Perception In Quiet Research Articles

Influence of channel and ChannelFree™ processing technology on the vocal parameters in hearing-impaired individuals

Introduction: Hearing loss is common in all age ranged population. Hearing loss leads to poor speech perception in quiet and more in noisy situation. Intact system over comes problem by masking release ability and its mechanism however impaired system fails to do. Hearing aid being common rehabilitation option, strategies and technology tries to support better speech perception in noise. Hence comparative studies of technology and strategies for the betterment of impaired population are needed. Objective of the Study: Enhancing speech perception is being the mainstay of hearing aid manufactures, Comparison of ChannelFreeTM, novel technology which claiming superior speech perception with channel hearing aids, specifically for competing signals is the objective. Materials and Methods: Thirty-three clients fitted with multi-channel and ChannelFreeTM with noise reductions (NR) On, Off condition. Comodulated and Uncomodulated masking release was the outcome measure in free field condition through audiometer. Results: Overall, ChannelFreeTM performed superior over channel hearing aids. Effect of channels, NR, and modulation type of background noise played key role. Perceptually, ChannelFreeTM was significantly preferred, especially in the first time users. Conclusion: ChannelFreeTM hearing aid strategies and NR are able to process incoming signal faster in order to retain the spectral contrast and also facilitate temporal cues from the amplified speech in noise. Acclimatization period has a vital role. Updating and implementing the validated novel technologies for the hearing impaired individual is recommended.

Improvement of speech perception in quiet and in noise without decreasing localization abilities with the bone conduction device Bonebridge.

The aim of this study was to examine the functional hearing results regarding speech perception and auditory sound localization in a high-resolution directional hearing setup following implantation with a new bone conduction device (MED-EL Bonebridge, Innsbruck, Austria). In addition, we assessed the patient acceptance of the Bonebridge system using a questionnaire. The study design is retrospective study. The setting is University Hospital Frankfurt. 18 patients implanted with a Bonebridge device from May 2012 to January 2015 were participated in this study. Speech perception in quiet was tested with the Freiburg monosyllable test at a presentation level of 65 dB SPL. Speech perception in noise was tested post-operatively with the Oldenburg sentence test (OLSA) in best-aided condition. We assessed auditory sound localization with a high-resolution directional hearing setup. To evaluate the acceptance by patients using the Bonebridge in daily life, we used a modified questionnaire. The overall average of functional hearing gain (n=18) was 29.3 dB (±20.7 dB). Speech perception of monosyllabic words in quiet improved by 20.7% on average, compared with the pre-operative aided condition. Mean speech reception thresholds (SRTs) of the Oldenburg sentence test (OLSA) improved significantly from -3.8 dB SNR (range -5.7 to 5.8 dB SNR) to -5.2 dB SNR (range -6.3 to -0.6 dB SNR) after implantation. Regarding localization abilities, no significant difference was found between the unaided and aided conditions following Bonebridge implantation. A survey of patients' acceptance and handling of the Bonebridge implant in daily life revealed high patient satisfaction. All patients accepted and benefited from the implanted system. No infections or adverse surgical effects occurred. Speech perception significantly improved in quiet and in noise. No significant difference in sound localization was observed. Acceptance of the Bonebridge implant, tested with a modified questionnaire, was high.

20 Years of Bilateral Cochlear Implantation - an Analysis of the Implanted Patients

Binaural hearing is essential for localization abilities and improves the speech perception in noise. Since 20 years, bilateral cochlear implantation is routinely performed to restore binaural hearing. In this cross-sectional study, we evaluated speech perception in quiet (Freiburger monosyllables, Hochmair-Schulz-Moser (HSM) sentence test, each at 70 dB) and in noise (HSM test, signal-to-noise ratio 10 dB) in 103 out of 165 adult patients who were bilaterally implanted in Würzburg between 1995 and June 2014. In almost half the patients, the second implanted side showed the better speech perception. Compared to the first implanted side, the average monosyllable scores with bilateral implants were improved from 54 to 63% and the HSM scores from 86 to 96%. In noise the speech perception improved from 47 to 65%. The speech perception of the second implanted side was independent of the time interval between the implantation of both sides in this cohort of postlingually deafened patients. This cross-sectional data underline the importance of bilateral cochlear implantation for speech understanding in quiet and even more in noise and thus, for the everyday life. For this, bilateral cochlear implantation should be the generally accepted standard in the treatment of deaf patients.

Systematic review to evaluate the safety, efficacy and economical outcomes of the Vibrant Soundbridge for the treatment of sensorineural hearing loss.

Introduced in the late 90s, the active middle ear implant Vibrant Soundbridge (VSB) is nowadays used for hearing rehabilitation in patients with mild to severe sensorineural hearing loss (SNHL) unable to tolerate conventional hearing aids. In experienced hands, the surgical implantation is fast done, safe and highly standardized. Here, we present a systematic review, after more than 15years of application, to determine the efficacy/effectiveness and cost-effectiveness, as well as patient satisfaction with the VSB active middle ear implant in the treatment of mild to severe SNHL. A systematic search of electronic databases, investigating the safety and effectiveness of the VSB in SNHL plus medical condition resulted in a total of 1640 papers. After removing duplicates, unrelated articles, screening against inclusion criteria and after in-depth screening, the number decreased to 37 articles. 13 articles were further excluded due to insufficient outcome data. 24 studies remained to be systematically reviewed. Data was searched on safety, efficacy and economical outcomes with the VSB. Safety-oriented outcomes included complication/adverse event rates, damage to the middle/inner ear, revision surgery/explant rate/device failure and mortality. Efficacy outcomes were divided into audiological outcomes, including hearing thresholds, functional gain, speech perception in quiet and noise, speech recognition thresholds, real ear insertion gain and subjective outcomes determined by questionnaires and patient-oriented scales. Data related to quality of life (QALY, ICER) were considered under economical outcomes. The VSB turns out to be a highly reliable and a safe device which significantly improves perception of speech in noisy situations with a high sound quality. In addition, the subjective benefit of the VSB was found to be mostly significant in all studies. Finally, implantation with the VSB proved to be a cost-effective and justified health care intervention.

Analysis of Outcome Domains in Adult Cochlear Implantation

To determine the breadth of outcome domains used in the reporting of adult cochlear implant surgery for the purpose of registry and quality measure development. Systematic review of randomized controlled trials. In consultation with a medical librarian, search strategies were constructed to identify randomized controlled trials studying adults undergoing cochlear implantation. MEDLINE, EMBASE, Scopus, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and the Database of Abstracts of Reviews of Effects were searched from database inception to July 2015. Studies were evaluated for level of evidence and risk of bias with the Cochrane Collaboration's Risk of Bias Tool, and outcome domains were extracted from each study. Of 4473 unique citations found, 8 studies were included in this review. All 8 trials were evidence level 1B. Risk of bias was low in 2 trials and high in the other 6. Reported outcome domains included speech perception in quiet and noise, speech tracking, quality of life, timbre perception, hearing preservation, vestibular function, electrode insertion technique, functional measures, functional imaging, fitting time, and tinnitus. An analysis of randomized controlled trials studying cochlear implantation in adults yielded a wide spectrum of outcome domains. This is the first study to comprehensively describe the breadth of outcome domains in adult cochlear implantation. Validated instruments from these domains could be considered for potential inclusion as quality measures and registry use.

Place dependent stimulation rates improve pitch perception in cochlear implantees with single-sided deafness

In normal hearing, the pitch of an acoustic tone can theoretically be encoded by either the place of stimulation in the cochlea or the corresponding rate of vibration. Thus spectral attributes and temporal fine structure of an acoustic signal are naturally correlated. Cochlear implants (CIs), neural prosthetic devices that restore hearing in the profoundly hearing impaired, currently disregard this mechanism; electrical stimulation is provided at fixed electrode positions with default place independent stimulation rate assignments. This does not account for individual cochlear encoding depending on electrode array placement, variations in insertion depth, and the proximity to nerve fibers. Encoding pitch in such manner delivers limited tonal information. Consequently, music appraisal in CI users is often rated cacophonic while speech perception in quiet is close to normal in top performers. We hypothesize that this limitation in electric stimulation is at least partially due to the mismatch between frequency and place encoding in CIs. In the present study, we determined individual electrode locations by analysis of cochlear radiographic images obtained after surgery and calculated place dependent stimulation rates according to models of the normal tonotopic function. Pitch matching in CI users with single-sided deafness shows that place dependent stimulation rates allow thus far unparalleled restoration of tonotopic pitch perception. Collapsed data of matched pitch frequencies as a function of calculated electrical stimulation rate were well fitted by linear regression (R2 = 0.878). Sound processing strategies incorporating place dependent stimulation rates are expected to improve pitch perception in CI users.

Level of emotion comprehension in children with mid to long term cochlear implant use: How basic and more complex emotion recognition relates to language and age at implantation

ObjectivesThe current study was designed with three main aims: To document the level of emotional comprehension skills, from basic to more complex ones, reached by a wide sample of cochlear implant (CI) deaf children with at least 36 months of device use; To investigate subjective and audiological factors that can affect their emotional development; To identify, if present, a “critical age”, in which early intervention might positively affect adequate emotional competence development. DesignThis is an observational cohort study. Children with congenital severe/profound deafness were selected based on: aged by 4–11 years, minimum of 36 months of CI use, Italian as the primary language in the family; normal cognitive level and absence of associated disorders or socio-economic difficulties. Audiological characteristics and language development were assessed throughout standardized tests, to measure speech perception in quiet, lexical comprehension and production. The development of emotions' understanding was assessed using the Test of Emotion Comprehension (TEC) of Pons and Harris, a hierarchical developmental model, where emotion comprehension is organized in 3 Stages (external, mental and reflective). Statistical analysis was accomplished via the Spearman Rank Correlation Coefficient, to study the relationship between the personal and audiological characteristics; a multivariate linear regression analysis was carried out to find which variables were better associated with the standardized TEC values; a chi-squared test with Yate's continuity correction and Mann-Whitney U test were used to account for differences between continuous variables and proportions. Results72 children (40 females, 32 males) with a mean age of 8.1 years were included. At TEC score, 57 children showed normal range performances (79.17% of recipients) and 15 fell below average (20.83% of recipients). The 16.63% of older subjects (range of age 8–12 years) didn't master the Stage 3 (reflective), which is normally acquired by 8 years of age and failed 2 or all the 3 items of this component. Subjects implanted within 18 months of age had better emotion comprehension skills. TEC results were also positively correlated with an early diagnosis, a longer implant use, better auditory skills and higher scores on lexical and morphosintactic tests. On the contrary, it was negatively correlated with the presence of siblings and the order of birth. The gender, the side and the severity of deafness, type of implant and strategy were not correlated. ConclusionsEarly implanted children have more chance to develop adequate emotion comprehension, especially when the complex aspects are included, due to the very strong link between listening and language skills and emotional development. Furthermore, longer CI auditory experience along with early intervention allows an adequate communication development which positively influences the acquisition of such competencies.

Perception in noise with the Digisonic SP cochlear implant: Clinical trial of Saphyr processor's upgraded signal processing

ObjectivesIn 2012, Bergeron et al. presented the outcomes of a study where speech recognition abilities were compared between the four major cochlear implant manufacturers from comparable samples assessed with the same protocols. At this moment, results showed no significant difference in speech perception between devices in quiet and in different noise conditions. But, while most devices appeared only slightly disturbed by the presence of a low to moderate noise level, the Oticon Medical device appeared significantly more sensitive to a degraded environment. In 2013, the signal processing strategy of this device has been upgraded. This study proposes to assess the benefits derived from this upgrade. Materials and methodsThe study involves eighteen adults; most were also part of the 2012 study. All were tested before the implementation of the new signal processing strategy, immediately following the implementation of the strategy and after a one-month experience with the strategy. The same speech recognition test and conditions used in the 2012 study were applied, that is the HINT in quiet and in noise at +10, +5 and 0dB signal to noise ratio. Subjective impressions on the upgraded strategy were also gathered. ResultsThe study evidences similar performance for speech perception in quiet, but significant improvements for speech perception in noise with the new processing strategy compared to the original. Subjective reports confirm this improvement in more challenging conditions. ConclusionThe high sensitivity to a degraded environment observed with the original Oticon Medical device has been significantly reduced by the introduction of more efficient noise reduction processing strategies.

Technical aids for speech understanding in cochlear implanted adults using cell-phones

ObjectivesThe present study sought to assess (1) phone use habits and awareness of listening aids in adult cochlear implant bearers, and (2) objective and subjective benefit of listening aids for cell-phone communication. Material and methodsA questionnaire was sent to 17 cochlear (Cochlear®) implanted adults to assess phone use and awareness of available listening aids. Speech perception without lip-reading was assessed in silence and in noise using Fournier dissyllabic word lists recorded on an iPhone 5C®, with and without listening aids. Subjective benefit was assessed according to listening aid system. ResultsSixty-five percent of adult cochlear implant bearers regularly used a phone with all kinds of correspondent. Eighty-eight percent phoned only in quiet conditions; 53% did not answer unknown callers; 71% never used listening aids. Speech discrimination scores for disyllabic words recorded on the phone were respectively 69%, 63%, 45% and 16% in quiet and 50, 60 and 70dB SPL noise. Speech perception in quiet and noise was improved by listening aids; the Roger system was the most beneficial, followed by the FM system, then the inductive system. ConclusionListening aids are effective, but little known by adult cochlear implant bearers.

The Carina© middle ear implant: surgical and functional outcomes.

The Carina© system (Cochlear Ltd, Sydney, Australia) is a totally implantable prosthesis designed to meet the needs of acoustic amplification in adults with moderate-to-severe sensorineural or mixed hearing loss. It mechanically stimulates the ossicles or labyrinthine windows. The object of this study was to update surgical and functional results obtained in a consistent sample of Carina© recipients. The data sheets of 26 patients who underwent Carina© surgery at two ENT units [i.e., ENT Audiology and Phoniatrics Unit of the University Hospital of Pisa (Pisa, Italy) and ENT Unit of "Guglielmo da Saliceto" Hospital of Piacenza (Piacenza, Italy)] were evaluated for the surgical and audiological outcomes. Twenty patients received a unilateral device, whereas six patients were bilaterally implanted (simultaneously in one patient and sequentially in the remaining five patients). The total number of ears implanted in this study was 32. Most implanted patients expressed a high degree of satisfaction with the prosthesis, which highlights the improvement in hearing in different environmental conditions, the cosmetic advantages, and greater freedom in performing common activities in daily living. Audiological examination demonstrated valid functional gain and significant improvement in speech perception in quiet. Based on this experience, the Carina© is a valid alternative to hearing aids. Moreover, a bilateral implantation, even a simultaneous implantation, is a viable option for selected motivated patients because the intervention is generally well tolerated and the surgery time is relatively fast.

Benefit of contralateral hearing aid in adult cochlear implant bearers

ObjectivesThe present study assessed the interest of a contralateral hearing aid (HA) in adult cochlear implant (CI) bearers. Material and methodsThe study recruited 10 French-speaking adult HA bearers with postlingual bilateral hearing loss, fitted for at least 2 years with a unilateral CI after loss of benefit from HA in one ear but continuing to use their contralateral HA: 4 male, 6 female; mean age, 58 years. All had regularly used bilateral HAs prior to CI. Audiometric assessment comprised: (1) individual ear hearing assessment on pure-tone audiometry and speech discrimination; and (2) free-field testing without aid, with CI only, with HA only and with CI plus HA, on pure-tone audiometry and speech discrimination with quiet background and on speech discrimination in noise. ResultsSpeech discrimination was significantly improved in the bimodal condition (CI plus HA) as compared to CI alone, on all tests. In quiet, discrimination for disyllabic words was>50% in 7 cases with HA alone, in 2 cases with CI alone and in 1 case in with HA+CI. Under 0dB signal-to-noise ratio, discrimination was>50% in 1 case with HA alone, in 3 cases with CI alone and in 6 cases with HA+CI. ConclusionThe present results showed benefit in auditory perception in quiet and in noise with bimodal stimulation. When there is residual hearing in the non-implanted ear, a HA should be fitted; and in progressive bilateral hearing loss, CI should be suggested when HA benefit decreases in one ear.

Clinical evaluation of the xDP output compression strategy for cochlear implants.

Technological advances in the domain of digital signal processing adapted to cochlear implants (CI) are partially responsible for the ever-improving outcomes observed with this neural prosthesis. The goal of the present study was to evaluate audiometric outcomes with a new signal processing strategy implemented in Oticon Medical-Neurelec cochlear implant systems, the xDP strategy. The core of this approach is a preset-based back-end output compression system, modulating a multi-channel transfer function depending on the intensity and information content of input sounds. Twenty adult CI patients, matched for age and CI experience, were included in this study. Pure-tone thresholds and vocal audiometry scores were measured with their former signal processing strategy and with xDP. Speech perception was assessed using dissyllabic words presented in quiet, at different intensity levels: 40, 55, 70, and 85dB SPL, and in a cocktail party noise at a signal-to-noise ratio of +10dB. Results with the xDP strategy showed, as awaited, no major modification of pure-tone thresholds. A global increase of speech perception scores was observed after a 1-month habituation period, with significant improvements for speech perception in quiet for moderate (55dB SPL), loud speech sounds (85dB SPL), and speech-in-noise comprehension. Subjective signal quality assessment showed a preference for Crystalis(xDP) over the former strategy. These results allow the quantification of improvements provided by the xDP signal processing strategy.

One-Year Follow Up of Auditory Performance in Post-Lingually Deafened Adults Implanted with the Neurelec Digisonic(®) SP/Saphyr(®) Neo Cochlear Implant System.

This study aimed to quantify outcomes in a group of patients who were implanted with an Oticon Medical Neurelec (Vallauris, France) cochlear implant system, the Digisonic® SP/Saphyr® Neo. Ten participants took part in this preliminary study. Their speech perception capacities were evaluated at 3, 6, and 12-months after cochlear implant activation and compared to pre-implantation scores and to scores observed with former versions of the sound processor. Compared to former versions of the sound processor, patients using the Saphyr® Neo processor obtained better speech perception scores for sentences in silence at each tests session (3 months: 79%, 6 months: 82% and 12 months: 94%) compared to Digisonic® users (respectively: 58%, 69% and 75%) and Convex sound processor users (resp. 39%, 59% and 51%). These observations confirm that the technological improvements made in the Saphyr® Neo sound processor coupled with the Digisonic® implant, provided quantifiable benefits in speech perception in Quiet compared to former versions of the processor Convex and Digisonic® SP.

Does Coupling and Positioning in Vibroplasty Matter? A Prospective Cohort Study.

Vibroplasty has offered a new modality of hearing rehabilitation in patients with mixed, conductive, and sensorineural hearing loss who cannot wear hearing aids. Potentially, the positioning of the floating mass transducer (FMT) in vibroplasty surgery has a critical effect on hearing outputs. In this study, the impact on hearing outputs and coupling efficiency are evaluated by comparing various vibroplasty applications in the middle ear. No other study to date has examined the coupling efficiency of round window (RW) versus an ossicular vibroplasty application. Prospective cohort study of patients with underlying ear pathologies who were not able to wear hearing aids. This is an ongoing prospective study of 16 patients. All patients had a standard audiological test battery. Direct drive transfer function analysis results were correlated with bone conduction thresholds to assess the efficiency of the FMT coupling. Speech perception in quiet and quality of life measure questionnaires were used to assess outcomes. Nine patients had round window vibroplasty, six patients had stapes vibroplasty, and one patient had traditional incus vibroplasty. Patients with a soft tissue coupler between the FMT and the RW had significantly reduced coupling efficiency. Patients who had direct RW contact had significantly improved coupling efficiency. Patients who underwent stapes or incus vibroplasty had the greatest coupling efficiency. This study demonstrates that attachment to the stapes or incus provides the best coupling when compared to round window vibroplasty. When applicable, stapes or incus coupling should be the first choice when implementing vibroplasty.

Sound quality in adult cochlear implant recipients using the HISQUI19

Conclusion: On average, adult CI recipients report a moderate sound quality using the Dutch version of the HISQUI19 questionnaire. These results are correlated with their age, speech perception scores, CI aided hearing thresholds, and the SSQ5 and the APHAB questionnaire. Background: The general aim of the study was to assess sound quality in adult cochlear implant (CI) recipients and to link these findings to other patients reported outcome measures (PROM) and subject characteristics. Therefore, the Hearing Implant Sound Quality Index (HISQUI19), which was translated into Dutch, was used. This user-friendly instrument quantifies sound quality experienced by hearing implant users. Methods: The Dutch version of the original German HISQUI19 was obtained by the process of translation and back-translation. The HISQUI19 was assessed in 65 experienced adult CI users at the Ear, Nose, and Throat (ENT) department of the Antwerp University Hospital to assess a sound quality profile of experiences adult CI recipients. Therefore, descriptive statistics were used to summarize the mean, standard deviation, and ceiling or floor effects of the total HISQUI19 scores in a CI population. Spearman correlations between the HISQUI19 scores and objective audiological measures and other PROM were investigated (APHAB and SSQ5 questionnaire). Results: The mean HISQUI19 score of the Dutch version in adult CI recipients was 64.9 (SD = 20.8), which corresponds to moderate sound quality. The psychometric characters of the Dutch questionnaire are similar to the characters of the original HISQUI19 questionnaire, emphasizing good internal consistency (α = 0.93) and construct validity. Moderate correlation was found with speech perception in quiet (r = 0.36, p < 0.01), speech perception in noise (r = 0.29, p < 0.05), CI aided Pure Tone Average (PTA0.5, 1, 2 and 4 kHz) of the subjects (r = 0.34, p < 0.01), and the age of the subject (r = 0.38, p < 0.01). Gender did not influence the experienced sound quality significantly. Furthermore, the relation to other questionnaires was found to be significantly strong (SSQ5: r = 0.68 and the APHAB: r = 0.64; p < 0.01).

Radiologic Results and Hearing Preservation With a Straight Narrow Electrode via Round Window Versus Cochleostomy Approach at Initial Activation.

To evaluate the potential influence of two different cochlear implant (CI) electrode carrier approaches to the scala tympani in terms of insertion depth and angle as well as hearing preservation. Retrospective follow-up study. Tertiary care academic center. Forty-one adult subjects underwent cochlear implantation using the Cochlear Nucleus CI 422 slim straight electrode (Cochlear Limited, New South Wales, Australia) with the intent of achieving atraumatic electrode insertion and hearing preservation. Fourteen subjects were implanted using a cochleostomy approach and 27 via a round window approach. Radiologic assessment of insertion depth and angle was performed on postoperative rotational tomography. Postoperative low-frequency hearing preservation, complete loss of residual low-frequency hearing, and speech perception in quiet measures were obtained in defined intervals for both groups. Mean insertion depth reached 21.5 mm (standard deviation, 1.1), whereas mean insertion angle of 388 degrees (standard deviation, 34.7) was revealed for all CI recipients, with no significant difference between the cochleostomy cohort and the round window cohort. The CI-aided speech perception in quiet showed significantly higher scores 3 to 4 months after activation compared with the preoperative speech perception results. The audiologic data demonstrated no statistically significant difference in probability of complete loss of residual low-frequency hearing at initial activation between the cochleostomy group and the round window group. The present results suggest that similar insertion depth and angle as well as similar low-frequency hearing preservation can be achieved in cochlear implantation with this straight narrow electrode via either cochleostomy approach or round window approach at least at initial activation. This fact gives the surgeon the opportunity to adapt access to the scala tympani as needed.

Speech Perception Ability in Noise is Correlated with Auditory Brainstem Response Wave I Amplitude.

Difficulty understanding speech in background noise is a common complaint of individuals with sensorineural hearing loss. Recent animal studies suggest this difficulty may be due, in part, to spiral ganglion cell degeneration related to aging or noise exposure. Although auditory brainstem response (ABR) thresholds and standard clinical audiometric tests are minimally affected by neuronal degeneration, the amplitude of wave I of the ABR is correlated to spiral ganglion cell density. This study hypothesized that wave I amplitude was correlated to speech-in-noise performance. To test this, the relationships between wave I amplitude, age, and speech perception ability were analyzed in human participants. This is a correlational study. A total of 101 ears from 57 adults ranging in age from 19 to 90 yr with a pure-tone average of 45 dB HL or better were examined in this study. Only individuals with no history of neurological disease and ears without any evidence of conductive involvement were included. Speech perception was measured in quiet using NU-6 word lists and in background noise using the QuickSIN. Ear canal electrodes were used to obtain ABR waveforms from each ear and the amplitude of wave I was measured as the absolute difference in voltage between the peak of the wave and the following trough. Speech perception performance in quiet and in background noise were both modeled using a linear mixed model with the covariates age, four-frequency pure-tone average (4fPTA), wave I amplitude, and the interaction between 4fPTA and wave I amplitude. ABR wave I amplitudes were modeled using a linear mixed model with age and 4fPTA as the covariates. The correlation between the right and left ears of the same participant were modeled using random effects. The results indicate that reduced ABR wave I amplitudes are (1) related to increased age, (2) associated with decreased speech-in-noise performance, with the greatest effects in individuals with poorer pure-tone thresholds, and (3) not correlated to speech perception in quiet. Reduced ABR wave I amplitude, an indicator of cochlear neuronal degeneration, is associated with decreased speech perception ability in noise, with a more pronounced effect in ears with poorer pure-tone thresholds, but does not appear to contribute to decreased speech perception in quiet.

Temporal processing and speech perception in quiet and noise across different degrees of ANSD

Objective: The aim of the present study was to examine the effect of degree of temporal processing impairment in adult listeners with ANSD on speech perception measures. Study design: Forty-six listeners with ANSD and 30 normal hearing listeners participated in the study. Temporal resolution was measured using the Temporal Modulation Transfer Function (TMTF). Speech identification scores in quiet were measured for bisyllabic words and Speech Reception Threshold in noise (SRTn) was measured for words. Furthermore, consonant identification was measured for 20 VCV stimuli. Results: Listeners with ANSD performed significantly worse than normal hearing listeners in both temporal resolution and speech perception measures. Peak sensitivity and 3dB cut-off frequency were estimated for each individual in both groups from the TMTFs data using an exponential fitting function. The listeners with ANSD were subgrouped into mild, moderate and severe degrees based on peak sensitivity. As the degree of temporal processing impairment increased, speech identification scores reduced and SRTn increased systematically. Similarly, consonant identification decreased with increase in temporal processing impairment. Among phonemic features, manner of articulation was better perceived compared to voice and place of articulation. Conclusion: The high correlation between temporal processing ability and speech perception suggests that temporal processing measures may be a potential tool for assessing the severity of ANSD in adult listeners.

Assessing speech perception in children with hearing loss: what conventional clinical tools may miss.

This study tested the hypothesis that word recognition in a complex, two-talker masker is more closely related to real-world speech perception for children with hearing loss than testing performed in quiet or steady-state noise. Sixteen school-age hearing aid users were tested on aided word recognition in noise or two-talker speech. Unaided estimates of speech perception in quiet were retrospectively obtained from the clinical record. Ten parents completed a questionnaire regarding their children's ease of communication and understanding in background noise. Unaided performance in quiet was correlated with aided performance in competing noise, but not in two-talker speech. Only results in the two-talker masker were correlated with parental reports of their children's functional hearing abilities. Speech perception testing in a complex background such as two-talker speech may provide a more accurate predictor of the communication challenges of children with hearing loss than testing in steady noise or quiet.

Predictive Factors of Cochlear Implant Outcomes in the Elderly

Objective: To analyze predictive factors of cochlear implant outcomes and postoperative complications in the elderly. Study Design: Prospective, longitudinal study performed in 10 tertiary referral centers. Methods: Ninety-four patients aged 65-85 years with a profound, postlingual hearing loss were evaluated before implantation, at time of activation, and 6 and 12 months after cochlear implantation. Speech perception and lipreading were measured using disyllabic word recognition in quiet and noise, and lipreading using disyllabic words and sentences. The influence of preoperative factors on speech perception in quiet and noise at 12 months was tested in a multivariate analysis. Complications, presence of tinnitus and of vestibular symptoms were collected at each evaluation. Results: The effect of age was observed only in difficult noisy conditions at SNR 0 dB. Lipreading ability for words and sentences was negatively correlated with speech perception in quiet and noise. Better speech perception scores were observed in patients with shorter duration of hearing deprivation, persistence of residual hearing for the low frequencies, the use of a hearing aid before implantation, the absence of cardiovascular risk factors, and in those with implantation in the right ear. General and surgical complications were very rare, and the percentage of vestibular symptoms remained stable over time. Conclusion:This study demonstrates that cochlear implantation in the elderly is a well-tolerated procedure and an effective method to improve communication ability. Advanced age has a low effect on cochlear implant outcome. Analyses of predictive factors in this population provide a convincing argument to recommend treatment with cochlear implantation as early as possible in elderly patients with confirmed diagnosis of a severe-to-profound hearing loss and with only limited benefit from hearing aid use in one ear.