Auditory cortical activity to different voice onset times in cochlear implant users

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Impaired perception of temporal fine structure and musical timbre in cochlear implant users

A cochlear implant (CI) is a hearing device introduced in the 1980s for profoundly deaf subjects who gained little or no benefit from powerful hearing aids. This device comprises an electrode array inserted in the cochlea, connected to an internal receiver, and an externally worn speech processor. The CI transforms acoustic signals into electrical currents which directly stimulate the auditory nerve. Since the early 1990s, cochlear implantation in children has been developing rapidly. Although it is still difficult to predict how a child will perform with a cochlear implant, the success of cochlear implantation can no longer be denied. In this paper, some recent papers and reports, and the results of the various Nijmegen cochlear implant studies, are reviewed. Issues about selection, examinations, surgery and the outcome are discussed. Overall, our results were comparable with those of other authors. It can be concluded that cochlear implantation is an effective treatment for postlingually deaf as well as prelingually (congenital or acquired) deaf children with profound bilateral sensorineural deafness.

ObjectivesTo document musical listening and enjoyment in recipients of Advanced Bionics cochlear implants (CIs) and to compare musical perception in those using early coding strategies with subjects using the newer HiRes and HiRes 120 strategies.MethodsA questionnaire was completed by 136 adult subjects, including questions on the ability to identify specific musical features. The subjects were in three groups: those using early coding strategies (n = 29), HiRes (n = 59), and HiRes 120 (n = 48), and results were compared with a group of 84 normally hearing (NH) subjects.ResultsOf the CI users, 79% reported listening to music. The NH group rated listening frequency and enjoyment higher than the CI users. Thirty-five users reported that they sang and this group had significantly higher overall performance. There were no significant differences in overall perception of specific musical features among the strategy groups, though some individual questions showed significantly higher performance in the HiRes 120 users.DiscussionUsers of current CI technology show a high level of musical appreciation, though still significantly less than NH subjects. Frequency of listening and enjoyment were significantly correlated and active participation in musical activities, specifically singing, resulted in significantly higher overall performance scores.

Some cochlear implant (CI) users report having difficulty accessing indexical information in the speech signal, presumably due to limitations in the transmission of fine spectrotemporal cues. The purpose of this review article was to systematically review and evaluate the existing research on talker processing in CI users. Specifically, we reviewed the performance of CI users in three types of talker- and voice-related tasks. We also examined the different factors (such as participant, hearing, and device characteristics) that might influence performance in these specific tasks. We completed a systematic search of the literature with select key words using citation aggregation software to search Google Scholar. We included primary reports that tested (a) talker discrimination, (b) voice perception, and (c) talker identification. Each report must have had at least one group of participants with CIs. Each included study was also evaluated for quality of evidence. The searches resulted in 1,561 references, which were first screened for inclusion and then evaluated in full. Forty-three studies examining talker discrimination, voice perception, and talker identification were included in the final review. Most studies were focused on postlingually deafened and implanted adult CI users, with fewer studies focused on prelingual implant users. In general, CI users performed above chance in these tasks. When there was a difference between groups, CI users performed less accurately than their normal-hearing (NH) peers. A subset of CI users reached the same level of performance as NH participants exposed to noise-vocoded stimuli. Some studies found that CI users and NH participants relied on different cues for talker perception. Within groups of CI users, there is moderate evidence for a bimodal benefit for talker processing, and there are mixed findings about the effects of hearing experience. The current review highlights the challenges faced by CI users in tracking and recognizing voices and how they adapt to it. Although large variability exists, there is evidence that CI users can process indexical information from speech, though with less accuracy than their NH peers. Recent work has described some of the factors that might ease the challenges of talker processing in CI users. We conclude by suggesting some future avenues of research to optimize real-world speech outcomes.

ObjectiveThe aim of the present study was to investigate speech processing development in children with normal hearing (NH) and cochlear implants (CI) groups using a multifeature event-related potential (ERP) paradigm. Singing is associated to enhanced attention and speech perception. Therefore, its connection to ERPs was investigated in the CI group.MethodsThe paradigm included five change types in a pseudoword: two easy- (duration, gap) and three difficult-to-detect (vowel, pitch, intensity) with CIs. The positive mismatch responses (pMMR), mismatch negativity (MMN), P3a and late differentiating negativity (LDN) responses of preschoolers (below 6 years 9 months) and schoolchildren (above 6 years 9 months) with NH or CIs at two time points (T1, T2) were investigated with Linear Mixed Modeling (LMM). For the CI group, the association of singing at home and ERP development was modeled with LMM.ResultsOverall, responses elicited by the easy- and difficult to detect changes differed between the CI and NH groups. Compared to the NH group, the CI group had smaller MMNs to vowel duration changes and gaps, larger P3a responses to gaps, and larger pMMRs and smaller LDNs to vowel identity changes. Preschoolers had smaller P3a responses and larger LDNs to gaps, and larger pMMRs to vowel identity changes than schoolchildren. In addition, the pMMRs to gaps increased from T1 to T2 in preschoolers. More parental singing in the CI group was associated with increasing pMMR and less parental singing with decreasing P3a amplitudes from T1 to T2.ConclusionThe multifeature paradigm is suitable for assessing cortical speech processing development in children. In children with CIs, cortical discrimination is often reflected in pMMR and P3a responses, and in MMN and LDN responses in children with NH. Moreover, the cortical speech discrimination of children with CIs develops late, and over time and age, their speech sound change processing changes as does the processing of children with NH. Importantly, multisensory activities such as parental singing can lead to improvement in the discrimination and attention shifting toward speech changes in children with CIs. These novel results should be taken into account in future research and rehabilitation.

Hearing impaired listeners using cochlear implants (CIs) suffer from a decrease in speech intelligibility (SI) in adverse listening conditions. Time-frequency masks are often applied to perform noise suppression in an attempt to increase SI. Two important masks are the so-called ideal binary mask (IBM) with its binary weights and the ideal Wiener filter (IWF) with its continuous weights. It is unclear which of the masks has the highest potential for SI and speech quality enhancement in CI users. In this study, both approaches for SI and quality enhancement were compared. The investigations were conducted in normal-hearing (NH) subjects listening to noise vocoder CI simulations and in CI users. The potential for SI improvement was assessed in a sentence recognition task with ideal mask estimates in multitalker babble and with an interfering talker. The robustness of the approaches was evaluated with simulated estimation errors. CI users assessed the speech quality in a preference rating. The IWF outperformed the IBM in NH listeners. In contrast, no significant difference was obtained in CI users. Estimation errors degraded SI in CI users for both approaches. In terms of quality, the IWF outperformed, slightly, the IBM processed signals. The outcomes of this study suggest that the mask pattern is not that crucial for CIs. Results of speech enhancement algorithms obtained with NH subjects listening to vocoded or normally processed stimuli do not translate to CI users. This outcome means that the effect of new strategies has to be quantified with the user group considered.

The temporal fine structure (TFS) of sound contributes significantly to the perception of music and speech in noise. The evaluation of new strategies to improve TFS delivery in cochlear implants (CIs) relies upon the assessment of fine structure encoding. Most modern CI sound processing schemes do not encode within-channel TFS per se, but some TFS information is delivered through temporal envelope cues across multiple channels. Positive and negative Schroeder-phase harmonic complexes differ primarily in acoustic TFS and provide a potential test of TFS discrimination ability in CI users for current and future processing strategies. The ability to discriminate Schroeder-phase stimuli was evaluated in 24 CI users and 7 normal-hearing listeners at four fundamental frequencies: 50, 100, 200, and 400 Hz. The dependent variables were percent correct at each fundamental frequency, average score across all fundamental frequencies, and a maximum-likelihood-predicted threshold fundamental frequency for 75% correct. CI listeners scored better than chance for all fundamental frequencies tested. The 50-Hz, average, and predicted threshold scores correlated significantly with consonant-nucleus-consonant word scores. The 200-Hz score correlated with a measure of speech perception in speech-shaped noise. Pitch-direction sensitivity is predicted jointly by the 400-Hz Schroeder score and a spectral ripple discrimination task. The results demonstrate that the Schroeder test is a potentially useful measure of clinically relevant temporal processing abilities in CI users.

Speech perception in noise is an important aspect of the rehabilitation of children with hearing loss. We aimed to evaluate the feasibility and reliability of the Dutch digits-in-noise (DIN) test in the clinical follow-up of children with hearing aids (HAs) and/or cochlear implants (CIs). A second aim of the study was to gain insight in the speech perception in noise performance of children with different degrees of hearing loss. We retrospectively analyzed DIN test data of Dutch-speaking children with hearing loss (N = 188; 5 to 18 years old). A free-field version of the DIN-test was used. Children with open-set phoneme recognition in quiet of >70% at 65 dB SPL (best aided condition) were included. Ages ranged from 5 to 18 years old. All were experienced HA or CI users and had used their device(s) for at least 1 year before the measurement in the study. The DIN-test was performed in the framework of a clinical rehabilitation program. During testing, children wore their own devices with normal daily programs. The average speech reception threshold (SRT) was -3.6 dB (SD 3.6) for the first list and significantly improved to -4.0 dB (SD 3.1) for the second list. HA users had a 4-dB better SRT compared with CI users. The larger the child's hearing loss, the worse the SRT is. However, 15% of the children who completed a first list of 24 trials were unable to complete a second list. Mean adaptive staircase trajectories across trials suggested that learning occurred throughout the first list, and that loss of sustained attention contributed to response variability during the second list. The DIN test can be used to assess speech perception in noise abilities for children with different degrees of hearing loss and using HAs or CIs. The children with hearing loss required a higher signal-to-noise ratio (SNR) than did normal-hearing children and the required SNR is larger as the hearing loss increases. However, the current measurement procedure should be optimized for use in standard pediatric audiological care, as 15% of the children were unable to conduct a second list after the first list to reach a more stable SNR.

Objectives Cochlear implants (CI) have dramatically improved speech perception for patients with sensorineural hearing impairment. However, listening to music is a great challenge for them. This study examined the perception and appraisal of Iranian musical instruments comparing with similar Western instruments. Methods Eleven adult CI users and 25 normal hearing (NH) individuals participated in this study. Musical stimuli of three commonly heard instrument pairs were prepared. Participants were asked to identify the instruments and rate their appraisal on a ten-point Likert scale (0 = dislike very much, 10 = like very much). Results The instrument recognition rate was 40.6% among the CI users, and the mean appraisal score was 5.2 ± 2.7. NH listeners had none significant higher scores on both tasks with a recognition rate of 50.0% and the mean appraisal score of 6.9 ± 1.5. Iranian instruments were more recognized in both groups. Regarding their appraisal, the mean score for both types was almost equal in the NH group, while CI users more appraised Iranian instruments. Conclusion In addition to better recognition of Iranian instruments, they were particularly better appraised in the CI group. Iranian instruments provide suitable musical pieces for CI recipients that can be considered in rehabilitation programs.

Cochlear implants (CIs) restore speech perception in quiet but they also eliminate or distort many acoustic cues that are important for music enjoyment. Unfortunately, quantifying music enjoyment by CI users has been difficult because comparisons must rely on their recollection of music before they lost their hearing. Here, we aimed to assess music enjoyment in CI users using a readily interpretable reference based on acoustic hearing. The comparison was done by testing "single-sided deafness" (SSD) patients who have normal hearing (NH) in one ear and a CI in the other ear. The study also aimed to assess binaural musical enjoyment, with the reference being the experience of hearing with a single NH ear. Three experiments assessed the effect of adding different kinds of input to the second ear: electrical, vocoded, or unmodified. In experiment 1, music enjoyment in SSD-CI users was investigated using a modified version of the MUSHRA (MUltiple Stimuli with Hidden Reference and Anchor) method. Listeners rated their enjoyment of song segments on a scale of 0 to 200, where 100 represented the enjoyment obtained from a song segment presented to the NH ear, 0 represented a highly degraded version of the same song segment presented to the same ear, and 200 represented enjoyment subjectively rated as twice as good as the 100 reference. Stimuli consisted of acoustic only, electric only, acoustic and electric, as well as other conditions with low pass filtered acoustic stimuli. Acoustic stimulation was provided by headphone to the NH ear and electric stimulation was provided by direct audio input to the subject's speech processor. In experiment 2, the task was repeated using NH listeners who received vocoded stimuli instead of electric stimuli. Experiment 3 tested the effect of adding the same unmodified song segment to the second ear, also in NH listeners. Music presented through the CI only was very unpleasant, with an average rating of 20. Surprisingly, the combination of the unpleasant CI signal in one ear with acoustic stimulation in the other ear was rated more enjoyable (mean = 123) than acoustic processing alone. Presentation of the same monaural musical signal to both ears in NH listeners resulted with even greater enhancement of the experience compared with presentation to a single ear (mean = 159). Repeating the experiment using a vocoder to one ear of NH listeners resulted in interference rather than enhancement. Music enjoyment from electric stimulation is extremely poor relative to a readily interpretable NH baseline for CI-SSD listeners. However, the combination of this unenjoyable signal presented through a CI and an unmodified acoustic signal presented to a NH (or near-NH) contralateral ear results in enhanced music enjoyment with respect to the acoustic signal alone. Remarkably, this two-ear enhancement experienced by CI-SSD listeners represents a substantial fraction of the two-ear enhancement seen in NH listeners. This unexpected benefit of electroacoustic auditory stimulation will have to be considered in theoretical accounts of music enjoyment and may facilitate the quest to enhance music enjoyment in CI users.

Watching a talker's mouth is beneficial for speech reception (SR) in many communication settings, especially in noise and when hearing is impaired. Measures for audiovisual (AV) SR can be valuable in the framework of diagnosing or treating hearing disorders. This study addresses the lack of standardized methods in many languages for assessing lipreading, AV gain, and integration. A new method is validated that supplements a German speech audiometric test with visualizations of the synthetic articulation of an avatar that was used, for it is feasible to lip-sync auditory speech in a highly standardized way. Three hypotheses were formed according to the literature on AV SR that used live or filmed talkers. It was tested whether respective effects could be reproduced with synthetic articulation: (1) cochlear implant (CI) users have a higher visual-only SR than normal-hearing (NH) individuals, and younger individuals obtain higher lipreading scores than older persons. (2) Both CI and NH gain from presenting AV over unimodal (auditory or visual) sentences in noise. (3) Both CI and NH listeners efficiently integrate complementary auditory and visual speech features. In a controlled, cross-sectional study with 14 experienced CI users (mean age 47.4) and 14 NH individuals (mean age 46.3, similar broad age distribution), lipreading, AV gain, and integration of a German matrix sentence test were assessed. Visual speech stimuli were synthesized by the articulation of the Talking Head system "MASSY" (Modular Audiovisual Speech Synthesizer), which displayed standardized articulation with respect to the visibility of German phones. In line with the hypotheses and previous literature, CI users had a higher mean visual-only SR than NH individuals (CI, 38%; NH, 12%; p < 0.001). Age was correlated with lipreading such that within each group, younger individuals obtained higher visual-only scores than older persons (rCI = -0.54; p = 0.046; rNH = -0.78; p < 0.001). Both CI and NH benefitted by AV over unimodal speech as indexed by calculations of the measures visual enhancement and auditory enhancement (each p < 0.001). Both groups efficiently integrated complementary auditory and visual speech features as indexed by calculations of the measure integration enhancement (each p < 0.005). Given the good agreement between results from literature and the outcome of supplementing an existing validated auditory test with synthetic visual cues, the introduced method can be considered an interesting candidate for clinical and scientific applications to assess measures important for AV SR in a standardized manner. This could be beneficial for optimizing the diagnosis and treatment of individual listening and communication disorders, such as cochlear implantation.

On the relationship between auditory cognition and speech intelligibility in cochlear implant users: An ERP study

ABSTRACTNormal auditory feedback contributes to moment-to-moment control of speech production. Effects of auditory feedback’s absence on hearing-impaired individuals are widely documented, but auditory perturbation has not been investigated. Our objective was to evaluate the effect of delayed auditory feedback (DAF) and frequency altered feedback (FAF) on speech production among prelingual cochlear implant (CI) users and normal hearing (NH) individuals, to evaluate CI users’ reliance on auditory feedback. Twenty young adults (10 CI, 10 NH), without developmental and cognitive impairments, participated in the study. Under variable auditory feedback conditions, speech production (spontaneous or reading aloud) was measured using speech rate, percentage of interruptions, fundamental frequency (F0), and relative intensity. Results showed that (1) both DAF and FAF caused slower speech rates and more interruptions while reading aloud, with DAF having larger effect; (2) altered feedback produced no differences between groups, except an increase in F0 for CI users during DAF; and (3) CI users’ ability to understand speech via phone and without lip-reading was positively correlated with performance under DAF. These findings suggest that auditory perturbation similarly affects speech production among prelingual CI users and NH individuals, indicating CI users depend on auditory feedback to the same degree as normal hearing individuals.

Cochlear implant (CI) trends are changing as more recipients are receiving bilateral implantation. Also more pre-lingually deafened adults are choosing to be implanted. Clinical assessment after cochlear implantation is usually based on speech perception tests. Such tests, however, may not be a realistic outcome measure for some of these cases, creating a need for more objective measures of CI performance. Cortical auditory evoked potentials (CAEPs) recorded in the sound field may be a fast and reliable procedure for the clinical audiologist to determine CI outcomes. This paper presents two case studies illustrating CAEP findings in an adult CI user who was pre-lingually deafened and a bilateral CI user. Copyright © 2009 John Wiley & Sons, Ltd.