Faculty Bibliography

OBJECTIVES:There are many potential advantages to combined electric and acoustic stimulation (EAS) with a cochlear implant (CI), including benefits for hearing in noise, localization, frequency selectivity, and music enjoyment. However, performance on these outcome measures is variable, and the residual acoustic hearing may not be beneficial for all patients. As such, we propose a measure of spectral resolution that might be more predictive of the usefulness of the residual hearing than the audiogram alone. In the following experiments, we measured performance on spectral resolution and speech perception tasks in individuals with normal hearing (NH) using low-pass filters to simulate steeply sloping audiograms of typical EAS candidates and compared it with performance on these tasks for individuals with sensorineural hearing loss with similar audiometric configurations. Because listeners with NH had similar levels of audibility and bandwidth to listeners with hearing loss, differences between the groups could be attributed to distortions due to hearing loss. DESIGN:Listeners with NH (n = 12) and those with hearing loss (n = 23) with steeply sloping audiograms participated in this study. The group with hearing loss consisted of 7 EAS users, 14 hearing aid users, and 3 who did not use amplification in the test ear. Spectral resolution was measured with the spectral-temporal modulated ripple test (SMRT), and speech perception was measured with AzBio sentences in quiet and noise. Listeners with NH listened to stimuli through low-pass filters and at two levels (40 and 60 dBA) to simulate low and high audibility. Listeners with hearing loss listened to SMRT stimuli unaided at their most comfortable listening level and speech stimuli at 60 dBA. RESULTS:Results suggest that performance with SMRT is significantly worse for listeners with hearing loss than for listeners with NH and is not related to audibility. Performance on the speech perception task declined with decreasing frequency information for both listeners with NH and hearing loss. Significant correlations were observed between speech perception, SMRT scores, and mid-frequency audiometric thresholds for listeners with hearing loss. CONCLUSIONS:NH simulations describe a "best case scenario" for hearing loss where audibility is the only deficit. For listeners with hearing loss, the likely broadening of auditory filters, loss of cochlear nonlinearities, and possible cochlear dead regions may have contributed to distorted spectral resolution and thus deviations from the NH simulations. Measures of spectral resolution may capture an aspect of hearing loss not evident from the audiogram and be a useful tool for assessing the contributions of residual hearing post-cochlear implantation.

OBJECTIVES:Pitch is poorly perceived by cochlear implant (CI) users. However, as it is not well understood how pitch is encoded with electric stimulation, improving pitch representation with a CI is challenging. Changes in place of stimulation along the cochlea have been described as changes in pitch and can be accurately ranked by CI users. However, it remains unknown if place-pitch can be used to encode musical intervals, which are a necessary attribute of pitch. The objective of these experiments is to determine if place-pitch coding can be used to represent musical intervals with a CI. DESIGN:In the first experiment, 10 CI users and 10 normal hearing (NH) controls were tested on their sensitivity to changes in the semitone spacing between each of the notes in the melody "Happy Birthday." The changes were implemented by uniformly expanding or compressing the frequency differences between each note in the melody. The participant's task was to scale how "out-of-tune" the melody was for various semitone spacing distortions. The notes were represented by pure-tones ≥440 Hz to minimize potential useful temporal information from the stimuli. A second experiment replicated the first experiment using single-sided deafened CI users allowing for a within-subject control. A third experiment verified that the CI users who participated in Experiment 1 were each able to determine pitch direction reliably. RESULTS:Unlike NH listeners, CI listeners often ranked all distortions of interval spacing similarly in both the first and second experiment, and no effect of interval spacing was detected across CI users. Some participants found distorted interval spacings to be less out-of-tune than the nominally correct interval spacings. However, these patterns were inconsistent across listeners. Although performance was better for the NH listeners, the third experiment demonstrated that the CI listeners were able to reliably identify changes in pitch direction from place-pitch coding. CONCLUSIONS:The data suggest that place-pitch intervals are not properly represented through a CI sound processor. Some limited support is found for place-pitch being useful for interval encoding as some participants demonstrated improved ratings for certain interval distortions. Presumably the interval representation for these participants could be improved by a change to the frequencies represented by each electrode. However, as these patterns vary across listeners, there is not a universal correction to frequency representation that will solve this issue. As results are similar for single-sided deafened CI users, the limitations in ratings are likely not limited by an eroded representation of the melody caused by an extended duration of deafness.

BACKGROUND:Prior studies have shown an advantage for electro-acoustic stimulation (EAS) in cochlear implant (CI) patients with residual hearing, but the degree of benefit can vary. The objective was to explore which factors relate to performance with and acceptance of EAS for CI users with conventional-length electrodes. METHODS:A retrospective chart review was conducted for adults with an average threshold of 75 dB hearing loss or better across 250 and 500 Hz preoperatively (n = 83). All patients underwent cochlear implantation with a conventional-length electrode. Low-frequency audiometric thresholds were measured at initial activation as well as 3 and 12 months postoperatively to determine who met the criteria for EAS. Speech perception for CNC words and AzBio sentences in quiet and +10 dB SNR noise was evaluated 3 and 12 months after activation. RESULTS:Speech perception in quiet and noise was similar regardless of whether or not the patient was eligible for EAS. Less than half of the patients who met the EAS criteria chose to use it, citing reasons such as physical discomfort or lack of perceived benefit. EAS users performed better on CNC words but not sentence recognition than EAS nonusers. CONCLUSIONS:EAS use is dependent on audiologic and nonaudiologic issues. Hearing preservation is possible with conventional electrodes, but hearing preservation alone does not guarantee superior speech perception.

OBJECTIVES/OBJECTIVE:Cochlear implants (CIs) restore speech perception in quiet but they also eliminate or distort many acoustic cues that are important for music enjoyment. Unfortunately, quantifying music enjoyment by CI users has been difficult because comparisons must rely on their recollection of music before they lost their hearing. Here, we aimed to assess music enjoyment in CI users using a readily interpretable reference based on acoustic hearing. The comparison was done by testing "single-sided deafness" (SSD) patients who have normal hearing (NH) in one ear and a CI in the other ear. The study also aimed to assess binaural musical enjoyment, with the reference being the experience of hearing with a single NH ear. Three experiments assessed the effect of adding different kinds of input to the second ear: electrical, vocoded, or unmodified. DESIGN/METHODS:In experiment 1, music enjoyment in SSD-CI users was investigated using a modified version of the MUSHRA (MUltiple Stimuli with Hidden Reference and Anchor) method. Listeners rated their enjoyment of song segments on a scale of 0 to 200, where 100 represented the enjoyment obtained from a song segment presented to the NH ear, 0 represented a highly degraded version of the same song segment presented to the same ear, and 200 represented enjoyment subjectively rated as twice as good as the 100 reference. Stimuli consisted of acoustic only, electric only, acoustic and electric, as well as other conditions with low pass filtered acoustic stimuli. Acoustic stimulation was provided by headphone to the NH ear and electric stimulation was provided by direct audio input to the subject's speech processor. In experiment 2, the task was repeated using NH listeners who received vocoded stimuli instead of electric stimuli. Experiment 3 tested the effect of adding the same unmodified song segment to the second ear, also in NH listeners. RESULTS:Music presented through the CI only was very unpleasant, with an average rating of 20. Surprisingly, the combination of the unpleasant CI signal in one ear with acoustic stimulation in the other ear was rated more enjoyable (mean = 123) than acoustic processing alone. Presentation of the same monaural musical signal to both ears in NH listeners resulted with even greater enhancement of the experience compared with presentation to a single ear (mean = 159). Repeating the experiment using a vocoder to one ear of NH listeners resulted in interference rather than enhancement. CONCLUSIONS:Music enjoyment from electric stimulation is extremely poor relative to a readily interpretable NH baseline for CI-SSD listeners. However, the combination of this unenjoyable signal presented through a CI and an unmodified acoustic signal presented to a NH (or near-NH) contralateral ear results in enhanced music enjoyment with respect to the acoustic signal alone. Remarkably, this two-ear enhancement experienced by CI-SSD listeners represents a substantial fraction of the two-ear enhancement seen in NH listeners. This unexpected benefit of electroacoustic auditory stimulation will have to be considered in theoretical accounts of music enjoyment and may facilitate the quest to enhance music enjoyment in CI users.

We introduce a real-time capable algorithm which estimates the long-term signal to noise ratio (SNR) of the speech in multi-talker babble noise. In real-time applications, long-term SNR is calculated over a sufficiently long moving frame of the noisy speech ending at the current time. The algorithm performs the real-time long-term SNR estimation by averaging "speech-likeness" values of multiple consecutive short-frames of the noisy speech which collectively form a long-frame with an adaptive length. The algorithm is calibrated to be insensitive to short-term fluctuations and transient changes in speech or noise level. However, it quickly responds to non-transient changes in long-term SNR by adjusting the duration of the long-frame on which the long-term SNR is measured. This ability is obtained by employing an event detector and adaptive frame duration. The event detector identifies non-transient changes of the long-term SNR and optimizes the duration of the long-frame accordingly. The algorithm was trained and tested for randomly generated speech samples corrupted with multi-talker babble. In addition to its ability to provide an adaptive long-term SNR estimation in a dynamic noisy situation, the evaluation results show that the algorithm outperforms the existing overall SNR estimation methods in multi-talker babble over a wide range of number of talkers and SNRs. The relatively low computational cost and the ability to update the estimated long-term SNR several times per second make this algorithm capable of operating in real-time speech processing applications.

OBJECTIVES/OBJECTIVE:The Quick Spectral Modulation Detection (QSMD) test provides a quick and clinically implementable spectral resolution estimate for cochlear implant (CI) users. However, the original QSMD software (QSMD(MySound)) has technical and usability limitations that prevent widespread distribution and implementation. In this article, we introduce a new software package EasyQSMD, which is freely available software with the goal of both simplifying and standardizing spectral resolution measurements. DESIGN/METHODS:QSMD was measured for 20 CI users using both software packages. RESULTS:No differences between the two software packages were detected, and based on the 95% confidence interval of the difference between tests, the difference between the tests is expected to be <2% points. The average test duration was under 4 minutes. CONCLUSIONS:EasyQSMD is considered functionally equivalent to QSMD(MySound) providing a clinically feasible and quick estimate of spectral resolution for CI users.

OBJECTIVES/OBJECTIVE:Many clinics are faced with the difficulty of evaluating performance in patients who speak a language for which there are no validated tests. It would be desirable to have a nonlinguistic method of evaluating these patients. Spectral ripple tests are nonlinguistic and highly correlated with speech identification performance. However, they are generally not amenable to clinical environments as they typically require the use of computers which are often not found in clinic sound booths. In this study, we evaluate the Spectral-temporally Modulated Ripple Test (SMRT) Lite for computeRless Measurement (SLRM), which is a new variant of the adaptive SMRT that can be implemented via a CD player. DESIGN/METHODS:SMRT and SLRM were measured for 10 normal hearing and 10 cochlear implant participants. RESULTS:Performance on the two tests was highly correlated (r = 0.97). CONCLUSIONS:The results suggest that SLRM can be used interchangeably with SMRT but can be implemented without a computer.

Background/UNASSIGNED:Harmony is an important part of tonal music that conveys context, form and emotion. Two notes sounded simultaneously form a harmonic interval. In normal-hearing (NH) listeners, some harmonic intervals (e.g., minor 2nd, tritone, major 7th) typically sound more dissonant than others (e.g., octave, major 3rd, 4th). Because of the limited spectro-temporal resolution afforded by cochlear implants (CIs), music perception is generally poor. However, CI users may still be sensitive to relative dissonance across intervals. In this study, dissonance ratings for harmonic intervals were measured in 11 unilaterally deaf CI patients, in whom ratings from the CI could be compared to those from the normal ear. Methods/UNASSIGNED:Stimuli consisted of pairs of equal amplitude MIDI piano tones. Intervals spanned a range of two octaves relative to two root notes (F3 or C4). Dissonance was assessed in terms of subjective pleasantness ratings for intervals presented to the NH ear alone, the CI ear alone, and both ears together (NH + CI). Ratings were collected for both root notes for within- and across-octave intervals (1-12 and 13-24 semitones). Participants rated the pleasantness of each interval by clicking on a line anchored with "least pleasant" and "most pleasant." A follow-up experiment repeated the task with a smaller stimulus set. Results/UNASSIGNED:< 0.001). Ratings were similar between NH-only and NH + CI listening, with no significant binaural enhancement/interference. The follow-up tests showed that ratings were reliable for the least and most pleasant intervals. Discussion/UNASSIGNED:Although pleasantness ratings were less differentiated for the CI ear than the NH ear, there were similarities between the two listening modes. Given the lack of spectro-temporal detail needed for harmonicity-based distinctions, temporal envelope interactions (within and across channels) associated with a perception of roughness may contribute to dissonance perception for harmonic intervals with CI-only listening.

The auditory system can theoretically encode frequencies by either the rate or place of stimulation within the cochlea. Previous work with cochlear implants has demonstrated that both changes in timing and place can be described as pitch changes but are perceptually orthogonal. Using multidimensional scaling, the present experiment extends the previous findings that timing and place changes are perceptually orthogonal into the cochlear apex using long 31-mm electrode arrays. However, temporal cues seem to be more reliable across subjects at the apex while place cues seem to be more reliable at the middle of the cochlea.

This study examined the interaction between polarity and electrode-activation order on loudness in cochlear implant users. Pulses were presented with the polarity of the leading phase alternating or constant across channels. Electrode-activation order was either consecutive or staggered. Staggered electrode-activation orders required less current for equal loudness than consecutive orders with constant polarity. Consecutive electrode-activation orders required less current than staggered orders with alternating polarity. The results support the hypothesis that crosstalk between channels can interfere with or facilitate neuronal activation depending on polarity.