Sound Localization in Single-Sided Deaf Participants Provided With a Cochlear Implant

Spatial hearing is crucial in real life but deteriorates in participants with severe sensorineural hearing loss or single-sided deafness. This ability can potentially be improved with a unilateral cochlear implant (CI). The present study investigated measures of sound localization in participants with single-sided deafness provided with a CI. Sound localization was measured separately at eight loudspeaker positions (4°, 30°, 60°, and 90°) on the CI side and on the normal-hearing side. Low- and high-frequency noise bursts were used in the tests to investigate possible differences in the processing of interaural time and level differences. Data were compared to normal-hearing adults aged between 20 and 83. In addition, the benefit of the CI in speech understanding in noise was compared to the localization ability. Fifteen out of 18 participants were able to localize signals on the CI side and on the normal-hearing side, although performance was highly variable across participants. Three participants always pointed to the normal-hearing side, irrespective of the location of the signal. The comparison with control data showed that participants had particular difficulties localizing sounds at frontal locations and on the CI side. In contrast to most previous results, participants were able to localize low-frequency signals, although they localized high-frequency signals more accurately. Speech understanding in noise was better with the CI compared to testing without CI, but only at a position where the CI also improved sound localization. Our data suggest that a CI can, to a large extent, restore localization in participants with single-sided deafness. Difficulties may remain at frontal locations and on the CI side. However, speech understanding in noise improves when wearing the CI. The treatment with a CI in these participants might provide real-world benefits, such as improved orientation in traffic and speech understanding in difficult listening situations.

Speech categorization reveals the role of early-stage temporal-coherence processing in auditory scene analysis

Temporal coherence of sound fluctuations across spectral channels is thought to aid auditory grouping and scene segregation. Although prior studies on the neural bases of temporal-coherence processing focused mostly on cortical contributions, neurophysiological evidence suggests that temporal-coherence-based scene analysis may start as early as the cochlear nucleus (i.e., the first auditory region supporting cross-channel processing over a wide frequency range). Accordingly, we hypothesized that aspects of temporal-coherence processing that could be realized in early auditory areas may shape speech understanding in noise. We then explored whether physiologically plausible computational models could account for results from a behavioral experiment that measured consonant categorization in different masking conditions. We tested whether within-channel masking of target-speech modulations predicted consonant confusions across the different conditions, and whether predicted performance was improved by adding across-channel temporal-coherence processing mirroring the computations known to exist in the cochlear nucleus. Consonant confusions provide a rich characterization of error patterns in speech categorization, and are thus crucial for rigorously testing models of speech perception; however, to the best of our knowledge, they have not been utilized in prior studies of scene analysis. We find that within-channel modulation masking can reasonably account for category confusions, but that it fails when temporal fine structure (TFS) cues are unavailable. However, the addition of across-channel temporal-coherence processing significantly improves confusion predictions across all tested conditions. Our results suggest that temporal-coherence processing strongly shapes speech understanding in noise, and that physiological computations that exist early along the auditory pathway may contribute to this process.

The Role of Autosensitivity Control (ASC) in Cochlear Implant Recipients

The purpose of the study was to examine the subjective and objective potential advantage for speech understanding in noise achieved by cochlear implant (CI) recipients when using the autosensitivity control (ASC) input signal processing in combination with the adaptive dynamic range optimization (ADRO). Eighteen subjects (8 females, 10 males, mean age 17.7 ± 6.7) were enrolled in a prospective open blinded comparative study between the ASC + ADRO condition vs. the ADRO alone; 16 were sequential binaural and 2 were monoaural CI recipients. All patients had been wearing their CI for at least 3 years, had no additional disabilities, had an age-appropriate receptive and expressive language. Word recognition performances in noise (at signal-to-noise ratio +5 dB HL) were significantly better in the ADRO-alone condition than in the ADRO + ASC condition. (p = 0.03) These objective outcomes were in agreement with the subjective reports. No significant difference was found in quiet. Our results, apparently in contrast with other reports in the literature, suggest that the decision of adding the slow-acting automatic reduction in microphone sensitivity provided by ASC should be limited to selected CI recipients.

Head Shadow, Summation, and Squelch in Bilateral Cochlear-Implant Users With Linked Automatic Gain Controls

Speech understanding in noise is poorer in bilateral cochlear-implant (BICI) users compared to normal-hearing counterparts. Independent automatic gain controls (AGCs) may contribute to this because adjusting processor gain independently can reduce interaural level differences that BICI listeners rely on for bilateral benefits. Bilaterally linked AGCs may improve bilateral benefits by increasing the magnitude of interaural level differences. The effects of linked AGCs on bilateral benefits (summation, head shadow, and squelch) were measured in nine BICI users. Speech understanding for a target talker at 0° masked by a single talker at 0°, 90°, or −90° azimuth was assessed under headphones with sentences at five target-to-masker ratios. Research processors were used to manipulate AGC type (independent or linked) and test ear (left, right, or both). Sentence recall was measured in quiet to quantify individual interaural asymmetry in functional performance. The results showed that AGC type did not significantly change performance or bilateral benefits. Interaural functional asymmetries, however, interacted with ear such that greater summation and squelch benefit occurred when there was larger functional asymmetry, and interacted with interferer location such that smaller head shadow benefit occurred when there was larger functional asymmetry. The larger benefits for those with larger asymmetry were driven by improvements from adding a better-performing ear, rather than a true binaural-hearing benefit. In summary, linked AGCs did not significantly change bilateral benefits in cases of speech-on-speech masking with a single-talker masker, but there was also no strong detriment across a range of target-to-masker ratios, within a small and diverse BICI listener population.

Cochlear Implant: Effect of the Number of Channel and Frequency Selectivity on Speech Understanding in Noise Preliminary Results in Simulation with Normal-Hearing Subjects

The cochlear implant is the most successful implantable device for the rehabilitation of profound deafness. However, in some cases, the electrical stimulation delivered by the electrode can spread inside the cochlea creating overlap and interaction between frequency channels. By using channel-selection algorithms like the “nofm” coding-strategy, channel interaction can be reduced. This paper describes the preliminary results of experiments conducted with normal hearing subjects (n = 9). Using a vocoder, the present study simulated the hearing through a cochlear implant. Speech understanding in noise was measured by varying the number of selected channels (“nofm”: 4, 8, 12 and 16of20) and the degree of simulated channel interaction (“Low”, “Medium”, “High”). Also, with the vocoder, we evaluated the impact of simulated channel interaction on frequency selectivity by measuring psychoacoustic tuning curves. The results showed a significant average effect of the signal-to-noise ratio (p < 0.0001), the degree of channel interaction (p < 0.0001) and the number of selected channels, (p = 0.029). The highest degree of channel interaction significantly decreases intelligibility as well as frequency selectivity. These results underline the importance of measuring channel interaction for cochlear implanted patients to have a prognostic test and to adjust fitting methods in consequence. The next step of this project will be to transpose these experiments to implant users, to support our results.

Phone Speech Recognition Improvement in Noisy Environment: Use of a Bluetooth Accessory

Objective: To evaluate speech understanding in noise and patient satisfaction using the new Cochlear Wireless Phone Clip device. Material and Methods: Twenty-nine experienced cochlear implant (CI) users (>6 months usage) were situated in a soundproof room where a 65 dB SPL Spanish cocktail noise was generated continuously from 4 loudspeakers. Lists of disyllabic words were presented through the clinic landline telephone to the patients. Patients were tested first holding the phone and then with the Cochlear Phone Clip© paired to the CP910 using various mixing ratios (2:1, 4:1, and Phone Clip© only). Results: Statistically significant ( P < .001) improvement of speech recognition performance was found in cell phone usage by wireless transmission and also when using this new device. Kepler questionnaire results showed that before using Phone Clip in everyday life, 55.2% of patients described themselves highly or greatly affected by their deafness for telephone use and 80% moderately to greatly affected. Kim questionnaire results showed statistically significant differences ( P < .001) in the subjective satisfaction of the Bluetooth-implemented CI compared to the conventional mode for sound quality, noise interference, and sound accuracy. Conclusions: The wireless Phone Clip© device helps implanted people to improve subjective and objective speech recognition performance through the phone in noisy environments.

AutoAdaptive: A Noise Level–Sensitive Beamformer for MED EL Cochlear Implant Patients

When cochlear implant (CI) listeners use a directional microphone or beamformer system to improve speech understanding in noise, the gain in understanding for speech presented from the front of the listener coexists with a decrease in speech understanding from the back. One way to maximize the usefulness of these systems is to keep a microphone in the omnidirectional mode in low noise and then switch to directional mode in high noise.The purpose of this experiment was to assess the levels of speech understanding in noise allowed by a new signal processing algorithm for MED EL CIs, AutoAdaptive, which operates in the manner described previously.Seven listeners fit with bilateral CIs were tested in a simulation of a crowded restaurant with speech presented from the front and from the back at three noise levels, 45, 55, and 65 dB SPL.The listeners were seated in the middle of an array of eight loudspeakers. Sentences from the AzBio sentence lists were presented from loudspeakers at 0 or 180° azimuth. Restaurant noise at 45, 55, and 65 dB SPL was presented from all eight loudspeakers. The speech understanding scores (words correct) were subjected to a two-factor (speaker location and noise level), repeated measures, analysis of variance with posttests.The analysis of variance showed a main effect for level and location and a significant interaction. Posttests showed that speech understanding scores from front and back loudspeakers did not differ significantly at the 45- and 55-dB noise levels but did differ significantly at the 65-dB noise level—with increased scores for signals from the front and decreased scores for signals from the back.The AutoAdaptive feature provides omnidirectional benefit at low noise levels, i.e., similar levels of speech understanding for talkers in front of, and in back of, a listener and beamformer benefit at higher noise levels, i.e., increased speech understanding for signals from in front. The automatic switching feature will be of value to the many patients who prefer not to manually switch programs on their CIs.