Dominik Riss

Speech and music perception with the new fine structure speech coding strategy: preliminary results

Conclusions. Taking into account the excellent results with significant improvements in the speech tests and the very high satisfaction of the patients using the new strategy, this first implementation of a fine structure strategy could offer a new quality of hearing with cochlear implants (CIs). Objective. This study consisted of an intra-individual comparison of speech recognition, music perception and patient preference when subjects used two different speech coding strategies with a MedEl Pulsar CI: continuous interleaved sampling (CIS) and the new fine structure processing (FSP) strategy. In contrast to envelope-based strategies, the FSP strategy also delivers subtle pitch and timing differences of sound to the user and is thereby supposed to enhance speech perception in noise and increase the quality of music perception. Patients and methods. This was a prospective study assessing performance with two different speech coding strategies. The setting was a CI programme at an academic tertiary referral centre. Fourteen post-lingually deaf patients using a MedEl Pulsar CI with a mean CI experience of 0.98 years were supplied with the new FSP speech coding strategy. Subjects consecutively used the two different speech coding strategies. Speech and music tests were performed with the previously fitted CIS strategy, immediately after fitting with the new FSP strategy and 4, 8 and 12 weeks later. The main outcome measures were individual performance and subjective assessment of two different speech processors. Results. Speech and music test scores improved statistically significantly after conversion from CIS to FSP strategy. Twelve of 14 patients preferred the new FSP speech processing strategy over the CIS strategy.

Indication criteria and outcomes with the Bonebridge transcutaneous bone-conduction implant

The aim of this study was to evaluate functional hearing gain, speech understanding, and preoperative bone‐conduction thresholds with the bone‐conduction implant Bonebridge.

1-year results using the Opus speech processor with the fine structure speech coding strategy

Conclusion: In contrast to the Tempo+ the new Opus speech processor stimulates with the new fine structure programming (FSP) speech coding strategy and offers an extended frequency spectrum. A significant improvement in speech perception for sentences at 10 dB SNR (signal to noise ratio) was observable. Objectives: The aim of this study was to investigate the long-term effects on speech perception in quiet and in noise with the Opus speech processor using FSP. Subjects and methods: Eight post-lingually deaf patients implanted with Pulsar cochlear implants and fitted with Tempo+ speech processors (both MED-EL) for a minimum of 1 year were tested at baseline with Tempo+ using continuous interleaved sampling (CIS), and at 1 year follow-up with the Opus speech processor using FSP. Monosyllables and sentence tests were performed in quiet, and sentence tests (HSM) in noise with 15, 10 and 5 dB SNR. Results: Mean speech perception scores showed a trend towards improvement for all tests. A statistically significant (p<0.05) improvement was only observed for the sentence test in noise at 10 dB SNR.

Intranasal submucosal bevacizumab for epistaxis in hereditary hemorrhagic telangiectasia: a double-blind, randomized, placebo-controlled trial.

The purpose of this study was to investigate the efficacy of bevacizumab (“Avastin”) for the treatment of epistaxis in hereditary hemorrhagic telangiectasia (HHT).

A new fine structure speech coding strategy: speech perception at a reduced number of channels.

Objective One of the most commonly used speech coding strategies for cochlear implants is continuous interleaved sampling (CIS), which codes the envelope information of an acoustic signal. Based on this strategy, MED-EL has recently developed the new fine structure processing (FSP) speech coding strategy, which also transmits subtle pitch and temporal cues. The aim of this study was to investigate the number of active channels necessary for good speech perception with FSP and whether there is an advantage for FSP compared with CIS at a reduced number of channels. Methods Ten postlingually deafened patients using MED-EL Pulsar cochlear implants participated in this study. Patients were tested with all 12, 8, 5, 3, and 2 channels with CIS and FSP strategy, resulting in a total of 10 conditions. Performance was tested with numbers, monosyllables, and sentence tests. Results Our results showed an improvement in speech perception, with up to 5 channels for numbers and for monosyllables and sentence tests. Statistically significant increases in performance were noted from 3 to 8 channels for numbers, from 3 to 5 channels for monosyllables, and from 5 to 8 channels for sentence tests. No statistical significance was observed whether FSP or CIS was used. Conclusion Based on these findings, the number of channels necessary for speech perception with FSP is similar to published results using CIS. There seems to be no advantage for FSP compared with CIS in the conditions of the present experiment.

FS4, FS4-p, and FSP: a 4-month crossover study of 3 fine structure sound-coding strategies.

Objectives: The aim of the present study was to compare two novel fine structure strategies “FS4” and “FS4-p” with the established fine structure processing (FSP) strategy. FS4 provides fine structure information on the apical four-electrode channels. With FS4-p, these electrodes may be stimulated in a parallel manner. The authors evaluated speech perception, sound quality, and subjective preference. Design: A longitudinal crossover study was done on postlingually deafened adults (N = 33) who were using FSP as their default strategy. Each participant was fitted with FS4, FS4-p, and FSP, for 4 months in a randomized and blinded order. After each run, an Adaptive Sentence test in noise (Oldenburger Sentence Test [OLSA]) and a Monosyllable test in quiet (Freiburger Monosyllables) were performed, and subjective sound quality was determined with a Visual Analogue Scale. At the end of the study the preferred strategy was noted. Results: Scores of the OLSA did not reveal any significant differences among the three strategies, but the Freiburger test showed a statistically significant effect (p = 0.03) with slightly worse scores for FS4 (49.7%) compared with FSP (54.3%). Performance of FS4-p (51.8%) was comparable with the other strategies. Both audiometric tests depicted a high variability among subjects. The number of best-performing strategies for each participant individually was as follows: (a) for the OLSA: FSP, N = 10.5; FS4, N = 10.5; and FS4-p, N = 12; and (b) for the Freiburger test: FSP, N = 14; FS4, N = 9; and FS4-p, N = 10. A moderate agreement was found in the best-performing strategies of the Speech tests within the participants. For sound quality, speech in quiet, classical, and pop music were assessed. No significant effects of strategy were found for speech in quiet and classical music, but auditory impression of pop music was rated as more natural in FSP compared with FS4 (p = 0.04). It is interesting that at the end of the study, a majority of the participants favored the new coding strategies over their previous default FSP (FSP, N = 13; FS4, N = 13; FS4-p, N = 7). Conclusions: In summary, FS4 and FS4-p offer new and further options in audio processor fitting, with similar levels of speech understanding in noise as FSP. This is an interesting result, given that the strategies’ presentation of temporal fine structure differs from FSP. At the end of the study, 20 of 33 subjects chose either FS4 or FS4-p over their previous default strategy FSP.

Envelope versus fine structure speech coding strategy: a crossover study.

Objective: The transmission of fine structure information to cochlear implant users is an expanding area of research. Previous studies comparing the fine structure processing (FSP) speech coding strategy to the envelope-based continuous interleaved sampling (CIS) strategy indicated improved speech perception when using the fine structure strategy. Those investigations were performed with an extended frequency spectrum in the low frequencies together with the fine structure strategy. The current study addresses the question whether these improvements are due to the presentation of fine structure per se or rather the extended frequency spectrum. Hence, this cross over study compares the two strategies using an identical frequency spectrum. Study Design: Randomized crossover study. Patients: 31 patients were randomly assigned to two groups. Interventions: One group was fitted with a CIS map for 4 weeks, tested and subsequently fitted with a FSP map for 4 weeks. The other group followed the same pattern in reverse. Main Outcome Measures: Test material consisted of sentence tests in noise, monosyllables in quiet and melody recognition. Results: No statistical significance was noted between the different speech coding strategies at an identical frequency spectrum. Conclusion: This study shows that there is no difference in speech perception with FSP compared to CIS at an extended frequency spectrum. Therefore, the extended frequency spectrum in the low frequencies might explain a benefit of FSP observed in previous studies.

Electric acoustic stimulation in patients with postlingual severe high-frequency hearing loss: clinical experience.

BACKGROUND/AIMS The aim of this study was to describe audiological outcomes and surgical considerations in electric acoustic stimulation for patients with severe to profound high-frequency hearing loss. METHODS In this latest series of patients in our center, all patients were supplied with the new (atraumatic) Flex EAS MED-EL electrode. Eleven patients (age 7.62-71.32 years) with profound high-frequency hearing loss were implanted with this electrode, which was designed to preserve residual hearing despite the intracochlear insertion of an electrode array. All patients were operated on by the same surgeon (W.G.). RESULTS The rate of complete or partial hearing preservation was 100% after a mean follow-up period of 7.85 months (range 0.95-15.65 months). CONCLUSION This study proves that both refined surgical techniques and atraumatic electrodes are mandatory to preserve residual hearing after cochlear implantation. Flexible, thin, and free-fitting straight electrodes, such as the MED-EL Flex EAS electrode used in this study, seem to most accurately meet the requirements for hearing preservation in electric acoustic stimulation.

Cochlear Implant Channel Separation and Its Influence on Speech Perception – Implications for a New Electrode Design

There are a variety of factors which can influence cochlear implantation outcome. Channel interaction is one of the variables responsible for audiological performance deterioration in multichannel implants. Electrode design is – among others – one way to decrease the incidence of channel interaction. At present, electrodes differ in overall length, diameter, contact design and distribution, but none of the electrodes available have a distinct variability in the amount of space between contacts across the length of the electrode. The aim of this study was to investigate whether a new electrode design featuring larger contact spacing in the apical part of deeply inserted electrodes would lead to an increase in speech perception. Eighteen postlingually deafened patients fitted with MedEl Combi 40+ or MedEl Pulsar cochlear implants using the MedEl implementation of continuous interleaved sampling participated in this study. Patients were tested in 6 conditions, in which the channel spacing and distribution of electrode contacts in each patient were artificially varied by activating or deactivating different channels. Performance was tested immediately after each change in setup with a monosyllable and sentence test (Hochmaier, Schultz and Moser). Our results showed that the condition with the highest distance between contacts in the apical part (up to 6.4 mm instead of 2.4 mm) is the most effective for the matched map condition: the results improved statistically significantly for the sentence test from 72% in the standard 12-channel condition to 83.2% and from 40.8 to 50% for the monosyllable test. Based on these findings, we present a new electrode design which can help achieve further increases in speech perception with cochlear implants.

The Intensity–Pitch Relation Revisited: Monopolar Versus Bipolar Cochlear Stimulation

Objective/Hypothesis: The very high speech perception scores now being achieved with cochlear implants have led to demands for similar levels of achievement in music perception and perception in noisy environments. One of the crucial factors in these fields is pitch perception. The aim of the present study was to investigate the extent to which pitch perception is influenced by the intensity of the stimulus, through the use of different stimulation modes (monopolar, bipolar) and different electrodes (lateral and perimodiolar).