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de Quillettes R, Kaandorp M, Merkus P, Kramer SE, Smits C. Experienced Adult Cochlear Implant Users Show Improved Speech Recognition When Target Fitting Parameters Are Applied. Ear Hear 2024; 45:1264-1273. [PMID: 38755742 PMCID: PMC11325977 DOI: 10.1097/aud.0000000000001513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/31/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES The aim of the present study was to investigate whether prediction models built by de Graaff et al. (2020 ) can be used to improve speech recognition in experienced adult postlingual implanted Cochlear CI users. de Graaff et al. (2020 ) found relationships between elevated aided thresholds and a not optimal electrical dynamic range (<50 CL or >60 CL), and poorer speech recognition in quiet and in noise. The primary hypothesis of the present study was that speech recognition improves both in quiet and in noise when the sound processor is refitted to match targets derived from the prediction models from de Graaff et al. (2020 ). A second hypothesis was that subjectively, most of the CI users would find the new setting too loud because of an increase in C levels, and therefore, prefer the old settings. DESIGN A within-participant repeated measures design with 18 adult Cochlear CI users was used. T- and C-levels were changed to "optimized settings," as predicted by the model of de Graaff et al. (2020 ). Aided thresholds, speech recognition in quiet, and speech recognition in noise were measured with the old settings and after a 4-week acclimatization period with the optimized settings. Subjective benefit was measured using the Device Oriented Subjective Outcome Scale questionnaire. RESULTS The mean electrical dynamic range changed from 41.1 (SD = 6.6) CL to 48.6 (SD = 3.0) CL. No significant change in aided thresholds was measured. Speech recognition improved for 16 out of 18 participants and remained stable for 2 participants. Average speech recognition scores in quiet significantly improved by 4.9% (SD = 3.8%). No significant change for speech recognition in noise was found. A significant improvement in subjective benefit was found for one of the Device Oriented Subjective Outcome subscales (speech cues) between the old and optimized settings. All participants chose to keep the optimized settings at the end of the study. CONCLUSIONS We were able to improve speech recognition in quiet by optimizing the electrical dynamic range of experienced adult CI users, according to the prediction models built by de Graaff et al. (2020 ). There was no significant change in aided thresholds nor in speech recognition in noise. The findings of the present study suggest that improved performance for speech recognition in quiet in adult Cochlear CI users can be achieved by setting the dynamic range as close as possible to values between 50 and 60 CL when the volume level is at 10.
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Affiliation(s)
- Richard de Quillettes
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Marre Kaandorp
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Paul Merkus
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Sophia E. Kramer
- Amsterdam UMC, Location Vrije Universiteit, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Cas Smits
- Amsterdam UMC, Location University of Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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Vermiglio AJ. A Critique of the National Academies of Sciences, Engineering, and Medicine Report (2021) and the Diagnostic Accuracy of Measurements of Functional Hearing Ability. Am J Audiol 2023:1-9. [PMID: 36944047 DOI: 10.1044/2023_aja-22-00141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
PURPOSE The Social Security Administration (SSA) asked the National Academies of Sciences, Engineering, and Medicine (NASEM, 2021) to make recommendations for tests of functional hearing ability. These tests include speech perception measures administered in quiet and in background noise. Such tests are required to make disability determinations for adults and children following cochlear implantation. The test review required an evaluation of the diagnostic accuracy of the speech perception measures. Following a review of the literature, NASEM wrote that the evidence needed to support such a recommendation was lacking. They resorted to "professional judgment" and recommended a monosyllabic word recognition test, presumably in quiet, along with a measure of self-report or parent report. The primary purpose of this article was to critically review the committee's report. The secondary purpose was to critique the committee's recommendation of a monosyllabic word test as a measure of functional hearing ability for disability determinations. The third purpose was to provide a review of diagnostic accuracy studies not included in NASEM (2021) with an emphasis on speech recognition in noise (SRN) tests. CONCLUSIONS In contrast to the committee's recommendation, studies have shown that a monosyllabic word test is a poor predictor of SRN ability. Contrary to the conclusion of NASEM (2021), diagnostic accuracy studies have been conducted for a few SRN tests. The Hearing in Noise Test and the AzBio SRN test have published data demonstrating their ability to correctly identify the presence and absence of an SRN disorder.
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Affiliation(s)
- Andrew J Vermiglio
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, North Carolina
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Effectiveness of Expanded Instantaneous Input Dynamic Range Adjustment on Speech Perception. J Pers Med 2022; 12:jpm12111860. [PMID: 36579582 PMCID: PMC9694124 DOI: 10.3390/jpm12111860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Instantaneous input dynamic range (IIDR), as defined by Cochlear Ltd. (Sydney, Australia), refers to the acoustic level of short-term input dynamic range (IDR). Our aim was to evaluate the efficacy of expanding IIDR to improve speech understanding. We enrolled 11 unilateral Cochlear Ltd. patients with post-lingual hearing loss. The two types of IIDR settings (T-SPL/C-SPL of 25/65 dB (default IIDR) and 25/80 dB (wide IIDR)) were blindly assigned, and only one IIDR setting selected according to their preference was used for at least three months. Each IIDR group was evaluated with both default and wide IIDR conditions using the recorded word and sentence test materials of the Japanese CD speech discrimination scoring system (CI-2004 test) in quiet and noise with a signal-to-noise ratio (SNR) of +10 dB, presented at 65/80 dB SPL. Wide IIDR significantly improved speech perception in all tests, except for sentences in quiet conditions at a presentation level of 65 dB. Improvements during loud conversations in noisy environments were obtained without any adaptation period. Wide IIDR should become a new individual configuration setting method in Cochlear Ltd. devices to improve hearing in loud conversations and noisy environments.
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Abstract
Supplemental Digital Content is available in the text. The primary objective of this study is to identify the biographic, audiologic, and electrode position factors that influence speech perception performance in adult cochlear implant (CI) recipients implanted with a device from a single manufacturer. The secondary objective is to investigate the independent association of the type of electrode (precurved or straight) with speech perception.
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Saeedi A, Englert L, Hemmert W. eABR THR Estimation Using High-Rate Multi-Pulse Stimulation in Cochlear Implant Users. Front Neurosci 2021; 15:705189. [PMID: 34393715 PMCID: PMC8358126 DOI: 10.3389/fnins.2021.705189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
We estimated the electrically-evoked auditory brainstem response thresholds (eABR THRs) in response to multi-pulses with high burst rate of 10,000 pulses-per-second (pps). Growth functions of wave eV amplitudes, root mean square (RMS) values, peak of phase-locking value (PLV), and the lowest valid data point (LVDP) were calculated in 1-, 2-, 4-, 8-, and 16-pulses conditions. The growth functions were then fitted and extrapolated with linear and exponential functions to find eABR THRs. The estimated THRs were compared to psychophysical THRs determined for multi-pulse conditions as well as to the clinical THRs measured behaviorally at the rate of 1,000 pps. The growth functions of features showed shallower growth slopes when the number of pulses increased. eABR THRs estimated in 4-, 8-, and 16-pulses conditions were closer to the clinical THRs, when compared to 1- and 2-pulses conditions. However, the smallest difference between estimated eABR THRs and clinical THRs was not always achieved from the same number of pulses. The smallest absolute difference of 30.3 μA was found for the linear fittings on growth functions of eABR RMS values in 4-pulses condition. Pearson's correlation coefficients (PCCs) between eABR THRs and psychophysical THRs were significant and relatively large in all but 16-pulses conditions. The PCCs between eABR THRs and clinical THRs, however, were smaller and in less cases significant. Results of this study showed that eABRs to multi-pulse stimulation could, to some extent, represent clinical stimulation paradigms, and thus in comparison to single pulses, could estimate clinical THRs with smaller errors.
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Affiliation(s)
- Ali Saeedi
- Department of Electrical and Computer Engineering, Technical University of Munich, Munich, Germany.,Munich School of Bioengineering, Technical University of Munich, Garching, Germany
| | - Ludwig Englert
- Department of Electrical and Computer Engineering, Technical University of Munich, Munich, Germany
| | - Werner Hemmert
- Department of Electrical and Computer Engineering, Technical University of Munich, Munich, Germany.,Munich School of Bioengineering, Technical University of Munich, Garching, Germany.,Munich School of Robotics and Machine Intelligence, Technical University of Munich, Munich, Germany
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Relationship Between Speech Recognition in Quiet and Noise and Fitting Parameters, Impedances and ECAP Thresholds in Adult Cochlear Implant Users. Ear Hear 2021; 41:935-947. [PMID: 31702597 DOI: 10.1097/aud.0000000000000814] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to identify parameters which are related to speech recognition in quiet and in noise of cochlear implant (CI) users. These parameters may be important to improve current fitting practices. DESIGN Adult CI users who visited the Amsterdam UMC, location VUmc, for their annual follow-up between January 2015 and December 2017 were retrospectively identified. After applying inclusion criteria, the final study population consisted of 138 postlingually deaf adult Cochlear CI users. Prediction models were built with speech recognition in quiet and in noise as the outcome measures, and aided sound field thresholds, and parameters related to fitting (i.e., T and C levels, dynamic range [DR]), evoked compound action potential thresholds and impedances as the independent variables. A total of 33 parameters were considered. Separate analyses were performed for postlingually deafened CI users with late onset (LO) and CI users with early onset (EO) of severe hearing impairment. RESULTS Speech recognition in quiet was not significantly different between the LO and EO groups. Speech recognition in noise was better for the LO group compared with the EO group. For CI users in the LO group, mean aided thresholds, mean electrical DR, and measures to express the impedance profile across the electrode array were identified as predictors of speech recognition in quiet and in noise. For CI users in the EO group, the mean T level appeared to be a significant predictor in the models for speech recognition in quiet and in noise, such that CI users with elevated T levels had worse speech recognition in quiet and in noise. CONCLUSIONS Significant parameters related to speech recognition in quiet and in noise were identified: aided thresholds, electrical DR, T levels, and impedance profiles. The results of this study are consistent with previous study findings and may guide audiologists in their fitting practices to improve the performance of CI users. The best performance was found for CI users with aided thresholds around the target level of 25 dB HL, and an electrical DR between 40 and 60 CL. However, adjustments of T and/or C levels to obtain aided thresholds around the target level and the preferred DR may not always be acceptable for individual CI users. Finally, clinicians should pay attention to profiles of impedances other than a flat profile with mild variations.
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Ernst R, Linxweiler M, Rink KA, Rothe H, Lecomte G, Bozzato A, Hecker D. [Neurophysiological parameters for speech recognition in patients with cochlear implants]. Laryngorhinootologie 2021; 101:216-227. [PMID: 33836549 DOI: 10.1055/a-1399-9540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Cochlea Implants (CI) are the preferred treatment for deaf and highly hearing imparied people. While deaf people already profit enormously from any regained hearing perception, it is not as easy to predict a profitable outcome for people with a remaining sense of hearing. To provide patients the best possible outcome in speech understanding, a lot of parameters have to be identified and adjusted. The aim of this study is to show the influence of objective parameters on classified speech understanding using collected data. MATERIAL AND METHODS A total of 52 patients and 65 ears aged between 18 and 80 years were included in this study. ECAP-thresholds from intraoperative measurements and impedance were used as objective parameters. T- and C/M-levels were defined as subjective parameters. To classify the performance the value of speech understanding was used. RESULTS Differences between both groups (age, time after implantation) were not significant. The gained word scores at 500 Hz correlated significantly with the results of the speech perception threshold on two-digit numbers. The electrode impedances correlated on average with speech understanding with constant variability. The distributions of objective and subjective parameters showed partially significant differences. Many distributions showed significant differences to the normal distribution. Accordingly, the overlapping areas of the significance levels are very narrow. CONCLUSION Higher impedances and incorrectly adjusted T-levels resulted in a worse speech understanding. Relation of C/M-levels to ECAP thresholds seem to be crucial for good speech understanding.
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Affiliation(s)
- Robert Ernst
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Maximilian Linxweiler
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Katharina Anna Rink
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Heike Rothe
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Gregory Lecomte
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Alessandro Bozzato
- Hals-, Nasen- und Ohrenklinik, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Dietmar Hecker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
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Martins KVC, Goffi-Gomez MVS, Tsuji RK, Bento RF. Do the minimum and maximum comfortable stimulation levels influence the cortical potential latencies or the speech recognition in adult cochlear implant users? Hear Res 2021; 404:108206. [PMID: 33677193 DOI: 10.1016/j.heares.2021.108206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/10/2021] [Accepted: 02/10/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Cochlear implants (CI) programming is based on both the measurement of the minimum levels required to stimulate the auditory nerve and the maximum levels to generate loud, yet comfortable loudness. Seeking for guidance in the adequacy of this programming, the cortical auditory evoked potentials (CAEP) have been gaining space as an important tool in the evaluation of CI users, providing information on the central auditory system. OBJECTIVE To evaluate the influence of mishandling of electrical stimulation levels on speech processor programming on hearing thresholds, speech recognition and cortical auditory evoked potential in adult CI users. MATERIAL AND METHODS This is a prospective cross-sectional study, with a sample of adult unilateral CI users of both sexes, aged at least 18 years, post-lingual deafness, with minimum experience of 12 months of device use. Selected subjects should have average free field hearing thresholds with cochlear implant equal to or better than 34 dBHL and monosyllable recognition different from 0%. Individuals who could not collaborate with the procedures or who had no CAEP recordings were excluded. Participants were routinely programmed, and the map was named MO (optimized original map). Then three experimentally wrong maps were made: optimized original map with 10 current units below the maximum comfort level (C), named MC- (map minus C); optimized original map with minus 10 current units at minimum threshold level (T), named MT- (map minus T) and optimized original map with 10 current units above minimum level (T), named MT + (map plus T). In all programs, participants underwent free-field auditory thresholds from 250Hz to 6000Hz, recorded sentences and monosyllabic recognition tests presented at 65dB SPL in quiet and in noise, and free field CAEP evaluation. All tests were performed in an acoustically treated booth, in a randomized order of map presentation. Data were compared by Wilcoxon test. RESULTS Thirty individuals were selected and signed an informed consent form. The MC- map provided worsening of all free field thresholds, quiet and noise speech recognition, and P1 wave latency delay with significant difference from the results with the MO map. The MT- map worsened the hearing thresholds and statistically significantly reduced the P2 wave latency; MT+ map improved free field thresholds except 6000Hz, worsening speech recognition, without statistical significance. CONCLUSIONS The results suggest that maximum levels below the optimal thresholds lead to worse cochlear implant performance in both hearing thresholds and speech recognition tests in quiet and noise, increasing CAEP component P1 latency. On the other hand, the manipulation of minimum threshold levels showed alteration in audibility without significant impact on speech recognition.
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Affiliation(s)
- Kelly Vasconcelos Chaves Martins
- Department of Otorhinolaryngology, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, São Paulo, SP 05403-000, Brazil.
| | | | - Robinson Koji Tsuji
- Department of Otorhinolaryngology, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, São Paulo, SP 05403-000, Brazil
| | - Ricardo Ferreira Bento
- Department of Otorhinolaryngology, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, São Paulo, SP 05403-000, Brazil
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Activating a Noise-Gating Algorithm and Personalizing Electrode Threshold Levels Improve Recognition of Soft Speech for Adults With CIs. Ear Hear 2021; 42:1208-1217. [PMID: 33577215 DOI: 10.1097/aud.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In contrast to the moderate presentation levels most commonly used in clinical practice, speech encountered in everyday life often occurs at low levels, such as when a conversational partner whispers or speaks from another room. In addition, even when the overall signal level is moderate, levels for particular words or speech sounds, such as voiceless consonants, can be considerably lower. Existing techniques for improving recognition of low-level speech for cochlear implant users include using a wider input dynamic range and elevating electrode threshold levels (T-levels). While these techniques tend to positively impact recognition of soft speech, each has also been associated with drawbacks. Recently, a noise-gating (NG) algorithm was reported, which works by eliminating input to an electrode when signal level in the associated frequency channel is at or below a predetermined threshold. Available evidence suggests that activation of this algorithm can improve recognition of sentences presented at low levels (35 to 50 dB SPL), though it remains unclear whether the benefits will be equally evident with both manufacturer default and individually optimized T-levels. The primary aim of this study was therefore to evaluate the independent and combined effects of NG activation and T-level personalization. METHODS Twenty adults between the ages of 25 and 77 years (M = 54.9 years, SD = 17.56) with postlingually acquired profound hearing loss completed testing for this study. Participants were fit with an Advanced Bionics Naida CI Q90 speech processor, which contained four programs based on each participant's existing everyday program. The programs varied by the NG algorithm setting (on, off) and T-level method (default 10% of M-level, personalized based on subjective ratings of "very quiet"). All participants completed speech sound detection threshold testing (/m/, /u/, /a/, /i/, /s/, and /ʃ/), as well as tests of monosyllabic word recognition in quiet (45 and 60 dB SPL), sentence recognition in quiet (45 and 60 dB SPL), and sentence recognition in noise (45-dB SPL speech, +10 dB SNR). RESULTS Findings demonstrated that both activating NG and personalizing T-levels in isolation significantly improved detection (speech sounds) and recognition (monosyllables, sentences in quiet, and sentences in noise) of soft speech, with their respective individual effects being comparable. However, the lowest speech sound detection thresholds and the highest speech recognition performance were identified when NG was activated in conjunction with personalized T-levels. Importantly, neither T-level personalization nor NG activation affected recognition of speech presented at 60 dB SPL, which suggests the strategies should not be expected to interfere with recognition of average conversational speech. CONCLUSIONS Taken together, these data support the clinical recommendation of personalizing T-levels and activating NG to improve the detection and recognition of soft speech. However, future work is needed to evaluate potential limitations of these techniques. Specifically, speech recognition testing should be performed in the presence of diverse noise backgrounds and home-trials should be conducted to determine processing effects on sound quality in realistic environments.
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Hendrickson K, Oleson J, Walker E. School-Age Children Adapt the Dynamics of Lexical Competition in Suboptimal Listening Conditions. Child Dev 2021; 92:638-649. [PMID: 33476043 DOI: 10.1111/cdev.13530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although the ability to understand speech in adverse listening conditions is paramount for effective communication across the life span, little is understood about how this critical processing skill develops. This study asks how the dynamics of spoken word recognition (i.e., lexical access and competition) change during soft speech in 8- to 11-year-olds (n = 26). Lexical competition and access for speech at lower intensity levels was measured using eye-tracking and the visual world paradigm. Overall the results suggest that soft speech influences the magnitude and timing of lexical access and competition. These results suggest that lexical competition is a cognitive process that can be adapted in the school-age years to help cope with increased uncertainty due to alterations in the speech signal.
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Variability of fitting parameters across cochlear implant centres. Eur Arch Otorhinolaryngol 2021; 278:4671-4679. [PMID: 33388985 DOI: 10.1007/s00405-020-06572-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE As a follow-up to the studies by Vaerenberg et al. (Sci World J 501738:1-12, 2014) and Browning et al. (Cochlear Implant Int 21(3):1-13, 2020), who used questionnaires, we determined whether there are between-centre variations in the fitting of cochlear implants by analysing the methodology, fitting parameters and hearing results of patients from four centres with real data. The purpose of this study is to highlight the lack of streamlined mapping guides and outcome measures with respect to cochlear implant (CI) fittings. METHODS A retrospective study with ninety-seven post-lingual adults with a nucleus cochlear implant placed between 2003 and 2013 was included to ensure at least 5 years of follow-up. The studied data were as follows: the methodology, including the fitter's professional background, the method of activation, the sequence of fitting sessions, the objectives measures and hearing outcomes; and the fitting parameters, including the speech processors, programming strategy, stimulation mode, T and C levels, T-SPL and C-SPL, maxima, pulse width, loudness growth and hearing results. RESULTS This investigation highlights some common practices across professionals and CI centres: the activation of a CI is behavioural; impedances are systematically measured at each fitting; and some parameters are rarely modified. However, there are also differences, either between centres, such as the sequences of fitting sessions (p < 0.05) or their approach to spectral bands (p < 0.05), or even within centres, such as the policy regarding T and C levels at high frequencies compared to those at low and mid-frequencies. CONCLUSION There are important variations between and within centres that reflect a lack of CI-related policies and outcome measures in the fitting of CI. CLINICAL TRIALS REGISTRY NCT03700268.
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Martins KVC, Goffi-Gomez MVS. The influence of stimulation levels on auditory thresholds and speech recognition in adult cochlear implant users. Cochlear Implants Int 2020; 22:42-48. [PMID: 32972324 DOI: 10.1080/14670100.2020.1822495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: This study aims to evaluate the influence of minimum and maximum stimulation levels on auditory thresholds and speech recognition abilities in adult cochlear implant users. Method: Fifteen adults implanted with a Cochlear® device with over 12 months listening experience. Participants underwent routine programming for optimization of minimum (T) and maximum comfort (C) stimulation levels, which was saved in Program 1 (MO). Three further maps were constructed artificially adjusting the measured levels: Program 2 - MO with 10 fewer electrical current units at C level (MC-); Program 3 - MO with 10 fewer electric current units at T level (MT-); and Program 4 - MO with 10 more electric current units at T level (MT+). Sound field thresholds, recorded sentence recognition and monosyllable tests were presented in quiet and in noise. Results: There were significantly better thresholds at 1, 3, 4, and 6 kHz frequencies in MT+ and worse in MC-. A statistically significant difference was observed for sentences in quiet and monosyllables in quiet and noise with changing C levels, with worsening of the results for MC- program. Conclusion: The results suggest that T levels above the behavioural threshold provided an improvement in sound field thresholds but did not influence performance on speech recognition tests in quiet and in noise. In contrast, C levels below the behavioural comfort level worsened sound field thresholds and led to poorer performance in tests of sentence recognition in quiet and monosyllable recognition in quiet and in noise.
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Affiliation(s)
- Kelly Vasconcelos Chaves Martins
- Department of Otorhinolaryngology, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, São Paulo, SP 05403-000, Brazil
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SoftVoice Improves Speech Recognition and Reduces Listening Effort in Cochlear Implant Users. Ear Hear 2020; 42:381-392. [PMID: 32796352 DOI: 10.1097/aud.0000000000000928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The ability to perceive soft speech by cochlear implant (CI) users is restricted in part by the inherent system noise produced by the speech processor, and in particular by the microphone(s). The algorithm "SoftVoice" (SV) was developed by Advanced Bionics to enhance the perception of soft speech by reducing the system noise in speech processors. The aim of this study was to examine the effects of SV on speech recognition and listening effort. DESIGN Seventeen adult Advanced Bionics CI recipients were recruited and tested in two sessions. The effect of SV on speech recognition was tested by determining the SRT in quiet using the Matrix test. Based on the individual subjects' SRTs, we investigated speech-recognition scores at fixed speech levels, namely SRT -5 dB, SRT +0 dB, SRT +5 dB, and SRT +10 dB, again in quiet and using the Matrix test. Listening effort was measured at each of these speech levels subjectively by using a rating scale, and objectively by determining pupil dilation with pupillometry. To verify whether SoftVoice had any negative effects on speech perception in noise, we determined the SRT in steady state, speech-weighted noise of 60 dBA. RESULTS Our results revealed a significant improvement of 2.0 dB on the SRT in quiet with SoftVoice. The average SRT in quiet without SoftVoice was 38 dBA. SoftVoice did not affect the SRT in steady state, speech-weighted noise of 60 dB. At an average speech level of 33 dBA (SRT -5 dB) and 38 dBA (SRT +0 dB) in quiet, significant improvements of 17% and 9% on speech-recognition scores were found with SoftVoice, respectively. At higher speech levels, SoftVoice did not significantly affect speech recognition. Pupillometry did not show significant effects of SoftVoice at any speech level. However, subjective ratings of listening effort indicated a decrease of listening effort with SoftVoice at a speech level of 33 dBA. CONCLUSIONS We conclude that SoftVoice substantially improves recognition of soft speech and lowers subjective listening effort at low speech levels in quiet. However, no significant effect of SoftVoice was found on pupil dilation. As SRTs in noise were not statistically significantly affected by SoftVoice, we conclude that SoftVoice can be used in noisy listening conditions with little negative impact on speech recognition, if any. The increased power demands of the algorithm are considered to be negligible. It is expected that SoftVoice will reduce power consumption at low ambient sound levels. These results support the use of SoftVoice as a standard feature of Advanced Bionics CI fittings for everyday use.
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Hendrickson K, Spinelli J, Walker E. Cognitive processes underlying spoken word recognition during soft speech. Cognition 2020; 198:104196. [PMID: 32004934 DOI: 10.1016/j.cognition.2020.104196] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 01/06/2020] [Accepted: 01/18/2020] [Indexed: 11/25/2022]
Abstract
In two eye-tracking experiments using the Visual World Paradigm, we examined how listeners recognize words when faced with speech at lower intensities (40, 50, and 65 dBA). After hearing the target word, participants (n = 32) clicked the corresponding picture from a display of four images - a target (e.g., money), a cohort competitor (e.g., mother), a rhyme competitor (e.g., honey) and an unrelated item (e.g., whistle) - while their eye-movements were tracked. For slightly soft speech (50 dBA), listeners demonstrated an increase in cohort activation, whereas for rhyme competitors, activation started later and was sustained longer in processing. For very soft speech (40 dBA), listeners waited until later in processing to activate potential words, as illustrated by a decrease in activation for cohorts, and an increase in activation for rhymes. Further, the extent to which words were considered depended on word length (mono- vs. bi-syllabic words), and speech-extrinsic factors such as the surrounding listening environment. These results advance current theories of spoken word recognition by considering a range of speech levels more typical of everyday listening environments. From an applied perspective, these results motivate models of how individuals who are hard of hearing approach the task of recognizing spoken words.
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Affiliation(s)
- Kristi Hendrickson
- Department of Communication Sciences & Disorders, University of Iowa, 250 Hawkins Drive, 52242 Iowa City, IA, United States of America; Department of Psychological & Brain Sciences, University of Iowa, 250 Hawkins Drive, 52242 Iowa City, IA, United States of America.
| | - Jessica Spinelli
- Department of Communication Sciences & Disorders, University of Iowa, 250 Hawkins Drive, 52242 Iowa City, IA, United States of America.
| | - Elizabeth Walker
- Department of Communication Sciences & Disorders, University of Iowa, 250 Hawkins Drive, 52242 Iowa City, IA, United States of America.
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Abstract
OBJECTIVES A positive relation between audibility and speech understanding has been established for cochlear implant (CI) recipients. Sound field thresholds of 20 dB HL across the frequency range provide CI users the opportunity to understand soft and very soft speech. However, programming the sound processor to attain good audibility can be time-consuming and difficult for some patients. To address these issues, Advanced Bionics (AB) developed the SoftVoice algorithm designed to remove system noise and thereby improve audibility of soft speech. The present study aimed to evaluate the efficacy of SoftVoice in optimizing AB CI recipients' soft-speech perception. DESIGN Two studies were conducted. Study 1 had two phases, 1A and 1B. Sixteen adult, AB CI recipients participated in Study 1A. Acute testing was performed in the unilateral CI condition using a Harmony processor programmed with participants' everyday-use program (Everyday) and that same program but with SoftVoice implemented. Speech recognition measures were administered at several presentation levels in quiet (35 to 60 dB SPL) and in noise (60 dB SPL). In Study 1B, 10 of the participants compared Everyday and SoftVoice at home to obtain feedback regarding the use of SoftVoice in various environments. During Study 2, soft-speech perception was acutely measured with Everyday and SoftVoice for 10 participants using the Naida CI Q70 processor. Results with the Harmony (Study 1A) and Naida processors were compared. Additionally, Study 2 evaluated programming options for setting electrode threshold levels (T-levels or Ts) to improve the usability of SoftVoice in daily life. RESULTS Study 1A showed significantly higher scores with SoftVoice than Everyday at soft presentation levels (35, 40, 45, and 50 dB SPL) and no significant differences between programs at a conversational level (60 dB SPL) in quiet or in noise. After take-home experience with SoftVoice and Everyday (Study 1B), 5 of 10 participants reported preferring SoftVoice over Everyday; however, 6 reported bothersome environmental sound when listening with SoftVoice at home. Results of Study 2 indicated similar soft-speech perception between Harmony and Naida processors. Additionally, implementing SoftVoice with Ts at the manufacturer's default setting of 10% of Ms reduced reports of bothersome environmental sound during take-home experience; however, soft-speech perception was best with SoftVoice when Ts were behaviorally set above 10% of Ms. CONCLUSIONS Results indicate that SoftVoice may be a potential tool for optimizing AB users' audibility and, in turn, soft-speech perception. To achieve optimal performance at soft levels and comfortable use in daily environments, setting Ts must be considered with SoftVoice. Future research should examine program parameters that may benefit soft-speech perception when used in combination with SoftVoice (e.g., increased input dynamic range).
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Plesch J, Ernst BP, Strieth S, Rader T. A psychoacoustic application for the adjustment of electrical hearing thresholds in cochlear implant patients. PLoS One 2019; 14:e0223625. [PMID: 31603927 PMCID: PMC6788687 DOI: 10.1371/journal.pone.0223625] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 09/24/2019] [Indexed: 12/04/2022] Open
Abstract
Objective Fitting cochlear implants, especially the precise determination of electrical hearing thresholds, is a time-consuming and complex task for patients as well as audiologists. Aim of the study was to develop a method that enables cochlear implant (CI) patients to determine their electrical hearing thresholds precisely and independently. Applicability and impact of this method on speech perception in noise at soft speech levels were evaluated. Method An adaptive psychoacoustic procedure for precise hearing threshold determination (precT) was implemented using MatLab (MathWorks) and a graphical user interface was created. Sound signals were calibrated with a CIC4-Implant-Decoder. Study design: A prospective study including 15 experienced adult cochlear implant users was conducted. Electrical hearing thresholds were determined using the automated precT procedure (auto-precT). Speech perception in noise at 50 dB SPL presentation levels was measured for three conditions: (P1) T-levels kept at the previously established T-levels; (P2) T-levels set to the hearing thresholds determined using auto-precT application; (P3) T-levels set 10 cu below the values determined with auto-precT. Results All subjects were able to perform the auto-precT application independently. T-levels were altered on average by an absolute value of 10.5 cu using auto-precT. Median speech reception thresholds were significantly improved from 2.5 dB SNR (P1) to 1.6 dB SNR (P2, p = 0.02). Speech perception was lowest using the globally lowered T-levels, median 2.9 dB SNR (P3, not significant compared to P1 and P2). Conclusion The applicability of the developed auto-precT application was confirmed in the present clinical study. Patients benefited from adjusting previously established T-levels to the threshold levels determined by the auto-precT application. The integration of the application in the clinical fitting routine as well as a remote fitting software approach is recommended. Furthermore, future possibilities of auto-precT include the implementation of the application on tablets or smart phones.
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Affiliation(s)
- Johannes Plesch
- Division of Audiological Acoustics, Department of Otolaryngology, University Medical Center, Mainz, Germany
| | - Benjamin P. Ernst
- Department of Otolaryngology—Head and Neck Surgery, University Medical Center, Mainz, Germany
| | - Sebastian Strieth
- Department of Otolaryngology—Head and Neck Surgery, University Medical Center, Mainz, Germany
| | - Tobias Rader
- Division of Audiological Acoustics, Department of Otolaryngology, University Medical Center, Mainz, Germany
- * E-mail:
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Wathour J, Govaerts PJ, Deggouj N. From manual to artificial intelligence fitting: Two cochlear implant case studies. Cochlear Implants Int 2019; 21:299-305. [PMID: 31530099 DOI: 10.1080/14670100.2019.1667574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To assess whether CI programming by means of a software application using artificial intelligence (AI), FOX®, may improve cochlear implant (CI) performance. Patients: Two adult CI recipients who had mixed auditory results with their manual fitting were selected for an AI-assisted fitting. Even after 17 months CI experience and 19 manual fitting sessions, the first subject hadn't developed open set word recognition. The second subject, after 9 months of manual fitting, had developed good open set word recognition, but his scores remained poor at soft and loud presentation levels. Main outcome measure(s): Cochlear implant fitting parameters, pure tone thresholds, bisyllabic word recognition, phonemic discrimination scores and loudness scaling curves. Results: For subject 1, a first approach trying to optimize the home maps by means of AI-proposed adaptations was not successful whereas a second approach based on the use of Automaps (an AI approach based on universal, i.e. population based group statistics) during 3 months allowed the development of open set word recognition. For subject 2, the word recognition scores improved at soft and loud intensities with the AI suggestions. The AI-suggested modifications seem to be atypical. Conclusions: The two case studies illustrate that adults implanted with manual CI fitting may experience an improvement in their auditory results with AI-assisted fitting.
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Affiliation(s)
- Justine Wathour
- Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels, 1200, Belgium
| | | | - Naïma Deggouj
- Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels, 1200, Belgium
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Nunn TB, Jiang D, Green T, Boyle PJ, Vickers DA. A systematic review of the impact of adjusting input dynamic range (IDR), electrical threshold (T) level and rate of stimulation on speech perception ability in cochlear implant users. Int J Audiol 2019; 58:317-325. [DOI: 10.1080/14992027.2018.1564844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Terry B. Nunn
- University College London Ear Institute, London, UK
- Guy’s and St Thomas’ NHS Trust, Hearing Implant Centre, London, UK
| | - Dan Jiang
- Guy’s and St Thomas’ NHS Trust, Hearing Implant Centre, London, UK
| | - Tim Green
- Department of Speech Hearing and Phonetic Sciences, University College London, London, UK
| | - Patrick J. Boyle
- Advanced Bionics GmbH, European Research Centre, Hannover, Germany
| | - Deborah A. Vickers
- Department of Speech Hearing and Phonetic Sciences, University College London, London, UK
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Rader T, Doms P, Adel Y, Weissgerber T, Strieth S, Baumann U. A method for determining precise electrical hearing thresholds in cochlear implant users. Int J Audiol 2018; 57:502-509. [DOI: 10.1080/14992027.2017.1412519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tobias Rader
- Division of Audiological Acoustics, ENT Department, University Hospital Frankfurt, Frankfurt, Germany
- Audiological Acoustics Division, Department of Otolaryngology, Head and Neck Surgery, University of Mainz, Mainz, Germany
| | - Philipp Doms
- Division of Audiological Acoustics, ENT Department, University Hospital Frankfurt, Frankfurt, Germany
| | - Youssef Adel
- Division of Audiological Acoustics, ENT Department, University Hospital Frankfurt, Frankfurt, Germany
| | - Tobias Weissgerber
- Division of Audiological Acoustics, ENT Department, University Hospital Frankfurt, Frankfurt, Germany
| | - Sebastian Strieth
- Division of Audiological Acoustics, ENT Department, University Hospital Frankfurt, Frankfurt, Germany
- Audiological Acoustics Division, Department of Otolaryngology, Head and Neck Surgery, University of Mainz, Mainz, Germany
| | - Uwe Baumann
- Division of Audiological Acoustics, ENT Department, University Hospital Frankfurt, Frankfurt, Germany
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Electrically Evoked Auditory Event-Related Responses in Patients with Auditory Brainstem Implants: Morphological Characteristics, Test-Retest Reliability, Effects of Stimulation Level, and Association with Auditory Detection. Ear Hear 2018; 37:634-649. [PMID: 27579988 DOI: 10.1097/aud.0000000000000342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to (1) characterize morphological characteristics of the electrically evoked cortical auditory event-related potentials (eERPs) and explore the potential association between onset eERP morphology and auditory versus nonauditory stimulation; (2) assess test-retest reliability of onset eERPs; (3) investigate effects of stimulation level on onset eERPs; and (4) explore the feasibility of using the onset eERP to estimate the lowest stimulation level that can be detected for individual stimulating electrodes in patients with auditory brainstem implants (ABIs). DESIGN Study participants included 5 children (S1 to S5) and 2 adults (S6 to S7) with unilateral Cochlear Nucleus 24M ABIs. Pediatric ABI recipients ranged in age from 2.6 to 10.2 years (mean: 5.2 years) at the time of testing. S6 and S7 were 21.2 and 24.6 years of age at the time of testing, respectively. S6 and S7 were diagnosed with neurofibromatosis II (NF2) and implanted with an ABI after a surgical removal of the tumors. All pediatric subjects received ABIs after being diagnosed with cochlear nerve deficiency. The lowest stimulation level that could be detected (behavioral T level) and the estimated maximum comfortable level (C level) was measured for individual electrodes using clinical procedures. For electrophysiological measures, the stimulus was a 100-msec biphasic pulse train that was delivered to individual electrodes in a monopolar-coupled stimulation mode at stimulation levels ranging from subthreshold to C levels. Electrophysiological recordings of the onset eERP were obtained in all subjects. For studies evaluating the test-retest reliability of the onset eERP, responses were measured using the same set of parameters in two test sessions. The time interval between test sessions ranged from 2 to 6 months. The lowest stimulation level that could evoke the onset eERP was defined as the objective T level. RESULTS Onset eERPs were recorded in all subjects tested in this study. Inter- and intrasubject variations in morphological characteristics of onset eERPs were observed. Onset eERPs with complex waveforms were recorded for electrodes that evoked nonauditory sensations, based on feedback from subjects, as well as for electrodes without any indications of nonauditory stimulations. Onset eERPs in patients with ABIs demonstrated good test-retest reliability. Increasing stimulation levels resulted in increased eERP amplitudes but showed inconsistent effects on response latencies in patients with ABIs. Objective and behavioral T levels were correlated. CONCLUSIONS eERPs could be recorded in both non-NF2 and NF2 patients with ABIs. eERPs in both ABI patient groups show inter- and intrasubject variations in morphological characteristics. However, onset eERPs measured within the same subject in this study tended to be stable across study sessions. The onset eERP can potentially be used to estimate behavioral T levels in patients with ABIs. Further studies with more adult ABI recipients are warranted to investigate whether the onset eERP can be used to identify electrodes with nonauditory stimulations.
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He S, Teagle HFB, Buchman CA. The Electrically Evoked Compound Action Potential: From Laboratory to Clinic. Front Neurosci 2017; 11:339. [PMID: 28690494 PMCID: PMC5481377 DOI: 10.3389/fnins.2017.00339] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/30/2017] [Indexed: 11/13/2022] Open
Abstract
The electrically evoked compound action potential (eCAP) represents the synchronous firing of a population of electrically stimulated auditory nerve fibers. It can be directly recorded on a surgically exposed nerve trunk in animals or from an intra-cochlear electrode of a cochlear implant. In the past two decades, the eCAP has been widely recorded in both animals and clinical patient populations using different testing paradigms. This paper provides an overview of recording methodologies and response characteristics of the eCAP, as well as its potential applications in research and clinical situations. Relevant studies are reviewed and implications for clinicians are discussed.
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Affiliation(s)
- Shuman He
- Center for Hearing Research, Boys Town National Research HospitalOmaha, NE, United States
| | - Holly F. B. Teagle
- Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel HillChapel Hill, NC, United States
| | - Craig A. Buchman
- Department of Otolaryngology—Head and Neck Surgery, Washington UniversitySt. Louis, MO, United States
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Moberly AC, Harris MS, Boyce L, Nittrouer S. Speech Recognition in Adults With Cochlear Implants: The Effects of Working Memory, Phonological Sensitivity, and Aging. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:1046-1061. [PMID: 28384805 PMCID: PMC5548076 DOI: 10.1044/2016_jslhr-h-16-0119] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 08/30/2016] [Accepted: 10/14/2016] [Indexed: 05/12/2023]
Abstract
Purpose Models of speech recognition suggest that "top-down" linguistic and cognitive functions, such as use of phonotactic constraints and working memory, facilitate recognition under conditions of degradation, such as in noise. The question addressed in this study was what happens to these functions when a listener who has experienced years of hearing loss obtains a cochlear implant. Method Thirty adults with cochlear implants and 30 age-matched controls with age-normal hearing underwent testing of verbal working memory using digit span and serial recall of words. Phonological capacities were assessed using a lexical decision task and nonword repetition. Recognition of words in sentences in speech-shaped noise was measured. Results Implant users had only slightly poorer working memory accuracy than did controls and only on serial recall of words; however, phonological sensitivity was highly impaired. Working memory did not facilitate speech recognition in noise for either group. Phonological sensitivity predicted sentence recognition for implant users but not for listeners with normal hearing. Conclusion Clinical speech recognition outcomes for adult implant users relate to the ability of these users to process phonological information. Results suggest that phonological capacities may serve as potential clinical targets through rehabilitative training. Such novel interventions may be particularly helpful for older adult implant users.
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Affiliation(s)
- Aaron C. Moberly
- Department of Otolaryngology–Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus
| | - Michael S. Harris
- Department of Otolaryngology–Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus
| | - Lauren Boyce
- Department of Otolaryngology–Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus
| | - Susan Nittrouer
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
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Moberly AC, Houston DM, Castellanos I. Non-auditory neurocognitive skills contribute to speech recognition in adults with cochlear implants. Laryngoscope Investig Otolaryngol 2016; 1:154-162. [PMID: 28660253 PMCID: PMC5467524 DOI: 10.1002/lio2.38] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Unexplained variability in speech recognition outcomes among postlingually deafened adults with cochlear implants (CIs) is an enormous clinical and research barrier to progress. This variability is only partially explained by patient factors (e.g., duration of deafness) and auditory sensitivity (e.g., spectral and temporal resolution). This study sought to determine whether non-auditory neurocognitive skills could explain speech recognition variability exhibited by adult CI users. STUDY DESIGN Thirty postlingually deafened adults with CIs and thirty age-matched normal-hearing (NH) controls were enrolled. METHODS Participants were assessed for recognition of words in sentences in noise and several non-auditory measures of neurocognitive function. These non-auditory tasks assessed global intelligence (problem-solving), controlled fluency, working memory, and inhibition-concentration abilities. RESULTS For CI users, faster response times during a non-auditory task of inhibition-concentration predicted better recognition of sentences in noise; however, similar effects were not evident for NH listeners. CONCLUSIONS Findings from this study suggest that inhibition-concentration skills play a role in speech recognition for CI users, but less so for NH listeners. Further research will be required to elucidate this role and its potential as a novel target for intervention.
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Affiliation(s)
- Aaron C Moberly
- Department of Otolaryngology The Ohio State University Wexner Medical Center Columbus Ohio USA
| | - Derek M Houston
- Department of Otolaryngology The Ohio State University Wexner Medical Center Columbus Ohio USA
| | - Irina Castellanos
- Department of Otolaryngology The Ohio State University Wexner Medical Center Columbus Ohio USA
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Hughes ML, Goehring JL, Baudhuin JL, Schmid KK. Effects of stimulus level and rate on psychophysical thresholds for interleaved pulse trains in cochlear implants. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2016; 140:2297. [PMID: 27794318 PMCID: PMC6910005 DOI: 10.1121/1.4963903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 09/09/2016] [Accepted: 09/14/2016] [Indexed: 06/06/2023]
Abstract
This study examined channel interactions using interleaved pulse trains to assess masking and potential facilitative effects in cochlear-implant recipients using clinically relevant stimuli. Psychophysical thresholds were measured for two adjacent mid-array electrodes; one served as the masker and the other as the probe. Two rates representative of those found in present-day strategies were tested: 1700 and 3400 pulses per second per channel. Four masker levels ranging from sub-threshold to loud-but-comfortable were tested. It was hypothesized that low-level maskers would produce facilitative effects, shifting to masking effects at high levels, and that faster rates would yield smaller masking effects due to greater stochastic neural firing patterns. Twenty-nine ears with Cochlear or Advanced Bionics devices were tested. High-level maskers produced more masking than low-level maskers, as expected. Facilitation was not observed for sub-threshold or threshold-level maskers in most cases. High masker levels yielded reduced probe thresholds for two Advanced Bionics subjects. This was partly eliminated with a longer temporal offset between each masker-probe pulse pair, as was used with Cochlear subjects. These findings support the use of temporal gaps between stimulation of subsequent electrodes to reduce channel interactions.
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Affiliation(s)
- Michelle L Hughes
- Boys Town National Research Hospital, 555 North 30th Street, Omaha, Nebraska 68131, USA
| | - Jenny L Goehring
- Boys Town National Research Hospital, 555 North 30th Street, Omaha, Nebraska 68131, USA
| | - Jacquelyn L Baudhuin
- Boys Town National Research Hospital, 555 North 30th Street, Omaha, Nebraska 68131, USA
| | - Kendra K Schmid
- Department of Biostatistics, 984375 University of Nebraska Medical Center, Omaha, Nebraska 68198-4375, USA
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Hey M, Hocke T, Mauger S, Müller-Deile J. A clinical assessment of cochlear implant recipient performance: implications for individualized map settings in specific environments. Eur Arch Otorhinolaryngol 2016; 273:4011-4020. [PMID: 27276990 PMCID: PMC5052294 DOI: 10.1007/s00405-016-4130-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 05/31/2016] [Indexed: 11/28/2022]
Abstract
Individual speech intelligibility was measured in quiet and noise for cochlear Implant recipients upgrading from the Freedom to the CP900 series sound processor. The postlingually deafened participants (n = 23) used either Nucleus CI24RE or CI512 cochlear implant, and currently wore a Freedom sound processor. A significant group mean improvement in speech intelligibility was found in quiet (Freiburg monosyllabic words at 50 dBSPL) and in noise (adaptive Oldenburger sentences in noise) for the two CP900 series SmartSound programs compared to the Freedom program. Further analysis was carried out on individual’s speech intelligibility outcomes in quiet and in noise. Results showed a significant improvement or decrement for some recipients when upgrading to the new programs. To further increase speech intelligibility outcomes when upgrading, an enhanced upgrade procedure is proposed that includes additional testing with different signal-processing schemes. Implications of this research are that future automated scene analysis and switching technologies could provide additional performance improvements by introducing individualized scene-dependent settings.
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Affiliation(s)
- Matthias Hey
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology, Christian-Albrechts-University, Kiel, Germany.
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Khater A, El Shennaway A, Anany A. Improvement of cochlear implant performance: changes in dynamic range. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2015. [DOI: 10.4103/1012-5574.152706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Boyle PJ, Moore BCJ. Balancing cochlear implant AGC and near-instantaneous compression to improve perception of soft speech. Cochlear Implants Int 2015; 16 Suppl 1:S9-11. [PMID: 25614273 DOI: 10.1179/1467010014z.000000000224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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van der Beek FB, Briaire JJ, Frijns JHM. Population-based prediction of fitting levels for individual cochlear implant recipients. Audiol Neurootol 2014; 20:1-16. [PMID: 25413720 DOI: 10.1159/000362779] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 04/09/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study analyzed the predictability of fitting levels for cochlear implant recipients based on a review of the clinical levels of the recipients. DESIGN Data containing threshold levels (T-levels) and maximum comfort levels (M-levels) for 151 adult subjects using a CII/HiRes 90K cochlear implant with a HiFocus 1/1 J electrode were used. The 10th, 25th, 50th, 75th and 90th percentiles of the T- and M-levels are reported. Speech perception of the subjects, using a HiRes speech coding strategy, was measured during routine clinical follow-up. RESULTS T-levels for most subjects were between 20 and 35% of their M-levels and were rarely (<1/50) below 10% of the M-levels. Furthermore, both T- and M-levels showed an increase over the first year of follow-up. Interestingly, levels expressed in linear charge units showed a clear increase in dynamic range (DR) over 1 year (29.8 CU; SD 73.0), whereas the DR expressed in decibels remained stable. T-level and DR were the only fitting parameters for which a significant correlation with speech perception (r = 0.34, p < 0.01, and r = 0.33, p < 0.01, respectively) could be demonstrated. Additionally, analysis showed that T- and M-level profiles expressed in decibels were independent of the subjects' across-site mean levels. Using mixed linear models, predictive models were obtained for the T- and M-levels of all separate electrode contacts. CONCLUSIONS On the basis of the data set from 151 subjects, clinically applicable predictive models for T- and M-levels have been obtained. Based on one psychophysical measurement and a population-based T- or M-level profile, individual recipients' T- and M-levels can be approximated with a closed-set formula. Additionally, the analyzed fitting level data can serve as a reference for future patients.
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Affiliation(s)
- Feddo B van der Beek
- Department of Otolaryngology, Leiden University Medical Center, Leiden, The Netherlands
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Battmer RD, Borel S, Brendel M, Buchner A, Cooper H, Fielden C, Gazibegovic D, Goetze R, Govaerts P, Kelleher K, Lenartz T, Mosnier I, Muff J, Nunn T, Vaerenberg B, Vanat Z. Assessment of ‘Fitting to Outcomes Expert’ FOX™with new cochlear implant users in a multi-centre study. Cochlear Implants Int 2014; 16:100-9. [DOI: 10.1179/1754762814y.0000000093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Buechner A, Vaerenberg B, Gazibegovic D, Brendel M, De Ceulaer G, Govaerts P, Lenarz T. Evaluation of the ‘Fitting to Outcomes eXpert’ (FOX®) with established cochlear implant users. Cochlear Implants Int 2014; 16:39-46. [DOI: 10.1179/1754762814y.0000000085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
OBJECTIVE A great deal of variability exists in the speech-recognition abilities of postlingually deaf adult cochlear implant (CI) recipients. A number of previous studies have shown that duration of deafness is a primary factor affecting CI outcomes; however, there is little agreement regarding other factors that may affect performance. The objective of the present study was to determine the source of variability in CI outcomes by examining three main factors, biographic/audiologic information, electrode position within the cochlea, and cognitive abilities in a group of newly implanted CI recipients. DESIGN Participants were 114 postlingually deaf adults with either the Cochlear or Advanced Bionics CI systems. Biographic/audiologic information, aided sentence-recognition scores, a high resolution temporal bone CT scan and cognitive measures were obtained before implantation. Monosyllabic word recognition scores were obtained during numerous test intervals from 2 weeks to 2 years after initial activation of the CI. Electrode position within the cochlea was determined by three-dimensional reconstruction of pre- and postimplant CT scans. Participants' word scores over 2 years were fit with a logistic curve to predict word score as a function of time and to highlight 4-word recognition metrics (CNC initial score, CNC final score, rise time to 90% of CNC final score, and CNC difference score). RESULTS Participants were divided into six outcome groups based on the percentile ranking of their CNC final score, that is, participants in the bottom 10% were in group 1; those in the top 10% were in group 6. Across outcome groups, significant relationships from low to high performance were identified. Biographic/audiologic factors of age at implantation, duration of hearing loss, duration of hearing aid use, and duration of severe-to-profound hearing loss were significantly and inversely related to performance as were frequency modulated tone, sound-field threshold levels obtained with the CI. That is, the higher-performing outcome groups were younger in age at the time of implantation, had shorter duration of severe-to-profound hearing loss, and had lower CI sound-field threshold levels. Significant inverse relationships across outcome groups were also observed for electrode position, specifically the percentage of electrodes in scala vestibuli as opposed to scala tympani and depth of insertion of the electrode array. In addition, positioning of electrode arrays closer to the modiolar wall was positively correlated with outcome. Cognitive ability was significantly and positively related to outcome; however, age at implantation and cognition were highly correlated. After controlling for age, cognition was no longer a factor affecting outcomes. CONCLUSION There are a number of factors that limit CI outcomes. They can act singularly or collectively to restrict an individual's performance and to varying degrees. The highest performing CI recipients are those with the least number of limiting factors. Knowledge of when and how these factors affect performance can favorably influence counseling, device fitting, and rehabilitation for individual patients and can contribute to improved device design and application.
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Validation of minimally invasive, image-guided cochlear implantation using Advanced Bionics, Cochlear, and Medel electrodes in a cadaver model. Int J Comput Assist Radiol Surg 2013; 8:989-95. [PMID: 23633113 DOI: 10.1007/s11548-013-0842-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Validation of a novel minimally invasive, image-guided approach to implant electrodes from three FDA-approved manufacturers-Medel, Cochlear, and Advanced Bionics-in the cochlea via a linear tunnel from the lateral cranium through the facial recess to the cochlea. METHODS Custom microstereotactic frames that mount on bone-implanted fiducial markers and constrain the drill along the desired path were utilized on seven cadaver specimens. A linear tunnel was drilled from the lateral skull to the cochlea followed by a marginal, round window cochleostomy and insertion of the electrode array into the cochlea through the drilled tunnel. Post-insertion CT scan and histological analysis were used to analyze the results. RESULTS All specimens ([Formula: see text]) were successfully implanted without visible injury to the facial nerve. The Medel electrodes ([Formula: see text]) had minimal intracochlear trauma with 8, 8, and 10 (out of 12) electrodes intracochlear. The Cochlear lateral wall electrodes (straight research arrays) ([Formula: see text]) had minimal trauma with 20 and 21 of 22 electrodes intracochlear. The Advanced Bionics electrodes ([Formula: see text]) were inserted using their insertion tool; one had minimal insertion trauma and 14 of 16 electrodes intracochlear, while the other had violation of the basilar membrane just deep to the cochleostomy following which it remained in scala vestibuli with 13 of 16 electrodes intracochlear. CONCLUSIONS Minimally invasive, image-guided cochlear implantation is possible using electrodes from the three FDA-approved manufacturers. Lateral wall electrodes were associated with less intracochlear trauma suggesting that they may be better suited for this surgical technique.
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King SE, Firszt JB, Reeder RM, Holden LK, Strube M. Evaluation of TIMIT sentence list equivalency with adult cochlear implant recipients. J Am Acad Audiol 2012; 23:313-31. [PMID: 22533975 DOI: 10.3766/jaaa.23.5.3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Current measures used to determine sentence recognition abilities in cochlear implant recipients often include tests with one talker and one rate of speech. Performance with these measures may not accurately represent the speech recognition abilities of the listeners. Evaluation of cochlear implant performance should include measures that reflect realistic listening conditions. For example, the use of multiple talkers who vary in gender, rate of speech, and regional dialects represent varied communication interactions that people encounter daily. The TIMIT sentences, which use multiple talkers and incorporate these variations, provide additional test material for evaluating speech recognition. Dorman and colleagues created 34 lists of TIMIT sentences that were normalized for equal intelligibility using simulations of cochlear implant processing with normal-hearing listeners. Adults with sensorineural hearing loss who listen with cochlear implants represent a different population. Further study is needed to determine if these lists are equivalent for adult cochlear implant recipients and, if not, to identify a subset of lists that may be used with this population. PURPOSE To evaluate the speech recognition equivalence of 34 TIMIT sentence lists with adult cochlear implant recipients. RESEARCH DESIGN A prospective study comparing test-retest results within the same group of listeners. STUDY SAMPLE Twenty-two adult cochlear implant recipients who met the inclusion criteria of at least 3 mo device use and a monosyllabic word score of 30% or greater participated in the study. DATA COLLECTION AND ANALYSIS Participants were administered 34 TIMIT sentence lists (20 sentences per list) at each of two test sessions several months apart. List order was randomized and results scored as percent of words correct. Test-retest correlations and 95% confidence intervals for the means were used to identify equivalent lists with high test-retest reliability. RESULTS Mean list scores across participants ranged from 66 to 81% with an overall mean of 73%. Twenty-nine lists had high test-retest reliability. Using the overall mean as a benchmark, the 95% confidence intervals indicated that 25 of the remaining 29 lists were equivalent (e.g., the benchmark of 73% fell within the 95% confidence interval for both test and retest). CONCLUSIONS Twenty-five of the TIMIT lists evaluated are equivalent when used with adult cochlear implant recipients who have open-set word recognition abilities. These lists may prove valuable for monitoring progress, comparing listening conditions or treatments, and developing aural rehabilitation plans for cochlear implant recipients.
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Affiliation(s)
- Sarah E King
- Program in Audiology and Communication Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA
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Baudhuin J, Cadieux J, Firszt JB, Reeder RM, Maxson JL. Optimization of programming parameters in children with the advanced bionics cochlear implant. J Am Acad Audiol 2012; 23:302-12. [PMID: 22533974 DOI: 10.3766/jaaa.23.5.2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cochlear implants provide access to soft intensity sounds and therefore improved audibility for children with severe-to-profound hearing loss. Speech processor programming parameters, such as threshold (or T-level), input dynamic range (IDR), and microphone sensitivity, contribute to the recipient's program and influence audibility. When soundfield thresholds obtained through the speech processor are elevated, programming parameters can be modified to improve soft sound detection. Adult recipients show improved detection for low-level sounds when T-levels are set at raised levels and show better speech understanding in quiet when wider IDRs are used. Little is known about the effects of parameter settings on detection and speech recognition in children using today's cochlear implant technology. PURPOSE The overall study aim was to assess optimal T-level, IDR, and sensitivity settings in pediatric recipients of the Advanced Bionics cochlear implant. RESEARCH DESIGN Two experiments were conducted. Experiment 1 examined the effects of two T-level settings on soundfield thresholds and detection of the Ling 6 sounds. One program set T-levels at 10% of most comfortable levels (M-levels) and another at 10 current units (CUs) below the level judged as "soft." Experiment 2 examined the effects of IDR and sensitivity settings on speech recognition in quiet and noise. STUDY SAMPLE Participants were 11 children 7-17 yr of age (mean 11.3) implanted with the Advanced Bionics High Resolution 90K or CII cochlear implant system who had speech recognition scores of 20% or greater on a monosyllabic word test. DATA COLLECTION AND ANALYSIS Two T-level programs were compared for detection of the Ling sounds and frequency modulated (FM) tones. Differing IDR/sensitivity programs (50/0, 50/10, 70/0, 70/10) were compared using Ling and FM tone detection thresholds, CNC (consonant-vowel nucleus-consonant) words at 50 dB SPL, and Hearing in Noise Test for Children (HINT-C) sentences at 65 dB SPL in the presence of four-talker babble (+8 signal-to-noise ratio). Outcomes were analyzed using a paired t-test and a mixed-model repeated measures analysis of variance (ANOVA). RESULTS T-levels set 10 CUs below "soft" resulted in significantly lower detection thresholds for all six Ling sounds and FM tones at 250, 1000, 3000, 4000, and 6000 Hz. When comparing programs differing by IDR and sensitivity, a 50 dB IDR with a 0 sensitivity setting showed significantly poorer thresholds for low frequency FM tones and voiced Ling sounds. Analysis of group mean scores for CNC words in quiet or HINT-C sentences in noise indicated no significant differences across IDR/sensitivity settings. Individual data, however, showed significant differences between IDR/sensitivity programs in noise; the optimal program differed across participants. CONCLUSIONS In pediatric recipients of the Advanced Bionics cochlear implant device, manually setting T-levels with ascending loudness judgments should be considered when possible or when low-level sounds are inaudible. Study findings confirm the need to determine program settings on an individual basis as well as the importance of speech recognition verification measures in both quiet and noise. Clinical guidelines are suggested for selection of programming parameters in both young and older children.
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Affiliation(s)
- Jacquelyn Baudhuin
- TL1 Multidisciplinary Clinical Research Program, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
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