Comparison of bimodal benefit for the use of DSL v5.0 and NAL-NL2 in cochlear implant listeners
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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.Keywords:
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The objective was to determine whether speech perception could be improved for bimodal listeners (those using a cochlear implant [CI] in one ear and hearing aid in the contralateral ear) by removing low-frequency information provided by the CI, thereby reducing acoustic-electric overlap.Subjects were adult CI subjects with at least 1 year of CI experience. Nine subjects were evaluated in the CI-only condition (control condition), and 26 subjects were evaluated in the bimodal condition. CIs were programmed with 4 experimental programs in which the low cutoff frequency (LCF) was progressively raised. Speech perception was evaluated using Consonant-Nucleus-Consonant words in quiet, AzBio sentences in background babble, and spondee words in background babble.The CI-only group showed decreased speech perception in both quiet and noise as the LCF was raised. Bimodal subjects with better hearing in the hearing aid ear (< 60 dB HL at 250 and 500 Hz) performed best for words in quiet as the LCF was raised. In contrast, bimodal subjects with worse hearing (> 60 dB HL at 250 and 500 Hz) performed similarly to the CI-only group.These findings suggest that reducing low-frequency overlap of the CI and contralateral hearing aid may improve performance in quiet for some bimodal listeners with better hearing.
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Objective: To assess speech perception in children, speech audiometric sentence tests are generally better suited than single word tests because of their steeper discrimination function and thus higher sensitivity. A disadvantage of older German single word speech audiometric tests for children is their inapplicability in quiet and in noise. Moreover, their discrimination functions are shallower than those of optimized sentence tests, particularly in noise. The Oldenburg sentence test for children (Oldenburger Kinder-Satztest; OlKiSa) has already been shown to test reliably the speech perception in noise in normal-hearing children. Testing hearing-impaired children in noise, however, may be difficult. Therefore, quality criteria and norms for testing in quiet are also needed. Study sample: The OlKiSa in quiet was validated with 224 normal-hearing children between ages 4 to 10 years. Results: The discrimination functions are steeper (6.4 to 10.7 %/dB) than those of the commonly used German single word tests. Age-specific standards for 50% speech perception in quiet (speech reception threshold, SRT) are provided. Conclusions: The OlKiSa is a valid audiometric test to quantify speech perception in quiet in children from age 4.
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The purpose of this project was to evaluate differences between groups and device configurations for emotional responses to non-speech sounds. Three groups of adults participated: 1) listeners with normal hearing with no history of device use, 2) hearing aid candidates with or without hearing aid experience, and 3) bimodal cochlear-implant listeners with at least 6 months of implant use. Participants ( n = 18 in each group) rated valence and arousal of pleasant, neutral, and unpleasant non-speech sounds. Listeners with normal hearing rated sounds without hearing devices. Hearing aid candidates rated sounds while using one or two hearing aids. Bimodal cochlear-implant listeners rated sounds while using a hearing aid alone, a cochlear implant alone, or the hearing aid and cochlear implant simultaneously. Analysis revealed significant differences between groups in ratings of pleasant and unpleasant stimuli; ratings from hearing aid candidates and bimodal cochlear-implant listeners were less extreme (less pleasant and less unpleasant) than were ratings from listeners with normal hearing. Hearing aid candidates’ ratings were similar with one and two hearing aids. Bimodal cochlear-implant listeners’ ratings of valence were higher (more pleasant) in the configuration without a hearing aid (implant only) than in the two configurations with a hearing aid (alone or with an implant). These data support the need for further investigation into hearing device optimization to improve emotional responses to non-speech sounds for adults with hearing loss.
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Cochlear implant speech processors compress a wide acoustical dynamic range of sounds into a smaller electrical dynamic range. Some patients show wider electrical dynamic ranges than others and most of them have good speech perception performance. The knowledge of the average psycho-acoustical dynamic range in adults will help the audiologist program children who do not give reliable responses.This study was conducted to analyse the dynamic ranges of experienced Nucleus 22 cochlear implant users with good speech-perception and patients with poor speech-perception performances.Thirty-one maps of adult subjects with Nucleus 22 cochlear implants using the SPEAK processing strategy, in bipolar stimulation were analysed. By the time of this study, all of them had used a cochlear implant for over a year. They were divided into two groups: group 1, composed of those with good speech perception for sentences (better than 80%), and group 2, composed of those with speech perception results for sentences worse than 70%.Results showed that both dynamic ranges were wide in the two groups (average 50 units).Although dynamic ranges vary among subjects and electrodes, a lower variability was observed within the group of patients with better speech perception.
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Recent research has demonstrated that the ability of adults with cochlear implants (CI) to perceive speech in noise is highly variable. There are many potential reasons why this may be so, including poor signal/noise segregation, and poor perception of phonetic features in noise. We examined the CI listeners’ perception of four synthetic speech continua in quiet and in noise. In two continua, dynamic spectral information was manipulated (/ra/-/la/ and /wa/-/ja/); in one, static spectral information was manipulated (/i/-/u/); and in one, only temporal information was manipulated (/sei/-/stei/). These were presented to 12 listeners with CIs and 13 normal-hearing listeners in quiet and concurrent with speech-shaped noise, at a +10 dB SNR. Noise affected identification (endpoints, boundaries, and slopes) of CI listeners more than NH listeners. Significant group-by-SNR interactions were found for endpoint identification of the /ra/-/la/, /wa/-/ja/, and /sei/-/stei/ continua. CI listeners had significantly shallower identification slopes for the /ra/-/la/ continuum; this was exaggerated in the +10 dB SNR condition. In addition, CI listeners showed more /u/ percepts than the NH listeners in the /i/-/u/ continuum at +10 dB SNR. Results are discussed with respect to the relative vulnerability of temporal and spectral features to misperception in noisy conditions.
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Studies have shown that unilateral cochlear implant users who have residual hearing in the contralateral ear can benefit from combining a hearing aid in the nonimplanted ear with their cochlear implant. The purpose of this study was to better understand the factors influencing decision making by adults. Adults who had discontinued hearing aid use shortly after cochlear implantation were selected from one Canadian cochlear implant program. An examination of hearing aid use revealed that of 96 patients, who used hearing aids preimplant, 49 had discontinued hearing aid use. Patient perspectives on the decision and experience of combining a hearing aid and a cochlear implant were collected through 12 individual semistructured interviews. The interviews were analyzed qualitatively to identify key themes. Questionnaires, based on the interview findings, were developed and sent to the 49 adults to further explore the factors affecting hearing aid decisions. Interview and questionnaire findings from 28 adults indicated that three factors primarily influenced patients' decision to discontinue hearing aid use: their perceptions of the experience with hearing aids prior to implantation, their views of superiority of a unilateral cochlear implant in comparison with hearing aids, and their perceptions of interference with sound quality when a cochlear implant and hearing aid were combined. This study provides information about patient perceptions, experiences, and understanding of the potential difficulties of a bimodal fitting that may assist clinicians in pre- and postimplant counseling.
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Introduction The objective of the evaluation of auditory perception of cochlear implant users is to determine how the acoustic signal is processed, leading to the recognition and understanding of sound. Objective To investigate the differences in the process of auditory speech perception in individuals with postlingual hearing loss wearing a cochlear implant, using two different speech coding strategies, and to analyze speech perception and handicap perception in relation to the strategy used. Methods This study is prospective cross-sectional cohort study of a descriptive character. We selected ten cochlear implant users that were characterized by hearing threshold by the application of speech perception tests and of the Hearing Handicap Inventory for Adults. Results There was no significant difference when comparing the variables subject age, age at acquisition of hearing loss, etiology, time of hearing deprivation, time of cochlear implant use and mean hearing threshold with the cochlear implant with the shift in speech coding strategy. There was no relationship between lack of handicap perception and improvement in speech perception in both speech coding strategies used. Conclusion There was no significant difference between the strategies evaluated and no relation was observed between them and the variables studied.
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Objectives: The objective of this study was to identify parameters which are related to speech recognition in quiet and in noise of cochlear implant (CI) users. These parameters may be important to improve current fitting practices. Design: Adult CI users who visited the Amsterdam UMC, location VUmc, for their annual follow-up between January 2015 and December 2017 were retrospectively identified. After applying inclusion criteria, the final study population consisted of 138 postlingually deaf adult Cochlear CI users. Prediction models were built with speech recognition in quiet and in noise as the outcome measures, and aided sound field thresholds, and parameters related to fitting (i.e., T and C levels, dynamic range [DR]), evoked compound action potential thresholds and impedances as the independent variables. A total of 33 parameters were considered. Separate analyses were performed for postlingually deafened CI users with late onset (LO) and CI users with early onset (EO) of severe hearing impairment. Results: Speech recognition in quiet was not significantly different between the LO and EO groups. Speech recognition in noise was better for the LO group compared with the EO group. For CI users in the LO group, mean aided thresholds, mean electrical DR, and measures to express the impedance profile across the electrode array were identified as predictors of speech recognition in quiet and in noise. For CI users in the EO group, the mean T level appeared to be a significant predictor in the models for speech recognition in quiet and in noise, such that CI users with elevated T levels had worse speech recognition in quiet and in noise. Conclusions: Significant parameters related to speech recognition in quiet and in noise were identified: aided thresholds, electrical DR, T levels, and impedance profiles. The results of this study are consistent with previous study findings and may guide audiologists in their fitting practices to improve the performance of CI users. The best performance was found for CI users with aided thresholds around the target level of 25 dB HL, and an electrical DR between 40 and 60 CL. However, adjustments of T and/or C levels to obtain aided thresholds around the target level and the preferred DR may not always be acceptable for individual CI users. Finally, clinicians should pay attention to profiles of impedances other than a flat profile with mild variations.
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Electric acoustic stimulation (EAS) is an increasingly popular means of treating individuals with a steeply sloping mid-to-high frequency hearing loss, who traditionally do not benefit from hearing instruments. These persons often have too much residual hearing to be considered for a cochlear implant. Several studies have demonstrated the ability both to preserve the remaining low-frequency hearing in these individuals, and to provide significant benefit through combining a cochlear implant with a hearing aid to amplify the same ear. These improvements in performance have been especially noted in noise. Often overlooked is that these outcomes may be influenced by the fitting parameters of both the cochlear implant and the hearing aid.This study assessed four EAS subjects, with a minimum of 1 month's EAS use, on eight different fitting parameters. Sentence testing in different noise levels (+15, +10, and +5 dB SPL) was conducted. Subjects also evaluated each condition using a visual analogue scale.Results demonstrated that a reduced overlap of cochlear implant and hearing aid amplification produced best results across listening conditions.The hearing aid should be fit to a patient-specific modified audiogram at least up to the point where low-frequency hearing is not measurable. The cochlear implant should be fit from a higher frequency point than is standard in patients without residual hearing in the implanted ear, to provide reduced overlap with the amplification provided by the hearing aid. Therefore, a small amount of overlap between the frequency ranges used by the hearing aid and the cochlear implant seems beneficial.
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