Speech Understanding In Quiet Research Articles

Validity and Reliability of the Korean Version of the Spatial Hearing Questionnaire in Cochlear Implant Users

Purpose: The Spatial Hearing Questionnaire (SHQ) is a self-report subjective questionnaire that includes eight subscales, including “understanding of male, female, and child’s voice”, “music”, “localization”, “speech understanding in quiet, noise-front, and noise-separate situations”. The aim of this study was to examine the validity and reliability of the Korean version of the SHQ (K-SHQ) in cochlear implant (CI) users. Methods: Fifty-two adult CI users participated in this study. Internal consistency and test-retest reliability of the K-SHQ were evaluated. Concurrent validity was identified by comparing the K-SHQ responses with the “spatial hearing” subscale scores from the Korean version of the Speech, Spatial, and Qualities of Hearing Scale (K-SSQ). We also examined the construct validity of the K-SHQ through an exploratory factor analysis. Results: Overall, the greatest difficulties were obtained from the subscale of “localization”, with the least difficulties in the subscale of “speech in quiet”. Both internal consistency and test-retest reliability were adequate for CI users based on all 24 items and the 8-subscale responses of the K-SHQ. The “localization” subscale responses of the K-SHQ were significantly correlated with the “spatial hearing”subscale responses of the K-SSQ, demonstrating a good concurrent validity in relation to localization performance. The results of the exploratory factor analysis showed that two factors, “speech understanding” and “localization”, explained 73.2% of the variance. Conclusion: The K-SHQ showed satisfactory reliability and validity in evaluating speech understanding as well as spatial hearing abilities in cochlear implant users, especially in complex listening situations.

A comparison of binaural cues transmitted by clinically available cochlear-implant stimulation strategies

Cochlear implants (Cis) effectively restore speech understanding in quiet for many recipients. However, bilateral CI listeners continue to perform poorer than acoustic-hearing listeners on spatial-hearing tasks (e.g., speech understanding in noise and sound localization). One explanation is that current clinically available stimulation strategies and unsynchronized sound processors degrade the fidelity of binaural cues. However, no conclusive comparison of the binaural cues transmitted by different stimulation strategies has been made. Therefore, this study compared binaural cues transmitted by two clinically available cochlear implant stimulation strategies. Two unsynchronized Cochlear Ltd. Nucleus 6 sound processors were placed on a binaural mannequin centered in a horizontal ring of loudspeakers in an anechoic chamber. Acoustic stimuli were presented from the loudspeakers and the resulting electrical pulse trains were recorded for both a peak-picking stimulation strategy and constantly stimulating strategy. Envelope interaural time differences and interaural level differences were extracted from the recordings and compared between stimulation strategies. Compared to the constantly stimulating strategy, results show that the peak-picking strategy led to more variable and less monotonic binaural cues, which could constrain sound-localization abilities. These findings argue for the bilateral synchronization of CIs in multiple domains, including electrode selection in peak-picking stimulation strategies and pulse timing.

Value of patient-reported outcome measures for evaluating the benefit of speech processor upgrading in patients with cochlear implants.

Patients with acochlear implant (CI) should be evaluated for anew speech processor every 6years. The aim of this analysis was to assess the subjective and audiological benefit of upgrades. Speech understanding and subjective benefit were analyzed in 99patients with the old and the new speech processor after 4weeks of wearing. Speech understanding was assessed using the Freiburg monosyllabic test in quiet (FBE) at 65 dB and 80 dB, and the Oldenburg Sentence Test (OLSA) at 65 dB noise with adaptive speech sound level. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was used to assess subjective hearing impairment, and the Audio Processor Satisfaction Questionnaire (APSQ) was used to assess subjective satisfaction. The speech processor upgrade resulted in asignificant improvement of speech understanding in quiet at 65 dB (mean difference 8.9 ± 25.9percentage points, p < 0.001) and 80 dB (mean difference 8.1 ± 29.7percentage points, p < 0.001) and in noise (mean difference 3.2 ± 10.7 dBsignal-to-noise ratio [S/N], p = 0.006). Using the APHAB, asignificant improvement (mean difference 0.07 ± 0.16, p < 0.001) in hearing impairment was demonstrated in all listening situations. The APSQ showed significantly higher patient satisfaction with the new speech processor (mean difference 0.42 ± 1.26, p = 0.006).A comparative assessment of the benefit based on subjective and speech audiometric results identified aproportion of patients (35-42%) who subjectively benefited from the upgrade but had no measurable benefit based on speech audiometry. There was asignificant improvement in audiologically measurable and subjectively reflected speech understanding and patient satisfaction after the upgrade. In patients with only asmall improvement in audiologically measurable speech understanding, the subjective benefit should also be assessed with validated measurement instruments in order to justify an upgrade to the payers in the health sector.

Speech Discrimination Outcomes in Adult Cochlear Implant Recipients by Primary Language and Bilingual Hispanic Patients.

Compare cochlear implant (CI) outcomes in English speakers, Spanish speakers, and bilingual Hispanics. Retrospective review. Academic tertiary care center. Eighty-five postlingually deafened adults unilaterally implanted between January 2014 and December 2018 were stratified by primary language. Primary outcomes were: (1) English consonant-nucleus-consonant and Spanish bisyllables word tests in quiet, and (2) English AzBio and Latin American Hearing In Noise Test (LA-HINT) sentence tests in quiet and in noise at multiple time-intervals postactivation. In the respective languages, primary Spanish speakers(n = 24), and English speakers (n = 61) experienced the greatest increases in average scores for word and sentence tests in quiet during the first 6 months postactivation, with gradual increases in average scores over time. English speakers performed significantly worse on AzBio tests in noise, compared to quiet, while the addition of noise did not significantly affect average LA-HINT scores in Spanish speakers across multiple time intervals. An early ceiling effect was also demonstrated for LA-HINT. Although not significant, bilingual Hispanics (n = 12) had lower average AzBio in quiet scores than English speakers and higher average LA-HINT in quiet scores than the Spanish speakers across multiple time intervals. English and Spanish CI users experienced the greatest increases in speech understanding in quiet the first few months after implant activation. An early ceiling effect is demonstrated with LA-HINT, indicating LA-HINT is not appropriate for evaluating longitudinal CI outcomes in Spanish speakers. Bilingual Hispanics represent a unique group, and further investigations are necessary to understand speech perception patterns in both languages and develop the best CI test strategies for these individuals.

Value of patient-reported outcome measures for evaluating the benefit of speech processor upgrading in patients with cochlear implants. German version

Patients with acochlear implant (CI) should be evaluated for anew speech processor every 6years. The aim of this analysis was to assess the subjective and audiological benefit of upgrades. Speech understanding and subjective benefit were analyzed in 99patients with the old and the new speech processor after 4weeks of wearing. Speech understanding was assessed using the Freiburg monosyllabic test in quiet (FBE) at 65 dB and 80 dB, and the Oldenburg Sentence Test (OLSA) at 65 dB noise with adaptive speech sound level. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was used to assess subjective hearing impairment, and the Audio Processor Satisfaction Questionnaire (APSQ) was used to assess subjective satisfaction. The speech processor upgrade resulted in asignificant improvement of speech understanding in quiet at 65 dB (mean difference 8.9 ± 25.9percentage points, p < 0.001) and 80 dB (mean difference 8.1 ± 29.7percentage points, p < 0.001) and in noise (mean difference 3.2 ± 10.7 dBsignal-to-noise ratio [S/N], p = 0.006). Using the APHAB, asignificant improvement (mean difference 0.07 ± 0.16, p < 0.001) in hearing impairment was demonstrated in all listening situations. The APSQ showed significantly higher patient satisfaction with the new speech processor (mean difference 0.42 ± 1.26, p = 0.006).A comparative assessment of the benefit based on subjective and speech audiometric results identified aproportion of patients (35-42%) who subjectively benefited from the upgrade but had no measurable benefit based on speech audiometry. There was asignificant improvement in audiologically measurable and subjectively reflected speech understanding and patient satisfaction after the upgrade. In patients with only asmall improvement in audiologically measurable speech understanding, the subjective benefit should also be assessed with validated measurement instruments in order to justify an upgrade to the payers in the health sector.

Using Anatomy-Based Fitting to Reduce Frequency-to-Place Mismatch in Experienced Bilateral Cochlear Implant Users: A Promising Concept.

Fitting cochlear implant (CI) users can be challenging. Anatomy-based fitting (ABF) maps may have the potential to lead to better objective and subjective outcomes than conventional clinically based fitting (CBF) methods. ABF maps were created via information derived from exact electrode contact positions, which were determined via post-operative high-resolution flat panel volume computer tomography and clinical fitting software. The outcome measures were speech understanding in quiet and noise and self-perceived sound quality with the CBF map and with the ABF map. Participants were 10 experienced bilateral CI users. The ABF map provided better speech understanding in quiet and noisy environments compared to the CBF map. Additionally, two approaches of reducing the frequency-to-place mismatch revealed that participants are more likely to accept the ABF map if their electrode array is inserted deep enough to stimulate the apical region of their cochlea. This suggests an Angular Insertion Depth of the most apical contact of around 720°-620°. Participants had better speech understanding in quiet and noise with the ABF map. The maps' self-perceived sound quality was similar. ABF mapping may be an effective tool for compensating the frequency-to-place mismatch in experienced bilateral CI users.

Performance with a new bone conduction implant audio processor in patients with single-sided deafness

PurposeThe SAMBA 2 BB audio processor for the BONEBRIDGE bone conduction implant features a new automatic listening environment detection to focus on target speech and to reduce interfering speech and background noises. The aim of this study was to evaluate the audiological benefit of the SAMBA 2 BB (AP2) and to compare it with its predecessor SAMBA BB (AP1).MethodsProspective within-subject comparison study. We compared the aided sound field hearing thresholds, speech understanding in quiet (Freiburg monosyllables), and speech understanding in noise (Oldenburg sentence test) with the AP1 and AP2. Each audio processor was worn for 2 weeks before assessment and seven users with single-sided sensorineural deafness (SSD) participated in the study. For speech understanding in noise, two complex noise scenarios with multiple noise sources including single talker interfering speech were used. The first scenario included speech presented from the front (S0NMIX), while in the second scenario speech was presented from the side of the implanted ear (SIPSINMIX). In addition, subjective evaluation using the SSQ12, APSQ, and the BBSS questionnaires was performed.ResultsWe found improved speech understanding in quiet with the AP2 compared to the AP1 aided condition (on average + 17%, p = 0.007). In both noise scenarios, the AP2 lead to improved speech reception thresholds by 1.2 dB (S0NMIX, p = 0.032) and 2.1 dB (SIPSINMIX, p = 0.048) compared to the AP1. The questionnaires revealed no statistically significant differences, except an improved APSQ usability score with the AP2.ConclusionClinicians can expect that patients with SSD will benefit from the SAMBA 2 BB by improved speech understanding in both quiet and in complex noise scenarios, when compared to the older SAMBA BB.

An Improved Noise Reduction Technique for Enhancing the Intelligibility of Sinewave Vocoded Speech: Implication in Cochlear Implants

A cochlear implant (CI) is the most suitable option for individuals with severe profound hearing loss. CI restores the audibility to near perfection and offers good speech understanding in quiet. However, the speech perception in noise with CIs is less optimal as most speech coding strategies of CIs encode only the temporal envelope. Besides the current CI signal coding strategies lacks sophisticated pre-processing. In the current study, we proposed a novel pre-processing method to improve speech Intelligibility in noise and tested using the acoustic simulations of cochlear implants. The proposed noise reduction technique aims to minimize the mean square error (MSE) between the temporal envelopes of the enhanced speech and its clean speech. Therefore, the proposed method will be suitable for CI applications. This paper provides an analysis of the theoretical derivation of the noise suppression function and also the performance evaluation using objective and subjective tests. The effectiveness of the proposed method was objectively evaluated using the SRMR-CI and ESTOI. Additionally, speech recognition through the acoustic simulations of the cochlear implant was done for the subjective evaluation. Performance of the proposed method was compared with the Weiner filter (WF) and sigmoidal functions. The sinewave vocoder was used to simulate the cochlear implant perception. Both objective and subjective scores revealed that the performance of the proposed technique is superior to the WF and sigmoidal function.

Comparison of two different bone anchored hearing instruments.

To compare the audiological performances of Turkey's most up-to-date bone conduction implant processors. Twenty-six bone-anchored hearing instrument users, thirteen in each group, were evaluated for speech understanding in quiet and several signal-to-noise ratios. We noticed the differences at 0.5 and 1kHz measurements in free field frequency specific test, aided SRT scores, non-adaptive and adaptive matrix test results for a few conditions created a statistically significant difference in favor of Baha-6®. Both processors offer positive gains to their users in noisy and silent conditions. However, the data showed statistically significant differences for some measurements that may be critical for patients in daily practice.

Cortical auditory evoked potentials, brain signal variability and cognition as biomarkers to detect the presence of chronic tinnitus

The current limited understanding of tinnitus neurophysiology is one of the major obstacles in developing effective treatments for chronic tinnitus. As such, there is an urgent need for knowledge on underlying neural and/or neurobehavioral correlates that might function as potential biomarkers for tinnitus. We aimed to develop a model for the detection of tinnitus cases based on such potential biomarkers. In a first step, data from twenty patients suffering from chronic tinnitus, but no concurrent hearing loss or psychological complaints, were compared to data from twenty matched controls. Cortical auditory evoked potentials (CAEP) were elicited using a standard oddball paradigm. Source estimation and brain signal variability were analyzed to investigate putative differences between tinnitus patients and controls. Other examinations included standard audiometry, speech understanding in quiet and noisy conditions, and cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The P300 component, a response to unexpected but relevant stimuli, was significantly reduced in the tinnitus group. Source estimation revealed that the response of tinnitus patients was characterized by a decreased activity in temporal cortex, parahippocampus and insula. Brain signal variability on fine time scales was significantly higher in the tinnitus group, suggesting that tinnitus patients rely more strongly on local information processing. Furthermore, tinnitus was associated with a decreased cognitive performance, especially on tasks measuring delayed memory. In a second step, a logistic regression model was constructed based on CAEP activity, brain signal variability and RBANS scores. This model performed significantly above chance level when detecting tinnitus cases in an unseen dataset (accuracy of 75%, area under the ROC curve of 0.86). The successful classification between tinnitus cases and controls demonstrates the potential value of the proposed combination of biomarkers. Moreover, the identified associations between tinnitus, auditory evoked activity and cognitive performance point towards a significant contribution of top-down information processing in the perception of tinnitus.

Influence of Compression Thresholds and Maximum Power Output on Speech Understanding with Bone-Anchored Hearing Systems.

Bone-anchored hearing systems (BAHS) transmit sound via osseointegrated implants behind the ear. They are used to treat patients with conductive or mixed hearing loss, but speech understanding may be limited especially in users with substantial additional cochlear hearing losses. In recent years, BAHS with higher maximum power output (MPO) and more advanced digital processing including loudness compression have become available. These features may be useful to increase speech understanding in users with mixed hearing loss. We have tested the effect of 4 combinations of two different MPO levels (highest level available and level reduced by 12 dB) and two different compression thresholds (CT) levels (50 dB and 65 dB sound pressure level) in 12 adult BAHS users on speech understanding in quiet and in noise. We have found that speech understanding in quiet was not influenced significantly by any of the changes in these two fitting parameters. In contrast, in users with average bone-conduction (BC) threshold of 25 dB or more, speech understanding in noise was improved by +0.8 dB to +1.1 dB (p < 0.03) when using the higher MPO level. In this user group, there may be an additional, but very small benefit of +0.1 dB to +0.4 dB when using the lower rather than the higher CT value, but the difference was not statistically significant (p > 0.27). In users with better average BC thresholds than 25 dB, none of the improvement was statistically significant. Higher MPOs and possibly, to a lesser degree, lower CTs seem to be able to improve speech understanding in noise in users with higher BC thresholds, but even their combined effect seems to be limited.

The impact of face masks on the communication of adults with hearing loss during COVID-19 in a clinical setting

Objective The aim of the study was to investigate the effect of surgical masks and face shields on speech intelligibility of adults with moderate to severe hearing loss. Design This study measured speech tracking scores in quiet for life speech in three different conditions: without a mask, with a surgical mask and with a face shield. Acoustic effects of the masks and face shields on the speech signal were also investigated. Study sample: The study sample consists of 42 patients with moderate to severe hearing loss, 23 cochlear implant users and 19 hearing aid users. Results A significant average difference in speech perception scores was found for the use of a surgical mask compared to the listening situation “without mask”. The worse the speech understanding in quiet, the larger the impact of the surgical mask. For the worse performers even the face shield had a negative impact on speech perception. The sound distortion for the face shield compared to the surgical mask was greater. Conclusion This study shows that even for speech perception in quiet, surgical face masks, and face shields to a lesser extent, have a negative effect for patients with moderate to severe hearing loss.

Evaluation of Extended-Wear Hearing Aids as a Solution for Intermittently Noise-Exposed Listeners With Hearing Loss.

Many individuals with noise-related hearing loss continue working in environments where they are periodically exposed to high levels of noise, which increases their risk for further hearing loss. These individuals often must remove their hearing aids in operational environments because of incompatibility with the mandated personal protective equipment, thus reducing situational awareness. Extended-wear hearing aids might provide a solution for these individuals because they can be worn for weeks or months at a time, protect users from high-level noise exposures, and are compatible with communication headsets, earmuffs, and other types of personal protective equipment. The purpose of this study was to evaluate localization ability and speech understanding, feasibility of fitting and use, and acceptability in terms of comfort in a population of noise-exposed, active duty Service members. Participants in the study were active duty Service members who were experienced hearing aid users and were currently using standard hearing aids bilaterally. Participants were fitted with extended-wear hearing aids for up to 14 weeks. Laboratory measures included functional gain, sound localization, and speech recognition (in quiet and in noise). Performance was compared between unaided, standard hearing aids, extended-wear hearing aids, and extended-wear hearing aids combined with a tactical communication device (3M Peltor ComTac). In addition, self-perceived benefit between extended-wear hearing aids and standard hearing aids was compared. The extended-wear hearing aids provided more attenuation of external sound when turned off compared to standard hearing aids. Speech understanding in quiet and in noise was comparable between extended-wear hearing aids and standard hearing aids and was better when a tactical communication device was worn in addition to extended-wear hearing aids. Localization with extended-wear hearing aids was the worst, intermediate with the standard hearing aids, and the best when the ears were unaided. The extended-wear hearing aids and standard hearing aids provided similar self-perceived communication benefits relative to unaided ears. Device failure and issues with extended-wear hearing aids fit and comfort contributed to a high participant withdrawal rate. Overall, the hearing benefits of extended-wear hearing aids for Service members with hearing loss were comparable to those obtained with standard hearing aids, except for sound localization, which was poorer with extended-wear hearing aids. Extended-wear hearing aids provide the additional benefits of protecting the ears from high-level impulsive noise and being compatible with tactical communication and protection systems and other existing personal protective equipment and communication gear. The withdrawal rate in this study, however, suggests that extended-wear hearing aids may not be suitable for active duty Service members in locations where properly trained hearing professionals are not available to replace or re-insert extended-wear hearing aids when needed due to discomfort or device failure.

Tablet-Based Telerehabilitation Versus Conventional Face-to-Face Rehabilitation After Cochlear Implantation: Prospective Intervention Pilot Study.

BackgroundTechnologies allowing home-based rehabilitation may be a key means of saving financial resources while also facilitating people’s access to treatment. After cochlear implantation, auditory training is necessary for the brain to adapt to new auditory signals transmitted by the cochlear implant (CI). To date, auditory training is conducted in a face-to-face setting at a specialized center. However, because of the COVID-19 pandemic’s impact on health care, the need for new therapeutic settings has intensified.ObjectiveThe aims of this study are to assess the feasibility of a novel teletherapeutic auditory rehabilitation platform in adult CI recipients and compare the clinical outcomes and economic benefits of this platform with those derived from conventional face-to-face rehabilitation settings in a clinic.MethodsIn total, 20 experienced adult CI users with a mean age of 59.4 (SD 16.3) years participated in the study. They completed 3 weeks of standard (face-to-face) therapy, followed by 3 weeks of computer-based auditory training (CBAT) at home. Participants were assessed at three intervals: before face-to-face therapy, after face-to-face therapy, and after CBAT. The primary outcomes were speech understanding in quiet and noisy conditions. The secondary outcomes were the usability of the CBAT system, the participants’ subjective rating of their own listening abilities, and the time required for completing face-to-face and CBAT sessions for CI users and therapists.ResultsGreater benefits were observed after CBAT than after standard therapy in nearly all speech outcome measures. Significant improvements were found in sentence comprehension in noise (P=.004), speech tracking (P=.004) and phoneme differentiation (vowels: P=.001; consonants: P=.02) after CBAT. Only speech tracking improved significantly after conventional therapy (P=.007). The program’s usability was judged to be high: only 2 of 20 participants could not imagine using the program without support. The different features of the training platform were rated as high. Cost analysis showed a cost difference in favor of CBAT: therapists spent 120 minutes per week face-to-face and 30 minutes per week on computer-based sessions. For CI users, attending standard therapy required an average of approximately 78 (SD 58.6) minutes of travel time per appointment.ConclusionsThe proposed teletherapeutic approach for hearing rehabilitation enables good clinical outcomes while saving time for CI users and clinicians. The promising speech understanding results might be due to the high satisfaction of users with the CBAT program. Teletherapy might offer a cost-effective solution to address the lack of human resources in health care as well as the global challenge of current or future pandemics.

Systematic Review on Late Cochlear Implantation in Early-Deafened Adults and Adolescents: Clinical Effectiveness.

Cochlear implantation in early-deafened patients, implanted as adolescents or adults, is not always advised due to poor expected outcomes. In order to judge whether such reluctance is justified, the current systematic review aimed to gather all available evidence on postoperative outcomes obtained by early-deafened patients using a state-of-the art cochlear implant (CI). Five electronic databases (PubMed, Embase, the Cochrane library, CINAHL, and PsycInfo) were systematically searched for studies in English, French, German, or Dutch, published between 2000 and September 2017. Studies that reported pre- and postoperative outcomes on any measure of speech or sound perception, audiovisual or subjective benefit (quality of life) were included. Study quality was assessed with the Institute of Health Economics quality appraisal tool for case series studies. The systematic search and subsequent full-text evaluation identified 38 studies meeting the inclusion criteria. Only a limited number of studies were judged to be of high quality according to the Institute of Health Economics tool, with lack of (clear) presentation of relevant study information being a recurring problem. Twenty-five studies presented viable outcomes on open-set speech understanding in quiet: mean postoperative scores obtained with CI remained below 50% for the vast majority of studies; significant postoperative improvements were found in 16 studies, although this number might have been higher if appropriate statistical testing had been performed in all studies. Eight studies observed increased audiovisual performance after implantation, which was statistically significant in six studies. A validated measure of hearing-related quality of life was used in only 5 of the 16 studies assessing subjective outcomes, showing significant postoperative improvements for most questionnaire domains. The relation between auditory and subjective outcomes was assessed in two studies, with contradictory results. The current review showed that late cochlear implantation in early-deafened subjects resulted in significantly improved open-set speech perception, audiovisual speech perception, and (hearing-related) quality of life in the majority of the studies involved. Nonetheless, more and especially higher-quality research is needed in order to gain a more detailed understanding of the outcomes of cochlear implantation in this population.

Application of Wireless Contralateral Routing of Signal (CROS) Technology in Unilateral Cochlear Implant Users

IntrodutionSingle cochlear implantation usually provides substantial speech intelligibility benefits but bilaterally deaf, unilaterally implanted subjects will continue to experience limitations due to the head shadow effect, like single-sided deaf individuals. In the treatment of individuals with single-sided deafness one option is contralateral routing of signal (CROS) devices, which constitute a non-surgical intervention of the second ear in unilaterally implanted individuals. MethodTwelve experienced adult cochlear implant (CI) users with Naída Q70 processor and the CROS device used in combination participated in the study. For the study three conditions were provided: CI only, omnidirectional microphone mode (CROS deactivated); CI plus CROS activated, omnidirectional microphone mode and CI plus CROS activated, UltraZoom mode. Speech reception thresholds were determined in quiet and noise. Subjective feedback regarding the practical usability of the CROS device and the perceived benefit were collected. ResultsThere was a 27.6% improvement in speech understanding in quiet and 32.5% improvement in noise when CROS device was activated. Using advanced directional microphones, a statistically significant benefit of 35% was obtained. The responses to the questionnaires revealed that the subjects perceived benefit in their everyday lives when using the CROS device with their CI. ConclusionThe investigated CROS device used by unilateral CI recipients in cases where bilateral implantation is not an option provides both subjective and objective speech recognition benefit when the signal is directed to the CROS device. Unfavourable conditions where speech is presented from the CI side and noise from the CROS side or diffusely were not included in this evaluation since the CROS device adds additional noise and performance is expected to decrease as has previously been shown.

Assessment of Speech Understanding After Cochlear Implantation in Adult Hearing Aid Users

Cochlear implants were approved for use in adults in the 1980s, but use remains low owing to a lack of awareness regarding cochlear implantation candidacy criteria and expected outcomes. There have been limited, small series examining the safety and effectiveness of cochlear implantation in adult hearing aid (HA) users with and without mild cognitive impairment (MCI). To investigate the safety and effectiveness of a single-ear cochlear implant in a group of optimized adult HA users with and without MCI across a variety of domains. In this nonrandomized controlled trial, a multicenter, prospective, repeated-measures investigation was conducted at 13 US institutions. The setting was academic and community-based cochlear implant programs. Eligible participants were 100 adults (aged >18 years) with postlinguistic onset of bilateral moderate sloping to profound or worse sensorineural hearing loss (≤20 years' duration). Fluent English speakers underwent an optimized bilateral HA trial for at least 30 days. Individuals with aided Consonant-Vowel Nucleus-Consonant (CNC) word score in quiet of 40% or less correct in the ear to be implanted and 50% or less correct in the contralateral ear were offered cochlear implants. The first participant was enrolled on February 20, 2017, and the last participant was enrolled on May 3, 2018. The final follow-up was on December 21, 2018. Participants received the same cochlear implant system and contralateral HA. The primary outcome measure was speech understanding in quiet (CNC word score) using both the cochlear implant and opposite ear HA. Secondary outcome measures included the following: adverse events; speech understanding in noise (AzBio signal-to-noise ratio of +10 db [+10 SNR]) Health Utilities Index Mark 3 (HUI3); Speech, Spatial, and Qualities of Hearing Questionnaire 49 (SSQ49); and Montreal Cognitive Assessment (MoCA). The median age at cochlear implantation of the 96 patients included in the trial was 71 years (range, 23-91 years), and 62 patients (65%) were male. Three serious adverse events requiring revision surgery occurred, and all resolved without sequelae. By 6 months after activation, the absolute marginal mean change in CNC word score and AzBio +10 SNR was 40.5% (95% CI, 35.9%-45.0%) and 24.1% (95% CI, 18.9%-29.4%), respectively. Ninety-one percent (87 of 96) of participants had a clinically important improvement (>15%) in the CNC word score in the implant ear. Mild cognitive impairment (MoCA total score ≤25) was observed in 48 of 81 study participants (59%) at baseline. Speech perception marginal mean improvements were similar between individuals with and without baseline MCI, with values of 40.9% (95% CI, 35.2%-46.6%) and 39.6% (95% CI, 31.8%-47.4%), respectively, for CNC word score and 27.5% (95% CI, 21.0%-33.9%) and 17.8% (95% CI, 9.0%-26.6%), respectively, for AzBio +10 SNR. Statistically significant and clinically important improvements in the HUI3 and SSQ49 were evident at 6 months. The findings of this nonrandomized controlled trial seem to indicate that cochlear implants are safe and effective in restoring speech understanding in both quiet and noise and improve quality of life in individuals with and without MCI. ClinicalTrials.gov Identifier: NCT03007472.

The effects of behind-the-ear and off-the-ear sound processors on speech understanding performance in cochlear implant users

ObjectiveThe first aim of this study was to compare speech understanding performance in adult cochlear implant users using behind-the-ear and off-the-ear sound processors in quiet and noise. Second, the impact of sound processor microphone location on speech understanding performance was compared. MethodsParticipants were tested with both types of sound processors in the free field with warble tones, and speech discrimination scores in quiet were obtained. Turkish Matrix Test was used to measure speech understanding in noise with five different loudspeaker settings. Twenty-seven participants of cochlear implants between 16 and 67 years-of-age using behind-the-ear or off-the-ear sound processors were included in the study. The results obtained with two types of sound processors were compared. ResultsAided free field thresholds were significantly better for the behind-the-ear vs. off-the-ear sound processor. The mean difference was 3.3 dB HL. There was no significant difference in speech discrimination scores in quite between the two processors (p > 0.05). Statistically significant differences were not seen for speech intelligibility in five spatial settings in the Turkish Matrix Test (p > 0.05). ConclusionAlthough both types of sound processors had different microphone locations, the outcomes were found to be consistent with previous results in adult users off-the-ear sound processors, demonstrating equivalent speech understanding in quiet and noise.

Aplicación de la tecnología de enrutamiento inalámbrico contralateral de la señal (CROS) en usuarios de implante coclear unilateral

IntroductionSingle cochlear implantation usually provides substantial speech intelligibility benefits but bilaterally deaf, unilaterally implanted subjects will continue to experience limitations due to the head shadow effect, like single-sided deaf individuals. In the treatment of individuals with single-sided deafness one option is contralateral routing of signal (CROS) devices, which constitute a non-surgical intervention of the second ear in unilaterally implanted individuals. MethodTwelve experienced adult cochlear implant users with Naída Q70 processor and the CROS device used in combination participated in the study. For the study 3 conditions were provided: cochlear implant only, omnidirectional microphone mode (CROS deactivated); cochlear implant plus CROS activated, omnidirectional microphone mode and cochlear implant plus CROS activated, UltraZoom mode. Speech reception thresholds were determined in quiet and noise. Subjective feedback regarding the practical usability of the CROS device and the perceived benefit were collected. ResultsThere was a 27.6% improvement in speech understanding in quiet and 32.5% improvement in noise when CROS device was activated. Using advanced directional microphones, a statistically significant benefit of 35% was obtained. The responses to the questionnaires revealed that the subjects perceived benefit in their everyday lives when using the CROS device with their cochlear implants. ConclusionThe investigated CROS device used by unilateral CI recipients in cases where bilateral implantation is not an option provides both subjective and objective speech recognition benefit when the signal is directed to the CROS device. Unfavourable conditions where speech is presented from the cochlear implant side and noise from the CROS side or diffusely were not included in this evaluation since the CROS device adds additional noise and performance is expected to decrease as has previously been shown.

Influence of maximum power output on speech understanding with bone anchored hearing systems

Background: Maximum power output (MPO) levels of bone anchored hearing systems (BAHS) vary between different devices, but are significantly lower than those of conventional hearing aids, potentially limiting speech understanding.Aims/objectives: To investigate, how MPO influences speech understanding in quiet and in noise in BAHS users.Materials and methods: 12 adult BAHS users with a bilateral conductive hearing loss and additional sensorineural hearing components between 4 and 45 dB (500–4000 Hz) participated in the study. Speech understanding was measured at 65 dB in quiet and in noise with 4 different MPO level settings, covering the approximate range of MPOs found in currently available BAHS devices.Results: Speech understanding in quiet and in noise decreased with increasing sensorineural hearing loss. MPOs levels did not influence speech understanding in quiet significantly. In contrast, speech understanding in noise was better with higher MPOs (average improvement in signal-to-noise ratio +3.2 dB, p < .001), but only if the sensorineural hearing loss component was above approximately 35 dB.Conclusions and significance: At normal conversational levels, higher MPOs have little or no influence on speech understanding in quiet with BAHS. However, they can improve speech understanding in noise for users with additional sensorineural hearing loss.