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Alfakhri M, Campbell N, Lineton B, Verschuur C. Integrated bimodal fitting and binaural streaming technology outcomes for unilateral cochlear implant users. Int J Audiol 2024:1-10. [PMID: 38701176 DOI: 10.1080/14992027.2024.2341954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/05/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Adults typically receive only one cochlear implant (CI) due to cost constraints, with a contralateral hearing aid recommended when there is aidable hearing. Standard hearing aids differ from a CI in terms of processing strategy and function as a separate entity, requiring the user to integrate the disparate signals. Integrated bimodal technology has recently been introduced to address this challenge. The aim of the study was to investigate the performance of unilateral CI users with and without an integrated bimodal fitting and determine whether binaural streaming technology offers additional benefit. STUDY SAMPLE Twenty-six CI users using integrated bimodal technology. DESIGN Repeated measures where outcomes and user experience were assessed using a functional test battery more representative of real life listening (speech perception in noise tests, localisation test, tracking test) and the speech, spatial and qualities-of-hearing scale (SSQ). RESULTS Bimodal outcomes were significantly better than for CI alone. Speech perception in noise improvements ranged from 1.4 dB to 3.5 dB depending on the location of speech and noise. The localisation and tracking tests, and the SSQ also showed significant improvements. Binaural streaming offered additional improvement (1.2 dB to 6.1 dB on the different speech tests). CONCLUSIONS Integrated bimodal and binaural streaming technology improved the performance of unilateral CI users.
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Affiliation(s)
- Manal Alfakhri
- Institute of Sound and Vibration Research, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
- Auditory Implant Service, University of Southampton, Southampton, UK
- Health Rehabilitation Department, College of Applied Medical Science, Kind Saud University, Riyadh, Saudi Arabia
| | - Nicole Campbell
- Institute of Sound and Vibration Research, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
- Auditory Implant Service, University of Southampton, Southampton, UK
| | - Ben Lineton
- Institute of Sound and Vibration Research, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Carl Verschuur
- Institute of Sound and Vibration Research, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
- Auditory Implant Service, University of Southampton, Southampton, UK
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Craddock LC, Hodson J, Gosling A, Cooper S, Morse RP, Begg P, Prokopiou A, Irving RM. Comparison of an Implantable Middle Ear Microphone and Conventional External Microphone for Cochlear Implants: A Clinical Feasibility Study. Otol Neurotol 2022; 43:1162-1169. [PMID: 36240742 PMCID: PMC7613807 DOI: 10.1097/mao.0000000000003713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES All commercially available cochlear implant (CI) systems use an external microphone and sound processor; however, external equipment carries lifestyle limitations. Although totally implantable devices using subcutaneous microphones have been developed, these are compromised by problems with soft tissue sound attenuation, feedback, and intrusive body noise. This in vivo pilot study evaluates a middle ear microphone (MEM) that aims to overcome these issues and compares hearing performance with that of an external CI microphone. DESIGN Six adult participants with an existing CI were implanted with a temporary MEM in the contralateral ear. Signals from the MEM were routed via a percutaneous plug and cable to the CI sound processor. Testing was performed in the CI microphone and MEM conditions using a range of audiometric assessments, which were repeated across four visits. RESULTS Performance of the MEM did not differ significantly from that of the CI on the assessments of Auditory Speech Sounds Evaluation loudness scaling at either 250 or 1000 Hz, or in the accuracy of repeating keywords presented at 70 dB. However, the MEM had significantly poorer aided sound-field thresholds, particularly at higher frequencies (≥4000 Hz), and significantly poorer performance on Arthur Boothroyd words presented at 55 dB, compared with the CI. CONCLUSION In this pilot study, the MEM showed comparable performance to that of an external CI microphone across some audiometric assessments. However, performance with the MEM was poorer than the CI in soft-level speech (55 dB) and at higher frequencies. As such, the benefits of MEM need to be considered against the compromises in hearing performance. However, with future development, MEM is a potentially promising technology.
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Affiliation(s)
| | - James Hodson
- University Hospitals Birmingham NHS Foundation Trust, UK
- Health Data Science Team, Research Development and Innovation, Institute for Translational Medicine, University Hospitals Birmingham NHS Foundation Trust
| | - Amy Gosling
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - Stacey Cooper
- University Hospitals Birmingham NHS Foundation Trust, UK
| | | | - Philip Begg
- University Hospitals Birmingham NHS Foundation Trust, UK
- University of Kentucky, USA
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Salorio-Corbetto M, Williges B, Lamping W, Picinali L, Vickers D. Evaluating Spatial Hearing Using a Dual-Task Approach in a Virtual-Acoustics Environment. Front Neurosci 2022; 16:787153. [PMID: 35350560 PMCID: PMC8957784 DOI: 10.3389/fnins.2022.787153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/11/2022] [Indexed: 11/18/2022] Open
Abstract
Spatial hearing is critical for communication in everyday sound-rich environments. It is important to gain an understanding of how well users of bilateral hearing devices function in these conditions. The purpose of this work was to evaluate a Virtual Acoustics (VA) version of the Spatial Speech in Noise (SSiN) test, the SSiN-VA. This implementation uses relatively inexpensive equipment and can be performed outside the clinic, allowing for regular monitoring of spatial-hearing performance. The SSiN-VA simultaneously assesses speech discrimination and relative localization with changing source locations in the presence of noise. The use of simultaneous tasks increases the cognitive load to better represent the difficulties faced by listeners in noisy real-world environments. Current clinical assessments may require costly equipment which has a large footprint. Consequently, spatial-hearing assessments may not be conducted at all. Additionally, as patients take greater control of their healthcare outcomes and a greater number of clinical appointments are conducted remotely, outcome measures that allow patients to carry out assessments at home are becoming more relevant. The SSiN-VA was implemented using the 3D Tune-In Toolkit, simulating seven loudspeaker locations spaced at 30° intervals with azimuths between -90° and +90°, and rendered for headphone playback using the binaural spatialization technique. Twelve normal-hearing participants were assessed to evaluate if SSiN-VA produced patterns of responses for relative localization and speech discrimination as a function of azimuth similar to those previously obtained using loudspeaker arrays. Additionally, the effect of the signal-to-noise ratio (SNR), the direction of the shift from target to reference, and the target phonetic contrast on performance were investigated. SSiN-VA led to similar patterns of performance as a function of spatial location compared to loudspeaker setups for both relative localization and speech discrimination. Performance for relative localization was significantly better at the highest SNR than at the lowest SNR tested, and a target shift to the right was associated with an increased likelihood of a correct response. For word discrimination, there was an interaction between SNR and word group. Overall, these outcomes support the use of virtual audio for speech discrimination and relative localization testing in noise.
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Affiliation(s)
- Marina Salorio-Corbetto
- SOUND Laboratory, Cambridge Hearing Group, Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Audio Experience Design, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
- Wolfson College, Cambridge, United Kingdom
| | - Ben Williges
- SOUND Laboratory, Cambridge Hearing Group, Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Wiebke Lamping
- SOUND Laboratory, Cambridge Hearing Group, Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Lorenzo Picinali
- Audio Experience Design, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Deborah Vickers
- SOUND Laboratory, Cambridge Hearing Group, Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Arras T, Snapp H, Sangen A, Snels C, Kuntz I, Theunen T, Kheirkhah K, Zarowski A, Wesarg T, van Wieringen A, Agterberg MJH. Instant improvement in monaural spatial hearing abilities through cognitive feedback. Exp Brain Res 2022; 240:1357-1369. [PMID: 35238954 PMCID: PMC9038864 DOI: 10.1007/s00221-022-06333-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 02/09/2022] [Indexed: 11/04/2022]
Abstract
Several studies report that sound localization performance of acute and chronic monauralized normal-hearing listeners can improve through training. Typically, training sessions are administered daily for several days or weeks. While this intensive training is effective, it may also be that monaural localization abilities improve instantly after providing explicit top-down information about the direction dependent change in timbre and level. The aim of the present study was to investigate whether cognitive feedback (i.e., top-down information) could instantly improve sound localization in naive acutely monauralized listeners. Forty-three normal-hearing listeners (experimental group), divided over five different centers, were tested. Two control groups, consisting of, respectively, nine and eleven normal-hearing listeners, were tested in one center. Broadband sounds (0.5-20 kHz) were presented from visible loudspeakers, positioned in azimuth (- 90° to 90°). Participants in the experimental group received explicit information about the noticeable difference in timbre and the poor localization in the monauralized listening condition, resulting in an instant improvement in sound localization abilities. With subsequent roving of stimulus level (20 dB), sound localization performance deteriorated immediately. The reported improvement is related to the context of the localization test. The results provide important implications for studies investigating sound localization in a clinical setting, especially during closed-set testing, and indicate the importance of top-down information.
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Affiliation(s)
- Tine Arras
- Department of Neurosciences, Experimental ORL, KU Leuven, University of Leuven, Leuven, Belgium
| | - Hillary Snapp
- Department of Otolaryngology, University of Miami, Miami, FL, USA
| | - Anouk Sangen
- Department of Neurosciences, Experimental ORL, KU Leuven, University of Leuven, Leuven, Belgium
| | - Chantal Snels
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands.,Department of Otorhinolaryngology, University Ghent, Ghent, Belgium
| | - Iris Kuntz
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Tinne Theunen
- ENT Department Sint-Augustinus Antwerp, European Institute For ORL, Antwerp, Belgium
| | - Kiana Kheirkhah
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Heyendaalseweg 135, 6525 AJ, Nijmegen, The Netherlands
| | - Andrzej Zarowski
- ENT Department Sint-Augustinus Antwerp, European Institute For ORL, Antwerp, Belgium
| | - Thomas Wesarg
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Astrid van Wieringen
- Department of Neurosciences, Experimental ORL, KU Leuven, University of Leuven, Leuven, Belgium
| | - Martijn J H Agterberg
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands. .,Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Heyendaalseweg 135, 6525 AJ, Nijmegen, The Netherlands.
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Hamdan EC, Fletcher MD. A Compact Two-Loudspeaker Virtual Sound Reproduction System for Clinical Testing of Spatial Hearing With Hearing-Assistive Devices. Front Neurosci 2022; 15:725127. [PMID: 35153652 PMCID: PMC8835348 DOI: 10.3389/fnins.2021.725127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
Exciting developments in hearing aid and cochlear implant technology for linking signal processing across the ears have improved spatial hearing outcomes. This has resulted in an increased emphasis on clinical assessment of the spatial hearing abilities of hearing-assistive device users. Effective assessment of spatial hearing currently requires a large and costly loudspeaker array system, housed in a heavily acoustically treated testing room. This imposes economic and logistical constraints that limit proliferation of array systems, particularly in developing nations. Despite their size and cost, the ability of current clinical array systems to reproduce realistic spatial sound fields is limited, which substantially reduces the range of realistic acoustic scenes that can be used for diagnostic testing. We propose an alternative low-cost, compact virtual acoustics system with just two loudspeakers. This system uses crosstalk cancelation to reproduce pressure signals at the device microphones that match those for real-world sound sources. Furthermore, in contrast to clinical array systems, the system can adapt to different room acoustics, removing the requirement for a heavily acoustically treated testing environment. We conducted a proof-of-concept study in two stages: in the first, we evaluated the physical performance of the system for a stationary listener in anechoic conditions and in a small audiological testing booth with moderate acoustic treatment. To do this, a head and torso simulator was fitted with specially adapted hearing-assistive devices that allowed direct access to the microphone signals. These microphone signals were compared for real and virtual sound sources at numerous source locations. In the second stage, we quantified the system’s robustness to head rotations with and without the system adapting for head position. In the stationary case, the system was found to be highly effective at reproducing signals, such as speech, at all tested source locations. When head rotation was added, it performed well for rotations of up to 2°, even without adapting. However, performance improved markedly for larger rotations when the system adapted. These findings suggest that a compact, low-cost virtual acoustics system can give wider access to advanced and ecologically valid audiological testing, which could substantially improve clinical assessment of hearing-assistive device users.
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Affiliation(s)
- Eric C. Hamdan
- University of Southampton Auditory Implant Service, University of Southampton, Southampton, United Kingdom
- Institute of Sound and Vibration Research, University of Southampton, Southampton, United Kingdom
- *Correspondence: Eric C. Hamdan,
| | - Mark D. Fletcher
- University of Southampton Auditory Implant Service, University of Southampton, Southampton, United Kingdom
- Institute of Sound and Vibration Research, University of Southampton, Southampton, United Kingdom
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Peters JPM, van Heteren JAA, Wendrich AW, van Zanten GA, Grolman W, Stokroos RJ, Smit AL. Short-term outcomes of cochlear implantation for single-sided deafness compared to bone conduction devices and contralateral routing of sound hearing aids-Results of a Randomised controlled trial (CINGLE-trial). PLoS One 2021; 16:e0257447. [PMID: 34644322 PMCID: PMC8513831 DOI: 10.1371/journal.pone.0257447] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 08/22/2021] [Indexed: 02/06/2023] Open
Abstract
Single-sided deafness (SSD) leads to difficulties with speech perception in noise, sound localisation, and sometimes tinnitus. Current treatments (Contralateral Routing of Sound hearing aids (CROS) and Bone Conduction Devices (BCD)) do not sufficiently overcome these problems. Cochlear implants (CIs) may help. Our aim was to evaluate these treatments in a Randomised Controlled Trial (RCT). Adult SSD patients were randomised using a web-based randomisation tool into one of three groups: CI; trial period of 'first BCD, then CROS'; trial period of 'first CROS, then BCD'. After these trial periods, patients opted for BCD, CROS, or No treatment. The primary outcome was speech perception in noise (directed from the front (S0N0)). Secondary outcomes were speech perception in noise with speech directed to the poor ear and noise to the better ear (SpeNbe) and vice versa (SbeNpe), sound localisation, tinnitus burden, and disease-specific quality of life (QoL). We described results at baseline (unaided situation) and 3 and 6 months after device activation. 120 patients were randomised. Seven patients did not receive the allocated intervention. The number of patients per group after allocation was: CI (n = 28), BCD (n = 25), CROS (n = 34), and No treatment (n = 26). In S0N0, the CI group performed significantly better when compared to baseline, and when compared to the other groups. In SpeNbe, there was an advantage for all treatment groups compared to baseline. However, in SbeNpe, BCD and CROS groups performed worse compared to baseline, whereas the CI group improved. Only in the CI group sound localisation improved and tinnitus burden decreased. In general, all treatment groups improved on disease-specific QoL compared to baseline. This RCT demonstrates that cochlear implantation for SSD leads to improved speech perception in noise, sound localisation, tinnitus burden, and QoL after 3 and 6 months of follow-up. For most outcome measures, CI outperformed BCD and CROS. Trial registration: Netherlands Trial Register (www.trialregister.nl): NTR4580, CINGLE-trial.
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Affiliation(s)
- Jeroen P. M. Peters
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan A. A. van Heteren
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne W. Wendrich
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gijsbert A. van Zanten
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Robert J. Stokroos
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Adriana L. Smit
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Development and Critical Evaluation of a Condition-Specific Preference-Based Measure Sensitive to Binaural Hearing in Adults: The York Binaural Hearing-Related Quality-of-Life System. Ear Hear 2021; 43:379-397. [PMID: 34432671 DOI: 10.1097/aud.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The widely-used generic preference-based measures of health-related quality of life-the EuroQol Descriptive System (EQ-5D) and the Health Utilities Index (HUI3)-are limited in their response to technologies that improve hearing. The EQ-5D lacks construct validity for hearing, while the HUI3 is restricted by a ceiling effect and by using speech reception as the only evidence of the ability to hear. Consequently, neither measure consistently registers benefits from binaural hearing, such as those from bilateral versus unilateral cochlear implantation. The objectives were to test whether informants value binaural hearing, to develop a condition-specific preference-based measure sensitive to binaural hearing, to assess the psychometric properties of the new instrument, and to determine whether it meets requirements for informing judgments of cost-effectiveness: does it measure greater gains than do the generic preference-based measures, while avoiding exaggerating losses, and displaying sensitivity to side effects? DESIGN Three levels of function, ranging from no difficulty to great difficulty, were defined on each of three dimensions where listening is easier or more successful when hearing is binaural rather than monaural: perception of speech in spatially separated noise, localization of sounds, and effort and fatigue. Informants (N = 203) valued the 27 combinations of levels and dimensions in a time trade-off task with a 10-year time frame to provide a value of binaural-related quality of life ("binaural utility") for each combination. A questionnaire was compiled to allow respondents to report their level of function on each dimension so that a value of binaural utility could be assigned to them. The questionnaire and the age-standardized valuations constitute The York Binaural Hearing-Related Quality-of-Life System (YBHRQL). Adult users of unilateral implants (N = 8), bilateral implants (N = 11), or bimodal aiding (N = 9) undertook performance tests of spatial listening and completed the HUI3, EQ-5D, and Speech, Spatial, and Qualities of Hearing (SSQ) questionnaires. They completed the YBHRQL questionnaire 24 and 38 mo later. RESULTS Despite long intervals between measurements, the YBHRQL demonstrated desirable psychometric properties: good construct validity evidenced by significant correlations with performance measures and the SSQ index; a greater ability than the EQ-5D or HUI3 to distinguish unilateral, bimodal, and bilateral listening; and good reproducibility. The YBHRQL did not exaggerate losses of utility but was insensitive to a potential side effect of implantation (pain/discomfort). It measured a gain in utility from bilateral compared with unilateral implantation (median = 0.11, interquartile range, 0.03 to 0.16) that was greater than the gain measured by the EQ-5D (0.00, 0.00 to 0.00) but not the HUI3 (0.00, 0.00 to 0.17). CONCLUSIONS The YBHRQL summarizes the contribution of binaural hearing to quality of life by combining the functional status of a listener with the preferences of independent informants. It would be an efficient clinical outcome measure. In addition, if used alongside the EQ-5D or HUI3, it would provide evidence which could beneficially modulate confidence in the cost-effectiveness of interventions. Further research on its sensitivity to side effects, and on the size of the gains in utility which it measures, is needed to determine whether it could stand alone to inform resource-allocation decisions.
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Stavrinos G, Iliadou V(V, Pavlou M, Bamiou DE. Remote Microphone Hearing Aid Use Improves Classroom Listening, Without Adverse Effects on Spatial Listening and Attention Skills, in Children With Auditory Processing Disorder: A Randomised Controlled Trial. Front Neurosci 2020; 14:904. [PMID: 32973443 PMCID: PMC7472992 DOI: 10.3389/fnins.2020.00904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/04/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Children with Auditory Processing Disorder (APD) often have poor auditory processing skills in the presence of normal peripheral hearing. These children have worse listening-in-noise skills compared to typically developing peers, while other commonly reported symptoms include poor attention and distractibility. One of the management strategies for children with APD is the use of Remote Microphone Hearing Aids (RMHAs), which can help improve the signal-to-noise ratio in the child's ears. The aim of this randomised controlled trial was to examine whether RMHAs improved classroom listening in children with APD, and to further test their effects on children's listening-in-noise and attention skills following a 6-month intervention. METHODS Twenty-six children diagnosed with APD, aged 7-12, in primary mainstream education, were randomised into the intervention (N = 13) and control group (N = 13). The primary outcome measure was the Listening Inventory for Education - Revised questionnaire, completed by children to assess their listening using RMHAs under several acoustically challenging situations in the classroom. Secondary outcome measures included the Listening in Spatialised Noise - Sentences test, assessing speech-in-noise perception and spatial listening, and the Test of Everyday Attention for Children, assessing different types of attention skills. Tests were conducted in unaided conditions. Mixed analysis of variance was used to analyse the data. The clinical trial was registered at clinicaltrials.gov (unique identifier: NCT02353091). RESULTS The questionnaire scores of self-reported listening skills in the classroom significantly improved in the intervention group after 3, MD = 7.31, SE = 2.113, p = 0.014, and after 6 months, M = 5.00, SE = 1.468, p = 0.016. The behavioural measures of listening-in-noise and attention did not significantly change. CONCLUSION Use of RMHAs improves classroom listening, evidenced by the results of the questionnaire analysis, while a 6-month use did not have adverse effects on unaided spatial listening or attention skills.
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Affiliation(s)
- Georgios Stavrinos
- Ear Institute, Faculty of Brain Sciences, University College London, London, United Kingdom
| | | | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, United Kingdom
| | - Doris-Eva Bamiou
- Ear Institute, Faculty of Brain Sciences, University College London, London, United Kingdom
- Neuro-Otology Department, University College London Hospitals NHS Trust, London, United Kingdom
- Biomedical Research Centre, National Institute for Health Research, London, United Kingdom
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Factors Affecting Sound-Source Localization in Children With Simultaneous or Sequential Bilateral Cochlear Implants. Ear Hear 2019; 40:870-877. [DOI: 10.1097/aud.0000000000000666] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mathew R, Vickers D, Boyle P, Shaida A, Selvadurai D, Jiang D, Undurraga J. Development of electrophysiological and behavioural measures of electrode discrimination in adult cochlear implant users. Hear Res 2018; 367:74-87. [DOI: 10.1016/j.heares.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
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Killan CF, Harman S, Killan EC. Changes in sound-source localization for children with bilateral severe to profound hearing loss following simultaneous bilateral cochlear implantation. Cochlear Implants Int 2018; 19:284-291. [DOI: 10.1080/14670100.2018.1479147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Affiliation(s)
| | - Sally Harman
- Yorkshire Auditory Implant Service, Bradford Royal Infirmary, Bradford, UK
| | - Edward C. Killan
- LICAMM, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Kraaijenga VJC, Ramakers GGJ, Smulders YE, van Zon A, Stegeman I, Smit AL, Stokroos RJ, Hendrice N, Free RH, Maat B, Frijns JHM, Briaire JJ, Mylanus EAM, Huinck WJ, Van Zanten GA, Grolman W. Objective and Subjective Measures of Simultaneous vs Sequential Bilateral Cochlear Implants in Adults: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2017; 143:881-890. [PMID: 28655036 DOI: 10.1001/jamaoto.2017.0745] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance To date, no randomized clinical trial on the comparison between simultaneous and sequential bilateral cochlear implants (BiCIs) has been performed. Objective To investigate the hearing capabilities and the self-reported benefits of simultaneous BiCIs compared with those of sequential BiCIs. Design, Setting, and Participants A multicenter randomized clinical trial was conducted between January 12, 2010, and September 2, 2012, at 5 tertiary referral centers among 40 participants eligible for BiCIs. Main inclusion criteria were postlingual severe to profound hearing loss, age 18 to 70 years, and a maximum duration of 10 years without hearing aid use in both ears. Data analysis was conducted from May 24 to June 12, 2016. Interventions The simultaneous BiCI group received 2 cochlear implants during 1 surgical procedure. The sequential BiCI group received 2 cochlear implants with an interval of 2 years between implants. Main Outcomes and Measures First, the results 1 year after receiving simultaneous BiCIs were compared with the results 1 year after receiving sequential BiCIs. Second, the results of 3 years of follow-up for both groups were compared separately. The primary outcome measure was speech intelligibility in noise from straight ahead. Secondary outcome measures were speech intelligibility in noise from spatially separated sources, speech intelligibility in silence, localization capabilities, and self-reported benefits assessed with various hearing and quality of life questionnaires. Results Nineteen participants were randomized to receive simultaneous BiCIs (11 women and 8 men; median age, 52 years [interquartile range, 36-63 years]), and another 19 participants were randomized to undergo sequential BiCIs (8 women and 11 men; median age, 54 years [interquartile range, 43-64 years]). Three patients did not receive a second cochlear implant and were unavailable for follow-up. Comparable results were found 1 year after simultaneous or sequential BiCIs for speech intelligibility in noise from straight ahead (difference, 0.9 dB [95% CI, -3.1 to 4.4 dB]) and all secondary outcome measures except for localization with a 30° angle between loudspeakers (difference, -10% [95% CI, -20.1% to 0.0%]). In the sequential BiCI group, all participants performed significantly better after the BiCIs on speech intelligibility in noise from spatially separated sources and on all localization tests, which was consistent with most of the participants' self-reported hearing capabilities. Speech intelligibility-in-noise results improved in the simultaneous BiCI group up to 3 years following the BiCIs. Conclusions and Relevance This study shows comparable objective and subjective hearing results 1 year after receiving simultaneous BiCIs and sequential BiCIs with an interval of 2 years between implants. It also shows a significant benefit of sequential BiCIs over a unilateral cochlear implant. Until 3 years after receiving simultaneous BiCIs, speech intelligibility in noise significantly improved compared with previous years. Trial Registration trialregister.nl Identifier: NTR1722.
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Affiliation(s)
- Véronique J C Kraaijenga
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geerte G J Ramakers
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yvette E Smulders
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alice van Zon
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology-Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Nadia Hendrice
- Department of Otorhinolaryngology-Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Rolien H Free
- Department of Otorhinolaryngology, University Medical Center Groningen, Groningen, the Netherlands.,Graduate School of Medical Sciences, Research School of Behavioural and Cognitive Neurosciences, University Medical Center Groningen, Groningen, the Netherlands
| | - Bert Maat
- Department of Otorhinolaryngology, University Medical Center Groningen, Groningen, the Netherlands.,Graduate School of Medical Sciences, Research School of Behavioural and Cognitive Neurosciences, University Medical Center Groningen, Groningen, the Netherlands
| | - Johan H M Frijns
- Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Briaire
- Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, the Netherlands
| | - E A M Mylanus
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wendy J Huinck
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gijsbert A Van Zanten
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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13
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Mathew R, Undurraga J, Li G, Meerton L, Boyle P, Shaida A, Selvadurai D, Jiang D, Vickers D. Objective assessment of electrode discrimination with the auditory change complex in adult cochlear implant users. Hear Res 2017; 354:86-101. [DOI: 10.1016/j.heares.2017.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/16/2017] [Accepted: 07/21/2017] [Indexed: 11/16/2022]
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Koohi N, Vickers D, Warren J, Werring D, Bamiou DE. Long-term use benefits of personal frequency-modulated systems for speech in noise perception in patients with stroke with auditory processing deficits: a non-randomised controlled trial study. BMJ Open 2017; 7:e013003. [PMID: 28389484 PMCID: PMC5558864 DOI: 10.1136/bmjopen-2016-013003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Approximately one in five stroke survivors suffer from difficulties with speech reception in noise, despite normal audiometry. These deficits are treatable with personal frequency-modulated systems (FMs). This study aimed to evaluate long-term benefits in speech reception in noise, after daily 10-week use of personal FMs, in non-aphasic patients with stroke with auditory processing deficits. DESIGN This was a prospective non-randomised controlled trial study. Patients were allocated to an intervention care group or standard care subjects group according to their willingness to use the intervention or not. SETTING Tertiary care setting. PARTICIPANTS Nine non-aphasic subjects with ischaemic stroke, normal/near-normal audiometry and auditory processing deficits and with reported difficulties understanding speech in background noise were recruited in the subacute stroke stage (3-12 months after stroke). INTERVENTIONS Four patients (intervention care subjects) used the FMs in their daily life over 10 weeks. Five patients (standard care subjects) received standard care. PRIMARY OUTCOME MEASURES All subjects were tested at baseline (visit 1) and 10 weeks later (visit 2) on a sentences in noise test with the FMs (aided) and without the FMs (unaided). RESULTS Speech reception thresholds showed clinically and statistically significant improvements in intervention but not in standard care subjects at 10 weeks in aided and unaided conditions. CONCLUSIONS 10-week use of FMs by adult patients with stroke may lead to benefits in unaided speech in noise perception. Our findings may indicate auditory plasticity type changes and require further investigation. TRIAL REGISTRATION NUMBER Pre-results; NCT02889107.
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Affiliation(s)
- Nehzat Koohi
- UCL Ear Institute, London, UK
- National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Jason Warren
- National Hospital for Neurology and Neurosurgery, London, UK
- UCL Dementia Research Centre
| | - David Werring
- National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Institute of Neurology
| | - Doris-Eva Bamiou
- UCL Ear Institute, London, UK
- National Hospital for Neurology and Neurosurgery, London, UK
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15
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van Zon A, Smulders YE, Stegeman I, Ramakers GGJ, Kraaijenga VJC, Koenraads SPC, Zanten GAV, Rinia AB, Stokroos RJ, Free RH, Frijns JHM, Huinck WJ, Mylanus EAM, Tange RA, Smit AL, Thomeer HGXM, Topsakal V, Grolman W. Stable benefits of bilateral over unilateral cochlear implantation after two years: A randomized controlled trial. Laryngoscope 2016; 127:1161-1168. [DOI: 10.1002/lary.26239] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/04/2016] [Accepted: 07/12/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Alice van Zon
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Medical Center UtrechtUtrecht the Netherlands
- Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht the Netherlands
| | - Yvette E. Smulders
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Medical Center UtrechtUtrecht the Netherlands
- Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht the Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Medical Center UtrechtUtrecht the Netherlands
- Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht the Netherlands
| | - Geerte G. J. Ramakers
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Medical Center UtrechtUtrecht the Netherlands
- Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht the Netherlands
| | - Veronique J. C. Kraaijenga
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Medical Center UtrechtUtrecht the Netherlands
- Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht the Netherlands
| | - Simone P. C. Koenraads
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Medical Center UtrechtUtrecht the Netherlands
- Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht the Netherlands
| | - Gijsbert A. Van Zanten
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Medical Center UtrechtUtrecht the Netherlands
- Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht the Netherlands
| | - Albert B. Rinia
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Medical Center UtrechtUtrecht the Netherlands
| | - Robert J. Stokroos
- Department of Otorhinolaryngology–Head and Neck SurgeryMaastricht University Medical CenterMaastricht the Netherlands
| | - Rolien H. Free
- Department of OtorhinolaryngologyUniversity Medical Center GroningenGroningen the Netherlands
- Graduate School of Medical Sciences, Research School of Behavioural and Cognitive NeurosciencesUniversity Medical Center GroningenGroningen the Netherlands
| | - Johan H. M. Frijns
- Department of Otorhinolaryngology–Head and Neck SurgeryLeiden University Medical CenterLeiden the Netherlands
- Leiden Institute for Brain and CognitionLeiden University Medical CenterLeiden the Netherlands
| | - Wendy J. Huinck
- Department of Otorhinolaryngology–Head and Neck SurgeryRadboud University Medical CenterNijmegen the Netherlands
- Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegen the Netherlands
| | - Emmanuel A. M. Mylanus
- Department of Otorhinolaryngology–Head and Neck SurgeryRadboud University Medical CenterNijmegen the Netherlands
- Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegen the Netherlands
| | - Rinze A. Tange
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Medical Center UtrechtUtrecht the Netherlands
- Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht the Netherlands
| | - Adriana L. Smit
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Medical Center UtrechtUtrecht the Netherlands
- Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht the Netherlands
| | - Hans G. X. M. Thomeer
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Medical Center UtrechtUtrecht the Netherlands
- Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht the Netherlands
| | - Vedat Topsakal
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Medical Center UtrechtUtrecht the Netherlands
- Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht the Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity Medical Center UtrechtUtrecht the Netherlands
- Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht the Netherlands
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16
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Fielden CA, Kitterick PT. Contralateral acoustic hearing aid use in adult unilateral cochlear implant recipients: Current provision, practice, and clinical experience in the UK. Cochlear Implants Int 2016; 17:132-45. [PMID: 27078521 DOI: 10.1080/14670100.2016.1162382] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The study surveyed practising cochlear implant (CI) audiologists with the aim of: (1) characterizing UK clinical practice around the management and fitting of a contralateral hearing aid (HA) in adult unilateral CI users ('bimodal aiding'); (2) identifying factors that may limit the provision of bimodal aiding; and (3) ascertaining the views of audiologists on bimodal aiding. METHODS An online survey was distributed to audiologists working at the 20 centres providing implantation services to adults in the UK. RESULTS Responses were received from 19 of the 20 centres. The majority of centres reported evaluating HAs as part of the candidacy assessment for cochlear implantation. However, a majority also indicated that they do not take responsibility for the contralateral HA following implantation, despite identifying few practical limiting factors. Bimodal aiding was viewed as more beneficial than wearing the implant alone, with most respondents actively encouraging bimodal listening where possible. Respondents reported that fitting bimodal devices to take account of each other's settings was potentially more beneficial than independently fit devices, but such sympathetic fitting was not routine practice in any centre. DISCUSSION The results highlight some potential inconsistencies in the provision of bimodal aiding across the UK as reported by practising audiologists. The views of audiologists about what is best practice appear to be at odds with the nature and structure of the services currently offered. CONCLUSION Stronger evidence that bimodal aiding can be beneficial for UK patients would be required in order for service providers to justify the routine provision of bimodal aiding and to inform guidelines to shape routine clinical practice.
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Affiliation(s)
- Claire A Fielden
- a NIHR Nottingham Hearing Biomedical Research Unit , 113 The Ropewalk, Nottingham NG1 5DU , UK.,b Nottingham University Hospitals NHS Trust, Queen's Medical Centre , Nottingham NG7 2UH , UK.,c Midlands Hearing Implant Programme, Nuffield House , Queen Elizabeth Hospital , Birmingham B15 2TH , UK
| | - Pádraig T Kitterick
- a NIHR Nottingham Hearing Biomedical Research Unit , 113 The Ropewalk, Nottingham NG1 5DU , UK.,d Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine , University of Nottingham NG7 2RD , UK
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17
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Koohi N, Vickers D, Chandrashekar H, Tsang B, Werring D, Bamiou DE. Auditory rehabilitation after stroke: treatment of auditory processing disorders in stroke patients with personal frequency-modulated (FM) systems. Disabil Rehabil 2016; 39:586-593. [PMID: 27008578 DOI: 10.3109/09638288.2016.1152608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Auditory disability due to impaired auditory processing (AP) despite normal pure-tone thresholds is common after stroke, and it leads to isolation, reduced quality of life and physical decline. There are currently no proven remedial interventions for AP deficits in stroke patients. This is the first study to investigate the benefits of personal frequency-modulated (FM) systems in stroke patients with disordered AP. METHODS Fifty stroke patients had baseline audiological assessments, AP tests and completed the (modified) Amsterdam Inventory for Auditory Disability and Hearing Handicap Inventory for Elderly questionnaires. Nine out of these 50 patients were diagnosed with disordered AP based on severe deficits in understanding speech in background noise but with normal pure-tone thresholds. These nine patients underwent spatial speech-in-noise testing in a sound-attenuating chamber (the "crescent of sound") with and without FM systems. RESULTS The signal-to-noise ratio (SNR) for 50% correct speech recognition performance was measured with speech presented from 0° azimuth and competing babble from ±90° azimuth. Spatial release from masking (SRM) was defined as the difference between SNRs measured with co-located speech and babble and SNRs measured with spatially separated speech and babble. The SRM significantly improved when babble was spatially separated from target speech, while the patients had the FM systems in their ears compared to without the FM systems. CONCLUSIONS Personal FM systems may substantially improve speech-in-noise deficits in stroke patients who are not eligible for conventional hearing aids. FMs are feasible in stroke patients and show promise to address impaired AP after stroke. Implications for Rehabilitation This is the first study to investigate the benefits of personal frequency-modulated (FM) systems in stroke patients with disordered AP. All cases significantly improved speech perception in noise with the FM systems, when noise was spatially separated from the speech signal by 90° compared with unaided listening. Personal FM systems are feasible in stroke patients, and may be of benefit in just under 20% of this population, who are not eligible for conventional hearing aids.
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Affiliation(s)
- Nehzat Koohi
- a Department of Neuro-Otology , National Hospital for Neurology and Neurosurgery , London , UK.,b The Ear Institute , University College London , London , UK
| | - Deborah Vickers
- b The Ear Institute , University College London , London , UK
| | | | - Benjamin Tsang
- a Department of Neuro-Otology , National Hospital for Neurology and Neurosurgery , London , UK
| | - David Werring
- c The Institute of Neurology , University College London , London , UK
| | - Doris-Eva Bamiou
- a Department of Neuro-Otology , National Hospital for Neurology and Neurosurgery , London , UK.,b The Ear Institute , University College London , London , UK
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18
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Bizley JK, Elliott N, Wood KC, Vickers DA. Simultaneous Assessment of Speech Identification and Spatial Discrimination: A Potential Testing Approach for Bilateral Cochlear Implant Users? Trends Hear 2015; 19:19/0/2331216515619573. [PMID: 26721927 PMCID: PMC4771039 DOI: 10.1177/2331216515619573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
With increasing numbers of children and adults receiving bilateral cochlear implants, there is an urgent need for assessment tools that enable testing of binaural hearing abilities. Current test batteries are either limited in scope or are of an impractical duration for routine testing. Here, we report a behavioral test that enables combined testing of speech identification and spatial discrimination in noise. In this task, multitalker babble was presented from all speakers, and pairs of speech tokens were sequentially presented from two adjacent speakers. Listeners were required to identify both words from a closed set of four possibilities and to determine whether the second token was presented to the left or right of the first. In Experiment 1, normal-hearing adult listeners were tested at 15° intervals throughout the frontal hemifield. Listeners showed highest spatial discrimination performance in and around the frontal midline, with a decline at more eccentric locations. In contrast, speech identification abilities were least accurate near the midline and showed an improvement in performance at more lateral locations. In Experiment 2, normal-hearing listeners were assessed using a restricted range of speaker locations designed to match those found in clinical testing environments. Here, speakers were separated by 15° around the midline and 30° at more lateral locations. This resulted in a similar pattern of behavioral results as in Experiment 1. We conclude, this test offers the potential to assess both spatial discrimination and the ability to use spatial information for unmasking in clinical populations.
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19
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Vickers D, Summerfield Q, Lovett R. Candidacy criteria for paediatric bilateral cochlear implantation in the United Kingdom. Cochlear Implants Int 2015; 16 Suppl 1:S48-9. [PMID: 25614269 DOI: 10.1179/1467010014z.000000000235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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20
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Killan CF, Royle N, Totten CL, Raine CH, Lovett RES. The effect of early auditory experience on the spatial listening skills of children with bilateral cochlear implants. Int J Pediatr Otorhinolaryngol 2015; 79:2159-65. [PMID: 26520909 DOI: 10.1016/j.ijporl.2015.09.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/25/2015] [Accepted: 09/30/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Both electrophysiological and behavioural studies suggest that auditory deprivation during the first months and years of life can impair listening skills. Electrophysiological studies indicate that 3½ years may be a critical age for the development of symmetrical cortical responses in children using bilateral cochlear implants. This study aimed to examine the effect of auditory experience during the first 3½ years of life on the behavioural spatial listening abilities of children using bilateral cochlear implants, with reference to normally hearing children. Data collected during research and routine clinical testing were pooled to compare the listening skills of children with bilateral cochlear implants and different periods of auditory deprivation. METHODS Children aged 4-17 years with bilateral cochlear implants were classified into three groups. Children born profoundly deaf were in the congenital early bilateral group (received bilateral cochlear implants aged ≤3½ years, n=28) or congenital late bilateral group (received first implant aged ≤3½ years and second aged >3½ years, n=38). Children with some bilateral acoustic hearing until the age of 3½ years, who subsequently became profoundly deaf and received bilateral cochlear implants, were in the acquired/progressive group (n=16). There were 32 children in the normally hearing group. Children completed tests of sound-source localization and spatial release from masking (a measure of the ability to use both ears to understand speech in noise). RESULTS The acquired/progressive group localized more accurately than both groups of congenitally deaf children (p<0.05). All three groups of children with cochlear implants showed similar spatial release from masking. The normally hearing group localized more accurately than all groups with bilateral cochlear implants and displayed more spatial release from masking than the congenitally deaf groups on average (p<0.05). CONCLUSION Children with bilateral cochlear implants and early experience of acoustic hearing showed more accurate localization skills, on average, than children born profoundly deaf.
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Affiliation(s)
- Catherine F Killan
- Yorkshire Auditory Implant Service, Bradford Royal Infirmary, Bradford, UK.
| | - Nicola Royle
- Yorkshire Auditory Implant Service, Bradford Royal Infirmary, Bradford, UK
| | - Catherine L Totten
- Yorkshire Auditory Implant Service, Bradford Royal Infirmary, Bradford, UK
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Peters JP, van Zon A, Smit AL, van Zanten GA, de Wit GA, Stegeman I, Grolman W. CINGLE-trial: cochlear implantation for siNGLE-sided deafness, a randomised controlled trial and economic evaluation. BMC EAR, NOSE, AND THROAT DISORDERS 2015; 15:3. [PMID: 27777509 PMCID: PMC5070298 DOI: 10.1186/s12901-015-0016-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/19/2015] [Indexed: 02/08/2023]
Abstract
Background Individuals with single-sided deafness (SSD) have problems with speech perception in noise, localisation of sounds and with communication and social interaction in their daily life. Current treatment modalities (Contralateral Routing of Sound systems [CROS] and Bone Conduction Devices [BCD]) do not restore binaural hearing. Based on low level of evidence studies, CROS and BCD do not improve speech perception in noise or sound localisation. In contrast, cochlear implantation (CI) may overcome the limitations of CROS and BCD, as binaural input can be restored. Promising results have previously been achieved on speech perception in noise, sound localisation, tinnitus and quality of life. Methods and design A single-center Randomised Controlled Trial (RCT) was designed to compare all treatment strategies for SSD. One hundred and twenty adult single-sided deaf patients (duration of deafness >3 months and maximum 10 years; pure tone average at 0.5, 1, 2, 4 kHz, deaf ear: threshold equal to or more than 70 dB, better ear: threshold of maximum 30 dB) will be included in this trial and randomised to CI, ‘first BCD, then CROS’ or ‘first CROS, then BCD’-groups. After the trial period, patients in the two latter groups may choose with which treatment option they continue. Outcomes of interest are speech perception in noise, sound localization, tinnitus and quality of life. These outcomes will be measured during a baseline visit and at follow up visits, which will take place at 6, 12, 18, 24, 36, 48 and 60 months after onset of treatment. Furthermore, an economic evaluation will be performed and adverse events will be monitored. Discussion This RCT allows for a comparison between the two current treatment modalities for single-sided deafness and a new promising treatment strategy, CI, on a range of health outcomes: speech perception in noise, sound localization, tinnitus and quality of life. Additionally, we will be able to answer the question if the additional costs of CI are justified by increased benefits, when compared to current treatment strategies. This study will inform health policy makers with regard to reimbursement of CI. Trial registration Netherlands Trial Register (www.trialregister.nl): NTR4580.
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Affiliation(s)
- Jeroen Pm Peters
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA Utrecht, The Netherlands ; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alice van Zon
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA Utrecht, The Netherlands ; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA Utrecht, The Netherlands ; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gijsbert A van Zanten
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA Utrecht, The Netherlands ; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA Utrecht, The Netherlands ; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA Utrecht, The Netherlands ; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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22
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Smulders YE, Rinia AB, Pourier VE, Van Zon A, Van Zanten GA, Stegeman I, Scherf FW, Smit AL, Topsakal V, Tange RA, Grolman W. Validation of the U-STARR with the AB-York Crescent of Sound, a New Instrument to Evaluate Speech Intelligibility in Noise and Spatial Hearing Skills. AUDIOLOGY AND NEUROTOLOGY EXTRA 2015. [DOI: 10.1159/000370300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Advanced Bionics® (AB)-York crescent of sound is a new test setup that comprises speech intelligibility in noise and localization tests that represent everyday listening situations. One of its tests is the Sentence Test with Adaptive Randomized Roving levels (STARR) with sentences and noise both presented from straight ahead. For the Dutch population, we adopted the AB-York setup and replaced the English sentences with a validated set of Dutch sentences. The Dutch version of the STARR is called the Utrecht-STARR (U-STARR). This study primarily assesses the validity and reliability of the U-STARR compared to the Plomp test, which is the current Dutch gold standard for speech-in-noise testing. The outcome of both tests is a speech reception threshold in noise (SRTn). Secondary outcomes are the SRTn measured with sounds from spatially separated sources (SISSS) as well as sound localization capability. We tested 29 normal-hearing adults and 18 postlingually deafened adult patients with unilateral cochlear implants (CI). This study shows that the U-STARR is adequate and reliable and seems better suited for severely hearing-impaired persons than the conventional Plomp test. Further, CI patients have poor spatial listening skills, as demonstrated with the AB-York test.
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Killan CF, Killan EC, Raine CH. Changes in children's speech discrimination and spatial release from masking between 2 and 4 years after sequential cochlear implantation. Cochlear Implants Int 2015; 16:270-6. [PMID: 25655134 DOI: 10.1179/1754762815y.0000000001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To document changes in speech reception thresholds (SRTs) and spatial release from masking (SRM) for sequentially implanted children at 2 and 4 years after they received their second cochlear implant (CI2). METHODS Participants were 17 children who consistently used two sequentially implanted and optimally programmed CIs. SRTs were measured monaurally in quiet and binaurally in noise using the adaptive McCormick toy discrimination test. Speech signals were presented from 0° azimuth and noise from 0°, +90° or -90° azimuth. SRM was calculated from SRTs in noise. Measurements were made at 2 and 4 year post-CI2. RESULTS There were significant improvements over time in SRTs in quiet, SRTs in noise and SRM. SRTs in quiet improved more for CI2 than for the first implant (CI1). SRTs in noise and SRM improved more when noise was presented closest to CI1 than when closest to CI2. Performance became more symmetrical over time. DISCUSSION Despite prolonged periods of unilateral auditory deprivation sequentially implanted children exhibited continued improvement in SRT and SRM. These results are valuable in setting expectations for and counselling families of children considering sequential CIs.
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Furness DN. Abstracts of the Fourth Joint Annual Conference, Experimental and Clinical Short Papers Meetings of the British Society of Audiology. Int J Audiol 2014. [DOI: 10.3109/14992027.2014.938194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lovett R, Summerfield Q, Vickers D. Test-retest reliability of the Toy Discrimination Test with a masker of noise or babble in children with hearing impairment. Int J Audiol 2013; 52:377-84. [DOI: 10.3109/14992027.2013.769064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Evidence for opponent process analysis of sound source location in humans. J Assoc Res Otolaryngol 2012; 14:83-101. [PMID: 23090057 DOI: 10.1007/s10162-012-0356-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 10/10/2012] [Indexed: 10/27/2022] Open
Abstract
Research with barn owls suggested that sound source location is represented topographically in the brain by an array of neurons each tuned to a narrow range of locations. However, research with small-headed mammals has offered an alternative view in which location is represented by the balance of activity in two opponent channels broadly tuned to the left and right auditory space. Both channels may be present in each auditory cortex, although the channel representing contralateral space may be dominant. Recent studies have suggested that opponent channel coding of space may also apply in humans, although these studies have used a restricted set of spatial cues or probed a restricted set of spatial locations, and there have been contradictory reports as to the relative dominance of the ipsilateral and contralateral channels in each cortex. The current study used electroencephalography (EEG) in conjunction with sound field stimulus presentation to address these issues and to inform the development of an explicit computational model of human sound source localization. Neural responses were compatible with the opponent channel account of sound source localization and with contralateral channel dominance in the left, but not the right, auditory cortex. A computational opponent channel model reproduced every important aspect of the EEG data and allowed inferences about the width of tuning in the spatial channels. Moreover, the model predicted the oft-reported decrease in spatial acuity measured psychophysically with increasing reference azimuth. Predictions of spatial acuity closely matched those measured psychophysically by previous authors.
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