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Kelly S, Kuhlmey ME, Despotidis MA, Alter IL, Hwa TP, Chern A, Lalwani AK. Speech Quality Perception in Unilateral Cochlear Implant Users With Single-Sided Deafness. Otolaryngol Head Neck Surg 2025; 172:224-232. [PMID: 39118494 DOI: 10.1002/ohn.941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/12/2024] [Accepted: 07/27/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE Cochlear implant (CI) users frequently complain about speech quality perception (SQP). In patients undergoing cochlear implantation for single-sided deafness, there is concern that poor SQP from the implanted ear will negatively impact binaural (CI + normal hearing [NH]) SQP. In this study, we investigate if binaural SQP is measurably different than unimplanted NH alone. STUDY DESIGN Cross-sectional study. SETTING Tertiary care center. METHODS Fifteen unilateral CI users with NH in the contralateral ear completed the validated Columbia Speech Quality Instrument. This instrument consists of 9 audio clips rated across 14 specific speech qualities using a 10-point visual analog scale. SQP was assessed in 3 conditions: CI only, NH only, and CI + NH. RESULTS Median speech quality scores were worse in the CI only condition compared to the NH only (50.0 vs 72.6, P = .0003) and binaural (50.0 vs 71.0, P = .007) conditions. Median speech quality scores were not significantly different between the NH only and binaural conditions (72.6 vs 71, P = .8). Compared to NH, CI speech quality sounded less clear, less natural, and more mechanical. CONCLUSION Compared to NH, SQP is poorer with a CI alone. However, in contrast to expectation, there is no significant difference between NH and binaural SQP. This suggests poorer CI speech perception does not negatively impact binaural SQP in patients undergoing cochlear implantation for single-sided deafness.
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Affiliation(s)
- Scott Kelly
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Megan E Kuhlmey
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Meghan A Despotidis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Isaac L Alter
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Tiffany P Hwa
- Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alexander Chern
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anil K Lalwani
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
- Department of Mechanical Engineering, Columbia University, New York City, New York, USA
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Öz O, D'Alessandro HD, Batuk MÖ, Sennaroğlu G, Govaerts PJ. Assessment of Binaural Benefits in Hearing and Hearing-Impaired Listeners. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3633-3648. [PMID: 37494143 DOI: 10.1044/2023_jslhr-23-00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
PURPOSE The purpose of this study was to (a) investigate which speech material is most appropriate as stimulus in head shadow effect (HSE) and binaural squelch (SQ) tests, (b) obtain normative values of both tests using the material decided to be optimal, and (c) explore the results in bilateral cochlear implant (CI) users. METHOD Study participants consisted of 30 normal-hearing (NH) persons and 34 bilateral CI users. This study consisted of three phases. In the first phase, three different speech materials (1) monosyllabic words, (2) spondee words, and (3) sentences were compared in terms of (a) effect size, (b) test-retest reliability, and (c) interindividual variability. In the second phase, the speech material selected in the first phase was used to test a further 24 NHs to obtain normative values for both tests. In the third phase, tests were administered to a further 23 bilateral CI users, together with localization test and the Speech, Spatial, and Qualities of Hearing scale. RESULTS The results of the first phase indicated that spondees and sentences were more robust materials compared with monosyllables. Although the effect size and interindividual variability were comparable for spondees and sentences, sentences had higher test-retest reliability in this sample of CI users. With sentences, the mean (± standard deviation) HSE and SQ in the NH group were 58 ± 14% and 22 ± 11%, respectively. In the CI group, the mean HSE and SQ were 49 ± 13% and 13 ± 14%, respectively. There were no statistically significant correlations between the test results and the interval between the implantations, the length of binaural listening experience, or the asymmetry between the ears. CONCLUSIONS Sentences are preferred as stimulus material in the binaural HSE and SQ tests. Normative data are given for HSE and SQ with the LiCoS (linguistically controlled sentences) test. HSE is present for all bilateral CI users, whereas SQ is present in approximately seven out of 10 cases.
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Affiliation(s)
- Okan Öz
- The Eargroup, Antwerp, Belgium
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | | | - Merve Özbal Batuk
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Gonca Sennaroğlu
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Paul J Govaerts
- The Eargroup, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Translational Neurosciences, Otorhinolaryngology & Head and Neck Surgery, University of Antwerp, Belgium
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Zirn S, Hemmert W, Roth S, Müller FU, Angermeier J. [Interaural stimulation timing mismatch in listeners provided with a cochlear implant and a hearing aid : A review focusing on quantification and compensation]. HNO 2023:10.1007/s00106-023-01308-8. [PMID: 37219567 DOI: 10.1007/s00106-023-01308-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/24/2023]
Abstract
Bimodal provision of patients with asymmetric hearing loss with a hearing aid ipsilaterally and a cochlear implant (CI) contralaterally is probably the most complicated type of CI provision due to a variety of inherent variables. This review article presents all the systematic interaural mismatches between electric and acoustic stimulation that can occur in bimodal listeners. One of these mismatches is the interaural latency offset, i.e., the time difference of activation of the auditory nerve by acoustic and electric stimulation. Methods for quantifying this offset are presented by registering electrically and acoustically evoked potentials and measuring processing delays in the devices. Technical compensation of the interaural latency offset and its positive effect on sound localization ability in bimodal listeners is also described. Finally, most recent findings are discussed which may explain why compensation of the interaural latency offset does not improve speech understanding in noise in bimodal listeners.
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Affiliation(s)
- Stefan Zirn
- Fakultät Elektrotechnik, Medizintechnik und Informatik, Peter-Osypka-Institut für Medizintechnik (POIM), Hochschule Offenburg, Badstr. 24, 77652, Offenburg, Deutschland.
| | - Werner Hemmert
- Bioinspirierte Informationsverarbeitung, Fakultät Elektrotechnik und Informationstechnik, Technische Universität München, München, Deutschland
| | - Sebastian Roth
- Fakultät Elektrotechnik, Medizintechnik und Informatik, Peter-Osypka-Institut für Medizintechnik (POIM), Hochschule Offenburg, Badstr. 24, 77652, Offenburg, Deutschland
- Bioinspirierte Informationsverarbeitung, Fakultät Elektrotechnik und Informationstechnik, Technische Universität München, München, Deutschland
| | - Franz-Ullrich Müller
- Fakultät Elektrotechnik, Medizintechnik und Informatik, Peter-Osypka-Institut für Medizintechnik (POIM), Hochschule Offenburg, Badstr. 24, 77652, Offenburg, Deutschland
| | - Julian Angermeier
- Fakultät Elektrotechnik, Medizintechnik und Informatik, Peter-Osypka-Institut für Medizintechnik (POIM), Hochschule Offenburg, Badstr. 24, 77652, Offenburg, Deutschland
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Xu K, Willis S, Gopen Q, Fu QJ. Effects of Spectral Resolution and Frequency Mismatch on Speech Understanding and Spatial Release From Masking in Simulated Bilateral Cochlear Implants. Ear Hear 2021; 41:1362-1371. [PMID: 32132377 DOI: 10.1097/aud.0000000000000865] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Due to interaural frequency mismatch, bilateral cochlear-implant (CI) users may be less able to take advantage of binaural cues that normal-hearing (NH) listeners use for spatial hearing, such as interaural time differences and interaural level differences. As such, bilateral CI users have difficulty segregating competing speech even when the target and competing talkers are spatially separated. The goal of this study was to evaluate the effects of spectral resolution, tonotopic mismatch (the frequency mismatch between the acoustic center frequency assigned to CI electrode within an implanted ear relative to the expected spiral ganglion characteristic frequency), and interaural mismatch (differences in the degree of tonotopic mismatch in each ear) on speech understanding and spatial release from masking (SRM) in the presence of competing talkers in NH subjects listening to bilateral vocoder simulations. DESIGN During testing, both target and masker speech were presented in five-word sentences that had the same syntax but were not necessarily meaningful. The sentences were composed of five categories in fixed order (Name, Verb, Number, Color, and Clothes), each of which had 10 items, such that multiple sentences could be generated by randomly selecting a word from each category. Speech reception thresholds (SRTs) for the target sentence presented in competing speech maskers were measured. The target speech was delivered to both ears and the two speech maskers were delivered to (1) both ears (diotic masker), or (2) different ears (dichotic masker: one delivered to the left ear and the other delivered to the right ear). Stimuli included the unprocessed speech and four 16-channel sine-vocoder simulations with different interaural mismatch (0, 1, and 2 mm). SRM was calculated as the difference between the diotic and dichotic listening conditions. RESULTS With unprocessed speech, SRTs were 0.3 and -18.0 dB for the diotic and dichotic maskers, respectively. For the spectrally degraded speech with mild tonotopic mismatch and no interaural mismatch, SRTs were 5.6 and -2.0 dB for the diotic and dichotic maskers, respectively. When the tonotopic mismatch increased in both ears, SRTs worsened to 8.9 and 2.4 dB for the diotic and dichotic maskers, respectively. When the two ears had different tonotopic mismatch (e.g., there was interaural mismatch), the performance drop in SRTs was much larger for the dichotic than for the diotic masker. The largest SRM was observed with unprocessed speech (18.3 dB). With the CI simulations, SRM was significantly reduced to 7.6 dB even with mild tonotopic mismatch but no interaural mismatch; SRM was further reduced with increasing interaural mismatch. CONCLUSIONS The results demonstrate that frequency resolution, tonotopic mismatch, and interaural mismatch have differential effects on speech understanding and SRM in simulation of bilateral CIs. Minimizing interaural mismatch may be critical to optimize binaural benefits and improve CI performance for competing speech, a typical listening environment. SRM (the difference in SRTs between diotic and dichotic maskers) may be a useful clinical tool to assess interaural frequency mismatch in bilateral CI users and to evaluate the benefits of optimization methods that minimize interaural mismatch.
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Affiliation(s)
- Kevin Xu
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Kan A, Meng Q. The Temporal Limits Encoder as a Sound Coding Strategy for Bilateral Cochlear Implants. IEEE/ACM TRANSACTIONS ON AUDIO, SPEECH, AND LANGUAGE PROCESSING 2020; 29:265-273. [PMID: 33409339 PMCID: PMC7781292 DOI: 10.1109/taslp.2020.3039601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The difference in binaural benefit between bilateral cochlear implant (CI) users and normal hearing (NH) listeners has typically been attributed to CI sound coding strategies not encoding the acoustic fine structure (FS) interaural time differences (ITD). The Temporal Limits Encoder (TLE) strategy is proposed as a potential way of improving binaural hearing benefits for CI users in noisy situations. TLE works by downward-transposition of mid-frequency band-limited channel information and can theoretically provide FS-ITD cues. In this work, the effect of choice of lower limit of the modulator in TLE was examined by measuring performance on a word recognition task and computing the magnitude of binaural benefit in bilateral CI users. Performance listening with the TLE strategy was compared with the commonly used Advanced Combinational Encoder (ACE) CI sound coding strategy. Results showed that setting the lower limit to ≥200 Hz maintained word recognition performance comparable to that of ACE. While most CI listeners exhibited a large binaural benefit (≥6 dB) in at least one of the conditions tested, there was no systematic relationship between the lower limit of the modulator and performance. These results indicate that the TLE strategy has potential to improve binaural hearing abilities in CI users but further work is needed to understand how binaural benefit can be maximized.
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Affiliation(s)
- Alan Kan
- Waisman Center, University of Wisconsin-Madison at the time this work was conducted. He is now with the School of Engineering, Macquarie University, NSW, Australia, 2109
| | - Qinglin Meng
- Acoustics Laboratory, School of Physics and Optoelectronics, South China University of Technology, Guangzhou, China, 510641
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Karoui C, James C, Barone P, Bakhos D, Marx M, Macherey O. Searching for the Sound of a Cochlear Implant: Evaluation of Different Vocoder Parameters by Cochlear Implant Users With Single-Sided Deafness. Trends Hear 2020; 23:2331216519866029. [PMID: 31533581 PMCID: PMC6753516 DOI: 10.1177/2331216519866029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cochlear implantation in subjects with single-sided deafness (SSD) offers a unique opportunity to directly compare the percepts evoked by a cochlear implant (CI) with those evoked acoustically. Here, nine SSD-CI users performed a forced-choice task evaluating the similarity of speech processed by their CI with speech processed by several vocoders presented to their healthy ear. In each trial, subjects heard two intervals: their CI followed by a certain vocoder in Interval 1 and their CI followed by a different vocoder in Interval 2. The vocoders differed either (i) in carrier type-(sinusoidal [SINE], bandfiltered noise [NOISE], and pulse-spreading harmonic complex) or (ii) in frequency mismatch between the analysis and synthesis frequency ranges-(no mismatch, and two frequency-mismatched conditions of 2 and 4 equivalent rectangular bandwidths [ERBs]). Subjects had to state in which of the two intervals the CI and vocoder sounds were more similar. Despite a large intersubject variability, the PSHC vocoder was judged significantly more similar to the CI than SINE or NOISE vocoders. Furthermore, the No-mismatch and 2-ERB mismatch vocoders were judged significantly more similar to the CI than the 4-ERB mismatch vocoder. The mismatch data were also interpreted by comparing spiral ganglion characteristic frequencies with electrode contact positions determined from postoperative computed tomography scans. Only one subject demonstrated a pattern of preference consistent with adaptation to the CI sound processor frequency-to-electrode allocation table and two subjects showed possible partial adaptation. Those subjects with adaptation patterns presented overall small and consistent frequency mismatches across their electrode arrays.
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Affiliation(s)
- Chadlia Karoui
- Centre de Recherche Cerveau et Cognition, Toulouse, France.,Cochlear France SAS, Toulouse, France
| | - Chris James
- Cochlear France SAS, Toulouse, France.,Department of Otology-Neurotology and Skull Base Surgery, Purpan University Hospital, Toulouse, France
| | - Pascal Barone
- Centre de Recherche Cerveau et Cognition, Toulouse, France
| | - David Bakhos
- Université François-Rabelais de Tours, CHRU de Tours, France.,Ear Nose and Throat department, CHUR de Tours, Tours, France
| | - Mathieu Marx
- Centre de Recherche Cerveau et Cognition, Toulouse, France.,Department of Otology-Neurotology and Skull Base Surgery, Purpan University Hospital, Toulouse, France
| | - Olivier Macherey
- Aix Marseille University, CNRS, Centrale Marseille, LMA, Marseille, France
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Sullivan CB, Al-Qurayshi Z, Zhu V, Liu A, Dunn C, Gantz BJ, Hansen MR. Long-term audiologic outcomes after cochlear implantation for single-sided deafness. Laryngoscope 2019; 130:1805-1811. [PMID: 31710701 DOI: 10.1002/lary.28358] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the long-term audiometric outcomes, sound localization abilities, binaural benefits, and tinnitus assessment of subjects with cochlear implant (CI) after a diagnosis of unilateral severe-to-profound hearing loss. METHOD The study group consisted of 60 (mean age 52 years, range 19-84) subjects with profound hearing loss in one ear and normal to near-normal hearing in the other ear who underwent CI. Data analysis included pre- and postoperative Consonant-Nucleus-Consonant (CNC) Word scores, AzBio Sentence scores, pure tone thresholds, sound localization, and Iowa Tinnitus Handicap Questionnaire scores. RESULTS Preoperative average duration of deafness was 3.69 years (standard deviation 4.31), with an average follow-up time of 37.9 months (range 1-87). CNC and AzBio scores significantly improved (both P < 0.001) postoperatively among the entire cohort, and there was much heterogeneity in outcomes with respect to deafness etiology subgroup analysis. Sound localization abilities tended to improve longitudinally in the entire cohort. Binaural benefits using an adaptive Hearing in Noise Test test showed a significant (P < 0.001) improvement with head shadow effect. Utilizing the Iowa Tinnitus Handicap Questionnaire, there was significant improvement in social, physical, and emotional well-being (P = 0.011), along with hearing abilities (P = 0.001). CONCLUSIONS This case series is the largest cohort of CI SSD subjects to date and systematically analyzes their functional outcomes. Subjects have meaningful improvement in word understanding, and sound localization tends to gradually improve over time. Binaural benefit analysis showed significant improvement with head shadow effect, which likely provides ease of listening. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1805-1811, 2020.
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Affiliation(s)
- Christopher Blake Sullivan
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Zaid Al-Qurayshi
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Vivian Zhu
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Andrew Liu
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Camille Dunn
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Bruce J Gantz
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Marlan R Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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Kan A, Goupell MJ, Litovsky RY. Effect of channel separation and interaural mismatch on fusion and lateralization in normal-hearing and cochlear-implant listeners. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 146:1448. [PMID: 31472555 PMCID: PMC6713556 DOI: 10.1121/1.5123464] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 05/29/2023]
Abstract
Bilateral cochlear implantation has provided access to some of the benefits of binaural hearing enjoyed by normal-hearing (NH) listeners. However, a gap in performance still exists between the two populations. Single-channel stimulation studies have shown that interaural place-of-stimulation mismatch (IPM) due to differences in implantation depth leads to decreased binaural fusion and lateralization of interaural time and level differences (ITDs and ILDs, respectively). While single-channel studies are informative, multi-channel stimulation is needed for good speech understanding with cochlear implants (CIs). Some multi-channel studies have shown that channel interaction due to current spread can affect ITD sensitivity. In this work, we studied the effect of IPM and channel spacing, along with their potential interaction, on binaural fusion and ITD/ILD lateralization. Experiments were conducted in adult NH listeners and CI listeners with a history of acoustic hearing. Results showed that IPM reduced the range of lateralization for ITDs but not ILDs. CI listeners were more likely to report a fused percept in the presence of IPM with multi-channel stimulation than NH listeners. However, no effect of channel spacing was found. These results suggest that IPM should be accounted for in clinical mapping practices in order to maximize bilateral CI benefits.
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Affiliation(s)
- Alan Kan
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, Wisconsin 53705, USA
| | - Matthew J Goupell
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland 20742, USA
| | - Ruth Y Litovsky
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, Wisconsin 53705, USA
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The Effect of Simulated Interaural Frequency Mismatch on Speech Understanding and Spatial Release From Masking. Ear Hear 2019; 39:895-905. [PMID: 29337763 DOI: 10.1097/aud.0000000000000541] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The binaural-hearing system interaurally compares inputs, which underlies the ability to localize sound sources and to better understand speech in complex acoustic environments. Cochlear implants (CIs) are provided in both ears to increase binaural-hearing benefits; however, bilateral CI users continue to struggle with understanding speech in the presence of interfering sounds and do not achieve the same level of spatial release from masking (SRM) as normal-hearing listeners. One reason for diminished SRM in CI users could be that the electrode arrays are inserted at different depths in each ear, which would cause an interaural frequency mismatch. Because interaural frequency mismatch diminishes the salience of interaural differences for relatively simple stimuli, it may also diminish binaural benefits for spectral-temporally complex stimuli like speech. This study evaluated the effect of simulated frequency-to-place mismatch on speech understanding and SRM. DESIGN Eleven normal-hearing listeners were tested on a speech understanding task. There was a female target talker who spoke five-word sentences from a closed set of words. There were two interfering male talkers who spoke unrelated sentences. Nonindividualized head-related transfer functions were used to simulate a virtual auditory space. The target was presented from the front (0°), and the interfering speech was either presented from the front (colocated) or from 90° to the right (spatially separated). Stimuli were then processed by an eight-channel vocoder with tonal carriers to simulate aspects of listening through a CI. Frequency-to-place mismatch ("shift") was introduced by increasing the center frequency of the synthesis filters compared with the corresponding analysis filters. Speech understanding was measured for different shifts (0, 3, 4.5, and 6 mm) and target-to-masker ratios (TMRs: +10 to -10 dB). SRM was calculated as the difference in the percentage of correct words for the colocated and separated conditions. Two types of shifts were tested: (1) bilateral shifts that had the same frequency-to-place mismatch in both ears, but no interaural frequency mismatch, and (2) unilateral shifts that produced an interaural frequency mismatch. RESULTS For the bilateral shift conditions, speech understanding decreased with increasing shift and with decreasing TMR, for both colocated and separate conditions. There was, however, no interaction between shift and spatial configuration; in other words, SRM was not affected by shift. For the unilateral shift conditions, speech understanding decreased with increasing interaural mismatch and with decreasing TMR for both the colocated and spatially separated conditions. Critically, there was a significant interaction between the amount of shift and spatial configuration; in other words, SRM decreased for increasing interaural mismatch. CONCLUSIONS A frequency-to-place mismatch in one or both ears resulted in decreased speech understanding. SRM, however, was only affected in conditions with unilateral shifts and interaural frequency mismatch. Therefore, matching frequency information between the ears provides listeners with larger binaural-hearing benefits, for example, improved speech understanding in the presence of interfering talkers. A clinical procedure to reduce interaural frequency mismatch when programming bilateral CIs may improve benefits in speech segregation that are due to binaural-hearing abilities.
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Buss E, Dillon MT, Rooth MA, King ER, Deres EJ, Buchman CA, Pillsbury HC, Brown KD. Effects of Cochlear Implantation on Binaural Hearing in Adults With Unilateral Hearing Loss. Trends Hear 2019; 22:2331216518771173. [PMID: 29732951 PMCID: PMC5950506 DOI: 10.1177/2331216518771173] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A FDA clinical trial was carried out to evaluate the potential benefit of cochlear implant (CI) use for adults with unilateral moderate-to-profound sensorineural hearing loss. Subjects were 20 adults with moderate-to-profound unilateral sensorineural hearing loss and normal or near-normal hearing on the other side. A MED-EL standard electrode was implanted in the impaired ear. Outcome measures included: (a) sound localization on the horizontal plane (11 positions, -90° to 90°), (b) word recognition in quiet with the CI alone, and (c) masked sentence recognition with the target at 0° and the masker at -90°, 0°, or 90°. This battery was completed preoperatively and at 1, 3, 6, 9, and 12 months after CI activation. Normative data were also collected for 20 age-matched control subjects with normal or near-normal hearing bilaterally. The CI improved localization accuracy and reduced side bias. Word recognition with the CI alone was similar to performance of traditional CI recipients. The CI improved masked sentence recognition when the masker was presented from the front or from the side of normal or near-normal hearing. The binaural benefits observed with the CI increased between the 1- and 3-month intervals but appeared stable thereafter. In contrast to previous reports on localization and speech perception in patients with unilateral sensorineural hearing loss, CI benefits were consistently observed across individual subjects, and performance was at asymptote by the 3-month test interval. Cochlear implant settings, consistent CI use, and short duration of deafness could play a role in this result.
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Affiliation(s)
- Emily Buss
- 1 Department of Otolaryngology/Head and Neck Surgery, 2331 University of North Carolina School of Medicine , Chapel Hill, NC, USA
| | - Margaret T Dillon
- 1 Department of Otolaryngology/Head and Neck Surgery, 2331 University of North Carolina School of Medicine , Chapel Hill, NC, USA
| | - Meredith A Rooth
- 1 Department of Otolaryngology/Head and Neck Surgery, 2331 University of North Carolina School of Medicine , Chapel Hill, NC, USA
| | - English R King
- 2 Department of Audiology, 2334 UNC Health Care , Chapel Hill, NC, USA
| | - Ellen J Deres
- 2 Department of Audiology, 2334 UNC Health Care , Chapel Hill, NC, USA
| | - Craig A Buchman
- 3 Department of Otolaryngology/Head and Neck Surgery, 12275 Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Harold C Pillsbury
- 1 Department of Otolaryngology/Head and Neck Surgery, 2331 University of North Carolina School of Medicine , Chapel Hill, NC, USA
| | - Kevin D Brown
- 1 Department of Otolaryngology/Head and Neck Surgery, 2331 University of North Carolina School of Medicine , Chapel Hill, NC, USA
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Benefits to Speech Perception in Noise From the Binaural Integration of Electric and Acoustic Signals in Simulated Unilateral Deafness. Ear Hear 2018; 37:248-59. [PMID: 27116049 PMCID: PMC4847646 DOI: 10.1097/aud.0000000000000252] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study used vocoder simulations with normal-hearing (NH) listeners to (1) measure their ability to integrate speech information from an NH ear and a simulated cochlear implant (CI), and (2) investigate whether binaural integration is disrupted by a mismatch in the delivery of spectral information between the ears arising from a misalignment in the mapping of frequency to place. DESIGN Eight NH volunteers participated in the study and listened to sentences embedded in background noise via headphones. Stimuli presented to the left ear were unprocessed. Stimuli presented to the right ear (referred to as the CI-simulation ear) were processed using an eight-channel noise vocoder with one of the three processing strategies. An Ideal strategy simulated a frequency-to-place map across all channels that matched the delivery of spectral information between the ears. A Realistic strategy created a misalignment in the mapping of frequency to place in the CI-simulation ear where the size of the mismatch between the ears varied across channels. Finally, a Shifted strategy imposed a similar degree of misalignment in all channels, resulting in consistent mismatch between the ears across frequency. The ability to report key words in sentences was assessed under monaural and binaural listening conditions and at signal to noise ratios (SNRs) established by estimating speech-reception thresholds in each ear alone. The SNRs ensured that the monaural performance of the left ear never exceeded that of the CI-simulation ear. The advantages of binaural integration were calculated by comparing binaural performance with monaural performance using the CI-simulation ear alone. Thus, these advantages reflected the additional use of the experimentally constrained left ear and were not attributable to better-ear listening. RESULTS Binaural performance was as accurate as, or more accurate than, monaural performance with the CI-simulation ear alone. When both ears supported a similar level of monaural performance (50%), binaural integration advantages were found regardless of whether a mismatch was simulated or not. When the CI-simulation ear supported a superior level of monaural performance (71%), evidence of binaural integration was absent when a mismatch was simulated using both the Realistic and the Ideal processing strategies. This absence of integration could not be accounted for by ceiling effects or by changes in SNR. CONCLUSIONS If generalizable to unilaterally deaf CI users, the results of the current simulation study would suggest that benefits to speech perception in noise can be obtained by integrating information from an implanted ear and an NH ear. A mismatch in the delivery of spectral information between the ears due to a misalignment in the mapping of frequency to place may disrupt binaural integration in situations where both ears cannot support a similar level of monaural speech understanding. Previous studies that have measured the speech perception of unilaterally deaf individuals after CI but with nonindividualized frequency-to-electrode allocations may therefore have underestimated the potential benefits of providing binaural hearing. However, it remains unclear whether the size and nature of the potential incremental benefits from individualized allocations are sufficient to justify the time and resources required to derive them based on cochlear imaging or pitch-matching tasks.
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Fitzgerald MB, Prosolovich K, Tan CT, Glassman EK, Svirsky MA. Self-Selection of Frequency Tables with Bilateral Mismatches in an Acoustic Simulation of a Cochlear Implant. J Am Acad Audiol 2017; 28:385-394. [PMID: 28534729 PMCID: PMC5563263 DOI: 10.3766/jaaa.15077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many recipients of bilateral cochlear implants (CIs) may have differences in electrode insertion depth. Previous reports indicate that when a bilateral mismatch is imposed, performance on tests of speech understanding or sound localization becomes worse. If recipients of bilateral CIs cannot adjust to a difference in insertion depth, adjustments to the frequency table may be necessary to maximize bilateral performance. PURPOSE The purpose of this study was to examine the feasibility of using real-time manipulations of the frequency table to offset any decrements in performance resulting from a bilateral mismatch. RESEARCH DESIGN A simulation of a CI was used because it allows for explicit control of the size of a bilateral mismatch. Such control is not available with users of CIs. STUDY SAMPLE A total of 31 normal-hearing young adults participated in this study. DATA COLLECTION AND ANALYSIS Using a CI simulation, four bilateral mismatch conditions (0, 0.75, 1.5, and 3 mm) were created. In the left ear, the analysis filters and noise bands of the CI simulation were the same. In the right ear, the noise bands were shifted higher in frequency to simulate a bilateral mismatch. Then, listeners selected a frequency table in the right ear that was perceived as maximizing bilateral speech intelligibility. Word-recognition scores were then assessed for each bilateral mismatch condition. Listeners were tested with both a standard frequency table, which preserved a bilateral mismatch, or with their self-selected frequency table. RESULTS Consistent with previous reports, bilateral mismatches of 1.5 and 3 mm yielded decrements in word recognition when the standard table was used in both ears. However, when listeners used the self-selected frequency table, performance was the same regardless of the size of the bilateral mismatch. CONCLUSIONS Self-selection of a frequency table appears to be a feasible method for ameliorating the negative effects of a bilateral mismatch. These data may have implications for recipients of bilateral CIs who cannot adapt to a bilateral mismatch, because they suggest that (1) such individuals may benefit from modification of the frequency table in one ear and (2) self-selection of a "most intelligible" frequency table may be a useful tool for determining how the frequency table should be altered to optimize speech recognition.
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Affiliation(s)
- Matthew B. Fitzgerald
- Department of Otolaryngology – Head and Neck Surgery, Stanford Ear Institute, Stanford University, Palo Alto, CA
- Department of Otolaryngology, New York University School of Medicine, New York, NY
| | - Ksenia Prosolovich
- Department of Otolaryngology, University of Southern California, Los Angeles, CA
| | - Chin-Tuan Tan
- Department of Otolaryngology, New York University School of Medicine, New York, NY
| | | | - Mario A. Svirsky
- Department of Otolaryngology, New York University School of Medicine, New York, NY
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Aronoff JM, Padilla M, Stelmach J, Landsberger DM. Clinically Paired Electrodes Are Often Not Perceived as Pitch Matched. Trends Hear 2016; 20:20/0/2331216516668302. [PMID: 27641682 PMCID: PMC5029799 DOI: 10.1177/2331216516668302] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
For bilateral cochlear implant (CI) patients, electrodes that receive the same frequency allocation often stimulate locations in the left and right ear that do not yield the same perceived pitch, resulting in a pitch mismatch. This pitch mismatch may be related to degraded binaural abilities. Pitch mismatches have been found for some bilateral CI users and the goal of this study was to determine whether pitch mismatches are prevalent in bilateral CI patients, including those with extensive experience with bilateral CIs. To investigate this possibility, pitch matching was conducted with 16 bilateral CI patients. For 14 of the 16 participants, there was a significant difference between those electrodes in the left and right ear that yielded the same pitch and those that received the same frequency allocation in the participant’s clinical map. The results suggest that pitch mismatches are prevalent with bilateral CI users. The results also indicated that pitch mismatches persist even with extended bilateral CI experience. Such mismatches may reduce the benefits patients receive from bilateral CIs.
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Affiliation(s)
- Justin M Aronoff
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, IL, USA Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, IL, USA Communication and Neuroscience Division, House Ear Institute, Los Angeles, CA, USA
| | - Monica Padilla
- Communication and Neuroscience Division, House Ear Institute, Los Angeles, CA, USA Department of Otolaryngology, New York University School of Medicine, NY, USA USC Tina and Rick Caruso Department of Otolaryngology, Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | - Julia Stelmach
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, IL, USA
| | - David M Landsberger
- Communication and Neuroscience Division, House Ear Institute, Los Angeles, CA, USA Department of Otolaryngology, New York University School of Medicine, NY, USA
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Aronoff JM, Shayman C, Prasad A, Suneel D, Stelmach J. Unilateral spectral and temporal compression reduces binaural fusion for normal hearing listeners with cochlear implant simulations. Hear Res 2014; 320:24-9. [PMID: 25549574 DOI: 10.1016/j.heares.2014.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/10/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
Patients with single sided deafness have recently begun receiving cochlear implants in their deaf ear. These patients gain a significant benefit from having a cochlear implant. However, despite this benefit, they are considerably slower to develop binaural abilities such as summation compared to bilateral cochlear implant patients. This suggests that these patients have difficulty fusing electric and acoustic signals. Although this may reflect inherent differences between electric and acoustic stimulation, it may also reflect properties of the processor and fitting system, which result in spectral and temporal compression. To examine the possibility that unilateral spectral and temporal compression can adversely affect binaural fusion, this study tested normal hearing listeners' binaural fusion through the use of vocoded speech with unilateral spectral and temporal compression. The results indicate that unilateral spectral and temporal compression can each hinder binaural fusion and thus may adversely affect binaural abilities in patients with single sided deafness who use a cochlear implant in their deaf ear.
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Affiliation(s)
- Justin M Aronoff
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, 901 S. 6th St., Champaign, IL 61820, USA.
| | - Corey Shayman
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, 901 S. 6th St., Champaign, IL 61820, USA; Department of Molecular and Cell Biology, University of Illinois at Urbana-Champaign, 393 Morrill Hall, 505 S. Goodwin Ave., Urbana, IL 61801, USA.
| | - Akila Prasad
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, 901 S. 6th St., Champaign, IL 61820, USA.
| | - Deepa Suneel
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, 901 S. 6th St., Champaign, IL 61820, USA.
| | - Julia Stelmach
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, 901 S. 6th St., Champaign, IL 61820, USA.
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Place pitch versus electrode location in a realistic computational model of the implanted human cochlea. Hear Res 2014; 315:10-24. [PMID: 24975087 DOI: 10.1016/j.heares.2014.06.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 06/06/2014] [Accepted: 06/15/2014] [Indexed: 11/23/2022]
Abstract
Place pitch was investigated in a computational model of the implanted human cochlea containing nerve fibres with realistic trajectories that take the variable distance between the organ of Corti and spiral ganglion into account. The model was further updated from previous studies by including fluid compartments in the modiolus and updating the electrical conductivity values of (temporal) bone and the modiolus, based on clinical data. Four different cochlear geometries are used, modelled with both lateral and perimodiolar implants, and their neural excitation patterns were examined for nerve fibres modelled with and without peripheral processes. Additionally, equations were derived from the model geometries that describe Greenwood's frequency map as a function of cochlear angle at the basilar membrane as well as at the spiral ganglion. The main findings are: (I) in the first (basal) turn of the cochlea, cochlear implant induced pitch can be predicted fairly well using the Greenwood function. (II) Beyond the first turn this pitch becomes increasingly unpredictable, greatly dependent on stimulus level, state of the cochlear neurons and the electrode's distance from the modiolus. (III) After the first turn cochlear implant induced pitch decreases as stimulus level increases, but the pitch does not reach values expected from direct spiral ganglion stimulation unless the peripheral processes are missing. (IV) Electrode contacts near the end of the spiral ganglion or deeper elicit very unpredictable pitch, with broad frequency ranges that strongly overlap with those of neighbouring contacts. (V) The characteristic place pitch for stimulation at either the organ of Corti or the spiral ganglion can be described as a function of cochlear angle by the equations presented in this paper.
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Chen F, Wong LLN, Qiu J, Liu Y, Azimi B, Hu Y. The contribution of matched envelope dynamic range to the binaural benefits in simulated bilateral electric hearing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2013; 56:1166-1174. [PMID: 23926330 DOI: 10.1044/1092-4388(2012/12-0255)] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE This study examined the effects of envelope dynamic-range mismatch on the intelligibility of Mandarin speech in noise by simulated bilateral electric hearing. METHOD Noise-vocoded Mandarin speech, corrupted by speech-shaped noise at 5 and 0 dB signal-to-noise ratios, was presented unilaterally or bilaterally to 10 normal-hearing listeners for recognition. For unilateral conditions, the right ear was presented with the 8-channel noise-vocoded stimuli generated using a 15-dB envelope dynamic range (DR). To simulate the envelope DR mismatch between the 2 ears, the left ear was presented with the 8-channel noise-vocoded stimuli generated using a 5-, 10-, or 15-dB envelope DR, respectively. RESULTS Significant binaural summation benefits for Mandarin speech recognition were observed only with matched envelope DR between the 2 ears. With reduced DR, the performance of tone identification was more consistent in the steady-state speech-shaped noise than that of sentence recognition. CONCLUSIONS Consistent with previous findings, the present results suggest that Mandarin speech-perception performance of bilateral electric listening in noise is affected by the difference of envelope DR between the 2 implanted ears, and the binaural summation benefits are maximized when DR mismatch is minimized between the 2 implanted ears.
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Affiliation(s)
- Fei Chen
- Prince Philip Dental Hospital, The University of Hong Kong, SAR, PR China.
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