attentional Separation of Competing Speech

Hearing loss is often asymmetric such that hearing thresholds differ substantially between the two ears. The extreme case of such asymmetric hearing is single-sided deafness. A unilateral cochlear implant (CI) on the more severely impaired ear is an effective treatment to restore hearing. The interactive effects of unilateral acoustic degradation and spatial attention to one sound source in multitalker situations are at present unclear. Here, we simulated some features of listening with a unilateral CI in young, normal-hearing listeners (N = 22) who were presented with 8-band noise-vocoded speech to one ear and intact speech to the other ear. Neural responses were recorded in the electroencephalogram to obtain the spectrotemporal response function to speech. Listeners made more mistakes when answering questions about vocoded (vs. intact) attended speech. At the neural level, we asked how unilateral acoustic degradation would impact the attention-induced amplification of tracking target versus distracting speech. Interestingly, unilateral degradation did not per se reduce the attention-induced amplification but instead delayed it in time: Speech encoding accuracy, modelled on the basis of the spectrotemporal response function, was significantly enhanced for attended versus ignored intact speech at earlier neural response latencies (<∼250 ms). This attentional enhancement was not absent but delayed for vocoded speech. These findings suggest that attentional selection of unilateral, degraded speech is feasible but induces delayed neural separation of competing speech, which might explain listening challenges experienced by unilateral CI users.

Individual Variability in Recalibrating to Spectrally Shifted Speech: Implications for Cochlear Implants

OBJECTIVES

Cochlear implant (CI) recipients are at a severe disadvantage compared with normal-hearing listeners in distinguishing consonants that differ by place of articulation because the key relevant spectral differences are degraded by the implant. One component of that degradation is the upward shifting of spectral energy that occurs with a shallow insertion depth of a CI. The present study aimed to systematically measure the effects of spectral shifting on word recognition and phoneme categorization by specifically controlling the amount of shifting and using stimuli whose identification specifically depends on perceiving frequency cues. We hypothesized that listeners would be biased toward perceiving phonemes that contain higher-frequency components because of the upward frequency shift and that intelligibility would decrease as spectral shifting increased.

DESIGN

Normal-hearing listeners (n = 15) heard sine wave-vocoded speech with simulated upward frequency shifts of 0, 2, 4, and 6 mm of cochlear space to simulate shallow CI insertion depth. Stimuli included monosyllabic words and /b/-/d/ and /∫/-/s/ continua that varied systematically by formant frequency transitions or frication noise spectral peaks, respectively. Recalibration to spectral shifting was operationally defined as shifting perceptual acoustic-phonetic mapping commensurate with the spectral shift. In other words, adjusting frequency expectations for both phonemes upward so that there is still a perceptual distinction, rather than hearing all upward-shifted phonemes as the higher-frequency member of the pair.

RESULTS

For moderate amounts of spectral shifting, group data suggested a general "halfway" recalibration to spectral shifting, but individual data suggested a notably different conclusion: half of the listeners were able to recalibrate fully, while the other halves of the listeners were utterly unable to categorize shifted speech with any reliability. There were no participants who demonstrated a pattern intermediate to these two extremes. Intelligibility of words decreased with greater amounts of spectral shifting, also showing loose clusters of better- and poorer-performing listeners. Phonetic analysis of word errors revealed certain cues were more susceptible to being compromised due to a frequency shift (place and manner of articulation), while voicing was robust to spectral shifting.

CONCLUSIONS

Shifting the frequency spectrum of speech has systematic effects that are in line with known properties of speech acoustics, but the ensuing difficulties cannot be predicted based on tonotopic mismatch alone. Difficulties are subject to substantial individual differences in the capacity to adjust acoustic-phonetic mapping. These results help to explain why speech recognition in CI listeners cannot be fully predicted by peripheral factors like electrode placement and spectral resolution; even among listeners with functionally equivalent auditory input, there is an additional factor of simply being able or unable to flexibly adjust acoustic-phonetic mapping. This individual variability could motivate precise treatment approaches guided by an individual's relative reliance on wideband frequency representation (even if it is mismatched) or limited frequency coverage whose tonotopy is preserved.

Dichotic listening performance with cochlear-implant simulations of ear asymmetry is consistent with difficulty ignoring clearer speech

There are an increasing number of bilateral and single-sided-deafness cochlear-implant (CI) users who hope to achieve improved spatial-hearing abilities through access to sound in both ears. It is, however, unclear how speech is processed when inputs are functionally asymmetrical, which may have an impact on spatial-hearing abilities. Therefore, functionally asymmetrical hearing was controlled and parametrically manipulated using a channel vocoder as a CI simulation. In Experiment 1, normal-hearing (NH) listeners performed a dichotic listening task (i.e., selective attention to one ear, ignoring the other) using asymmetrical signal degradation. Spectral resolution varied independently in each ear (4, 8, 16 channels, and unprocessed control). Performance decreased with decreasing resolution in the target ear and increasing resolution in the interferer ear. In Experiment 2, these results were replicated using a divided attention task (attend to both ears, report one after sentence completion) in both NH and bilateral CI listeners, although overall performance was lower than in Experiment 1. In Experiment 3, frequency-to-place mismatch simulated shallow CI insertion depths (0, 3, 6-mm shifts, and unprocessed control). Performance mostly decreased with increasing shift in the target ear and decreasing shift in the interferer ear; however, performance nonmonotonicities occurred. The worst performance occurred when the shift matched across ears, suggesting that pitch similarity increases difficulty. The results show that it is more difficult to attend an ear that is relatively degraded or distorted, which may set spatial-hearing limitations for CI users when trying to attend to a target in complex auditory scenes.

Perceptual Learning of Vocoded Speech With and Without Contralateral Hearing: Implications for Cochlear Implant Rehabilitation

Purpose An increasing number of individuals with residual or even normal contralateral hearing are being considered for cochlear implantation. It remains unknown whether the presence of contralateral hearing is beneficial or detrimental to their perceptual learning of cochlear implant (CI)-processed speech. The aim of this experiment was to provide a first insight into this question using acoustic simulations of CI processing. Method Sixty normal-hearing listeners took part in an auditory perceptual learning experiment. Each subject was randomly assigned to one of three groups of 20 referred to as NORMAL, LOWPASS, and NOTHING. The experiment consisted of two test phases separated by a training phase. In the test phases, all subjects were tested on recognition of monosyllabic words passed through a six-channel "PSHC" vocoder presented to a single ear. In the training phase, which consisted of listening to a 25-min audio book, all subjects were also presented with the same vocoded speech in one ear but the signal they received in their other ear differed across groups. The NORMAL group was presented with the unprocessed speech signal, the LOWPASS group with a low-pass filtered version of the speech signal, and the NOTHING group with no sound at all. Results The improvement in speech scores following training was significantly smaller for the NORMAL than for the LOWPASS and NOTHING groups. Conclusions This study suggests that the presentation of normal speech in the contralateral ear reduces or slows down perceptual learning of vocoded speech but that an unintelligible low-pass filtered contralateral signal does not have this effect. Potential implications for the rehabilitation of CI patients with partial or full contralateral hearing are discussed.

Recognition of vocoded words and sentences in quiet and multi-talker babble with children and adults

A vocoder is used to simulate cochlear-implant sound processing in normal-hearing listeners. Typically, there is rapid improvement in vocoded speech recognition, but it is unclear if the improvement rate differs across age groups and speech materials. Children (8–10 years) and young adults (18–26 years) were trained and tested over 2 days (4 hours) on recognition of eight-channel noise-vocoded words and sentences, in quiet and in the presence of multi-talker babble at signal-to-noise ratios of 0, +5, and +10 dB. Children achieved poorer performance than adults in all conditions, for both word and sentence recognition. With training, vocoded speech recognition improvement rates were not significantly different between children and adults, suggesting that improvement in learning how to process speech cues degraded via vocoding is absent of developmental differences across these age groups and types of speech materials. Furthermore, this result confirms that the acutely measured age difference in vocoded speech recognition persists after extended training.

Effects of noise on integration of acoustic and electric hearing within and across ears

In bimodal listening, cochlear implant (CI) users combine electric hearing (EH) in one ear and acoustic hearing (AH) in the other ear. In electric-acoustic stimulation (EAS), CI users combine EH and AH in the same ear. In quiet, integration of EH and AH has been shown to be better with EAS, but with greater sensitivity to tonotopic mismatch in EH. The goal of the present study was to evaluate how external noise might affect integration of AH and EH within or across ears. Recognition of monosyllabic words was measured for normal-hearing subjects listening to simulations of unimodal (AH or EH alone), EAS, and bimodal listening in quiet and in speech-shaped steady noise (10 dB, 0 dB signal-to-noise ratio). The input/output frequency range for AH was 0.1–0.6 kHz. EH was simulated using an 8-channel noise vocoder. The output frequency range was 1.2–8.0 kHz to simulate a shallow insertion depth. The input frequency range was either matched (1.2–8.0 kHz) or mismatched (0.6–8.0 kHz) to the output frequency range; the mismatched input range maximized the amount of speech information, while the matched input resulted in some speech information loss. In quiet, tonotopic mismatch differently affected EAS and bimodal performance. In noise, EAS and bimodal performance was similarly affected by tonotopic mismatch. The data suggest that tonotopic mismatch may differently affect integration of EH and AH in quiet and in noise.

The effect of dopamine on the comprehension of spectrally-shifted noise-vocoded speech: a pilot study

Objectives: Cochlear implantation has proven beneficial in restoring hearing. However, success is variable, and there is a need for a simple post-implantation therapy that could significantly increase implantation success. Dopamine has a general role in learning and in assigning value to environmental stimuli. We tested the effect of dopamine in the comprehension of spectrally-shifted noise-vocoded (SSNV) speech, which simulates, in hearing individuals, the signal delivered by a cochlear implant (CI).Design and study sample: Thirty-five participants (age = 38.0 ± 10.1 SD) recruited from the general population were divided into three groups. We tested SSNV speech comprehension in two experimental sessions. In one session, a metabolic precursor of dopamine (L-DOPA) was administered to participants in two of the groups; a placebo was administered in the other session.Results: A single dose of L-DOPA interacted with training to improve perception of SSNV speech, but did not significantly accelerate learning.Conclusions: These findings are a first step in exploring the use of dopamine to enhance speech understanding in CI patients. Replications of these results using SSNV in individuals with normal hearing, and also in CI users, are needed to determine whether these effects can translate into benefits in everyday language comprehension.

Searching for the Sound of a Cochlear Implant: Evaluation of Different Vocoder Parameters by Cochlear Implant Users With Single-Sided Deafness

Cochlear implantation in subjects with single-sided deafness (SSD) offers a unique opportunity to directly compare the percepts evoked by a cochlear implant (CI) with those evoked acoustically. Here, nine SSD-CI users performed a forced-choice task evaluating the similarity of speech processed by their CI with speech processed by several vocoders presented to their healthy ear. In each trial, subjects heard two intervals: their CI followed by a certain vocoder in Interval 1 and their CI followed by a different vocoder in Interval 2. The vocoders differed either (i) in carrier type-(sinusoidal [SINE], bandfiltered noise [NOISE], and pulse-spreading harmonic complex) or (ii) in frequency mismatch between the analysis and synthesis frequency ranges-(no mismatch, and two frequency-mismatched conditions of 2 and 4 equivalent rectangular bandwidths [ERBs]). Subjects had to state in which of the two intervals the CI and vocoder sounds were more similar. Despite a large intersubject variability, the PSHC vocoder was judged significantly more similar to the CI than SINE or NOISE vocoders. Furthermore, the No-mismatch and 2-ERB mismatch vocoders were judged significantly more similar to the CI than the 4-ERB mismatch vocoder. The mismatch data were also interpreted by comparing spiral ganglion characteristic frequencies with electrode contact positions determined from postoperative computed tomography scans. Only one subject demonstrated a pattern of preference consistent with adaptation to the CI sound processor frequency-to-electrode allocation table and two subjects showed possible partial adaptation. Those subjects with adaptation patterns presented overall small and consistent frequency mismatches across their electrode arrays.

The Effect of Simulated Interaural Frequency Mismatch on Speech Understanding and Spatial Release From Masking

OBJECTIVE

The binaural-hearing system interaurally compares inputs, which underlies the ability to localize sound sources and to better understand speech in complex acoustic environments. Cochlear implants (CIs) are provided in both ears to increase binaural-hearing benefits; however, bilateral CI users continue to struggle with understanding speech in the presence of interfering sounds and do not achieve the same level of spatial release from masking (SRM) as normal-hearing listeners. One reason for diminished SRM in CI users could be that the electrode arrays are inserted at different depths in each ear, which would cause an interaural frequency mismatch. Because interaural frequency mismatch diminishes the salience of interaural differences for relatively simple stimuli, it may also diminish binaural benefits for spectral-temporally complex stimuli like speech. This study evaluated the effect of simulated frequency-to-place mismatch on speech understanding and SRM.

DESIGN

Eleven normal-hearing listeners were tested on a speech understanding task. There was a female target talker who spoke five-word sentences from a closed set of words. There were two interfering male talkers who spoke unrelated sentences. Nonindividualized head-related transfer functions were used to simulate a virtual auditory space. The target was presented from the front (0°), and the interfering speech was either presented from the front (colocated) or from 90° to the right (spatially separated). Stimuli were then processed by an eight-channel vocoder with tonal carriers to simulate aspects of listening through a CI. Frequency-to-place mismatch ("shift") was introduced by increasing the center frequency of the synthesis filters compared with the corresponding analysis filters. Speech understanding was measured for different shifts (0, 3, 4.5, and 6 mm) and target-to-masker ratios (TMRs: +10 to -10 dB). SRM was calculated as the difference in the percentage of correct words for the colocated and separated conditions. Two types of shifts were tested: (1) bilateral shifts that had the same frequency-to-place mismatch in both ears, but no interaural frequency mismatch, and (2) unilateral shifts that produced an interaural frequency mismatch.

RESULTS

For the bilateral shift conditions, speech understanding decreased with increasing shift and with decreasing TMR, for both colocated and separate conditions. There was, however, no interaction between shift and spatial configuration; in other words, SRM was not affected by shift. For the unilateral shift conditions, speech understanding decreased with increasing interaural mismatch and with decreasing TMR for both the colocated and spatially separated conditions. Critically, there was a significant interaction between the amount of shift and spatial configuration; in other words, SRM decreased for increasing interaural mismatch.

CONCLUSIONS

A frequency-to-place mismatch in one or both ears resulted in decreased speech understanding. SRM, however, was only affected in conditions with unilateral shifts and interaural frequency mismatch. Therefore, matching frequency information between the ears provides listeners with larger binaural-hearing benefits, for example, improved speech understanding in the presence of interfering talkers. A clinical procedure to reduce interaural frequency mismatch when programming bilateral CIs may improve benefits in speech segregation that are due to binaural-hearing abilities.

Interaural Time-Difference Discrimination as a Measure of Place of Stimulation for Cochlear-Implant Users With Single-Sided Deafness

Current clinical practice in programming a cochlear implant (CI) for individuals with single-sided deafness (SSD) is to maximize the transmission of speech information via the implant, with the implicit assumption that this will also result in improved spatial-hearing abilities. However, binaural sensitivity is reduced by interaural place-of-stimulation mismatch, a likely occurrence with a standard CI frequency-to-electrode allocation table (FAT). As a step toward reducing interaural mismatch, this study investigated whether a test of interaural-time-difference (ITD) discrimination could be used to estimate the acoustic frequency yielding the best place match for a given CI electrode. ITD-discrimination performance was measured by presenting 300-ms bursts of 100-pulses-per-second electrical pulse trains to a single CI electrode and band-limited pulse trains with variable carrier frequencies to the acoustic ear. Listeners discriminated between two reference intervals (four bursts each with constant ITD) and a moving target interval (four bursts with variable ITD). For 17 out of the 26 electrodes tested across eight listeners, the function describing the relationship between ITD-discrimination performance and carrier frequency had a discernable peak where listeners achieved 70% to 100% performance. On average, this peak occurred 1.15 octaves above the CI manufacturer’s default FAT. ITD discrimination shows promise as a method of estimating the cochlear place of stimulation for a given electrode, thereby providing information to optimize the FAT for SSD-CI listeners.

A Randomized Controlled Crossover Study of the Impact of Online Music Training on Pitch and Timbre Perception in Cochlear Implant Users

Cochlear implant (CI) biomechanical constraints result in impoverished spectral cues and poor frequency resolution, making it difficult for users to perceive pitch and timbre. There is emerging evidence that music training may improve CI-mediated music perception; however, much of the existing studies involve time-intensive and less readily accessible in-person music training paradigms, without rigorous experimental control paradigms. Online resources for auditory rehabilitation remain an untapped potential resource for CI users. Furthermore, establishing immediate value from an acute music training program may encourage CI users to adhere to post-implantation rehabilitation exercises. In this study, we evaluated the impact of an acute online music training program on pitch discrimination and timbre identification. Via a randomized controlled crossover study design, 20 CI users and 21 normal hearing (NH) adults were assigned to one of two arms. Arm-A underwent 1 month of online self-paced music training (intervention) followed by 1 month of audiobook listening (control). Arm-B underwent 1 month of audiobook listening followed by 1 month of music training. Pitch and timbre sensitivity scores were taken across three visits: (1) baseline, (2) after 1 month of intervention, and (3) after 1 month of control. We found that performance improved in pitch discrimination among CI users and NH listeners, with both online music training and audiobook listening. Music training, however, provided slightly greater benefit for instrument identification than audiobook listening. For both tasks, this improvement appears to be related to both fast stimulus learning as well as procedural learning. In conclusion, auditory training (with either acute participation in an online music training program or audiobook listening) may improve performance on untrained tasks of pitch discrimination and timbre identification. These findings demonstrate a potential role for music training in perceptual auditory appraisal of complex stimuli. Furthermore, this study highlights the importance and the need for more tightly controlled training studies in order to accurately evaluate the impact of rehabilitation training protocols on auditory processing.

Memory Span for Spoken Digits in Adults With Cochlear Implants or Typical Hearing: Effects of Age and Identification Ability

PURPOSE

Short-term and working memory vary across individuals and life span. Studies of how cochlear implant (CI) users remember spoken words often do not fully disentangle perceptual influences from memory assessment because stimulus identification is rarely checked; instead, correct perception is assumed by using simple or practiced stimuli. Here, we examine whether the accuracy and speed of auditory digit identification are associated with short-term and working memory in adults with CIs as a function of age. Do perceptual errors and longer processing times depress memory span scores for such listeners? An intensive digit span assessment using manual responses is compared with traditional digit span, which uses only a few speech-based trials. We also assess how vocoder-based degradation impacts identification and digit span in older versus younger listeners with normal hearing (NH).

METHOD

We measured forward and backward recall for spoken digits in 25 adults with CIs (M = 57 years; range = 20-82 years), 10 older adults with NH (> 55 years; M = 64 years), and 11 younger adults with NH (< 22 years). Listeners identified recorded digits one at a time by clicking numerals on a computer screen and then were cued to recall the list. In a comparison condition, listeners only identified each item. Listeners with NH also completed the tasks under four conditions of signal degradation implemented using a channel vocoder: four or eight channels crossed with 0- or 6-mm simulated tonotopic shift, administered in randomized blocks. A mixed design was used, with the effects of degradation examined within subject, across different listener groups, and as a function of age.

RESULTS

CI users were near perfect at identifying auditory digits (> 99% correct, on average), both in isolation and while experiencing a memory load. Perceptual accuracy, thus, did not affect digit span in these listeners. Identification times, however, were significantly slower under memory load. Age was only weakly related to span in CI listeners. Instead, individual differences in span in the CI group were better predicted by simple no-load identification times. Among listeners with NH, spans for vocoded digits that were not frequency shifted did not differ from spans for unprocessed stimuli. Frequency-shifted vocoded digits, however, yielded lower scores that could mostly, but not entirely, be accounted for by crediting for perceptual errors. Frequency-shifted vocoded digits were particularly challenging for older adult listeners with NH to identify. Traditional digit span correlated more strongly with our primary span measure for listeners with CIs than for listeners with NH.

CONCLUSIONS

Digit span can be studied independently of perception in many adult CI users. For both CI listeners and listeners with NH, stimulus degradation does not appear to significantly affect memory span, unless an effect on simple identification is also present. Auditory degradation that may slow, but which does not ultimately prevent identification, appears to have negligible impact on short-term and working memory spans.

Effects of Training on Lateralization for Simulations of Cochlear Implants and Single-Sided Deafness

While cochlear implantation has benefitted many patients with single-sided deafness (SSD), there is great variability in cochlear implant (CI) outcomes and binaural performance remains poorer than that of normal-hearing (NH) listeners. Differences in sound quality across ears-temporal fine structure (TFS) information with acoustic hearing vs. coarse spectro-temporal envelope information with electric hearing-may limit integration of acoustic and electric patterns. Binaural performance may also be limited by inter-aural mismatch between the acoustic input frequency and the place of stimulation in the cochlea. SSD CI patients must learn to accommodate these differences between acoustic and electric stimulation to maximize binaural performance. It is possible that training may increase and/or accelerate accommodation and further improve binaural performance. In this study, we evaluated lateralization training in NH subjects listening to broad simulations of SSD CI signal processing. A 16-channel vocoder was used to simulate the coarse spectro-temporal cues available with electric hearing; the degree of inter-aural mismatch was varied by adjusting the simulated insertion depth (SID) to be 25 mm (SID25), 22 mm (SID22) and 19 mm (SID19) from the base of the cochlea. Lateralization was measured using headphones and head-related transfer functions (HRTFs). Baseline lateralization was measured for unprocessed speech (UN) delivered to the left ear to simulate SSD and for binaural performance with the acoustic ear combined with the 16-channel vocoders (UN+SID25, UN+SID22 and UN+SID19). After completing baseline measurements, subjects completed six lateralization training exercises with the UN+SID22 condition, after which performance was re-measured for all baseline conditions. Post-training performance was significantly better than baseline for all conditions (p < 0.05 in all cases), with no significant difference in training benefits among conditions. Given that there was no significant difference between the SSD and the SSD CI conditions before or after training, the results suggest that NH listeners were unable to integrate TFS and coarse spectro-temporal cues across ears for lateralization, and that inter-aural mismatch played a secondary role at best. While lateralization training may benefit SSD CI patients, the training may largely improve spectral analysis with the acoustic ear alone, rather than improve integration of acoustic and electric hearing.

The Effect of Interaural Mismatches on Contralateral Unmasking With Single-Sided Vocoders

OBJECTIVES

Cochlear-implant (CI) users with single-sided deafness (SSD)-that is, one normal-hearing (NH) ear and one CI ear-can obtain some unmasking benefits when a mixture of target and masking voices is presented to the NH ear and a copy of just the masking voices is presented to the CI ear. NH listeners show similar benefits in a simulation of SSD-CI listening, whereby a mixture of target and masking voices is presented to one ear and a vocoded copy of the masking voices is presented to the opposite ear. However, the magnitude of the benefit for SSD-CI listeners is highly variable across individuals and is on average less than for NH listeners presented with vocoded stimuli. One possible explanation for the limited benefit observed for some SSD-CI users is that temporal and spectral discrepancies between the acoustic and electric ears might interfere with contralateral unmasking. The present study presented vocoder simulations to NH participants to examine the effects of interaural temporal and spectral mismatches on contralateral unmasking.

DESIGN

Speech-reception performance was measured in a competing-talker paradigm for NH listeners presented with vocoder simulations of SSD-CI listening. In the monaural condition, listeners identified target speech masked by two same-gender interferers, presented to the left ear. In the bilateral condition, the same stimuli were presented to the left ear, but the right ear was presented with a noise-vocoded copy of the interfering voices. This paradigm tested whether listeners could integrate the interfering voices across the ears to better hear the monaural target. Three common distortions inherent in CI processing were introduced to the vocoder processing: spectral shifts, temporal delays, and reduced frequency selectivity.

RESULTS

In experiment 1, contralateral unmasking (i.e., the benefit from adding the vocoded maskers to the second ear) was impaired by spectral mismatches of four equivalent rectangular bandwidths or greater. This is equivalent to roughly a 3.6-mm mismatch between the cochlear places stimulated in the electric and acoustic ears, which is on the low end of the average expected mismatch for SSD-CI listeners. In experiment 2, performance was negatively affected by a temporal mismatch of 24 ms or greater, but not for mismatches in the 0 to 12 ms range expected for SSD-CI listeners. Experiment 3 showed an interaction between spectral shift and spectral resolution, with less effect of interaural spectral mismatches when the number of vocoder channels was reduced. Experiment 4 applied interaural spectral and temporal mismatches in combination. Performance was best when both frequency and timing were aligned, but in cases where a mismatch was present in one dimension (either frequency or latency), the addition of mismatch in the second dimension did not further disrupt performance.

CONCLUSIONS

These results emphasize the need for interaural alignment-in timing and especially in frequency-to maximize contralateral unmasking for NH listeners presented with vocoder simulations of SSD-CI listening. Improved processing strategies that reduce mismatch between the electric and acoustic ears of SSD-CI listeners might improve their ability to obtain binaural benefits in multitalker environments.

Benefits to Speech Perception in Noise From the Binaural Integration of Electric and Acoustic Signals in Simulated Unilateral Deafness

OBJECTIVES

This study used vocoder simulations with normal-hearing (NH) listeners to (1) measure their ability to integrate speech information from an NH ear and a simulated cochlear implant (CI), and (2) investigate whether binaural integration is disrupted by a mismatch in the delivery of spectral information between the ears arising from a misalignment in the mapping of frequency to place.

DESIGN

Eight NH volunteers participated in the study and listened to sentences embedded in background noise via headphones. Stimuli presented to the left ear were unprocessed. Stimuli presented to the right ear (referred to as the CI-simulation ear) were processed using an eight-channel noise vocoder with one of the three processing strategies. An Ideal strategy simulated a frequency-to-place map across all channels that matched the delivery of spectral information between the ears. A Realistic strategy created a misalignment in the mapping of frequency to place in the CI-simulation ear where the size of the mismatch between the ears varied across channels. Finally, a Shifted strategy imposed a similar degree of misalignment in all channels, resulting in consistent mismatch between the ears across frequency. The ability to report key words in sentences was assessed under monaural and binaural listening conditions and at signal to noise ratios (SNRs) established by estimating speech-reception thresholds in each ear alone. The SNRs ensured that the monaural performance of the left ear never exceeded that of the CI-simulation ear. The advantages of binaural integration were calculated by comparing binaural performance with monaural performance using the CI-simulation ear alone. Thus, these advantages reflected the additional use of the experimentally constrained left ear and were not attributable to better-ear listening.

RESULTS

Binaural performance was as accurate as, or more accurate than, monaural performance with the CI-simulation ear alone. When both ears supported a similar level of monaural performance (50%), binaural integration advantages were found regardless of whether a mismatch was simulated or not. When the CI-simulation ear supported a superior level of monaural performance (71%), evidence of binaural integration was absent when a mismatch was simulated using both the Realistic and the Ideal processing strategies. This absence of integration could not be accounted for by ceiling effects or by changes in SNR.

CONCLUSIONS

If generalizable to unilaterally deaf CI users, the results of the current simulation study would suggest that benefits to speech perception in noise can be obtained by integrating information from an implanted ear and an NH ear. A mismatch in the delivery of spectral information between the ears due to a misalignment in the mapping of frequency to place may disrupt binaural integration in situations where both ears cannot support a similar level of monaural speech understanding. Previous studies that have measured the speech perception of unilaterally deaf individuals after CI but with nonindividualized frequency-to-electrode allocations may therefore have underestimated the potential benefits of providing binaural hearing. However, it remains unclear whether the size and nature of the potential incremental benefits from individualized allocations are sufficient to justify the time and resources required to derive them based on cochlear imaging or pitch-matching tasks.

Effect of carrier bandwidth on integration of simulations of acoustic and electric hearing within or across ears

Differences in current spread and/or spread of excitation may differently affect integration of acoustic and electric hearing within (electric-acoustic stimulation, or EAS) or across ears (bimodal). In this study, vowel recognition was measured in normal-hearing subjects listening to simulations of cochlear implant (CI), EAS, and bimodal listening. Residual acoustic hearing was limited between 0.1 and 0.6 kHz. The carrier bandwidth in the CI simulations was varied across carriers: broad-band noise, narrow-band noise, and sine waves. Results showed that reducing the bandwidth (and the inherent noise fluctuations) in the CI simulations significantly affected CI-only and bimodal performance, but not EAS performance.

Integration of acoustic and electric hearing is better in the same ear than across ears

Advances in cochlear implant (CI) technology allow for acoustic and electric hearing to be combined within the same ear (electric-acoustic stimulation, or EAS) and/or across ears (bimodal listening). Integration efficiency (IE; the ratio between observed and predicted performance for acoustic-electric hearing) can be used to estimate how well acoustic and electric hearing are combined. The goal of this study was to evaluate factors that affect IE in EAS and bimodal listening. Vowel recognition was measured in normal-hearing subjects listening to simulations of unimodal, EAS, and bimodal listening. The input/output frequency range for acoustic hearing was 0.1–0.6 kHz. For CI simulations, the output frequency range was 1.2–8.0 kHz to simulate a shallow insertion depth and the input frequency range was varied to provide increasing amounts of speech information and tonotopic mismatch. Performance was best when acoustic and electric hearing was combined in the same ear. IE was significantly better for EAS than for bimodal listening; IE was sensitive to tonotopic mismatch for EAS, but not for bimodal listening. These simulation results suggest acoustic and electric hearing may be more effectively and efficiently combined within rather than across ears, and that tonotopic mismatch should be minimized to maximize the benefit of acoustic-electric hearing, especially for EAS.

Vocoder Simulations Explain Complex Pitch Perception Limitations Experienced by Cochlear Implant Users

Pitch plays a crucial role in speech and music, but is highly degraded for people with cochlear implants, leading to severe communication challenges in noisy environments. Pitch is determined primarily by the first few spectrally resolved harmonics of a tone. In implants, access to this pitch is limited by poor spectral resolution, due to the limited number of channels and interactions between adjacent channels. Here we used noise-vocoder simulations to explore how many channels, and how little channel interaction, are required to elicit pitch. Results suggest that two to four times the number of channels are needed, along with interactions reduced by an order of magnitude, than available in current devices. These new constraints not only provide insights into the basic mechanisms of pitch coding in normal hearing but also suggest that spectrally based complex pitch is unlikely to be generated in implant users without significant changes in the method or site of stimulation.

Using prosody to infer discourse prominence in cochlear-implant users and normal-hearing listeners

Cochlear implants (CIs) provide speech perception to adults with severe-to-profound hearing loss, but the acoustic signal remains severely degraded. Limited access to pitch cues is thought to decrease sensitivity to prosody in CI users, but co-occurring changes in intensity and duration may provide redundant cues. The current study investigates how listeners use these cues to infer discourse prominence. CI users and normal-hearing (NH) listeners were presented with sentences varying in prosody (accented vs. unaccented words) while their eye-movements were measured to referents varying in discourse status (given vs. new categories). In Experiment 1, all listeners inferred prominence when prosody on nouns distinguished categories ("SANDWICH"→not sandals). In Experiment 2, CI users and NH listeners presented with natural speech inferred prominence when prosody on adjectives implied contrast across both categories and properties ("PINK horse"→not the orange horse). In contrast, NH listeners presented with simulated CI (vocoded) speech were sensitive to acoustic differences in prosody, but did not use these cues to infer discourse status. Together, this suggests that exploiting redundant cues for comprehension varies with the demands of language processing and prior experience with the degraded signal.

Speech Rate Normalization and Phonemic Boundary Perception in Cochlear-Implant Users

PURPOSE

Normal-hearing (NH) listeners rate normalize, temporarily remapping phonemic category boundaries to account for a talker's speech rate. It is unknown if adults who use auditory prostheses called cochlear implants (CI) can rate normalize, as CIs transmit degraded speech signals to the auditory nerve. Ineffective adjustment to rate information could explain some of the variability in this population's speech perception outcomes.

METHOD

Phonemes with manipulated voice-onset-time (VOT) durations were embedded in sentences with different speech rates. Twenty-three CI and 29 NH participants performed a phoneme identification task. NH participants heard the same unprocessed stimuli as the CI participants or stimuli degraded by a sine vocoder, simulating aspects of CI processing.

RESULTS

CI participants showed larger rate normalization effects (6.6 ms) than the NH participants (3.7 ms) and had shallower (less reliable) category boundary slopes. NH participants showed similarly shallow slopes when presented acoustically degraded vocoded signals, but an equal or smaller rate effect in response to reductions in available spectral and temporal information.

CONCLUSION

CI participants can rate normalize, despite their degraded speech input, and show a larger rate effect compared to NH participants. CI participants may particularly rely on rate normalization to better maintain perceptual constancy of the speech signal.

Self-Selection of Frequency Tables with Bilateral Mismatches in an Acoustic Simulation of a Cochlear Implant

BACKGROUND

Many recipients of bilateral cochlear implants (CIs) may have differences in electrode insertion depth. Previous reports indicate that when a bilateral mismatch is imposed, performance on tests of speech understanding or sound localization becomes worse. If recipients of bilateral CIs cannot adjust to a difference in insertion depth, adjustments to the frequency table may be necessary to maximize bilateral performance.

PURPOSE

The purpose of this study was to examine the feasibility of using real-time manipulations of the frequency table to offset any decrements in performance resulting from a bilateral mismatch.

RESEARCH DESIGN

A simulation of a CI was used because it allows for explicit control of the size of a bilateral mismatch. Such control is not available with users of CIs.

STUDY SAMPLE

A total of 31 normal-hearing young adults participated in this study.

DATA COLLECTION AND ANALYSIS

Using a CI simulation, four bilateral mismatch conditions (0, 0.75, 1.5, and 3 mm) were created. In the left ear, the analysis filters and noise bands of the CI simulation were the same. In the right ear, the noise bands were shifted higher in frequency to simulate a bilateral mismatch. Then, listeners selected a frequency table in the right ear that was perceived as maximizing bilateral speech intelligibility. Word-recognition scores were then assessed for each bilateral mismatch condition. Listeners were tested with both a standard frequency table, which preserved a bilateral mismatch, or with their self-selected frequency table.

RESULTS

Consistent with previous reports, bilateral mismatches of 1.5 and 3 mm yielded decrements in word recognition when the standard table was used in both ears. However, when listeners used the self-selected frequency table, performance was the same regardless of the size of the bilateral mismatch.

CONCLUSIONS

Self-selection of a frequency table appears to be a feasible method for ameliorating the negative effects of a bilateral mismatch. These data may have implications for recipients of bilateral CIs who cannot adapt to a bilateral mismatch, because they suggest that (1) such individuals may benefit from modification of the frequency table in one ear and (2) self-selection of a "most intelligible" frequency table may be a useful tool for determining how the frequency table should be altered to optimize speech recognition.

Vocoded speech perception with simulated shallow insertion depths in adults and children

It is unclear how adults and children differ in their ability to learn distorted speech signals. Normal-hearing adults (≥18 years) and children (8-10 years) were repeatedly tested on vocoded speech perception with 0-, 3-, and 6-mm of frequency-to-place mismatch (i.e., shift). Between testing blocks, listeners were provided training blocks with feedback on the 6-mm shift condition. Adults performed better than children at 0-mm shift, but performed similarly at 3- and 6-mm shifts. Therefore, differences between adults and children in vocoded speech perception are dependent on the degree of distortion, and this difference seems unaltered by training with feedback.

Acoustic Detail But Not Predictability of Task-Irrelevant Speech Disrupts Working Memory

Attended speech is comprehended better not only if more acoustic detail is available, but also if it is semantically highly predictable. But can more acoustic detail or higher predictability turn into disadvantages and distract a listener if the speech signal is to be ignored? Also, does the degree of distraction increase for older listeners who typically show a decline in attentional control ability? Adopting the irrelevant-speech paradigm, we tested whether younger (age 23–33 years) and older (60–78 years) listeners’ working memory for the serial order of spoken digits would be disrupted by the presentation of task-irrelevant speech varying in its acoustic detail (using noise-vocoding) and its semantic predictability (of sentence endings). More acoustic detail, but not higher predictability, of task-irrelevant speech aggravated memory interference. This pattern of results did not differ between younger and older listeners, despite generally lower performance in older listeners. Our findings suggest that the focus of attention determines how acoustics and predictability affect the processing of speech: first, as more acoustic detail is known to enhance speech comprehension and memory for speech, we here demonstrate that more acoustic detail of ignored speech enhances the degree of distraction. Second, while higher predictability of attended speech is known to also enhance speech comprehension under acoustically adverse conditions, higher predictability of ignored speech is unable to exert any distracting effect upon working memory performance in younger or older listeners. These findings suggest that features that make attended speech easier to comprehend do not necessarily enhance distraction by ignored speech.