Everyday Auditory Environment Among Elderly Cochlear Implant Users

Effect of exceeding compliance voltage on speech perception in cochlear implants

For patients who have received cochlear implants (CIs), speech-perception testing requires specialized equipment. This limits locations where these services can be provided, which can introduce barriers for provision of care. Providing speech test stimuli directly to the CI via wireless digital audio streaming (DAS) or wired direct audio input (DAI) allows for testing without the need for a sound booth (SB). A few studies have investigated the use of DAI for testing speech perception in CIs, but none have evaluated DAS. The goal of this study was to compare speech perception testing in CI users via DAS versus a traditional SB to determine if differences exist between the two presentation modes. We also sought to determine whether pre-processing the DAS signal with room acoustics (reverberation and noise floor) to emulate the SB environment would affect performance differences between the SB and DAS. In Experiment 1, speech perception was measured for monosyllabic words in quiet and sentences in quiet and in noise. Scores were obtained in a SB and compared to those obtained via DAS with unprocessed speech (DAS-U) for 11 adult CI users (12 ears). In Experiment 2, speech perception was measured for sentences in noise, where both the speech and noise stimuli were pre-processed to emulate the SB environment. Scores were obtained for 11 adult CI users (12 ears) in the SB, via DAS-U, and via DAS with the processed speech (DAS-P). For Experiment 1, there was no significant difference between SB and DAS-U conditions for words or sentences in quiet. However, DAS-U scores were significantly better than SB scores for sentences in noise. For Experiment 2, there was no significant difference between the SB and DAS-P conditions. Similar to Experiment 1, DAS-U scores were significantly better than SB or DAS-P scores. By pre-processing the test materials to emulate the noise and reverberation characteristics of a traditional SB, we can account for differences in speech-perception scores between those obtained via DAS and in a SB.

Breaking News

Introduction: Hearing loss is a major global public health issue that negatively impacts quality of life, communication, cognition, social participation, and mental health. The cochlear implant (CI) is the most efficacious treatment for severe-to-profound sensorineural hearing loss. However, variability in outcomes remains high among CI users. Our previous research demonstrated that the existing subjective methodology of CI programming does not consistently produce optimal stimulation for speech perception, thereby limiting the potential for CI users to derive the maximum device benefit to achieve their peak potential. We demonstrated the benefit of utilising the objective method of measuring auditory-evoked cortical responses to speech stimuli as a reliable tool to guide and verify CI programming and, in turn, significantly improve speech perception performance. The present study was designed to investigate the impact of patient- and device-specific factors on the application of acoustically-evoked cortical auditory-evoked potential (aCAEP) measures as an objective clinical tool to verify CI mapping in adult CI users with bilateral deafness (BD). Methods: aCAEP responses were elicited using binaural peripheral auditory stimulation for four speech tokens (/m/, /g/, /t/, and /s/) and recorded by HEARLab™ software in adult BD CI users. Participants were classified into groups according to subjective or objective CI mapping procedures to elicit present aCAEP responses to all four speech tokens. The impact of patient- and device-specific factors on the presence of aCAEP responses and speech perception was investigated between participant groups. Results: Participants were categorised based on the presence or absence of the P1-N1-P2 aCAEP response to speech tokens. Out of the total cohort of adult CI users (n = 132), 63 participants demonstrated present responses pre-optimisation, 37 participants exhibited present responses post-optimisation, and the remaining 32 participants either showed an absent response for at least one speech token post-optimisation or did not accept the optimised CI map adjustments. Overall, no significant correlation was shown between patient and device-specific factors and the presence of aCAEP responses or speech perception scores. Conclusion: This study reinforces that aCAEP measures offer an objective, non-invasive approach to verify CI mapping, irrespective of patient or device factors. These findings further our understanding of the importance of personalised CI rehabilitation through CI mapping to minimise the degree of speech perception variation post-CI and allow all CI users to achieve maximum device benefit.

Purpose: The current study investigates how individual differences in cochlear implant (CI) users’ sensitivity to word–nonword differences, reflecting lexical uncertainty, relate to their reliance on sentential context for lexical access in processing continuous speech.Method: Fifteen CI users and 14 normal-hearing (NH) controls participated in an auditory lexical decision task (Experiment 1) and a visual-world paradigm task (Experiment 2). Experiment 1 tested participants’ reliance on lexical statistics, and Experiment 2 studied how sentential context affects the time course and patterns of lexical competition leading to lexical access.Results: In Experiment 1, CI users had lower accuracy scores and longer reaction times than NH listeners, particularly for nonwords. In Experiment 2, CI users’ lexical competition patterns were, on average, similar to those of NH listeners, but the patterns of individual CI users varied greatly. Individual CI users’ word–nonword sensitivity (Experiment 1) explained differences in the reliance on sentential context to resolve lexical competition, whereas clinical speech perception scores explained competition with phonologically related words.Conclusions: The general analysis of CI users’ lexical competition patterns showed merely quantitative differences with NH listeners in the time course of lexical competition, but our additional analysis revealed more qualitative differences in CI users’ strategies to process speech. Individuals’ word–nonword sensitivity explained different parts of individual variability than clinical speech perception scores. These results stress, particularly for heterogeneous clinical populations such as CI users, the importance of investigating individual differences in addition to group averages, as they can be informative for clinical rehabilitation.Supplemental Material S1. An overview of the word and nonword characteristics of the stimuli that were used for the auditory lexical decision task (Experiment 1).Supplemental Material S2. Table with the coefficients of the best fitting model of participants’ accuracy scores for the auditory lexical decision task (Experiment 1).Supplemental Material S3. Table with the coefficients of the best fitting model of participants’ reaction times for the auditory lexical decision task (Experiment 1).Supplemental Material S4. Table with the coefficients of the best fitting model for fixations towards the phonological competitor (Experiment 2).Supplemental Material S5. Table with the coefficients of the best fitting model for fixations towards the semantic competitor (Experiment 2).Supplemental Material S6. Table with the coefficients of the best fitting model for fixations towards the phonological competitor by the subgroup of CI users (Experiment 2).Supplemental Material S7. Table with the coefficients of the best fitting model for fixations towards the semantic competitor by the subgroup of CI users (Experiment 2).Nagels, L., Bastiaanse, R., Baskent, D., & Wagner, A. (2019). Individual differences in lexical access among cochlear implant users. Journal of Speech, Language, and Hearing Research. Advance online publication. https://doi.org/10.1044/2019_JSLHR-19-00192

Background and Objectives Although many cochlear implant (CI) recipients receive significant benefits from using the implants, speech perception ability is still known to vary among CI users, and the variability is closely related to the ability of users to process temporal information. As one of the important temporal cues for speech perception in CI users, voice onset time (VOT) can be used to examine behavioral perception and neural correlates of temporal processing. In this study, we measured categorical perception and N1-P2 cortical auditory evoked potentials (CAEPs) using a /ba/-/pa/ VOT continuum in CI users as well as in normal-hearing (NH) listeners. Subjects and Method Ten CI subjects and 11 NH controls participated in syllable identification tasks and in electroencephalography recording. CI subjects were divided into two groups, which were ‘good’ and ‘poor’ performers based on their speech perception scores. The stimuli used in both experiments were a synthetic /ba/-/pa/ VOT continuum. The identification boundary and N1-P2 peak-to-peak amplitude were measured for each subject group. Results Behavioral results revealed that poor CI performers had a delayed identification boundary compared to NH listeners and good CI performers. However, N1-P2 peak-to-peak amplitudes in both good and poor CI performers were significantly smaller than those in NH group. Conclusion N1-P2 amplitudes reflected decreased auditory cortical activity of temporal cues in CI users. The categorical perception of good CI performers was similar to that of NH listeners, whereas their cortical responses were decreased to the level similar to that of poor CI performers. This finding indicates that CAEPs would be more sensitive to altered temporal processing of CI users than to behavioral measures. Key words: Categorical perception ㆍ Cochlear implant ㆍ N1-P2 cortical auditory evoked potentials ㆍ Temporal processing ㆍ Voice onset time

Pitch plasticity has been observed in Hybrid cochlear implant (CI) users. Does pitch plasticity also occur in bimodal CI users with traditional long-electrode CIs, and is pitch adaptation pattern associated with electrode discrimination or speech recognition performance? The goals of this study were to characterize pitch adaptation patterns in long-electrode CI users, to correlate these patterns with electrode discrimination and speech perception outcomes, and to analyze which subject factors are associated with the different patterns. Electric-to-acoustic pitch matches were obtained in 19 subjects over time from CI activation to at least 12 months after activation, and in a separate group of 18 subjects in a single visit after at least 24 months of CI experience. Audiometric thresholds, electrode discrimination performance, and speech perception scores were also measured. Subjects measured over time had pitch adaptation patterns that fit one of the following categories: (1) "Pitch-adapting," that is, the mismatch between perceived electrode pitch and the corresponding frequency-to-electrode allocations decreased; (2) "Pitch-dropping," that is, the pitches of multiple electrodes dropped and converged to a similar low-pitch; and (3) "Pitch-unchanging," that is, the electrode pitches did not change. Subjects measured after CI experience had a parallel set of adaptation patterns: (1) "Matched-pitch," that is, the electrode pitch was matched to the frequency allocation; (2) "Low-pitch," that is, the pitches of multiple electrodes were all around the lowest frequency allocation; and (3) "Nonmatched-pitch," that is, the pitch patterns were compressed relative to the frequency allocations and did not fit either the matched-pitch or low-pitch categories. Unlike Hybrid CI users which were mostly in the pitch-adapting or matched-pitch category, the majority of bimodal CI users were in the latter two categories, pitch-dropping/low-pitch or pitch-unchanging/nonmatched-pitch. Subjects with pitch-adapting or matched-pitch patterns tended to have better low-frequency thresholds than subjects in the latter categories. Changes in electrode discrimination over time were not associated with changes in pitch differences between electrodes. Reductions in speech perception scores over time showed a weak but nonsignificant association with dropping-pitch patterns. Bimodal CI users with more residual hearing may have somewhat greater similarity to Hybrid CI users and be more likely to adapt pitch perception to reduce mismatch with the frequencies allocated to the electrodes and the acoustic hearing. In contrast, bimodal CI users with less residual hearing exhibit either no adaptation, or surprisingly, a third pattern in which the pitches of the basal electrodes drop to match the frequency range allocated to the most apical electrode. The lack of association of electrode discrimination changes with pitch changes suggests that electrode discrimination does not depend on perceived pitch differences between electrodes, but rather on some other characteristics such as timbre. In contrast, speech perception may depend more on pitch perception and the ability to distinguish pitch between electrodes, especially since during multielectrode stimulation, cues such as timbre may be less useful for discrimination.

A cochlear implant (CI) is a hearing device introduced in the 1980s for profoundly deaf subjects who gained little or no benefit from powerful hearing aids. This device comprises an electrode array inserted in the cochlea, connected to an internal receiver, and an externally worn speech processor. The CI transforms acoustic signals into electrical currents which directly stimulate the auditory nerve. Since the early 1990s, cochlear implantation in children has been developing rapidly. Although it is still difficult to predict how a child will perform with a cochlear implant, the success of cochlear implantation can no longer be denied. In this paper, some recent papers and reports, and the results of the various Nijmegen cochlear implant studies, are reviewed. Issues about selection, examinations, surgery and the outcome are discussed. Overall, our results were comparable with those of other authors. It can be concluded that cochlear implantation is an effective treatment for postlingually deaf as well as prelingually (congenital or acquired) deaf children with profound bilateral sensorineural deafness.

Breaking News

Event-related potentials for better speech perception in noise by cochlear implant users

Daily Sound Awareness of CI Users

Speech intelligibility and subjective benefit in single-sided deaf adults after cochlear implantation

Objectives: (1) Characterize pitch adaptation patterns in bimodal long-electrode cochlear implant (CI) users over time, and correlate these with electrode discrimination and speech perception outcomes. (2) Compare to pitch plasticity observed in hybrid CI users. Methods: Observational cohort over a 12-month period after CI activation or of long-term CI experience. Severe to profound hearing impairment in 19 newly activated bimodal CI users and 20 long-term CI users was studied in an audiology clinic. Outcome measures: Electric-to-acoustic pitch matches, audiometric thresholds, electrode discrimination performance, and speech perception scores, measured over time. Results: Recently activated (12 months) subjects had these pitch adaptation patterns: pitch-adapting, pitch-dropping, and pitch-unchanging. Long-term subjects had a parallel set of adaptation patterns: matched-pitch, low-pitch, and nonmatched-pitch. Unlike hybrid CI users who are mostly pitch-adapting/matched-pitch, the majority of bimodal CI users demonstrated pitch-dropping/low-pitch or pitch-unchanging/nonmatched-pitch. Subjects with pitch-adapting/matched-pitch patterns trended towards better low-frequency thresholds. Changes in electrode discrimination were not associated with pitch differences between electrodes. Reductions in speech perception scores over time were associated with dropping-pitch patterns. Conclusions: Bimodal CI users with more residual hearing seem similar to hybrid CI users in adapting pitch perception to reduce mismatch with the frequencies allocated to the electrodes and acoustic hearing. In contrast, those with less residual hearing exhibit no adaptation or a drop in the pitches of the basal electrodes. Our data suggest that electrode discrimination does not depend on perceived pitch differences between electrodes. Speech perception may depend more on pitch perception and the ability to distinguish pitch between electrodes.

Cochlear implantation in children with cognitive impairments

Introduction: Several factors are known to influence speech perception in cochlear implant (CI) users. To date, the underlying mechanisms have not yet been fully clarified. Although many CI users achieve a high level of speech perception, a small percentage of patients does not or only slightly benefit from the CI (poor performer, PP). In a previous study, PP showed significantly poorer results on nonauditory-based cognitive and linguistic tests than CI users with a very high level of speech understanding (star performer, SP). We now investigate if PP also differs from the CI user with an average performance (average performer, AP) in cognitive and linguistic performance. Methods: Seventeen adult postlingually deafened CI users with speech perception scores in quiet of 55 (9.32) % (AP) on the German Freiburg monosyllabic speech test at 65 dB underwent neurocognitive (attention, working memory, short- and long-term memory, verbal fluency, inhibition) and linguistic testing (word retrieval, lexical decision, phonological input lexicon). The results were compared to the performance of 15 PP (speech perception score of 15 [11.80] %) and 19 SP (speech perception score of 80 [4.85] %). For statistical analysis, U-Test and discrimination analysis have been done. Results: Significant differences between PP and AP were observed on linguistic tests, in Rapid Automatized Naming (RAN: p = 0.0026), lexical decision (LexDec: p = 0.026), phonological input lexicon (LEMO: p = 0.0085), and understanding of incomplete words (TRT: p = 0.0024). AP also had significantly better neurocognitive results than PP in the domains of attention (M3: p = 0.009) and working memory (OSPAN: p = 0.041; RST: p = 0.015) but not in delayed recall (delayed recall: p = 0.22), verbal fluency (verbal fluency: p = 0.084), and inhibition (Flanker: p = 0.35). In contrast, no differences were found hereby between AP and SP. Based on the TRT and the RAN, AP and PP could be separated in 100%. Discussion: The results indicate that PP constitute a distinct entity of CI users that differs even in nonauditory abilities from CI users with an average speech perception, especially with regard to rapid word retrieval either due to reduced phonological abilities or limited storage. Further studies should investigate if improved word retrieval by increased phonological and semantic training results in better speech perception in these CI users.