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

The Relationship Between Spatial Release From Masking and Listening Effort Among Cochlear Implant Users With Single-Sided Deafness

OBJECTIVES

To examine speech intelligibility and listening effort in a group of patients with single-sided deafness (SSD) who received a cochlear implant (CI). There is limited knowledge on how effectively SSD-CI users can integrate electric and acoustic inputs to obtain spatial hearing benefits that are important for navigating everyday noisy environments. The present study examined speech intelligibility in quiet and noise simultaneously with measuring listening effort using pupillometry in individuals with SSD before, and 1 year after, CI activation. The study was designed to examine whether spatial separation between target and interfering speech leads to improved speech understanding (spatial release from masking [SRM]), and is associated with a decreased effort (spatial release from listening effort [SRE]) measured with pupil dilation (PPD).

DESIGN

Eight listeners with adult-onset SSD participated in two visits: (1) pre-CI and (2) post-CI (1 year after activation). Target speech consisted of Electrical and Electronics Engineers sentences and masker speech consisted of AzBio sentences. Outcomes were measured in three target-masker configurations with the target fixed at 0° azimuth: (1) quiet, (2) co-located target/maskers, and (3) spatially separated (±90° azimuth) target/maskers. Listening effort was quantified as change in peak proportional PPD on the task relative to baseline dilation. Participants were tested in three listening modes: acoustic-only, CI-only, and SSD-CI (both ears). At visit 1, the acoustic-only mode was tested in all three target-masker configurations. At visit 2, the acoustic-only and CI-only modes were tested in quiet, and the SSD-CI listening mode was tested in all three target-masker configurations.

RESULTS

Speech intelligibility scores in quiet were at the ceiling for the acoustic-only mode at both visits, and in the SSD-CI listening mode at visit 2. In quiet, at visit 2, speech intelligibility scores were significantly worse in the CI-only listening modes than in all other listening modes. Comparing SSD-CI listening at visit 2 with pre-CI acoustic-only listening at visit 1, speech intelligibility scores for co-located and spatially separated configurations showed a trend toward improvement (higher scores) that was not significant. However, speech intelligibility was significantly higher in the separated compared with the co-located configuration in acoustic-only and SSD-CI listening modes, indicating SRM. PPD evoked by speech presented in quiet was significantly higher with CI-only listening at visit 2 compared with acoustic-only listening at visit 1. However, there were no significant differences between co-located and spatially separated configurations on PPD, likely due to the variability among this small group of participants. There was a negative correlation between SRM and SRE, indicating that improved speech intelligibility with spatial separation of target and masker is associated with a greater decrease in listening effort on those conditions.

CONCLUSIONS

The small group of patients with SSD-CI in the present study demonstrated improved speech intelligibility from spatial separation of target and masking speech, but PPD measures did not reveal the effects of spatial separation on listening effort. However, there was an association between the improvement in speech intelligibility (SRM) and the reduction in listening effort (SRE) from spatial separation of target and masking speech.

Speech Quality Perception in Unilateral Cochlear Implant Users With Single-Sided Deafness

OBJECTIVE

Cochlear implant (CI) users frequently complain about speech quality perception (SQP). In patients undergoing cochlear implantation for single-sided deafness, there is concern that poor SQP from the implanted ear will negatively impact binaural (CI + normal hearing [NH]) SQP. In this study, we investigate if binaural SQP is measurably different than unimplanted NH alone.

STUDY DESIGN

Cross-sectional study.

SETTING

Tertiary care center.

METHODS

Fifteen unilateral CI users with NH in the contralateral ear completed the validated Columbia Speech Quality Instrument. This instrument consists of 9 audio clips rated across 14 specific speech qualities using a 10-point visual analog scale. SQP was assessed in 3 conditions: CI only, NH only, and CI + NH.

RESULTS

Median speech quality scores were worse in the CI only condition compared to the NH only (50.0 vs 72.6, P = .0003) and binaural (50.0 vs 71.0, P = .007) conditions. Median speech quality scores were not significantly different between the NH only and binaural conditions (72.6 vs 71, P = .8). Compared to NH, CI speech quality sounded less clear, less natural, and more mechanical.

CONCLUSION

Compared to NH, SQP is poorer with a CI alone. However, in contrast to expectation, there is no significant difference between NH and binaural SQP. This suggests poorer CI speech perception does not negatively impact binaural SQP in patients undergoing cochlear implantation for single-sided deafness.

Reduced digit spans and ear dominance using dichotic digits in bimodal cochlear-implant users

Bimodal stimulation, a cochlear implant (CI) in one ear and a hearing aid (HA) in the other, provides highly asymmetrical inputs. To understand how asymmetry affects perception and memory, forward and backward digit spans were measured in nine bimodal listeners. Spans were unchanged from monotic to diotic presentation; there was an average two-digit decrease for dichotic presentation with some extreme cases of decreases to zero spans. Interaurally asymmetrical decreases were not predicted based on the device or better-functioning ear. Therefore, bimodal listeners can demonstrate a strong ear dominance, diminishing memory recall dichotically even when perception was intact monaurally.

Factors that can affect divided speech intelligibility

Previous studies have shown that in challenging listening situations, people find it hard to equally divide their attention between two simultaneous talkers and tend to favor one talker over the other. The aim here was to investigate whether talker onset/offset, sex and location determine the favored talker. Fifteen people with normal hearing were asked to recognize as many words as possible from two sentences uttered by two talkers located at 45° and +45° azimuth, respectively. The sentences were from the same corpus, were time-centered and had equal sound level. In Conditions 1 and 2, the talkers had different sexes (male at +45°), sentence duration was not controlled for, and sentences were presented at 65 and 35 dB SPL, respectively. Listeners favored the male over the female talker, even more so at 35 dB SPL (62 % vs 43 % word recognition, respectively) than at 65 dB SPL (74 % vs 64 %, respectively). The greater asymmetry in intelligibility at the lower level supports that divided listening is harder and more 'asymmetric' in challenging acoustic scenarios. Listeners continued to favor the male talker when the experiment was repeated with sentences of equal average duration for the two talkers (Condition 3). This suggests that the earlier onset or later offset of male sentences (52 ms on average) was not the reason for the asymmetric intelligibility in Conditions 1 or 2. When the location of the talkers was switched (Condition 4) or the two talkers were the same woman (Condition 5), listeners continued to favor the talker to their right albeit non-significantly. Altogether, results confirm that in hard divided listening situations, listeners tend to favor the talker to their right. This preference is not affected by talker onset/offset delays less than 52 ms on average. Instead, the preference seems to be modulated by the voice characteristics of the talkers.

Review of Binaural Processing With Asymmetrical Hearing Outcomes in Patients With Bilateral Cochlear Implants

Bilateral cochlear implants (BiCIs) result in several benefits, including improvements in speech understanding in noise and sound source localization. However, the benefit bilateral implants provide among recipients varies considerably across individuals. Here we consider one of the reasons for this variability: difference in hearing function between the two ears, that is, interaural asymmetry. Thus far, investigations of interaural asymmetry have been highly specialized within various research areas. The goal of this review is to integrate these studies in one place, motivating future research in the area of interaural asymmetry. We first consider bottom-up processing, where binaural cues are represented using excitation-inhibition of signals from the left ear and right ear, varying with the location of the sound in space, and represented by the lateral superior olive in the auditory brainstem. We then consider top-down processing via predictive coding, which assumes that perception stems from expectations based on context and prior sensory experience, represented by cascading series of cortical circuits. An internal, perceptual model is maintained and updated in light of incoming sensory input. Together, we hope that this amalgamation of physiological, behavioral, and modeling studies will help bridge gaps in the field of binaural hearing and promote a clearer understanding of the implications of interaural asymmetry for future research on optimal patient interventions.

Effect of experimentally introduced interaural frequency mismatch on sentence recognition in bilateral cochlear-implant listeners

Bilateral cochlear-implant users experience interaural frequency mismatch because of asymmetries in array insertion and frequency-to-electrode assignment. To explore the acute perceptual consequences of such mismatch, sentence recognition in quiet was measured in nine bilateral cochlear-implant listeners as frequency allocations in the poorer ear were shifted by ±1.5, ±3, and ±4.5 mm using experimental programs. Shifts in frequency allocation >3 mm reduced bilateral sentence scores below those for the better ear alone, suggesting that the poorer ear interfered with better-ear perception. This was not a result of fewer active channels; deactivating electrodes without frequency shifting had minimal effect.

"Unattended, distracting or irrelevant": Theoretical implications of terminological choices in auditory selective attention research

For seventy years, auditory selective attention research has focused on studying the cognitive mechanisms of prioritizing the processing a 'main' task-relevant stimulus, in the presence of 'other' stimuli. However, a closer look at this body of literature reveals deep empirical inconsistencies and theoretical confusion regarding the extent to which this 'other' stimulus is processed. We argue that many key debates regarding attention arise, at least in part, from inappropriate terminological choices for experimental variables that may not accurately map onto the cognitive constructs they are meant to describe. Here we critically review the more common or disruptive terminological ambiguities, differentiate between methodology-based and theory-derived terms, and unpack the theoretical assumptions underlying different terminological choices. Particularly, we offer an in-depth analysis of the terms 'unattended' and 'distractor' and demonstrate how their use can lead to conflicting theoretical inferences. We also offer a framework for thinking about terminology in a more productive and precise way, in hope of fostering more productive debates and promoting more nuanced and accurate cognitive models of selective attention.

Effect of experimentally introduced interaural frequency mismatch on sentence recognition in bilateral cochlear-implant listeners

Bilateral cochlear-implant users experience interaural frequency mismatch because of asymmetries in array insertion and frequency-to-electrode assignment. To explore the acute perceptual consequences of such mismatch, sentence recognition in quiet was measured in nine bilateral cochlear-implant listeners as frequency allocations in the poorer ear were shifted by ±1.5, ±3 and ±4.5 mm using experimental programs. Shifts in frequency allocation >3 mm were found to reduce bilateral sentence scores below those for the better ear alone, suggesting that the poorer ear interfered with better-ear perception. This was not a result of fewer active channels; deactivating electrodes without frequency shifting had minimal effect.

Interaural asymmetry of dynamic range: Abnormal fusion, bilateral interference, and shifts in attention

Speech information in the better ear interferes with the poorer ear in patients with bilateral cochlear implants (BiCIs) who have large asymmetries in speech intelligibility between ears. The goal of the present study was to assess how each ear impacts, and whether one dominates, speech perception using simulated CI processing in older and younger normal-hearing (ONH and YNH) listeners. Dynamic range (DR) was manipulated symmetrically or asymmetrically across spectral bands in a vocoder. We hypothesized that if abnormal integration of speech information occurs with asymmetrical speech understanding, listeners would demonstrate an atypical preference in accuracy when reporting speech presented to the better ear and fusion of speech between the ears (i.e., an increased number of one-word responses when two words were presented). Results from three speech conditions showed that: (1) When the same word was presented to both ears, speech identification accuracy decreased if one or both ears decreased in DR, but listeners usually reported hearing one word. (2) When two words with different vowels were presented to both ears, speech identification accuracy and percentage of two-word responses decreased consistently as DR decreased in one or both ears. (3) When two rhyming words (e.g., bed and led) previously shown to phonologically fuse between ears (e.g., bled) were presented, listeners instead demonstrated interference as DR decreased. The word responded in (2) and (3) came from the right (symmetric) or better (asymmetric) ear, especially in (3) and for ONH listeners in (2). These results suggest that the ear with poorer dynamic range is downweighted by the auditory system, resulting in abnormal fusion and interference, especially for older listeners.

Asymmetric temporal envelope sensitivity: Within- and across-ear envelope comparisons in listeners with bilateral cochlear implants

For listeners with bilateral cochlear implants (BiCIs), patient-specific differences in the interface between cochlear implant (CI) electrodes and the auditory nerve can lead to degraded temporal envelope information, compromising the ability to distinguish between targets of interest and background noise. It is unclear how comparisons of degraded temporal envelope information across spectral channels (i.e., electrodes) affect the ability to detect differences in the temporal envelope, specifically amplitude modulation (AM) rate. In this study, two pulse trains were presented simultaneously via pairs of electrodes in different places of stimulation, within and/or across ears, with identical or differing AM rates. Results from 11 adults with BiCIs indicated that sensitivity to differences in AM rate was greatest when stimuli were paired between different places of stimulation in the same ear. Sensitivity from pairs of electrodes was predicted by the poorer electrode in the pair or the difference in fidelity between both electrodes in the pair. These findings suggest that electrodes yielding poorer temporal fidelity act as a bottleneck to comparisons of temporal information across frequency and ears, limiting access to the cues used to segregate sounds, which has important implications for device programming and optimizing patient outcomes with CIs.

Reconsidering commonly used stimuli in speech perception experiments

This paper examines some commonly used stimuli in speech perception experiments and raises questions about their use, or about the interpretations of previous results. The takeaway messages are: 1) the Hillenbrand vowels represent a particular dialect rather than a gold standard, and English vowels contain spectral dynamics that have been largely underappreciated, 2) the /ɑ/ context is very common but not clearly superior as a context for testing consonant perception, 3) /ɑ/ is particularly problematic when testing voice-onset-time perception because it introduces strong confounds in the formant transitions, 4) /dɑ/ is grossly overrepresented in neurophysiological studies and yet is insufficient as a generalized proxy for "speech perception," and 5) digit tests and matrix sentences including the coordinate response measure are systematically insensitive to important patterns in speech perception. Each of these stimulus sets and concepts is described with careful attention to their unique value and also cases where they might be misunderstood or over-interpreted.

Effects of better-ear glimpsing, binaural unmasking, and spectral resolution on spatial release from masking in cochlear-implant users

Bilateral cochlear-implant (BICI) listeners obtain less spatial release from masking (SRM; speech-recognition improvement for spatially separated vs co-located conditions) than normal-hearing (NH) listeners, especially for symmetrically placed maskers that produce similar long-term target-to-masker ratios at the two ears. Two experiments examined possible causes of this deficit, including limited better-ear glimpsing (using speech information from the more advantageous ear in each time-frequency unit), limited binaural unmasking (using interaural differences to improve signal-in-noise detection), or limited spectral resolution. Listeners had NH (presented with unprocessed or vocoded stimuli) or BICIs. Experiment 1 compared natural symmetric maskers, idealized monaural better-ear masker (IMBM) stimuli that automatically performed better-ear glimpsing, and hybrid stimuli that added worse-ear information, potentially restoring binaural cues. BICI and NH-vocoded SRM was comparable to NH-unprocessed SRM for idealized stimuli but was 14%-22% lower for symmetric stimuli, suggesting limited better-ear glimpsing ability. Hybrid stimuli improved SRM for NH-unprocessed listeners but degraded SRM for BICI and NH-vocoded listeners, suggesting they experienced across-ear interference instead of binaural unmasking. In experiment 2, increasing the number of vocoder channels did not change NH-vocoded SRM. BICI SRM deficits likely reflect a combination of across-ear interference, limited better-ear glimpsing, and poorer binaural unmasking that stems from cochlear-implant-processing limitations other than reduced spectral resolution.

Development of Ultrasensitive Biomimetic Auditory Hair Cells Based on Piezoresistive Hydrogel Nanocomposites

With an ageing population, hearing disorders are predicted to rise considerably in the following decades. Thus, developing a new class of artificial auditory system has been highlighted as one of the most exciting research topics for biomedical applications. Herein, a design of a biocompatible piezoresistive-based artificial hair cell sensor is presented consisting of a highly flexible and conductive polyvinyl alcohol (PVA) nanocomposite with vertical graphene nanosheets (VGNs). The bilayer hydrogel sensor demonstrates excellent performance to mimic biological hair cells, responding to acoustic stimuli in the audible range between 60 Hz to 20 kHz. The sensor output demonstrates stable mid-frequency regions (∼4-9 kHz), with the greatest sensitivity as high frequencies (∼13-20 kHz). This is somewhat akin to the mammalian auditory system, which has remarkable sensitivity and sharp tuning at high frequencies due to the "active process". This work validates the PVA/VGN sensor as a potential candidate to play a similar functional role to that of the cochlear hair cells, which also operate over a wide frequency domain in a viscous environment. Further characterizations of the sensor show that increasing the sound amplitude results in higher responses from the sensor while taking it to the depth drops the sensor outputs due to attenuation of sound in water. Meanwhile, the acoustic pressure distribution of sound waves is predicted through finite element analysis, whereby the numerical results are in perfect agreement with experimental data. This proof-of-concept work creates a platform for the future design of susceptible, flexible biomimetic sensors to closely mimic the biological cochlea.

Dichotic listening performance and effort as a function of spectral resolution and interaural symmetry

One potential benefit of bilateral cochlear implants is reduced listening effort in speech-on-speech masking situations. However, the symmetry of the input across ears, possibly related to spectral resolution, could impact binaural benefits. Fifteen young adults with normal hearing performed digit recall with target and interfering digits presented to separate ears and attention directed to the target ear. Recall accuracy and pupil size over time (used as an index of listening effort) were measured for unprocessed, 16-channel vocoded, and 4-channel vocoded digits. Recall accuracy was significantly lower for dichotic (with interfering digits) than for monotic listening. Dichotic recall accuracy was highest when the target was less degraded and the interferer was more degraded. With matched target and interferer spectral resolution, pupil dilation was lower with more degradation. Pupil dilation grew more shallowly over time when the interferer had more degradation. Overall, interferer spectral resolution more strongly affected listening effort than target spectral resolution. These results suggest that interfering speech both lowers performance and increases listening effort, and that the relative spectral resolution of target and interferer affect the listening experience. Ignoring a clearer interferer is more effortful.