Dean Mancuso

Does cochlear implantation restore music appreciation

BACKGROUND The cochlear implant (CI) restores hearing to deafened individuals, allowing most CI users to reach an excellent level of speech discrimination, often to the point of being able to use a telephone. The increased ability to communicate afforded by cochlear implantation has been shown to have a significant positive effect on the quality of life of deafened individuals. Does CI lead to similar restoration of ability to appreciate and consume music?

Music Engineering as a Novel Strategy for Enhancing Music Enjoyment in the Cochlear Implant Recipient.

Objective. Enjoyment of music remains an elusive goal following cochlear implantation. We test the hypothesis that reengineering music to reduce its complexity can enhance the listening experience for the cochlear implant (CI) listener. Methods. Normal hearing (NH) adults (N = 16) and CI listeners (N = 9) evaluated a piece of country music on three enjoyment modalities: pleasantness, musicality, and naturalness. Participants listened to the original version along with 20 modified, less complex, versions created by including subsets of the musical instruments from the original song. NH participants listened to the segments both with and without CI simulation processing. Results. Compared to the original song, modified versions containing only 1–3 instruments were less enjoyable to the NH listeners but more enjoyable to the CI listeners and the NH listeners with CI simulation. Excluding vocals and including rhythmic instruments improved enjoyment for NH listeners with CI simulation but made no difference for CI listeners. Conclusions. Reengineering a piece of music to reduce its complexity has the potential to enhance music enjoyment for the cochlear implantee. Thus, in addition to improvements in software and hardware, engineering music specifically for the CI listener may be an alternative means to enhance their listening experience.

Reduction of the Harmonic Series Influences Musical Enjoyment With Cochlear Implants

OBJECTIVE Cochlear implantation is associated with poor music perception and enjoyment. Reducing music complexity has been shown to enhance music enjoyment in cochlear implant (CI) recipients. In this study, we assess the impact of harmonic series reduction on music enjoyment. STUDY DESIGN Prospective analysis of music enjoyment in normal-hearing (NH) individuals and CI recipients. SETTING Single tertiary academic medical center. PATIENTS NH adults (N = 20) and CI users (N = 8) rated the Happy Birthday song on three validated enjoyment modalities-musicality, pleasantness, and naturalness. INTERVENTION Subjective rating of music excerpts. MAIN OUTCOME MEASURES Participants listened to seven different instruments play the melody, each with five levels of harmonic reduction (Full, F3+F2+F1+F0, F2+F1+F0, F1+F0, F0). NH participants listened to the segments both with and without CI simulation. Linear mixed effect models (LME) and likelihood ratio tests were used to assess the impact of harmonic reduction on enjoyment. RESULTS NH listeners without simulation rated segments with the first four harmonics (F3+F2+F1+F0) most pleasant and natural (p <0.001, p = 0.004). NH listeners with simulation rated the first harmonic alone (F0) most pleasant and natural (p <0.001, p = 0.003). Their ratings demonstrated a positive linear relationship between harmonic reduction and both pleasantness (slope estimate = 0.030, SE = 0.004, p <0.001, LME) and naturalness (slope estimate = 0.012, SE = 0.003, p = 0.003, LME). CI recipients also found the first harmonic alone (F0) to be most pleasant (p = 0.003), with a positive linear relationship between harmonic reduction and pleasantness (slope estimate = 0.029, SE = 0.008, p <0.001, LME). CONCLUSION Harmonic series reduction increases music enjoyment in CI and NH individuals with or without CI simulation. Therefore, minimization of the harmonics may be a useful strategy for enhancing musical enjoyment among both NH and CI listeners.

Reverberation time influences musical enjoyment with cochlear implants.

Objective To identify factors that enhance the enjoyment of music in cochlear implant (CI) recipients. Specifically, we assessed the hypothesis that variations in reverberation time (RT60) may be linked to variations in the level of musical enjoyment in CI users. Study design Prospective analysis of music enjoyment in normal-hearing individuals. Setting Single tertiary academic medical center. Patients Normal-hearing adults (N = 20) were asked to rate a novel 20-second melody on three enjoyment modalities: musicality, pleasantness, and naturalness. Intervention Subjective rating of music excerpts. Main outcome measures Participants listened to seven different instruments play the melody, each with five levels (0.2, 1.6, 3.0, 5.0, 10.0 s) of RT60, both with and without CI simulation processing. Linear regression analysis with analysis of variance was used to assess the impact of RT60 on music enjoyment. Results Without CI simulation, music samples with RT60 = 3.0 seconds were ranked most pleasant and most musical, whereas those with RT60 = 1.6 seconds and RT60 = 3.0 seconds were ranked equally most natural (all p < 0.05). With CI simulation, music samples with RT60 = 0.2 seconds were ranked most pleasant, most musical, and most natural (all p < 0.05). Samples without CI simulation show a preference for middle-range RT60, whereas samples with CI simulation show a negative linear relationship between RT60 and musical enjoyment, with preference for minimal reverberation. Conclusion Minimization of RT60 may be a useful strategy for increasing musical enjoyment under CI conditions, both in altering existing music as well as in composition of new music.

Skin Necrosis After Implantation With the BAHA Attract: A Case Report and Review of the Literature

OBJECTIVE The bone-anchored hearing aid (BAHA) Attract is a transcutaneous bone conduction hearing aid that uses magnetic coupling to enable sound conduction. We report the first case of skin necrosis associated with the BAHA Attract and perform a literature review of soft tissue complications related to the device. PATIENT A single patient who was found to develop skin necrosis 2 weeks after being fitted for the BAHA Attract speech processor. INTERVENTION After the patient developed skin necrosis from the device, she was advised to immediately discontinue use of the Attract to allow complete wound healing, upon which the Attract was successfully converted to a percutaneous BAHA. MAIN OUTCOME AND RESULTS We monitored for the development of skin complications from the BAHA Attract. The patients immediate postoperative course was unremarkable and she was fitted with a speech processor of M5 magnet strength at 1 month postoperatively. After 1 week of use, she reported discomfort and was advised to downgrade to an M4 magnet; however, she continued to use the M5 and the following week was found to have developed skin necrosis around the device. CONCLUSION Despite the infrequency of skin necrosis related to the BAHA Attract, it must be considered in counseling and managing candidates for the device.

Impact of Noise Reduction Algorithm in Cochlear Implant Processing on Music Enjoyment.

Objective: Noise reduction algorithm (NRA) in speech processing strategy has positive impact on speech perception among cochlear implant (CI) listeners. We sought to evaluate the effect of NRA on music enjoyment. Study Design: Prospective analysis of music enjoyment. Setting: Academic medical center. Patients: Normal-hearing (NH) adults (N = 16) and CI listeners (N = 9). Intervention: Subjective rating of music excerpts. Main Outcome Measures: NH and CI listeners evaluated country music piece on three enjoyment modalities: pleasantness, musicality, and naturalness. Participants listened to the original version and 20 modified, less complex versions created by including subsets of musical instruments from the original song. NH participants listened to the segments through CI simulation and CI listeners listened to the segments with their usual speech processing strategy, with and without NRA. Results: Decreasing the number of instruments was significantly associated with increase in the pleasantness and naturalness in both NH and CI subjects (p < 0.05). However, there was no difference in music enjoyment with or without NRA for either NH listeners with CI simulation or CI listeners across all three modalities of pleasantness, musicality, and naturalness (p > 0.05): this was true for the original and the modified music segments with one to three instruments (p > 0.05). Conclusion: NRA does not affect music enjoyment in CI listener or NH individual with CI simulation. This suggests that strategies to enhance speech processing will not necessarily have a positive impact on music enjoyment. However, reducing the complexity of music shows promise in enhancing music enjoyment and should be further explored.

Reliability measure of a clinical test: Appreciation of Music in Cochlear Implantees (AMICI).

PURPOSE The goals of this study were (1) to investigate the reliability of a clinical music perception test, Appreciation of Music in Cochlear Implantees (AMICI), and (2) examine associations between the perception of music and speech. AMICI was developed as a clinical instrument for assessing music perception in persons with cochlear implants (CIs). The test consists of four subtests: (1) music versus environmental noise discrimination, (2) musical instrument identification (closed-set), (3) musical style identification (closed-set), and (4) identification of musical pieces (open-set). To be clinically useful, it is crucial for AMICI to demonstrate high test-retest reliability, so that CI users can be assessed and retested after changes in maps or programming strategies. RESEARCH DESIGN Thirteen CI subjects were tested with AMICI for the initial visit and retested again 10-14 days later. Two speech perception tests (consonant-nucleus-consonant [CNC] and Bamford-Kowal-Bench Speech-in-Noise [BKB-SIN]) were also administered. DATA ANALYSIS Test-retest reliability and equivalence of the tests three forms were analyzed using paired t-tests and correlation coefficients, respectively. Correlation analysis was also conducted between results from the music and speech perception tests. RESULTS Results showed no significant difference between test and retest (p > 0.05) with adequate power (0.9) as well as high correlations between the three forms (Forms A and B, r = 0.91; Forms A and C, r = 0.91; Forms B and C, r = 0.95). Correlation analysis showed high correlation between AMICI and BKB-SIN (r = -0.71), and moderate correlation between AMICI and CNC (r = 0.4). CONCLUSIONS The study showed AMICI is highly reliable for assessing musical perception in CI users.

The development and validation of the speech quality instrument: Speech Quality Instrument

Although speech perception tests are available to evaluate hearing, there is no standardized validated tool to quantify speech quality. The objective of this study is to develop a validated tool to measure quality of speech heard.

Response to “Letter to Editor” Skin Necrosis After Implantation with the Baha Attract: A Case Report and Review of the Literature

1. Available at: http://www.cochlear.com/wps/wcm/connect/d538a90135aa-40fb-b812-725c34612da2/BUN225+ISS2+JAN14+Baha+ Attract+Sound+Processor+Magnet+Selection.pdf?MOD=AJPERES &CONVERT_TO=url&CACHEID=d538a901-35aa-40fb-b812725c34612da2. Accessed July 18, 2017. 2. Briggs R, Van Hasselt A, Luntz M, et al. Clinical performance of a new magnetic bone conduction hearing implant system: Results from a prospective, multicenter, clinical investigation. Otol Neurotol 2015;36:834–41. 3. Dimitriadis PA, Carrick S, Ray J. Intermediate outcomes of a transcutaneous bone conduction hearing device in a paediatric population. Int J Pediatr Otorhinolaryngol 2017;94:59–63. 4. Junker JP, Philip J, Kiwanuka E, Hackl F, Caterson EJ, Eriksson E. Assessing quality of healing in skin: Review of available methods and devices. Wound Repair Regen 2014;22 (suppl 1): 2–10. 5. Butzelaar L, Ulrich MM, Mink van der Molen AB, Niessen FB, Beelen RH. Currently known risk factors for hypertrophic skin scarring: A review. J Plast Reconstr Aesthet Surg 2016;69: 163–9.

Features of Music That Affect Its Enjoyment following Cochlear Implantation

Objectives: Enjoyment of music remains an elusive goal following cochlear implantation (CI). We assessed the hypothesis that reducing the complexity of music has the potential to enhance the listening experience for the cochlear implantee. Methods: Normal hearing adults (n = 17) were asked to evaluate an original and modified 20-second piece of country music for its musicality, pleasantness, and naturalness before and after it was processed through CI simulation software. The music was modified by removing the vocals and/or changing the type of musical instruments playing (rhythmic only, melodic only, or combined rhythmic and melodic). Linear regression analysis with analysis of variance was used to assess the impact of music variation on music appreciation. Results: Without CI simulation, music segments that included the vocals, melodic instruments only, or combined rhythmic and melodic instruments sounded more pleasant, natural, and musical. In contrast, music segments processed through the CI simulation sounded more pleasant, natural, and musical when the vocals were removed and when only rhythmic instruments were included (all P values < 0.005). Conclusions: Musical enjoyment with or without CI is influenced by the complexity of the original music. Our study offers preliminary evidence that reduction of music complexity has the potential to make listening more enjoyable for the CI listener. Thus, in addition to improvement in software and hardware, engineering of music specifically for a CI listener may be an alternative means to enhance their listening experience.