The Effects of Paired versus Sequential Stimulation on Speech Recognition Outcomes of Adult Cochlear Implant Recipients

2021 ◽  
pp. 1-7
Author(s):  
Meredith A. Holcomb ◽  
James R. Dornhoffer ◽  
Theodore R McRackan
Keyword(s):  
Speech Recognition ◽  
Confidence Interval ◽  
Cochlear Implant ◽  
Recognition Performance ◽  
Medical Center ◽  
Demographic Data ◽  
Academic Medical Center ◽  
Processing Strategy ◽  
Sound Processing ◽  
Processing Strategies

<b><i>Purpose:</i></b> Cochlear implant (CI) sound-processing strategies are important to the overall success of a CI recipient. This study aimed to determine the effects of 2 Advanced Bionics (AB) CI-processing strategies, Optima-S and Optima-P, on speech recognition outcomes in adult CI users. <b><i>Methods:</i></b> A retrospective chart review was completed at a tertiary academic medical center. Seventeen post-lingually deafened adult CI users (median age = 58.6 years; age range: 23.5–78.9 years) with long-term use of a paired sound-processing strategy (Optima-P) were reprogrammed with a sequential strategy (Optima-S). Demographic data and speech recognition scores with pre- and post-intervention analyses were collected and compared with respect to the 95% confidence interval for common CI word and sentence recognition tests. <b><i>Results:</i></b> Using Optima-S sound-processing strategy, all patients (100%) performed equivalent or better on word and sentence testing than with Optima-P. More specifically, 17.6, 41.2, and 58.8% of the patients performed above the 95% confidence interval for speech recognition conditions of monosyllabic words, sentences in quiet, and sentences in noise, respectively. All patients (100%) selected Optima-S as their preferred strategy for future CI use. <b><i>Conclusion:</i></b> Speech recognition performance with Optima-S processing strategy was stable or improved compared to results with Optima-P in all tested conditions, and subjective preference of Optima-S was selected by all patients. Given these results, CI clinicians should consider programming AB CI users with Optima-S sound-processing strategy to optimize overall speech recognition performance.

Efficacy of a Cochlear Implant Simultaneous Analog Stimulation Strategy Coupled with a Monopolar Electrode Configuration

2005 ◽  
Vol 114 (11) ◽  
pp. 886-893 ◽  
Author(s):  
Li Xu ◽  
Teresa A. Zwolan ◽  
Catherine S. Thompson ◽  
Bryan E. Pfingst
Keyword(s):  
Speech Recognition ◽  
Cochlear Implant ◽  
Speech Processing ◽  
Dynamic Range ◽  
Recognition Performance ◽  
Electrode Configuration ◽  
Processing Strategy ◽  
Open Set ◽  
Hearing In Noise ◽  
Noise Test

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.

scholarly journals Preimplant Hearing Aid Fittings and Aided Audibility for Pediatric Cochlear Implant Recipients

2019 ◽  
Vol 30 (08) ◽  
pp. 703-711 ◽  
Author(s):  
Alissa Nickerson ◽  
Lisa S. Davidson ◽  
Rosalie M. Uchanski
Keyword(s):  
Speech Recognition ◽  
Speech Perception ◽  
Cochlear Implant ◽  
Hearing Aids ◽  
Speech Intelligibility ◽  
Recognition Performance ◽  
Demographic Data ◽  
The United States ◽  
Mean Deviation ◽  
The Relationship

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.

Speech Recognition as a Function of the Number of Electrodes Used in the SPEAK Cochlear Implant Speech Processor

1997 ◽  
Vol 40 (5) ◽  
pp. 1201-1215 ◽  
Author(s):  
Kim E. Fishman ◽  
Robert V. Shannon ◽  
William H. Slattery
Keyword(s):  
Speech Recognition ◽  
Cochlear Implant ◽  
Speech Processing ◽  
Recognition Performance ◽  
Spectral Information ◽  
Processing Strategy ◽  
Speech Processor ◽  
Average Performance ◽  
Speech Stimuli ◽  
Monosyllabic Words

Speech recognition was measured in listeners with the Nucleus-22 SPEAK speech processing strategy as a function of the number of electrodes. Speech stimuli were analyzed into 20 frequency bands and processed according to the usual SPEAK processing strategy. In the normal clinical processor each electrode is assigned to represent the output of one filter. To create reduced-electrode processors the output of several adjacent filters were directed to a single electrode, resulting in processors with 1, 2, 4, 7, 10, and 20 electrodes. The overall spectral bandwidth was preserved, but the number of active electrodes was progressively reduced. After a 2-day period of adjustment to each processor, speech recognition performance was measured on medial consonants, vowels, monosyllabic words, and sentences. Performance with a single electrode processor was poor in all listeners, and average performance increased dramatically on all test materials as the number of electrodes was increased from 1 to 4. No differences in average performance were observed on any test in the 7-, 10-, and 20-electrode conditions. On sentence and consonant tests there was no difference between average performance with the 4-electrode and 20-electrode processors. This pattern of results suggests that cochlear implant listeners are not able to make full use of the spectral information on all 20 electrodes. Further research is necessary to understand the reasons for this limitation and to understand how to increase the amount of spectral information in speech received by implanted listeners.

scholarly journals Multivariate Predictors of Music Perception and Appraisal by Adult Cochlear Implant Users

2008 ◽  
Vol 19 (02) ◽  
pp. 120-134 ◽  
Author(s):  
Kate Gfeller ◽  
Jacob Oleson ◽  
John F. Knutson ◽  
Patrick Breheny ◽  
Virginia Driscoll ◽  
...  
Keyword(s):  
Speech Recognition ◽  
Cochlear Implant ◽  
Music Perception ◽  
Life Experience ◽  
Recognition Performance ◽  
Strong Predictor ◽  
Music Listening ◽  
Linear Regression Models ◽  
Hearing Aid Use ◽  
Music Appraisal

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.

scholarly journals Association between Interleukin-6 Levels and Perioperative Fatigue in Gastric Adenocarcinoma Patients

2019 ◽  
Vol 8 (4) ◽  
pp. 543 ◽  
Author(s):  
Jin-Ming Wu ◽  
Hui-Ting Yang ◽  
Te-Wei Ho ◽  
Shiow-Ching Shun ◽  
Ming-Tsan Lin
Keyword(s):  
Confidence Interval ◽  
Gastric Adenocarcinoma ◽  
Cancer Cachexia ◽  
Medical Center ◽  
Academic Medical Center ◽  
Gastric Surgery ◽  
Time Points ◽  
Cell Counts ◽  
Cytokine Levels ◽  
The Mean

Background: Gastric adenocarcinoma (GA), one of the most common gastrointestinal cancers worldwide, is often accompanied by cancer cachexia in the advanced stage owing to malnutrition and cancer-related symptoms. Although resection is the most effective curative procedure for GA patients, it may cause perioperative fatigue, worsening the extent of cancer cachexia. Although the relationship between cytokines and cancer fatigue has been evaluated, it is unclear which cytokines are associated with fatigue in GA patients. Therefore, this study aimed to investigate whether the changes in cytokine levels were associated with the perioperative changes in fatigue amongst GA patients. Methods: We included GA patients undergoing gastric surgery in a single academic medical center between June 2017 and December 2018. Fatigue-related questionnaires, serum cytokine levels (interferon-gamma, interleukin (IL)-1, IL-2, IL-5, IL-6, IL-12 p70, tumor necrosis factor-alpha, and granulocyte-macrophage colony-stimulating factor), and biochemistry profiles (albumin, prealbumin, C-reactive protein, and white blood cell counts) were assessed at three time points (preoperative day 0 (POD 0), post-operative day 1 (POD 1), and postoperative day 7 (POD 7)). We used the Brief Fatigue Inventory-Taiwan Form to assess the extent of fatigue. The change in fatigue scores among the three time points, as an independent variable, was adjusted for clinicopathologic characteristics, malnutrition risk, and cancer stages. Results: A total of 34 patients were included for analysis, including 12 female and 22 male patients. The mean age was 68.9 years. The mean score for fatigue on POD 0, POD 1, and POD 7 was 1.7, 6.2, and 3.6, respectively, with significant differences among the three time points (P < 0.001). Among the cytokines, only IL-6 was significantly elevated from POD 0 to POD 1. In the regression model, the change in IL-6 levels between POD 0 and POD 1 (coefficients = 0.01 for every 1 pg/mL increment; 95% confidence interval: 0.01–0.02; P = 0.037) and high malnutrition risk (coefficients = 2.80; 95% confidence interval: 1.45–3.52; P = 0.041) were significantly associated with changes in fatigue scores. Conclusions: The perioperative changes in plasma IL-6 levels are positively associated with changes in the fatigue scores of GA patients undergoing gastric surgery. Targeting the IL-6 signaling cascade or new fatigue-targeting medications may attenuate perioperative fatigue, and further clinical studies should be designed to validate this hypothesis.

scholarly journals Speech Perception for Adult Cochlear Implant Recipients in a Realistic Background Noise: Effectiveness of Preprocessing Strategies and External Options for Improving Speech Recognition in Noise

2010 ◽  
Vol 21 (07) ◽  
pp. 441-451 ◽  
Author(s):  
René H. Gifford ◽  
Lawrence J. Revit
Keyword(s):  
Speech Recognition ◽  
Speech Perception ◽  
Cochlear Implant ◽  
Repeated Measures ◽  
Recognition Performance ◽  
Single Subject ◽  
Repeated Measures Design ◽  
Listening Environments ◽  
Improved Performance ◽  
Listening In Noise

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.

Speech Perception Performance in Experienced Cochlear-Implant Patients Receiving the SPEAK Processing Strategy in the Nucleus Spectra-22 Cochlear Implant

1998 ◽  
Vol 41 (5) ◽  
pp. 1073-1087 ◽  
Author(s):  
Aaron J. Parkinson ◽  
Wendy S. Parkinson ◽  
Richard S. Tyler ◽  
Mary W. Lowder ◽  
Bruce J. Gantz
Keyword(s):  
Speech Recognition ◽  
Speech Perception ◽  
Cochlear Implant ◽  
Sound Quality ◽  
Learning Effects ◽  
Processing Strategy ◽  
Subjective Ratings ◽  
Open Set ◽  
Wide Range

Sixteen experienced cochlear implant patients with a wide range of speechperception abilities received the SPEAK processing strategy in the Nucleus Spectra-22 cochlear implant. Speech perception was assessed in quiet and in noise with SPEAK and with the patients' previous strategies (for most, Multipeak) at the study onset, as well as after using SPEAK for 6 months. Comparisons were made within and across the two test sessions to elucidate possible learning effects. Patients were also asked to rate the strategies on seven speech recognition and sound quality scales. After 6 months' experience with SPEAK, patients showed significantly improved mean performance on a range of speech recognition measures in quiet and noise. When mean subjective ratings were compared over time there were no significant differences noted between strategies. However, many individuals rated the SPEAK strategy better for two or more of the seven subjective measures. Ratings for "appreciation of music" and "quality of my own voice" in particular were generally higher for SPEAK. Improvements were realized by patients with a wide range of speech perception abilities, including those with little or no open-set speech recognition.

scholarly journals The Prescribing and Education of Naloxone in a Large Academic Medical Center

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 31
Author(s):  
Sabrina Miller ◽  
Lauren Williams ◽  
Amy N. Thompson
Keyword(s):  
Medical Center ◽  
Demographic Data ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Reversal Agents ◽  
Outpatient Prescription ◽  
Current State ◽  
Academic Medical ◽  
History Of ◽  
Improvement Measures

The opioid epidemic has led to increased needs for opioid reversal agents which require education and counseling for proper use. The purpose of this study was to evaluate outpatient naloxone prescribing and education practices at an academic medical center to understand the current state and inform quality improvement measures. This retrospective chart review study included 439 patients that were at least 18 years old and received an outpatient prescription for naloxone between 1 July 2017 and 30 June 2018. Descriptive and demographic data were collected. The primary endpoint was whether an indication for naloxone and education on administration were documented when naloxone was initially prescribed to patients. Overall, 39% of naloxone prescriptions did not have an indication for prescribing listed in the medical record. Of those with a documented indication, concomitant benzodiazepines and history of overdose or substance abuse were most common (22% and 14%). The average morphine milligram equivalents were 165. Additionally, 69% of dispenses did not have documentation that the patient or a caregiver received education regarding the use and administration of naloxone. These findings suggest that patients are receiving naloxone for appropriate indications. Documentation of medication education is needed to ensure it is occurring and that patients are informed.

scholarly journals Metastatic Tumors of the Sinonasal Cavity: A 15-Year Review of 17 Cases

2019 ◽  
Vol 8 (4) ◽  
pp. 539 ◽  
Author(s):  
Miao-Hsu Chang ◽  
Ying-Ju Kuo ◽  
Ching-Yin Ho ◽  
Edward C. Kuan ◽  
Ming-Ying Lan
Keyword(s):  
Medical Center ◽  
Metastatic Cancer ◽  
Demographic Data ◽  
Academic Medical Center ◽  
Tumor Resection ◽  
Palliative Therapy ◽  
Previous History ◽  
Rare Condition ◽  
Treatment Modalities ◽  
Patient Demographic Data

Extranasal cancers that metastasize to the sinonasal cavity are very rare. To date, there are only limited reports regarding this rare condition within the literature. Therefore, we retrospectively reviewed all patients diagnosed with metastatic cancer of the sinonasal tract from 2003 to 2018 at a tertiary academic medical center. Patient demographic data, clinical presentation, treatment modalities, and outcomes were investigated. There were a total of 17 patients (9 males and 8 females) included in the analysis. The mean age was 56.8 years (range 27–80). The most common primary malignancies were hepatocellular carcinoma (n = 3) and gastrointestinal tract adenocarcinoma (n = 3). The most common site of metastasis was the nasal cavity (n = 8). Five patients received radical tumor resection and the others underwent radiotherapy, chemotherapy, or combined chemoradiotherapy. The 2-year survival was 28%. In summary, metastasis to the sinonasal cavity remains extremely rare. A high degree of suspicion regarding the possibility of metastatic spread to the sinonasal region is necessary for patients with a previous history of malignancy who present with new sinonasal symptoms. The treatment strategy of sinonasal metastatic cancer is usually palliative therapy and the prognosis remains poor. However, early detection and diagnosis, coupled with aggressive treatment, may improve patient quality of life.

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