Patient and clinician experiences with the multidisciplinary single-day cochlear implant selection (MSCS) protocol

PURPOSE

This study assessed the MSCS (Multidisciplinary Single-day Cochlear Implant Selection) protocol with a primary focus on sustaining or enhancing patient satisfaction throughout the cochlear implant selection process.

MATERIALS AND METHODS

Following the implementation of the new selection protocol, where all selection appointments take place on the same day, we surveyed 37 individuals who underwent the process. Twenty adhered to the standard procedure, while 17 followed the MSCS protocol. We also gathered feedback from seven out of eight involved healthcare providers. This method enabled us to evaluate the protocol's effectiveness in maintaining patient satisfaction and ensuring staff contentment with care delivery within a condensed timeframe.

RESULTS

Patient responses showed slight variations in average scores without statistical significant differences, indicating comparable satisfaction between the MSCS pathway and the standard protocol. The majority of patients preferred the MSCS protocol, with none of the MSCS participants opting for appointments spread over multiple days. Healthcare practitioners of the CI center also displayed similar or increased satisfaction levels with the MSCS protocol.

CONCLUSION

The adoption of the MSCS in daily clinical care has led to a decrease in patient appointment times without sacrificing patient satisfaction. Additionally, the majority of individuals actively choose the MSCS protocol. Among those who have directly experienced it, there is unanimous preference for the consolidated appointments over spreading them across multiple days. Professionals within the CI team express equal satisfaction with both the new and old protocols, indicating that the reduction in patient time does not diminish overall satisfaction.

Pilot study of a multidisciplinary single-day cochlear implant selection protocol

PURPOSE

This study aimed to explore and introduce the potential of a MSCS (Multidisciplinary Single-day Cochlear Implant Selection) protocol. The primary objectives of this pilot were to reduce the duration between referral and surgery, minimize hospital visits and decrease the time healthcare professionals dedicate to the cochlear implant (CI) selection process.

MATERIALS AND METHODS

We established a pilot program at the CI center of the Erasmus MC, a tertiary referral center in the Netherlands, with the goal of improving and shorten the selection process. We evaluated our pilot, including 15 CI candidates, and conducted a retrospective analysis for time and cost savings.

RESULTS

The results showed that the pilot of the MSCS protocol significantly reduced the length of the CI selection phase (84 days vs 1; standard intake vs MSCS protocol) and the number of hospital visits (6 vs 2 visits; standard vs MSCS protocol), resulting in less travel time and lower costs for the CI candidates. The total time of professionals spend on patients was also reduced with 27 %.

CONCLUSION

This study highlights the potential benefits of the MSCS protocol in terms of reducing the burden on patients and healthcare providers and improving the efficiency of the CI selection process.

Communicating Emotion: Vocal Expression of Linguistic and Emotional Prosody in Children With Mild to Profound Hearing Loss Compared With That of Normal Hearing Peers

OBJECTIVES

Emotional prosody is known to play an important role in social communication. Research has shown that children with cochlear implants (CCIs) may face challenges in their ability to express prosody, as their expressions may have less distinct acoustic contrasts and therefore may be judged less accurately. The prosody of children with milder degrees of hearing loss, wearing hearing aids, has sparsely been investigated. More understanding of the prosodic expression by children with hearing loss, hearing aid users in particular, could create more awareness among healthcare professionals and parents on limitations in social communication, which awareness may lead to more targeted rehabilitation. This study aimed to compare the prosodic expression potential of children wearing hearing aids (CHA) with that of CCIs and children with normal hearing (CNH).

DESIGN

In this prospective experimental study, utterances of pediatric hearing aid users, cochlear implant users, and CNH containing emotional expressions (happy, sad, and angry) were recorded during a reading task. Of the utterances, three acoustic properties were calculated: fundamental frequency (F0), variance in fundamental frequency (SD of F0), and intensity. Acoustic properties of the utterances were compared within subjects and between groups.

RESULTS

A total of 75 children were included (CHA: 26, CCI: 23, and CNH: 26). Participants were between 7 and 13 years of age. The 15 CCI with congenital hearing loss had received the cochlear implant at median age of 8 months. The acoustic patterns of emotions uttered by CHA were similar to those of CCI and CNH. Only in CCI, we found no difference in F0 variation between happiness and anger, although an intensity difference was present. In addition, CCI and CHA produced poorer happy-sad contrasts than did CNH.

CONCLUSIONS

The findings of this study suggest that on a fundamental, acoustic level, both CHA and CCI have a prosodic expression potential that is almost on par with normal hearing peers. However, there were some minor limitations observed in the prosodic expression of these children, it is important to determine whether these differences are perceptible to listeners and could affect social communication. This study sets the groundwork for more research that will help us fully understand the implications of these findings and how they may affect the communication abilities of these children. With a clearer understanding of these factors, we can develop effective ways to help improve their communication skills.

A systematic review on the impact of auditory functioning and language proficiency on psychosocial difficulties in children and adolescents with hearing loss

OBJECTIVE

Approximately 20% to 40% of children with hearing loss encounter psychosocial difficulties. This prevalence may be outdated, given the advancements in hearing technology and rehabilitation efforts to enhance the psychosocial well-being of these children. A systematic review of up-to-date literature can help to identify factors that may contribute to the children's psychosocial well-being.

DESIGN/STUDY SAMPLE

A systematic review was conducted. Original articles were identified through systematic searches in Embase, Medline, PsychINFO, and Web of Science Core Collection. The quality of the papers was assessed using the Newcastle-Ottawa Quality Assessment Scale and custom Reviewers' Criteria.

RESULTS

A search was performed on 20 October 2022. A total of 1561 articles were identified, and 36 were included for review. Critical appraisal led to 24 good to fair quality articles, and 12 poor quality articles.

CONCLUSION

Children with hearing loss have a twofold risk of experiencing psychosocial difficulties compared to normal hearing peers. Estimates for functioning in social interactions, like speech perception (in noise) or language proficiency, have proven to be more adequate predictors for psychosocial difficulties than the degree of hearing loss. Our findings can be useful for identifying children at risk for difficulties and offering them earlier and more elaborate psychological interventions.

First results of the Strengths and Difficulties Questionnaire, applied as a screening tool for psychosocial difficulties in pediatric audiology

PURPOSE

Despite major improvements in rehabilitation possibilities, children with sensorineural hearing loss are at risk for psychosocial difficulties. These difficulties can impact their educational and career achievements and may be two to three times more common in children with hearing loss compared to those with normal hearing. Early identification of psychosocial difficulties can be facilitated using the Strengths and Difficulties Questionnaire (SDQ) and may improve outcomes and quality of life. We implemented the SDQ into the clinical follow-up of children with hearing loss in a tertiary referral hospital. With this, prevalence and severity of difficulties in specific psychosocial domains and several predictors were investigated.

METHODS

A retrospective, cross-sectional investigation was performed of the following factors in association with the SDQ results: type of hearing device, type and degree of hearing loss, speech perception in quiet and in noise, and type of schooling.

RESULTS

Between June 2020 and January 2022, parents of 312 children (age 4-18) completed the SDQ. An additional 113 child-reports were completed. The response rate of the parents was 69%. Problems with peer relationships and prosocial behavior were the most affected areas with clinically elevated scores in 22% of the children. Psychosocial difficulties were distributed similarly across types of hearing device, nature and degrees of hearing loss, and educational settings. Better speech perception in quiet was significantly associated with fewer parent-reported conduct problems.

CONCLUSION

The results of the present study suggest that children with hearing loss may be at risk of experiencing challenges with social interactions and attachment in social contexts. Using the SDQ in clinical follow-up may improve the chances for early psychological assessment and intervention. In addition, the study found that children's mental health may be impacted by their communication abilities.

Risk Factors For Hearing Decline From Childhood To Early Adolescence

OBJECTIVE

To identify risk factors of hearing decline between 9 and 13 years of age. The risk factors examined included sociodemographic, health, and lifestyle-related factors.

METHODS

This study was embedded within a population-based prospective cohort study from fetal life onwards in the Netherlands. Pure-tone audiometry and tympanometry were performed at the age of 9 and 13 years. The hearing decline was defined as an increase in low-frequency or high-frequency pure-tone average of at least 5 dB in one of both ears. Multivariable logistic regression was performed to examine the association of possible risk factors with hearing decline. The study was conducted from April 2012 to October 2015, and from April 2016 to September 2019.

RESULTS

Of the 3,508 participants included, 7.8% demonstrated a hearing decline in the low frequencies, and 11.3% in the high frequencies. Participants who reported alcohol consumption were more likely to have a hearing decline in the low frequencies (OR 1.5, 95% CI 1.1; 2.0). Moreover, a lower educational level was associated with an increased odds of having a hearing decline in the high frequencies (OR 1.4, 95% CI 1.0; 1.8). Age, sex, household income, personal music player use, and body mass index were not associated with hearing decline.

CONCLUSION

Educational level and risky behavior were significantly associated with hearing decline from childhood to early adolescence. The findings of the present study can help in the design of public health interventions to prevent hearing loss at a young age.

LEVEL OF EVIDENCE

2 (prospective cohort study) Laryngoscope, 133:389-395, 2023.

The association of sociodemographic factors and risk behavior with unsafe use of personal listening devices in adolescents

Many young people are potentially at risk of noise-induced hearing loss due to unsafe use of personal listening devices. The aim of this cross-sectional study was to examine the association of sociodemographic factors and risk behavior with unsafe use of personal listening devices in adolescents to identify a target group for prevention. A smartphone application was developed to objectively measure music listening habits among 314 adolescents with a mean age of 13 years and 7 months (SD ±5 months). Listening habits were characterized as safe or unsafe based on the weekly noise dose. Data on sociodemographic factors and traditional health risk behaviors were obtained by questionnaires. Within the study group, 10.5% of the participants exceeded the 50%, and 4.8% the 100% recommended weekly noise dose. Adolescents with a lower socioeconomic status were more likely to engage in unsafe listening habits as compared to adolescents with a higher socioeconomic status. Additionally, risk behavior was associated with higher odds of having unsafe listening habits as compared to no risk behavior. Age, sex and educational levels were not significantly associated with unsafe listening habits. The findings of the present study indicate that interventions to promote safe listening habits should target adolescents with a lower socioeconomic status and higher risk behavior. Future research is needed to investigate how these adolescents can be motivated to adopt safe listening habits.

Distortion Product Otoacoustic Emissions in Screening for Early Stages of High-frequency Hearing Loss in Adolescents

Objective

Adolescents may be at risk of noise-induced hearing loss due to recreational sound. The aim of this study was to examine the role of distortion product otoacoustic emissions (DPOAEs) in screening for early stages of high-frequency loss such as can be observed in noise-induced hearing loss.

Setting and design

This cross-sectional study was embedded within Generation R, an ongoing prospective birth cohort study in Rotterdam, The Netherlands. Data were collected from April 2016 to September 2019.

Methods

A total of 3456 adolescents with a mean age of 13 years and 8 months old (standard deviation ± 5 months) were included. Pure-tone thresholds were measured in a sound-treated booth. DPOAEs were recorded using an ILO V6 analyzer with primary levels of 65/55 dB SPL and frequency ratio f₂/f₁ of 1.22. Subjects had normal middle ear function at the time of assessment, based on tympanometry results.

Results

Measurements in 6065 ears showed that DPOAE levels tend to decrease with increasing pure-tone thresholds. However, the intersubject variability of DPOAE levels in ears with the same threshold was large. DPOAE levels could reasonably identify early stages of high-frequency hearing loss.

Conclusion

The findings of present study indicate that DPOAE measurements can potentially be used for adolescents hearing screening in the high frequencies. Future research is needed to optimize test performance.

Revision surgery for chronically discharging mastoid cavities: mastoid obliteration with canal wall reconstruction versus non-obliteration surgery

Purpose

To evaluate the surgical results of revision canal wall down (CWD) surgery for chronically discharging mastoid cavities and to compare the non-obliteration approach to mastoid obliteration with canal wall reconstruction.

Methods

This is a retrospective cohort study. All adult patients (≥ 18 years) who underwent revision surgery for chronically draining mastoid cavities between January 2013 and January 2020 were included. Primary outcome measures included the dry ear rate, complications and postoperative hearing.

Results

79 ears were included; 56 ears received revision CWD with mastoid obliteration and posterior canal wall reconstruction and 23 ears received CWD without mastoid obliteration. The dry ear rate at the most recent outpatient clinic visit (median 28.0 months postoperative) was significantly higher in the obliteration group with 96.4% compared to 73.9% for the non-obliteration group (p = .002). There were no differences in audiological outcome and incidence of complications between the two techniques.

Conclusion

We show that in our study population revision CWD surgery with mastoid obliteration and posterior canal wall reconstruction is superior to revision CWD surgery without mastoid obliteration in the management of chronically discharging mastoid cavities. In the obliteration group, a dry ear was achieved in 96.4% as this was 73.9% in the non-obliteration group. We found no differences in audiological outcome and in incidence of complications between the two techniques.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00405-021-07138-0.

Treatment Outcome of the Bony Obliteration Tympanoplasty Versus Nonobliterative Techniques in Cholesteatoma Surgery: A Retrospective Analysis

OBJECTIVE

In cholesteatoma surgery, obliteration of the mastoid and epitympanic space (bony obliteration tympanoplasty, BOT) is an increasingly used technique with low recurrent and residual cholesteatoma rates. While factors as the postoperative hearing level and infection rate are important for the patient as well, these outcome parameters are not frequently reported on in current literature. The objective of this study is to evaluate the recurrent and residual cholesteatoma rates of the BOT technique and nonobliterative canal wall up (CWU) and canal wall down (CWD) mastoidectomy in a large patient cohort. Secondary objectives were to evaluate the infection rate and hearing outcome for all three techniques.

DESIGN

Retrospective cohort study.

SETTING

Single-center study.

PATIENTS

All 337 adult patients (≥18 yrs) who underwent primary or revision cholesteatoma surgery between January 2013 and March 2019 were included.

MAIN OUTCOME AND MEASURES

Recurrent cholesteatoma rates, residual cholesteatoma rates, postoperative infections and other complications, hearing outcome.

RESULTS

The estimated combined rate of recurrent and residual cholesteatoma at 5 years follow-up was 7.6% in the BOT group, 34.9% in the CWU group, and 17.9% in the CWD group. The postoperative infection rate in the different groups ranged from 4.3% to 4.9%. The median gain in AC threshold level varied from 0.0 dB in the BOT and CWD group to 3.8 dB in the CWU group.

CONCLUSIONS

We show that cholesteatoma recurrence rates after the BOT technique in our clinic are significantly lower compared to CWU surgery. There were no differences in infection rate and no clinically relevant differences in postoperative hearing between the BOT, CWU, and CWD technique.

The impact of face masks on the communication of adults with hearing loss during COVID-19 in a clinical setting

OBJECTIVE

The aim of the study was to investigate the effect of surgical masks and face shields on speech intelligibility of adults with moderate to severe hearing loss.

DESIGN

This study measured speech tracking scores in quiet for life speech in three different conditions: without a mask, with a surgical mask and with a face shield. Acoustic effects of the masks and face shields on the speech signal were also investigated. Study sample: The study sample consists of 42 patients with moderate to severe hearing loss, 23 cochlear implant users and 19 hearing aid users.

RESULTS

A significant average difference in speech perception scores was found for the use of a surgical mask compared to the listening situation "without mask". The worse the speech understanding in quiet, the larger the impact of the surgical mask. For the worse performers even the face shield had a negative impact on speech perception. The sound distortion for the face shield compared to the surgical mask was greater.

CONCLUSION

This study shows that even for speech perception in quiet, surgical face masks, and face shields to a lesser extent, have a negative effect for patients with moderate to severe hearing loss.

Impact of face masks in public spaces during COVID-19 pandemic on daily life communication of cochlear implant users

OBJECTIVE/HYPOTHESIS

Investigate potential problems in the daily life communication of cochlear implant (CI) patients due to the widespread use of face masks in public places during the COVID-19 pandemic.

STUDY DESIGN

Prospective survey study.

METHODS

This study used an online questionnaire about the effects of face masks on daily life communication of adult CI users. The questionnaire consists of three parts: (a) A face mask questionnaire, (b) loneliness question (c) three subdomains of the Nijmegen Cochlear Implant Questionnaire to assess quality of life. The questionnaires were send out on October 20, 2020. Four hundred and seven adult CI users were invited to participate in the study. The survey inclusion was closed on November 5, 2020. The study setting was the Rotterdam Cochlear Implant Center, Erasmus MC, a tertiary referral center in The Netherlands. The loneliness question and Nijmegen Cochlear Implant Questionnaire were analyzed for possible differences between the current situation with masks and the situation before, when masks were not commonly used.

RESULTS

Two hundred and twenty one adult CI users (54% female, mean age 62 years) participated in the study. The face mask questionnaire showed that face masks cause considerable problems in daily life communication of 80% of the participants. Also, CI users tend to feel more lonely and all used subdomains of the Nijmegen Cochlear Implant Questionnaire worsened due to the use of face masks.

CONCLUSION

The widespread use of face masks greatly complicates the daily life communication of CI users and reduces quality of life.

LEVEL OF EVIDENCE

3.

Objective Measurement of Listening Device Use and Its Relation to Hearing Acuity

Objectives

To examine whether adolescents exceed recommended noise exposure limits when using personal listening devices (PLDs) and to investigate the relationship between objectively measured PLD use and hearing thresholds

Study Design

Cross-sectional study.

Setting

This study was embedded within an ongoing prospective birth cohort study in Rotterdam, the Netherlands. Data were collected from May 2017 to September 2019.

Methods

A smartphone application was developed to measure daily noise exposure from PLDs. Listening habits were monitored among 314 adolescents with a mean age of 13 years 7 months (SD, 5 months), of whom 51.6% were male. Hearing acuity was measured by pure tone audiometry, and tympanometry was performed in both ears.

Results

Within the study group, 2.2% adolescents exceeded the recommended daily noise dose (85 dBA as an 8-hour time-weighted average) among all days when the application was active and 9.9% when among only the listening days. No significant correlation was found between the daily noise dose from PLDs and pure tone thresholds.

Conclusions

The majority of adolescents exhibited listening habits that could be considered safe. As noise-induced hearing loss develops slowly over time, it could be that the effects of PLD use on hearing are not evident yet in this young population with a relatively short duration of PLD use.

A 4-year follow-up study of hearing acuity in a large population-based cohort of children and adolescents

OBJECTIVES

To describe the prevalence of hearing loss among 13 year old adolescents, and to examine the change in prevalence between ages 9 and 13 years.

METHODS

This study was embedded within Generation R, a population-based prospective cohort study from fetal life onwards in the Netherlands. Pure-tone thresholds were obtained at 0.5 to 8 kHz, and tympanometry was performed. Sensorineural hearing loss (SNHL) was defined as a low-frequency and/or high-frequency pure-tone average of more than 15 dB HL in one of both ears. Audiometric signs suggestive of noise-induced hearing loss (NIHL) included the presence of a notch and/or high-frequency hearing loss. The study was conducted from April 2012 to October 2015, and April 2016 to September 2019.

RESULTS

A total of 4572 adolescents with a mean age of 13 years and 7 months (SD, 5 months) were included, of whom 2334 (51.0%) were girls. Within the cohort, 6.4% (95% CI, 5.7%-7.2%) were estimated to have SNHL, and 12.4% (95% CI, 11.5%-13.4%) met the criteria of NIHL. In total, 3675 participants were included in the longitudinal analysis. The prevalence of SNHL decreased from 8.0% to 5.3% between ages 9 and 13 years (P < .001). The prevalence of NIHL increased from 9.8% to 11.7% (P = .004), due to an increase in number of participants with a notch.

CONCLUSIONS

The prevalence of SNHL significantly decreased by 2.7% (95% CI, 1.6%-3.9%) between ages 9 and 13 years, probably due to a change in alertness during assessment at the age of 13 years. Other possible explanations include the presence of selection bias or a decline in prevalence of conductive hearing loss. The number of participants with audiometric signs suggestive of NIHL increased by 1.9% (95% CI, 0.5%-3.3%).

LEVEL OF EVIDENCE

Level 3.

A smartphone application to objectively monitor music listening habits in adolescents : Personal listening device usage and the accuracy of self-reported listening habits

Background

Listening to music through personal listening devices (PLDs) has become more prevalent during last decades. The aim of this study was to evaluate music listening habits through PLDs in adolescents with a smartphone application, and to assess the accuracy of self-reported listening habits.

Methods

This study was embedded in the Generation R Study, a population-based prospective birth cohort in Rotterdam, the Netherlands. A smartphone application for Android operating systems was developed to objectively monitor music listening habits for a period of 35 days. A postal questionnaire was used to subjectively assess listening habits. The level of agreement between the objectively measured and self-reported listening habits were evaluated using weighted kappa coefficients. Data were collected from May 2017 to March 2019.

Results

A total of 311 adolescents aged 12 to 15 years were included, of whom 237 (76.2%) completed the postal questionnaire. The results of the smartphone application showed that the median listening frequency was 2.1 days a week (IQR 1.0–3.4), the median listening time 21.1 min a day (IQR 9.1–53.7), and the mean listening level 54.5% (SD 18.1%). There was a slight to fair agreement between the objectively measured, and self-reported listening habits according to the weighted kappa coefficients (k = 0.179 to 0.364).

Conclusions

The results of the current study suggest that self-reported measures of listening habits are not always accurate. We consider a smartphone application to monitor listening habits of added value in future research investigating the possible damaging effects of PLDs on hearing acuity.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40463-020-00488-5.

Comparing the Effect of Different Hearing Aid Fitting Methods in Bimodal Cochlear Implant Users

Purpose The aim of the study was to investigate the effect of 3 hearing aid fitting procedures on provided gain of the hearing aid in bimodal cochlear implant users and their effect on bimodal benefit. Method This prospective study measured hearing aid gain and auditory performance in a cross-over design in which 3 hearing aid fitting methods were compared. Hearing aid fitting methods differed in initial gain prescription rule (NAL-NL2 and Audiogram+) and loudness balancing method (broadband vs. narrowband loudness balancing). Auditory functioning was evaluated by a speech-in-quiet test, a speech-in-noise test, and a sound localization test. Fourteen postlingually deafened adult bimodal cochlear implant users participated in the study. Results No differences in provided gain and in bimodal performance were found for the different hearing aid fittings. For all hearing aid fittings, a bimodal benefit was found for speech in noise and sound localization. Conclusion Our results confirm that cochlear implant users with residual hearing in the contralateral ear substantially benefit from bimodal stimulation. However, on average, no differences were found between different types of fitting methods, varying in prescription rule and loudness balancing method.

A directional remote-microphone for bimodal cochlear implant recipients

To evaluate whether speech recognition in noise differs according to whether a wireless remote microphone is connected to just the cochlear implant (CI) or to both the CI and to the hearing aid (HA) in bimodal CI users. The second aim was to evaluate the additional benefit of the directional microphone mode compared with the omnidirectional microphone mode of the wireless microphone. This prospective study measured Speech Recognition Thresholds (SRT) in babble noise in a 'within-subjects repeated measures design' for different listening conditions. Eighteen postlingually deafened adult bimodal CI users. No difference in speech recognition in noise in the bimodal listening condition was found between the wireless microphone connected to the CI only and to both the CI and the HA. An improvement of 4.1 dB was found for switching from the omnidirectional microphone mode to the directional mode in the CI only condition. The use of a wireless microphone improved speech recognition in noise for bimodal CI users. The use of the directional microphone mode led to a substantial additional improvement of speech perception in noise for situations with one target signal.

The Effect of Binaural Beamforming Technology on Speech Intelligibility in Bimodal Cochlear Implant Recipients

Although the benefit of bimodal listening in cochlear implant users has been agreed on, speech comprehension remains a challenge in acoustically complex real-life environments due to reverberation and disturbing background noises. One way to additionally improve bimodal auditory performance is the use of directional microphones. The objective of this study was to investigate the effect of a binaural beamformer for bimodal cochlear implant (CI) users. This prospective study measured speech reception thresholds (SRT) in noise in a repeated-measures design that varied in listening modality for static and dynamic listening conditions. A significant improvement in SRT of 4.7 dB was found with the binaural beamformer switched on in the bimodal static listening condition. No significant improvement was found in the dynamic listening condition. We conclude that there is a clear additional advantage of the binaural beamformer in bimodal CI users for predictable/static listening conditions with frontal target speech and spatially separated noise sources.

Effects of a transient noise reduction algorithm on speech intelligibility in noise, noise tolerance and perceived annoyance in cochlear implant users

OBJECTIVE

To evaluate the validity and efficacy of a transient noise reduction algorithm (TNR) in cochlear implant processing and the interaction of TNR with a continuous noise reduction algorithm (CNR).

DESIGN

We studied the effects of TNR and CNR on the perception of realistic sound samples with transients, using subjective ratings of annoyance, a speech-in-noise test and a noise tolerance test.

STUDY SAMPLE

Participants were 16 experienced cochlear implant recipients wearing an Advanced Bionics Naida Q70 processor.

RESULTS

CI users rated sounds with transients as moderately annoying. Annoyance was slightly, but significantly reduced by TNR. Transients caused a large decrease in speech intelligibility in noise and a moderate decrease in noise tolerance, measured on the Acceptable Noise Level test. The TNR had no significant effect on noise tolerance or on speech intelligibility in noise. The combined application of TNR and CNR did not result in interactions.

CONCLUSIONS

The TNR algorithm was effective in reducing annoyance from transient sounds, but was not able to prevent a decreasing effect of transients on speech understanding in noise and noise tolerance. TNR did not reduce the beneficial effect of CNR on speech intelligibility in noise, but no cumulated improvement was found either.