Prognostic Indicators of Speech Recognition Performance in Postlinguistically Deafened Adult Cochlear Implant Users

Author(s):  
D. Shipp ◽  
J. Nedzelski ◽  
J. Chen ◽  
L. Hanusaik
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.


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.


Author(s):  
Ning Zhou ◽  
Zhen Zhu ◽  
Lixue Dong ◽  
John Galvin

AbstractIn cochlear implants, loudness has been shown to grow more slowly with increasing pulse phase duration (PPD) than with pulse amplitude (PA), possibly due to “leaky” charge integration. This leakiness has been recently quantified in terms of “charge integration efficiency,” defined as the log difference between the PPD dynamic range and PA dynamic range (both expressed in charge units), relative to a common threshold anchor. Such leakiness may differ across electrodes and/or test ears, and may reflect underlying neural health. In this study, we examined the across-site variation of charge integration in recipients of Cochlear© devices. PPD and PA dynamic ranges were measured relative to two threshold anchors with either a 25- or 50-microsecond PPD. Strength-duration functions, previously shown to relate to survival of spiral ganglion cells and peripheral processes, were compared to charge integration efficiency on selected electrodes. Results showed no significant or systematic relationship between the across-site variation in charge integration efficiency and electrode position or threshold levels. Charge integration efficiency was poorer with the 50-μs threshold anchor, suggesting that greater leakiness was associated with larger PPD dynamic ranges. Poorer and more variable charge integration efficiency across electrodes was associated with longer duration of any hearing loss, consistent with the idea that poor integration is related to neural degeneration. More variable integration efficiency was also associated with poorer speech recognition performance across test ears. The slopes of the strength-duration functions at maximum acceptable loudness were significantly correlated with charge integration efficiency. However, the strength-duration slopes were not predictive of duration of any hearing loss or speech recognition performance in our participants. As such, charge integration efficiency may be a better candidate to measure leakiness in neural populations across the electrode array, as well as the general health of the auditory nerve in human cochlear implant recipients.


Author(s):  
Sharon Miller ◽  
Jace Wolfe ◽  
Mila Duke ◽  
Erin Schafer ◽  
Smita Agrawal ◽  
...  

Abstract Background Cochlear implant (CI) recipients frequently experience difficulty understanding speech over the telephone and rely on hearing assistive technology (HAT) to improve performance. Bilateral inter-processor audio streaming technology using nearfield magnetic induction is an advanced technology incorporated within a hearing aid or CI processor that can deliver telephone audio signals captured at one sound processor to the sound processor at the opposite ear. To date, limited data exist examining the efficacy of this technology in CI users to improve speech understanding on the telephone. Purpose The primary objective of this study was to examine telephone speech recognition outcomes in bilateral CI recipients in a bilateral inter-processor audio streaming condition (DuoPhone) compared with a monaural condition (i.e., telephone listening with one sound processor) in quiet and in background noise. Outcomes in the monaural and bilateral conditions using either a telecoil or T-Mic2 technology were also assessed. The secondary aim was to examine how deactivating microphone input in the contralateral processor in the bilateral wireless streaming conditions, and thereby modifying the signal-to-noise ratio, affected speech recognition in noise. Research Design A repeated-measures design was used to evaluate speech recognition performance in quiet and competing noise with the telephone signal transmitted acoustically or via the telecoil to the ipsilateral sound processor microphone in monaural and bilateral wireless streaming listening conditions. Study Sample Nine bilateral CI users with Advanced Bionics HiRes 90K and/or CII devices were included in the study. Data Collection and Analysis The effects of phone input (monaural [DuoPhone Off] vs. bilateral [DuoPhone on]) and processor input (T-Mic2 vs. telecoil) on word recognition in quiet and noise were assessed using separate repeated-measures analysis of variance. Effect of the contralateral device mic deactivation on speech recognition outcomes for the T-Mic2 DuoPhone conditions was assessed using paired Student's t-tests. Results Telephone speech recognition was significantly better in the bilateral inter-processor streaming conditions relative to the monaural conditions in both quiet and noise. Speech recognition outcomes were similar in quiet and noise when using the T-Mic2 and telecoil in the monaural and bilateral conditions. For the acoustic DuoPhone conditions using the T-Mic2, speech recognition in noise was significantly better when the microphone of the contralateral processor was disabled. Conclusion Inter-processor audio streaming allows for bilateral listening on the telephone and produces better speech recognition in quiet and in noise compared with monaural listening conditions for adult CI recipients.


2019 ◽  
Vol 30 (08) ◽  
pp. 703-711 ◽  
Author(s):  
Alissa Nickerson ◽  
Lisa S. Davidson ◽  
Rosalie M. Uchanski

AbstractAudibility of speech for children with hearing loss (HL) depends on the degree of HL and the fitting of the hearing aids (HAs) themselves. Many studies on cochlear implant (CI) users have demonstrated that preimplant hearing is associated with postimplant outcomes, but there have been very few reports on the fitting of HAs before surgery.The aims of this study were to characterize HA fittings and aided audibility of speech for pediatric HA users with severe to profound HL and to examine the relation between preimplant aided audibility and postimplant speech perception.A descriptive/observational and correlational study. Audiologic records of pediatric CI participants involved in a larger study examining the effects of early acoustic hearing were analyzed retrospectively; when available, these records included HA verification and speech recognition performance.The CI participants were enrolled in audiology centers and oral schools for the deaf across the United States.To determine whether deviations from prescribed DSL target were significantly greater than zero, 95% confidence intervals of the mean deviation were calculated for each frequency (250, 500, 1000, 2000, and 4000 Hz). Correlational analyses were used to examine the relationship between preimplant aided Speech Intelligibility Indices (SIIs) and postimplant speech perception in noise. Correlational analyses were also used to explore the relationship between preimplant aided SIIs and demographic data. T-tests were used to compare preimplant-aided SIIs of HAs of listeners who later became users of either sequential CIs, simultaneous CIs, or bimodal devices.Preimplant fittings of HAs were generally very close to prescriptive targets, except at 4000 Hz for those HAs with active frequency-lowering processing, and preimplant SIIs, albeit low, were correlated with postimplant speech recognition performance in noise. These results suggest that aided audibility should be maximized throughout the HA trial for later speech recognition purposes.It is recommended that HA fittings be optimized to support speech audibility even when considering implantation. In addition to the age at which HA use begins, the aided audibility itself is important in determining CI candidacy and decisions regarding bimodal HA use.


1995 ◽  
Vol 4 (3) ◽  
pp. 49-54 ◽  
Author(s):  
Laura K. Holden ◽  
Margaret W. Skinner ◽  
Timothy A. Holden ◽  
Susan M. Binzer

Eight subjects participated in a comparison of the multipeak (MPEAK) and spectral peak (SPEAK) speech coding strategies of the Nucleus TM 22-channel cochlear implant system as part of a long-term monitoring study. Sound-field threshold levels and speech recognition performance on the Bamford-Kowal-Bench Sentence Test, NU-6 Monosyllabic Word Test, and Connected Speech Test or CID Everyday Sentence Test were analyzed for the two speech coding strategies. For the group, speech recognition performance was significantly higher with the SPEAK speech coding strategy than with the MPEAK strategy on all speech tests. For individual subjects, scores with the SPEAK strategy were significantly higher for some subjects on each of the speech tests. None of the subjects scored significantly higher on any of the tests with MPEAK.


2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Ling-Chia Chen ◽  
Pascale Sandmann ◽  
Jeremy D. Thorne ◽  
Martin G. Bleichner ◽  
Stefan Debener

Cochlear implant (CI) users show higher auditory-evoked activations in visual cortex and higher visual-evoked activation in auditory cortex compared to normal hearing (NH) controls, reflecting functional reorganization of both visual and auditory modalities. Visual-evoked activation in auditory cortex is a maladaptive functional reorganization whereas auditory-evoked activation in visual cortex is beneficial for speech recognition in CI users. We investigated their joint influence on CI users’ speech recognition, by testing 20 postlingually deafened CI users and 20 NH controls with functional near-infrared spectroscopy (fNIRS). Optodes were placed over occipital and temporal areas to measure visual and auditory responses when presenting visual checkerboard and auditory word stimuli. Higher cross-modal activations were confirmed in both auditory and visual cortex for CI users compared to NH controls, demonstrating that functional reorganization of both auditory and visual cortex can be identified with fNIRS. Additionally, the combined reorganization of auditory and visual cortex was found to be associated with speech recognition performance. Speech performance was good as long as the beneficial auditory-evoked activation in visual cortex was higher than the visual-evoked activation in the auditory cortex. These results indicate the importance of considering cross-modal activations in both visual and auditory cortex for potential clinical outcome estimation.


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