Faculty Bibliography

OBJECTIVES:: Perception of spectrally degraded speech is particularly difficult when the signal is also distorted along the frequency axis. This might be particularly important for post-lingually deafened recipients of cochlear implants (CIs), who must adapt to a signal where there may be a mismatch between the frequencies of an input signal and the characteristic frequencies of the neurons stimulated by the CI. However, there is a lack of tools that can be used to identify whether an individual has adapted fully to a mismatch in the frequency-to-place relationship and if so, to find a frequency table that ameliorates any negative effects of an unadapted mismatch. The goal of the proposed investigation is to test the feasibility of whether real-time selection of frequency tables can be used to identify cases in which listeners have not fully adapted to a frequency mismatch. The assumption underlying this approach is that listeners who have not adapted to a frequency mismatch will select a frequency table that minimizes any such mismatches, even at the expense of reducing the information provided by this frequency table. DESIGN:: Thirty-four normal-hearing adults listened to a noise-vocoded acoustic simulation of a CI and adjusted the frequency table in real time until they obtained a frequency table that sounded "most intelligible" to them. The use of an acoustic simulation was essential to this study because it allowed the authors to explicitly control the degree of frequency mismatch present in the simulation. None of the listeners had any previous experience with vocoded speech, in order to test the hypothesis that the real-time selection procedure could be used to identify cases in which a listener has not adapted to a frequency mismatch. After obtaining a self-selected table, the authors measured consonant nucleus consonant word-recognition scores with that self-selected table and two other frequency tables: a "frequency-matched" table that matched the analysis filters with the noisebands of the noise-vocoder simulation, and a "right information" table that is similar to that used in most CI speech processors, but in this simulation results in a frequency shift equivalent to 6.5 mm of cochlear space. RESULTS:: Listeners tended to select a table that was very close to, but shifted slightly lower in frequency from the frequency-matched table. The real-time selection process took on average 2 to 3 min for each trial, and the between-trial variability was comparable with that previously observed with closely related procedures. The word-recognition scores with the self-selected table were clearly higher than with the right-information table and slightly higher than with the frequency-matched table. CONCLUSIONS:: Real-time self-selection of frequency tables may be a viable tool for identifying listeners who have not adapted to a mismatch in the frequency-to-place relationship, and to find a frequency table that is more appropriate for them. Moreover, the small but significant improvements in word-recognition ability observed with the self-selected table suggest that these listeners based their selections on intelligibility rather than some other factor. The within-subject variability in the real-time selection procedure was comparable with that of a genetic algorithm, and the speed of the real-time procedure appeared to be faster than either a genetic algorithm or a simplex procedure.

OBJECTIVES:: The purpose of this study was to determine how the bandwidth of the hearing aid (HA) fitting affects bimodal speech recognition of listeners with a cochlear implant (CI) in one ear and severe-to-profound hearing loss in the unimplanted ear (but with residual hearing sufficient for wideband amplification using National Acoustic Laboratories Revised, Profound [NAL-RP] prescriptive guidelines; unaided thresholds no poorer than 95 dB HL through 2000 Hz). DESIGN:: Recognition of sentence material in quiet and in noise was measured with the CI alone and with CI plus HA as the amplification provided by the HA in the high and mid-frequency regions was systematically reduced from the wideband condition (NAL-RP prescription). Modified bandwidths included upper frequency cutoffs of 2000, 1000, or 500 Hz. RESULTS:: On average, significant bimodal benefit was obtained when the HA provided amplification at all frequencies with aidable residual hearing. Limiting the HA bandwidth to only low-frequency amplification (below 1000 Hz) did not yield significant improvements in performance over listening with the CI alone. CONCLUSIONS:: These data suggest the importance of providing amplification across as wide a frequency region as permitted by audiometric thresholds in the HA used by bimodal users.

Acoustic models have been used in numerous studies over the past thirty years to simulate the percepts elicited by auditory neural prostheses. In these acoustic models, incoming signals are processed the same way as in a cochlear implant speech processor. The percepts that would be caused by electrical stimulation in a real cochlear implant are simulated by modulating the amplitude of either noise bands or sinusoids. Despite their practical usefulness these acoustic models have never been convincingly validated. This study presents a tool to conduct such validation using subjects who have a cochlear implant in one ear and have near perfect hearing in the other ear, allowing for the first time a direct perceptual comparison of the output of acoustic models to the stimulation provided by a cochlear implant.

OBJECTIVES/HYPOTHESIS: This pilot study details the use of a software tool that uses continuous impedance measurement during electrode insertion, with the eventual potential to assess and optimize electrode position and reduce insertional trauma. STUDY DESIGN: Software development and experimental study with human cadaveric cochleae and two live surgeries. METHODS: A prototype program to measure intracochlear electrode impedance and display it graphically in real time has been developed. The software was evaluated in human cadaveric temporal bones while simultaneously making real-time fluoroscopic recordings and in two live surgeries during intracochlear electrode insertion. RESULTS: Impedance changes were observed with various scalar positions, and values were consistent with those obtained using clinically available software. Using Contour Advance electrodes, impedance values increased after stylet removal, particularly when using the monopolar mode. CONCLUSIONS: Impedance values seem systematically affected by electrode position, with higher values being associated with proximity to the cochlear wall. The new software is capable of acquiring impedance measurements during electrode insertion, and these data may be useful to guide surgeons to achieve optimal and atraumatic electrode insertion, to guide robotic electrode insertion, and to provide insights about electrode position in the cochlea.

Informationists at NYU Health Sciences Libraries (NYUHSL) successfully applied for a NLM supplement to a translational research grant obtained by PIs in the NYU School of Medicine Department of Otolaryngology titled, "Clinical Management of Cochlear Implant Patients with Contralateral Hearing Aids". The grant involves development of evidence-based guidelines for post-implant management of patients with bimodal cochlear implants. The PIs are also seeking to acquire new data sets to merge with grant-generated data. In light of the shifting data requirements, and the potential introduction of additional datasets, informationists will evaluate and restructure the data model and data entry tool. Report queries will be refined for the new data model and options for a query tool appropriate for users unfamiliar with query languages will be assessed and implemented. The services offered through this supplement represent the deepest and most detailed data management support offered by NYUHSL to date. The components of the supplement are being analyzed as a pilot of a broader offering of these data management services

The Laboratory of Translational Auditory Research (LTAR/NYUSM) is part of the Department of Otolaryngology at the New York University School of Medicine and has close ties to the New York University Cochlear Implant Center. LTAR investigators have expertise in multiple related disciplines including speech and hearing science, audiology, engineering, and physiology. The lines of research in the laboratory deal mostly with speech perception by hearing impaired listeners, and particularly those who use cochlear implants (CIs) or hearing aids (HAs). Although the laboratory's research interests are diverse, there are common threads that permeate and tie all of its work. In particular, a strong interest in translational research underlies even the most basic studies carried out in the laboratory. Another important element is the development of engineering and computational tools, which range from mathematical models of speech perception to software and hardware that bypass clinical speech processors and stimulate cochlear implants directly, to novel ways of analyzing clinical outcomes data. If the appropriate tool to conduct an important experiment does not exist, we may work to develop it, either in house or in collaboration with academic or industrial partners. Another notable characteristic of the laboratory is its interdisciplinary nature where, for example, an audiologist and an engineer might work closely to develop an approach that would not have been feasible if each had worked singly on the project. Similarly, investigators with expertise in hearing aids and cochlear implants might join forces to study how human listeners integrate information provided by a CI and a HA. The following pages provide a flavor of the diversity and the commonalities of our research interests.

This study examines behavioral and physiological measures of pitch matching in cochlear implant (CI) users who have residual hearing in the contralateral ear. Subjects adjusted the frequency of an acoustic tone to match the pitch percept elicited by electrical stimulation in the other ear, when stimulation was alternating across two ears. In general, the selected acoustic frequencies did not line up perfectly with the center frequencies of the analysis bands corresponding to each stimulation electrode. Similar alternating electro-acoustic stimuli were used to record Auditory Evoked Potentials on 8 NH subjects and 3 CI patients. NH subjects were presented with a fixed tone in one ear, while tones in the other ear varied within a few octaves from the fixed tone. CI patients were stimulated with six different audible tones including their pitch-matched tones, while receiving electrical stimulation in the electrode. N1 latency for NH subjects was minimized when the same frequency was presented to both ears. Similarly, N1 latency for CI patients who are able to pitch match was minimized when the tone was at the pitch matched frequency of the stimulated electrode. These results suggest that N1 latency can be a possible objective measure of pitch matching. (Work supported by NIH/NIDCD 1K25DC010834-01;PI:Tan, PSC-CUNY;PI:Martin, and NIH/NIDCD R01-DC03937;PI:Svirsky.).

The multidimensional phoneme identification model is applied to consonant confusion matrices obtained from 28 postlingually deafened cochlear implant users. This model predicts consonant matrices based on these subjects' ability to discriminate a set of postulated spectral, temporal, and amplitude speech cues as presented to them by their device. The model produced confusion matrices that matched many aspects of individual subjects' consonant matrices, including information transfer for the voicing, manner, and place features, despite individual differences in age at implantation, implant experience, device and stimulation strategy used, as well as overall consonant identification level. The model was able to match the general pattern of errors between consonants, but not the full complexity of all consonant errors made by each individual. The present study represents an important first step in developing a model that can be used to test specific hypotheses about the mechanisms cochlear implant users employ to understand speech

A portable real-time speech processor that implements an acoustic simulation model of a cochlear implant (CI) has been developed on the Apple iPhone / iPod Touch to permit testing and experimentation under extended exposure in real-world environments. This simulator allows for both a variable number of noise band channels and electrode insertion depth. Utilizing this portable CI simulator, we tested perceptual learning in normal hearing listeners by measuring word and sentence comprehension behaviorally before and after 2 weeks of exposure. To evaluate changes in neural activation related to adaptation to transformed speech, fMRI was also conducted. Differences in brain activation after training occurred in the inferior frontal gyrus and areas related to language processing. A 15-20% improvement in word and sentence comprehension of cochlear implant simulated speech was also observed. These results demonstrate the effectiveness of a portable CI simulator as a research tool and provide new information about the physiological changes that accompany perceptual learning of degraded auditory input.