Using the HISQUI29 to assess the sound quality levels of Spanish adults with unilateral cochlear implants and no contralateral hearing
Miryam CalvinoJaviér GavilánIsabel Sánchez‐CuadradoRosa Pérez‐MoraElena MuñozJesús Díez‐SebastiánLuis Lassaletta
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Cochlear Implantation
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Objective: This paper aimed to estimate the difference in speech perception outcomes that may occur due to timing of cochlear implantation in relation to the progression of hearing loss. Design: Data from a large population-based sample of adults with acquired hearing loss using cochlear implants (CIs) was used to estimate the effects of duration of hearing loss, age, and pre-implant auditory skills on outcomes for a hypothetical standard patient. Study sample: A total of 310 adults with acquired severe/profound bilateral hearing loss who received a CI in Melbourne, Australia between 1994 and 2006 provided the speech perception data and demographic information to derive regression equations for estimating CI outcomes. Results: For a hypothetical CI candidate with progressive sensorineural hearing loss, the estimates of speech perception scores following cochlear implantation are significantly better if implantation occurs relatively soon after onset of severe hearing loss and before the loss of all functional auditory skills. Conclusions: Improved CI outcomes and quality of life benefit may be achieved for adults with progressive severe hearing loss if they are implanted earlier in the progression of the pathology.
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Normal-hearing listeners gain important everyday benefits from having two ears, particularly for determining where sounds come from and for understanding speech in noisy environments. Users of two cochlear implants may have the opportunity to experience some of these bilateral advantages. The primary aim of this study was to document bilateral versus unilateral listening benefit in 15 postlinguistically deafened adults implanted simultaneously with two Harmony(®) (HiRes 90K(®)) cochlear implants. Speech perception (in quiet and in noise) and localization accuracy were assessed for each ear alone and both ears together. Subjects showed improved sound localization and better speech perception in quiet and in noise when using two implants compared with using one implant alone.
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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.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 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.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.
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Objective This study aimed to adapt a method used in sound quality measurements named CI-MUSHRA (the multiple stimuli with hidden reference and anchor for cochlear implant users) to the Turkish language. The effect of low-frequency information and non-native musical stimuli on sound quality perception was investigated.Design Subjects completed the Turkish version of the MUSHRA test, called TR-MUSHRA, and the original CI-MUSHRA test. Participants also completed the Turkish monosyllabic word recognition test and the spectral temporal modulated ripple test (SMRT).Study sample 19 cochlear implant (CI) users and 16 normal-hearing (NH) adults were included.Results CI users demonstrated a lack of ability to detect the sound quality differences between original stimuli and stimuli with omitted low-frequency information up to 600 Hz in both tests. There was no significant main effect of the test version on sound quality ratings for the two groups. No significant correlation was found between mean sound quality scores, SMRT, and speech recognition in quiet and noise conditions.Conclusions Our study suggests that CI users perform poorly in discriminating high-pass filtered musical sounds regardless of the language of the musical stimuli. The TR-MUSHRA can be used as a reliable research tool to evaluate the perceived sound quality.
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Background: The most pressing problem facing cochlear implant research is no longer making artificial hearing a reality. Instead, it is to develop devices that can more clearly reflect the capabilities of the human auditory system. Current cochlear implants rarely provide adequate pitch perception. As hearing loss commonly affects higher, more than lower frequencies, a possible solution is to preserve acoustic hearing at low frequencies by inserting a short electrode array and thus deliver combined electro‐acoustic stimulation (EAS). Objective of review: To determine whether individuals with severe‐to‐profound high‐frequency hearing loss have realised this predicted benefit of combined EAS, over conventional cochlear implants, with respect to pitch. Type of review: A systematic review of publications pertaining to the benefits of combined EAS over conventional cochlear implantation, with specific reference to pitch perception. Search strategy: A systematic literature search was conducted across multiple databases and supplemented by searching the reference lists of relevant trials and identified reviews. Results: The included studies suggest an overall benefit of combined EAS, over conventional cochlear implants, with respect to pitch. In addition, (i) 13% sustained a total loss of low‐frequency hearing post‐implantation of the short electrode array and, (ii) 24% had >20 dB hearing loss across all frequencies and/or total hearing loss. Conclusions: For patients with severe‐to‐profound high‐frequency hearing loss combined EAS appears to offer a significant, everyday, long‐term benefit. However, further clinical trials with larger numbers of candidates are necessary to confirm this finding. The risks involved cannot be ignored, but there is potential for a variety of strategies to improve the safety margin.
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Abstract Objectives/Hypothesis: Although it is clear that early auditory stimulation through cochlear implantation (CI) has been shown to improve speech and language development trajectories for children with prelingual hearing loss, data supporting implantation in postlingual children are mostly lacking. The purpose of this study was to characterize speech perception abilities following CI in a group of children with previously well‐developed language abilities. Study Design: Retrospective analysis. Methods: Twenty‐eight hearing‐impaired children who received CIs were selected for study based on the presence of well‐developed spoken language skills before implantation. Fifteen children with prelingual hearing loss served as a control group. Speech perception skills were assessed using developmentally appropriate measures. Results: Children with postlingual hearing loss showed a statistically significant improvement in open‐set speech perception scores as early as 6 months following CI, whereas prelingual children demonstrated significant improvements only after 24 months of use. Despite these early disparities in performance, the two groups were similar 36 months after implantation and beyond (60 months of implant use). Conclusions: Children with well‐developed language abilities before CI showed substantial (and statistically significant) early improvements in open‐set speech perception abilities following implantation that continued beyond 2 years of follow‐up. These results suggest that postlingual children are excellent candidates for CI. Laryngoscope, 2012
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Objective To evaluate impacts of cochlear implantation on speech perception and quality of life in postlingual deaf adults. Method Twelve adult cochlear implant users (7 females and 5 males) participated in this study. Mandarin Hearing in Noise Test (MHINT) was used to assess speech perception. Test score in noise was defined as the signal-to-noise ratio (SNR) at which speech perception in noise was approximately 50% of the score in quiet. The Nijmegen Cochlear Implantation Questionnaire (NICQ) was administered to quantify quality of life. Result Cochlear implants demonstrated a large and significant positive impact on quality of life and auditory perception. 1) The average speech perception scores in quiet was 63.5% (SD=26.6). 2) The average score in noise was 10.3 dB (SD=3.7). 3) Differences between pre- and post-implant total and all sub-domain NCIQ scores were statistically significant (P 0.05). 4) No obvious correlations were found between NCIQ outcomes and auditory perception (P 0.05). Conclusion Cochlear implants have a large and significant positive impact on quality of life. Improvement in quality of life is greater than that in auditory perception.
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Charcot-Marie-Tooth (CMT) disease is the most common hereditary motor and sensory neuropathy and can result in profound sensori-neural hearing loss with deficiency in speech perception out of proportion to that which would be expected if the loss was cochlear in origin. This study investigates whether the reintroduction of auditory synchrony by means of cochlear implantation will improve speech perception in those with dys-synchrony related to impairment of temporal processing abilities secondary to CMT.A 67-year-old male presented with a gradual but significant decrease in his hearing as part of a slowly progressing demyelinating peripheral neuropathy. On open-set speech discrimination he scored 0%.A Med-el Flex(SOFT) cochlear implant (CI) was fully inserted into the left ear with no surgical complications. The CI speech processor was fitted 1 month post-implantation and standardized speech assessments conducted at 1 week, 3 months, 9 months, and 21 months following initial fitting, gave open-set speech discrimination scores of 0, 0, 53, and 54%, respectively.This report demonstrates that cochlear implantation is an option to rehabilitate severe-to-profound hearing loss in adults with auditory dys-synchrony secondary to CMT disease. Progress post-implantation is likely to be slower than for the average CI user.
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Objective: For a group of bimodal subjects with moderate to severe hearing loss contralateral to the cochlear implant (CI), the bimodal benefit of the hearing aid (HA) gain prescriptions DSL v5.0, NAL-NL2 and the recipients’ own gain setting were assessed.Design: Speech perception in quiet and in noise as well as self-reported ratings of benefit were determined for all three gain-settings. Speech tests were performed in the bimodal, the HA alone and the CI alone condition. The bimodal benefit was assessed for each prescription as the difference score of the bimodal condition and the better ear.Study Sample: Twenty adults with post-lingual hearing loss.Results: Speech perception with DSL v5.0 was significantly higher compared to NAL-NL2 and the own prescription in both quiet and noise. The median bimodal benefit was highest for DSL v5.0 with an average of 15 percentage points for both words in quiet and sentences in noise.Conclusions: DSL v5.0 and NAL-NL2 are both suitable for HA fitting in bimodal users. For subjects with moderate to severe hearing loss and HA experience contralateral to the implanted side, DSL v5.0 may provide better speech perception and bimodal benefit.
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