Speech Intelligibility and Spatial Release From Masking Improvements Using Spatial Noise Reduction Algorithms in Bimodal Cochlear Implant Users.

This study investigated the speech intelligibility benefit of using two different spatial noise reduction algorithms in cochlear implant (CI) users who use a hearing aid (HA) on the contralateral side (bimodal CI users). The study controlled for head movements by using head-related impulse responses to simulate a realistic cafeteria scenario and controlled for HA and CI manufacturer differences by using the master hearing aid platform (MHA) to apply both hearing loss compensation and the noise reduction algorithms (beamformers). Ten bimodal CI users with moderate to severe hearing loss contralateral to their CI participated in the study, and data from nine listeners were included in the data analysis. The beamformers evaluated were the adaptive differential microphones (ADM) implemented independently on each side of the listener and the (binaurally implemented) minimum variance distortionless response (MVDR). For frontal speech and stationary noise from either left or right, an improvement (reduction) of the speech reception threshold of 5.4 dB and 5.5 dB was observed using the ADM, and 6.4 dB and 7.0 dB using the MVDR, respectively. As expected, no improvement was observed for either algorithm for colocated speech and noise. In a 20-talker babble noise scenario, the benefit observed was 3.5 dB for ADM and 7.5 dB for MVDR. The binaural MVDR algorithm outperformed the bilaterally applied monaural ADM. These results encourage the use of beamformer algorithms such as the ADM and MVDR by bimodal CI users in everyday life scenarios

Minimal Reporting Standards for Active Middle Ear Hearing Implants.

There is currently no standardized method for reporting audiological, surgical and subjective outcome measures in clinical trials with active middle ear implants (AMEIs). It is often difficult to compare studies due to data incompatibility and to perform meta-analyses across different centres is almost impossible. A committee of ENT and audiological experts from Germany, Austria and Switzerland decided to address this issue by developing new minimal standards for reporting the outcomes of AMEI clinical trials. The consensus presented here aims to provide a recommendation to enable better inter-study comparability

Cochlear implant programming: a global survey on the state of the art

The programming of CIs is essential for good performance. However, no Good Clinical Practice guidelines exist. This paper reports on the results of an inventory of the current practice worldwide. A questionnaire was distributed to 47 CI centers. They follow 47600 recipients in 17 countries and 5 continents. The results were discussed during a debate. Sixty-two percent of the results were verified through individual interviews during the following months. Most centers (72%) participated in a cross-sectional study logging 5 consecutive fitting sessions in 5 different recipients. Data indicate that general practice starts with a single switch-on session, followed by three monthly sessions, three quarterly sessions, and then annual sessions, all containing one hour of programming and testing. The main focus lies on setting maximum and, to a lesser extent, minimum current levels per electrode. These levels are often determined on a few electrodes and then extrapolated. They are mainly based on subjective loudness perception by the CI user and, to a lesser extent, on pure tone and speech audiometry. Objective measures play a small role as indication of the global MAP profile. Other MAP parameters are rarely modified. Measurable targets are only defined for pure tone audiometry. Huge variation exists between centers on all aspects of the fitting practice

Cochlear Implant Programming: A Global Survey on the State of the Art

The programming of CIs is essential for good performance. However, no Good Clinical Practice guidelines exist. This paper reports on the results of an inventory of the current practice worldwide. A questionnaire was distributed to 47 CI centers. They follow 47600 recipients in 17 countries and 5 continents. The results were discussed during a debate. Sixty-two percent of the results were verified through individual interviews during the following months. Most centers (72%) participated in a cross-sectional study logging 5 consecutive fitting sessions in 5 different recipients. Data indicate that general practice starts with a single switch-on session, followed by three monthly sessions, three quarterly sessions, and then annual sessions, all containing one hour of programming and testing. The main focus lies on setting maximum and, to a lesser extent, minimum current levels per electrode. These levels are often determined on a few electrodes and then extrapolated. They are mainly based on subjective loudness perception by the CI user and, to a lesser extent, on pure tone and speech audiometry. Objective measures play a small role as indication of the global MAP profile. Other MAP parameters are rarely modified. Measurable targets are only defined for pure tone audiometry. Huge variation exists between centers on all aspects of the fitting practice

Cochlear Implant Programming: A Global Survey on the State of the Art

The programming of CIs is essential for good performance. However, no Good Clinical Practice guidelines exist. This paper reports on the results of an inventory of the current practice worldwide. A questionnaire was distributed to 47 CI centers. They follow 47600 recipients in 17 countries and 5 continents. The results were discussed during a debate. Sixty-two percent of the results were verified through individual interviews during the following months. Most centers (72%) participated in a cross-sectional study logging 5 consecutive fitting sessions in 5 different recipients. Data indicate that general practice starts with a single switch-on session, followed by three monthly sessions, three quarterly sessions, and then annual sessions, all containing one hour of programming and testing. The main focus lies on setting maximum and, to a lesser extent, minimum current levels per electrode. These levels are often determined on a few electrodes and then extrapolated. They are mainly based on subjective loudness perception by the CI user and, to a lesser extent, on pure tone and speech audiometry. Objective measures play a small role as indication of the global MAP profile. Other MAP parameters are rarely modified. Measurable targets are only defined for pure tone audiometry. Huge variation exists between centers on all aspects of the fitting practice

Interaural Time Difference Perception with a Cochlear Implant and a Normal Ear

Currently there is a growing population of cochlear-implant (CI) users with (near) normal hearing in the non-implanted ear. This configuration is often called SSD (single-sided deafness) CI. The goal of the CI is often to improve spatial perception, so the question raises to what extent SSD CI listeners are sensitive to interaural time differences (ITDs). In a controlled lab setup, sensitivity to ITDs was investigated in 11 SSD CI listeners. The stimuli were 100-pps pulse trains on the CI side and band-limited click trains on the acoustic side. After determining level balance and the delay needed to achieve synchronous stimulation of the two ears, the just noticeable difference in ITD was measured using an adaptive procedure. Seven out of 11 listeners were sensitive to ITDs, with a median just noticeable difference of 438 μs. Out of the four listeners who were not sensitive to ITD, one listener reported binaural fusion, and three listeners reported no binaural fusion. To enable ITD sensitivity, a frequency-dependent delay of the electrical stimulus was required to synchronize the electric and acoustic signals at the level of the auditory nerve. Using subjective fusion measures and refined by ITD sensitivity, it was possible to match a CI electrode to an acoustic frequency range. This shows the feasibility of these measures for the allocation of acoustic frequency ranges to electrodes when fitting a CI to a subject with (near) normal hearing in the contralateral ear.status: publishe

Influence of Bilateral Fitting Parameters on Binaural Unmasking in BICI Users

The ability to detect a target signal masked by noise is improved in normal-hearing listeners when interaural phase differences (IPDs) between the ear signals exist either in the masker or in the signal. To improve binaural hearing in bilaterally implanted cochlear implant (BiCI) users, a coding strategy providing the best possible access to IPDs is highly desirable. Outcomes of a previous study (Zirn, Arndt et al. 2016) revealed that a subset of BiCI users showed improved IPD detection thresholds with the fine structure processing strategy FS4 compared to the constant rate strategy HDCIS using narrowband stimuli. In contrast, little differences between the coding strategies were found for broadband stimuli with regard to binaural speech intelligibility level differences (BILD) as an estimate of binaural unmasking. Compared to normalhearing listeners (7.5 ± 1.2 dB) BILD were small in BiCI users (around 0.5 dB with both coding strategies). In the present work, we investigated the influence of binaural fitting parameters on BILD. In our cohort of BiCI users many were implanted with electrode arrays differing in length left versus right. Because this length difference typically corresponded to the distance of two electrode contacts the first modification of bilateral fitting was a tonotopic adjustment by deactivation of the most apical electrode contact on the side with the deeper inserted array (tonotopic approach). The second modification was the isolation of the residual, most apical electrode contacts by deactivation of the basally adjacent electrode contact on each side (tonotopic sparse approach). Applying these modifications, BILD improved by up to 1.5 dB

Reducing the Device Delay Mismatch Can Improve Sound Localization in Bimodal Cochlear Implant/Hearing-Aid Users

In users of a cochlear implant (CI) together with a contralateral hearing aid (HA), so-called bimodal listeners, differences in processing latencies between digital HA and CI up to 9 ms constantly superimpose interaural time differences. In the present study, the effect of this device delay mismatch on sound localization accuracy was investigated. For this purpose, localization accuracy in the frontal horizontal plane was measured with the original and minimized device delay mismatch. The reduction was achieved by delaying the CI stimulation according to the delay of the individually worn HA. For this, a portable, programmable, battery-powered delay line based on a ring buffer running on a microcontroller was designed and assembled. After an acclimatization period to the delayed CI stimulation of 1 hr, the nine bimodal study participants showed a highly significant improvement in localization accuracy of 11.6% compared with the everyday situation without the delay line ( p  < .01). Concluding, delaying CI stimulation to minimize the device delay mismatch seems to be a promising method to increase sound localization accuracy in bimodal listeners