John P. Preece

Patients utilizing a hearing aid and a cochlear implant: Speech perception and localization

Objective The purpose of this pilot study was to document speech perception and localization abilities in patients who use a cochlear implant in one ear and a hearing aid in the other ear. Design We surveyed a group of 111 cochlear implant patients and asked them whether they used a hearing aid on their unimplanted ear. The first three patients who were available were tested on word and sentence recognition and localization tasks. Speech stimuli were presented from the front in quiet and in noise. In the latter conditions, noise was either from the front, the right, or the left. Localization was tested with noise bursts presented at 45° from the right or left. In addition we asked the patients about their abilities to integrate the information from both devices. Results Speech perception tests in quiet showed a binaural advantage for only one of the three patients for words and none for sentences. With speech and noise both in front of the patient, two patients performed better with both devices than with either device alone. With speech in front and noise on the hearing aid side, no binaural advantage was seen, but with noise on the cochlear implant side, one patient showed a binaural advantage. Localization ability improved with both devices for two patients. The third patient had above-chance localization ability with his implant alone. Conclusions A cochlear implant in one ear and a hearing aid in the other ear can provide binaural advantages. The patient who did not show a clear binaural advantage had the poorest hearing aid alone performance. The absolute and relative levels of performance at each ear are likely to influence the potential for binaural integration.

Binaural cochlear implants placed during the same operation

Objective To evaluate the binaural listening advantages for speech in quiet and in noise and to localize sound when independently programmed binaural cochlear implants are used, and to determine whether ears with different hearing ability and duration of profound deafness perform differently with cochlear implants as well as to what extent preimplant psychophysical and physiologic assessment could be predictive of performance. Study Design Prospective study in which patients were prospectively selected to undergo bilateral implantation during a single surgical procedure at a tertiary referral center. All testing was performed with patients using their right, left, or both cochlear implants. Preimplant and intraoperative measures used electrical stimulation at the round window and stimulation through the cochlear implant. Results Bilateral implantation during the same operation did not cause any postoperative problems such as severe vertigo or ataxia. At 1 year, results of speech testing in quiet demonstrated a binaural advantage for 2 of 10 subjects. Speech-in-noise testing demonstrated that two implants were beneficial for two individuals. All subjects benefited from a head shadow effect when an ear with a better signal-to-noise ratio was available. The ability to localize sound was improved with binaural implants in all subjects. Preimplant psychophysical or physiologic measures were not predictive of eventual speech perception performance. Conclusion Binaural cochlear implants can assist in the localization of sounds and have the potential in some individuals to improve speech understanding in quiet and in noise.

Three-month results with bilateral cochlear implants.

Objectives To evaluate possible binaural listening advantages for speech in quiet, speech in noise, and for localization in a group of postlingually deafened adults with two cochlear implants functioning independently after 3 mo experience. Design Nine postlingually deafened subjects who had received a Cochlear Corporation CI24M implant in each ear were evaluated on a number of tasks. The subjects all had audiometric or biographical (e.g., duration of deafness) differences between the ears. Word and sentence materials were presented to the subjects in quiet and in noise with the signal always in the front and the noise from the front or either side. Results are reported for each ear and for both ears with the noise on either side. This allowed evaluation of head shadow and squelch effects. Additionally, localization ability was assessed for broadband noise presented either to the right or left of center at 45° azimuth. Localization was assessed for each ear and for both ears. Results Results of speech testing in quiet showed a significant advantage for the binaural condition over the better ear in four subjects. In noise, with both signal and noise in front of the subject, a significant advantage of two ears over the better ear was found for four subjects. For noise to one side of the head, when the ear opposite the noise source was added to the ear ipsilateral to the noise, a significant advantage was demonstrated for seven of seven tested subjects. When the ear ipsilateral to the noise was added to the ear contralateral to the noise, a significant advantage was shown for only one of seven (noise on right) and three of seven (noise on left) tested subjects. The localization task showed that all seven tested subjects could discriminate 45° left from 45° right above chance with bilateral stimulation. Three subjects could perform the discrimination above chance with only one ear. However, performance with both ears was significantly better than performance with one ear for two of these latter subjects. Conclusions We conclude that bilateral cochlear implants can provide real advantages, particularly when it is possible to utilize the ear that is away from a noise source, thus taking advantage of the head shadow effect. In addition, localization ability was generally better with two implants than with one.

Update on bilateral cochlear implantation.

Purpose of reviewProviding a unilateral cochlear implant in a patient with a profound bilateral hearing loss has now been a standard clinical practice for more than a decade. Although results are often very good, normal hearing has not been restored. One exciting opportunity to improve hearing in this population is to provide a second implant. However, it is not obvious that bilateral electrical stimulation can be integrated by the central nervous system. This article describes binaural hearing and reviews currently published articles on binaural cochlear implants. Recent findingsControlled laboratory trials have focused on distinguishing different categories of potential binaural advantages. A potential summation effect occurs when the same stimulus is available at two ears. Listening in noise with two ears should be better than listening with one ear when the additional ear is away from the noise. This head shadow benefit results from acoustic effects, not physiologic ones. When the second ear is added near the noise source, a binaural squelch benefit can occur, requiring neural integration from both sides. Finally, two ears may improve sound localization. Binaural implantees generally benefit from head shadow effects. Only some benefit from summation and squelch effects. Most, but not all, show improved horizontal plane localization. SummaryIt is now appropriate to begin experimental studies of binaural cochlear implants. Preliminary results show promise to improve head shadow, a physical advantage, and sound localization. Some benefits have been observed for improved summation and squelch. These findings have demonstrated that the brain can integrate electrical stimulation from the two ears. Future studies will be required to maximize this binaural hearing.

Audiological results with two single channel cochlear implants.

We tested six patients with single channel cochlear implants on several tests from the Minimal Auditory Capabilities battery and the Iowa Cochlear Implant Tests. All patients were able to discriminate some everyday sounds and to identify the number of syllables in the words presented. Five patients were able to identify speaker sex reliably. Surprisingly, some patients had difficulty discriminating between a modulated noise and a voice or between a question and a statement or identifying the accented word in a sentence. On several audiovisual tests, an improvement was observed for the sound plus vision condition compared to the vision only condition. This was particularly true for sentence tests, but was not uniform across patients or across tests.

Iowa cochlear implant clinical project: Results with two single-channel cochlear implants and one multi-channel cochlear implant.†

Cochlenr implants have become a realistic alternative for the management of profoundly deaf patients. A variety of implants with differing electrode designs and coding strategies have been developed by nine major implant centers around the world. Each center has their “star” patient, but objective comparisons between these different implant designs are unavailable. In order to determine the performance characteristics of the present generation of cochlear implants, comparison data are vital. We have developed an independent center where uniform objective comparisons of different cochlear implants can be performed longitudinally. This report will present results of nine patients implanted with three different cochlear implant prostheses. Four patients have been implanted with the Los Angeles (House) single‐channel implant, three patients have received the Vienna (Hochmair) single‐channel intracochlear device, and two patients have been implanted with the Melbourne (Clark) 21‐channel unit. All patients have had 11 months or more of experience with their cochlear prostheses. The results of a comprehensive audiologic battery which includes audiovisual and environmental tasks are presented. All implants provide significant improvement in speechreading and sound awareness. The findings to date suggest that there is strong correlation between top‐down cognitive processing (as reflected by lip reading skills) and performance with cochlear implants.

Detection, loudness, and discrimination of five‐component tonal complexes differing in crest factor

The detection, loudness, and discrimination performances of subjects with normal hearing were assessed using 3 five-component tonal complexes (1020-1100 Hz) with crest factors of 1.8, 2.6, and 3.2. The 3 five-component tonal complexes were: (1) equally detectable in broadband noise when presented at equal rms amplitude; (2) perceived as equally loud when presented at essentially equal rms amplitude; and (3) discriminable from one another when presented at equal loudness. The present data indicate that listeners can make discriminations on the basis of amplitude variations.

Localization of sound by binaural cochlear implant users

We examined the localization ability in five adult patients who were implanted bilaterally with the CI24M implant from Cochlear Corporation. These patients demonstrated a difference in either length of time deaf before implantation, preimplant thresholds, or both. Patients were tested in an anechoic room. Signals were four 200‐ms bursts of broadband noise separated by 55 ms of silence. Stimuli were randomly presented from one of eight loudspeakers arrayed in an arc at ear level in front of the patient. The speakers were separated by 15 deg azimuth. The patient was seated 1.5 m from the speakers and responded orally with a speaker number. The level of individual stimuli was varied randomly over an 8‐dB range with an average level of presentation of 65‐dB SPL measured at the approximate location of the center of the patient’s head. Patients were tested with each ear separately and with both ears together. The results show a very good ability in all five patients to localize sounds with two cochlear implants...

Preliminary assessment of the Los Angeles, Vienna and Melbourne cochlear implants.

We tested four patients using the single-channel cochlear implant from Los Angeles, three patients using the single-channel cochlear implant from Vienna, and two patients using the multichannel cochlear implant from Melbourne. Tests from the MAC battery and the Iowa Cochlear Implant Battery were used. Most patients were able to identify some environmental sounds. Three of the patients had difficulty distinguishing between male and female voices, and three could not distinguish between a noise and a voice. All patients had difficulty discriminating between unknown speakers of the same sex. A four-choice spondee test in noise showed that all patients suffered drastically from background noise. In all cases there was an improvement in lipreading ability with the implant. On a sentence test with a contextual cue seven patients got some words with sound alone. Results obtained with the multichannel implant are superior on several tasks, but we have tested too few patients to allow us any firm conclusions.

Comparative analyses of canine hearing using event‐related potentials

The hearing of three dogs was tested using auditory brainstem response (ABR) and distortion product oto‐acoustic emissions (DPOAE) tests. The three subject dogs included one with known normal hearing, one congenitally deaf dog, and one dog with presbycusis. ABRs were run using a 100‐s click stimulus at a repetition rate of 19.7 Hz at 90, 60, and 40 dB nHL. Based on the combined analysis of ABR and DPOAE, differences in canine hearing of dogs with presbycusis and congenital (Waardenburg syndrome) are evident. These results continue to be compared with those of other dogs of known otology and audiology in an effort to develop canine norms for ABR and to readily detect these pathologies in companion animals to assist veterinarians in the diagnosis and treatment of hearing loss in dogs.