The Impact of Vocal Boost Manipulations on Musical Sound Quality for Cochlear Implant Users

OBJECTIVE

To evaluate the impact of vocal boost manipulations on cochlear implant (CI) musical sound quality appraisals.

METHODS

An anonymous, online study was distributed to 33 CI users. Participants listened to auditory tokens and assessed the musical quality of acoustic stimuli with vocal boosting and attenuation using a validated sound quality rating scale. Four versions of real-world musical stimuli were created: a version with +9 dB vocal boost, a version with -9 dB vocal attenuation, a composite stimulus containing a 1,000 Hz low-pass filter and white noise ("anchor"), and an unaltered version ("hidden reference"). Subjects listened to all four versions and provided ratings based on a 100-point scale that reflected the perceived sound quality difference of the music clip relative to the reference excerpt.

RESULTS

Vocal boost increased musical sound quality ratings relative to the reference clip (11.7; 95% CI, 1.62-21.8, p = 0.016) and vocal attenuation decreased musical sound quality ratings relative to the reference clip (28.5; 95% CI, 18.64-38.44, p < 0.001). When comparing the non-musical training group and musical training group, there was a significant difference in musical sound quality rating scores for the vocal boost condition (21.2; 95% CI: 1.76-40.7, p = 0.028).

CONCLUSIONS

CI-mediated musical sound quality appraisals are impacted by vocal boost and attenuation. Musically trained CI users to report greater musical sound quality enhancement with a vocal boost with respect to CI users with no musical training background. Implementation of front-end vocal boost manipulations in music may improve sound quality and music appreciation among CI users.

LEVEL OF EVIDENCE

2 (Individual cohort study) Laryngoscope, 133:938-947, 2023.

Effect of Realistic Test Conditions on Perception of Speech, Music, and Binaural Cues in Normal-Hearing Listeners

PURPOSE

The purpose of this study was to determine the feasibility of online testing in a quiet room for three auditory perception experiments in normal-hearing listeners: speech, music, and binaural cue.

METHOD

Under Experiment 1, sentence perception was measured using fixed signal-to-noise ratios (SNRs: +10 dB, 0 dB, and -10 dB) and using adaptive speech reception threshold (SRT) procedures. The correct scores were compared between quiet room and soundproof booth listening environments. Experiment 2 was designed to compare melodic contour identification between the two listening environments. Melodic contour identification was assessed with 1, 2, and 4 semitone spacings. Under Experiment 3, interaural level difference (ILD) and interaural time differences (ITD) were measured as a function of carrier frequency. For both measures, two modulated tones (400-ms duration and 100-Hz modulation rate) were sequentially presented through headphones to both ears, and subjects were asked to indicate whether the sound moved to the left or right ear. The measured ITD and ILD were then compared between the two listening environments.

RESULTS

There were no significant differences in any outcome measures (SNR- and SRT-based speech perception, melodic contour identification, and ITD/ILD) between the two listening environments.

CONCLUSIONS

These results suggest that normal-hearing listeners may not require a controlled listening environment in any of the three auditory assessments. As comparable data can be obtained via the online testing tool, using the online auditory experiments is recommended.

Effect of Frequency Response Manipulations on Musical Sound Quality for Cochlear Implant Users

Cochlear implant (CI) users commonly report degraded musical sound quality. To improve CI-mediated music perception and enjoyment, we must understand factors that affect sound quality. In the present study, we utilize frequency response manipulation (FRM), a process that adjusts the energies of frequency bands within an audio signal, to determine its impact on CI-user sound quality assessments of musical stimuli. Thirty-three adult CI users completed an online study and listened to FRM-altered clips derived from the top songs in Billboard magazine. Participants assessed sound quality using the MUltiple Stimulus with Hidden Reference and Anchor for CI users (CI-MUSHRA) rating scale. FRM affected sound quality ratings (SQR). Specifically, increasing the gain for low and mid-range frequencies led to higher quality ratings than reducing them. In contrast, manipulating the gain for high frequencies (those above 2 kHz) had no impact. Participants with musical training were more sensitive to FRM than non-musically trained participants and demonstrated preference for gain increases over reductions. These findings suggest that, even among CI users, past musical training provides listeners with subtleties in musical appraisal, even though their hearing is now mediated electrically and bears little resemblance to their musical experience prior to implantation. Increased gain below 2 kHz may lead to higher sound quality than for equivalent reductions, perhaps because it offers greater access to lyrics in songs or because it provides more salient beat sensations.

Cochlear Implant Compression Optimization for Musical Sound Quality in MED-EL Users

OBJECTIVES

Variations in loudness are a fundamental component of the music listening experience. Cochlear implant (CI) processing, including amplitude compression, and a degraded auditory system may further degrade these loudness cues and decrease the enjoyment of music listening. This study aimed to identify optimal CI sound processor compression settings to improve music sound quality for CI users.

DESIGN

Fourteen adult MED-EL CI recipients participated (Experiment No. 1: n = 17 ears; Experiment No. 2: n = 11 ears) in the study. A software application using a modified comparison category rating (CCR) test method allowed participants to compare and rate the sound quality of various CI compression settings while listening to 25 real-world music clips. The two compression settings studied were (1) Maplaw, which informs audibility and compression of soft level sounds, and (2) automatic gain control (AGC), which applies compression to loud sounds. For each experiment, one compression setting (Maplaw or AGC) was held at the default, while the other was varied according to the values available in the clinical CI programming software. Experiment No. 1 compared Maplaw settings of 500, 1000 (default), and 2000. Experiment No. 2 compared AGC settings of 2.5:1, 3:1 (default), and 3.5:1.

RESULTS

In Experiment No. 1, the group preferred a higher Maplaw setting of 2000 over the default Maplaw setting of 1000 (p = 0.003) for music listening. There was no significant difference in music sound quality between the Maplaw setting of 500 and the default setting (p = 0.278). In Experiment No. 2, a main effect of AGC setting was found; however, no significant difference in sound quality ratings for pairwise comparisons were found between the experimental settings and the default setting (2.5:1 versus 3:1 at p = 0.546; 3.5:1 versus 3:1 at p = 0.059).

CONCLUSIONS

CI users reported improvements in music sound quality with higher than default Maplaw or AGC settings. Thus, participants preferred slightly higher compression for music listening, with results having clinical implications for improving music perception in CI users.

Assessment of music experience after cochlear implantation: A review of current tools and their utilization

Objective

To provide an overview of the current available music assessment tools after cochlear implantation (CI); to report on the utilization of music assessments in the literature; to propose potential future directions in music assessment after CI.

Methods

A thorough search was performed in PubMed, Embase, and The Cochrane Library through October 31, 2020. MeSH search terms, keywords, and phrases included “cochlear implant,” “cochlear prosthesis,” “auditory prosthesis,” “music,” “music assessment,” “music questionnaire,” “music perception,” “music enjoyment, and “music experience.” Potentially relevant studies were reviewed for inclusion, with particular focus on assessments developed specifically for the cochlear implant population and intended for widespread use.

Results/conclusions

Six hundred and forty-three studies were screened for relevance to assessment of music experience among cochlear implantees. Eighty-one studies ultimately met criteria for inclusion. There are multiple validated tools for assessment of music experience after cochlear implantation, each of which provide slightly differing insights into the patients’ subjective and/or objective post-activation experience. However, no single assessment tool has been adopted into widespread use and thus, much of the literature pertaining to this topic evaluates outcomes non-uniformly, including single-use assessments designed specifically for the study at hand. The lack of a widely accepted universal tool for assessment of music limits our collective understanding the contributory and mitigating factors applicable to current music experience of cochlear implantees, and limits our ability to uniformly evaluate the success of new implant technologies or music training paradigms.

Effect of Compression on Musical Sound Quality in Cochlear Implant Users

OBJECTIVES

Cochlear implant (CI) users frequently report poor sound quality while listening to music, although the specific parameters responsible for this loss of sound quality remain poorly understood. Audio compression, which reduces the dynamic range (DR) for a given sound, is a ubiquitous component of signal processing used by both CI and hearing aid technology. However, the relative impact of compression for acoustic and electric hearing on music perception has not been well studied, an important consideration especially given that most compression algorithms in CIs were developed to optimize speech perception. The authors hypothesized that normal-hearing (NH) listeners would detect increased levels of compression more easily than CI users, but that both groups would perceive a loss of sound quality with increasing compression levels.

DESIGN

The present study utilizes the Cochlear Implant-MUltiple Stimulus with Hidden Reference and Anchor to evaluate the listener sensitivity to increasing levels of compression applied to music stimuli. The Cochlear Implant-MUltiple Stimulus with Hidden Reference and Anchor is a tool used to assess relative changes in the perceived sound quality of music across increasingly degraded listening conditions, in both CI and NH subjects. In this study, the authors applied multiple iterations of an aggressive compression algorithm to the music clips using Adobe Audition. The test conditions included 1, 3, 5, and 20 iterations sound tokens, with the 20-iteration samples serving as the Anchor stimuli. The compressed excerpts were 5 sec in length, with five clips for each of the five common musical genres (i.e., Classical, Jazz, Country, Rock, and Hip-Hop). Subjects were also presented with a Reference excerpt, which was the original music clip without any additional compression applied. CI recipients (n = 7, 11 ears) and NH listeners (n = 10) were asked to rate the sound quality of additionally compressed music as compared to the Reference.

RESULTS

Although both NH and CI groups could detect sound quality differences as a function of compression level, the discriminatory ability of the CI group was blunted compared to the NH group. The CI group had less variability in their responses and overall demonstrated reduced sensitivity to deterioration caused by excessive levels of compression. On average, the CI group rated the Anchor condition as only "Slightly worse" than the Reference. The music clips that were most affected by the compression were from Jazz and Hip-Hop genres and less so for Rock and Country clips. Corollary to this was a small but statistically significant impact of DR of the music clips on sound quality ratings, with narrower DR showing an association with poorer ratings.

CONCLUSIONS

These results indicate that CI users exhibit less sensitivity to sound quality changes in music attributable to high levels of compression. These findings may account for another contributing factor to the generally poor music perception observed in CI users, particularly when listening to commercially recorded music.

Impact of room acoustic parameters on speech and music perception among participants with cochlear implants

OBJECTIVES

Besides numerous other factors, listening experience with cochlear implants is substantially impaired by room acoustics. Even for persons without hearing impairment, the perception of auditory scenes, for example, concerning speech intelligibility, acoustic quality or audibility, is considerably influenced by room acoustics. For CI users, complex listening environments are usually associated with heavy losses. The aim of the present study was to determine room acoustic criteria that particularly influence speech pleasantness for CI users.

DESIGN

Accordingly, speech material of the Oldenburg Sentence Test (Oldenburger Satztest, OLSA) as well as basic music material (major and minor triads) were auralized using the software Auratorium which allows auralization of simulated rooms. The constructed rooms for speech stimuli were based on the standard DIN 18041:2016-03 concerning acoustic quality in rooms, the binding standard referred to by room acoustic consultants in Germany, which also includes specifications for inclusive applications in schools. For the music perception tests, two typical concert halls of different sizes were modelled. The auralized test stimuli were unilaterally presented to 10 CI users via their auxiliary input as well as to 18 participants with typical hearing via headphones (control group). Speech pleasantness was evaluated using modified MUSHRA tests. Concerning music perception, chord discrimination was tested using paired comparisons.

RESULTS

A strong preference of small source to listener distances by CI users was found, but no significant preference for room acoustic attenuation which exceeded the recommended for inclusive applications in schools. The analyses of the energy-time-structures suggested that a dense concentration of early reflections makes a beneficial impact on CI listeners' pleasantness ratings. Music materials were distinguished more consistently without any room acoustic impact, while any room acoustic impact led to performance close to chance level. This effect is probably due to spectral smearing effects caused by reverberation.

CONCLUSIONS

These results suggest that in terms of pleasantness of speech, for CI-users, source-to-listener distance is the more influential parameter than room attenuation which goes beyond the German standard recommendation. Reflections from which CI users can benefit seem to occur much earlier than those from which NH listeners benefit. Future studies on chord discrimination concerning room acoustics are needed.

Effects of test method and participant musical training on preference ratings of stimuli with different reverberation times

Selecting an appropriate listening test design for concert hall research depends on several factors, including listening test method and participant critical-listening experience. Although expert listeners afford more reliable data, their perceptions may not be broadly representative. The present paper contains two studies that examined the validity and reliability of the data obtained from two listening test methods, a successive and a comparative method, and two types of participants, musicians and non-musicians. Participants rated their overall preference of auralizations generated from eight concert hall conditions with a range of reverberation times (0.0-7.2 s). Study 1, with 34 participants, assessed the two methods. The comparative method yielded similar results and reliability as the successive method. Additionally, the comparative method was rated as less difficult and more preferable. For study 2, an additional 37 participants rated the stimuli using the comparative method only. An analysis of variance of the responses from both studies revealed that musicians are better than non-musicians at discerning their preferences across stimuli. This result was confirmed with a k-means clustering analysis on the entire dataset that revealed five preference groups. Four groups exhibited clear preferences to the stimuli, while the fifth group, predominantly comprising non-musicians, demonstrated no clear preference.

Assessment and improvement of sound quality in cochlear implant users

Objectives

Cochlear implants (CIs) have successfully provided speech perception to individuals with sensorineural hearing loss. Recent research has focused on more challenging acoustic stimuli such as music and voice emotion. The purpose of this review is to evaluate and describe sound quality in CI users with the purposes of summarizing novel findings and crucial information about how CI users experience complex sounds.

Data Sources

Here we review the existing literature on PubMed and Scopus to present what is known about perceptual sound quality in CI users, discuss existing measures of sound quality, explore how sound quality may be effectively studied, and examine potential strategies of improving sound quality in the CI population.

Results

Sound quality, defined here as the perceived richness of an auditory stimulus, is an attribute of implant‐mediated listening that remains poorly studied. Sound quality is distinct from appraisal, which is generally defined as the subjective likability or pleasantness of a sound. Existing studies suggest that sound quality perception in the CI population is limited by a range of factors, most notably pitch distortion and dynamic range compression. Although there are currently very few objective measures of sound quality, the CI‐MUSHRA has been used as a means of evaluating sound quality. There exist a number of promising strategies to improve sound quality perception in the CI population including apical cochlear stimulation, pitch tuning, and noise reduction processing strategies.

Conclusions

In the published literature, sound quality perception is severely limited among CI users. Future research should focus on developing systematic, objective, and quantitative sound quality metrics and designing therapies to mitigate poor sound quality perception in CI users.

Level of Evidence

NA