Reducing interaural tonotopic mismatch preserves binaural unmasking in cochlear implant simulations of single-sided deafness

Association of Tonotopic Mismatch With the Speech Recognition of Cochlear Implant Users With Unilateral Hearing Loss

OBJECTIVE

Review the relationship of tonotopic mismatch with the speech recognition of cochlear implant (CI) users with unilateral hearing loss (UHL; also known as single-sided deafness).

PATIENTS

Twenty-seven adults (≥18 yr of age) with late-onset UHL.

INTERVENTION

Cochlear implantation.

MAIN OUTCOME MEASURES

Speech recognition was assessed at 6 months post-activation with consonant-nucleus-consonant (CNC) words in the CI alone condition (contralateral ear masked). In the combined condition (CI plus the normal-hearing ear), masked speech recognition was assessed using AzBio sentences in a 10-talker masker (0-dB signal-to-noise ratio) in three target-to-masker configurations. Tonotopic mismatch was calculated as the semitone deviation between the center filter frequency and the cochlear place frequency of the most apical electrode contact.

RESULTS

There was a significant, negative association between tonotopic mismatch and CNC scores (r27= -0.43, p = 0.013) and masked speech recognition when the target was from the front and the masker was presented toward the normal-hearing ear (r27= -0.36, p = 0.033).

CONCLUSIONS

The speech recognition of adult CI users with UHL in the CI alone and bilateral listening conditions may be significantly influenced by tonotopic mismatches. These findings support the need for prospective investigation of methods to reduce or eliminate tonotopic mismatches (e.g., implantation of electrode arrays that approximate cochlear place and/or individualized mapping of filter frequencies) for CI users with UHL.

A Level-Adjusted Cochlear Frequency-to-Place Map for Estimating Tonotopic Frequency Mismatch With a Cochlear Implant

OBJECTIVES

To provide a level-adjusted correction to the current standard relating anatomical cochlear place to characteristic frequency (CF) in humans, and to re-evaluate anatomical frequency mismatch in cochlear implant (CI recipients considering this correction. It is proposed that a level-adjusted place-frequency function may represent a more relevant tonotopic benchmark for CIs in comparison to the current standard.

DESIGN

The present analytical study compiled data from 15 previous animal studies that reported isointensity responses from cochlear structures at different stimulation levels. Extracted outcome measures were CFs and centroid-based best frequencies at 70 dB SPL input from 47 specimens spanning a broad range of cochlear locations. A simple relationship was used to transform these measures to human estimates of characteristic and best frequencies, and nonlinear regression was applied to these estimates to determine how the standard human place-frequency function should be adjusted to reflect best frequency rather than CF. The proposed level-adjusted correction was then compared with average place-frequency positions of commonly used CI devices when programmed with clinical settings.

RESULTS

The present study showed that the best frequency at 70 dB SPL (BF70) tends to shift away from CF. The amount of shift was statistically significant (signed-rank test z = 5.143, p < 0.001), but the amount and direction of shift depended on cochlear location. At cochlear locations up to 600° from the base, BF70 shifted downward in frequency relative to CF by about 4 semitones on average. Beyond 600° from the base, BF70 shifted upward in frequency relative to CF by about 6 semitones on average. In terms of spread (90% prediction interval), the amount of shift between CF and BF70 varied from relatively no shift to nearly an octave of shift. With the new level-adjusted place-frequency function, the amount of anatomical frequency mismatch for devices programmed with standard-of-care settings is less extreme than originally thought and may be nonexistent for all but the most apical electrodes.

CONCLUSIONS

The present study validates the current standard for relating cochlear place to CF, and introduces a level-adjusted correction for how best frequency shifts away from CF at moderately loud stimulation levels. This correction may represent a more relevant tonotopic reference for CIs. To the extent that it does, its implementation may potentially enhance perceptual accommodation and speech understanding in CI users, thereby improving CI outcomes and contributing to advancements in the programming and clinical management of CIs.

Employing deep learning model to evaluate speech information in acoustic simulations of Cochlear implants

Acoustic vocoders play a key role in simulating the speech information available to cochlear implant (CI) users. Traditionally, the intelligibility of vocoder CI simulations is assessed through speech recognition experiments with normally-hearing subjects, a process that can be time-consuming, costly, and subject to individual variability. As an alternative approach, we utilized an advanced deep learning speech recognition model to investigate the intelligibility of CI simulations. We evaluated model's performance on vocoder-processed words and sentences with varying vocoder parameters. The number of vocoder bands, frequency range, and envelope dynamic range were adjusted to simulate sound processing settings in CI devices. Additionally, we manipulated the low-cutoff frequency and intensity quantization of vocoder envelopes to simulate psychophysical temporal and intensity resolutions in CI patients. The results were evaluated within the context of the audio analysis performed in the model. Interestingly, the deep learning model, despite not being originally designed to mimic human speech processing, exhibited a human-like response to alterations in vocoder parameters, resembling existing human subject results. This approach offers significant time and cost savings compared to testing human subjects, and eliminates learning and fatigue effects during testing. Our findings demonstrate the potential of speech recognition models in facilitating auditory research.

A level adjusted cochlear frequency-to-place map for estimating tonotopic frequency mismatch with a cochlear implant

Objectives

To provide a level-adjusted correction to the current standard relating anatomical cochlear place to characteristic frequency in humans, and to re-evaluate anatomical frequency mismatch in cochlear implant (CI) recipients considering this correction. It is hypothesized that a level-adjusted place-frequency function may represent a more accurate tonotopic benchmark for CIs in comparison to the current standard.

Design

The present analytical study compiled data from fifteen previous animal studies that reported iso-intensity responses from cochlear structures at different stimulation levels. Extracted outcome measures were characteristic frequencies and centroid-based best frequencies at 70 dB SPL input from 47 specimens spanning a broad range of cochlear locations. A simple relationship was used to transform these measures to human estimates of characteristic and best frequencies, and non-linear regression was applied to these estimates to determine how the standard human place-frequency function should be adjusted to reflect best frequency rather than characteristic frequency. The proposed level-adjusted correction was then compared to average place-frequency positions of commonly used CI devices when programmed with clinical settings.

Results

The present study showed that the best frequency at 70 dB SPL (BF70) tends to shift away from characteristic frequency (CF). The amount of shift was statistically significant (signed-rank test z = 5.143, p < 0.001), but the amount and direction of shift depended on cochlear location. At cochlear locations up to 600° from the base, BF70 shifted downwards in frequency relative to CF by about 4 semitones on average. Beyond 600° from the base, BF70 shifted upwards in frequency relative to CF by about 6 semitones on average. In terms of spread (90% prediction interval), the amount of shift between CF and BF70 varied from relatively no shift to nearly an octave of shift. With the new level-adjusted frequency-place function, the amount of anatomical frequency mismatch for devices programmed with standard of care settings is less extreme than originally thought, and may be nonexistent for all but the most apical electrodes.

Conclusions

The present study validates the current standard for relating cochlear place to characteristic frequency, and introduces a level-adjusted correction for how best frequency shifts away from characteristic frequency at moderately loud stimulation levels. This correction may represent a more accurate tonotopic reference for CIs. To the extent that it does, its implementation may potentially enhance perceptual accommodation and speech understanding in CI users, thereby improving CI outcomes and contributing to advancements in the programming and clinical management of CIs.

Considerations for Fitting Cochlear Implants Bimodally and to the Single-Sided Deaf

When listening with a cochlear implant through one ear and acoustically through the other, binaural benefits and spatial hearing abilities are generally poorer than in other bilaterally stimulated configurations. With the working hypothesis that binaural neurons require interaurally matched inputs, we review causes for mismatch, their perceptual consequences, and experimental methods for mismatch measurements. The focus is on the three primary interaural dimensions of latency, frequency, and level. Often, the mismatch is not constant, but rather highly stimulus-dependent. We report on mismatch compensation strategies, taking into consideration the specific needs of the respective patient groups. Practical challenges typically faced by audiologists in the proposed fitting procedure are discussed. While improvement in certain areas (e.g., speaker localization) is definitely achievable, a more comprehensive mismatch compensation is a very ambitious endeavor. Even in the hypothetical ideal fitting case, performance is not expected to exceed that of a good bilateral cochlear implant user.