scholarly journals Effect of Hearing Aid Bandwidth on Speech Recognition Performance of Listeners Using a Cochlear Implant and Contralateral Hearing Aid (Bimodal Hearing)

2013 ◽  
Vol 34 (5) ◽  
pp. 553-561 ◽  
Author(s):  
Arlene C. Neuman ◽  
Mario A. Svirsky
2009 ◽  
Vol 20 (06) ◽  
pp. 353-373 ◽  
Author(s):  
Lisa G. Potts ◽  
Margaret W. Skinner ◽  
Ruth A. Litovsky ◽  
Michael J. Strube ◽  
Francis Kuk

Background: The use of bilateral amplification is now common clinical practice for hearing aid users but not for cochlear implant recipients. In the past, most cochlear implant recipients were implanted in one ear and wore only a monaural cochlear implant processor. There has been recent interest in benefits arising from bilateral stimulation that may be present for cochlear implant recipients. One option for bilateral stimulation is the use of a cochlear implant in one ear and a hearing aid in the opposite nonimplanted ear (bimodal hearing). Purpose: This study evaluated the effect of wearing a cochlear implant in one ear and a digital hearing aid in the opposite ear on speech recognition and localization. Research Design: A repeated-measures correlational study was completed. Study Sample: Nineteen adult Cochlear Nucleus 24 implant recipients participated in the study. Intervention: The participants were fit with a Widex Senso Vita 38 hearing aid to achieve maximum audibility and comfort within their dynamic range. Data Collection and Analysis: Soundfield thresholds, loudness growth, speech recognition, localization, and subjective questionnaires were obtained six–eight weeks after the hearing aid fitting. Testing was completed in three conditions: hearing aid only, cochlear implant only, and cochlear implant and hearing aid (bimodal). All tests were repeated four weeks after the first test session. Repeated-measures analysis of variance was used to analyze the data. Significant effects were further examined using pairwise comparison of means or in the case of continuous moderators, regression analyses. The speech-recognition and localization tasks were unique, in that a speech stimulus presented from a variety of roaming azimuths (140 degree loudspeaker array) was used. Results: Performance in the bimodal condition was significantly better for speech recognition and localization compared to the cochlear implant–only and hearing aid–only conditions. Performance was also different between these conditions when the location (i.e., side of the loudspeaker array that presented the word) was analyzed. In the bimodal condition, the speech-recognition and localization tasks were equal regardless of which side of the loudspeaker array presented the word, while performance was significantly poorer for the monaural conditions (hearing aid only and cochlear implant only) when the words were presented on the side with no stimulation. Binaural loudness summation of 1–3 dB was seen in soundfield thresholds and loudness growth in the bimodal condition. Measures of the audibility of sound with the hearing aid, including unaided thresholds, soundfield thresholds, and the Speech Intelligibility Index, were significant moderators of speech recognition and localization. Based on the questionnaire responses, participants showed a strong preference for bimodal stimulation. Conclusions: These findings suggest that a well-fit digital hearing aid worn in conjunction with a cochlear implant is beneficial to speech recognition and localization. The dynamic test procedures used in this study illustrate the importance of bilateral hearing for locating, identifying, and switching attention between multiple speakers. It is recommended that unilateral cochlear implant recipients, with measurable unaided hearing thresholds, be fit with a hearing aid.


2014 ◽  
Vol 23 (1) ◽  
pp. 79-92 ◽  
Author(s):  
Lisa G. Potts ◽  
Ruth Y. Litovsky

Purpose The use of bilateral stimulation is becoming common for cochlear implant (CI) recipients with either (a) a CI in one ear and a hearing aid (HA) in the nonimplanted ear (CI&HA—bimodal) or (b) CIs in both ears (CI&CI—bilateral). The objective of this study was to evaluate 4 individuals who transitioned from bimodal to bilateral stimulation. Method Participants had completed a larger study of bimodal hearing and subsequently received a second CI. Test procedures from the bimodal study, including roaming speech recognition, localization, and a questionnaire (the Speech, Spatial, and Qualities of Hearing Scale; Gatehouse & Noble, 2004) were repeated after 6–7 months of bilateral CI experience. Results Speech recognition and localization were not significantly different between bimodal and unilateral CI. In contrast, performance was significantly better with CI&CI compared with unilateral CI. Speech recognition with CI&CI was significantly better than with CI&HA for 2 of 4 participants. Localization was significantly better for all participants with CI&CI compared with CI&HA. CI&CI performance was rated as significantly better on the Speech, Spatial, and Qualities of Hearing Scale compared with CI&HA. Conclusions There was a strong preference for CI&CI for all participants. The variability in speech recognition and localization, however, suggests that performance under these stimulus conditions is individualized. Differences in hearing and/or HA history may explain performance differences.


2019 ◽  
Vol 40 (3) ◽  
pp. 621-635 ◽  
Author(s):  
Arlene C. Neuman ◽  
Annette Zeman ◽  
Jonathan Neukam ◽  
Binhuan Wang ◽  
Mario A. Svirsky

2012 ◽  
Vol 23 (08) ◽  
pp. 577-589 ◽  
Author(s):  
Mary Rudner ◽  
Thomas Lunner ◽  
Thomas Behrens ◽  
Elisabet Sundewall Thorén ◽  
Jerker Rönnberg

Background: Recently there has been interest in using subjective ratings as a measure of perceived effort during speech recognition in noise. Perceived effort may be an indicator of cognitive load. Thus, subjective effort ratings during speech recognition in noise may covary both with signal-to-noise ratio (SNR) and individual cognitive capacity. Purpose: The present study investigated the relation between subjective ratings of the effort involved in listening to speech in noise, speech recognition performance, and individual working memory (WM) capacity in hearing impaired hearing aid users. Research Design: In two experiments, participants with hearing loss rated perceived effort during aided speech perception in noise. Noise type and SNR were manipulated in both experiments, and in the second experiment hearing aid compression release settings were also manipulated. Speech recognition performance was measured along with WM capacity. Study Sample: There were 46 participants in all with bilateral mild to moderate sloping hearing loss. In Experiment 1 there were 16 native Danish speakers (eight women and eight men) with a mean age of 63.5 yr (SD = 12.1) and average pure tone (PT) threshold of 47. 6 dB (SD = 9.8). In Experiment 2 there were 30 native Swedish speakers (19 women and 11 men) with a mean age of 70 yr (SD = 7.8) and average PT threshold of 45.8 dB (SD = 6.6). Data Collection and Analysis: A visual analog scale (VAS) was used for effort rating in both experiments. In Experiment 1, effort was rated at individually adapted SNRs while in Experiment 2 it was rated at fixed SNRs. Speech recognition in noise performance was measured using adaptive procedures in both experiments with Dantale II sentences in Experiment 1 and Hagerman sentences in Experiment 2. WM capacity was measured using a letter-monitoring task in Experiment 1 and the reading span task in Experiment 2. Results: In both experiments, there was a strong and significant relation between rated effort and SNR that was independent of individual WM capacity, whereas the relation between rated effort and noise type seemed to be influenced by individual WM capacity. Experiment 2 showed that hearing aid compression setting influenced rated effort. Conclusions: Subjective ratings of the effort involved in speech recognition in noise reflect SNRs, and individual cognitive capacity seems to influence relative rating of noise type.


2008 ◽  
Vol 19 (02) ◽  
pp. 120-134 ◽  
Author(s):  
Kate Gfeller ◽  
Jacob Oleson ◽  
John F. Knutson ◽  
Patrick Breheny ◽  
Virginia Driscoll ◽  
...  

The research examined whether performance by adult cochlear implant recipients on a variety of recognition and appraisal tests derived from real-world music could be predicted from technological, demographic, and life experience variables, as well as speech recognition scores. A representative sample of 209 adults implanted between 1985 and 2006 participated. Using multiple linear regression models and generalized linear mixed models, sets of optimal predictor variables were selected that effectively predicted performance on a test battery that assessed different aspects of music listening. These analyses established the importance of distinguishing between the accuracy of music perception and the appraisal of musical stimuli when using music listening as an index of implant success. Importantly, neither device type nor processing strategy predicted music perception or music appraisal. Speech recognition performance was not a strong predictor of music perception, and primarily predicted music perception when the test stimuli included lyrics. Additionally, limitations in the utility of speech perception in predicting musical perception and appraisal underscore the utility of music perception as an alternative outcome measure for evaluating implant outcomes. Music listening background, residual hearing (i.e., hearing aid use), cognitive factors, and some demographic factors predicted several indices of perceptual accuracy or appraisal of music. La investigación examinó si el desempeño, por parte de adultos receptores de un implante coclear, sobre una variedad de pruebas de reconocimiento y evaluación derivadas de la música del mundo real, podrían predecirse a partir de variables tecnológicas, demográficas y de experiencias de vida, así como de puntajes de reconocimiento del lenguaje. Participó una muestra representativa de 209 adultos implantados entre 1965 y el 2006. Usando múltiples modelos de regresión lineal y modelos mixtos lineales generalizados, se seleccionaron grupos de variables óptimas de predicción, que pudieran predecir efectivamente el desempeño por medio de una batería de pruebas que permitiera evaluar diferentes aspectos de la apreciación musical. Estos análisis establecieron la importancia de distinguir entre la exactitud en la percepción musical y la evaluación de estímulos musicales cuando se utiliza la apreciación musical como un índice de éxito en la implantación. Importantemente, ningún tipo de dispositivo o estrategia de procesamiento predijo la percepción o la evaluación musical. El desempeño en el reconocimiento del lenguaje no fue un elemento fuerte de predicción, y llegó a predecir primariamente la percepción musical cuando los estímulos de prueba incluyeron las letras. Adicionalmente, las limitaciones en la utilidad de la percepción del lenguaje a la hora de predecir la percepción y la evaluación musical, subrayan la utilidad de la percepción de la música como una medida alternativa de resultado para evaluar la implantación coclear. La música de fondo, la audición residual (p.e., el uso de auxiliares auditivos), los factores cognitivos, y algunos factores demográficos predijeron varios índices de exactitud y evaluación perceptual de la música.


Author(s):  
Poonam Raj ◽  
Ruchika Mittal

<p class="abstract"><strong>Background:</strong> With the steady increase in unilateral cochlear implant surgery as management of bilateral sensorineural hearing loss, the benefits of bimodal hearing have been well documented. However very few studies are available on the timing of bimodal hearing stimulation after cochlear implantation. The present study deals with when to provide bimodal hearing in unilaterally implanted children to achieve maximum benefit<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> This study was carried out in 120 children aged between 3-5 years who underwent unilateral cochlear implant surgery. The implant was switched-on two weeks after surgery in all cases. The children were randomized into two groups of 60 each. Group 1 comprised of children who continued to use hearing aid in the non-implanted ear immediately after the cochlear implant surgery. Group 2 children discontinued using hearing aid in the non-implanted ear after surgery and restarted its usage after four weeks of switch on of the cochlear implant. The progress in both groups was monitored using category of auditory performance (CAP) scores and through a questionnaire<span lang="EN-IN">.  </span></p><p class="abstract"><strong>Results:</strong> The mean age of the children was 3.55 years. 11.6 % of the recipients could localize sounds and 5% could understand speech in noisy environment in Group 2 whereas in 1.7% of the recipients could localize sounds and none of the recipient could understand speech in noisy environment in Group 1 after 3 months of follow up.  CAP scores increased steadily in Group 2 over the study period whereas Group 1 recipients did not show the same progress<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> We recommend that bimodal fitting should be the standard practice for clinical management of children who receive unilateral cochlear implant. The best practice is to restart the use of the hearing aid in the non-implanted ear, after one month of activation of the implant to achieve maximum benefit<span lang="EN-IN">.</span></p>


Author(s):  
Snandan Sharma ◽  
Waldo Nogueira ◽  
A. John van Opstal ◽  
Josef Chalupper ◽  
Lucas H. M. Mens ◽  
...  

Purpose Speech understanding in noise and horizontal sound localization is poor in most cochlear implant (CI) users with a hearing aid (bimodal stimulation). This study investigated the effect of static and less-extreme adaptive frequency compression in hearing aids on spatial hearing. By means of frequency compression, we aimed to restore high-frequency audibility, and thus improve sound localization and spatial speech recognition. Method Sound-detection thresholds, sound localization, and spatial speech recognition were measured in eight bimodal CI users, with and without frequency compression. We tested two compression algorithms: a static algorithm, which compressed frequencies beyond the compression knee point (160 or 480 Hz), and an adaptive algorithm, which aimed to compress only consonants leaving vowels unaffected (adaptive knee-point frequencies from 736 to 2946 Hz). Results Compression yielded a strong audibility benefit (high-frequency thresholds improved by 40 and 24 dB for static and adaptive compression, respectively), no meaningful improvement in localization performance (errors remained > 30 deg), and spatial speech recognition across all participants. Localization biases without compression (toward the hearing-aid and implant side for low- and high-frequency sounds, respectively) disappeared or reversed with compression. The audibility benefits provided to each bimodal user partially explained any individual improvements in localization performance; shifts in bias; and, for six out of eight participants, benefits in spatial speech recognition. Conclusions We speculate that limiting factors such as a persistent hearing asymmetry and mismatch in spectral overlap prevent compression in bimodal users from improving sound localization. Therefore, the benefit in spatial release from masking by compression is likely due to a shift of attention to the ear with the better signal-to-noise ratio facilitated by compression, rather than an improved spatial selectivity. Supplemental Material https://doi.org/10.23641/asha.16869485


2003 ◽  
Vol 12 (1) ◽  
pp. 41-51 ◽  
Author(s):  
Paula Henry ◽  
Todd Ricketts

Improving the signal-to-noise ratio (SNR) for individuals with hearing loss who are listening to speech in noise provides an obvious benefit. Although binaural hearing provides the greatest advantage over monaural hearing in noise, some individuals with symmetrical hearing loss choose to wear only one hearing aid. The present study tested the hypothesis that individuals with symmetrical hearing loss fit with one hearing aid would demonstrate improved speech recognition in background noise with increases in head turn. Fourteen individuals were fit monaurally with a Starkey Gemini in-the-ear (ITE) hearing aid with directional and omnidirectional microphone modes. Speech recognition performance in noise was tested using the audiovisual version of the Connected Speech Test (CST v.3). The test was administered in auditory-only conditions as well as with the addition of visual cues for each of three head angles: 0°, 20°, and 40°. Results indicated improvement in speech recognition performance with changes in head angle for the auditory-only presentation mode at the 20° and 40° head angles when compared to 0°. Improvement in speech recognition performance for the auditory + visual mode was noted for the 20° head angle when compared to 0°. Additionally, a decrement in speech recognition performance for the auditory + visual mode was noted for the 40° head angle when compared to 0°. These results support a speech recognition advantage for listeners fit with one ITE hearing aid listening in a close listener-to-speaker distance when they turn their head slightly in order to increase signal intensity.


2010 ◽  
Vol 21 (07) ◽  
pp. 441-451 ◽  
Author(s):  
René H. Gifford ◽  
Lawrence J. Revit

Background: Although cochlear implant patients are achieving increasingly higher levels of performance, speech perception in noise continues to be problematic. The newest generations of implant speech processors are equipped with preprocessing and/or external accessories that are purported to improve listening in noise. Most speech perception measures in the clinical setting, however, do not provide a close approximation to real-world listening environments. Purpose: To assess speech perception for adult cochlear implant recipients in the presence of a realistic restaurant simulation generated by an eight-loudspeaker (R-SPACE™) array in order to determine whether commercially available preprocessing strategies and/or external accessories yield improved sentence recognition in noise. Research Design: Single-subject, repeated-measures design with two groups of participants: Advanced Bionics and Cochlear Corporation recipients. Study Sample: Thirty-four subjects, ranging in age from 18 to 90 yr (mean 54.5 yr), participated in this prospective study. Fourteen subjects were Advanced Bionics recipients, and 20 subjects were Cochlear Corporation recipients. Intervention: Speech reception thresholds (SRTs) in semidiffuse restaurant noise originating from an eight-loudspeaker array were assessed with the subjects' preferred listening programs as well as with the addition of either Beam™ preprocessing (Cochlear Corporation) or the T-Mic® accessory option (Advanced Bionics). Data Collection and Analysis: In Experiment 1, adaptive SRTs with the Hearing in Noise Test sentences were obtained for all 34 subjects. For Cochlear Corporation recipients, SRTs were obtained with their preferred everyday listening program as well as with the addition of Focus preprocessing. For Advanced Bionics recipients, SRTs were obtained with the integrated behind-the-ear (BTE) mic as well as with the T-Mic. Statistical analysis using a repeated-measures analysis of variance (ANOVA) evaluated the effects of the preprocessing strategy or external accessory in reducing the SRT in noise. In addition, a standard t-test was run to evaluate effectiveness across manufacturer for improving the SRT in noise. In Experiment 2, 16 of the 20 Cochlear Corporation subjects were reassessed obtaining an SRT in noise using the manufacturer-suggested “Everyday,” “Noise,” and “Focus” preprocessing strategies. A repeated-measures ANOVA was employed to assess the effects of preprocessing. Results: The primary findings were (i) both Noise and Focus preprocessing strategies (Cochlear Corporation) significantly improved the SRT in noise as compared to Everyday preprocessing, (ii) the T-Mic accessory option (Advanced Bionics) significantly improved the SRT as compared to the BTE mic, and (iii) Focus preprocessing and the T-Mic resulted in similar degrees of improvement that were not found to be significantly different from one another. Conclusion: Options available in current cochlear implant sound processors are able to significantly improve speech understanding in a realistic, semidiffuse noise with both Cochlear Corporation and Advanced Bionics systems. For Cochlear Corporation recipients, Focus preprocessing yields the best speech-recognition performance in a complex listening environment; however, it is recommended that Noise preprocessing be used as the new default for everyday listening environments to avoid the need for switching programs throughout the day. For Advanced Bionics recipients, the T-Mic offers significantly improved performance in noise and is recommended for everyday use in all listening environments.


2005 ◽  
Vol 114 (11) ◽  
pp. 886-893 ◽  
Author(s):  
Li Xu ◽  
Teresa A. Zwolan ◽  
Catherine S. Thompson ◽  
Bryan E. Pfingst

Objectives: The present study was performed to evaluate the efficacy and clinical feasibility of using monopolar stimulation with the Clarion Simultaneous Analog Stimulation (SAS) strategy in patients with cochlear implants. Methods: Speech recognition by 10 Clarion cochlear implant users was evaluated by means of 4 different speech processing strategy/electrode configuration combinations; ie, SAS and Continuous Interleaved Sampling (CIS) strategies were each used with monopolar (MP) and bipolar (BP) electrode configurations. The test measures included consonants, vowels, consonant-nucleus-consonant words, and Hearing in Noise Test sentences with a +10 dB signal-to-noise ratio. Additionally, subjective judgments of sound quality were obtained for each strategy/configuration combination. Results: All subjects but 1 demonstrated open-set speech recognition with the SAS/MP combination. The group mean Hearing in Noise Test sentence score for the SAS/MP combination was 31.6% (range, 0% to 92%) correct, as compared to 25.0%, 46.7%, and 37.8% correct for the CIS/BP, CIS/MP, and SAS/BP combinations, respectively. Intersubject variability was high, and there were no significant differences in mean speech recognition scores or mean preference ratings among the 4 strategy/configuration combinations tested. Individually, the best speech recognition performance was with the subject's everyday strategy/configuration combination in 72% of the applicable cases. If the everyday strategy was excluded from the analysis, the subjects performed best with the SAS/MP combination in 37.5% of the remaining cases. Conclusions: The SAS processing strategy with an MP electrode configuration gave reasonable speech recognition in most subjects, even though subjects had minimal previous experience with this strategy/configuration combination. The SAS/MP combination might be particularly appropriate for patients for whom a full dynamic range of electrical hearing could not be achieved with a BP configuration.


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