Improved Speech Hearing in Noise with Invasive Electrical Brain Stimulation.

The Use of Listening Devices to Ameliorate Auditory Deficit in Children with Autism

IntroductionThe frequency modulation system is a device that helps to improve speech perception in noise and is considered the most beneficial approach to improve speech recognition in noise in cochlear implant users. According to guidelines, there is a need to perform a check before fitting the frequency modulation system. Although there are recommendations regarding the behavioral tests that should be performed at the fitting of the frequency modulation system to cochlear implant users, there are no published recommendations regarding the electroacoustic test that should be performed. ObjectivePerform and determine the validity of an electroacoustic verification test for frequency modulation systems coupled to different cochlear implant speech processors. MethodsThe sample included 40 participants between 5 and 18 year's users of four different models of speech processors. For the electroacoustic evaluation, we used the Audioscan Verifit device with the HA-1 coupler and the listening check devices corresponding to each speech processor model. In cases where the transparency was not achieved, a modification was made in the frequency modulation gain adjustment and we used the Brazilian version of the “Phrases in Noise Test” to evaluate the speech perception in competitive noise. ResultsIt was observed that there was transparency between the frequency modulation system and the cochlear implant in 85% of the participants evaluated. After adjusting the gain of the frequency modulation receiver in the other participants, the devices showed transparency when the electroacoustic verification test was repeated. It was also observed that patients demonstrated better performance in speech perception in noise after a new adjustment, that is, in these cases; the electroacoustic transparency caused behavioral transparency. ConclusionThe electroacoustic evaluation protocol suggested was effective in evaluation of transparency between the frequency modulation system and the cochlear implant. Performing the adjustment of the speech processor and the frequency modulation system gain are essential when fitting this device.

Aims: To investigate the long-term effects of the fine structure processing (FSP) coding strategy on speech perception in noise and quality of life in experienced cochlear implant (CI) users. Methods: In a prospective comparative clinical trial, 32 experienced postlingually deafened CI recipients were upgraded from the Tempo+ to the Opus 2 audio processor, implementing FSP in one group and high-definition continuous interleaved sampling (HDCIS) coding strategy in another group with identical frequency ranges. Speech perception in noise testing and the Speech, Spatial and Qualities (SSQ) questionnaire were administered at 0, 6, 12 and 24 months after the upgrade. Results: FSP yielded significant long-term improvement of speech perception in noise of in total 13.2 dB from 16.2 dB SNR at the upgrade to 3.0 dB SNR after 24 months of FSP experience. No significant improvement of speech perception in noise over time was measured for the HDCIS group. With the SSQ questionnaire, a significant benefit of the FSP coding strategy was observed. Conclusions: The FSP coding strategy as implemented in the Med-EL Opus 2 audio processor improves speech perception in noise. This beneficial effect of FSP on speech perception in noise is not immediate but is significant after 12 months and further improves up to 24 months after implementation of FSP.

There is a lack of high level of evidence studies comparing the effect of different treatment options for single-sided deafness (SSD). To determine the effect of a cochlear implant (CI), bone conduction device (BCD), contralateral routing of signals hearing aid (CROS), and no treatment on speech perception in noise outcomes in patients with SSD. In this single-center randomized clinical trial, adult patients with SSD were randomized into 3 groups: CI; a trial period with first a BCD on a headband and then a CROS; or a trial period with first a CROS and then a BCD on a headband. After the trial periods, patients opted for a BCD, CROS, or no treatment. Measurements were completed at baseline and at 3, 6, 12, and 24 months of follow-up. Data were collected from July 2014 to October 2021, and data were analyzed from December 2022 to May 2023. CI, BCD then CROS, or CROS then BCD. The primary outcome was the speech reception threshold in noise (SRTn), measured with speech and noise from the front (S0N0), speech directed to the poor ear and noise to the better ear (SpeNbe), and vice versa (SbeNpe). The secondary outcome was disease-specific quality of life (QOL). Of 120 included patients, 60 (50.0%) were female, and the mean (SD) age at inclusion was 53.0 (12.1) years. At the start of follow-up, 28 patients received a CI, 25 a BCD, 34 a CROS, and 26 chose no treatment. At 24 months, the CI group had significantly better speech perception in noise scores than the BCD group (difference in SRTn: SbeNpe, -4.7 dB; 95% confidence interval, -6.6 to -3.0; SpeNbe, -2.2 dB; 95% confidence interval, -4.6 to -1.1), the CROS group (difference in SRTn: S0N0, -1.3 dB; 95% confidence interval, -1.7 to -0.2; SbeNpe, -5.3 dB; 95% confidence interval, -6.0 to -3.1), and the no treatment group (difference in SRTn: SpeNbe, -6.3 dB; 95% confidence interval, -7.5 to -4.9). Compared with the no treatment group, the BCD and CROS groups showed significantly better (difference in SRTn for SpeNbe, -4.1 dB [95% confidence interval, -5.2 to -1.5] and -4.1 dB [95% confidence interval, -6.1 to -3.3], respectively) or worse (difference for SbeNpe, 4.0 dB [95% confidence interval, 2.6 to 6.2] and 4.6 dB [95% confidence interval, 2.8 to 5.7], respectively) speech perception in noise. Self-reported speech perception abilities were significantly better for the CI group compared with the BCD, CROS, and no treatment groups. In this randomized clinical trial, the CI group outperformed the BCD, CROS, and no treatment groups in terms of speech perception in noise and disease-specific QOL in patients with SSD after 24 months of follow-up. These results indicate that patients with SSD can partially regain the advantages of binaural hearing after treatment. trialregister.nl Identifier: NL4457.

The aim of the study was to assess the effect of short-term musical training on speech perception in noise. In the present study speech perception in noise was measured pre- and post- short-term musical training. The musical training involved auditory perceptual training for raga identification of two Carnatic ragas. The training was given for eight sessions. A total of 18 normal hearing adults in the age range of 18-25 years participated in the study wherein group 1 consisted of ten individuals who underwent musical training and group 2 consisted of eight individuals who did not undergo any training. Results revealed that post training, speech perception in noise improved significantly in group 1, whereas group 2 did not show any changes in speech perception scores. Thus, short-term musical training shows an enhancement of speech perception in the presence of noise. However, generalization and long-term maintenance of these benefits needs to be evaluated.

Purpose: The present study examines auditory training outcomes in terms of speech perception in noise, working memory, reasoning ability, and subjective hearing aid satisfaction. Methods: Ten older adults who wear hearing aids (mean age: 71.6) voluntarily participated in the study. For the training material, 78 sentence sets composed of 3 to 5 sentences were used. During the auditory training, participants tried to remember the order of sentences. Among the 78 sentence sets, 45 contained clues and the rest did not. Each participant underwent assessments including speech perception in noise and digit spans and reasoning test and completed a self-report hearing aid satisfaction questionnaire both pre- and post-auditory training. The participants completed eight sessions of the auditory training. Results: The results showed a statistically significant increase in speech recognition ability in noise, short-term memory, and working memory, as well as satisfaction with hearing aid use. Despite a slight increase on the reasoning test, there was no statistically significant improvement.Conclusion: The results of this study suggested that the auditory training in remembering the order of sentences improved speech perception in noise, sensory and working memory, and subjective satisfaction with hearing aids. Future research can investigate more effective auditory training tools to improve the various cognitive skills and communication ability of older adults who wear hearing aids.

Although several previous studies have confirmed that listeners find it difficult to perceive the speech of face-mask-wearing speakers, there has been little research into how masks affect hearing-impaired individuals using hearing aids. Therefore, the aim of this study was to compare the effects of masks on the speech perception in noise of hearing-impaired individuals and normal-hearing individuals. We also investigated the effect of masks on the gain conferred by hearing aids. The hearing-impaired group included 24 listeners (age: M = 69.5, SD = 8.6; M:F = 13:11) who had used hearing aids in everyday life for >1 month (M = 20.7, SD = 24.0) and the normal-hearing group included 26 listeners (age: M = 57.9, SD = 11.1; M:F = 13:13). Speech perception in noise was measured under no mask-auditory-only (no-mask-AO), no mask-auditory-visual (no-mask-AV), and mask-AV conditions at five signal-to-noise ratios (SNRs; -16, -12, -8, -4, 0 dB) using five lists of 25 monosyllabic Korean words. Video clips that included a female speaker's face and sound or the sound only were presented through a monitor and a loudspeaker located 1 m in front of the listener in a sound-attenuating booth. The degree of deterioration in speech perception caused by the mask (no-mask-AV minus mask-AV) was significantly greater for hearing-impaired vs. normal-hearing participants only at 0 dB SNR (Bonferroni's corrected p < 0.01). When the effects of a mask on speech perception, with and without hearing aids, were compared in the hearing-impaired group, the degree of deterioration in speech perception caused by the mask was significantly reduced by the hearing aids compared with that without hearing aids at 0 and -4 dB SNR (Bonferroni's corrected p < 0.01). The improvement conferred by hearing aids (unaided speech perception score minus aided speech perception score) was significantly greater at 0 and -4 dB SNR than at -16 dB SNR in the mask-AV group (Bonferroni's corrected p < 0.01). These results demonstrate that hearing aids still improve speech perception when the speaker is masked, and that hearing aids partly offset the effect of a mask at relatively low noise levels.

Background and ObjectivesA deficit in phonological processing abilities has been hypothesized as a cause of reading deficits among poor readers, but the precise etiology of this deficit is still unknown. Many studies have investigated the relation of auditory processing and speech perception with phonological processing, while the relation between these are not well understood. Thus, the present study was carried out to investigate the relation between these abilities among poor readers.Subjects and MethodsA total of 20 children between 7-12 years of age participated in the study. Among these 10 were typically developing children and 10 were poor readers. Auditory processing, speech perception in noise and phonological processing skills were assessed in both the groups.ResultsAuditory processing was not significantly different between children in both the groups. In contrast, phonological awareness, verbal short-term memory and rapid automatized naming, which reflect phonological processing, and speech perception in noise were found to be significantly affected in poor readers. In addition, the results showed a significant correlation between phonological processing and speech perception in noise.ConclusionsThe present study found a significant relationship between speech perception in noise and phonological processing, while there was no relationship between auditory processing and phonological processing. This finding suggests that poor speech perception among poor readers may be one of the contributing factors for phonological processing deficits, which in turn leads to reading difficulties.

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The main objective of this study was to examine the effect of a classifier-based noise management algorithm (AutoSense Sky OS 3.0) on speech perception in noise in pediatric cochlear implant (CI) recipients and to compare the speech perception outcomes with typically hearing peers. This prospective observational study included nine children (ages 9-15 years) with bilateral CIs and nine age-matched, typically hearing peers. Speech perception outcomes were measured in noise using Pediatric AzBio sentences to compare performance in the omnidirectional microphone mode with the classifier-based automatic noise management mode at four signal-to-noise ratios. Ratings of listening ease and speech clarity were recorded to obtain subjective measures of benefit. Results from the bilateral CI recipients were compared to a group of typically hearing children. Paired t tests were used to evaluate outcomes. Classifier-based noise management improved speech perception in noise compared to listening in the omnidirectional microphone mode. CI group averages revealed a 21.4 percentage point and 47.1 percentage point improvement in speech perception when using the Sky OS 3.0 algorithm at 0 and -5 dB SNR, respectively. Listening ease and speech clarity were improved when using the classifier-based noise management algorithm. Pediatric CI recipients can benefit from classifier-based noise management. Given the difficult listening environments children face, especially in typical classroom settings while listening for learning, audiologists should consider activating classifier-based noise management in this population.

Background and Aims Various aspects and characteristics of hearing aid performance can be enhanced using music. Binaural hearing also plays a crucial role in speech perception in the presence of noise. This study used music, tests, and a questionnaire related to speech perception in noise to investigate the effect of listening to music on speech perception in the presence of noise in bilateral and unilateral hearing aid users. Methods This study included 40 bilateral and unilateral hearing aid users aged 25-55 years (23 women, 17 men). The quick speech-in-noise (Q-SIN) test and speech, spatial, and qualities of hearing scale questionnaire (SSQ) were used to investigate the effects of music on speech perception in the presence of noise. Results The results of the Q-SIN test in both groups showed that music reduced signal-to-noise ratio (SNR) 50 and signal-to-noise ratio (SNR) loss, which was more pronounced in the bilateral hearing aid users (P&lt;0.05). The results of the SSQ also showed that the questionnaire score increased after the three-month music therapy. This increase in score was greater in bilateral hearing aid users (P&lt;0.05). Conclusion Regular listening to music on a program basis improves speech perception in noise. The results of the present study showed that bilateral hearing aids had a greater effect on improving speech perception in noise than unilateral hearing aids.

A cochlear implant is a neuroprosthetic device that can restore speech perception for people with severe to profound hearing loss. Because of recent evolutions, a growing number of people with a cochlear implant have useful residual acoustic hearing. While combined electro-acoustic stimulation has been shown to improve speech perception for this group of people, some studies report limited adoption rates. Here, we present electro-vibrational stimulation as an alternative combined stimulation strategy that similarly targets the full cochlear reserve. This novel strategy combines the electrical stimulation by the cochlear implant with low-frequency bone conduction stimulation. In a first evaluation of electro-vibrational stimulation, speech perception in noise was assessed in 9 subjects with a CI and symmetrical residual hearing. We demonstrate a statistically significant and clinically relevant improvement for speech perception in noise of 1.9 dB signal-to-noise ratio. This effect was observed with a first prototype that provides vibrational stimulation to both ears with limited transcranial attenuation. Future integration of electro-vibrational stimulation into one single implantable device could ultimately allow cochlear implant users to benefit from their low-frequency residual hearing without the need for an additional insert earphone.

Objective: There could be efferent system damage in individuals with type II diabetes mellitus. The study attempts to determine the efferent auditory system functioning through contralateral suppression of otoacoustic emissions (OAE) and speech perception in noise (SPIN) in individuals with type II diabetes mellitus (DM). Method: The study was carried out on twenty five participants (50 ears) with type II DM patients who were diagnosed by an endocrinologist and twenty five healthy age matched controls (50 ears) were included in the study. Contralateral suppression of OAE and SPIN were administered on both the groups and they were compared and correlated. Results: The results of the study show that individuals with type II DM had statistically significant lower contralateral suppression values and had poorer speech perception in noise. In addition, there were significant correlations between SPIN scores and the amount of suppression in individuals with type II DM. Conclusion: The individuals with DM showed difficulty understanding speech in presence of noise and that can be attributed to efferent system damage. Thus, contralateral suppression can be a useful marker in early diagnosis of cochleopathy and auditory efferent disorder. The present study can provide important evidence for early diagnosis and early treatment of diabetic complications.

To investigate the effect of musical training on speech-in-noise (SIN) performance, a complex task requiring the integration of working memory and stream segregation as well as the detection of time-varying perceptual cues. Previous research has indicated that, in combination with lifelong experience with musical stream segregation, musicians have better auditory perceptual skills and working memory. It was hypothesized that musicians would benefit from these factors and perform better on speech perception in noise than age-matched nonmusician controls. The performance of 16 musicians and 15 nonmusicians was compared on clinical measures of speech perception in noise-QuickSIN and Hearing-In-Noise Test (HINT). Working memory capacity and frequency discrimination were also assessed. All participants had normal hearing and were between the ages of 19 and 31 yr. To be categorized as a musician, participants needed to have started musical training before the age of 7 yr, have 10 or more years of consistent musical experience, and have practiced more than three times weekly within the 3 yr before study enrollment. Nonmusicians were categorized by the failure to meet the musician criteria, along with not having received musical training within the 7 yr before the study. Musicians outperformed the nonmusicians on both QuickSIN and HINT, in addition to having more fine-grained frequency discrimination and better working memory. Years of consistent musical practice correlated positively with QuickSIN, working memory, and frequency discrimination but not HINT. The results also indicate that working memory and frequency discrimination are more important for QuickSIN than for HINT. Musical experience appears to enhance the ability to hear speech in challenging listening environments. Large group differences were found for QuickSIN, and the results also suggest that this enhancement is derived in part from musicians' enhanced working memory and frequency discrimination. For HINT, in which performance was not linked to frequency discrimination ability and was only moderately linked to working memory, musicians still performed significantly better than the nonmusicians. The group differences for HINT were evident in the most difficult condition in which the speech and noise were presented from the same location and not spatially segregated. Understanding which cognitive and psychoacoustic factors as well as which lifelong experiences contribute to SIN may lead to more effective remediation programs for clinical populations for whom SIN poses a particular perceptual challenge. These results provide further evidence for musical training transferring to nonmusical domains and highlight the importance of taking musical training into consideration when evaluating a person's SIN ability in a clinical setting.

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.