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Zhang H, Wang G, Zhang X, Liu W, Xiao J, Xia H, Yuan Y, Gao B, Kang D, Shao H, Dai P. Clinical Application of the 4K-3D Exoscope System in Cochlear Implantation. Otol Neurotol 2024; 45:521-528. [PMID: 38728554 DOI: 10.1097/mao.0000000000004184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
PURPOSE To evaluate a system for otomicrosurgery based on 4K three-dimensional (3D) exoscope technology and apply it to cochlear implantation. METHODS An open stereoscopic vision-based surgical system, which differs from traditional surgical microscopes, was created by utilizing 4K stereo imaging technology and combining it with low-latency 4K ultra-high-definition 3D display. The system underwent evaluation based on 57 cochlear implantation operations, three designed microscopic manipulations, and a questionnaire survey. RESULTS The surgical images displayed by the 4K-3D exoscope system (4K-3D-ES) are stereoscopic, clear, and smooth. The use of 4K-3D-ES in cochlear implantation is not inferior to traditional microscopes in terms of intraoperative bleeding and surgical complications, and the surgical duration is not slower or may even be faster than when using traditional microscopes. The results of micromanipulation experiments conducted on 16 students also confirmed this and demonstrated that 4K-3D-ES can be easily adapted. Furthermore, additional advantages of 4K-3D-ES were gathered. Significantly enlarged and high-definition stereoscopic images contribute to the visualization of finer anatomical microstructures such as chordae tympani, ensuring safer surgery. Users feel more comfortable in their necks, shoulders, waists, and backs. Real-time shared stereoscopic view for multiple people, convenient for collaboration and teaching. The ear endoscope and 4K-3D-ES enable seamless switching on the same screen. High-definition 3D images and videos can be saved with just one click, making future publication and communication convenient. CONCLUSION The feasibility and safety of 4K-3D-ES for cochlear implantation surgery have been demonstrated. The 4K-3D-ES also offers numerous unique advantages and holds clinical application and promotional value.
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Affiliation(s)
| | | | - Xin Zhang
- Zhejiang Future Technology Institute, Jiaxing, China
| | - Wei Liu
- Zhejiang Future Technology Institute, Jiaxing, China
| | - Jun Xiao
- Air Force Medical Center, PLA, Beijing, China
| | - Han Xia
- Zhejiang Future Technology Institute, Jiaxing, China
| | | | | | | | - Hang Shao
- Zhejiang Future Technology Institute, Jiaxing, China
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Lassaletta L, Calvino M, Díaz M, Morales-Puebla JM, Sánchez-Cuadrado I, Varela-Nieto I, Gavilán J. Intraoperative assessment of cochlear nerve functionality in various vestibular schwannoma scenarios: Lessons learned. Hear Res 2024; 446:108997. [PMID: 38564963 DOI: 10.1016/j.heares.2024.108997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
The use of cochlear implants (CIs) is on the rise for patients with vestibular schwannoma (VS). Besides CI following tumor resection, new scenarios such as implantation in observed and/or irradiated tumors are becoming increasingly common. A significant emerging trend is the need of intraoperative evaluation of the functionality of the cochlear nerve in order to decide if a CI would be placed. The purpose of this paper is to explore the experience of a tertiary center with the application of the Auditory Nerve Test System (ANTS) in various scenarios regarding VS patients. The results are compared to that of the studies that have previously used the ANTS in this condition. Patients with unilateral or bilateral VS (NF2) who were evaluated with the ANTS prior to considering CI in a tertiary center between 2021 and 2023 were analyzed. The presence of a robust wave V was chosen to define a positive electrical auditory brainstem response (EABR). Two patients underwent promontory stimulation (PromStim) EABR previous to ANTS evaluation. Seven patients, 2 NF-2 and 5 with sporadic VS were included. The initial scenario was simultaneous translabyrinthine (TL) tumor resection and CI in 3 cases while a CI placement without tumor resection was planned in 4 cases. The ANTS was positive in 4 cases, negative in 2 cases, and uncertain in one case. Two patients underwent simultaneous TL and CI, 1 patient simultaneous TL and auditory brainstem implant, 3 patients posterior tympanotomy with CI, and 1 patient had no implant placement. In the 5 patients undergoing CI, sound detection was present. There was a good correlation between the PromStim and ANTS EABR. The literature research yielded 35 patients with complete information about EABR response. There was one false negative and one false positive case; that is, the 28 implanted cases with a present wave V following tumor resection had some degree of auditory perception in all but one case. The ANTS is a useful intraoperative tool to asses CI candidacy in VS patients undergoing observation, irradiation or surgery. A positive strongly predicts at least sound detection with the CI.
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Affiliation(s)
- Luis Lassaletta
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
| | - Miryam Calvino
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
| | - Miguel Díaz
- MED-EL Elektromedizinische Geräte GmbH. Madrid, Spain
| | - José Manuel Morales-Puebla
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
| | - Isabel Sánchez-Cuadrado
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain
| | - Isabel Varela-Nieto
- La Paz Research Institute (IdiPAZ), Madrid, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain; Neuropathology of Hearing and Myelinopathies, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM, Madrid, Spain
| | - Javier Gavilán
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (IdiPAZ), Madrid, Spain
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Aghaei F, Khoramshahi H, Zamani P, Dehqan A, Hesam S. A Cepstral Peak Prominence (CPP) Voice Analysis in Iranian Post-lingual Deaf Adult Cochlear Implant Users. J Voice 2024; 38:795.e11-795.e20. [PMID: 34857450 DOI: 10.1016/j.jvoice.2021.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In standardized connected speech samples, cepstral peak prominence (CPP) and smoothed CPP (CPPS) have been described as accurate parameters to evaluate voice quality. Lack of normal auditory feedback in post-lingually deaf CI users might influence tuning the acoustic parameters in speech production. Based on shreds of evidence, normal hearing results in suitable vocal control through the sensory-motor linkage. The main aim of the present study was to compare the cepstral values between the Iranian cochlear implant group and normal peers. METHOD Persian CAPE-V sentences were recorded from 30 CI users and 30 healthy speakers (mean age=36.7 years, SD=13.5, range=18-60 years). Thirteen /a/vowels were extracted manually from syllables. Each subject phonated sustained /a/vowel for 5 seconds. PRAAT was used to calculate CPP and CPPS. To compare two age- and gender-matched groups, the independent sample t-test was applied. Then, ANCOVA was used to assess the impact of demographic factors on cepstral scores in CI participants. RESULTS Significant differences between the CI group and normal peers were discovered based on CPP and CPPS in both tasks (reading sentences and sustained vowel) (P < 0.05). Overall, CI users showed higher cepstral values. The implanted ear and prosthesis model had no significant impact on both CPP and CPPS (P ≥ 0.8). CONCLUSION Higher CPP and CPPS values in the CI users might be due to increased phonatory instability and spectral noise, with the possibility of decreased vocal control and its quality. The outcome suggests that CI group uses a different voice control strategy. These findings should be kept in mind for intervention methods, especially by assessing vocal characteristics and considering the voice quality in adult CI users.
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Affiliation(s)
- Fatemeh Aghaei
- Department of Speech Therapy, Ahvaz Jundishapur University of Medical Sciences, Iran
| | - Hassan Khoramshahi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Iran; Department of Speech Therapy, School of Rehabilitation, Babol University of Medical Sciences, Babol, Iran
| | - Peyman Zamani
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Ali Dehqan
- Department of Speech Therapy, Rehabilitation Faculty, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Saeed Hesam
- Hearing Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Rak K, Kaulitz S, Voelker J, Müller-Graff T, Engert J, Spahn B, Hackenberg S, Grasso P, Hagen R. [Online training for hearing implant surgery : A new approach to otological training. German version]. HNO 2024; 72:317-324. [PMID: 38530381 PMCID: PMC11045577 DOI: 10.1007/s00106-024-01451-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE Education in microsurgery of the ear includes staged training to allow for mastering of the complex microsurgical procedures, particularly in the context of middle ear reconstruction and cochlear implantation. Traditional surgical training includes temporal bone preparations by cadaver dissection and supervised operating room practice. As these on-site trainings are limited, there is a need to broaden education facilities in an on-line format. Therefore, a first basic on-line training for otosurgery was developed. MATERIALS AND METHODS The system consists of an artificial temporal bone model together with a set of basic surgical instruments and implant dummies. As an essential part of the training kit, a high-resolution camera set is included that allows for connection to a video streaming platform and enables remote supervision of the trainees' surgical steps by experienced otological surgeons. In addition, a pre-learning platform covering temporal bone anatomy and instrumentation and pre-recorded lectures and instructional videos has been developed to allow trainees to review and reinforce their understanding before hands-on practice. RESULTS Over the three courses held to date, 28 participants with varying levels of prior surgical experience took part in this otological surgical training program. The immediate feedback of the participants was evaluated by means of a questionnaire. On this basis, the high value of the program became apparent and specific areas could by identified where further refinements could lead to an even more robust training experience. CONCLUSION The presented program of an otosurgical online training allows for basal education in practical exercises on a remote system. In this way, trainees who have no direct access to on-site instruction facilities in ear surgery now have the chance to start their otosurgical training in an educational setting adapted to modern technologies.
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Affiliation(s)
- Kristen Rak
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland.
| | - Stefan Kaulitz
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Johannes Voelker
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Tassilo Müller-Graff
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Jonas Engert
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Björn Spahn
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Stephan Hackenberg
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Peter Grasso
- MED-EL Elektromedizinische Geräte Gesellschaft m.b.H., Innsbruck, Österreich
| | - Rudolf Hagen
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
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Potts LG, Olivo AM, Reeder RM, Firszt JB. Evaluation of the American English Matrix Test with Cochlear Implant Recipients. Int J Audiol 2024; 63:342-348. [PMID: 36896781 DOI: 10.1080/14992027.2023.2185757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/22/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE Currently, the variety of speech recognition tests used to evaluate cochlear implant (CI) recipients makes it difficult to compare results, especially across languages. The Matrix Test limits contextual cues and is available in multiple languages, including American English. The current study investigated test format and noise type for the American English Matrix Test (AMT) and compared results to AzBio sentence scores in adult CI recipients. DESIGN Fifteen experienced CI recipients were administered the AMT in fixed- and adaptive-level formats and AzBio sentences in a fixed-level format. Testing in noise used the AMT-specific noise and 4-talker babble. RESULTS Ceiling effects were present for all AMT fixed-level conditions and AzBio sentences in quiet. Group mean AzBio scores were poorer than AMT scores. Noise type affected performance regardless of format; 4-talker babble was more challenging. CONCLUSIONS The limited number of word choices in each category likely aided listeners performance for the AMT compared to AzBio sentences. The use of the AMT in the designed adaptive-level format would allow effective evaluation and comparison of CI performance internationally. A test battery with the AMT may also benefit from including AzBio sentences in 4-talker babble to reflect performance during listening challenges.
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Affiliation(s)
- Lisa G Potts
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, MO, USA
| | - Alison M Olivo
- Program in Audiology and Communication Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Ruth M Reeder
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jill B Firszt
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, MO, USA
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Inguscio BMS, Cartocci G, Sciaraffa N, Nicastri M, Giallini I, Aricò P, Greco A, Babiloni F, Mancini P. Two are better than one: Differences in cortical EEG patterns during auditory and visual verbal working memory processing between Unilateral and Bilateral Cochlear Implanted children. Hear Res 2024; 446:109007. [PMID: 38608331 DOI: 10.1016/j.heares.2024.109007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
Despite the proven effectiveness of cochlear implant (CI) in the hearing restoration of deaf or hard-of-hearing (DHH) children, to date, extreme variability in verbal working memory (VWM) abilities is observed in both unilateral and bilateral CI user children (CIs). Although clinical experience has long observed deficits in this fundamental executive function in CIs, the cause to date is still unknown. Here, we have set out to investigate differences in brain functioning regarding the impact of monaural and binaural listening in CIs compared with normal hearing (NH) peers during a three-level difficulty n-back task undertaken in two sensory modalities (auditory and visual). The objective of this pioneering study was to identify electroencephalographic (EEG) marker pattern differences in visual and auditory VWM performances in CIs compared to NH peers and possible differences between unilateral cochlear implant (UCI) and bilateral cochlear implant (BCI) users. The main results revealed differences in theta and gamma EEG bands. Compared with hearing controls and BCIs, UCIs showed hypoactivation of theta in the frontal area during the most complex condition of the auditory task and a correlation of the same activation with VWM performance. Hypoactivation in theta was also observed, again for UCIs, in the left hemisphere when compared to BCIs and in the gamma band in UCIs compared to both BCIs and NHs. For the latter two, a correlation was found between left hemispheric gamma oscillation and performance in the audio task. These findings, discussed in the light of recent research, suggest that unilateral CI is deficient in supporting auditory VWM in DHH. At the same time, bilateral CI would allow the DHH child to approach the VWM benchmark for NH children. The present study suggests the possible effectiveness of EEG in supporting, through a targeted approach, the diagnosis and rehabilitation of VWM in DHH children.
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Affiliation(s)
- Bianca Maria Serena Inguscio
- Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena 291, Rome 00161, Italy; BrainSigns Srl, Via Tirso, 14, Rome 00198, Italy.
| | - Giulia Cartocci
- Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena 291, Rome 00161, Italy; BrainSigns Srl, Via Tirso, 14, Rome 00198, Italy
| | | | - Maria Nicastri
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 31, Rome 00161, Italy
| | - Ilaria Giallini
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 31, Rome 00161, Italy
| | - Pietro Aricò
- Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena 291, Rome 00161, Italy; BrainSigns Srl, Via Tirso, 14, Rome 00198, Italy; Department of Computer, Control, and Management Engineering "Antonio Ruberti", Sapienza University of Rome, Via Ariosto 125, Rome 00185, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 31, Rome 00161, Italy
| | - Fabio Babiloni
- Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena 291, Rome 00161, Italy; BrainSigns Srl, Via Tirso, 14, Rome 00198, Italy; Department of Computer Science, Hangzhou Dianzi University, Xiasha Higher Education Zone, Hangzhou 310018, China
| | - Patrizia Mancini
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 31, Rome 00161, Italy
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Hendrikse MME, Dingemanse G, Goedegebure A. On the Feasibility of Using Behavioral Listening Effort Test Methods to Evaluate Auditory Performance in Cochlear Implant Users. Trends Hear 2024; 28:23312165241240572. [PMID: 38676325 PMCID: PMC11055488 DOI: 10.1177/23312165241240572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/28/2024] Open
Abstract
Realistic outcome measures that reflect everyday hearing challenges are needed to assess hearing aid and cochlear implant (CI) fitting. Literature suggests that listening effort measures may be more sensitive to differences between hearing-device settings than established speech intelligibility measures when speech intelligibility is near maximum. Which method provides the most effective measurement of listening effort for this purpose is currently unclear. This study aimed to investigate the feasibility of two tests for measuring changes in listening effort in CI users due to signal-to-noise ratio (SNR) differences, as would arise from different hearing-device settings. By comparing the effect size of SNR differences on listening effort measures with test-retest differences, the study evaluated the suitability of these tests for clinical use. Nineteen CI users underwent two listening effort tests at two SNRs (+4 and +8 dB relative to individuals' 50% speech perception threshold). We employed dual-task paradigms-a sentence-final word identification and recall test (SWIRT) and a sentence verification test (SVT)-to assess listening effort at these two SNRs. Our results show a significant difference in listening effort between the SNRs for both test methods, although the effect size was comparable to the test-retest difference, and the sensitivity was not superior to speech intelligibility measures. Thus, the implementations of SVT and SWIRT used in this study are not suitable for clinical use to measure listening effort differences of this magnitude in individual CI users. However, they can be used in research involving CI users to analyze group data.
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Affiliation(s)
- Maartje M. E. Hendrikse
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Gertjan Dingemanse
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - André Goedegebure
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Haumann S, Timm ME, Büchner A, Lenarz T, Salcher RB. Intracochlear Recording of Electrocochleography During and After Cochlear Implant Insertion Dependent on the Location in the Cochlea. Trends Hear 2024; 28:23312165241248973. [PMID: 38717441 PMCID: PMC11080744 DOI: 10.1177/23312165241248973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 02/23/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
To preserve residual hearing during cochlear implant (CI) surgery it is desirable to use intraoperative monitoring of inner ear function (cochlear monitoring). A promising method is electrocochleography (ECochG). Within this project the relations between intracochlear ECochG recordings, position of the recording contact in the cochlea with respect to anatomy and frequency and preservation of residual hearing were investigated. The aim was to better understand the changes in ECochG signals and whether these are due to the electrode position in the cochlea or to trauma generated during insertion. During and after insertion of hearing preservation electrodes, intraoperative ECochG recordings were performed using the CI electrode (MED-EL). During insertion, the recordings were performed at discrete insertion steps on electrode contact 1. After insertion as well as postoperatively the recordings were performed at different electrode contacts. The electrode location in the cochlea during insertion was estimated by mathematical models using preoperative clinical imaging, the postoperative location was measured using postoperative clinical imaging. The recordings were analyzed from six adult CI recipients. In the four patients with good residual hearing in the low frequencies the signal amplitude rose with largest amplitudes being recorded closest to the generators of the stimulation frequency, while in both cases with severe pantonal hearing losses the amplitude initially rose and then dropped. This might be due to various reasons as discussed in the following. Our results indicate that this approach can provide valuable information for the interpretation of intracochlearly recorded ECochG signals.
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Affiliation(s)
- Sabine Haumann
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
| | - Max E. Timm
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
| | - Andreas Büchner
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
| | - Rolf B. Salcher
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
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Haumann S, Mynarek (née Bradler) M, Maier H, Helmstaedter V, Büchner A, Lenarz T, Teschner MJ. Does Intraoperative Extracochlear Electrocochleography Correlate With Postoperative Audiometric Hearing Thresholds in Cochlear Implant Surgery? A Retrospective Analysis of Cochlear Monitoring. Trends Hear 2024; 28:23312165241252240. [PMID: 38715410 PMCID: PMC11080760 DOI: 10.1177/23312165241252240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/12/2024] Open
Abstract
In recent years, tools for early detection of irreversible trauma to the basilar membrane during hearing preservation cochlear implant (CI) surgery were established in several clinics. A link with the degree of postoperative hearing preservation in patients was investigated, but patient populations were usually small. Therefore, this study's aim was to analyze data from intraoperative extracochlear electrocochleography (ECochG) recordings for a larger group.During hearing preservation CI surgery, extracochlear recordings were made before, during, and after CI electrode insertion using a cotton wick electrode placed at the promontory. Before and after insertion, amplitudes and stimulus response thresholds were recorded at 250, 500, and 1000 Hz. During insertion, response amplitudes were recorded at one frequency and one stimulus level. Data from 121 patient ears were analyzed.The key benefit of extracochlear recordings is that they can be performed before, during, and after CI electrode insertion. However, extracochlear ECochG threshold changes before and after CI insertion were relatively small and did not independently correlate well with hearing preservation, although at 250 Hz they added some significant information. Some tendencies-although no significant relationships-were detected between amplitude behavior and hearing preservation. Rising amplitudes seem favorable and falling amplitudes disadvantageous, but constant amplitudes do not appear to allow stringent predictions.Extracochlear ECochG measurements seem to only partially realize expected benefits. The questions now are: do gains justify the effort, and do other procedures or possible combinations lead to greater benefits for patients?
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Affiliation(s)
- Sabine Haumann
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
| | - Marlene Mynarek (née Bradler)
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
| | - Hannes Maier
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
| | - Victor Helmstaedter
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
| | - Andreas Büchner
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
| | - Magnus J. Teschner
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany
- Cluster of Excellence “Hearing4All”, Hannover, Germany
- Department of Otorhinolaryngology, Proselis Klinikum Recklinghausen, Recklinghausen, Germany
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Stronks HC, Tops AL, Hehrmann P, Briaire JJ, Frijns JHM. Personalizing Transient Noise Reduction Algorithm Settings for Cochlear Implant Users. Ear Hear 2021; 42:1602-1614. [PMID: 33974780 PMCID: PMC8542075 DOI: 10.1097/aud.0000000000001048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 02/14/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Speech understanding in noise is difficult for patients with a cochlear implant. One common and disruptive type of noise is transient noise. We have tested transient noise reduction (TNR) algorithms in cochlear implant users to investigate the merits of personalizing the noise reduction settings based on a subject's own preference. DESIGN The effect of personalizing two parameters of a broadband and a multiband TNR algorithm (TNRbb and TNRmb, respectively) on speech recognition was tested in a group of 15 unilaterally implanted subjects in cafeteria noise. The noise consisted of a combination of clattering dishes and babble noise. Each participant could individually vary two parameters, namely the scaling factor of the attenuation and the release time (τ). The parameter τ represents the duration of the attenuation applied after a transient is detected. As a reference, the current clinical standard TNR "SoundRelax" from Advanced Bionics was tested (TNRbb-std). Effectiveness of the algorithms on speech recognition was evaluated adaptively by determining the speech reception threshold (SRT). Possible subjective benefits of the algorithms were assessed using a rating task at a fixed signal-to-noise ratio (SNR) of SRT + 3 dB. Rating was performed on four items, namely speech intelligibility, speech naturalness, listening effort, and annoyance of the noise. Word correct scores were determined at these fixed speech levels as well. RESULTS The personalized TNRmb improved the SRT statistically significantly with 1.3 dB, while the personalized TNRbb degraded it significantly by 1.7 dB. For TNRmb, we attempted to further optimize its settings by determining a group-based setting, leaving out those subjects that did not experience a benefit from it. Using these group-based settings, however, TNRmb did not have a significant effect on the SRT any longer. TNRbb-std did not affect speech recognition significantly. No significant effects on subjective ratings were found for any of the items investigated. In addition, at a constant speech level of SRT + 3 dB, no effect of any of the algorithms was found on word correct scores, including TNRmb with personalized settings. CONCLUSIONS Our study results indicate that personalizing noise reduction settings of a multiband TNR algorithm can significantly improve speech intelligibility in transient noise, but only under challenging listening conditions around the SRT. At more favorable SNRs (SRT + 3 dB), this benefit was lost. We hypothesize that TNRmb was beneficial at lower SNRs, because of more effective artifact detection under those conditions. Group-averaged settings of the multiband algorithm did not significantly affect speech recognition. TNRbb decreased speech recognition significantly using personalized parameter settings. Rating scores were not significantly affected by the algorithms under any condition tested. The currently available TNR algorithm for Advanced Bionics systems (SoundRelax) is a broadband filter that does not support personalization of its settings. Future iterations of this algorithm might benefit from upgrading it to a multiband variant with the option to personalize its parameter settings.
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Affiliation(s)
- H. Christiaan Stronks
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annemijn L. Tops
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jeroen J. Briaire
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan H. M. Frijns
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
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11
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Gao X, Grayden D, McDonnell M. Unifying information theory and machine learning in a model of electrode discrimination in cochlear implants. PLoS One 2021; 16:e0257568. [PMID: 34543336 PMCID: PMC8451994 DOI: 10.1371/journal.pone.0257568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 09/06/2021] [Indexed: 12/02/2022] Open
Abstract
Despite the development and success of cochlear implants over several decades, wide inter-subject variability in speech perception is reported. This suggests that cochlear implant user-dependent factors limit speech perception at the individual level. Clinical studies have demonstrated the importance of the number, placement, and insertion depths of electrodes on speech recognition abilities. However, these do not account for all inter-subject variability and to what extent these factors affect speech recognition abilities has not been studied. In this paper, an information theoretic method and machine learning technique are unified in a model to investigate the extent to which key factors limit cochlear implant electrode discrimination. The framework uses a neural network classifier to predict which electrode is stimulated for a given simulated activation pattern of the auditory nerve, and mutual information is then estimated between the actual stimulated electrode and predicted ones. We also investigate how and to what extent the choices of parameters affect the performance of the model. The advantages of this framework include i) electrode discrimination ability is quantified using information theory, ii) it provides a flexible framework that may be used to investigate the key factors that limit the performance of cochlear implant users, and iii) it provides insights for future modeling studies of other types of neural prostheses.
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Affiliation(s)
- Xiao Gao
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia
- School of Physics, The University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - David Grayden
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia
| | - Mark McDonnell
- Computational Learning Systems Laboratory, School of Information Technology & Mathematical Sciences, University of South Australia, Mawson Lakes, SA, Australia
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12
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Gärtner L, Lenarz T, Büchner A. Measurements of the local evoked potential from the cochlear nucleus in patients with an auditory brainstem implant and its implication to auditory perception and audio processor programming. PLoS One 2021; 16:e0249535. [PMID: 33793674 PMCID: PMC8016231 DOI: 10.1371/journal.pone.0249535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/22/2021] [Indexed: 11/18/2022] Open
Abstract
The measurement of the electrically evoked compound action potential (ECAP) in cochlear implant (CI) patients is widely used to provide evidence of a functioning electrode-nerve interface, to confirm proper location of the electrode array and to program the sound processor. In patients with an auditory brainstem implant (ABI), a likewise versatile measurement would be desirable. The ECAP measurement paradigm “Alternating Polarity” was utilized to record responses via the implanted ABI electrode array placed on the cochlear nucleus. Emphasizing on the different location of stimulation and recording, these responses are called local evoked potentials (LEP). LEP measurements were conducted during the clinical routine in 16 ABI patients (12 children and 4 adults), corresponding to 191 electrode contacts. A retrospective analysis of these data revealed, that LEP responses were observed in 64.9% of all measured electrode contacts. LEP responses predicted auditory perception with a sensitivity of 90.5%. False-positive rate was 33.7%. Objective LEP thresholds were highly significantly (p < 0.001) correlated both to behavioral thresholds (Pearson’s r = 0.697) and behavioral most comfortable levels (r = 0.840). Therefore, LEP measurements have the potential to support fitting in ABI patients.
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Affiliation(s)
- Lutz Gärtner
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- * E-mail:
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Andreas Büchner
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
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13
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Abstract
INTRODUCTION Using the United States Food and Drug Administration (FDA) as example, we argue that regulatory agencies worldwide should review their guidance on cochlear implants (CIs). METHODS This is a position paper, thus the methods are strictly argumentation. Here we give the motivation for our recommendation. The FDA's original approval of implantation in prelingually deaf children was granted without full benefit of information on language acquisition, on childcaregiver communication, and on the lived experience of being deaf. The CI clinical trials, accordingly, did not address risks of linguistic deprivation, especially when the caregiver's communication is not fully accessible to the prelingually deaf child. Wide variability in the effectiveness of CIs since initial and updated approval has been indicated but has not led to new guidance. Children need to be exposed frequently and regularly to accessible natural language while their brains are still plastic enough to become fluent in any language. For the youngest infants, who are not yet producing anything that could be called language although they might be producing salient social signals (Goldstein et al. Child Dev 80:636-644, 2009), good comprehension of communication from caregiver to infant is critical to the development of language. Sign languages are accessible natural languages that, because they are visual, allow full immersion for deaf infants, and they supply the necessary support for this comprehension. The main language contributor to health outcomes is this combination of natural visual language and comprehension in communication. Accordingly, in order to prevent possible language deprivation, all prelingually deaf children should be exposed to both sign and spoken languages when their auditory status is detected, with sign language being critical during infancy and early childhood. Additionally, all caregivers should be given support to learn a sign language if it is new to them so that they can comprehend their deaf children's language expressions fully. However, both languages should be made accessible in their own right, not combined in a simultaneous or total communication approach since speaking one language and signing the other at the same time is problematic. RESULTS Again, because this is a position paper, our results are our recommendations. We call for the FDA (and similar agencies in other countries) to review its approval of cochlear implantation in prelingually deaf children who are within the sensitive period for language acquisition. In the meantime, the FDA should require manufacturers to add a highlighted warning to the effect that results with CI vary widely and CIs should not be relied upon to provide adequate auditory input for complete language development in all deaf children. Recent best information on users' experience with CIs (including abandonment) should be clearly provided so that informed decisions can be made. The FDA should require manufacturers' guidance and information materials to include encouragement to parents of deaf children to offer auditory input of a spoken language and visual input of a sign language and to have their child followed closely from birth by developmental specialists in language and cognition. In this way parents can align with providers to prioritize cognitive development and language access in both audio-vocal and visuo-gestural modalities. DISCUSSION The arguments and recommendations in this paper are discussed at length as they come up.
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Affiliation(s)
- Tom Humphries
- Education Studies and Department of Communication, University of California at San Diego, La Jolla, CA, USA
| | | | - Gaurav Mathur
- Department of Linguistics, Gallaudet University, Washington, DC, USA
| | - Donna Jo Napoli
- Department of Linguistics, Swarthmore College, Swarthmore, PA, USA.
| | - Christian Rathmann
- Department of Deaf Studies and Sign Language Interpreting, Humboldt-Universität Zu Berlin, Berlin, Germany
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Ghayedlou L, Ahmadi A, Ghorbani A, Torabinezhad F, Keyhani MR, Hashemi SB. Vowel duration measurement in school-age children with cochlear implant. Int J Pediatr Otorhinolaryngol 2020; 136:110142. [PMID: 32544641 DOI: 10.1016/j.ijporl.2020.110142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/23/2020] [Accepted: 05/23/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Normal hearing system is an essential factor for accurate production of speech segments. It seems that cochlear implant prosthesis helps children with hearing impairment to speak more accurately than before receiving prosthesis. The current research aimed to compare the vowel duration in school-aged children with cochlear implants and that in children with normal hearing. Additionally, the performance of girls and boys in two groups were investigated. METHODS A cross-sectional and descriptive-analytical study was carried out to compare the vowel duration in 9- to 12-year-old children with cochlear implant and those with normal hearing. Participants were 52 children who were matched by age and sex. We asked the children to read the target words with each word including one vowel and then participants' voice samples were recorded. Then, vowel duration was measured using Praat software. Finally, the vowel duration was compared between the two groups running independent sample t-test. The level of significance was (P < 0.05). RESULTS There was no statistically significant difference observed between the two groups in the mean values of the vowel duration for the six Persian vowels (P > 0.05). Also, no significant difference was found between boys and girls in the mean value of the vowel duration between the two groups (P > 0.05). CONCLUSION Persian vowels in school-aged children with cochlear implant and with typical hearing are produced with similar durations. This finding is probably related to the increased duration of using prosthesis in this age range and speech mode used to measure vowel duration in the present study.
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Affiliation(s)
- Leila Ghayedlou
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Ahmadi
- Department of Speech Therapy, School of Rehabilitation, Babol University of Medical Sciences, Babol, I.R, Iran.
| | - Ali Ghorbani
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Farhad Torabinezhad
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Keyhani
- Department of Basic Rehabilitation Sciences, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Basir Hashemi
- Department of Otolaryngology, Shiraz University of Medical Sciences, Khalili St., Khalili Hospital, Shiraz, Iran
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15
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Rau TS, Zuniga MG, Salcher R, Lenarz T. A simple tool to automate the insertion process in cochlear implant surgery. Int J Comput Assist Radiol Surg 2020; 15:1931-1939. [PMID: 32857248 PMCID: PMC7603473 DOI: 10.1007/s11548-020-02243-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 08/03/2020] [Indexed: 12/28/2022]
Abstract
Purpose Automated insertion of electrode arrays (EA) in cochlear implant surgery is presumed to be less traumatic than manual insertions, but no tool is widely available in the operating room. We sought (1) to design and create a simple tool able to automate the EA insertion process; and (2) to perform preliminary evaluations of the designed prototype. Methods A first prototype of a tool with maximum simplicity was designed and fabricated to take advantage of hydraulic actuation. The prototype facilitates automated forward motion using a syringe connected to an infusion pump. Initial prototype evaluation included: (1) testing of forward motion at different velocities (2) EA insertion trials into an artificial cochlear model with force recordings, and (3) evaluation of device handling, fixation and positioning using cadaver head specimens and a surgical retractor. Alignment of the tool was explored with CT imaging. Results In this initial phase, the prototype demonstrated easy assembly and ability to respond to hydraulic actuation driven by an infusion pump at different velocities. EA insertions at an ultra-slow velocity of 0.03 mm/s revealed smooth force profiles with mean maximum force of 0.060 N ± 0.007 N. Device positioning with an appropriate insertion axis into the cochlea was deemed feasible and easy to achieve. Conclusions Initial testing of our hydraulic insertion tool did not reveal any serious complications that contradict the initially defined design specifications. Further meticulous testing is needed to determine the safety of the device, its reliability and clinical applicability.
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Affiliation(s)
- Thomas S Rau
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany.
| | - M Geraldine Zuniga
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany
| | - Rolf Salcher
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany
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16
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Zhou N, Zhu Z, Dong L, Galvin JJ. Effect of pulse phase duration on forward masking and spread of excitation in cochlear implant listeners. PLoS One 2020; 15:e0236179. [PMID: 32687516 PMCID: PMC7371170 DOI: 10.1371/journal.pone.0236179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/30/2020] [Indexed: 11/18/2022] Open
Abstract
Previous cochlear implant (CI) research has shown that at a pulse train with a long pulse phase duration (PPD) requires less current but greater charge to obtain the same loudness as a pulse train with a short PPD. This might result in different excitation patterns between long and short PPDs. At equal loudness, long PPDs might produce greater masking due to greater charge. However, because they require less current, long PPDs may produce a smaller spatial spread of excitation (SOE) compared to short PPDs by evoking a greater neural firing probability within the relatively small current field. To investigate the effects of PPD on excitation patterns, overall masking and SOE were compared for equally loud stimuli with short or long PPD in 10 adult CI ears. Forward masking patterns were measured at relatively soft, medium, and loud presentation levels. Threshold shifts were calculated in terms of percent dynamic range (DR) of the probe. The area under the curve (AUC) of the masking functions was significantly larger for the long PPD than for the short PPD masker. The difference in AUC was proportional to the difference in charge between the short and long PPD maskers. To estimate SOE, the masking patterns were first normalized to the peak masking, and then AUC was calculated. SOE was significantly larger for the short PPD than for the long PPD masker. Thus, at equal loudness, long PPDs produced greater overall masking (possibly due to greater charge) but less SOE (possibly due to less current spread) than did short PPDs. The effect of the interaction between masking and SOE by long PPD stimulation remains to be tested.
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Affiliation(s)
- Ning Zhou
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, North Carolina, United States of America
| | - Zhen Zhu
- Department of Engineering, East Carolina University, Greenville, North Carolina, United States of America
| | - Lixue Dong
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, North Carolina, United States of America
| | - John J. Galvin
- House Ear Institute, Los Angeles, California, United States of America
- * E-mail:
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17
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Buechner A, Krueger B, Klawitter S, Zimmermann D, Fredelake S, Holube I. The perception of the stereo effect in bilateral and bimodal cochlear implant users and its contribution to music enjoyment. PLoS One 2020; 15:e0235435. [PMID: 32628690 PMCID: PMC7337296 DOI: 10.1371/journal.pone.0235435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/15/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives In this clinical study, stereo perception of music samples and its contribution to music enjoyment in CI users is investigated. It is studied in free field as well as direct audio presentation. Methods 20 bilateral and 9 bimodal CI users performed stereo detection tests and music enjoyment ratings. Music was presented either in mono or in stereo in free field or with direct audio presentation. Stereo detection was assessed with a 3-AFC paradigm. Music enjoyment was studied with scale ratings. Results For bilateral CI users, stereo detection increased from 52% correct in free field to 86% with direct audio presentation. Increased music enjoyment with improved stereo detection was obtained. Bimodal CI users could not identify stereo sounds. Music enjoyment did not increase for stereo presentations in bimodal subjects. Discussion For bilateral CI users, improved stereo detection might increase music enjoyment with direct audio presentation, which is likely due to bypassing the room acoustics. In bimodal CI users, no clear improvement was found, which is likely attributed due to the different hearing losses and therefore individually different interaural frequency overlaps between the hearing aid and the cochlear implant. Conclusion Direct audio presentation is an efficient method to improve music enjoyment in bilateral CI users.
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Affiliation(s)
- Andreas Buechner
- Medical University of Hanover, Hanover, Germany
- Cluster of Excellence Hearing4all, Germany
- * E-mail:
| | | | | | | | - Stefan Fredelake
- Advanced Bionics GmbH, European Research Center, Hanover, Germany
| | - Inga Holube
- Cluster of Excellence Hearing4all, Germany
- Institute of Hearing Technology and Audiology, Jade University of Applied Sciences, Oldenburg, Germany
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18
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Abstract
The cochlear implant (CI) is the most widely used neuroprosthesis, recovering hearing for more than half a million severely-to-profoundly hearing-impaired people. However, CIs still have significant limitations, with users having severely impaired pitch perception. Pitch is critical to speech understanding (particularly in noise), to separating different sounds in complex acoustic environments, and to music enjoyment. In recent decades, researchers have attempted to overcome shortcomings in CIs by improving implant technology and surgical techniques, but with limited success. In the current study, we take a new approach of providing missing pitch information through haptic stimulation on the forearm, using our new mosaicOne_B device. The mosaicOne_B extracts pitch information in real-time and presents it via 12 motors that are arranged in ascending pitch along the forearm, with each motor representing a different pitch. In normal-hearing subjects listening to CI simulated audio, we showed that participants were able to discriminate pitch differences at a similar performance level to that achieved by normal-hearing listeners. Furthermore, the device was shown to be highly robust to background noise. This enhanced pitch discrimination has the potential to significantly improve music perception, speech recognition, and speech prosody perception in CI users.
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Affiliation(s)
- Mark D Fletcher
- University of Southampton Auditory Implant Service, University of Southampton, University Road, Southampton, SO17 1BJ, United Kingdom.
| | - Nour Thini
- Faculty of Engineering and Physical Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, United Kingdom
| | - Samuel W Perry
- University of Southampton Auditory Implant Service, University of Southampton, University Road, Southampton, SO17 1BJ, United Kingdom
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19
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Lamping W, Goehring T, Marozeau J, Carlyon RP. The effect of a coding strategy that removes temporally masked pulses on speech perception by cochlear implant users. Hear Res 2020; 391:107969. [PMID: 32320925 PMCID: PMC7116331 DOI: 10.1016/j.heares.2020.107969] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/26/2020] [Accepted: 04/05/2020] [Indexed: 01/11/2023]
Abstract
Speech recognition in noisy environments remains a challenge for cochlear implant (CI) recipients. Unwanted charge interactions between current pulses, both within and between electrode channels, are likely to impair performance. Here we investigate the effect of reducing the number of current pulses on speech perception. This was achieved by implementing a psychoacoustic temporal-masking model where current pulses in each channel were passed through a temporal integrator to identify and remove pulses that were less likely to be perceived by the recipient. The decision criterion of the temporal integrator was varied to control the percentage of pulses removed in each condition. In experiment 1, speech in quiet was processed with a standard Continuous Interleaved Sampling (CIS) strategy and with 25, 50 and 75% of pulses removed. In experiment 2, performance was measured for speech in noise with the CIS reference and with 50 and 75% of pulses removed. Speech intelligibility in quiet revealed no significant difference between reference and test conditions. For speech in noise, results showed a significant improvement of 2.4 dB when removing 50% of pulses and performance was not significantly different between the reference and when 75% of pulses were removed. Further, by reducing the overall amount of current pulses by 25, 50, and 75% but accounting for the increase in charge necessary to compensate for the decrease in loudness, estimated average power savings of 21.15, 40.95, and 63.45%, respectively, could be possible for this set of listeners. In conclusion, removing temporally masked pulses may improve speech perception in noise and result in substantial power savings.
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Affiliation(s)
- Wiebke Lamping
- Hearing Systems Section, Department of Health Technology, Technical University of Denmark, DK-2800, Kgs. Lyngby, Denmark; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, United Kingdom.
| | - Tobias Goehring
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, United Kingdom
| | - Jeremy Marozeau
- Hearing Systems Section, Department of Health Technology, Technical University of Denmark, DK-2800, Kgs. Lyngby, Denmark
| | - Robert P Carlyon
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, United Kingdom
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Abstract
OBJECTIVES To compare the clinical efficiency of the CR220 intraoperative remote assistant device used by the surgical team with that of the custom sound (CS) system used by an audiologist. METHODS This was a prospective clinical study in a quaternary care center (King Abdullah Ear Specialist Centre) in Riyadh, Saudi Arabia, between October 2018 and March 2019. We included adult and pediatric patients who underwent cochlear implant (CI) surgeries. For every participant, the intraoperative CI testing was performed via both the aforementioned methods. The time taken to complete the measurements with both approaches, including the time required by the audiologist to reach the operating room (OR) and to complete the test, was recorded. RESULTS There were no significant differences in the number of responding electrodes between the 2 approaches. For the 25 participants, the time taken for the measurements was 566 minutes with the CS and 173 with the CR220 systems. This significant difference indicates that considerable time can be saved. CONCLUSION The CR220 enables intraoperative CI electrode tests and auto-NRT measurements. Its ergonomics and ease-of-use help the surgical team conduct the tests without an audiologist in the OR, resulting in the efficient use of clinical resources. Further, the results generated were consistent with those of the CS system.
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Affiliation(s)
- Eman A Hajr
- Otolaryngology Department, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Francis-Auton E, Warren C, Braithwaite J, Rapport F. Exploring the recruitment, ethical considerations, conduct and information dissemination of an audiology trial: a pretrial qualitative study (q-COACH). Trials 2020; 21:28. [PMID: 31907073 PMCID: PMC6945488 DOI: 10.1186/s13063-019-3968-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/06/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Randomised controlled trials (RCTs), while still considered the gold standard approach in medical research, can encounter impediments to their successful conduct and the dissemination of results. Pretrial qualitative research can usefully address some of these impediments, including recruitment and retention, ethical conduct, and preferred methods of dissemination. However, pretrial qualitative work is rarely undertaken in audiology. The Comparison of outcomes with hearing aids and cochlear implants in adults with moderately severe-to-profound bilateral sensorineural hearing loss (COACH) is a proposed RCT aiming to clarify when hearing aids (HAs) or cochlear implants (CIs) are the most suitable for different degrees of hearing loss and for which kinds of patients. q-COACH is a pretrial, qualitative study examining stakeholders' experiences of HAs and CIs, current clinical practices and stakeholders' perspectives of the design, conduct and dissemination plans for the proposed COACH study. METHODS Twenty-four participants including general practitioners, audiologists, adult HA users, and adult support networks undertook either semi-structured individual or paired interviews and completed demographic questionnaires. Data were analysed thematically. RESULTS Four key themes arose from this study: 1) rethinking sampling and recruitment strategies, 2) ethical considerations, 3) refining trial conduct, and 4) interconnected, appropriate and accessible methods of results dissemination. CONCLUSIONS This qualitative investigation identified key considerations for the proposed RCT design, conduct and dissemination to help with successful implementation of COACH, and to indicate a plan of action at all RCT stages that would be acceptable to potential participants. By drawing on the perspectives of multiple key stakeholders and including a more general discussion of their experience and opinions of hearing loss, hearing device use and service availability, the study revealed experiential and ethical paradigms in which stakeholders operate. In so doing, q-COACH has exposed the benefits of preliminary qualitative investigations that enable detailed and rich understandings of the phenomenon at stake, forestalling problems and improving the quality of trial design, conduct and dissemination, while informing future RCT development discussions.
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Affiliation(s)
- Emilie Francis-Auton
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW 2109 Australia
| | - Chris Warren
- Cochlear Ltd, 1 University Ave, Macquarie Park, NSW 2113 Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW 2109 Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW 2109 Australia
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Stultiens JJA, Postma AA, Guinand N, Pérez Fornos A, Kingma H, van de Berg R. Vestibular Implantation and the Feasibility of Fluoroscopy-Guided Electrode Insertion. Otolaryngol Clin North Am 2019; 53:115-126. [PMID: 31677739 DOI: 10.1016/j.otc.2019.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Recent research has shown promising results for the development of a clinically feasible vestibular implant in the near future. However, correct electrode placement remains a challenge. It was shown that fluoroscopy was able to visualize the semicircular canal ampullae and electrodes, and guide electrode insertion in real time. Ninety-four percent of the 18 electrodes were implanted correctly (<1.5 mm distance to target). The median distances were 0.60 mm, 0.85 mm, and 0.65 mm for the superior, lateral, and posterior semicircular canal, respectively. These findings suggest that fluoroscopy can significantly improve electrode placement during vestibular implantation.
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Affiliation(s)
- Joost Johannes Antonius Stultiens
- Department of Otorhinolaryngology-Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alida Annechien Postma
- Department of Radiology and Nuclear Medicine, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nils Guinand
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Hermanus Kingma
- Department of Otorhinolaryngology-Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Raymond van de Berg
- Department of Otorhinolaryngology-Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands.
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Wijetillake AA, van Hoesel RJM, Cowan R. Sequential stream segregation with bilateral cochlear implants. Hear Res 2019; 383:107812. [PMID: 31630083 DOI: 10.1016/j.heares.2019.107812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 11/18/2022]
Abstract
Sequential stream segregation on the basis of binaural 'ear-of-entry', modulation rate and electrode place-of-stimulation cues was investigated in bilateral cochlear implant (CI) listeners using a rhythm anisochrony detection task. Sequences of alternating 'A' and 'B' bursts were presented via direct electrical stimulation and comprised either an isochronous timing structure or an anisochronous structure that was generated by delaying just the 'B' bursts. 'B' delay thresholds that enabled rhythm anisochrony detection were determined. Higher thresholds were assumed to indicate a greater likelihood of stream segregation, resulting specifically from stream integration breakdown. Results averaged across subjects showed that thresholds were significantly higher when monaural 'A' and 'B' bursts were presented contralaterally rather than ipsilaterally, and that diotic presentation of 'A', with a monaural 'B', yielded intermediate thresholds. When presented monaurally and ipsilaterally, higher thresholds were also found when successive bursts had mismatched rather than matched modulation rates. In agreement with previous studies, average delay thresholds also increased as electrode separation between bursts increased when presented ipsilaterally. No interactions were found between ear-of-entry, modulation rate and place-of-stimulation. However, combining moderate electrode difference cues with either diotic-'A' ear-of-entry cues or modulation-rate mismatch cues did yield greater threshold increases than observed with any of those cues alone. The results from the present study indicate that sequential stream segregation can be elicited in bilateral CI users by differences in the signal across ears (binaural cues), in modulation rate (monaural cues) and in place-of-stimulation (monaural cues), and that those differences can be combined to further increase segregation.
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Affiliation(s)
| | | | - Robert Cowan
- The Hearing CRC, 550 Swanston St, Carlton, 3053, Victoria, Australia.
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Hong T, Wang J, Zhang L, Zhang Y, Shu H, Li P. Age-sensitive associations of segmental and suprasegmental perception with sentence-level language skills in Mandarin-speaking children with cochlear implants. Res Dev Disabil 2019; 93:103453. [PMID: 31421305 DOI: 10.1016/j.ridd.2019.103453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/22/2019] [Accepted: 07/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND AIM It remains unclear how recognition of segmental and suprasegmental phonemes contributes to sentence-level language processing skills in Mandarin-speaking children with cochlear implants (CIs). Our study examined the influence of implantation age on the recognition of consonants, lexical tones and sentences respectively, and more importantly, the contribution of phonological skills to sentence repetition accuracy in Mandarin-speaking children with CIs. METHODS The participants were three groups of prelingually deaf children who received cochlear implants at various ages and their age-matched controls with normal hearing. Three tasks were administered to assess their consonant perception, lexical tone recognition and language skills in open-set sentence repetition. RESULTS Children with CIs lagged behind NH peers in all the three tests, and performances on segmental, suprasegmental and sentence-level processing were differentially modulated by implantation age. Furthermore, performances on recognition of consonants and lexical tones were significant predictors of sentence repetition accuracy in the children with CIs. CONCLUSION Overall, segmental and suprasegmental perception as well as sentence-level processing is impaired in Mandarin-speaking children with CIs compared with age-matched children with NH. In children with CIs recognition of segmental and suprasegmental phonemes at the lower level predicts sentence repetition accuracy at the higher level. More importantly, implantation age plays an important role in the development of phonological skills and higher-order language skills, suggesting that age-appropriate aural rehabilitation and speech intervention programs need to be developed in order to better help CI users who receive CIs at different ages.
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Affiliation(s)
- Tian Hong
- National Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Jiuju Wang
- Peking University Sixth Hospital, Beijing, China
| | - Linjun Zhang
- Beijing Advanced Innovation Center for Language Resources and College of Advanced Chinese Training, Beijing Language and Culture University, No.15 Xueyuan Road, Beijing 100083, China.
| | - Yang Zhang
- Department of Speech-Language-Hearing Sciences and Center for Neurobehavioral Development, University of Minnesota, Minneapolis, MN, USA
| | - Hua Shu
- National Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China.
| | - Ping Li
- Department of Psychology & Center for Brain, Behavior and Cognition, Pennsylvania State University, PA, USA
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Weiss NM, Dhanasingh A, Schraven SP, Schulze M, Langner S, Mlynski R. Surgical approach for complete cochlear coverage in EAS-patients after residual hearing loss. PLoS One 2019; 14:e0223121. [PMID: 31557251 PMCID: PMC6762079 DOI: 10.1371/journal.pone.0223121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/14/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction In cases with residual-hearing (RH) loss after cochlear implantation, a safe method is needed to provide full spectral resolution and as much auditory information as possible without implant replacement. Aim of this study was to prove the feasibility of accessing a partially inserted cochlear-implant-electrode for complete insertion to its maximum length through the external ear canal using a transcanal approach. Methods Two CI electrodes were customized with 18 stimulating channels. The electrode design enables the use of 12 active channels available for electrical stimulation inside the cochlea both after partial and full insertion. 10 CI electrodes were implanted in 10 fresh human cadaveric temporal bones. After initial partial insertion by posterior tympanotomy, the electrode was inserted to its maximum length via a transcanal approach. Radiographs and CT scans were performed to confirm the electrode position. The electrodes were investigated via x-ray after removal. Results X-ray and CT-scans confirmed the electrode prototypes covering an angular insertion depth between 236° to 307° after initial insertion. Accessing the electrode in the middle ear space was feasible and insertion to its full length was successful. Post-insertion CT confirmed insertion of the 28mm and 31.5mm electrode arrays covering an angular insertion depth between 360° and 540° respectively. No tip foldovers were detected. Conclusion This study confirms the feasibility of extending the electrode insertion to its maximum insertion length using a transcanal approach in temporal bone specimens. This constitutes a second stage procedure on demand in EAS-surgery. This may be beneficial for EAS-patients providing electrical stimulation beyond the basal turn of the cochlea once the functional residual hearing is lost, without replacing the entire CI.
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Affiliation(s)
- Nora M. Weiss
- Dept. of Otorhinolaryngology, Head and Neck Surgery,”Otto Koerner”Rostock University Medical Center, Rostock, Germany
- * E-mail:
| | | | - Sebastian P. Schraven
- Dept. of Otorhinolaryngology, Head and Neck Surgery,”Otto Koerner”Rostock University Medical Center, Rostock, Germany
| | - Marko Schulze
- Rostock University Medical Center, Institute of Anatomy Gertrudenstraße, Rostock, Germany
| | - Soenke Langner
- Institute of Diagnostic and Interventional Radiology, Pediatric and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Robert Mlynski
- Dept. of Otorhinolaryngology, Head and Neck Surgery,”Otto Koerner”Rostock University Medical Center, Rostock, Germany
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Lin DPY, Chen JKC, Tung TH, Li LPH. Differences in the impedance of cochlear implant devices within 24 hours of their implantation. PLoS One 2019; 14:e0222711. [PMID: 31536550 PMCID: PMC6752796 DOI: 10.1371/journal.pone.0222711] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/05/2019] [Indexed: 11/26/2022] Open
Abstract
Cochlear implantation is a surgical procedure, which is performed on severely hearing-impaired patients. Impedance field telemetry is commonly used to determine the integrity of the cochlear implant device during and after surgery. At the Department of Otolaryngology, Cheng Hsin General Hospital (Taipei, Taiwan), the cochlear implant devices are switched on within 24 hours of their implantation. In the present study, the impedance changes of Advanced Bionics™ cochlear implant devices were compared with previous studies and other devices. The aim was to confirm previous hypotheses and to explore other potential associated factors that could influence impedance following cochlear implantation. The current study included 12 patients who underwent cochlear implantation at Cheng Hsin General Hospital with Advanced Bionics cochlear implant devices. The cochlear devices were all switched on within 24 hours of their implantation. The impedance was measured and compared across all contact channels of the electrode, both intra-operatively and post-operatively. The intra-operative impedance was compared with the switch-on impedance (within 24 hours of the cochlear implantation); the impedance was notably increased for all contact channels at switch-on. Of the 16 channels examined, 4 channels had a significant increase in impedance between the intra-operative measurement and the switch-on measurement. To the best of our knowledge, the impedance of a cochlear implant device can be affected by the diameter of the electrode, the position of the electrode arrays in the scala tympani, sheath formation and fibrosis surrounding the electrode after implantation and electrical stimulation during or after surgery. When the results of the current study were compared with previous studies, it was found that the impedance changes were opposite to that of Cochlear™ implant devices. This may be explained by the position of the electrode arrays, sheath formation, the blow-out effect and differences in electrical stimulation.
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Affiliation(s)
- David Po-Yi Lin
- Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | | | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Lieber Po-Hung Li
- Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Qian XH, Wu YC, Yang TY, Cheng CH, Chu HC, Cheng WH, Yen TY, Lin TH, Lin YJ, Lee YC, Chang JH, Lin ST, Li SH, Wu TC, Huang CC, Wang SH, Lee CF, Yang CH, Hung CC, Chi TS, Liu CH, Ker MD, Wu CY. Design and In Vivo Verification of a CMOS Bone-Guided Cochlear Implant Microsystem. IEEE Trans Biomed Eng 2019; 66:3156-3167. [PMID: 30802846 DOI: 10.1109/tbme.2019.2901374] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To develop and verify a CMOS bone-guided cochlear implant (BGCI) microsystem with electrodes placed on the bone surface of the cochlea and the outside of round window for treating high-frequency hearing loss. METHODS The BGCI microsystem consists of an external unit and an implanted unit. The external system-on-chip is designed to process acoustic signals through an acquisition circuit and an acoustic DSP processor to generate stimulation patterns and commands that are transmitted to the implanted unit through a 13.56 MHz wireless power and bidirectional data telemetry. In the wireless power telemetry, a voltage doubler/tripler (2X/3X) active rectifier is used to enhance the power conversion efficiency and generate 2 and 3 V output voltages. In the wireless data telemetry, phase-locked loop based binary phase-shift keying and load-shift keying modulators/demodulators are adopted for the downlink and uplink data through high-Q coils, respectively. The implanted chip with four-channel high-voltage-tolerant stimulator generates biphasic stimulation currents up to 800 μA. RESULTS Electrical tests on the fabricated BGCI microsystem have been performed to verify the chip functions. The in vivo animal tests in guinea pigs have shown the evoked third wave of electrically evoked auditory brainstem response waveforms. It is verified that auditory nerves can be successfully stimulated and acoustic hearing can be partially preserved. CONCLUSION AND SIGNIFICANCE Different from traditional cochlear implants, the proposed BGCI microsystem is less invasive, preserves partially acoustic hearing, and provides an effective alternative for treating high-frequency hearing loss.
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Xu Y, Luo C, Zeng FG, Middlebrooks JC, Lin HW, You Z. Design, Fabrication, and Evaluation of a Parylene Thin-Film Electrode Array for Cochlear Implants. IEEE Trans Biomed Eng 2019; 66:573-583. [PMID: 30004866 PMCID: PMC6328340 DOI: 10.1109/tbme.2018.2850753] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To improve the existing manually assembled cochlear implant electrode arrays, a thin-film electrode array (TFEA) was microfabricated having a maximum electrode density of 15 sites along an 8-mm length, with each site having a 75 μm × 1.8 μm (diameter × height) disk electrode. METHODS The microfabrication method adopted photoresist transferring, lift-off, two-step oxygen plasma etching, and fuming nitric acid release to reduce lift-off complexity, protect the metal layer, and increase the release efficiency. RESULTS Systematic in vitro characterization showed that the TFEA's bending stiffness was 6.40 × 10-10 N·m2 near the base and 1.26 × 10-10 N·m2 near the apex. The TFEA electrode produced an average impedance of 16 kΩ and a maximum current limit of 800 μA, measured with 1-kHz sinusoidal current using monopolar stimulation in saline. A TFEA prototype was implanted in a cat cochlea to obtain in vivo measurements of electrically evoked auditory brainstem and inferior colliculus responses to monopolar stimulation with 41-μs/phase biphasic pulses. Both physiological responses produced a threshold of ∼300 μA and a dynamic range of 5-8 dB above the threshold. Compared with existing arrays, the present TFEA had 104 times less bending stiffness, 97% less electrode area, and comparable physiological thresholds. CONCLUSION Using a simplified structure and stable fabrication method, the present TEFA produced physical and physiological performance comparable to existing commercial devices. SIGNIFICANCE The present TFEA represents a step closer toward an automated process replacing the labor-intensive and expensive manual assembly of the cochlear implant electrode arrays.
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Tejani VD, Abbas PJ, Brown CJ, Woo J. An improved method of obtaining electrocochleography recordings from Nucleus Hybrid cochlear implant users. Hear Res 2019; 373:113-120. [PMID: 30665078 DOI: 10.1016/j.heares.2019.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/26/2018] [Accepted: 01/04/2019] [Indexed: 11/16/2022]
Abstract
Interest in electrocochleography (ECoG) has recently resurged as a potential tool to assess peripheral auditory function in cochlear implant (CI) users. ECoG recordings can be evoked using acoustic stimulation and recorded from an extra- or intra-cochlear electrode in CI users. Recordings reflect contributions from cochlear hair cells and the auditory nerve. We recently demonstrated the feasibility of using Custom Sound EP (clinically available software) to record ECoG responses in Nucleus Hybrid CI users with preserved acoustic hearing in the implanted ear (Abbas et al, 2017). While successful, the recording procedures were time intensive, limiting clinical applications. The current report describes how we improved data collection efficiency by writing custom software using Python programming language. The software interfaced with Nucleus Implant Communicator (NIC) routines to record responses from an intracochlear electrode. ECoG responses were recorded in eight CI users with preserved acoustic hearing using Custom Sound EP and the Python-based software. Responses were similar across both recording systems, but the recording time decreased significantly using the Python-based software. Seven additional CI users underwent repeated testing using the Python-based software and showed high test-retest reliability. The improved efficiency and high reliability increases the likelihood of translating intracochlear ECoG to clinical practice.
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Affiliation(s)
- Viral D Tejani
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA; Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Paul J Abbas
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA; Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Carolyn J Brown
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA; Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jihwan Woo
- Department of Biomedical Engineering, University of Ulsan, Ulsan, Republic of Korea.
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Sabri M, Fabiano-Smith L. Phonological Development in a Bilingual Arabic-English-Speaking Child With Bilateral Cochlear Implants: A Longitudinal Case Study. Am J Speech Lang Pathol 2018; 27:1506-1522. [PMID: 30326047 DOI: 10.1044/2018_ajslp-17-0162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE This longitudinal study examined the phonological development of a bilingual Arabic-English-speaking child with bilateral cochlear implants (CIs). The focus of the study was to observe the interaction between her two languages and to observe the effect of CIs on the acquisition of two speech sound systems. METHOD This study followed a 3;6-year-old (2;5 hearing age) bilingual Arabic-English-speaking child with bilateral CIs to age 4;4 (3;2 hearing age). Single-word samples were collected bimonthly in both languages. Phon software (Rose et al., 2006) was used to transcribe and analyze speech samples. Measures derived included Percent Consonants Correct-Revised (Shriberg & Kwiatkowski, 1994), percent vowels correct, phonetic inventory complexity, and common phonological patterns for both English and Arabic. RESULTS Our findings supported previous research on phonological development exhibited by children with CIs, with the gradual suppression of typical and atypical error patterns and gradual increase in segmental accuracy with maturation. In addition, language interaction and separation between English and Arabic were found, supporting previous cross-linguistic work on bilingual phonological acquisition (e.g., Fabiano-Smith & Goldstein, 2010b). CONCLUSION Bilingual children with CIs have the capability to learn both of their languages and perform similarly to, and even surpass in accuracy, monolingual children with CIs; however, it is also possible to exhibit a slower rate of acquisition of segmental accuracy as compared to their typically developing, hearing peers. Clinical implications of bilingual early intervention are discussed.
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Abbs E, Aronoff JM, Kirchner A, O'Brien E, Harmon B. Cochlear Implant Users' Vocal Control CorrelatesAcross Tasks. J Voice 2018; 34:490.e7-490.e10. [PMID: 30447798 DOI: 10.1016/j.jvoice.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 11/17/2022]
Abstract
Cochlear implants (CIs) provide access to auditory information that can affect vocal control. For example, previous research shows that, when producing a sustained vowel, CI users will alter the pitch of their voice when the feedback of their own voice is perceived to shift. Although these results can be informative as to how perception and production are linked for CI users, the artificial nature of the task raises questions as to the applicability of the results to real-world vocal productions. To examine how vocal control, when producing sustained vowels, relates to vocal control for more ecologically valid tasks, 10 CI users' vocal control was measured across two tasks: (1) sustained vowel production, and (2) singing. The results found that vocal control, as measured by the variability of the participants' fundamental frequency, was significantly correlated when producing sustained vowels and when singing, although variability was significantly greater when singing. This suggests that, despite the artificial nature of sustained vowel production, vocal control on such tasks is related to vocal control for more ecologically valid tasks. However, the results also suggest that vocal control may be overestimated with sustained vowel production tasks.
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Affiliation(s)
- Elizabeth Abbs
- University of Illinois at Urbana-Champaign, Department of Speech and Hearing Science, Champaign, Illinois
| | - Justin M Aronoff
- University of Illinois at Chicago, Department of Otolaryngology-Head and Neck Surgery, Chicago, Illinois; University of Illinois at Urbana-Champaign, Department of Speech and Hearing Science, Champaign, Illinois.
| | - Abbigail Kirchner
- University of Illinois at Urbana-Champaign, Department of Speech and Hearing Science, Champaign, Illinois
| | - EmilyAnn O'Brien
- University of Illinois at Urbana-Champaign, Department of Speech and Hearing Science, Champaign, Illinois
| | - Bailey Harmon
- University of Illinois at Urbana-Champaign, Department of Speech and Hearing Science, Champaign, Illinois
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Archer-Boyd AW, Southwell RV, Deeks JM, Turner RE, Carlyon RP. Development and validation of a spectro-temporal processing test for cochlear-implant listeners. J Acoust Soc Am 2018; 144:2983. [PMID: 30522311 PMCID: PMC6805218 DOI: 10.1121/1.5079636] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/01/2018] [Indexed: 06/06/2023]
Abstract
Psychophysical tests of spectro-temporal resolution may aid the evaluation of methods for improving hearing by cochlear implant (CI) listeners. Here the STRIPES (Spectro-Temporal Ripple for Investigating Processor EffectivenesS) test is described and validated. Like speech, the test requires both spectral and temporal processing to perform well. Listeners discriminate between complexes of sine sweeps which increase or decrease in frequency; difficulty is controlled by changing the stimulus spectro-temporal density. Care was taken to minimize extraneous cues, forcing listeners to perform the task only on the direction of the sweeps. Vocoder simulations with normal hearing listeners showed that the STRIPES test was sensitive to the number of channels and temporal information fidelity. An evaluation with CI listeners compared a standard processing strategy with one having very wide filters, thereby spectrally blurring the stimulus. Psychometric functions were monotonic for both strategies and five of six participants performed better with the standard strategy. An adaptive procedure revealed significant differences, all in favour of the standard strategy, at the individual listener level for six of eight CI listeners. Subsequent measures validated a faster version of the test, and showed that STRIPES could be performed by recently implanted listeners having no experience of psychophysical testing.
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Affiliation(s)
- Alan W. Archer-Boyd
- MRC Cognition & Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - Rosy V. Southwell
- MRC Cognition & Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - John M. Deeks
- MRC Cognition & Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - Richard E. Turner
- MRC Cognition & Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
| | - Robert P. Carlyon
- MRC Cognition & Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom
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Kim JS, Tejani VD, Abbas PJ, Brown CJ. Postoperative Electrocochleography from Hybrid Cochlear Implant users: An Alternative Analysis Procedure. Hear Res 2018; 370:304-315. [PMID: 30393003 DOI: 10.1016/j.heares.2018.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/18/2018] [Accepted: 10/26/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Shorter electrode arrays and soft surgical techniques allow for preservation of acoustic hearing in many cochlear implant (CI) users. Recently, we developed a method of using the Neural Response Telemetry (NRT) system built in Custom Sound EP clinical software to record acoustically evoked electrocochleography (ECoG) responses from an intracochlear electrode in Nucleus Hybrid CI users (Abbas et al., 2017). We recorded responses dominated by the hair cells (cochlear microphonic, CM/DIF) and the auditory nerve (auditory nerve neurophonic, ANN/SUM). Unfortunately, the recording procedure was time consuming, limiting potential clinical applications. This report describes a modified method to record the ECoG response more efficiently. We refer to this modified technique as the "short window" method, while our previous technique (Abbas et al., 2017) is referred as the "long window" method. In this report, our goal was to 1) evaluate the feasibility of the short window method to record the CM/DIF and ANN/SUM responses, 2) characterize the reliability and sensitivity of the measures recorded using the short window method, and 3) evaluate the relationship between the CM/DIF and ANN/SUM measures recorded using the modified method and audiometric thresholds. METHOD Thirty-four postlingually deafened adult Hybrid CI users participated in this study. Acoustic tone bursts were presented at four frequencies (250, 500, 750, and 1000 Hz) at various stimulation levels via an insert earphone in both condensation and rarefaction polarities. Acoustically evoked ECoG responses were recorded from the most apical electrode in the intracochlear array. These two responses were subtracted to emphasize the CM/DIF responses and added to emphasize the ANN/SUM responses. Response thresholds were determined based on visual inspection of time waveforms, and trough-to-peak analysis technique was used to quantify response amplitudes. Within-subject comparison of responses measured using both short and long window methods were obtained from seven subjects. We also assessed the reliability and sensitivity of the short window method by comparing repeated measures from 19 subjects at different times. Correlations between CM/DIF and ANN/SUM measures using the short window recording method and audiometric thresholds were also assessed. RESULTS Regardless of the recording method, CM/DIF responses were larger than ANN/SUM responses. Responses obtained using the short window method were positively correlated to those obtained using the conventional long window method. Subjects who had stable acoustic hearing at two different time points had similar ECoG responses at those points, confirming high test-retest reliability of the short window method. Subjects who lost hearing between two different time points showed increases in ECoG thresholds, suggesting that physiologic ECoG responses are sensitive to audiometric changes. Correlations between CM/DIF and ANN/SUM thresholds and audiometric thresholds at all tested frequencies were significant. CONCLUSION This study compares two different recording methods. Intracochlear ECoG measures recorded using the short window technique were efficient, reliable, and repeatable. We were able to collect more frequency specific data with the short window method, and observed similar results between the long window and short window methods. Correlations between physiological thresholds and audiometric thresholds were similar to those reported previously using the long window method (Abbas et al., 2017). This is an important finding because it demonstrates that clinically-available software can be used to measure frequency-specific ECoG responses with enhanced efficiency, increasing the odds that this technique might move from the laboratory into clinical practice.
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Affiliation(s)
- Jeong-Seo Kim
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA; Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| | - Viral D Tejani
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA; Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Paul J Abbas
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA; Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Carolyn J Brown
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA; Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Pfiffner F, Prochazka L, Dobrev I, Klein K, Sulser P, Péus D, Sim JH, Dalbert A, Röösli C, Obrist D, Huber A. Proof of Concept for an Intracochlear Acoustic Receiver for Use in Acute Large Animal Experiments. Sensors (Basel) 2018; 18:s18103565. [PMID: 30347862 PMCID: PMC6210337 DOI: 10.3390/s18103565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 11/24/2022]
Abstract
(1) Background: The measurement of intracochlear sound pressure (ICSP) is relevant to obtain better understanding of the biomechanics of hearing. The goal of this work was a proof of concept of a partially implantable intracochlear acoustic receiver (ICAR) fulfilling all requirements for acute ICSP measurements in a large animal. The ICAR was designed not only to be used in chronic animal experiments but also as a microphone for totally implantable cochlear implants (TICI). (2) Methods: The ICAR concept was based on a commercial MEMS condenser microphone customized with a protective diaphragm that provided a seal and optimized geometry for accessing the cochlea. The ICAR was validated under laboratory conditions and using in-vivo experiments in sheep. (3) Results: For the first time acute ICSP measurements were successfully performed in a live specimen that is representative of the anatomy and physiology of the human. Data obtained are in agreement with published data from cadavers. The surgeons reported high levels of ease of use and satisfaction with the system design. (4) Conclusions: Our results confirm that the developed ICAR can be used to measure ICSP in acute experiments. The next generation of the ICAR will be used in chronic sheep experiments and in TICI.
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Affiliation(s)
- Flurin Pfiffner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
| | - Lukas Prochazka
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
| | - Ivo Dobrev
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
| | - Karina Klein
- Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland.
| | - Patrizia Sulser
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
| | - Dominik Péus
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
| | - Jae Hoon Sim
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
| | - Adrian Dalbert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
| | - Christof Röösli
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
| | - Dominik Obrist
- ARTORG Center, University of Bern, 3010 Bern, Switzerland.
| | - Alexander Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
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SKARZYNSKI H, MATUSIAK M, FURMANEK M, PILKA A, WLODARCZYK E, OLDAK M, SKARZYNSKI P. Radiologic measurement of cochlea and hearing preservation rate using slim straight electrode (CI422) and round window approach. Acta Otorhinolaryngol Ital 2018; 38:468-475. [PMID: 30498276 PMCID: PMC6265667 DOI: 10.14639/0392-100x-1579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 03/14/2018] [Indexed: 11/23/2022]
Abstract
Hearing preservation surgery constitutes a considerable branch of cochlear implantation surgery and is being steadily developed and perfected. The aim of the study was to verify if insertion of a cochlear implant electrode according to individually calculated linear insertion depth improves hearing preservation. We evaluated the relations between the size of a cochlea, insertion depth angle, linear insertion depth and hearing preservation rate (HP) according to Hearing Preservation Classification in a retrospective case review of 54 patients implanted with a slim straight electrode Nucleus CI422 in 2008-2011. Group HP was 0.75 at activation, 0.67 at 12 months (for 53 patients) and 0.60 at 24 months. In 53 cases, the mean insertion depth angle was 375° (SD 17°); mean calculated cochlear duct length 35.87 mm (SD 1.95); mean calculated linear insertion depth 23.14 mm (SD 1.68). There was no significantly relevant relation between HP values and angular insertion depth or insertion depth. Preoperative measurements of cochlea and specific parameters such as linear insertion depth have no effect on hearing preservation. Poor hearing preservation in some deep insertion cases cannot be explained entirely by the electrode position.
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Affiliation(s)
- H. SKARZYNSKI
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - M. MATUSIAK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - M. FURMANEK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - A. PILKA
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - E. WLODARCZYK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - M. OLDAK
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
| | - P.H. SKARZYNSKI
- Institute of Physiology and Pathology of Hearing, Mochnackiego, Warsaw, Poland
- World Hearing Center, Mokra, Kajetany, Poland
- Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Kondratowicza, Warszawa, Poland
- Institute of Sensory Organs, Mokra, Kajetany, Poland
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Fabie JE, Keller RG, Hatch JL, Holcomb MA, Camposeo EL, Lambert PR, Meyer TA, McRackan TR. Evaluation of Outcome Variability Associated With Lateral Wall, Mid-scalar, and Perimodiolar Electrode Arrays When Controlling for Preoperative Patient Characteristics. Otol Neurotol 2018; 39:1122-1128. [PMID: 30106854 PMCID: PMC6131042 DOI: 10.1097/mao.0000000000001951] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Determine the impact of electrode array selection on audiometric performance when controlling for baseline patient characteristics. STUDY DESIGN Retrospective evaluation of a prospective cochlear implant (CI) database (January 1, 2012-May 31, 2017). SETTING Tertiary Care University Hospital. PATIENTS Three hundred twenty-eight adult CI recipients. INTERVENTIONS/MAIN OUTCOMES MEASURED Hearing outcomes were measured through unaided/aided pure tone thresholds and speech recognition testing before and after cochlear implantation. All reported postoperative results were performed at least 6 months after CI activation. All device manufacturers were represented. RESULTS Of the 328 patients, 234 received lateral wall (LW) arrays, 46 received perimodiolar (PM) arrays, and 48 received mid-scalar (MS) arrays. Patients receiving PM arrays had significantly poorer preoperative earphone and aided PTAs and SRTs, and aided Consonant-Nucleus-Consonant(CNC) word and AzBio +10 SNR scores compared with patients receiving LW arrays (all p ≤ 0.04), and poorer PTAs and AzBio +10 SNR scores compared with MS recipients (all p ≤ 0.02). No preoperative audiological variables were found to significantly differ between MS and LW patients. After controlling for preoperative residual hearing and speech recognition ability in a hierarchical multiple regression analysis, no statistically significant difference in audiological outcomes was detected (CNC words, AzBio quiet, or AzBio +10 SNR) among the three electrode array types (all p > 0.05). CONCLUSION While previous studies have demonstrated superior postoperative speech recognition scores in LW electrode array recipients, these differences lose significance when controlling for baseline hearing and speech recognition ability. These data demonstrate the proclivity for implanting individuals with greater residual hearing with LW electrodes and its impact on postoperative results.
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Affiliation(s)
- Joshua E Fabie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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El Boghdady N, Başkent D, Gaudrain E. Effect of frequency mismatch and band partitioning on vocal tract length perception in vocoder simulations of cochlear implant processing. J Acoust Soc Am 2018; 143:3505. [PMID: 29960490 DOI: 10.1121/1.5041261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The vocal tract length (VTL) of a speaker is an important voice cue that aids speech intelligibility in multi-talker situations. However, cochlear implant (CI) users demonstrate poor VTL sensitivity. This may be partially caused by the mismatch between frequencies received by the implant and those corresponding to places of stimulation along the cochlea. This mismatch can distort formant spacing, where VTL cues are encoded. In this study, the effects of frequency mismatch and band partitioning on VTL sensitivity were investigated in normal hearing listeners with vocoder simulations of CI processing. The hypotheses were that VTL sensitivity may be reduced by increased frequency mismatch and insufficient spectral resolution in how the frequency range is partitioned, specifically where formants lie. Moreover, optimal band partitioning might mitigate the detrimental effects of frequency mismatch on VTL sensitivity. Results showed that VTL sensitivity decreased with increased frequency mismatch and reduced spectral resolution near the low frequencies of the band partitioning map. Band partitioning was independent of mismatch, indicating that if a given partitioning is suboptimal, a better partitioning might improve VTL sensitivity despite the degree of mismatch. These findings suggest that customizing the frequency partitioning map may enhance VTL perception in individual CI users.
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Affiliation(s)
- Nawal El Boghdady
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology/Head and Neck Surgery, Groningen, The Netherlands
| | - Deniz Başkent
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology/Head and Neck Surgery, Groningen, The Netherlands
| | - Etienne Gaudrain
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology/Head and Neck Surgery, Groningen, The Netherlands
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Feng L, Oxenham AJ. Effects of spectral resolution on spectral contrast effects in cochlear-implant users. J Acoust Soc Am 2018; 143:EL468. [PMID: 29960500 PMCID: PMC6002271 DOI: 10.1121/1.5042082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/02/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
The identity of a speech sound can be affected by the long-term spectrum of a preceding stimulus. Poor spectral resolution of cochlear implants (CIs) may affect such context effects. Here, spectral contrast effects on a phoneme category boundary were investigated in CI users and normal-hearing (NH) listeners. Surprisingly, larger contrast effects were observed in CI users than in NH listeners, even when spectral resolution in NH listeners was limited via vocoder processing. The results may reflect a different weighting of spectral cues by CI users, based on poorer spectral resolution, which in turn may enhance some spectral contrast effects.
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Affiliation(s)
- Lei Feng
- Department of Psychology, University of Minnesota, N218 Elliott Hall, 75 East River Parkway, Minneapolis, Minnesota 55455, USA ,
| | - Andrew J Oxenham
- Department of Psychology, University of Minnesota, N218 Elliott Hall, 75 East River Parkway, Minneapolis, Minnesota 55455, USA ,
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Aronoff JM, Kirchner A, Abbs E, Harmon B. When singing with cochlear implants, are two ears worse than one for perilingually/postlingually deaf individuals? J Acoust Soc Am 2018; 143:EL503. [PMID: 29960471 DOI: 10.1121/1.5043093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Many individuals with bilateral cochlear implants hear different pitches when listening with their left versus their right cochlear implant. This conflicting information could potentially increase the difficulty of singing with cochlear implants. To determine if bilateral cochlear implants are detrimental for singing abilities, ten perilingually/postlingually deaf bilateral adult cochlear implant users were asked to sing "Happy Birthday" when using their left, right, both, or neither cochlear implant. The results indicated that bilateral cochlear implant users have more difficulty singing the appropriate pitch contour when using both cochlear implants as opposed to the better ear alone.
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Affiliation(s)
- Justin M Aronoff
- Speech and Hearing Science Department, University of Illinois at Urbana-Champaign, 901 South 6th Street, Champaign, Illinois 61820, USA , , ,
| | - Abbigail Kirchner
- Speech and Hearing Science Department, University of Illinois at Urbana-Champaign, 901 South 6th Street, Champaign, Illinois 61820, USA , , ,
| | - Elizabeth Abbs
- Speech and Hearing Science Department, University of Illinois at Urbana-Champaign, 901 South 6th Street, Champaign, Illinois 61820, USA , , ,
| | - Bailey Harmon
- Speech and Hearing Science Department, University of Illinois at Urbana-Champaign, 901 South 6th Street, Champaign, Illinois 61820, USA , , ,
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Hajiaghababa F, Marateb HR, Kermani S. The design and validation of a hybrid digital-signal-processing plug-in for traditional cochlear implant speech processors. Comput Methods Programs Biomed 2018; 159:103-109. [PMID: 29650304 DOI: 10.1016/j.cmpb.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 02/07/2018] [Accepted: 03/09/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Cochlear implants (CIs) are electronic devices restoring partial hearing to deaf individuals with profound hearing loss. In this paper, a new plug-in for traditional IIR filter-banks (FBs) is presented for cochlear implants based on wavelet neural networks (WNNs). Having provided such a plug-in for commercially available CIs, it is possible not only to use available hardware in the market but also to optimize their performance compared with the-state-of-the-art. METHODS An online database of Dutch diphone perception was used in our study. The weights of the WNNs were tuned using particle swarm optimization (PSO) on a training set (speech-shaped noise (SSN) of 2 dB SNR), while its performance was assessed on a test set in terms of objective and composite measures in the hold-out validation framework. The cost function was defined based on the combination of mean square error (MSE), short‑time objective intelligibility (STOI) criteria on the training set. Variety of performance indices were used including segmental signal- to -noise ratio (SNRseg), MSE, STOI, log-likelihood ratio (LLR), weighted spectral slope (WSS), and composite measures Csig,Cbak and Covl. Meanwhile, the following CI speech processing techniques were used for comparison: traditional FBs, dual resonance nonlinear (DRNL) and simple dual path nonlinear (SPDN) models. RESULTS The average SNRseg, MSE, and LLR values for the WNN in the entire data set were 2.496 ± 2.794, 0.086 ± 0.025 and 2.323 ± 0.281, respectively. The proposed method significantly improved MSE, SNR, SNRseg, LLR, Csig Cbak and Covl compared with the other three methods (repeated-measures analysis of variance (ANOVA); P < 0.05). The average running time of the proposed algorithm (written in Matlab R2013a) on the training and test sets for each consonant or vowel on an Intel dual-core 2.10 GHz CPU with 2GB of RAM was 9.91 ± 0.87 (s) and 0.19 ± 0.01 (s), respectively. CONCLUSIONS The proposed algorithm is accurate and precise and is thus a promising new plug-in for traditional CIs. Although the tuned algorithm is relatively fast, it is necessary to use efficient vectorized implementations for real-time CI speech signal processing.
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Affiliation(s)
- Fatemeh Hajiaghababa
- Electrical Engineering Department, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Hamid R Marateb
- Department of Biomedical Engineering, Faculty of Engineering, the University of Isfahan, Isfahan, Iran.
| | - Saeed Kermani
- Department of Bioelectrics and Biomedical Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Abstract
The severe hearing loss problems that some people suffer can be treated by providing them with a surgically implanted electrical device called cochlear implant (CI). CI users struggle to perceive complex audio signals such as music; however, previous studies show that CI recipients find music more enjoyable when the vocals are enhanced with respect to the background music. In this manuscript source separation (SS) algorithms are used to remix pop songs by applying gain to the lead singing voice. This work uses deep convolutional auto-encoders, a deep recurrent neural network, a multilayer perceptron (MLP), and non-negative matrix factorization to be evaluated objectively and subjectively through two different perceptual experiments which involve normal hearing subjects and CI recipients. The evaluation assesses the relevance of the artifacts introduced by the SS algorithms considering their computation time, as this study aims at proposing one of the algorithms for real-time implementation. Results show that the MLP performs in a robust way throughout the tested data while providing levels of distortions and artifacts which are not perceived by CI users. Thus, an MLP is proposed to be implemented for real-time monaural audio SS to remix music for CI users.
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Affiliation(s)
- Tom Gajęcki
- Department of Otolaryngology, Medical University Hannover and Cluster of Excellence Hearing4all, Hannover, 30625, Germany
| | - Waldo Nogueira
- Department of Otolaryngology, Medical University Hannover and Cluster of Excellence Hearing4all, Hannover, 30625, Germany
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Lund E. The Effects of Parent Training on Vocabulary Scores of Young Children With Hearing Loss. Am J Speech Lang Pathol 2018; 27:765-777. [PMID: 29587301 DOI: 10.1044/2018_ajslp-16-0239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/19/2017] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the effects of short-term parent training on maternal use of language stimulation strategies and vocabulary scores in children with hearing loss. METHOD Six mother-child dyads participated in the multiple-baseline study. During baseline and maintenance, children engaged in a business-as-usual model of clinician-only therapy. During intervention, mothers and children participated in parent training focused on transparent labeling and linguistic mapping strategies. Parent strategy use was measured via weekly play-based probe assessments. Child vocabulary growth was measured via parent report. RESULTS A relation between parent training and use of transparent labeling was established for all mothers, and a relation between parent training and use of linguistic mapping was established for 3 of 6 mothers. Child vocabulary growth rate increased from baseline to intervention in 4 of 6 children. CONCLUSIONS Short-term parent training can change parent behavior. However, parents may not maintain these skills without support. Further research is needed to characterize the extent to which short-term training can make long-term changes in parent and child outcomes.
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Affiliation(s)
- Emily Lund
- Department of Communication Sciences & Disorders, Texas Christian University, Fort Worth
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Jung J, Ertmer DJ. Grammatical Abilities in Young Cochlear Implant Recipients and Children With Normal Hearing Matched by Vocabulary Size. Am J Speech Lang Pathol 2018; 27:751-764. [PMID: 29625430 PMCID: PMC6105123 DOI: 10.1044/2018_ajslp-16-0164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 05/30/2017] [Accepted: 12/17/2017] [Indexed: 05/29/2023]
Abstract
PURPOSE This study sought to expand understanding of the impact of cochlear implantation on grammatical acquisition by comparing young children who have vocabularies of comparable size. Two research questions were investigated: (a) Do young cochlear implant (CI) recipients have grammatical skills comparable to those of children with normal hearing (NH) matched by spoken vocabulary size? (b) Do these groups show associations between vocabulary size and grammatical measures? METHOD The participants included 13 CI recipients at 24 months postactivation (chronological ages = 33-60 months; M = 44.62) and 13 children with NH between 27 and 30 months old (M = 20.69). The 2 groups were matched by their vocabulary size. Four grammatical outcomes were analyzed from the MacArthur Communicative Development Inventory (Fenson, Marchman, Thal, Dale, & Reznick, 2007) and 20-min language samples: (a) grammatical complexity, (b) mean length of utterances, (c) tense marker total, and (d) productivity scores. RESULTS The 2 groups showed comparable grammatical skills across the 4 measures. Consistently significant associations between vocabulary size and grammatical outcomes were found in the CI group, with fewer associations in the NH group. CONCLUSIONS The 2 groups showed similar grammatical abilities. The young CI recipients appeared to be following a typical pattern of linguistic development.
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Ching TYC, Zhang VW, Flynn C, Burns L, Button L, Hou S, McGhie K, Van Buynder P. Factors influencing speech perception in noise for 5-year-old children using hearing aids or cochlear implants. Int J Audiol 2018; 57:S70-S80. [PMID: 28687057 PMCID: PMC5756692 DOI: 10.1080/14992027.2017.1346307] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/18/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We investigated the factors influencing speech perception in babble for 5-year-old children with hearing loss who were using hearing aids (HAs) or cochlear implants (CIs). DESIGN Speech reception thresholds (SRTs) for 50% correct identification were measured in two conditions - speech collocated with babble, and speech with spatially separated babble. The difference in SRTs between the two conditions give a measure of binaural unmasking, commonly known as spatial release from masking (SRM). Multiple linear regression analyses were conducted to examine the influence of a range of demographic factors on outcomes. STUDY SAMPLE Participants were 252 children enrolled in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. RESULTS Children using HAs or CIs required a better signal-to-noise ratio to achieve the same level of performance as their normal-hearing peers but demonstrated SRM of a similar magnitude. For children using HAs, speech perception was significantly influenced by cognitive and language abilities. For children using CIs, age at CI activation and language ability were significant predictors of speech perception outcomes. CONCLUSIONS Speech perception in children with hearing loss can be enhanced by improving their language abilities. Early age at cochlear implantation was also associated with better outcomes.
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Affiliation(s)
- Teresa YC Ching
- National Acoustic Laboratories, Sydney, Australia
- The Hearing CRC, Melbourne, Australia
| | - Vicky W Zhang
- National Acoustic Laboratories, Sydney, Australia
- The Hearing CRC, Melbourne, Australia
| | - Christopher Flynn
- National Acoustic Laboratories, Sydney, Australia
- Australian Hearing, Australia
| | - Lauren Burns
- National Acoustic Laboratories, Sydney, Australia
- The Hearing CRC, Melbourne, Australia
- Australian Hearing, Australia
| | - Laura Button
- National Acoustic Laboratories, Sydney, Australia
- The Hearing CRC, Melbourne, Australia
| | - Sanna Hou
- National Acoustic Laboratories, Sydney, Australia
- The Hearing CRC, Melbourne, Australia
| | - Karen McGhie
- National Acoustic Laboratories, Sydney, Australia
- Australian Hearing, Australia
| | - Patricia Van Buynder
- National Acoustic Laboratories, Sydney, Australia
- The Hearing CRC, Melbourne, Australia
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Wang D, Hansen JHL. Speech enhancement for cochlear implant recipients. J Acoust Soc Am 2018; 143:2244. [PMID: 29716262 PMCID: PMC6786892 DOI: 10.1121/1.5031112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 02/24/2018] [Accepted: 03/26/2018] [Indexed: 06/08/2023]
Abstract
In this study, a single microphone speech enhancement algorithm is proposed to improve speech intelligibility for cochlear implant recipients. The proposed algorithm combines harmonic structure estimation with a subsequent statistical based speech enhancement stage. Traditional minimum mean square error (MMSE) based speech enhancement methods typically focus on statistical characteristics of the noise and track the noise variance along time dimension. The MMSE method is usually effective for stationary noise, but not as useful for non-stationary noise. To address both stationary and non-stationary noise, the current proposed method not only tracks noise over time, but also estimates the noise structure along the frequency dimension by exploiting the harmonic structure of the target speech. Next, the estimated noise is employed in the traditional MMSE framework for speech enhancement. To evaluate the proposed speech enhancement solution, a formal listener evaluation was performed with 6 cochlear implant recipients. The results suggest that a substantial improvement in speech intelligibility performance can be gained for cochlear implant recipients in noisy environments.
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Affiliation(s)
- Dongmei Wang
- Center for Robust Speech System (CRSS), Cochlear Implant Processing Lab (CILab), Department of Electrical Engineering, The University of Texas at Dallas, 800 West Campbell Road, Richardson, Texas 75080, USA
| | - John H L Hansen
- Center for Robust Speech System (CRSS), Cochlear Implant Processing Lab (CILab), Department of Electrical Engineering, The University of Texas at Dallas, 800 West Campbell Road, Richardson, Texas 75080, USA
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Hu H, Dietz M, Williges B, Ewert SD. Better-ear glimpsing with symmetrically-placed interferers in bilateral cochlear implant users. J Acoust Soc Am 2018; 143:2128. [PMID: 29716260 DOI: 10.1121/1.5030918] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
For a frontal target in spatially symmetrically placed interferers, normal hearing (NH) listeners can use "better-ear glimpsing" to select time-frequency segments with favorable signal-to-noise ratio in either ear. With an ideal monaural better-ear mask (IMBM) processing, some studies showed that NH listeners can reach similar performance as in the natural binaural listening condition, although interaural phase differences at low frequencies can further improve performance. In principle, bilateral cochlear implant (BiCI) listeners could use the same better-ear glimpsing, albeit without exploiting interaural phase differences. Speech reception thresholds of NH and BiCI listeners were measured in three interferers (speech-shaped stationary noise, nonsense speech, or single talker) either co-located with the target, symmetrically placed at ±60°, or independently presented to each ear, with and without IMBM processing. Furthermore, a bilateral noise vocoder based on the BiCI electrodogram was used in the same NH listeners. Headphone presentation and direct stimulation with head-related transfer functions for spatialization were used in NH and BiCI listeners, respectively. Compared to NH listeners, both NH listeners with vocoder and BiCI listeners showed strongly reduced binaural benefit from spatial separation. However, both groups greatly benefited from IMBM processing as part of the stimulation strategy.
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Affiliation(s)
- Hongmei Hu
- Medizinische Physik, Carl von Ossietzky Universität Oldenburg and Cluster of Excellence "Hearing4all," Küpkersweg 74, 26129, Oldenburg, Germany
| | - Mathias Dietz
- Medizinische Physik, Carl von Ossietzky Universität Oldenburg and Cluster of Excellence "Hearing4all," Küpkersweg 74, 26129, Oldenburg, Germany
| | - Ben Williges
- Medizinische Physik, Carl von Ossietzky Universität Oldenburg and Cluster of Excellence "Hearing4all," Küpkersweg 74, 26129, Oldenburg, Germany
| | - Stephan D Ewert
- Medizinische Physik, Carl von Ossietzky Universität Oldenburg and Cluster of Excellence "Hearing4all," Küpkersweg 74, 26129, Oldenburg, Germany
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Vashishth A, Fulcheri A, Guida M, Caruso A, Sanna M. Incomplete and false tract insertions in cochlear implantation: retrospective review of surgical and auditory outcomes. Eur Arch Otorhinolaryngol 2018; 275:1059-1068. [PMID: 29504040 DOI: 10.1007/s00405-018-4924-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 03/02/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate incidence, demographics, surgical, and radiological correlates of incomplete and false tract electrode array insertions during cochlear implantation (CI). To evaluate outcomes in patients with incomplete electrode insertion (IEI). STUDY DESIGN Retrospective analysis. SETTING Otology and skull base center. PATIENTS AND METHODS Charts of 18 patients (19 ears) with incomplete or false tract insertions of the electrode array were evaluated who underwent CI, with at least 1 year follow-up (from 470 cases). Demographic findings, etiologies, pre-operative radiologic findings, operative records, post-operative plain radiographic assessment for extent of electrode insertion, and switch-on mapping were evaluated. Audiological outcomes were evaluated using maximum and last recorded vowel, word, sentence, and comprehension scores for patients with IEI. RESULTS Incidence of insertional abnormalities was 4.25% with 17 instances of incomplete and 2 cases of insertion into superior semicircular canal. Mean age and duration of deafness were 55.18 ± 4.62 and 22.12 ± 5.71 years. Etiologies in the IEI group were idiopathic, otosclerosis, meningitis, chronic otitis media (COM), temporal bone fractures, and Neurofibromatosis-2. 29.4% cases had cochlear luminal obstruction. Mean radiological and active electrophysiological length of insertion was 20.49 ± 0.66 and 19.49 ± 0.88 mm, respectively. No significant correlation was observed between audiological outcomes and insertional length except in time to achieve maximum word scores (p = 0.04). Age at implantation had significant correlations with last recorded word and comprehension scores at mean follow-up of 42.9 months, and with time to achieve maximum auditory scores. CONCLUSIONS IEI during cochlear implantation using straight electrodes can occur with or without cochlear luminal obstruction. Age plays an important role in the auditory rehabilitation in this patient subset.
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Affiliation(s)
- Ashish Vashishth
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy.
| | - Andrea Fulcheri
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Maurizio Guida
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Antonio Caruso
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
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Chatterjee M, Kulkarni AM. Modulation detection interference in cochlear implant listeners under forward masking conditions. J Acoust Soc Am 2018; 143:1117. [PMID: 29495705 PMCID: PMC5821512 DOI: 10.1121/1.5025059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/06/2018] [Accepted: 02/06/2018] [Indexed: 06/08/2023]
Abstract
Little is known about cochlear implant (CI) users' ability to process amplitude modulation (AM) under conditions of forward masking (forward-modulation detection/discrimination interference, or F-MDI). In this study, F-MDI was investigated in adult CI listeners using direct electrical stimulation via research interface. The target was sinusoidally amplitude modulated at 50 Hz, and presented to a fixed electrode in the middle of the array. The forward masker was either amplitude modulated at the same rate (AM) or unmodulated and presented at the peak amplitude of its AM counterpart (steady-state peak, SSP). Results showed that the AM masker produced higher modulation thresholds in the target than the SSP masker. The difference (F-MDI) was estimated to be 4.6 dB on average, and did not change with masker-target delays up to 100 ms or with masker-target spatial electrode distances up to eight electrodes. Results with a coherent remote cue presented with the masker showed that confusion effects did not play a role in the observed F-MDI. Traditional recovery from forward masking using the same maskers and a 20-ms probe, measured in four of the subjects, confirmed the expected result: higher thresholds with the SSP masker than the AM masker. Collectively, the results indicate that significant F-MDI occurs in CI users.
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Affiliation(s)
- Monita Chatterjee
- Auditory Prostheses and Perception Laboratory, Center for Hearing Research, Boys Town National Research Hospital, 555 North 30th Street, Omaha, Nebraska 68104, USA
| | - Aditya M Kulkarni
- Auditory Prostheses and Perception Laboratory, Center for Hearing Research, Boys Town National Research Hospital, 555 North 30th Street, Omaha, Nebraska 68104, USA
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Abstract
The perception of temporal amplitude modulations is critical for speech understanding by cochlear implant (CI) users. The present study compared the ability of CI users to detect sinusoidal modulations of the electrical stimulation rate and current level, at different presentation levels (80% and 40% of the dynamic range) and modulation frequencies (10 and 100 Hz). Rate modulation detection thresholds (RMDTs) and amplitude modulation detection thresholds (AMDTs) were measured and compared to assess whether there was a perceptual advantage to either modulation method. Both RMDTs and AMDTs improved with increasing presentation level and decreasing modulation frequency. RMDTs and AMDTs were correlated, indicating that a common processing mechanism may underlie the perception of rate modulation and amplitude modulation, or that some subject-dependent factors affect both types of modulation detection.
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Affiliation(s)
- Tim Brochier
- Department of Medical Bionics, University of Melbourne, 384-388 Albert Street, East Melbourne, Victoria 3002, Australia
| | - Colette McKay
- The Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria 3002, Australia
| | - Hugh McDermott
- The Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria 3002, Australia
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