Assessment of music experience after cochlear implantation: A review of current tools and their utilization

A study on the perception, learning experiences, and preferences in music among hard-of hearing adults

The purpose of this study was to investigate the music perception, learning experiences, and preferences of adults with hard-of-hearing and to examine how these factors vary depending on the type of rehabilitative assistive devices they use. A total of 107 adults with hard-of-hearing participated in a questionnaire consisting of 25 items related to music perception, learning experiences, and preferences with desires for learning music. The participants demonstrated a relatively high ability to perceive and identify music sounds, although they experienced difficulties in fully appreciating music while using rehabilitative assistive devices. Despite these challenges, participants expressed a strong desire to engage in music learning, with a particular interest in elements that foster enjoyment, rhythm, and tactile-based learning. Significant differences were observed between groups wearing different types of rehabilitative assistive devices and those not wearing devices, particularly in terms of the recognition of emotional content in songs (P = .003), music preference (P = .019), and perception level of music sounds (P = .000). In addition, significant differences were found in the consideration of self-learning function (P < .05) and listening to songs function (P < .05) when developing music-learning devices based on the use of rehabilitative assistive devices. Based on these research findings, priorities for the development of music-learning devices for adults with hard-of-hearing and relevant technological considerations have been proposed.

The Music-Related Quality of Life Measure (MuRQoL): A Scoping Review of Its Validation and Application

BACKGROUND

The Music-Related Quality of Life (MuRQoL) was launched in 2017 as a valid psychometric measure of Cochlear Implant (CI) users' music experience and its impact on Quality of Life (QoL). This scoping review aimed to explore the implementation and effectiveness of the instrument since its introduction.

METHODS

PubMed and Google Scholar databases were searched for publications written in English reporting a translation, validation or application of the MuRQoL.

RESULTS

Eleven publications were found, including three validated versions and eight studies that applied the MuRQoL in Italy, Turkey, Spain and the US in research and clinical settings for various purposes. The review showcases the reliability, validity and potential clinical utility of the tool underscoring its growing adoption and integration with other assessment tools. Based on the findings, we make recommendations and provide a roadmap for optimizing the use of MuRQoL globally, including naming and terminology conventions. Anecdotal evidence, such as forthcoming or non-English publications offer further insights into the tool's future potential.

CONCLUSIONS

The MuRQoL is currently available in four languages and applicable across diverse cultural contexts, populations and settings. It is a versatile, patient-centered tool providing a deep understanding of CI users' music experiences. As research and validation efforts continue, the instrument has the potential to set a benchmark for assessing the broader impacts of CIs beyond speech perception, emphasizing the significance of music in enriching the lives of individuals with Hearing Loss (HL).

Continuous monitoring of temporal skills during long-term in-home training by cochlear implant users

Cochlear implants improve auditory function in individuals with severe hearing loss, yet cochlear implant users often struggle with tasks such as identifying speaker characteristics and musical elements. While music therapy shows promise in addressing these deficits, standardized rehabilitation protocols, especially those focusing on music-based sound recognition, remain underdeveloped. This study evaluates the efficacy of EARPLANTED, a free platform developed at the Faculty of Physics, University of Bialystok, which includes a melodic contour identification test accessible on personal computers and mobile devices. Fifty cochlear implant users and 45 normally hearing volunteers participated in repeated testing sessions. Logistic regression with restricted cubic splines was used to analyse temporal changes in musical perception, offering insights into score distributions and progression over time. Results revealed significant differences in scores, with volunteers outperforming cochlear implant users. However, many volunteers also found the test challenging, highlighting its complexity. Temporal analysis showed that extended use of the platform generally led to improved scores among cochlear implant users. The findings underscore the need for cautious interpretation of melodic contour identification test results, given the difficulty experienced by both cochlear implant users and normally hearing individuals. The platform's utility, particularly for unilateral users, suggests its potential role in auditory rehabilitation. This study highlights the benefits of continuous monitoring and remote data collection via smartphones, providing clinicians and researchers with a practical tool for long-term rehabilitation strategies.

Remote assessment of music perception in pediatric cochlear implant recipients

OBJECTIVE

The primary objective of this study was to explore the feasibility of remotely assessing music perception in paediatric cochlear implant (CI) recipients. Pitch direction discrimination (PDD) and timbre recognition (TR) tests were administered remotely. We aimed to provide insights into the potential benefits and challenges of remote assessments.

DESIGN

The study was exploratory in nature. All participants underwent remote assessments for the PDD and TR tests. Eight participants completed both online and face-to-face tests. Supervising parents in remote tests completed the System Usability Scale (SUS).

STUDY SAMPLE

A cohort of 27 children with CI, averaging 11.19 years of age, participated in this study.

RESULTS

In the online condition, the average PDD score was 3.29 semitones (st), the TR score was 37.86%, and the average duration for PDD and TR testing was 9.98 and 6.18 minutes, respectively. Face-to-face sessions had an average PDD score of 3.00 st, a TR score of 32.81% and durations of 10.20 and 5.42 minutes for PDD and TR tests, respectively. The SUS score averaged 64.04.

CONCLUSION

These findings contribute to the growing body of knowledge supporting the integration of remote assessments in audiological practices.

Spanish translation and validation of the Music-Related Quality of Life Questionnaire (MuRQoL) in postlingually deaf cochlear implant users

PURPOSE

The aim of this study was to translate and validate the "Music-Related Quality of Life Questionnaire" into Spanish (sMuRQoL) and assess its convergent validity and discriminative capacity by comparing its scores with the outcomes of the musical perception test Meludia.

METHODS

The sMuRQoL was completed by 129 patients: 55 cochlear implant (CI) users and 74 normal hearing (NH) individuals. Conducted in this study were an exploratory factor analysis, an evaluation of internal consistency, an assessment of score stability through test-retest reliability, a comparison of sMuRQoL scores between CI users and NH individuals and an examination of potential evidence of convergent validity and discriminative capacity of sMuRQoL in relation to other tools. This involved the comparison of the questionnaire scores with the Meludia outcomes.

RESULTS

The sMuRQoL demonstrated a two-dimensional structure. All the dimensions displayed high internal consistency (α = 0.879-0.945) and score stability (ICC = 0.890-0.942). There were significant differences in the Frequency test between NH and CI users (d = 1.19-1.45). There's evidence of convergent validity between the scores of the Frequency test and the results of Meludia (r = 0.242-0.645). Additionally, the Frequency test demonstrate a good discriminative capacity to identify patients with poorer musical perception.

CONCLUSIONS

The sMuRQoL is a reliable questionnaire, with adequate evidence of validity based on internal structure. This study provides an accessible, cost-effective, and quick-to-administer instrument in Spanish, optimizing available healthcare resources and bringing us closer to the patient needs.

Influence of Anatomy-Based Fitting in Cochlear Implant Users on Music Perception Using the Montreal Battery of Evaluation of Amusia

OBJECTIVES

The aim is to investigate the influence of the anatomy-based fitting (ABF) in cochlear implants (CI) on the perception of specific musical features.

DESIGN

The Montreal Battery of Evaluation of Amusia (MBEA) test battery was performed with a collective of 16 CI users with and without an anatomy-based fitting and 9 normal hearing subjects. The insertion angles of the intracochlear electrode arrays were calculated using Otoplan® (MED-EL, Innsbruck, Austria) software.

RESULTS

CI users with an anatomy-based fitting achieve better results in the MBEA in all categories, especially in rhythm, meter, and memory. There is no effect of insertion depth alone on the ability to perceive musical features, even after anatomy-based fitting.

CONCLUSIONS

The results of the CI users in comparison to normal hearing people confirm previous studies. Apart from better speech understanding in CI users, which has been demonstrated in other studies, the anatomy-based fitting also contributes to a better perception of musical features. Currently, there are no comparable studies on this relationship. Investigations with further parameters with the help of the MBEA are pending.

SIGNIFICANCE

Our results show that anatomy-based fitting of cochlear implants significantly improves the perception of specific musical attributes and thus leads to an increased enjoyment of music.

Differences in music appreciation between bilateral and single-sided cochlear implant recipients

OBJECTIVE

To compare changes in music appreciation after cochlear implant (CI) surgery for patients with bilateral and single-sided deafness (SSD).

METHODS

A retrospective cohort study was performed on all adult CI unilateral or bilateral recipients from November 2019 to March 2023. Musical questionnaire subset data from the Cochlear Implant Quality of Life (CIQOL) - 35 Profile Instrument Score (maximum raw score of 15) was collected. Functional CI assessment was measured with CI-alone speech-in-quiet (SIQ) scores (AzBio and CNC).

RESULTS

22 adults underwent CI surgery for SSD and 21 adults for bilateral deafness (8 sequentially implanted). Every patient group had clinically significant improvements (p < 0.001) in mean SIQ scores in the most recently implanted ear (Azbio (% correct) SSD: 14.23 to 68.48, bilateral: 24.54 to 82.23, sequential: 6.25 to 82.57). SSD adults on average had higher music QOL scores at baseline (SSD: 11.05; bilateral: 7.86, p < 0.001). No group had significant increases in raw score at the first post-operative visit (SSD: 11.45, p = 0.86; bilateral: 8.15, p = 0.15). By the most recent post-implantation evaluation (median 12.8 months for SSD, 12.3 months for bilateral), SSD adults had a significant increase in raw score from baseline (11.05 to 12.45, p = 0.03), whereas bilaterally deafened (7.86 to 9.38, p = 0.12) adults had nonsignificant increases.

CONCLUSIONS

SSD patients demonstrate higher baseline music appreciation than bilaterally deafened individuals regardless of unilateral or bilateral implantation and are more likely to demonstrate continued improvement in subjective music appreciation at last follow-up even when speech perception outcomes are similar.

Meludia platform as a tool to evaluate music perception in pediatric and adult cochlear implant users

PURPOSE

Music perception is one of the greatest challenges for cochlear implant (CI) users. The aims of this study were: (i) to evaluate the music perception of CI users using the online Meludia music training program as music testing platform, (ii) to compare performance among three age groups, and (iii) to compare CI users with their normal hearing (NH) peers.

METHODS

138 individuals participated, divided between children (6-10 y), adolescents (11-16 y), and adults (≥ 17 y). Five music perception tasks were evaluated: Rhythm, Spatialization, Stable/unstable, Melody, and Density. We also administered the music related quality of life (MuRQoL) questionnaire for adults, and a music questionnaire for pediatric population (6-16 y) (MuQPP).

RESULTS

A significantly higher percentage of the adolescent CI users completed the five tasks compared to the other age groups. Both pediatric and adolescent CI users had similar performance to their NH peers in most categories. On the MuRQoL, adult NH listeners reported more music exposure than CI users (3.8 ± 0.6 vs 3.0 ± 0.6, p < 0.01), but both groups reported similar levels of perceived music importance (3.4 ± 0.7 vs 3.2 ± 1.1, p = 0.340). On the MuQPP, pediatric CI users who scored highly on music perception also had higher reported questionnaire scores (54.2 ± 12.9 vs 40.9 ± 12.1, p = 0.009).

CONCLUSIONS

Meludia can be used to evaluate music perception and to use for music training in CI users of all ages. Adolescents had the highest performance in most musical tasks. Pediatric CI users were more similar to their NH peers. The importance of music in adult CI users was comparable to their NH peers.

Objective and Subjective Assessment of Music Perception and Musical Experiences in Young Cochlear Implant Users

For many individuals, music has a significant impact on the quality and enjoyability of life. Cochlear implant (CI) users must cope with the constraints that the CI imposes on music perception. Here, we assessed the musical experiences of young CI users and age-matched controls with normal hearing (NH). CI users and NH peers were divided into subgroups according to age: children and adolescents. Participants were tested on their ability to recognize vocal and instrumental music and instruments. A music questionnaire for pediatric populations (MuQPP) was also used. CI users and NH peers identified a similar percentage of vocal music. CI users were significantly worse at recognizing instruments (p < 0.05) and instrumental music (p < 0.05). CI users scored similarly to NH peers on the MuQPP, except for the musical frequency domain, where CI users in the children subgroup scored higher than their NH peers (p = 0.009). For CI users in the children subgroup, the identification of instrumental music was positively correlated with music importance (p = 0.029). Young CI users have significant deficits in some aspects of music perception (instrumental music and instrument identification) but have similar scores to NH peers in terms of interest in music, frequency of music exposure, and importance of music.

Evaluation of the Effect of Musical Perception Activities on Speech Perception in Adult Cochlear Implant Users

Objective

This study aimed to evaluate clinical musical perception, analyze the relationship between speech recognition and music perception, and investigate the effects of a three-month musical perception activities on these parameters in adult cochlear implant (CI) users with post-lingual hearing loss.

Methods

Free-field hearing and speech tests in a quiet environment, the Turkish matrix test, and the Turkish version of the clinical assessment of musical perception test were performed on 18 adult unilateral CI users before and after the three-month music training. Results were compared with those of 18 healthy controls.

Results

Prior to the musical perception activities, word recognition scores, Turkish matrix test results, and 500, 1000, and 6000 Hz free-field hearing thresholds were significantly correlated with the clinical assessment of musical perception test scores in the CI group (p<0.047). Timbre recognition scores (p=0.019) had improved significantly in the CI group after the three-month musical perception activities. On the other hand, timbre recognition scores had significantly affected the Turkish matrix test results (R2adjusted=0.56).

Conclusion

Our study showed that speech perception in noise and clinical musical perception measurements affected each other in CI users. The inclusion of musical perception activities to support an auditory rehabilitation program may contribute to increased speech recognition skills in noise.

Application of Patient Reported Outcome Measures in Cochlear Implant Patients: Implications for the Design of Specific Rehabilitation Programs

INTRODUCTION

Cochlear implants (CI) have been developed to enable satisfying verbal communication, while music perception has remained in the background in both the research and technological development, thus making CI users dissatisfied by the experience of listening to music. Indications for clinicians to test and train music abilities are at a preliminary stage compared to the existing and well-established hearing and speech rehabilitation programs. The main aim of the present study was to test the utility of the application of two different patient reporting outcome (PRO) measures in a group of CI users. A secondary objective was to identify items capable of driving the indication and design specific music rehabilitation programs for CI patients.

MATERIALS AND METHODS

A consecutive series of 73 CI patients referred to the Audiology Unit, University of Padova, was enrolled from November 2021 to May 2022 and evaluated with the audiological battery test and PRO measures: Musica e Qualità della Vita (MUSQUAV) and Nijmegen Cochlear Implant Questionnaire (NCIQ) Italian version.

RESULTS

The reliability analysis showed good consistency between the different PRO measures (Cronbach's alpha = 0.873). After accounting for the epidemiological and clinical variables, the PRO measures showed a correlation with audiological outcomes in only one case (rho = -0.304; adj. p = 0.039) for NCIQ-T with the CI-pure tone average. A willingness for musical rehabilitation was present in 63% of patients (Rehab Factor, mean value of 0.791 ± 0.675).

CONCLUSIONS

We support the role of the application of MUSQUAV and NCIQ to improve the clinical and audiological evaluation of CI patients. Moreover, we proposed a derivative item, called the rehab factor, which could be used in clinical practice and future studies to clarify the indication and priority of specific music rehabilitation programs.

The music-related quality of life: Italian validation of MuRQoL into MUSQUAV questionnaire and preliminary data from a cohort of postlingually deafened cochlear implant users

PURPOSE

Cochlear implant (CI) users do not receive much of the auditory information necessary for an accurate perception of music. This usually entails a dissatisfaction with the music they hear, so that their quality of life may potentially be affected. The main aim of this paper was to translate and validate into Italian an instrument to evaluate these aspects-The Music-Related Quality of Life Questionnaire (MuRQoL)-to help the work of clinicians and therapists.

METHODS

The translation of the MuRQoL into "Questionario Musica e Qualità della Vita" (MUSQUAV) was done according to the international guidelines. The translated questionnaire was administered to normal hearing (NH) and CI users adults. Exploratory factor analysis, confirmatory factor analysis and known group method were used to confirm construct validity and applicability of MUSQUAV.

RESULTS

We retrieved 225 results. The MUSQUAV questionnaire was acceptable according to the goodness-of-fit indices. The correlation between the items, evaluated using Cronbach's α coefficient, indicates a good internal consistency (> 0.80). The non-parametric Mann-Whitney test showed significant differences in the distinct populations tested.

CONCLUSIONS

The MUSQUAV questionnaire is a valid, low-cost and rapid instrument for professional workers in the audiological field, especially useful in the assessment of the patients' perception and musical engagement.

Normative Cochlear Implant Quality of Life (CIQOL)-35 Profile and CIQOL-10 Global Scores for Experienced Cochlear Implant Users from a Multi-Institutional Study

OBJECTIVE

Although adult cochlear implant (CI) outcomes have primarily focused on speech recognition scores, the rigorous development of a CI-specific patient-reported outcome measure provides an opportunity for a more comprehensive and ecologically valid approach to measure the real-world functional abilities of adult CI users. Here, we report for the first time normative Cochlear Implant Quality of Life (CIQOL)-35 Profile and global scores and variance for a large, multi-institutional sample of adult CI users.

STUDY DESIGN

Cross-sectional study design.

SETTING

CI centers in the United States.

PATIENTS

Seven hundred five adults with bilateral moderate to profound hearing loss with at least 1 year of CI use.

INTERVENTIONS

Cochlear implantation.

MAIN OUTCOME MEASURES

CIQOL-35 Profile and CIQOL-10 Global scores.

RESULTS

During the development of the CIQOL instruments, 1,000 CI users from all regions of the United States were invited to participate in studies. Of these, 705 (70.5%) completed all portions of the study, and their data are reported here. Mean CIQOL domain scores were highest (indicating better function) for the emotional and social domains and lowest for listening effort. The entertainment and social domains demonstrated the widest distribution of scores and largest standard deviations, indicating greatest variability in function. Overall, there were minimal ceiling and floor effects for all domains.

CONCLUSION

Normative scores from a large sample of experienced adult CI users are consistent with clinical observations, showing large differences in functional abilities and large variability. Normative CIQOL data for adult CI users have the potential to enhance preoperative discussions with CI candidates, improve post-CI activation monitoring, and establish standards for CI centers.