.Signal Transparency of Remote Microphone Technology in Pediatric Bone Conduction Device Users

INTRODUCTION: Competing noise in the environment negatively affects speech intelligibility, particularly when listening at a distance. This is especially true for children with hearing loss in classroom environments where the signal-to-noise ratio is often poor. Remote microphone technology has been shown to be highly beneficial at improving the signal-to-noise ratio in hearing device users. Children with bone conduction devices, however, often must rely on indirect transmission of the acoustic signal for commonly used classroom-based remote microphone listening (e.g., digital adaptive microphone) which may negatively affect speech intelligibility. There are no studies on the effectiveness of using a relay method of signal delivery using remote microphone technology to improve speech intelligibility in adverse listening environments in bone conduction device users. METHODS: Nine children with irresolvable conductive hearing loss and 12 adult controls with normal hearing were included for study. Controls were bilaterally plugged to simulate conductive hearing loss. All testing was conducted using the Cochlear™ Baha® 5 standard processor coupled with either the Cochlear™ Mini Microphone 2+ digital remote microphone or the Phonak Roger™ adaptive digital remote microphone. Speech intelligibility in noise was evaluated in the (1) bone conduction device processor alone, (2) bone conduction device + personal remote microphone, and (3) bone conduction device + personal remote microphone + adaptive digital remote microphone listening conditions at -10 dB, 0 dB, and +5 dB signal-to-noise ratios. RESULTS AND CONCLUSIONS: Speech intelligibility in noise improved significantly in the bone conduction device + personal remote microphone condition over the bone conduction device alone, demonstrating significant benefit for listening at poor signal-to-noise ratios in children with conductive hearing loss using bone conduction devices with personal remote microphone use. Experimental findings demonstrate poor signal transparency when using the relay method. Coupling of the adaptive digital remote microphone technology to the personal remote microphone negatively affects signal transparency, and no hearing in noise improvements are observed. Significant gains in speech intelligibility are consistently observed for direct streaming methods and are confirmed in adult controls. Behavioral findings are supported by objective verification of the signal transparency between the remote microphone and the bone conduction device.

Clinical consensus document for fitting non-surgical transcutaneous bone conduction hearing devices to children.

This clinical consensus document addresses the assessment, selection, and fitting considerations for non-surgical bone conduction hearing devices (BCHD) for children under the age of 5 years identified as having unilateral or bilateral, permanent conductive or mixed hearing losses. Children with profound unilateral sensorineural hearing losses are not addressed. The document was developed based on evidence review and consensus by The Paediatric Bone Conduction Working Group, which is composed of audiologists from North America who have experience working with BCHDs in children. The document aims to provide clinical direction for an area of paediatric audiology practice that is under development and is therefore lacking in standard protocols or guidelines. This work may serve as a basis for future research and clinical contributions to support prospective paediatric audiology practices.

Comparisons of performance in pediatric bone conduction implant recipients using remote microphone technology.

OBJECTIVES: For children with hearing loss, remote microphone (RM) technology can significantly improve access to speech in environments with poor signal-to-noise ratios (SNRs), such as classrooms. Yet, this has never been studied in bone conduction device (BCD) users, a common treatment for children with irresolvable conductive hearing loss resulting from anatomical malformations of the outer ear. The objective of this study was to investigate the benefits of RM technology on speech perception in noise in pediatric BCD users with Microtia/Atresia. A secondary aim was to assess parent and child perceptions of RM technology before and after exposure to RM technology. METHODS: Participants included 10 pediatric bone conduction implant users with unilateral conductive hearing loss ages 7-17 years, and their guardians. Speech perception in noise for soft and moderate inputs was assessed with and without RM technology. Guardians actively observed the child's hearing performance with and without the RM and were asked to complete a questionnaire assessing their perceptions about their child's performance. Children were also administered the questionnaire prior to and immediately following exposure to the RM technology. RESULTS: Participants showed improved speech understanding in noise for both soft and moderate speech inputs when using the RM with their BCD compared to their BCD alone. Questionnaire results indicated good parent-child agreement. Further, significant improvements were reported for child understanding speech, parent hearing domains after exposure to the RM. No significant differences were noted for ease of use/likability. CONCLUSIONS: Significant hearing in noise benefits were observed with RM technology for children using BCDs. Consistent with objective findings, children reported improved speech understanding with the RM. Improved parental perceptions of hearing benefit following exposure to the RM suggests that active participation may serve as an effective strategy to help improve parent understanding of the benefits of RM technology for their child.

Speech Perception Outcomes in Transcutaneous Versus Percutaneous Bone Conduction Stimulation in Individuals With Single-sided Deafness.

OBJECTIVE(S): To investigate the differences in percutaneous versus passive transcutaneous bone-conduction stimulation in individuals with single-sided deafness. STUDY DESIGN: Prospective, single-subject. SETTING: Tertiary academic referral center. PATIENTS: Adult bone-anchored implant listeners with single-sided deafness using a percutaneous implant system. INTERVENTIONS: Experienced percutaneous bone anchored implant recipients were tested in the percutaneous and transcutaneous conditions using a BAHA 5 (Cochlear Corp., Cochlear Bone-Anchored Solutions, Mölnlycke, Sweden) sound processor on the patient's own abutment and on a softband. MAIN OUTCOME MEASURES: Phoneme recognition was assessed using Consonant-Nucleus-Consonant (CNC) words for soft (47 dB SPL) and average (62 dB SPL) speech inputs. Speech perception in noise performance was also assessed for soft (47 dB SPL) and average (62 dB SPL) speech inputs using sentences presented in multi-talker babble. Aided free-field thresholds were obtained in both conditions using warble tone stimuli. RESULTS: Compared with percutaneous bone-conduction stimulation, transcutaneous stimulation demonstrated reduced effective gain for high frequency stimulation. Transcutaneous stimulation required higher signal to noise ratios to achieve comparable performance to the percutaneous condition. Phoneme recognition was poorer in transcutaneous versus percutaneous stimulation with the most significant impact observed for soft speech inputs. CONCLUSION: A significant performance gap in speech recognition is observed between percutaneous and transcutaneous bone-conduction stimulation in individuals with single-sided deafness at the same signal to noise ratios. Compared with percutaneous bone-conduction stimulation, transcutaneous stimulation demonstrated reduced effective gain, decreased phoneme recognition, word recognition, and performance in noise, with the most significant impact observed for soft speech inputs.

Transcranial Attenuation in Patients with Single-Sided Deafness.

Transcranial attenuation (TA) of bone-conducted sound has a high degree of variability by frequency and subject, which may play a role in the objective benefit of individuals with single-sided deafness (SSD) treated with a bone-anchored implant (BAI). This study sought to determine whether TA is predictive of benefit in individuals with SSD who receive a BAI. Adult, English-speaking patients with unilateral profound sensorineural hearing loss who underwent a BAI evaluation were included for study. Absolute TA values were consistent with previously published reports. Regression analysis indicated no correlation between TA values and aided speech-in-noise performance for any combined or individual frequencies. Measures of TA do not provide predictive value in determining behavioral outcomes in the SSD population. Specifically, low TA does not suggest improved outcomes with a BAI.

Utricular paresis and semicircular canal hyperactivity: a distinct otolith syndrome.

CONCLUSIONS: Although combined utricular and canal paresis has been described previously, this is the first report of canal hyperactivity associated with utricular hypofunction. Unsteadiness and swaying were the most common symptoms, and patients with shorter duration of symptoms also had positional vertigo. We propose that this syndrome is a variant of utricular dysfunction and should be considered in the differential diagnosis of peripheral vestibular disorders. OBJECTIVE: To describe a syndrome of instability associated with utricular dysfunction and hyperactive caloric responses. METHODS: The study comprised 11 consecutive patients exhibiting abnormalities of the eccentric subjective visual vertical test (e-SVV) and high responses during the caloric test of the videonystagmography (VNG). We carried out a review of symptoms, physical examination, and vestibular tests. RESULTS: There was no gender predilection or obvious etiology. The patients' main complaint included instability with linear symptoms (i.e., tilting, rocking, and swaying), with positional vertigo as a secondary symptom. Oculomotor testing, visual fixation index, and brain MRI were normal, excluding a central nervous system disorder. VNG was essentially normal except for hyperactive responses during the caloric testing in all patients. Abnormal e-SVV was found in 10 patients unilaterally and bilaterally in 1 patient. Abnormal oVEMP was found in seven of seven patients, further supporting a utricular site of lesion.

An in situ calibration for hearing thresholds.

Quantifying how the sound delivered to the ear canal relates to hearing threshold has historically relied on acoustic calibration in physical assemblies with an input impedance intended to match the human ear (e.g., a Zwislocki coupler). The variation in the input impedance of the human ear makes such a method of calibration questionable. It is preferable to calibrate the acoustic signal in each ear individually. By using a calibrated sound source and microphone, the acoustic input impedance of the ear can be determined, and the sound delivered to the ear calibrated in terms of either (i) the incident sound pressure wave or (ii) that portion of the incident sound pressure wave transmitted to the middle ear and cochlea. Hearing thresholds expressed in terms of these quantities are reported, these in situ calibrations not being confounded by ear canal standing waves. Either would serve as a suitable replacement for the current practice of hearing thresholds expressed in terms of sound pressure level calibrated in a 6cc or 2cc coupler.