Microphone directionality and wind noise reduction enhance speech perception in users of the MED-EL SONNET audio processor.

Objectives: Speech understanding in noise remains a challenge for many cochlear implant users. To improve this, the SONNET audio processor features three microphone directionality (MD) settings and three wind noise reduction (WNR) settings. The primary aim of this study was to assess if speech understanding in noise and hearing in real life was superior with the SONNET or with the OPUS 2, which does not feature MD or WNR.Methods: 31 of 33 participants completed the study. Speech understanding was assessed in two types of acoustic noise, in wind noise, and in quiet. A 4-speaker setup was used and speech was presented from 0° and noise from 90°, 180°, and 270°. Wind noise was simulated with a fan. Sound quality and hearing-related abilities were assessed via two subjective questionnaires.Results: Speech understanding in acoustic noise with the SONNET was significantly better or equal to than with the OPUS 2. Speech understanding in wind with the OPUS 2 was significantly better than with the SONNET in some settings. Sound quality and hearing-related abilities were both significantly better with the SONNET.Conclusions: The SONNET provides the same or significantly improved speech understanding than the OPUS 2 in quiet and in noise. While OPUS 2 was superior in wind than the SONNET in some settings, this was offset by SONNET's superiority in real-life listening situations. We therefore conclude that the front-end processing of the SONNET provides users with better hearing than does the OPUS 2.

Remote programming of cochlear implants in users of all ages.

BACKGROUND: Remote programming for adult cochlear implant (CI) users is feasible, safe, and effective. Limited evidence, however, exists on if remote CI programming can also be productively done with paediatric CI users. AIMS/OBJECTIVES: To assess the safety and feasibility of remote CI programming in CI users for all ages. MATERIALS AND METHODS: Forty-six (25 children, 21 adults) experienced CI users were fit locally and remotely. The results of these two fitting sessions were compared in terms of safety, Impedance Field Telemetry (IFT), Maximum Comfortable Levels (MCL), Threshold Levels (THR), audiometry, fitting duration, and speech understanding. RESULTS: The subjects' safety was not compromised during any of the fitting procedures. No significant difference was found for IFT, MCL, THR, audiometry, or speech understanding for either remote or local fitting. Remote fittings took slightly longer than local fittings when only the fitting time itself was measured. CONCLUSIONS AND SIGNIFICANCE: Remote follow-up fitting is as safe, feasible, and effective as local fitting for CI users of all ages. A more extensive adoption of remote fitting may allow many CI users greater access to clinics and therefore increased benefit from CI use.

Introducing real-life listening features into the clinical test environment: Part II: Measuring the hearing performance and evaluating the listening effort of individuals with a hearing implant.

Objectives: The controlled clinical test environment is very different from real-life listening situations, where the presence of additional speakers and variations in background noise signals can affect listening performances. The primary objective of this study is to reduce the gap between clinical results and real-life performances that are reported for many hearing implant users. Methods: Similar to Part I of this study, hearing performance and sound perception are evaluated using the following tests: (i) the Roving Level Test, (ii) the Just Understanding Speech Test, (iii) the Performance Perceptual Test, (iv) the Visual Analogue Scale to evaluate the perceived listening effort required for a range of background noise levels, and (v) the Hearing Implant Sound Quality questionnaire. All subjects recruited for this study used MED-EL hearing implant systems. Results: Results show that, similar to normal hearing listeners, hearing implant users tend to accurately estimate their hearing abilities, and both listening effort and speech recognition thresholds tend to increase with increasing noise. Discussion: The proposed test battery for evaluating speech understanding and listening effort were suitable for use in this study as all of the implant users were able to complete the tests. This test battery can be used to provide audiologists with further information relating to real-life listening performances. Conclusion: Evaluating the self-estimated and verified performance measurements of hearing implant users in real-life listening situations are essential for providing information regarding the discrepancies observed between the objective and subjective reports of hearing difficulties.

Site of cochlear stimulation and its effect on electrically evoked compound action potentials using the MED-EL standard electrode array.

BACKGROUND: The standard electrode array for the MED-EL MAESTRO cochlear implant system is 31 mm in length which allows an insertion angle of approximately 720 degrees . When fully inserted, this long electrode array is capable of stimulating the most apical region of the cochlea. No investigation has explored Electrically Evoked Compound Action Potential (ECAP) recordings in this region with a large number of subjects using a commercially available cochlear implant system. The aim of this study is to determine if certain properties of ECAP recordings vary, depending on the stimulation site in the cochlea. METHODS: Recordings of auditory nerve responses were conducted in 67 subjects to demonstrate the feasibility of ECAP recordings using the Auditory Nerve Response Telemetry (ART) feature of the MED-EL MAESTRO system software. These recordings were then analyzed based on the site of cochlear stimulation defined as basal, middle and apical to determine if the amplitude, threshold and slope of the amplitude growth function and the refractory time differs depending on the region of stimulation. RESULTS: Findings show significant differences in the ECAP recordings depending on the stimulation site. Comparing the apical with the basal region, on average higher amplitudes, lower thresholds and steeper slopes of the amplitude growth function have been observed. The refractory time shows an overall dependence on cochlear region; however post-hoc tests showed no significant effect between individual regions. CONCLUSIONS: Obtaining ECAP recordings is also possible in the most apical region of the cochlea. However, differences can be observed depending on the region of the cochlea stimulated. Specifically, significant higher ECAP amplitude, lower thresholds and steeper amplitude growth function slopes have been observed in the apical region. These differences could be explained by the location of the stimulating electrode with respect to the neural tissue in the cochlea, a higher density, or an increased neural survival rate of neural tissue in the apex. TRIAL REGISTRATION: The Clinical Investigation has the Competent Authority registration number DE/CA126/AP4/3332/18/05.