Use of a Smartphone App for Cochlear Implant Patients With Tinnitus.

Purpose Smartphone apps for tinnitus relief are now emerging; however, research supporting their use and effectiveness is lacking. Research has shown that Tinnitus Therapy sounds intended for individuals with acoustic hearing provide relief to some patients using cochlear implants (CIs) with tinnitus. Here, we evaluated the use and acceptability of a smartphone app to help CI patients with tinnitus. Method Participants completed a laboratory trial (n = 19) and an at-home trial (n = 14) using the ReSound Tinnitus Relief app to evaluate its acceptability and effectiveness in reducing their tinnitus. During the laboratory trial, participants selected a sound that was most acceptable in managing their tinnitus (termed chosen sound). Word recognition scores in quiet were obtained before and after sound therapy. Participants were randomly assigned to one of two groups for the at-home trial, that is, AB or BA, using (A) the chosen sound for 2 weeks and (B) the study sound (i.e., broadband noise at hearing threshold) for another 2 weeks. Ratings were collected weekly to determine acceptability and effectiveness of the app in reducing tinnitus loudness and annoyance. Results Results indicated that some, but not all, participants found their chosen sound to be acceptable and/or effective in reducing their tinnitus. A majority of the participants rated the chosen sound or the study sound to be acceptable in reducing their tinnitus. Word recognition scores for most participants were not adversely affected using the chosen sound; however, a significant decrease was observed for three participants. All 14 participants had a positive experience with the app during the at-home trial on tests of sound therapy acceptability, effectiveness, and word recognition. Conclusions Sound therapy using a smartphone app can be effective for many tinnitus patients using CIs. Audiologists should recommend a sound and a level for tinnitus masking that do not interfere with speech perception.

Programming a Cochlear Implant for Tinnitus Suppression.

BACKGROUND: Electrical stimulation of the cochlea to treat tinnitus has been explored for decades. However, few studies have investigated the most salient programming parameters for tinnitus suppression in cochlear implant (CI) patients. PURPOSE: The purpose of this study was to review the available CI programming parameters for tinnitus suppression and to consider possible clinical research designs for selecting the optimal programming parameters for CI patients. RESULTS: Across research studies, the optimal parameters vary significantly and are often based on data fromonly a fewparticipants. Electrical stimulation using lowand high rates, different electrode numbers, and low T-levels were helpful in suppressing tinnitus, although more research is needed from a greater number of CI patients. Possible designs for evaluating these parameters in a clinical setting are presented. CONCLUSIONS: Programming a CI to reduce the prominence of tinnitus is complex, and audiologists should consider adjusting CI parameters systematically for CI patients with bothersome tinnitus.

Complaints of People with Hyperacusis.

BACKGROUND: Hyperacusis is a prevalent auditory disorder that causes significant distress and negatively affects quality of life for many patients. Patients with hyperacusis often have different complaints about the sounds and situations that they experience. Audiologists may have few patients with hyperacusis, and a limited understanding of the sounds and situations that are reported to be challenging by their patients. PURPOSE: To investigate the common complaints reported by hyperacusis patients. RESEARCH DESIGN: A qualitative study was conducted with 11 hyperacusis patients who participated in a group session. RESULTS: All 11 hyperacusis patients experienced negative reactions to specific sounds. In addition, many patients reported physical symptoms such as headaches, balance problems, dysosmia (strong smell problems), and light sensitivity. Sounds that induced discomfort were wide ranging and included low-frequency sounds, high-frequency sounds, wide-band noise, and sudden, high-intensity sounds. Most patients (9/11, 81.8%) reported negative reactions to music in loud rock concerts. Patients reported that stress/tension (90.9%) worsened their hyperacusis, while removing themselves from noise (90.9%) relieved their hyperacusis. CONCLUSION: Loudness is only one of the many factors related to the discomfort of patients with hyperacusis. Across patients, we observed that there were different complaints about the sounds and situations that produced difficulty due to hyperacusis. Physical symptoms following sound exposure were also reported by the patients, suggesting that hyperacusis is a complex disorder and requires intervention that often involves multiple members of the medical team.

Tinnitus Sound Therapy Trial Shows Effectiveness for Those with Tinnitus.

BACKGROUND: It is well accepted among clinicians that maskers and hearing aids combined with counseling are generally helpful to tinnitus patients, but there are few controlled studies exploring the efficacy of maskers alone to decrease the prominence of tinnitus. PURPOSE: We investigated the benefit of maskers for patients with chronic, bothersome tinnitus. RESEARCH DESIGN: Crossover single-participant design, where each participant served as their own control. STUDY SAMPLE: 18 adults with subjective, nonpulsatile, sensorineural tinnitus. INTERVENTION: Participants participated in two six-week trials: one with sound therapy and one without. No counseling was provided in either group. Masking devices were fit with sounds intended to reduce the tinnitus prominence. DATA COLLECTION AND ANALYSIS: Participants rated tinnitus loudness, tinnitus annoyance, and acceptability of the background sounds using a numeric 0-100 interval scale and completed the Tinnitus Primary Functions Questionnaire (TPFQ). RESULTS: Three participants dropped out. On the total score of the TPFQ, 5 of 15 remaining participants (33%) showed a benefit. Using a derived score based on functions showing a handicap before the study, maskers benefit was observed in the areas of sleep (five of nine), hearing (three of eight), thoughts and emotions (three of four), and concentration (four of eight). The TPFQ and annoyance data complemented each other well. CONCLUSIONS: This study demonstrates the benefit of partial masking, encouraging patients to seek help from audiologists interested in providing support for tinnitus patients.

Establishing a Group Educational Session for Hyperacusis Patients.

Purpose Audiologists should be treating hyperacusis patients. However, it can be difficult to know where to begin because treatment protocols and evidence-based treatment studies are lacking. A good place to start in any tinnitus and hyperacusis clinic is to incorporate a group educational session. Method Here, we outline our approach to establishing a hyperacusis group educational session that includes specific aspects of getting to know each patient to best meet their needs, understanding the problems associated with hyperacusis, explaining the auditory system and the relationship of hyperacusis to hearing loss and tinnitus, describing the influence of hyperacusis on daily life, and introducing treatment options. Subjective responses from 11 adults with hyperacusis, who participated in a recent clinical group education session, were discussed to illustrate examples from actual patients. Conclusions Due to the devastating nature of hyperacusis, patients need to be reassured that they are not alone and that they can rely on audiologists to provide support and guidance. A group approach can facilitate the therapeutic process by connecting patients with others who are also affected by hyperacusis, and by educating patients and significant others on hyperacusis and its treatment options. Supplemental Material https://doi.org/10.23641/asha.8121197.

Tinnitus: How Partners Can Help?

Purpose Tinnitus can be distressing for sufferers, but for those who do not have tinnitus, it is difficult to understand what it is like. We attempted to gain an understanding of the knowledge and misconceptions of sufferers and their partners about tinnitus. Method Two different websites were created with surveys, 1 for tinnitus sufferers and the other for their partners. A mass e-mail was sent to employees and students at The University of Iowa inviting people with tinnitus and their significant others to fill out the online surveys. Those with tinnitus were asked to rate how their tinnitus affected their thoughts and emotions, sleep, concentration, and hearing. They were also invited to fill out the Iowa Tinnitus Primary Function Questionnaire (12-item version; Tyler et al., 2014 ). Partners completed a similar survey that asked how tinnitus affected the sufferer in these domains. Open-ended questions were also included to obtain more specific feedback from the participants regarding their experiences and how tinnitus affects their lifestyle and relationships. Results Two hundred twenty-two replies were obtained from 197 tinnitus sufferers and 25 partners of those with tinnitus. Partners and sufferers were not completely in agreement regarding their knowledge about tinnitus or familiar with the impact that this symptom may have on the sufferers. Sufferers showed more confidence in their hearing ability, regardless of tinnitus, than their partners. Furthermore, sufferers and partners do not generally talk about tinnitus to each other. Conclusion We conclude that both sufferers and partners would benefit from receiving counseling to address many misunderstandings regarding tinnitus and its consequences in their everyday life activities.

Tinnitus Suppression in Cochlear Implant Patients Using a Sound Therapy App.

PURPOSE: The use of acoustic stimuli to reduce the prominence of tinnitus has been used for decades. Counseling and tinnitus sound therapy options are not currently widespread for cochlear implant (CI) users. The goal of this study was to determine whether tinnitus therapy sounds created for individuals with acoustic hearing may also benefit CI users. METHOD: Sixteen sounds from the ReSound Relief app (Version 3.0) were selected for the study. Sixteen participants were asked to rate the overall acceptability of each sound and to write the description of the sound they perceived. Sounds were streamed from an Apple™ iPod (6th generation) to the CI using a Cochlear™ Wireless Mini Microphone 2+. Thirteen participants then completed a 5-min trial where they rated their pretrial and posttrial tinnitus and the acceptability of a subset of preferred sounds. Ten out of these 13 participants completed a 2-week home trial with a preferred sound after which they answered an online tinnitus questionnaire and rated the effectiveness of the sound therapy. RESULTS: Individual differences were large. Results from the 5-min trial showed that sounds perceived as rain, music, and waves were rated the most acceptable. For all of the participants, the posttrial tinnitus loudness rating was lower than the pretrial rating, with some participants experiencing greater difference in their tinnitus loudness than others. At the end of the 2-week home trial, 3 of 10 participants rated the effectiveness of sound therapy 70% or higher. CONCLUSION: The results suggest that the use of tinnitus therapy sounds delivered through a CI can be acceptable and provides relief for some tinnitus sufferers.

Listening Effort Measured in Adults with Normal Hearing and Cochlear Implants.

BACKGROUND: Studies have examined listening effort in individuals with hearing loss to determine the extent of the impairment. Regarding cochlear implants (CIs), results suggest that listening effort is improved using bilateral CIs compared to unilateral CIs. Few studies have investigated listening effort and outcomes related to the hybrid CI. PURPOSE: Here, we compared listening effort across three CI groups, and to a normal-hearing control group. The impact of listener traits, that is, age, age at onset of hearing loss, duration of CI use, and working memory capacity, were examined relative to listening effort. RESEARCH DESIGN: The participants completed a dual-task paradigm with a primary task identifying sentences in noise and a secondary task measuring reaction time on a Stroop test. Performance was assessed for all participant groups at different signal-to-noise ratios (SNRs), ranging in 2-dB steps from 0 to +10 dB relative to an individual's SNR-50, at which the speech recognition performance is 50% correct. Participants completed three questions on listening effort, the Spatial Hearing Questionnaire, and a reading span test. STUDY SAMPLE: All 46 participants were adults. The four participant groups included (1) 12 individuals with normal hearing, (2) 10 with unilateral CIs, (3) 12 with bilateral CIs, and (4) 12 with a hybrid short-electrode CI and bilateral residual hearing. DATA COLLECTION AND ANALYSIS: Results from the dual-task experiment were compared using a mixed 4 (hearing group) by 6 (SNR condition) analysis of variance (ANOVA). Questionnaire results were compared using one-way ANOVAs, and correlations between listener traits and the objective and subjective measures were compared using Pearson correlation coefficients. RESULTS: Significant differences were found in speech perception among the normal-hearing and the unilateral and the bilateral CI groups. There was no difference in primary task performance among the hybrid CI and the normal-hearing groups. Across the six SNR conditions, listening effort improved to a greater degree for the normal-hearing group compared to the CI groups. However, there was no significant difference in listening effort between the CI groups. The subjective measures revealed significant differences between the normal-hearing and CI groups, but no difference among the three CI groups. Across all groups, age was significantly correlated with listening effort. We found no relationship between listening effort and the age at the onset of hearing loss, age at implantation, the duration of CI use, and working memory capacity for these participants. CONCLUSIONS: Listening effort was reduced to a greater degree for the normal-hearing group compared to the CI users. There was no significant difference in listening effort among the CI groups. For the CI users in this study, age was a significant factor with regard to listening effort, whereas other variables such as the duration of CI use and the age at the onset of hearing loss were not significantly related to listening effort.

Development of a Shortened Version of the Spatial Hearing Questionnaire (SHQ-S) for Screening Spatial-Hearing Ability.

PURPOSE: The Spatial Hearing Questionnaire (SHQ) was developed to address how to measure spatial-hearing ability in complex listening situations (Tyler, Perreau, & Ji, 2009). It has been translated and validated into various languages, including Chinese, Dutch, French, and Persian. Although the SHQ contains only 24 items, it could be time-consuming in a busy clinic to administer. The purposes of this study were to develop and validate a shortened version of the SHQ (SHQ-S) and to compare self-perceived spatial-hearing ability across adults with normal hearing (NH), hearing loss (HL), and cochlear implants (CIs). METHOD: This was a retrospective study. The full version of the SHQ was administered to measure self-perceived spatial-hearing ability for 51 adults with NH at Augustana College, 47 adults with essentially mild to moderately severe sensorineural HL at Illinois State University, and 72 adult CI users at the University of Iowa. Exploratory factor analysis was performed for the full version for the data collected from adults with NH and HL. Appropriate items were chosen to develop the SHQ-S from the results of the exploratory factor analysis. Confirmatory factor analysis was then applied to test the factor structure of the SHQ-S for all participants. One-way analysis of variance was used to compare the self-perceived spatial-hearing performance scores between the 3 groups. RESULTS: The exploratory factor analysis revealed scores loaded on 2 factors. Six items from the full version were chosen accordingly. The results of the confirmatory factor analysis indicated that that a shortened version of 6 items is sufficient to measure spatial-hearing ability. The internal consistency reliability of the SHQ-S was high. The main effect of the one-way analysis of variance was significant for the groups, F(2, 167) = 36.0, p < .0001. The comparisons with the Tukey adjustment indicated that the NH group reported significantly better spatial-hearing ability than either the HL or the CI group (both adjusted p values < .05). There was no significant difference between the participants with HL and CI users. CONCLUSIONS: The psychometric characteristics of the 6-item SHQ-S were similar to those of the full version of the SHQ. We conclude that the SHQ-S is a reliable and valid tool for measuring spatial-hearing ability and screening for spatial-hearing difficulties. Participants with NH reported better spatial-hearing ability than those with HL or with CIs, whereas the CI users and participants with HL perceived similar spatial-hearing ability in the present study.

Validation of the Chinese Translation of the Spatial Hearing Questionnaire and Its Short Form.

PURPOSE: Few questionnaires address how to measure spatial hearing ability in complex listening situations. The purpose of the study was (a) to validate the Chinese translation of the Spatial Hearing Questionnaire (C-SHQ) among Chinese participants and (b) to provide a shortened version for the purpose of clinical screening. METHOD: This was a cross-sectional study. The C-SHQ was developed from the process of translation and back-translation of the original 24-item, English version (Tyler, Perreau, & Ji, 2009). The C-SHQ was administered to 146 patients at the Department of Otolaryngology Clinic of Sichuan Provincial People's Hospital between October 2013 and May 2014 at Sichuan, China. Exploratory factor analysis and reliability tests were performed for the full version, and confirmatory factor analysis was applied for the shortened version of the C-SHQ. RESULTS: The exploratory factor analysis revealed scores loaded on 3 similar factors compared with the original SHQ. The internal consistency reliability was high (Cronbach's α = 0.99). The confirmatory factor analysis indicated that a shortened version of 12 items is sufficient to measure spatial hearing abilities. CONCLUSIONS: The C-SHQ and its short form are both reliable and valid questionnaires, which are suitable for both research and clinical settings to measure spatial hearing ability in the Chinese population.

Self-reported spatial hearing abilities across different cochlear implant profiles.

PURPOSE: The goal of this study was to determine how self-reported spatial hearing abilities differ across various cochlear implant (CI) profiles and to examine the degree of subjective benefit following cochlear implantation across different groups of CI users. METHOD: This was a retrospective study of subjective spatial hearing ability of CI recipients. The subjects consisted of 99 unilateral CI users, 49 bilateral CI users, 32 subjects with a CI and contralateral hearing aid (bimodal users), and 37 short-electrode CI users. All subjects completed the Spatial Hearing Questionnaire (Tyler, Perreau, & Ji, 2009), a questionnaire assessing spatial hearing ability, after implantation, and a subset of the subjects completed the questionnaire pre- and postimplantation. RESULTS: Subjective spatial hearing ability was rated higher for the bilateral and short electrode CI users compared to the unilateral and bimodal users. There was no significant difference in subjective spatial hearing performance between the bilateral and short electrode CI users and the unilateral CI and bimodal users. A separate analysis of pre- and postimplant performance revealed that all CI groups reported significant improvements in spatial hearing ability after implantation. CONCLUSION: This study suggests that there are substantial differences in perceived spatial hearing ability among unilateral and bimodal CI users compared with bilateral and short electrode CI users.

Development and validation of the tinnitus primary function questionnaire.

PURPOSE: To create a questionnaire focused on the primary activities impaired by tinnitus and therefore more sensitive to treatments. METHOD: Questions were developed on (a) emotions, (b) hearing, (c) sleep, and (d) concentration. A 20-item questionnaire was administered to 158 patients. First, confirmatory factor analysis was used to select 3 questions per domain. Second, factor analysis was used to evaluate the appropriateness of the 12-item questionnaire. RESULTS: The analysis indicated that the selected questions successfully represented 4 independent domains. Scores were correlated with the Tinnitus Handicap Questionnaire ( r = .77, p < .01) and loudness ( r = .40, p < .01). The Sleep subscale correlated with the Pittsburgh Sleep Index ( r = .68, p < .01); the Emotion subscale correlated with the Beck Inventory ( r = .66, p < .01) and the Trait Anxiety questionnaire ( r = .67, p < .01). The average scores went from 51% to 38% following treatment. CONCLUSION: The Tinnitus Primary Function Questionnaire is valid, reliable, and sensitive and can be used to determine the efficacy of clinical trials.

The spatial hearing questionnaire: data from individuals with normal hearing.

PURPOSE: Although a number of questionnaires are available to assess hearing aid benefit and general hearing disability, relatively few investigate spatial hearing ability in more complex listening situations. The aim of this study was to document the performance of individuals with normal hearing using the Spatial Hearing Questionnaire (SHQ; Tyler, Perreau, & Ji, 2009) and to compare performance with published data from cochlear implant (CI) users. METHOD: Fifty-one participants with normal hearing participated. All participants completed the 24-item SHQ. Also, a factor analysis and reliability tests were performed. RESULTS: Performance on the SHQ was high (87%) for the participants with normal hearing. Subjective ratings varied across different listening situations: Understanding speech in quiet (98%) was rated higher than sound localization (84%) and understanding speech in a background of noise (85%). Compared with previously published data (Tyler, Perreau, & Ji, 2009), listeners with normal hearing rated their spatial hearing ability significantly better than bilateral and unilateral CI users. Results confirmed that the SHQ is a reliable measure of spatial hearing ability for listeners with normal hearing. CONCLUSIONS: Overall, results indicated that the SHQ is able to capture expected differences between individuals with normal hearing and CI users. These new data can be used as targets following the provision of hearing devices.

The contribution of a frequency-compression hearing aid to contralateral cochlear implant performance.

BACKGROUND: Frequency-lowering signal processing in hearing aids has re-emerged as an option to improve audibility of the high frequencies by expanding the input bandwidth. Few studies have investigated the usefulness of the scheme as an option for bimodal users (i.e., combined use of a cochlear implant and a contralateral hearing aid). In this study, that question was posed. PURPOSE: The purposes of this study were (1) to determine if frequency compression was a better bimodal option than conventional amplification and (2) to determine the impact of a frequency-compression hearing aid on speech recognition abilities. RESEARCH DESIGN: There were two separate experiments in this study. The first experiment investigated the contribution of a frequency-compression hearing aid to contralateral cochlear implant (CI) performance for localization and speech perception in noise. The second experiment assessed monaural consonant and vowel perception in quiet using the frequency-compression and conventional hearing aid without the use of a contralateral CI or hearing aid. STUDY SAMPLE: Ten subjects fitted with a cochlear implant and hearing aid participated in the first experiment. Seventeen adult subjects with a cochlear implant and hearing aid or two hearing aids participated in the second experiment. To be included, subjects had to have a history of postlingual deafness, a moderate or moderate-to-severe hearing loss, and have not worn this type of frequency-lowering hearing aid previously. DATA COLLECTION AND ANALYSIS: In the first experiment, performance using the frequency-compression and conventional hearing aids was assessed on tests of sound localization, speech perception in a background of noise, and two self-report questionnaires. In the second experiment, consonant and vowel perception in quiet was assessed monaurally for the two conditions. In both experiments, subjects alternated daily between a frequency-compression and conventional hearing aid for 2 mo. The parameters of frequency compression were set individually for each subject, and audibility was measured for the frequency compression and conventional hearing aid programs by comparing estimations of the Speech Intelligibility Index (SII) using a modified algorithm (Bentler et al, 2011). In both experiments, the outcome measures were administered following the hearing aid fitting to assess performance at baseline and after 2 mo of use. RESULTS: For this group of subjects, the results revealed no significant difference between the frequency-compression and conventional hearing aid on tests of localization and consonant recognition. Spondee-in-noise and vowel perception scores were significantly higher with the conventional hearing aid compared to the frequency-compression hearing aid after 2 mo of use. CONCLUSIONS: These results suggest that, for the subjects in this study, frequency compression is not a better bimodal option than conventional amplification. In addition, speech perception may be negatively influenced by frequency compression because formant frequencies are too severely compressed and can no longer be distinguished.

Effects of lower frequency-to-electrode allocations on speech and pitch perception with the hybrid short-electrode cochlear implant.

Because some users of a Hybrid short-electrode cochlear implant (CI) lose their low-frequency residual hearing after receiving the CI, we tested whether increasing the CI speech processor frequency allocation range to include lower frequencies improves speech perception in these individuals. A secondary goal was to see if pitch perception changed after experience with the new CI frequency allocation. Three subjects who had lost all residual hearing in the implanted ear were recruited to use an experimental CI frequency allocation with a lower frequency cutoff than their current clinical frequency allocation. Speech and pitch perception results were collected at multiple time points throughout the study. In general, subjects showed little or no improvement for speech recognition with the experimental allocation when the CI was worn with a hearing aid in the contralateral ear. However, all 3 subjects showed changes in pitch perception that followed the changes in frequency allocations over time, consistent with previous studies showing that pitch perception changes upon provision of a CI.

The effect of reducing the number of electrodes on spatial hearing tasks for bilateral cochlear implant recipients.

BACKGROUND: Many studies have documented the effect of reducing spectral information for speech perception in listeners with normal hearing and hearing impairment. While it is understood that more spectral bands are needed for unilateral cochlear implant listeners to perform well on more challenging listening tasks such as speech perception in noise, it is unclear how reducing the number of spectral bands or electrodes in cochlear implants influences the ability to localize sound or understand speech with spatially separate noise sources. PURPOSE: The purpose of this study was to measure the effect of reducing the number of electrodes for patients with bilateral cochlear implants on spatial hearing tasks. RESEARCH DESIGN: Performance on spatial hearing tasks was examined as the number of bilateral electrodes in the speech processor was deactivated equally across ears and the full frequency spectrum was reallocated to a reduced number of active electrodes. Program parameters (i.e., pulse width, stimulation rate) were held constant among the programs and set identically between the right and left cochlear implants so that only the number of electrodes varied. STUDY SAMPLE: Nine subjects had used bilateral Nucleus or Advanced Bionics cochlear implants for at least 12 mo prior to beginning the study. Only those subjects with full insertion of the electrode arrays with all electrodes active in both ears were eligible to participate. DATA COLLECTION AND ANALYSIS: Two test measures were utilized to evaluate the effect of reducing the number of electrodes, including a speech-perception-in-noise test with spatially separated sources and a sound source localization test. RESULTS: Reducing the number of electrodes had different effects across individuals. Three patterns emerged: (1) no effect on localization (two of nine subjects), (2) at least two to four bilateral electrodes were required for maximal performance (five of nine subjects), and (3) performance gradually decreased across conditions as electrode number was reduced (two of nine subjects). For the test of speech perception in spatially separated noise, performance was affected as the number of electrodes was reduced for all subjects. Two categories of performance were found: (1) at least three or four bilateral electrodes were needed for maximum performance (five of seven subjects) and (2) as the number of electrodes were reduced, performance gradually decreased across conditions (two of seven subjects). CONCLUSION: Large individual differences exist in determining maximum performance using bilateral electrodes for localization and speech perception in noise. For some bilateral cochlear implant users, as few as three to four electrodes can be used to obtain maximal performance on localization and speech-in-noise tests. However, other listeners show a gradual decrement in performance on both tasks when the number of electrodes is reduced.

Benefits of localization and speech perception with multiple noise sources in listeners with a short-electrode cochlear implant.

BACKGROUND: Research suggests that for individuals with significant low-frequency hearing, implantation of a short-electrode cochlear implant may provide benefits of improved speech perception abilities. Because this strategy combines acoustic and electrical hearing within the same ear while at the same time preserving low-frequency residual acoustic hearing in both ears, localization abilities may also be improved. However, very little research has focused on the localization and spatial hearing abilities of users with a short-electrode cochlear implant. PURPOSE: The purpose of this study was to evaluate localization abilities for listeners with a short-electrode cochlear implant who continue to wear hearing aids in both ears. A secondary purpose was to document speech perception abilities using a speech-in-noise test with spatially separate noise sources. RESEARCH DESIGN: Eleven subjects that utilized a short-electrode cochlear implant and bilateral hearing aids were tested on localization and speech perception with multiple noise locations using an eight-loudspeaker array. Performance was assessed across four listening conditions using various combinations of cochlear implant and/or hearing aid use. RESULTS: Results for localization showed no significant difference between using bilateral hearing aids and bilateral hearing aids plus the cochlear implant. However, there was a significant difference between the bilateral hearing aid condition and the implant plus use of a contralateral hearing aid for all 11 subjects. Results for speech perception showed a significant benefit when using bilateral hearing aids plus the cochlear implant over use of the implant plus only one hearing aid. CONCLUSION: Combined use of both hearing aids and the cochlear implant show significant benefits for both localization and speech perception in noise for users with a short-electrode cochlear implant. These results emphasize the importance of low-frequency information in two ears for the purpose of localization and speech perception in noise.

An attempt to improve bilateral cochlear implants by increasing the distance between electrodes and providing complementary information to the two ears.

OBJECTIVES: The purpose of this investigation was to determine if adult bilateral cochlear implant recipients could benefit from using a speech processing strategy in which the input spectrum was interleaved among electrodes across the two implants. DESIGN: Two separate experiments were conducted. In both experiments, subjects were tested using a control speech processing strategy and a strategy in which the full input spectrum was filtered so that only the output of half of the filters was audible to one implant, while the output of the alternative filters was audible to the other implant. The filters were interleaved in a way that created alternate frequency "holes" between the two cochlear implants. RESULTS: In experiment one, four subjects were tested on consonant recognition. Results indicated that one of the four subjects performed better with the interleaved strategy, one subject received a binaural advantage with the interleaved strategy that they did not receive with the control strategy, and two subjects showed no decrement in performance when using the interleaved strategy. In the second experiment, 11 subjects were tested on word recognition, sentences in noise, and localization (it should be noted that not all subjects participated in all tests). Results showed that for speech perception testing one subject achieved significantly better scores with the interleaved strategy on all tests, and seven subjects showed a significant improvement with the interleaved strategy on at least one test. Only one subject showed a decrement in performance on all speech perception tests with the interleaved strategy. Out of nine subjects, one subject preferred the sound quality of the interleaved strategy. No one performed better on localization with the interleaved strategy. CONCLUSION: Data from this study indicate that some adult bilateral cochlear implant recipients can benefit from using a speech processing strategy in which the input spectrum is interleaved among electrodes across the two implants. It is possible that the subjects in this study who showed a significant improvement with the interleaved strategy did so because of less channel interaction; however, this hypothesis was not directly tested.

Validation of the Spatial Hearing Questionnaire.

OBJECTIVES: Subjective questionnaires are informative in understanding the difficulties faced by patients with hearing loss. Our intent was to establish and validate a new questionnaire that encompasses situations emphasizing binaural hearing. The Spatial Hearing Questionnaire is a self-report assessment tool with eight subscales representing questions; pertaining to the perception of male, female, and children's voices; music in quiet; source localization; understanding speech in quiet; and understanding speech in noise. DESIGN: The Spatial Hearing Questionnaire, composed of 24 items, is scored from 0 to 100. It was administered to 142 subjects using one or two cochlear implants. Speech perception and localization abilities were measured, and the Speech, Spatial, and Other Qualities questionnaire was completed to evaluate validity of the questionnaire. Psychometric tests were performed to test the reliability and factor structure of the Spatial Hearing Questionnaire. RESULTS: Results showed high internal consistency reliability (Cronbach's alpha = 0.98) and good construct validity (correlations between the Spatial Hearing Questionnaire and other test measures, including the Speech, Spatial, and Other Qualities, were significant). A preliminary factor analysis revealed scores loaded on three factors, representing the following conditions: localization, speech in noise and music in quiet, and speech in quiet, explaining 64.9, 13.0, and 5.3% of the variance, respectively. Most of the questionnaire items (12/24) loaded onto the first factor that represents the subscale related to source localization. Mean scores on the Spatial Hearing Questionnaire were higher for subjects with bilateral cochlear implants than for subjects with a unilateral cochlear implant, consistent with other research and supporting construct validity. CONCLUSIONS: The Spatial Hearing Questionnaire is a reliable and valid questionnaire that can be completed independently by most patients in about 10 minutes. It is likely to be a valuable tool for clinicians and researchers to measure spatial hearing abilities.

A daily alternating method for comparing different signal-processing strategies in hearing aids and in cochlear implants.

BACKGROUND: Although we always want to select the best signal-processing strategy for our hearing-aid and cochlear-implant patients, no efficient and valid procedure is available. Comparisons in the office are without listening experience, and short-term take-home trials are likely influenced by the order of strategies tried. PURPOSE: The purpose of this study was to evaluate a new procedure for comparing signal-processing strategies whereby patients listen with one strategy one day and another strategy the next day. They continue this daily comparison for several weeks. We determined (1) if differences existed between strategies without prior listening experience and (2) if performance differences (or lack there of) obtained at the first listening experience are consistent with performance after two to three months of alternating between strategies on a daily basis (equal listening experience). RESEARCH DESIGN: Eight subjects were tested pretrial with a vowel, sentence, and spondee recognition test, a localization task, and a quality rating test. They were required to listen to one of two different signal processing strategies alternating between strategies on a daily basis. After one to three months of listening, subjects returned for follow-up testing. Additionally, subjects were asked to make daily ratings and comments in a diary. RESULTS: Pre-trial (no previous listening experience), a clear trend favoring one strategy was observed in four subjects. Four other subjects showed no clear advantage. Post-trial (after alternating daily between strategies), of the four subjects who showed a clear advantage for one signal processing strategy, only one subject showed that same advantage. One subject ended up with an advantage for the other strategy. Post-trial, of the four subjects who showed no advantage for a particular signal processing strategy, three did show an advantage for one strategy over the other. CONCLUSION: Patients are willing to alternate between signal processing strategies on a daily basis for up to three months in an attempt to determine their optimal strategy. Although some patients showed superior performance with initial fittings (and some did not), the results of pre-trial comparison did not always persist after having equal listening experience. We recommend this daily alternating listening technique when there is interest in determining optimal performance among different signal processing strategies when fitting hearing aids or cochlear implants.