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Deniz B, Deniz R, Ataş A. Loudness Balancing Optimization for Better Speech Intelligibility, Music Perception, and Spectral Temporal Resolution in Cochlear Implant Users. Otol Neurotol 2024; 45:e385-e392. [PMID: 38518764 DOI: 10.1097/mao.0000000000004164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
HYPOTHESIS The behaviorally based programming with loudness balancing (LB) would result in better speech understanding, spectral-temporal resolution, and music perception scores, and there would be a relationship between these scores. BACKGROUND Loudness imbalances at upper stimulation levels may cause sounds to be perceived as irregular, gravelly, or overly echoed and may negatively affect the listening performance of the cochlear implant (CI) user. LB should be performed after fitting to overcome these problems. METHODS The study included 26 unilateral Med-EL CI users. Two different CI programs based on the objective electrically evoked stapedial reflex threshold (P1) and the behaviorally program with LB (P2) were recorded for each participant. The Turkish Matrix Sentence Test (TMS) was applied to evaluate speech perception; the Random Gap Detection Test (RGDT) and Spectral-Temporally Modulated Ripple Test (SMRT) were applied to evaluate spectral temporal resolution skills; the Mini Profile of Music Perception Skills (mini-PROMS) and Melodic Contour Identification (MCI) tests were applied to evaluate music perception, and the results were compared. RESULTS Significantly better scores were obtained with P2 in TMS tests performed in noise and quiet. SMRT scores were significantly correlated with TMS in quiet and noise, and mini-PROMS sound perception results. Although better scores were obtained with P2 in the mini-PROMS total score and MCI, a significant difference was found only for MCI. CONCLUSION The data from the current study showed that equalization of loudness across CI electrodes leads to better perceptual acuity. It also revealed the relationship between speech perception, spectral-temporal resolution, and music perception.
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Affiliation(s)
- Burcu Deniz
- Istanbul University-Cerrahpaşa, Faculty of Health Science, Department of Audiology, İstanbul, Türkiye
| | - Rişvan Deniz
- Koç University Hospital, Department of Audiology, İstanbul, Türkiye
| | - Ahmet Ataş
- Koç University, Faculty of Medicine, Department of Otorhinolaryngology, İstanbul, Türkiye
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Berg KA, Chen C, Noble JH, Dawant BM, Dwyer RT, Labadie RF, Gifford RH. Effects of the Number of Channels and Channel Stimulation Rate on Speech Recognition and Sound Quality Using Precurved Electrode Arrays. Am J Audiol 2023; 32:403-416. [PMID: 37249492 PMCID: PMC10468116 DOI: 10.1044/2023_aja-22-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/16/2022] [Accepted: 02/05/2023] [Indexed: 05/31/2023] Open
Abstract
PURPOSE This study investigated the relationship between the number of active electrodes, channel stimulation rate, and their interaction on speech recognition and sound quality measures while controlling for electrode placement. Cochlear implant (CI) recipients with precurved electrode arrays placed entirely within scala tympani and closer to the modiolus were hypothesized to be able to utilize more channels and possibly higher stimulation rates to achieve better speech recognition performance and sound quality ratings than recipients in previous studies. METHOD Participants included seven postlingually deafened adult CI recipients with Advanced Bionics Mid-Scala electrode arrays confirmed to be entirely within scala tympani using postoperative computerized tomography. Twelve conditions were tested using four, eight, 12, and 16 electrodes and channel stimulation rates of 600 pulse per second (pps), 1,200 pps, and each participant's maximum allowable rate (1,245-4,800 pps). Measures of speech recognition and sound quality were acutely assessed. RESULTS For the effect of channels, results showed no significant improvements beyond eight channels for all measures. For the effect of channel stimulation rate, results showed no significant improvements with higher rates, suggesting that 600 pps was sufficient for maximum speech recognition performance and sound quality ratings. However, across all conditions, there was a significant relationship between mean electrode-to-modiolus distance and all measures, suggesting that a lower mean electrode-to-modiolus distance was correlated with higher speech recognition scores and sound quality ratings. CONCLUSION These findings suggest that even well-placed precurved electrode array recipients may not be able to take advantage of more than eight channels or higher channel stimulation rates (> 600 pps), but that closer electrode array placement to the modiolus correlates with better outcomes for these recipients.
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Affiliation(s)
- Katelyn A. Berg
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Chen Chen
- Research and Technology, Advanced Bionics, LLC, Valencia, CA
| | - Jack H. Noble
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN
| | - Benoit M. Dawant
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN
| | - Robert T. Dwyer
- Research and Technology, Advanced Bionics, LLC, Valencia, CA
| | - Robert F. Labadie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - René H. Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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Gauer J, Nagathil A, Lentz B, Völter C, Martin R. A subjective evaluation of different music preprocessing approaches in cochlear implant listeners. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 153:1307. [PMID: 36859137 DOI: 10.1121/10.0017249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Cochlear implants (CIs) can partially restore speech perception to relatively high levels in listeners with moderate to profound hearing loss. However, for most CI listeners, the perception and enjoyment of music remains notably poor. Since a number of technical and physiological restrictions of current implant designs cannot be easily overcome, a number of preprocessing methods for music signals have been proposed recently. They aim to emphasize the leading voice and rhythmic elements and to reduce their spectral complexity. In this study, CI listeners evaluated five remixing approaches in comparison to unprocessed signals. To identify potential explaining factors of CI preference ratings, different signal quality criteria of the processed signals were additionally assessed by normal-hearing listeners. Additional factors were investigated based on instrumental signal-level features. For three preprocessing methods, a significant improvement over the unprocessed reference was found. Especially, two deep neural network-based remix strategies proved to enhance music perception in CI listeners. These strategies provide remixes of the respective harmonic and percussive signal components of the four source stems "vocals," "bass," "drums," and "other accompaniment." Moreover, the results demonstrate that CI listeners prefer an attenuation of sustained components of drum source signals.
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Affiliation(s)
- Johannes Gauer
- Institute of Communication Acoustics, Ruhr-Universität Bochum, Bochum, Germany
| | - Anil Nagathil
- Institute of Communication Acoustics, Ruhr-Universität Bochum, Bochum, Germany
| | - Benjamin Lentz
- Institute of Communication Acoustics, Ruhr-Universität Bochum, Bochum, Germany
| | - Christiane Völter
- Department of Otorhinolaringology, Head and Neck Surgery, St. Elisabeth-Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Rainer Martin
- Institute of Communication Acoustics, Ruhr-Universität Bochum, Bochum, Germany
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Berg KA, Noble JH, Dawant BM, Dwyer RT, Labadie RF, Gifford RH. Speech recognition as a function of the number of channels for Mid-Scala electrode array recipients. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 152:67. [PMID: 35931512 PMCID: PMC9984239 DOI: 10.1121/10.0012163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This study investigated the number of channels needed for maximum speech understanding and sound quality in 15 adult cochlear implant (CI) recipients with Advanced Bionics (AB) Mid-Scala electrode arrays completely within scala tympani. In experiment I, CI programs used a continuous interleaved sampling (CIS)-based strategy and 4-16 active electrodes. In experiment II, CI programs used an n-of-m strategy featuring 16 active electrodes with either 8- or 12-maxima. Speech understanding and sound quality measures were assessed. For CIS programs, participants demonstrated performance gains using up to 4-10 electrodes on speech measures and sound quality ratings. For n-of-m programs, there was no significant effect of maxima, suggesting 8-maxima is sufficient for this sample's maximum performance and sound quality. These results are largely consistent with previous studies using straight electrode arrays [e.g., Fishman, Shannon, and Slattery (1997). J. Speech Lang. Hear. Res. 40, 1201-1215; Friesen, Shannon, Baskent, and Wang (2001). J. Acoust. Soc. Am. 110, 1150-1163; Shannon, Cruz, and Galvin (2011). Audiol. Neurotol. 16, 113-123; Berg, Noble, Dawant, Dwyer, Labadie, and Gifford (2020). J. Acoust. Soc. Am. 147, 3646-3656] and in contrast with recent studies looking at cochlear precurved electrode arrays [e.g., Croghan, Duran, and Smith (2017). J. Acoust. Soc. Am. 142, EL537-EL543; Berg, Noble, Dawant, Dwuer, Labadie, and Gifford (2019b). J. Acoust. Soc. Am. 145, 1556-1564], which found continuous improvements up to 16 independent channels. These findings suggest that Mid-Scala electrode array recipients demonstrate similar channel independence to straight electrode arrays rather than other manufacturer's precurved electrode arrays.
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Affiliation(s)
- Katelyn A Berg
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, Tennessee 37232, USA
| | - Jack H Noble
- Department of Electrical Engineering and Computer Science, Vanderbilt University, 2201 West End Avenue, Nashville, Tennessee 37235, USA
| | - Benoit M Dawant
- Department of Electrical Engineering and Computer Science, Vanderbilt University, 2201 West End Avenue, Nashville, Tennessee 37235, USA
| | - Robert T Dwyer
- Advanced Bionics, 28515 Westinghouse Place, Valencia, California 91355, USA
| | - Robert F Labadie
- Department of Otolaryngology, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, Tennessee 37232, USA
| | - René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, Tennessee 37232, USA
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Predictors of Postoperative Electrode Deactivation Among Adult Cochlear Implantees. Otol Neurotol 2021; 42:e675-e683. [PMID: 33625193 DOI: 10.1097/mao.0000000000003093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize postoperative electrode functionality after adult cochlear implantation; to identify rationale and risk factors for electrode deactivation. STUDY DESIGN Retrospective Chart Review. SETTING Academic Cochlear Implant Center. SUBJECT POPULATION Five hundred nineteen cochlear implants in 433 adult patients over 5 years. INTERVENTIONS Unilateral or bilateral cochlear implantation. MAIN OUTCOME MEASURES Rate of electrode deactivation after adult cochlear implantation. RESULTS One hundred twenty (27.7%) patients experienced electrode deactivation postoperatively, involving a total of 447 electrodes. The most common reasons for deactivation were bothersome nonauditory symptoms (n = 170, 38.0%), perceived benefit by patients (n = 64, 14.3%), and bothersome auditory symptoms (n = 60, 13.4%). Four hundred nineteen (93.7%) of involved electrodes remained deactivated at most recent follow-up, whereas 28 (6.3%) were able to be reactivated. Deactivation was most likely to occur within the first 4 weeks after activation (n = 90 patients,75.0%; p < 0.01). Among affected patients, the average number of electrodes deactivated was 3.44 (range 1-13; SD 2.50). Age was not associated with electrode deactivation. CONCLUSIONS While 98% of cochlear implants had full insertions, more than a quarter of implantees may experience electrode deactivation postoperatively for a multitude of reasons, with bothersome nonauditory symptoms most prevalent. Deactivation of five or more electrodes and simultaneous deactivation of two or three electrodes seems to increase the odds of subsequent device failure. However, deactivation encompasses a wide range of issues that likely include patient factors, surgical technique, and device-specific issues. Prognosis varies greatly at the individual level and further evaluation is required to better identify the issues underlying deactivation and identify true predictors of failure.
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Berg KA, Noble JH, Dawant BM, Dwyer RT, Labadie RF, Gifford RH. Speech recognition as a function of the number of channels for an array with large inter-electrode distances. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 149:2752. [PMID: 33940865 PMCID: PMC8062138 DOI: 10.1121/10.0004244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 05/28/2023]
Abstract
This study investigated the number of channels available to cochlear implant (CI) recipients for maximum speech understanding and sound quality for lateral wall electrode arrays-which result in large electrode-to-modiolus distances-featuring the greatest inter-electrode distances (2.1-2.4 mm), the longest active lengths (23.1-26.4 mm), and the fewest number of electrodes commercially available. Participants included ten post-lingually deafened adult CI recipients with MED-EL electrode arrays (FLEX28 and STANDARD) entirely within scala tympani. Electrode placement and scalar location were determined using computerized tomography. The number of channels was varied from 4 to 12 with equal spatial distribution across the array. A continuous interleaved sampling-based strategy was used. Speech recognition, sound quality ratings, and a closed-set vowel recognition task were measured acutely for each electrode condition. Participants did not demonstrate statistically significant differences beyond eight channels at the group level for almost all measures. However, several listeners showed considerable improvements from 8 to 12 channels for speech and sound quality measures. These results suggest that channel interaction caused by the greater electrode-to-modiolus distances of straight electrode arrays could be partially compensated for by a large inter-electrode distance or spacing.
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Affiliation(s)
- Katelyn A Berg
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, Tennessee 37232, USA
| | - Jack H Noble
- Department of Electrical Engineering and Computer Science, Vanderbilt University, 2201 West End Avenue, Nashville, Tennessee 37235, USA
| | - Benoit M Dawant
- Department of Electrical Engineering and Computer Science, Vanderbilt University, 2201 West End Avenue, Nashville, Tennessee 37235, USA
| | - Robert T Dwyer
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, Tennessee 37232, USA
| | - Robert F Labadie
- Department of Otolaryngology, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, Tennessee 37232, USA
| | - René H Gifford
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, Tennessee 37232, USA
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