Bilateral Cochlear Implant Users Research Articles

Improved Neural Coding of ITD with Bilateral Cochlear Implants by Introducing Short Inter-pulse Intervals.

Bilateral cochlear implant (CI) users have poor perceptual sensitivity to interaural time differences (ITDs), which limits their ability to localize sounds and understand speech in noisy environments. This is especially true for high-rate (> 300pps) periodic pulse trains, which are used as carriers in CI processors. Here, we investigate a novel stimulation strategy in which extra pulses are added to high-rate periodic pulse trains to introduce short inter-pulse intervals (SIPIs). We hypothesized that SIPIs can improve neural ITD sensitivity similarly to the effect observed by randomly jittering IPIs (Hancock et al., J. Neurophysiol. 108:714-28, 2012). To test this hypothesis, we measured ITD sensitivity of single units in the inferior colliculus (IC) of unanesthetized rabbits with bilateral CIs. Introducing SIPIs into high-rate pulse trains significantly increased firing rates for ~ 60% of IC neurons, and the extra spikes tended to be synchronized to the SIPIs. The additional firings produced by SIPIs uncovered latent ITD sensitivity that was comparable to that observed with low-rate pulse trains. In some neurons, high spontaneous firing rates masked the ITD sensitivity introduced by SIPIs. ITD sensitivity in these neurons could be revealed by emphasizing stimulus-synchronized spikes with a coincidence detection analysis. Overall, these results with SIPIs are consistent with the effects observed previously with jittered pulse trains, with the added benefit of retaining control over the timing and number of SIPIs. A novel CI processing strategy could incorporate SIPIs by inserting them at selected times to high-rate pulse train carriers. Such a strategy could potentially improve ITD perception without degrading speech intelligibility and thereby improve outcomes for bilateral CI users.

The Effect of Simulated Interaural Frequency Mismatch on Speech Understanding and Spatial Release From Masking.

The binaural-hearing system interaurally compares inputs, which underlies the ability to localize sound sources and to better understand speech in complex acoustic environments. Cochlear implants (CIs) are provided in both ears to increase binaural-hearing benefits; however, bilateral CI users continue to struggle with understanding speech in the presence of interfering sounds and do not achieve the same level of spatial release from masking (SRM) as normal-hearing listeners. One reason for diminished SRM in CI users could be that the electrode arrays are inserted at different depths in each ear, which would cause an interaural frequency mismatch. Because interaural frequency mismatch diminishes the salience of interaural differences for relatively simple stimuli, it may also diminish binaural benefits for spectral-temporally complex stimuli like speech. This study evaluated the effect of simulated frequency-to-place mismatch on speech understanding and SRM. Eleven normal-hearing listeners were tested on a speech understanding task. There was a female target talker who spoke five-word sentences from a closed set of words. There were two interfering male talkers who spoke unrelated sentences. Nonindividualized head-related transfer functions were used to simulate a virtual auditory space. The target was presented from the front (0°), and the interfering speech was either presented from the front (colocated) or from 90° to the right (spatially separated). Stimuli were then processed by an eight-channel vocoder with tonal carriers to simulate aspects of listening through a CI. Frequency-to-place mismatch ("shift") was introduced by increasing the center frequency of the synthesis filters compared with the corresponding analysis filters. Speech understanding was measured for different shifts (0, 3, 4.5, and 6 mm) and target-to-masker ratios (TMRs: +10 to -10 dB). SRM was calculated as the difference in the percentage of correct words for the colocated and separated conditions. Two types of shifts were tested: (1) bilateral shifts that had the same frequency-to-place mismatch in both ears, but no interaural frequency mismatch, and (2) unilateral shifts that produced an interaural frequency mismatch. For the bilateral shift conditions, speech understanding decreased with increasing shift and with decreasing TMR, for both colocated and separate conditions. There was, however, no interaction between shift and spatial configuration; in other words, SRM was not affected by shift. For the unilateral shift conditions, speech understanding decreased with increasing interaural mismatch and with decreasing TMR for both the colocated and spatially separated conditions. Critically, there was a significant interaction between the amount of shift and spatial configuration; in other words, SRM decreased for increasing interaural mismatch. A frequency-to-place mismatch in one or both ears resulted in decreased speech understanding. SRM, however, was only affected in conditions with unilateral shifts and interaural frequency mismatch. Therefore, matching frequency information between the ears provides listeners with larger binaural-hearing benefits, for example, improved speech understanding in the presence of interfering talkers. A clinical procedure to reduce interaural frequency mismatch when programming bilateral CIs may improve benefits in speech segregation that are due to binaural-hearing abilities.

Speech Understanding in Noise for Adults With Cochlear Implants: Effects of Hearing Configuration, Source Location Certainty, and Head Movement.

The primary purpose of this study was to assess speech understanding in quiet and in diffuse noise for adult cochlear implant (CI) recipients utilizing bimodal hearing or bilateral CIs. Our primary hypothesis was that bilateral CI recipients would demonstrate less effect of source azimuth in the bilateral CI condition due to symmetric interaural head shadow. Sentence recognition was assessed for adult bilateral (n = 25) CI users and bimodal listeners (n = 12) in three conditions: (1) source location certainty regarding fixed target azimuth, (2) source location uncertainty regarding roving target azimuth, and (3) Condition 2 repeated, allowing listeners to turn their heads, as needed. (a) Bilateral CI users exhibited relatively similar performance regardless of source azimuth in the bilateral CI condition; (b) bimodal listeners exhibited higher performance for speech directed to the better hearing ear even in the bimodal condition; (c) the unilateral, better ear condition yielded higher performance for speech presented to the better ear versus speech to the front or to the poorer ear; (d) source location certainty did not affect speech understanding performance; and (e) head turns did not improve performance. The results confirmed our hypothesis that bilateral CI users exhibited less effect of source azimuth than bimodal listeners. That is, they exhibited similar performance for speech recognition irrespective of source azimuth, whereas bimodal listeners exhibited significantly poorer performance with speech originating from the poorer hearing ear (typically the nonimplanted ear). Bilateral CI users overcame ear and source location effects observed for the bimodal listeners. Bilateral CI users have access to head shadow on both sides, whereas bimodal listeners generally have interaural asymmetry in both speech understanding and audible bandwidth limiting the head shadow benefit obtained from the poorer ear (generally the nonimplanted ear). In summary, we found that, in conditions with source location uncertainty and increased ecological validity, bilateral CI performance was superior to bimodal listening.

Changing stimulation patterns can change the broadness of contralateral masking functions for bilateral cochlear implant users

Past studies have found that contralateral masking functions are sharper than ipsilateral masking functions for cochlear implant (CI) users. This could suggest that contralateral masking effects are only sensitive to the peak of the masker stimulation for this population. To determine if that is the case, this study investigated whether using broader stimulation patterns affects the broadness of the contralateral masking function. Contralateral masking functions were measured for six bilateral CI users using both a broad and narrow masker. Findings from this study revealed that the broad masker resulted in a broader contralateral masking function. This would suggest that stimulation outside of the peak of the masker affects contralateral masking functions for CI users.

Binaural Pitch Fusion in Bilateral Cochlear Implant Users.

Binaural pitch fusion is the fusion of stimuli that evoke different pitches between the ears into a single auditory image. Individuals who use hearing aids or bimodal cochlear implants (CIs) experience abnormally broad binaural pitch fusion, such that sounds differing in pitch by as much as 3-4 octaves are fused across ears, leading to spectral averaging and speech perception interference. The goal of this study was to determine if adult bilateral CI users also experience broad binaural pitch fusion. Stimuli were pulse trains delivered to individual electrodes. Fusion ranges were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus to find the range that fused with the reference stimulus. Bilateral CI listeners had binaural pitch fusion ranges varying from 0 to 12 mm (average 6.1 ± 3.9 mm), where 12 mm indicates fusion over all electrodes in the array. No significant correlations of fusion range were observed with any subject factors related to age, hearing loss history, or hearing device history, or with any electrode factors including interaural electrode pitch mismatch, pitch match bandwidth, or within-ear electrode discrimination abilities. Bilateral CI listeners have abnormally broad fusion, similar to hearing aid and bimodal CI listeners. This broad fusion may explain the variability of binaural benefits for speech perception in quiet and in noise in bilateral CI users.

Restoring binaural and spatial hearing in cochlear implant users

Adults and children who receive bilateral cochlear implants (BiCIs) have the potential to benefit from the integration of inputs arriving at the brain from both ears. Several factors play a key role in determining if patients will demonstrate binaural sensitivity. We are exploring these factors using two experimental approaches. In the first approach, BiCI users receive pulsatile stimulation to specific pairs of electrodes using research processors that synchronize stimulation with fidelity. We vary stimulus parameters such as temporal fine structure and envelope cues, places of stimulation along the cochleae, and number of electrodes to find parameters that maximize sensitivity to interaural differences for each patient. We also investigate the role of the electrode-neuron interface which is affected by numerous factors including neural health. In a second stimulation approach, we use clinical speech processor to deliver binaural stimulation designed specifically for that patient based on their clinical MAP. In these studies, we are using both standard psychophysics and eye gaze paradigms to understand the underlying processing involved in binaural and spatial hearing. This combined approach is enabling us to design multi-channel multi-rate stimulation strategies aimed at restoring binaural sensitivity and preserving speech understanding.Adults and children who receive bilateral cochlear implants (BiCIs) have the potential to benefit from the integration of inputs arriving at the brain from both ears. Several factors play a key role in determining if patients will demonstrate binaural sensitivity. We are exploring these factors using two experimental approaches. In the first approach, BiCI users receive pulsatile stimulation to specific pairs of electrodes using research processors that synchronize stimulation with fidelity. We vary stimulus parameters such as temporal fine structure and envelope cues, places of stimulation along the cochleae, and number of electrodes to find parameters that maximize sensitivity to interaural differences for each patient. We also investigate the role of the electrode-neuron interface which is affected by numerous factors including neural health. In a second stimulation approach, we use clinical speech processor to deliver binaural stimulation designed specifically for that patient based on their clinical ...

Binaural speech unmasking and interference in adult bilateral cochlear-implant users

Bilateral cochlear implants (BICIs) provide improved speech perception in noise, primarily derived from the head-shadow benefit. BICI listeners can also demonstrate binaural speech unmasking or squelch, particularly if the interferer is a single other speaker. However, under the same conditions, some BICI listeners can experience interference. This study tested 21 adult BICI listeners on speech understanding using a range of masker conditions (1, 2, 3, or 4 same-sex talkers, speech-modulated noise, or speech-shaped stationary noise). For listeners that showed binaural unmasking, the amount of unmasking was highest for the one-talker condition and least for the stationary noise, decreasing as the number of interfering talkers increased and the envelope modulation depth decreased. For listeners that showed interference, there were mainly two types of interference patterns: (1) where the amount of interference varied idiosyncratically across masker type, and (2) any stimulation in one ear essentially produced chance performance in the other ear for all masker conditions. The latter interference pattern occurred for the listeners with the largest asymmetries in speech understanding. This suggests, in these extreme cases, a possible central cortical processing bias for one ear and a more equal speech understanding between the ears may diminish interference.

Contralateral Interference Caused by Binaurally Presented Competing Speech in Adult Bilateral Cochlear-Implant Users

Bilateral cochlear implants (BI-CIs) are intended to improve sound localization and speech understanding in the presence of interfering sounds. For normal-hearing listeners, improved speech understanding in the presence of interfering sounds can be achieved with monaural head shadow and binaural unmasking. While some BI-CI listeners experience binaural unmasking under certain testing conditions, others appear to not. This study tested a group of BI-CI users with hearing histories that have been linked to poor binaural processing-early onset of deafness or long duration of deafness in just one ear. We predicted that these listeners would experience the opposite of binaural unmasking (i.e., contralateral interference) when trying to understand speech in the presence of a competing talker. Nine adult BI-CI users who were deafened early in life or had an asymmetric hearing history (e.g., a much longer duration of deafness in one ear) participated in this study. The coordinate response measure corpus was used to assess speech understanding for a male target talker in quiet or in the presence of one male competing talker. Experiment 1 measured binaural unmasking in a paradigm that provided no head-shadow component. The target was always presented monaurally, while the interferer was presented either monaurally or diotically. Experiment 2 measured spatial release from masking in a paradigm that included both a head-shadow component and possible binaural-unmasking component. Nonindividualized head-related transfer functions were used to simulate talker locations in the front or 90° to the left or right. In experiment 1, all nine listeners experienced contralateral interference (9 dB on average). Four listeners demonstrated roughly symmetric contralateral interference; five listeners experienced asymmetrical contralateral interference. In experiment 2, the listeners experienced only 1 dB of spatial release from masking on average; this small amount was possibly a result of the contralateral interference observed in experiment 1. The results were best explained by individual differences in speech understanding in quiet, which significantly correlated with the duration of deafness in the ipsilateral ear. Specifically, instances of asymmetrical contralateral interference could correspond to asymmetrical hearing histories. Bilateral cochlear implantation should provide a hearing benefit to the recipient. For the BI-CI listeners specifically recruited for this study, there seems to be a conflict with processing the auditory information across the two ears, which produced the opposite of the desired hearing benefit. This suggests that there may be a subset of potential BI-CI users for whom contralateral interference offsets much of the potential head-shadow benefit. If so, earlier implantation in the second implanted ear might have produced larger binaural benefits, which is important information for clinicians advising patients considering bilateral implantation.

Improving Speech Recognition in Bilateral Cochlear Implant Users by Listening With the Better Ear.

For patients with bilateral cochlear implants (BiCIs), understanding a target talker in a noisy situation can be difficult. Current efforts for improving speech-in-noise understanding have focused on improving signal-to-noise ratio by using multiple microphones or signal processing, with only moderate improvements in speech understanding performance. However, BiCI users typically report having a better ear for listening which can lead to an asymmetry in speech unmasking performance. This work proposes a novel listening strategy for improving speech-in-noise understanding by combining (a) a priori knowledge of a better ear and having a BiCI user selectively attend to a target talker in that ear with (b) signal processing that delivers the target talker to the better ear and the noisy background to the opposite ear. This strategy is different from traditional noise reduction strategies because it maintains situational awareness (background sounds are delivered to the ear contralateral to the better ear) while improving speech understanding. Speech recognition performance was evaluated with and without the better ear strategy in a speech-in-noise listening test using a virtual auditory space created from individualized head-related transfer functions. Listeners showed an average improvement of 4.4 dB signal-to-noise ratio in their speech reception threshold when using the better ear strategy with no listener showing a decrement in performance. This implies that the strategy has the potential to boost speech-in-noise recognition in BiCI users and may be useful in other hearing assistance devices such as hearing aids.

Coherent Coding of Enhanced Interaural Cues Improves Sound Localization in Noise With Bilateral Cochlear Implants

Bilateral cochlear implant (BCI) users only have very limited spatial hearing abilities. Speech coding strategies transmit interaural level differences (ILDs) but in a distorted manner. Interaural time difference (ITD) information transmission is even more limited. With these cues, most BCI users can coarsely localize a single source in quiet, but performance quickly declines in the presence of other sound. This proof-of-concept study presents a novel signal processing algorithm specific for BCIs, with the aim to improve sound localization in noise. The core part of the BCI algorithm duplicates a monophonic electrode pulse pattern and applies quasistationary natural or artificial ITDs or ILDs based on the estimated direction of the dominant source. Three experiments were conducted to evaluate different algorithm variants: Experiment 1 tested if ITD transmission alone enables BCI subjects to lateralize speech. Results showed that six out of nine BCI subjects were able to lateralize intelligible speech in quiet solely based on ITDs. Experiments 2 and 3 assessed azimuthal angle discrimination in noise with natural or modified ILDs and ITDs. Angle discrimination for frontal locations was possible with all variants, including the pure ITD case, but for lateral reference angles, it was only possible with a linearized ILD mapping. Speech intelligibility in noise, limitations, and challenges of this interaural cue transmission approach are discussed alongside suggestions for modifying and further improving the BCI algorithm.

Turn an Ear to Hear: How Hearing-Impaired Listeners Can Exploit Head Orientation to Enhance Their Speech Intelligibility in Noisy Social Settings.

Turning an ear toward the talker can enhance spatial release from masking. Here, with their head free, listeners attended to speech at a gradually diminishing signal-to-noise ratio and with the noise source azimuthally separated from the speech source by 180° or 90°. Young normal-hearing adult listeners spontaneously turned an ear toward the speech source in 64% of audio-only trials, but a visible talker’s face or cochlear implant (CI) use significantly reduced this head-turn behavior. All listener groups made more head movements once instructed to explore the potential benefit of head turns and followed the speech to lower signal-to-noise ratios. Unilateral CI users improved the most. In a virtual restaurant simulation with nine interfering noises or voices, hearing-impaired listeners and simulated bilateral CI users typically obtained a 1 to 3 dB head-orientation benefit from a 30° head turn away from the talker. In diffuse interference environments, the advice to U.K. CI users from many CI professionals and the communication guidance available on the Internet most often advise the CI user to face the talker head on. However, CI users would benefit from guidelines that recommend they look sidelong at the talker with their better hearing or implanted ear oriented toward the talker.

Binaural Speech Understanding With Bilateral Cochlear Implants in Reverberation.

The purpose of this study was to investigate whether bilateral cochlear implant (CI) listeners who are fitted with clinical processors are able to benefit from binaural advantages under reverberant conditions. Another aim of this contribution was to determine whether the magnitude of each binaural advantage observed inside a highly reverberant environment differs significantly from the magnitude measured in a near-anechoic environment. Ten adults with postlingual deafness who are bilateral CI users fitted with either Nucleus 5 or Nucleus 6 clinical sound processors (Cochlear Corporation) participated in this study. Speech reception thresholds were measured in sound field and 2 different reverberation conditions (0.06 and 0.6 s) as a function of the listening condition (left, right, both) and the noise spatial location (left, front, right). The presence of the binaural effects of head-shadow, squelch, summation, and spatial release from masking in the 2 different reverberation conditions tested was determined using nonparametric statistical analysis. In the bilateral population tested, when the ambient reverberation time was equal to 0.6 s, results indicated strong positive effects of head-shadow and a weaker spatial release from masking advantage, whereas binaural squelch and summation contributed no statistically significant benefit to bilateral performance under this acoustic condition. These findings are consistent with those of previous studies, which have demonstrated that head-shadow yields the most pronounced advantage in noise. The finding that spatial release from masking produced little to almost no benefit in bilateral listeners is consistent with the hypothesis that additive reverberation degrades spatial cues and negatively affects binaural performance. The magnitude of 4 different binaural advantages was measured on the same group of bilateral CI subjects fitted with clinical processors in 2 different reverberation conditions. The results of this work demonstrate the impeding properties of reverberation on binaural speech understanding. In addition, results indicate that CI recipients who struggle in everyday listening environments are also more likely to benefit less in highly reverberant environments from their bilateral processors.

Combined Effects of Noise and Reverberation on Sound Localization for Listeners With Normal Hearing and Bilateral Cochlear Implants.

This study examined the individual and combined effects of noise and reverberation on the ability of listeners with normal hearing (NH) and with bilateral cochlear implants (BCIs) to localize speech. Six adults with BCIs and 10 with NH participated. All subjects completed a virtual localization test in quiet and at 0-, -4-, and -8-dB signal-to-noise ratios (SNRs) in simulated anechoic and reverberant (0.2-, 0.6-, and 0.9-s RT60) environments. BCI users were also tested at +8- and +4-dB SNR. A 3-word phrase was presented at 70 dB SPL from 9 simulated locations in the frontal horizontal plane (±90°), with the noise source at 0°. BCIs users had significantly poorer localization than listeners with NH in all conditions. BCI users' performance started to decrease at a higher SNR (+4 dB) and shorter RT60 (0.2 s) than listeners with NH (-4 dB and 0.6 s). The combination of noise and reverberation began to degrade localization of BCI users at a higher SNR and a shorter RT60 than listeners with NH. The clear effect of noise and reverberation on the performance of BCI users provides information that should be useful for refining cochlear implant processing strategies and developing cochlear implant rehabilitation plans to optimize binaural benefit for BCI users in everyday listening situations.

Loudness Functions and Binaural Loudness Summation in Bilateral Cochlear Implant Users

AbstractLoudness functions and binaural loudness summation was investigated in acoustically stimulated bilaterally implanted cochlear implant users. The study was aimed at evaluating growth of loudness functions and binaural loudness summation in cochlear implant subjects as a function of stimulus presentation level at different frequencies. Loudness was assessed using a rating procedure on a scale of 0 to 100. Three experimental conditions were tested: monaural right, monaural left and binaural, each with bands of noise with center frequencies of 0.25, 1, and 4 kHz. Fifteen implanted and five normal-hearing subjects (control group) participated in the experiments. Results demonstrated large variability in the slopes of the loudness functions and the presence of loudness summation in bilateral cochlear implant users, with large individual differences among subjects.

Voice gender release from masking in cochlear implant users is correlated with binaural pitch fusion

Spatial and voice gender separation of target from masking speech leads to substantial release from masking in normal-hearing listeners. However, binaural pitch fusion is often broad in cochlear implant (CI) listeners, such that dichotic stimuli with pitches differing by up to 3-4 octaves are fused (Reiss et al., 2014). We hypothesized that broad binaural fusion could reduce a listener’s ability to separate competing speech streams with different voice pitches, and thus reduce the voice gender as well as spatial benefit for speech perception in noise. Speech reception thresholds were measured in both bilateral and bimodal CI users, using male and female target talkers at two spatial configurations (co-location and 60-degrees of target-masker separation). Binaural pitch fusion was also measured. Different-gender maskers improved target detection performance in bimodal CI users, and performance was better with female than male targets in bilateral CI users. No spatial benefit was seen in either CI group. As hypothesized, voice gender masking release was strongly correlated with binaural fusion range in bimodal CI users. These results suggest that sharp binaural fusion is necessary for maximal speech perception in noise in bimodal CI users, but does not benefit bilateral CI users. [Work supported by NIH-NIDCD grant R01 DC01337.]Spatial and voice gender separation of target from masking speech leads to substantial release from masking in normal-hearing listeners. However, binaural pitch fusion is often broad in cochlear implant (CI) listeners, such that dichotic stimuli with pitches differing by up to 3-4 octaves are fused (Reiss et al., 2014). We hypothesized that broad binaural fusion could reduce a listener’s ability to separate competing speech streams with different voice pitches, and thus reduce the voice gender as well as spatial benefit for speech perception in noise. Speech reception thresholds were measured in both bilateral and bimodal CI users, using male and female target talkers at two spatial configurations (co-location and 60-degrees of target-masker separation). Binaural pitch fusion was also measured. Different-gender maskers improved target detection performance in bimodal CI users, and performance was better with female than male targets in bilateral CI users. No spatial benefit was seen in either CI group. As...

Sensitivity to interaural timing differences using the advanced combinational encoder strategy

When listening through clinical processors, sound localization in bilateral cochlear implant (BiCI) users is highly variable, and some patients perform rather poorly. While this is often ascribed to lack of access to temporal fine-structure interaural timing differences (ITDs), the potential role of envelope ITDs is often disregarded. Furthermore, sensitivity to ITDs alone has not been closely examined with the commonly used Advanced Combinational Encoder (ACE) strategy. In theory, envelope ITDs could be encoded with ACE and some BiCI users may be sensitive to this cue to locate sounds, which may explain why some BiCI users have better localization performance. ITD just noticeable differences (JNDs) were measured in 9 participants, using a novel setup of presenting whole-waveform-delayed words through the auxillary port of clinical processors. Listening with ACE, ITD JNDs ranged from 105-680 µs (unmeasurable in one listener). Localization root-mean-squared error ranged from 19-68 degrees. However, ITD sensitivity and sound localization were not significantly correlated (ρ = 0.5, p = 0.17). The unexplained range of sound localization performance in BiCI users is likely due to distorted and inconsistent binaural cues that arise from uncoordinated device programming and signal processing across the two ears. [Work supported by NIH-NIDCD (R03DC015321 to AK and R01DC003083 to RYL) and NIH-NICHD (P30HD03352 to Waisman Center).]

Factors associated with broad binaural pitch fusion in children and adults with hearing aids and cochlear implants

Many hearing-impaired adults who use hearing aids (HAs) and/or cochlear implants (CIs) have broad binaural pitch fusion, such that sounds with large pitch differences are fused across ears (Reiss et al., JARO 2014; JASA). The goal was to determine which subject factors are associated with broad binaural pitch fusion. Binaural pitch fusion was measured in bilateral HA users, bimodal CI users who use a HA in the contralateral ear, and bilateral CI users. Fusion ranges were measured by simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus to find the range that fused with the reference stimulus. Both children (ages 6-9) and adults were tested. Children in the HA and bilateral CI groups had broader fusion than the bimodal CI group. In addition, broad fusion was positively correlated with long durations of HA use and early onset of hearing loss in adult HA users, and negatively correlated with duration of CI use in pediatric bimodal CI users. No correlations with subject factors were seen in bilateral CI users. The findings suggest that type of hearing device experience may influence binaural pitch fusion in hearing-impaired individuals, especially children. [Work supported by NIH-NIDCD grant R01 DC013307.]

Extent of lateralization at large interaural time differences in simulated electric hearing and bilateral cochlear implant users.

Normal-hearing (NH) listeners are able to localize sound sources with extraordinary accuracy through interaural cues, most importantly interaural time differences (ITDs) in the temporal fine structure. Bilateral cochlear implant (CI) users are also able to localize sound sources, yet generally at lower accuracy than NH listeners. The gap in performance can in part be attributed to current CI systems not faithfully transmitting interaural cues, especially ITDs. With the introduction of binaurally linked CI systems, the presentation of ITD cues for bilateral CI users is foreseeable. The current study therefore investigated extent-of-lateralization percepts elicited in bilateral CI listeners when presented with single-electrode pulse-trains carrying controlled ITD cues. The results were compared against NH listeners listening to broadband stimuli as well as simulations of CI listening. Broadband stimuli in NH listeners were perceived as fully lateralized within the natural ITD range. Using simulated as well as real CI stimuli, however, only a fraction of the full extent of lateralization range was covered by natural ITDs. The maximum extent of lateralization was reached at ITDs as large as twice the natural limit. The results suggest that ITD-enhancement might be a viable option for improving localization abilities with future binaural CI systems.

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

Treatment with cochlear implants (CIs) in single-sided deaf individuals started less than a decade ago. CIs can successfully reduce incapacitating tinnitus on the deaf ear and allow, so some extent, the restoration of binaural hearing. Until now, systematic evaluations of subjective CI benefit in post-lingually single-sided deaf individuals and analyses of speech intelligibility outcome for the CI in isolation have been lacking.For the prospective part of this study, the Bern Benefit in Single-Sided Deafness Questionnaire (BBSS) was administered to 48 single-sided deaf CI users to evaluate the subjectively perceived CI benefit across different listening situations. In the retrospective part, speech intelligibility outcome with the CI up to 12 month post-activation was compared between 100 single-sided deaf CI users and 125 bilaterally implanted CI users (2nd implant).The positive median ratings in the BBSS differed significantly from zero for all items suggesting that most individuals with single-sided deafness rate their CI as beneficial across listening situations. The speech perception scores in quiet and noise improved significantly over time in both groups of CI users. Speech intelligibility with the CI in isolation was significantly better in bilaterally implanted CI users (2nd implant) compared to the scores obtained from single-sided deaf CI users.Our results indicate that CI users with single-sided deafness can reach open set speech understanding with their CI in isolation, encouraging the extension of the CI indication to individuals with normal hearing on the contralateral ear. Compared to the performance reached with bilateral CI users’ second implant, speech reception threshold are lower, indicating an aural preference and dominance of the normal hearing ear. The results from the BBSS propose good satisfaction with the CI across several listening situations.

Intelligibility in speech maskers with a binaural cochlear implant sound coding strategy inspired by the contralateral medial olivocochlear reflex

We have recently proposed a binaural cochlear implant (CI) sound processing strategy inspired by the contralateral medial olivocochlear reflex (the MOC strategy) and shown that it improves intelligibility in steady-state noise (Lopez-Poveda et al., 2016, Ear Hear 37:e138-e148). The aim here was to evaluate possible speech-reception benefits of the MOC strategy for speech maskers, a more natural type of interferer. Speech reception thresholds (SRTs) were measured in six bilateral and two single-sided deaf CI users with the MOC strategy and with a standard (STD) strategy. SRTs were measured in unilateral and bilateral listening conditions, and for target and masker stimuli located at azimuthal angles of (0°, 0°), (−15°, +15°), and (−90°, +90°). Mean SRTs were 2–5 dB better with the MOC than with the STD strategy for spatially separated target and masker sources. For bilateral CI users, the MOC strategy (1) facilitated the intelligibility of speech in competition with spatially separated speech maskers in both unilateral and bilateral listening conditions; and (2) led to an overall improvement in spatial release from masking in the two listening conditions. Insofar as speech is a more natural type of interferer than steady-state noise, the present results suggest that the MOC strategy holds potential for promising outcomes for CI users.