Horst Hessel

Verbesserung der Sprachverständlichkeit durch neuen Cochlear-Implant-Sprachprozessor

The aim of this multicenter clinical field study was to assess the benefits of the new Freedom 24 sound processor for cochlear implant (CI) users implanted with the Nucleus 24 cochlear implant system. The study included 48 postlingually profoundly deaf experienced CI users who demonstrated speech comprehension performance with their current speech processor on the Oldenburg sentence test (OLSA) in quiet conditions of at least 80% correct scores and who were able to perform adaptive speech threshold testing using the OLSA in noisy conditions. Following baseline measures of speech comprehension performance with their current speech processor, subjects were upgraded to the Freedom 24 speech processor. After a take-home trial period of at least 2 weeks, subject performance was evaluated by measuring the speech reception threshold with the Freiburg multisyllabic word test and speech intelligibility with the Freiburg monosyllabic word test at 50 dB and 70 dB in the sound field. The results demonstrated highly significant benefits for speech comprehension with the new speech processor. Significant benefits for speech comprehension were also demonstrated with the new speech processor when tested in competing background noise.In contrast, use of the Abbreviated Profile of Hearing Aid Benefit (APHAB) did not prove to be a suitably sensitive assessment tool for comparative subjective self-assessment of hearing benefits with each processor. Use of the preprocessing algorithm known as adaptive dynamic range optimization (ADRO) in the Freedom 24 led to additional improvements over the standard upgrade map for speech comprehension in quiet and showed equivalent performance in noise. Through use of the preprocessing beam-forming algorithm BEAM, subjects demonstrated a highly significant improved signal-to-noise ratio for speech comprehension thresholds (i.e., signal-to-noise ratio for 50% speech comprehension scores) when tested with an adaptive procedure using the Oldenburg sentences in the clinical setting S(0)N(CI), with speech signal at 0 degrees and noise lateral to the CI at 90 degrees . With the convincing findings from our evaluations of this multicenter study cohort, a trial with the Freedom 24 sound processor for all suitable CI users is recommended. For evaluating the benefits of a new processor, the comparative assessment paradigm used in our study design would be considered ideal for use with individual patients.

Improving speech comprehension using a new cochlear implant speech processor

The aim of this multicenter clinical field study was to assess the benefits of the new Freedom 24 sound processor for cochlear implant (CI) users implanted with the Nucleus 24 cochlear implant system. The study included 48 postlingually profoundly deaf experienced CI users who demonstrated speech comprehension performance with their current speech processor on the Oldenburg sentence test (OLSA) in quiet conditions of at least 80% correct scores and who were able to perform adaptive speech threshold testing using the OLSA in noisy conditions. Following baseline measures of speech comprehension performance with their current speech processor, subjects were upgraded to the Freedom 24 speech processor. After a take-home trial period of at least 2 weeks, subject performance was evaluated by measuring the speech reception threshold with the Freiburg multisyllabic word test and speech intelligibility with the Freiburg monosyllabic word test at 50 dB and 70 dB in the sound field. The results demonstrated highly significant benefits for speech comprehension with the new speech processor. Significant benefits for speech comprehension were also demonstrated with the new speech processor when tested in competing background noise.In contrast, use of the Abbreviated Profile of Hearing Aid Benefit (APHAB) did not prove to be a suitably sensitive assessment tool for comparative subjective self-assessment of hearing benefits with each processor. Use of the preprocessing algorithm known as adaptive dynamic range optimization (ADRO) in the Freedom 24 led to additional improvements over the standard upgrade map for speech comprehension in quiet and showed equivalent performance in noise. Through use of the preprocessing beam-forming algorithm BEAM, subjects demonstrated a highly significant improved signal-to-noise ratio for speech comprehension thresholds (i.e., signal-to-noise ratio for 50% speech comprehension scores) when tested with an adaptive procedure using the Oldenburg sentences in the clinical setting S(0)N(CI), with speech signal at 0 degrees and noise lateral to the CI at 90 degrees . With the convincing findings from our evaluations of this multicenter study cohort, a trial with the Freedom 24 sound processor for all suitable CI users is recommended. For evaluating the benefits of a new processor, the comparative assessment paradigm used in our study design would be considered ideal for use with individual patients.

Binaural integration of periodically alternating speech following cochlear implantation in subjects with profound sensorineural unilateral hearing loss.

In cochlear implant (CI) recipients with unilateral hearing loss (UHL) and normal hearing (NH) in the contralateral ear, the central auditory system receives signals of different auditory modalities, i.e. electrically via the CI ear as well as acoustically via the NH ear. The present study investigates binaural integration of bimodal stimulation in the central auditory system of 10 CI subjects with UHL by applying a modified version of the Rapidly Alternating Speech Perception (RASP) test to characterise speech recognition ability under monotic and dichotic listening arrangements. Subsequently, the results for each monotic and dichotic test condition were compared to quantify the binaural benefit from CI usage. The study results demonstrate significantly improved speech recognition under dichotic compared to monotic listening conditions, providing evidence that there is binaural integration of acoustically and electrically transmitted speech segments in the central nervous system at brainstem and cortical levels. In contrast to more commonly used tests of binaural integration, such as localisation, the RASP test provides the clinical option to investigate binaural integration involving structures at the cortical level.

Audiologische Ergebnisse bei transkranieller CROS-Versorgung in Abhängigkeit von der Ertaubungsdauer

In single sided deafness, treatment with transcranial CROS makes pseudo stereophonic listening possible. This leads to improved speech understanding in noise. However, several reports show large variations between the individual results of the benefit by speech audiometry in noise. One possible factor is the duration and changes in the auditory pathway between the onset of deafness to CROS supply. 18 patients with single sided deafness have tested a transcranial CROS supply. The speech intelligibility thresholds were evaluated in 2 spatial hearing situations each with CROS and unaided. When speech was arriving at 45° from the deaf ear and noise at 45° from the hearing ear, a significant improvement of speech reception threshold for 50% intelligibility was detected by CROS supply compared the medians. Patients with longer duration of deafness showed higher benefit by an average of -4.0 dB, in contrast to patients with short duration of deafness. In the reversed situation, that speech on the hearing ear and noise on the deaf ear was a significant deterioration observed, an average of 3.1 dB at longer deafened patients. In addition, a highly significant correlation was found with the individual changes in the speech recognition threshold between the two situations. The duration of deafness is an essential factor in the individual benefit estimate for treatment with transcranial CROS supply. The time frame for audimetrically proven changes in the auditory pathway as a result of unilateral auditory deprivation can be estimated to about 1-3 years. Patients with short duration of deafness have low or no benefit from transcranial CROS supply.

Facilitation and refractoriness of the electrically evoked compound action potential

Abstract In this study we aim to resolve the contributions of facilitation and refractoriness at very short pulse intervals. Measurements of the refractory properties of the electrically evoked compound action potential (ECAP) of the auditory nerve in cochlear implant (CI) users at inter pulse intervals below 300 &mgr;s are influenced by facilitation and recovery effects. ECAPs were recorded using masker pulses with a wide range of current levels relative to the probe pulse levels, for three suprathreshold probe levels and pulse intervals from 13 to 200 &mgr;s. Evoked potentials were measured for 21 CI patients by using the masked response extraction artifact cancellation procedure. During analysis of the measurements the stimulation current was not used as absolute value, but in relation to the patients individual ECAP threshold. This enabled a more general approach to describe facilitation as a probe level independent effect. Maximum facilitation was found for all tested inter pulse intervals at masker levels near patients individual ECAP threshold, independent from probe level. For short inter pulse intervals an increased N1P1 amplitude was measured for subthreshold masker levels down to 120 CL below patients individual ECAP threshold in contrast to the recreated state. ECAPs recorded with inter pulse intervals up to 200 &mgr;s are influenced by facilitation and recovery. Facilitation effects are most pronounced for masker levels at or below ECAP threshold, while recovery effects increase with higher masker levels above ECAP threshold. The local maximum of the ECAP amplitude for masker levels around ECAP threshold can be explained by the mutual influence of maximum facilitation and minimal refractoriness. HighlightsFacilitation for short pulse intervals is maximal for masker level at ECAP threshold.Facilitation is still present for masker level far below ECAP threshold.The amount of facilitation is independent of probe level.Refractoriness is dependent of probe level.Facilitation decreases logarithmically depending on pulse interval.

Detection of binaural interaction in free-field evoked auditory brainstem responses by time-scale representations

The so called β-wave of the binaural interaction component (BIC) in auditory brainstem responses (ABR) has been shown to be an objective measure for binaural interaction (BI). This component is the arithmetical difference between the sum of the monaurally evoked ABRs and the binaurally evoked ABR. Unfortunately, these neural responses are known to be very fragile and as a result the calculated BIC. An additional issue is, that the findings of this measurement are predominantly needed in people with hearing loss who may use hearing devices like hearing aids (HA) or cochlear implants (CI), thus they are not able to use headphones (like in conventional ABR measurements) during the detection of possible BI. This is a crucial problem, because it is known that factors like the interaural time delay (ITD) between the receiving ears are responsible for solving tasks like sound source localization or sound source separation, but specially designed measurements to coordinate the fitting of HAs or CIs with respect to BI are still missing. In this paper, we introduce a new measurement setup that is able to detect BI depending on different ITDs in free-field evoked responses by using the more reliable instantaneous phase in the time-scale representation. With this pilot study we are able to demonstrate a decreasing BI with an increasing ITD using the wavelet phase synchronization stability analysis in ten normal hearing subjects.The so called β-wave of the binaural interaction component (BIC) in auditory brainstem responses (ABR) has been shown to be an objective measure for binaural interaction (BI). This component is the arithmetical difference between the sum of the monaurally evoked ABRs and the binaurally evoked ABR. Unfortunately, these neural responses are known to be very fragile and as a result the calculated BIC. An additional issue is, that the findings of this measurement are predominantly needed in people with hearing loss who may use hearing devices like hearing aids (HA) or cochlear implants (CI), thus they are not able to use headphones (like in conventional ABR measurements) during the detection of possible BI. This is a crucial problem, because it is known that factors like the interaural time delay (ITD) between the receiving ears are responsible for solving tasks like sound source localization or sound source separation, but specially designed measurements to coordinate the fitting of HAs or CIs with respect to BI are still missing. In this paper, we introduce a new measurement setup that is able to detect BI depending on different ITDs in free-field evoked responses by using the more reliable instantaneous phase in the time-scale representation. With this pilot study we are able to demonstrate a decreasing BI with an increasing ITD using the wavelet phase synchronization stability analysis in ten normal hearing subjects.

Test–retest reliability of frequency discrimination in CI-listeners

Introduction Cochlear implants (CI) are fairly successful in improving speech perception by CI recipients (Lin et al., 2009). However, current CI devices are limited in encoding music and other melodic sounds and thus, CI-listeners are very restricted in pitch and music perception (Gfeller and Lansing, 1992; Pijl, 1997; Geurts and Wouters, 2001). It has been shown that CI users often cannot discriminate musical intervals that are separated by less than one-third and the just-noticeable differences of fundamental frequency ranges from 4 to 13% (Geurts and Wouters, 2001). It is possible to determine the frequency resolution of CI users with standard adaptive tests as developed for normal hearing subjects. However, one has to take into account that pitch perception is altered compared to normal hearing listeners. So far, there is no detailed analysis of adequate psychophysical testing for pitch perception in CI users. As a consequence, the purpose of the current study was to investigate the pitch resolution and the pitch perception of CI users, as well as the reliability of the test procedures.

Verbesserung der Sprachverständlichkeit durch neuen Cochlear-Implant-Sprachprozessor@@@Improving speech comprehension using a new cochlear implant speech processor

The aim of this multicenter clinical field study was to assess the benefits of the new Freedom 24 sound processor for cochlear implant (CI) users implanted with the Nucleus 24 cochlear implant system. The study included 48 postlingually profoundly deaf experienced CI users who demonstrated speech comprehension performance with their current speech processor on the Oldenburg sentence test (OLSA) in quiet conditions of at least 80% correct scores and who were able to perform adaptive speech threshold testing using the OLSA in noisy conditions. Following baseline measures of speech comprehension performance with their current speech processor, subjects were upgraded to the Freedom 24 speech processor. After a take-home trial period of at least 2 weeks, subject performance was evaluated by measuring the speech reception threshold with the Freiburg multisyllabic word test and speech intelligibility with the Freiburg monosyllabic word test at 50 dB and 70 dB in the sound field. The results demonstrated highly significant benefits for speech comprehension with the new speech processor. Significant benefits for speech comprehension were also demonstrated with the new speech processor when tested in competing background noise.In contrast, use of the Abbreviated Profile of Hearing Aid Benefit (APHAB) did not prove to be a suitably sensitive assessment tool for comparative subjective self-assessment of hearing benefits with each processor. Use of the preprocessing algorithm known as adaptive dynamic range optimization (ADRO) in the Freedom 24 led to additional improvements over the standard upgrade map for speech comprehension in quiet and showed equivalent performance in noise. Through use of the preprocessing beam-forming algorithm BEAM, subjects demonstrated a highly significant improved signal-to-noise ratio for speech comprehension thresholds (i.e., signal-to-noise ratio for 50% speech comprehension scores) when tested with an adaptive procedure using the Oldenburg sentences in the clinical setting S(0)N(CI), with speech signal at 0 degrees and noise lateral to the CI at 90 degrees . With the convincing findings from our evaluations of this multicenter study cohort, a trial with the Freedom 24 sound processor for all suitable CI users is recommended. For evaluating the benefits of a new processor, the comparative assessment paradigm used in our study design would be considered ideal for use with individual patients.