One Year Assessment of the Hearing Preservation Potential of the EVO Electrode Array.

BACKGROUND: A prospective longitudinal multicentre study was conducted to assess the one-year postsurgical hearing preservation profile of the EVOTM electrode array. METHODS: Fifteen adults presenting indications of electro-acoustic stimulation (pure-tone audiometry (PTA) thresholds ≤70 dB below 750 Hz) were implanted with the EVO™ electrode array. Hearing thresholds were collected at five time-points from CI activation to twelve months (12M) after activation. Hearing thresholds and hearing preservation profiles (HEARRING group classification) were assessed. RESULTS: All subjects had measurable hearing thresholds at follow-up. No case of complete loss of hearing or minimal hearing preservation was reported at any time point. At activation (Nact = 15), five participants had complete hearing preservation, and ten participants had partial hearing preservation. At the 12M time point (N12m = 6), three participants had complete hearing preservation, and three participants had partial hearing preservation. Mean hearing loss at activation was 11 dB for full range PTA and 25 dB for PTAs low-frequency (125-500 Hz). CONCLUSIONS: This study provides the first longitudinal follow-up on associated hearing profiles to the EVO™ electrode array, which are comparable to the literature. However, other studies on larger populations should be performed.

Adult Users of the Oticon Medical Neuro Cochlear Implant System Benefit from Beamforming in the High Frequencies.

The Oticon Medical Neuro cochlear implant system includes the modes Opti Omni and Speech Omni, the latter providing beamforming (i.e., directional selectivity) in the high frequencies. Two studies compared sentence identification scores of adult cochlear implant users with Opti Omni and Speech Omni. In Study 1, a double-blind longitudinal crossover study, 12 new users trialed Opti Omni or Speech Omni (random allocation) for three months, and their sentence identification in quiet and noise (+10 dB signal-to-noise ratio) with the trialed mode were measured. The same procedure was repeated for the second mode. In Study 2, a single-blind study, 11 experienced users performed a speech identification task in quiet and at relative signal-to-noise ratios ranging from -3 to +18 dB with Opti Omni and Speech Omni. The Study 1 scores in quiet and in noise were significantly better with Speech Omni than with Opti Omni. Study 2 scores were significantly better with Speech Omni than with Opti Omni at +6 and +9 dB signal-to-noise ratios. Beamforming in the high frequencies, as implemented in Speech Omni, leads to improved speech identification in medium levels of background noise, where cochlear implant users spend most of their day.

The Development of the "Telislife" Questionnaire for the Evaluation of Telephone Use in Cochlear Implant Users.

Purpose For cochlear implant users, the ability to use the telephone is often seen as an important landmark during rehabilitation and an indicator of cochlear implant benefit. The goal of this study was to develop a short questionnaire exploring the ability to use the telephone in cochlear implant users, named Telislife, and test it in a group of experienced users. Method This prospective multicenter study was based on the completion of self-administrated questionnaires. The Telislife includes 20 items using a 5-point Likert scale for answers. Speech recognition scores were obtained with monosyllabic word lists at 70 dB HL. Quality of life was evaluated with the Nijmegen Cochlear Implant Questionnaire. This study included 55 adult patients wearing a cochlear implant for over 1 year. Results The Telislife questionnaire showed excellent reliability (Cronbach's α = .91). A significant correlation was found between Telislife scores and Nijmegen Cochlear Implant Questionnaire scores (r = .69, p < .001) and speech recognition scores (r = .35, p = .007). Conclusion Given significant correlations between Telislife scores and both speech recognition and quality of life and given its short form, the Telislife questionnaire appears to be a reliable tool to evaluate cochlear implant outcomes in clinical practice. Supplemental Material https://doi.org/10.23641/asha.13322873.

Pupillometry Assessment of Speech Recognition and Listening Experience in Adult Cochlear Implant Patients.

OBJECTIVE: The aim of the present study was to investigate the pupillary response to word identification in cochlear implant (CI) patients. Authors hypothesized that when task difficulty (i.e., addition of background noise) increased, pupil dilation markers such as the peak dilation or the latency of the peak dilation would increase in CI users, as already observed in normal-hearing and hearing-impaired subjects. METHODS: Pupillometric measures in 10 CI patients were combined to standard speech recognition scores used to evaluate CI outcomes, namely, speech audiometry in quiet and in noise at +10 dB signal-to-noise ratio (SNR). The main outcome measures of pupillometry were mean pupil dilation, maximal pupil dilation, dilation latency, and mean dilation during return to baseline or retention interval. Subjective hearing quality was evaluated by means of one self-reported fatigue questionnaire, and the Speech, Spatial, and Qualities (SSQ) of Hearing scale. RESULTS: All pupil dilation data were transformed to percent change in event-related pupil dilation (ERPD, %). Analyses show that the peak amplitudes for both mean pupil dilation and maximal pupil dilation were higher during the speech-in-noise test. Mean peak dilation was measured at 3.47 ± 2.29% noise vs. 2.19 ± 2.46 in quiet and maximal peak value was detected at 9.17 ± 3.25% in noise vs. 8.72 ± 2.93% in quiet. Concerning the questionnaires, the mean pupil dilation during the retention interval was significantly correlated with the spatial subscale score of the SSQ Hearing scale [r(8) = -0.84, p = 0.0023], and with the global score [r(8) = -0.78, p = 0.0018]. CONCLUSION: The analysis of pupillometric traces, obtained during speech audiometry in quiet and in noise in CI users, provided interesting information about the different processes engaged in this task. Pupillometric measures could be indicative of listening difficulty, phoneme intelligibility, and were correlated with general hearing experience as evaluated by the SSQ of Hearing scale. These preliminary results show that pupillometry constitutes a promising tool to improve objective quantification of CI performance in clinical settings.

The sound sensation of a pure tone in cochlear implant recipients with single-sided deafness.

Ten cochlear implant (CI) users with single-sided deafness were asked to vary the parameters of an acoustic sound played to their contralateral ear to characterize the perception evoked by a pure tone played through the direct audio input of their CI. Two frequencies, centered on an apical and a medial electrode, were tested. In six subjects, the electrode positions were estimated on CT scans. The study was divided in 3 experiments in which the parameters of the acoustic sound varied. The listeners had to vary the frequency of a pure tone (Exp.1), the center frequency and the bandwidth of a filter applied to a harmonic complex sound (Exp.2), and the frequency of the components and the inharmonicity factor of a complex sound (Exp.3). Two testing sessions were performed at 3 and 12 months after activation. The mean results of Exp. 1 showed that the frequency of the matched tone was significantly lower for the apical than for the medial stimulus. In Exp.2, the mean center frequencies of the filters were also significantly lower for the apical than for the medial stimulus. As this parameter modifies the energy ratio between the high and low-frequency components, this result suggests that the medial stimulus was perceived with a brighter timbre than the apical stimulus. In Exp.3, the mean frequencies of the components were not significantly different between the sounds resulting from the stimulation of the two electrodes, but were significantly lower at the12-month session compared to the 3-month visit. These results suggest that a change in place of excitation may be perceived as a change in timbre rather than a change in pitch, and that an effect of adaptation can be observed.

Prospective Multicentric Follow-up Study of Cochlear Implantation in Adults With Single-Sided Deafness: Tinnitus and Audiological Outcomes.

OBJECTIVE: This study investigated the audiological and tinnitus outcomes of cochlear implantation (CI) in adults with single-sided deafness (SSD) and tinnitus. STUDY DESIGN: Multicentered prospective, non-randomized intervention study. SETTING: Six French CI centers. PATIENTS: Twenty-six patients with SSD and incapacitating tinnitus (Tinnitus Handicap Inventory [THI] >58) underwent cochlear implantation. INTERVENTIONS: First, CIs delivered only masking white noise stimulation for 1 month and then standard CI stimulation. MAIN OUTCOME MEASURES: Before and after CI surgery, patients completed the THI, Tinnitus Reaction Questionnaire (TRQ), Subjective Tinnitus Severity Scale (STSS), and two visual analogue scales quantifying tinnitus loudness and annoyance. Speech perception in spatialized noise was tested at 13 months. RESULTS: The first month of white noise stimulation triggered a significant improvement in THI scores (72 ±â€Š9 to 55 ±â€Š20, p < 0.05). No change was observed for the other measures. After 1 year of standard CI stimulation, 23 patients (92%) reported a significant improvement in tinnitus. This improvement started 1 to 2 months after CI and exceeded 40% improvement for 14 patients (54%). Average speech-in-noise perception after 1 year significantly improved for the 23 patients who completed these measures. CONCLUSIONS: CI is efficacious to reduce the handicap of patient with SSD and incapacitating tinnitus, leading to a decrease in reported tinnitus and partial restoration of binaural hearing abilities.

The Oticon Medical Neuro Zti cochlear implant and the Neuro 2 sound processor: multicentric evaluation of outcomes in adults and children.

Objective: This study evaluated the outcomes of the Oticon Medical Neuro Zti cochlear implant and the Neuro 2 sound processor.Design: Neuro One users were upgraded to Neuro 2. Monosyllabic word identification was evaluated in adults with Neuro One after ≥5 months, with Neuro 2 at upgrade, and with Neuro 2 after 3 months. Self-reported listening ability, satisfaction, and usability were measured in adults and children.Study sample: Participants were 44 adults and 26 children.Results: Speech identification scores in quiet and noise were 58% and 45% with Neuro One and 67% and 55% with Neuro 2 after 3 months, respectively. Hearing impairment duration and number of active electrodes significantly predicted speech identification in noise with Neuro 2. Significantly higher questionnaire ratings were obtained for Neuro 2 than Neuro One regarding listening ability in complex listening situations, comfort and music, as well as nine aspects of satisfaction and usability.Conclusion: This study demonstrates the clinical superiority of the Neuro 2 sound processor over Neuro One in terms of speech identification in quiet and in noise and reported patient benefit and satisfaction. Given the study design, sources of improvement may include factors unrelated to the sound processor itself.

The Voice Track multiband single-channel modified Wiener-filter noise reduction system for cochlear implants: patients' outcomes and subjective appraisal.

OBJECTIVE: The aim of this study was to evaluate the potential improvements of speech perception and sound quality provided by a multiband single channel noise-reduction algorithm based on the modified Wiener-filter adapted to cochlear implant sound processing. DESIGN: This study was a longitudinal trial with a repeated-measures design. Outcome measures were performed on the first day when the noise reduction feature was provided and after a one month habituation period. Objective measures included pure-tone thresholds and vocal audiometry assessments. Speech perception was measured in quiet and in the presence of two types of noise: a stationary speech shaped noise and a two-talker cocktail noise. Subjective sound quality was assessed using a ten item questionnaire. STUDY SAMPLE: Thirteen post-lingual deaf adults, experienced users of a cochlear implant system, took part in this study. RESULTS: The noise-reduction algorithm provided a benefit for the perception of speech presented in a stationary speech shaped noise and an overall improvement in subjective sound quality ratings. CONCLUSIONS: It was shown that a single channel noise reduction system based on a modified Wiener-filter approach can improve speech in noise perception performance and subjective sound quality in cochlear implant patients.

Clinical evaluation of the xDP output compression strategy for cochlear implants.

Technological advances in the domain of digital signal processing adapted to cochlear implants (CI) are partially responsible for the ever-improving outcomes observed with this neural prosthesis. The goal of the present study was to evaluate audiometric outcomes with a new signal processing strategy implemented in Oticon Medical-Neurelec cochlear implant systems, the xDP strategy. The core of this approach is a preset-based back-end output compression system, modulating a multi-channel transfer function depending on the intensity and information content of input sounds. Twenty adult CI patients, matched for age and CI experience, were included in this study. Pure-tone thresholds and vocal audiometry scores were measured with their former signal processing strategy and with xDP. Speech perception was assessed using dissyllabic words presented in quiet, at different intensity levels: 40, 55, 70, and 85 dB SPL, and in a cocktail party noise at a signal-to-noise ratio of +10 dB. Results with the xDP strategy showed, as awaited, no major modification of pure-tone thresholds. A global increase of speech perception scores was observed after a 1-month habituation period, with significant improvements for speech perception in quiet for moderate (55 dB SPL), loud speech sounds (85 dB SPL), and speech-in-noise comprehension. Subjective signal quality assessment showed a preference for Crystalis(xDP) over the former strategy. These results allow the quantification of improvements provided by the xDP signal processing strategy.

The intelligibility of interrupted speech depends upon its uninterrupted intelligibility.

Recognition of sentences containing periodic, 5-Hz, silent interruptions of differing duty cycles was assessed for three types of processed speech. Processing conditions employed different combinations of spectral resolution and the availability of fundamental frequency (F0) information, chosen to yield similar, below-ceiling performance for uninterrupted speech. Performance declined with decreasing duty cycle similarly for each processing condition, suggesting that, at least for certain forms of speech processing and interruption rates, performance with interrupted speech may reflect that obtained with uninterrupted speech. This highlights the difficulty in interpreting differences in interrupted speech performance across conditions for which uninterrupted performance is at ceiling.

Importance of temporal-envelope speech cues in different spectral regions.

This study investigated the ability to use temporal-envelope (E) cues in a consonant identification task when presented within one or two frequency bands. Syllables were split into five bands spanning the range 70-7300 Hz with each band processed to preserve E cues and degrade temporal fine-structure cues. Identification scores were measured for normal-hearing listeners in quiet for individual processed bands and for pairs of bands. Consistent patterns of results were obtained in both the single- and dual-band conditions: identification scores increased systematically with band center frequency, showing that E cues in the higher bands (1.8-7.3 kHz) convey greater information.

Perception of temporal fine-structure cues in speech with minimal envelope cues for listeners with mild-to-moderate hearing loss.

The contribution of temporal fine-structure (TFS) cues to consonant identification was compared for seven young adults with normal hearing and five young adults with mild-to-moderate hearing loss and flat, high- or low-frequency gently sloping audiograms. Nonsense syllables were degraded using two schemes (PM: phase modulation; FM: frequency modulation) designed to remove temporal envelope (E) cues while preserving TFS cues in 16 0.35-octave-wide frequency bands spanning the range of 80 to 8020 Hz. For both schemes, hearing-impaired listeners performed significantly above chance level (PM: 36%; FM: 31%; chance level: 6.25%), but more poorly than normal-hearing listeners (PM: 80%; FM: 65%). Three hearing-impaired listeners showed normal or near-normal reception of nasality information. These results indicate that for mild to moderate levels of hearing loss, cochlear damage reduces but does not abolish the ability to use the TFS cues of speech. The deficits observed for both schemes in hearing-impaired listeners suggest involvement of factors other than only poor reconstruction of temporal envelope from temporal fine structure.

Effects of lowpass and highpass filtering on the intelligibility of speech based on temporal fine structure or envelope cues.

This study aimed to assess whether or not temporal envelope (E) and fine structure (TFS) cues in speech convey distinct phonetic information. Syllables uttered by a male and female speaker were (i) processed to retain either E or TFS within 16 frequency bands, (ii) lowpass or highpass filtered at different cut-off frequencies, and (iii) presented for identification to seven listeners. Psychometric functions were fitted using a sigmoid function, and used to determine crossover frequencies (cut-off frequencies at which lowpass and highpass filtering yielded equivalent performance), and gradients at each point of the psychometric functions (change in performance with respect to cut-off frequency). Crossover frequencies and gradients were not significantly different across speakers. Crossover frequencies were not significantly different between E and TFS speech ( approximately 1.5kHz). Gradients were significantly different between E and TFS speech in various filtering conditions. When stimuli were highpass filtered above 2.5kHz, performance was significantly above chance level and gradients were significantly different from 0 for E speech only. These findings suggest that E and TFS convey important but distinct phonetic cues between 1 and 2kHz. Unlike TFS, E conveys information up to 6kHz, consistent with the characteristics of neural phase locking to E and TFS.

Speech identification based on temporal fine structure cues.

The contribution of temporal fine structure (TFS) cues to consonant identification was assessed in normal-hearing listeners with two speech-processing schemes designed to remove temporal envelope (E) cues. Stimuli were processed vowel-consonant-vowel speech tokens. Derived from the analytic signal, carrier signals were extracted from the output of a bank of analysis filters. The "PM" and "FM" processing schemes estimated a phase- and frequency-modulation function, respectively, of each carrier signal and applied them to a sinusoidal carrier at the analysis-filter center frequency. In the FM scheme, processed signals were further restricted to the analysis-filter bandwidth. A third scheme retaining only E cues from each band was used for comparison. Stimuli processed with the PM and FM schemes were found to be highly intelligible (50-80% correct identification) over a variety of experimental conditions designed to affect the putative reconstruction of E cues subsequent to peripheral auditory filtering. Analysis of confusions between consonants showed that the contribution of TFS cues was greater for place than manner of articulation, whereas the converse was observed for E cues. Taken together, these results indicate that TFS cues convey important phonetic information that is not solely a consequence of E reconstruction.

Investigation of perceptual constancy in the temporal-envelope domain.

The ability to discriminate complex temporal envelope patterns submitted to temporal compression or expansion was assessed in normal-hearing listeners. An XAB, matching-to-sample-procedure was used. X, the reference stimulus, is obtained by applying the sum of two, inharmonically related, sinusoids to a broadband noise carrier. A and B are obtained by multiplying the frequency of each modulation component of X by the same time expansion/compression factor, alpha (alphain[0.35-2.83]). For each trial, A or B is a time-reversed rendering of X, and the listeners' task is to choose which of the two is matched by X. Overall, the results indicate that discrimination performance degrades for increasing amounts of time expansion/compression (i.e., when alpha departs from 1), regardless of the frequency spacing of modulation components and the peak-to-trough ratio of the complex envelopes. An auditory model based on envelope extraction followed by a memory-limited, template-matching process accounted for results obtained without time scaling of stimuli, but generally underestimated discrimination ability with either time expansion or compression, especially with the longer stimulus durations. This result is consistent with partial or incomplete perceptual normalization of envelope patterns.

Speech masking release in listeners with flat hearing loss: effects of masker fluctuation rate on identification scores and phonetic feature reception.

Consonant identification was measured for a stationary and amplitude-modulated noise masker in four listeners with flat cochlear hearing loss, and four age-matched normal-hearing listeners. The masker modulation rate was systematically varied between 2 and 128 Hz. Masking release (MR), that is better identification performance in fluctuating, than in stationary noise, was highest in a masker fluctuating at 8-16 Hz in all normal-hearing listeners. In comparison, MR was only observed in two out of the four impaired listeners. In these listeners, MR was poorer than normal, and peaked at lower rates, that is 2 or 8 Hz. MR corresponded to increased reception of information for voicing, place, and manner between 2 and 64 Hz in all normal-hearing listeners. In impaired listeners, increased reception of information was mainly observed for manner, and mainly reduced for place, but these differences were not significant. For all phonetic features, MR was observed at lower masker fluctuation rates (< or =32 Hz) than in normal-hearing listeners. This study therefore shows that cochlear damage affects MR, both quantitatively and qualitatively.