Masked Speech Perception with Bone Conduction Device, Contralateral Routing of Signals Hearing Aid, and Cochlear Implant Use in Adults with Single-Sided Deafness: A Prospective Hearing Device Comparison using a Unified Testing Framework.

INTRODUCTION: For the treatment of single-sided deafness (SSD), common treatment choices include a contralateral routing of signals (CROS) hearing aid, a bone conduction device (BCD), and a cochlear implant (CI). The primary aim of this study was to compare speech understanding in noise and binaural benefits in adults with postlingual SSD between preoperative unaided baseline, preoperative CROS and BCD trial devices, and CI, following recommendations from a consensus protocol. In addition, we investigated the effect of masker type on speech understanding. METHODS: This was a prospective study with twelve participants. Binaural effects of head shadow, squelch, summation, and spatial release from masking were assessed by measuring speech reception thresholds (SRTs) in five different spatial target-masker configurations using two different maskers: two-talker babble (TTB), and speech-shaped noise (SSN). Preoperatively, participants were assessed unaided and with CROS and BCD trial devices. After cochlear implantation, participants were assessed at 1, 3, and 6 months post-activation. RESULTS: For TTB, significant improvements in SRT with a CI relative to preoperatively unaided were found in all spatial configurations. With CI at 6 months, median benefits were 7.8 dB in SSSDNAH and 5.1 dB in S0NAH (head shadow), 3.4 dB in S0N0 (summation), and 4.6 dB in S0NSSD and 5.1 dB in SAHNSSD (squelch). CROS yielded a significant head shadow benefit of 2.4 dB in SSSDNAH and a significant deterioration in squelch of 2.5 dB in S0NSSD and SAHNSSD, but no summation effect. With BCD, there was a significant summation benefit of 1.5 dB, but no head shadow nor squelch effect. For SSN, significant improvements in SRT with CI compared to preoperatively unaided were found in three spatial configurations. Median benefits with CI at 6 months were: 8.5 dB in SSSDNAH and 4.6 dB in S0NAH (head shadow), 1.4 dB in S0N0 (summation), but no squelch. CROS showed a significant head shadow benefit of 1.7 dB in SSSDNAH, but no summation effect, and a significant deterioration in squelch of 2.9 dB in S0NSSD and 3.2 dB in SAHNSSD. With BCD, no binaural effect was obtained. Longitudinally, we found significant head shadow benefits with a CI in SSSDNAH in both maskers at all postoperative intervals and in S0NAH at 3 and 6 months post-activation. CONCLUSION: With a CI, a clear benefit for masked speech perception was observed for all binaural effects. Benefits with CROS and BCD were more limited. CROS usage was detrimental to the squelch effect.

Speech Understanding and Subjective Listening Effort in Noise With Different OTEs and Sound Processing Technologies.

OBJECTIVE: To determine speech reception thresholds (SRTs) in noise and subjective listening effort (LE) in cochlear implant (CI) recipients for application of three sound processing (SP) technologies with two off-the-ear (OTE) CI sound processors, a fixed moderately directional microphone (Standard), an adaptive directional microphone (Beam), and the spatial noise-reduction setting ForwardFocus, with the Kanso 2 (OTE2), and Beam with the Kanso (OTE1). STUDY DESIGN: Prospective repeated measures, within-subject design. SETTING: Single tertiary-referral center. PATIENTS: Twenty CI recipients with bilateral severe-to-profound sensorineural hearing loss. MAIN OUTCOME MEASURES: SRTs were assessed in two spatial configurations with frontal speech and noise from 90-180-270 degrees (S0N90-180-270) or from the CI side (S0NCI). SRTs were obtained for sentences of the Oldenburg sentence test presented in International Collegium of Rehabilitative Audiology (ICRA) noise ICRA5-250. LE for speech understanding in noise was evaluated in S0N90-180-270 and assessed in effort scale categorical units (ESCUs) by using Adaptive Categorical Listening Effort Scaling (ACALES). LEs at 5-dB signal-to-noise ratio (SNR) were calculated from fitted psychometric curves. RESULTS: With OTE2 in S0N90-180-270, SRT with ForwardFocus (-4.28 dB SNR) was better than with Beam (-3.13 dB SNR) and Standard (0.43 dB SNR). ForwardFocus showed lower LE5dB (2.61 ESCU) compared with Beam (4.60 ESCU) and Standard (5.32 ESCU). In a comparison of both OTEs in S0N90-180-270 regarding best-performing SP technology, ForwardFocus with OTE2 yielded a better SRT and better LE5dB than Beam with OTE1 (SRT: -1.70 dB SNR; LE5dB: 4.00 ESCU). With OTE2 in S0NCI, SRT was improved with ForwardFocus (-2.78 dB SNR) compared with Beam (-1.23 dB SNR) and Standard (1.83 dB SNR). CONCLUSION: With respect to SP technology and OTE, CI recipients experience best SRT and lowest LE in S0N90-180-270 when using ForwardFocus with OTE2. ACALES is feasible for assessing subjective LE in CI recipients.

Binaural Integration of Spectrally Degraded Speech in Adult Cochlear Implant Recipients with Single-Sided Deafness.

INTRODUCTION: Our purpose was to investigate binaural integration for spectrally degraded speech in normal-hearing (NH) subjects, single-sided deafness (SSD) cochlear implant (CI) recipients, and bilateral deaf bilateral CI recipients. METHODS: We tested ten adult subjects in each group with a modified version of the binaural fusion test according to Matzker. Speech recognition was assessed for monotic listening with the better-hearing ear or CI, monotic listening with the poorer-hearing ear or CI, and dichotic listening. We employed two presentation modes: (1) low pass (LP)-filtered speech to the better ear or CI and high pass (HP)-filtered speech to the poorer ear or CI, and (2) LP-filtered speech to the poorer ear or CI and HP-filtered speech to the better ear or CI. Five magnitudes of LP and HP filtering, i.e., spectral degradation, for each presentation mode were applied yielding two spectrally overlapping and three nonoverlapping presentation conditions. Sentences from the Oldenburg Children's sentence test were applied to assess speech recognition. RESULTS: NH subjects, SSD CI recipients, and bilateral CI recipients were able to understand spectrally degraded speech under both monotic and dichotic listening conditions for both the presentation modes. Speech performance decreased with the increasing loss of spectral information in all the three subject groups. In the NH subjects, speech recognition scores significantly improved for dichotic compared with each monotic listening type under two spectrally nonoverlapping conditions. The SSD CI subjects showed a significant improvement in speech scores for dichotic listening compared with monotic listening with the NH ear under one nonoverlapping condition, i.e., a dichotic benefit in speech recognition with CI. We saw a dichotic benefit in the bilateral CI recipients who achieved significantly better speech scores for dichotic compared with monotic listening with the better CI in three nonoverlapping conditions. CONCLUSIONS: All the three groups (NH subjects, SSD CI recipients, and BiCI recipients) showed binaural integration for the side-separated presentation of spectrally degraded speech. Use of strictly side-separated dichotic stimulus presentation avoided the possible occurrence of physical effects such as the head shadow effect and therefore, confirmed the binaural benefit attributable to central binaural processing.

PET/CT background noise and its effect on speech recognition.

Positron emission tomography (PET) has been successfully used to investigate central nervous processes, including the central auditory pathway. Unlike early water-cooled PET-scanners, novel PET/CT scanners employ air cooling and include a CT system, both of which result in higher background noise levels. In the present study, we describe the background noise generated by two state-of-the-art air-cooled PET/CT scanners. We measured speech recognition in background noise: recorded PET noise and a speech-shaped noise applied in clinical routine to subjects with normal hearing. Background noise produced by air-cooled PET/CT is considerable: 75.1 dB SPL (64.5 dB(A)) for the Philips Gemini TF64 and 76.9 dB SPL (68.4 dB(A)) for the Philips Vereos PET/CT (Philips Healthcare, The Netherlands). Subjects with normal hearing exhibited better speech recognition in recorded PET background noise compared with clinically applied speech-shaped noise. Speech recognition in both background noises correlated significantly. Background noise generated by PET/CT scanners should be considered when PET is used for the investigation of the central auditory pathway. Speech in PET noise is better than in speech-shaped noise because of the minor masking effect of the background noise of the PET/CT.

Speech Intelligibility and Spatial Release From Masking Improvements Using Spatial Noise Reduction Algorithms in Bimodal Cochlear Implant Users.

This study investigated the speech intelligibility benefit of using two different spatial noise reduction algorithms in cochlear implant (CI) users who use a hearing aid (HA) on the contralateral side (bimodal CI users). The study controlled for head movements by using head-related impulse responses to simulate a realistic cafeteria scenario and controlled for HA and CI manufacturer differences by using the master hearing aid platform (MHA) to apply both hearing loss compensation and the noise reduction algorithms (beamformers). Ten bimodal CI users with moderate to severe hearing loss contralateral to their CI participated in the study, and data from nine listeners were included in the data analysis. The beamformers evaluated were the adaptive differential microphones (ADM) implemented independently on each side of the listener and the (binaurally implemented) minimum variance distortionless response (MVDR). For frontal speech and stationary noise from either left or right, an improvement (reduction) of the speech reception threshold of 5.4 dB and 5.5 dB was observed using the ADM, and 6.4 dB and 7.0 dB using the MVDR, respectively. As expected, no improvement was observed for either algorithm for colocated speech and noise. In a 20-talker babble noise scenario, the benefit observed was 3.5 dB for ADM and 7.5 dB for MVDR. The binaural MVDR algorithm outperformed the bilaterally applied monaural ADM. These results encourage the use of beamformer algorithms such as the ADM and MVDR by bimodal CI users in everyday life scenarios.

Application of Digital Remote Wireless Microphone Technology in Single-Sided Deaf Cochlear Implant Recipients.

BACKGROUND: Previous research showed benefits of remote wireless technology in bilaterally moderate- to-severe hearing-impaired participants provided with hearing aid(s), cochlear implant(s) (CIs), or bimodal devices as well as in single-sided deaf (SSD) cochlear implant recipients (with CI from Cochlear™) and normal-hearing (NH) participants. PURPOSE: To evaluate the effect of the digital remote wireless microphone system, Roger™, on speech recognition at different levels of multisource noise in SSD CI recipients using MED-EL CI sound processor OPUS 2. Outcomes were assessed as a function of the listening condition (NH only, NH + CI, NH + CIRog, NHRog + CI, and NHRog + CIRog), Roger™ receiver type (Roger™ Focus for NH; Roger™ Xand Roger™ MyLink for CI) and accessory mixing ratio. STUDY SAMPLE: Eleven adult, SSD participants aided with CI from MED-EL. DATA COLLECTION AND ANALYSIS: Speech recognition in noise was assessed in two no-Roger™ conditions, one Roger™ X condition, and two Roger™ MyLink conditions. For the Roger™ X and no-Roger™ conditions, speech recognition was tested at 60.3 dB(A) with the Oldenburg Sentence Test in classroom noise at levels of 55, 65, and 75 dB(A). For the two Roger™ MyLink conditions, speech recognition at 60.3 dB(A) was measured at a noise level of 75 dB(A). Roger™ X was assessed with an accessory mixing ratio of 1:1 (summation of unattenuated microphone and audio accessory input). For Roger™ MyLink, two accessory mixing ratios were investigated, MT (1:1, summation of unattenuated microphone and telecoil input) and T with maximum attenuation of microphone input. RESULTS: Speech recognition at higher noise levels (65 and 75 dB(A)) improved significantly with Roger™ in both unilateral use conditions (NH + CIRog and NHRog + CI) as well as bilateral use condition (NHRog + CIRog). Both the bilateral application of Roger™ and the unilateral Roger™ application on the NH ear outperformed the Roger™ application on CI alone. There was no statistically significant effect of type of CI Roger™ receiver (Roger™ X or Roger™ MyLink) and the accessory mixing ratio (MT or T) on speech recognition. CONCLUSIONS: Speech recognition for distant speakers in multisource noise improved significantly with the application of Roger™ in SSD CI recipients. Both the unilateral Roger™ application on the NH ear or the CI as well as the bilateral Roger™ application can be recommended.

Speech Recognition in Noise in Single-Sided Deaf Cochlear Implant Recipients Using Digital Remote Wireless Microphone Technology.

BACKGROUND: Previous research in cochlear implant (CI) recipients with bilateral severe-to-profound sensorineural hearing loss showed improvements in speech recognition in noise using remote wireless microphone systems. However, to our knowledge, no previous studies have addressed the benefit of these systems in CI recipients with single-sided deafness. PURPOSE: The objective of this study was to evaluate the potential improvement in speech recognition in noise for distant speakers in single-sided deaf (SSD) CI recipients obtained using the digital remote wireless microphone system, Roger. In addition, we evaluated the potential benefit in normal hearing (NH) participants gained by applying this system. RESEARCH DESIGN: Speech recognition in noise for a distant speaker in different conditions with and without Roger was evaluated with a two-way repeated-measures design in each group, SSD CI recipients, and NH participants. Post hoc analyses were conducted using pairwise comparison t-tests with Bonferroni correction. STUDY SAMPLE: Eleven adult SSD participants aided with CIs and eleven adult NH participants were included in this study. DATA COLLECTION AND ANALYSIS: All participants were assessed in 15 test conditions (5 listening conditions × 3 noise levels) each. The listening conditions for SSD CI recipients included the following: (I) only NH ear and CI turned off, (II) NH ear and CI (turned on), (III) NH ear and CI with Roger 14, (IV) NH ear with Roger Focus and CI, and (V) NH ear with Roger Focus and CI with Roger 14. For the NH participants, five corresponding listening conditions were chosen: (I) only better ear and weaker ear masked, (II) both ears, (III) better ear and weaker ear with Roger Focus, (IV) better ear with Roger Focus and weaker ear, and (V) both ears with Roger Focus. The speech level was fixed at 65 dB(A) at 1 meter from the speech-presenting loudspeaker, yielding a speech level of 56.5 dB(A) at the recipient's head. Noise levels were 55, 65, and 75 dB(A). Digitally altered noise recorded in school classrooms was used as competing noise. Speech recognition was measured in percent correct using the Oldenburg sentence test. RESULTS: In SSD CI recipients, a significant improvement in speech recognition was found for all listening conditions with Roger (III, IV, and V) versus all no-Roger conditions (I and II) at the higher noise levels (65 and 75 dB[A]). NH participants significantly benefited from the application of Roger in noise for higher levels, too. In both groups, no significant difference was detected between any of the different listening conditions at 55 dB(A) competing noise. There was also no significant difference between any of the Roger conditions III, IV, and V across all noise levels. CONCLUSIONS: The application of the advanced remote wireless microphone system, Roger, in SSD CI recipients provided significant benefits in speech recognition for distant speakers at higher noise levels. In NH participants, the application of Roger also produced a significant benefit in speech recognition in noise.

Interaural Time Difference Perception with a Cochlear Implant and a Normal Ear.

Currently there is a growing population of cochlear-implant (CI) users with (near) normal hearing in the non-implanted ear. This configuration is often called SSD (single-sided deafness) CI. The goal of the CI is often to improve spatial perception, so the question raises to what extent SSD CI listeners are sensitive to interaural time differences (ITDs). In a controlled lab setup, sensitivity to ITDs was investigated in 11 SSD CI listeners. The stimuli were 100-pps pulse trains on the CI side and band-limited click trains on the acoustic side. After determining level balance and the delay needed to achieve synchronous stimulation of the two ears, the just noticeable difference in ITD was measured using an adaptive procedure. Seven out of 11 listeners were sensitive to ITDs, with a median just noticeable difference of 438 µs. Out of the four listeners who were not sensitive to ITD, one listener reported binaural fusion, and three listeners reported no binaural fusion. To enable ITD sensitivity, a frequency-dependent delay of the electrical stimulus was required to synchronize the electric and acoustic signals at the level of the auditory nerve. Using subjective fusion measures and refined by ITD sensitivity, it was possible to match a CI electrode to an acoustic frequency range. This shows the feasibility of these measures for the allocation of acoustic frequency ranges to electrodes when fitting a CI to a subject with (near) normal hearing in the contralateral ear.