Electric And Acoustic Stimulation Research Articles

Objective measure of binaural processing: acoustic change complex in response to interaural phase differences

Combining cochlear implants with binaural acoustic hearing via preserved hearing in the implanted ear(s) if commonly referred to as combined electric and acoustic stimulation (EAS). EAS fittings can provide patients with significant benefit for speech recognition in complex noise, perceived listening difficulty, and horizontal-plane localization as compared to traditional bimodal hearing conditions with contralateral and monaural acoustic hearing. However, EAS benefit varies across patients and the degree of benefit is not reliably related to the underlying audiogram. Previous research has indicated that EAS benefit for speech recognition in complex listening scenarios and localization is significantly correlated with the patients’ binaural cue sensitivity, namely interaural time differences (ITD). In the context of pure tones, interaural phase differences (IPD) and ITD can be understood as two perspectives on the same phenomenon. Through simple mathematical conversion, one can be transformed into the other, illustrating their inherent interrelation for spatial hearing abilities. However, assessing binaural cue sensitivity is not part of a clinical assessment battery as psychophysical tasks are time consuming, require training to achieve performance asymptote, and specialized programming and software all of which render this clinically unfeasible. In this study, we investigated the possibility of using an objective measure of binaural cue sensitivity by the acoustic change complex (ACC) via imposition of an IPD of varying degrees at stimulus midpoint. Ten adult listeners with normal hearing were assessed on tasks of behavioral and objective binaural cue sensitivity for carrier frequencies of 250 and 1000 Hz. Results suggest that 1) ACC amplitude increases with IPD; 2) ACC-based IPD sensitivity for 250 Hz is significantly correlated with behavioral ITD sensitivity; 3) Participants were more sensitive to IPDs at 250 Hz as compared to 1000 Hz. Thus, this objective measure of IPD sensitivity may hold clinical application for pre- and post-operative assessment for individuals meeting candidacy indications for cochlear implantation with low-frequency acoustic hearing preservation as this relatively quick and objective measure may provide clinicians with information identifying patients most likely to derive benefit from EAS technology.

A Case of Electric and Acoustic Stimulation

EAS (electric and acoustic stimulation) is a hybrid system which has two parts, a cochlear implant and a hearing aid. This system is useful for patients with residual acoustic hearing in the lower frequencies. Herein, we report one case in which EAS implantation was useful.

Hearing Asymmetry Biases Spatial Hearing in Bimodal Cochlear-Implant Users Despite Bilateral Low-Frequency Hearing Preservation.

Many cochlear implant users with binaural residual (acoustic) hearing benefit from combining electric and acoustic stimulation (EAS) in the implanted ear with acoustic amplification in the other. These bimodal EAS listeners can potentially use low-frequency binaural cues to localize sounds. However, their hearing is generally asymmetric for mid- and high-frequency sounds, perturbing or even abolishing binaural cues. Here, we investigated the effect of a frequency-dependent binaural asymmetry in hearing thresholds on sound localization by seven bimodal EAS listeners. Frequency dependence was probed by presenting sounds with power in low-, mid-, high-, or mid-to-high-frequency bands. Frequency-dependent hearing asymmetry was present in the bimodal EAS listening condition (when using both devices) but was also induced by independently switching devices on or off. Using both devices, hearing was near symmetric for low frequencies, asymmetric for mid frequencies with better hearing thresholds in the implanted ear, and monaural for high frequencies with no hearing in the non-implanted ear. Results show that sound-localization performance was poor in general. Typically, localization was strongly biased toward the better hearing ear. We observed that hearing asymmetry was a good predictor for these biases. Notably, even when hearing was symmetric a preferential bias toward the ear using the hearing aid was revealed. We discuss how frequency dependence of any hearing asymmetry may lead to binaural cues that are spatially inconsistent as the spectrum of a sound changes. We speculate that this inconsistency may prevent accurate sound-localization even after long-term exposure to the hearing asymmetry.

Cochlear implant spectral bandwidth for optimizing electric and acoustic stimulation (EAS)

Cochlear implantation with acoustic hearing preservation is becoming increasingly prevalent allowing cochlear implant (CI) users to combine electric and acoustic stimulation (EAS) in the implanted ears. Despite a growing EAS population, our field does not have definitive guidance regarding EAS technology optimization and the majority of previous studies investigating hearing aid (HA) and cochlear implant (CI) programming for EAS listeners have been mixed. Thus, the purpose of this exploratory study was to explore the effects of various EAS crossover frequencies—defined as the low-frequency (LF) CI cutoff—relative to the underlying spiral ganglion (SG) characteristic frequency associated with the most distal or apical electrode in the array. Speech recognition in semi-diffuse noise and subjective estimates of listening difficulty were measured for 15 adult CI recipients with acoustic hearing preservation in three listening conditions: 1) CI-alone, 2) bimodal (CI+HA), and best-aided EAS (CIHA+HA). The results showed no effect of LF CI cutoff for any of the three listening conditions such that there was no trend for increased performance or less subjective listening difficulty across LF CI cutoffs, referenced to underlying SG-place frequency. Consistent with past studies, the current results were also consistent with significant speech recognition and subject listening difficulty benefits for both bimodal (CI+HA) and best-aided EAS (CIHA+HA) as compared to CI-alone listening as well as significant additional benefits for best-aided EAS (CIHA+HA) compared to bimodal hearing (CI+HA). Future studies are necessary to investigate the efficacy of SG-place-based fittings for i) large samples of experienced EAS listeners for whom perceptual adaptation has occurred to the frequency mismatch provided by standard CI frequency allocations, and ii) EAS users at or close to CI activation as place-based approaches may ultimately yield greater outcomes, particularly for newly activated CI users for whom SG-place-based approaches may afford a steeper trajectory to performance asymptote.

Bimodal Cochlear Implant Processing based on Assisted Hearing algorithms with CCi-MOBILE: an open-source research platform.

While speech understanding for cochlear implant (CI) and Hearing aid (HA) users in quiet is relatively effective, listeners experience difficulty in identification of speakers and sound location. Previous studies have reported improved localization and better speech perception when the unilateral CI is coupled with a HA in the contralateral ear. This is referred to as bimodal presentation of speech or electric and acoustic stimulation (EAS). Various CI research interfaces developed by either academic or industry sponsored research teams support proposed signal processing and psychoacoustic investigations but have limited ability to efficiently validate bimodal algorithms. Platforms that support bimodal testing (CI and HA) are either not portable or only provide limited features due to proprietary parameters/routines. CCi-MOBILE, an open-source, portable signal processing research device, developed by UT-Dallas, enables electric and acoustic stimulations simultaneously, thus providing researchers the opportunity to explore new technology and scientific paradigms for the hearing impaired. In the present work, we provide verification and implementation of synchronized bimodal (electric-acoustic) output in an authenticated and efficient manner to support sound and acoustic localization algorithms for experimental investigations.

Combined Electric and Acoustic Stimulation (EAS) in Children: Investigating Benefit Afforded by Bilateral Versus Unilateral Acoustic Hearing.

Electric and acoustic stimulation (EAS) with preserved hearing in the implanted ear provides benefit for speech understanding, spatial hearing, and quality of life in adults. However, there is limited research on EAS outcomes in children. The aims of this study were to estimate the magnitude of EAS-related benefit on speech understanding in children with preserved acoustic hearing and to determine what role acoustic interaural time difference (ITD) sensitivity may have on said EAS benefit. Six children with acoustic hearing preservation and 20 children with normal hearing (NH) were recruited to participate. Speech recognition was assessed via an eight-loudspeaker array with speech presented from one loudspeaker at 0 degree and restaurant noise from all other loudspeakers (45-315 degrees). ITD thresholds were measured for a 250-Hz signal presented acoustically via insert earphones. Only one EAS listener demonstrated significant benefit from bilateral acoustic hearing as compared with acoustic hearing from a single ear. ITD thresholds were poor in the range of 302 to 1000+ ms and were considerably poorer than ITD thresholds for the NH group. These data suggest that children with acoustic hearing preservation may not exhibit initial EAS benefit for speech recognition in semi-diffuse noise; however, because none exhibited a decrement in performance with bilateral acoustic stimulation, EAS fittings are recommended to provide binaural acoustic access allowing for EAS adaptation to binaural cues over time. Future research should address the emergence of EAS benefit, binaural cue sensitivity, and the role of EAS experience in children and adults.

Improving the Intelligibility of Speech for Simulated Electric and Acoustic Stimulation Using Fully Convolutional Neural Networks.

Combined electric and acoustic stimulation (EAS) has demonstrated better speech recognition than conventional cochlear implant (CI) and yielded satisfactory performance under quiet conditions. However, when noise signals are involved, both the electric signal and the acoustic signal may be distorted, thereby resulting in poor recognition performance. To suppress noise effects, speech enhancement (SE) is a necessary unit in EAS devices. Recently, a time-domain speech enhancement algorithm based on the fully convolutional neural networks (FCN) with a short-time objective intelligibility (STOI)-based objective function (termed FCN(S) in short) has received increasing attention due to its simple structure and effectiveness of restoring clean speech signals from noisy counterparts. With evidence showing the benefits of FCN(S) for normal speech, this study sets out to assess its ability to improve the intelligibility of EAS simulated speech. Objective evaluations and listening tests were conducted to examine the performance of FCN(S) in improving the speech intelligibility of normal and vocoded speech in noisy environments. The experimental results show that, compared with the traditional minimum-mean square-error SE method and the deep denoising autoencoder SE method, FCN(S) can obtain better gain in the speech intelligibility for normal as well as vocoded speech. This study, being the first to evaluate deep learning SE approaches for EAS, confirms that FCN(S) is an effective SE approach that may potentially be integrated into an EAS processor to benefit users in noisy environments.

Children's combined electric and acoustic stimulation (EAS): A study of the benefits of bilateral vs. unilateral acoustic hearing

In adults, electric and acoustic stimulation (EAS) with intact hearing in the implanted ear improves speech comprehension, spatial hearing, and overall quality of life. However, there is a scarcity of research on the effects of EAS in children. The aims of this study was to evaluate the degree of EAS-related speech understanding benefit in children with retained acoustic hearing, as well as what role acoustic interaural time difference (ITD) sensitivity may have in that benefit. Six children with acoustic hearing loss and twenty children with normal hearing (NH) were chosen to take part in the study. An eight-loudspeaker array was used to test voice recognition, with speech coming from one loudspeaker at 0 degrees and restaurant noise coming from the other loudspeakers (45–315 degrees). The ITD thresholds for a 250-Hz stimulus presented acoustically via insert earphones were measured.

Effect of temporal misalignment on understanding Mandarin sentences in simulated combined electric-and-acoustic stimulation.

The present work assessed Mandarin sentence understanding when the electric and acoustic portions are not temporally aligned in simulated combined electric-and-acoustic stimulation (EAS). A relative time shift was added between the electric and acoustic portions, simulating the temporal misalignment effect in EAS processing. The processed stimuli were played to normal-hearing listeners to recognize. Experimental results showed a significant decrease of the intelligibility score caused by the temporal misalignment in the two portions of EAS processing, suggesting the need to avoid temporal misalignment in EAS. The preceding acoustic-portion more significantly decreased the understanding of EAS-processed Mandarin stimuli than the preceding electric-portion.

Assessing the Quality of Low-Frequency Acoustic Hearing: Implications for Combined Electroacoustic Stimulation With Cochlear Implants.

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.

Binaural cue sensitivity in cochlear implant recipients with acoustic hearing preservation

Bilateral acoustic hearing in cochlear implant (CI) recipients with hearing preservation may allow access to binaural cues. Sensitivity to acoustic binaural cues has been shown in some listeners combining electric and acoustic stimulation (EAS), yet remains poorly understood and may be subject to limitations imposed by the electrical stimulation and/or amplification asymmetries. The purpose of this study was to investigate the effect of stimulus level, frequency-dependent gain, and the addition of unilateral electrical stimulation on sensitivity to low-frequency binaural cues. Thresholds were measured for interaural time and level differences (ITD and ILD) carried by a low-frequency, bandpass noise (100–800 Hz). 16 adult CI EAS listeners (mean age = 50.2 years) each participated in three listening conditions: acoustic hearing only at 90 dB SPL, acoustic hearing only at 60 dB SPL with frequency-dependent gain, and acoustic hearing plus unilateral CI at 60 dB SPL with frequency-dependent gain applied to the acoustic channels only. Results revealed thresholds within the ecologically relevant ITD and/or ILD range for most EAS listeners. No significant effects of presentation level, frequency-dependent gain, or the addition of unilateral electrical stimulation on the resultant thresholds for ITDs or ILDs were observed at the group level. Correlational analyses related ITD and ILD thresholds to the degree of EAS benefit (i.e., advantage of acoustic hearing in the implanted ear) for speech recognition in diffuse noise. There was a significant relationship between EAS benefit and ITD thresholds, but no statistically significant relationship between EAS benefit and ILD thresholds. In summary, the results of this study are not consistent with our previous data obtained with simulated EAS in normal-hearing listeners, which showed significant binaural interference by a unilateral electrical “distractor” (Van Ginkel et al., 2019). The difference between studies suggests that chronic exposure to unilateral electrical stimulation combined with bilateral acoustic stimulation may reduce interference effects, perhaps because listeners adapt to the presence of the constant but binaurally incongruous CI stimulus. These results are consistent with past studies that demonstrated no interference in spatial hearing tasks due to the addition of a unilateral CI in adult EAS listeners.

Effect of spectral amplitude elevation for vowel identification in simulated combined electric-and-acoustic hearing

Though the benefits of combined electric-and-acoustic stimulation (EAS) have been widely reported, its underlying mechanisms responsible are not well understood yet. This study assessed the effect of balanced spectral amplitudes between acoustic and electric portions in EAS to vowel identification via two experiments. Four vowels (i.e., /iy/, /eh/, /oo/ and /ah/) were synthesized using pure-tone harmonic components. In Experiment 1, the spectral amplitudes of natural vowels were elevated for either acoustic (below 600 Hz) or electric portions (above 600 Hz) from 5 dB to 30 dB. Vowel identification scores were collected from eight normal-hearing listeners. In Experiment 2, the synthesized vowel stimuli were processed by the signal processing condition simulating the electric-and-acoustic stimulation. The results of identifying synthesized vowels and synthesized EAS-processed vowels in the two experiments showed the similar patterns of declined identification rates as a function of (acoustic or electric) sp...

Long-term follow-up of hearing preservation in electric-acoustic stimulation patients.

Hearing preservation (HP) surgery was initiated more than 10 years ago for combined electric and acoustic stimulation (EAS). Preserved residual low-frequency hearing has been demonstrated to improve speech perception in noise as well as music appreciation in EAS users up to 2 years. Multiple study groups aimed to evaluate initial loss of residual hearing (RH) as a consequence of HP surgery. However, after 1 year and 2 years of follow-up, further decline was reported. This study aimed to determine RH, speech perception, and the subjective benefits of EAS 10 years after HP surgery. Nine postlingual EAS partially deaf patients who underwent HP surgery at Antwerp University Hospital were included in this study (11 implanted ears). Hearing preservation (0% = loss of hearing; >0%-25% = minimal HP; >25%-75% = partial HP; >75% = complete HP), speech perception and subjective benefits were evaluated preoperatively; at 3, 6, 12, 18, and 24 months postoperatively; and annually thereafter. Complete HP was obtained in three of 11 ears; partial HP in five of 11 ears; and minimal HP in two of 11 ears, measured during their most recent follow-up. One subject lost his RH completely across time. The mean rate of HP was 48% (ranging from 6 months up to 10 years postoperatively). Speech perception analysis up to 10 years showed a continuous statistically significant improvement. The maximum subjective benefit was reached 3 months after implantation and subsequently remained statistically significant unchanged for the next 10 years. Long-term HP in EAS users after HP surgery is feasible, although a small continuous decline of HP rate of 3% per year was observed (measured from first fitting up to 6 years postoperative). Nevertheless, a continuous improvement was found in the speech perception results of the EAS users across 10 years. Moreover, the positive subjective benefit, assessed 3 months postoperative, remained stable up to 10 years.

Hearing preservation: Better hearing with advanced technology

Preservation of residual hearing after cochlear implantation allows patients the synergetic use of electric and acoustic stimulation (EAS). The application of specific surgical and therapeutic techniques enables the reduction of inner ear trauma, which leads otherwise to complete hearing loss. Due to simultaneous electric and acoustic stimulation, speech understanding is improved especially in noise. EAS is a well-accepted therapeutic treatment for subjects with profound hearing loss in the higher frequencies and no or mild hearing loss in the low frequencies. Several Manufacturers offer individual soft electrodes specially designed for hearing preservation as well as combined electric-acoustic audio processors.

Electrophysiologic Consequences of Flexible Electrode Insertions in Gerbils With Noise-Induced Hearing Loss

Flexible electrode interaction with intracochlear structures in a noise-damaged region of the cochlea can lead to measureable electrophysiologic changes. An emerging goal in cochlear implantation is preservation of residual hearing subsequently allowing for combined electric and acoustic stimulation (EAS). However, residual hearing is at least partially lost in most patients as a result of electrode insertion. A gerbil model was used to examine changes to acoustically evoked cochlear potentials during simulated cochlear implantation. Gerbils were partially deafened by noise exposure to mimic residual hearing in human cochlear implant candidates. After 1 month, round window and intracochlear recordings during flexible electrode insertion were made in response to 1 kHz tone burst stimuli at 80 dB SPL. After the insertion, the cochleas were histologically examined for hair cell loss because of the noise exposure and trauma because of the electrode insertion. Anatomic damage from the flexible electrode was not observable in most cases. However, insertions caused response declines that were, on average, greater than the controls, although some losses were similar to the controls. The CM was more sensitive than the CAP for detecting cochlear disturbance. Because response reductions occurred in the absence of anatomic damage, disturbances in the fluid at the base appear to affect responses from the apex. The losses were less than in previous experiments where the basilar membrane was penetrated.

Electroacoustic stimulation: now and into the future.

Cochlear implants have provided hearing to hundreds of thousands of profoundly deaf people around the world. Recently, the eligibility criteria for cochlear implantation have been relaxed to include individuals who have some useful residual hearing. These recipients receive inputs from both electric and acoustic stimulation (EAS). Implant recipients who can combine these hearing modalities demonstrate pronounced benefit in speech perception, listening in background noise, and music appreciation over implant recipients that rely on electrical stimulation alone. The mechanisms bestowing this benefit are unknown, but it is likely that interaction of the electric and acoustic signals in the auditory pathway plays a role. Protection of residual hearing both during and following cochlear implantation is critical for EAS. A number of surgical refinements have been implemented to protect residual hearing, and the development of hearing-protective drug and gene therapies is promising for EAS recipients. This review outlines the current field of EAS, with a focus on interactions that are observed between these modalities in animal models. It also outlines current trends in EAS surgery and gives an overview of the drug and gene therapies that are clinically translatable and may one day provide protection of residual hearing for cochlear implant recipients.

Cochlear Implantation With Hearing Preservation Yields Significant Benefit for Speech Recognition in Complex Listening Environments

The aim of this study was to assess the benefit of having preserved acoustic hearing in the implanted ear for speech recognition in complex listening environments. The present study included a within-subjects, repeated-measures design including 21 English-speaking and 17 Polish-speaking cochlear implant (CI) recipients with preserved acoustic hearing in the implanted ear. The patients were implanted with electrodes that varied in insertion depth from 10 to 31 mm. Mean preoperative low-frequency thresholds (average of 125, 250, and 500 Hz) in the implanted ear were 39.3 and 23.4 dB HL for the English- and Polish-speaking participants, respectively. In one condition, speech perception was assessed in an eight-loudspeaker environment in which the speech signals were presented from one loudspeaker and restaurant noise was presented from all loudspeakers. In another condition, the signals were presented in a simulation of a reverberant environment with a reverberation time of 0.6 sec. The response measures included speech reception thresholds (SRTs) and percent correct sentence understanding for two test conditions: CI plus low-frequency hearing in the contralateral ear (bimodal condition) and CI plus low-frequency hearing in both ears (best-aided condition). A subset of six English-speaking listeners were also assessed on measures of interaural time difference thresholds for a 250-Hz signal. Small, but significant, improvements in performance (1.7-2.1 dB and 6-10 percentage points) were found for the best-aided condition versus the bimodal condition. Postoperative thresholds in the implanted ear were correlated with the degree of electric and acoustic stimulation (EAS) benefit for speech recognition in diffuse noise. There was no reliable relationship among measures of audiometric threshold in the implanted ear nor elevation in threshold after surgery and improvement in speech understanding in reverberation. There was a significant correlation between interaural time difference threshold at 250 Hz and EAS-related benefit for the adaptive speech reception threshold. The findings of this study suggest that (1) preserved low-frequency hearing improves speech understanding for CI recipients, (2) testing in complex listening environments, in which binaural timing cues differ for signal and noise, may best demonstrate the value of having two ears with low-frequency acoustic hearing, and (3) preservation of binaural timing cues, although poorer than observed for individuals with normal hearing, is possible after unilateral cochlear implantation with hearing preservation and is associated with EAS benefit. The results of this study demonstrate significant communicative benefit for hearing preservation in the implanted ear and provide support for the expansion of CI criteria to include individuals with low-frequency thresholds in even the normal to near-normal range.

THE PSYCHOPHYSICS OF LOW-FREQUENCY ACOUSTIC HEARING IN ELECTRIC AND ACOUSTIC STIMULATION (EAS) AND BIMODAL PATIENTS

This paper provides a review of the current literature on psychophysical properties of low-frequency hearing, both before and after implantation, with a focus on frequency selectivity, nonlinear cochlear processing, and speech perception in temporally modulated maskers for bimodal listeners as well as patients with hearing preservation in the implanted ear and receiving combined electric and acoustic stimulation (EAS). In this paper we review our work, the work of others, and report results not previously published for speech perception in steady-state and temporally fluctuating maskers; the degree of masking release and frequency resolution for 11 bimodal, 6 hearing preservation patients; and 5 control subjects with normal hearing. The results demonstrate that a small masking release is possible with acoustic hearing in just one ear, with the degree of masking release being correlated with the low-frequency pure tone average in the non-implanted ear; furthermore, frequency selectivity as defined by the width of the auditory filter was not correlated with the degree of masking release. Descriptions of the clinical utility of hearing preservation in the implanted ear for improving speech perception in complex listening environments, as well as directions for the future, are discussed.

Combined Acoustic and Electric Stimulation

Combined Acoustic and Electric Stimulation

A simulation study of harmonics regeneration in noise reduction for electric and acoustic stimulation

Recent research results show that combined electric and acoustic stimulation (EAS) significantly improves speech recognition in noise, and it is generally established that access to the improved F0 representation of target speech, along with the glimpse cues, provide the EAS benefits. Under noisy listening conditions, noise signals degrade these important cues by introducing undesired temporal-frequency components and corrupting harmonics structure. In this study, the potential of combining noise reduction and harmonics regeneration techniques was investigated to further improve speech intelligibility in noise by providing improved beneficial cues for EAS. Three hypotheses were tested: (1) noise reduction methods can improve speech intelligibility in noise for EAS; (2) harmonics regeneration after noise reduction can further improve speech intelligibility in noise for EAS; and (3) harmonics sideband constraints in frequency domain (or equivalently, amplitude modulation in temporal domain), even deterministic ones, can provide additional benefits. Test results demonstrate that combining noise reduction and harmonics regeneration can significantly improve speech recognition in noise for EAS, and it is also beneficial to preserve the harmonics sidebands under adverse listening conditions. This finding warrants further work into the development of algorithms that regenerate harmonics and the related sidebands for EAS processing under noisy conditions.