Long-Term Binaural Hearing Improvements for Cochlear Implant Users with Asymmetric Hearing Loss.

OBJECTIVE: To assess long-term binaural hearing abilities for cochlear implant (CI) users with unilateral hearing loss (UHL) or asymmetric hearing loss (AHL). METHODS: A prospective, longitudinal, repeated measures study was completed at a tertiary referral center evaluating adults with UHL or AHL undergoing cochlear implantation. Binaural hearing abilities were assessed with masked speech recognition tasks using AzBio sentences in a 10-talker masker. Performance was evaluated as the ability to benefit from spatial release from masking (SRM). SRM was calculated as the difference in scores when the masker was presented toward the CI-ear (SRMci ) or the contralateral ear (SRMcontra ) relative to the co-located condition (0°). Assessments were completed pre-operatively and at annual intervals out to 5 years post-activation. RESULTS: Twenty UHL and 19 AHL participants were included in the study. Linear Mixed Models showed significant main effects of interval and group for SRMcontra . There was a significant interaction between interval and group, with UHL participants reaching asymptotic performance early and AHL participants demonstrating continued growth in binaural abilities to 5 years post-activation. The improvement in SRM showed a significant positive correlation with contralateral unaided hearing thresholds (p = 0.050) as well as age at implantation (p = 0.031). CONCLUSIONS: CI recipients with UHL and AHL showed improved SRM with long-term device use. The time course of improvement varied by cohort, with the UHL cohort reaching asymptotic performance early and the AHL cohort continuing to improve beyond 1 year. Differences between cohorts could be driven by differences in age at implantation as well as contralateral unaided hearing thresholds. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:1480-1485, 2023.

Responses to dichotic tone-in-noise stimuli in the inferior colliculus.

Human listeners are more sensitive to tones embedded in diotic noise when the tones are out-of-phase at the two ears (N0Sπ) than when they are in-phase (N0S0). The difference between the tone-detection thresholds for these two conditions is referred to as the binaural masking level difference (BMLD) and reflects a benefit of binaural processing. Detection in the N0Sπ condition has been explained in modeling studies by changes in interaural correlation (IAC), but this model has only been directly tested physiologically for low frequencies. Here, the IAC-based hypothesis for binaural detection was examined across a wide range of frequencies and masker levels using recordings in the awake rabbit inferior colliculus (IC). IAC-based cues were strongly correlated with neural responses to N0Sπ stimuli. Additionally, average rate-based thresholds were calculated for both N0S0 and N0Sπ conditions. The rate-based neural BMLD at 500 Hz matched rabbit behavioral data, but the trend of neural BMLDs across frequency differed from that of humans.

Hearing in African pygmy hedgehogs (Atelerix albiventris): audiogram, sound localization, and ear anatomy.

The behavioral audiogram and sound localization performance, together with the middle and inner ear anatomy, were examined in African pygmy hedgehogs Atelerix albiventris. Their auditory sensitivity at 60 dB SPL extended from 2 to 46 kHz, revealing a relatively narrow hearing range of 4.6 octaves, with a best sensitivity of 21 dB at 8 kHz. Their noise-localization acuity around the midline (minimum audible angle) was 14°, matching the mean of terrestrial mammals. The African pygmy hedgehog was not able to localize low-frequency pure tones or a 3-kHz amplitude-modulated tone when forced to rely on the interaural phase-difference cue, a trait shared by at least nine other mammals. The middle ear of Atelerix has a configuration including an ectotympanic which is not fused to the surrounding bones, a substantial pars flaccida, a synostosed malleo-ectotympanic articulation and a 'microtype' malleus. The hearing and sound localization of A. albiventris is compared to that of a broad range of other mammals. It is shown that a malleus morphology like that of Atelerix, including a stiff articulation with the ectotympanic, is a consistent feature of other mammals that do not hear frequencies below 400 Hz.

Long-Term Improvement in Localization for Cochlear Implant Users with Single-Sided Deafness.

OBJECTIVES/HYPOTHESIS: To assess whether early, significant improvements in sound source localization observed in cochlear implant (CI) recipients with normal hearing (NH) in the contralateral ear are maintained after 5 years of CI use. STUDY DESIGN: Prospective, repeated measures study. METHODS: Participants were recruited from a sample of CI + NH listeners (n = 20) who received their device as part of a prospective clinical trial investigating outcomes of CI use for adult cases of single-sided deafness. Sound source localization was assessed annually after the clinical trial endpoint (1-year post-activation). Listeners were asked to indicate the perceived sound source for a broadband noise burst presented randomly at varied intensity levels from one of 11 speakers along a 180° arc. Performance was quantified as root-mean-squared (RMS) error. RESULTS: Linear mixed models showed superior post-activation performance was maintained with long-term CI use as compared to preoperative abilities (P < .001). Unexpectedly, a significant improvement (P = .009) in sound source localization was observed over the long-term post-activation period (1-5 years). To better understand these long-term findings, the response patterns for the 11 participants who were evaluated at the 1- and 5-year visits were reviewed. This subgroup demonstrated a significant improvement in RMS error (P = .020) and variable error (P = .031), indicating more consistent responses at the 5-year visit. CONCLUSION: Adult CI + NH listeners experience significant improvements in sound source localization within the initial weeks of listening experience, with additional improvements observed after long-term device use. The present sample demonstrated significant improvements between the 1-year and 5-year visits, with greater accuracy and consistency noted in their response patterns. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:2453-2458, 2022.

Binaural Signal Processing in Hearing Aids.

For many years, clinicians have understood the advantages of listening with two ears compared with one. In addition to improved speech intelligibility in quiet, noisy, and reverberant environments, binaural versus monaural listening improves perceived sound quality and decreases the effort listeners must expend to understand a target voice of interest or to monitor a multitude of potential target voices. For most individuals with bilateral hearing impairment, the body of evidence collected across decades of research has also found that the provision of two compared with one hearing aid yields significant benefit for the user. This article briefly summarizes the major advantages of binaural compared with monaural hearing, followed by a detailed description of the related technological advances in modern hearing aids. Aspects related to the communication and exchange of data between the left and right hearing aids are discussed together with typical algorithmic approaches implemented in modern hearing aids.

Reaching to sounds in virtual reality: A multisensory-motor approach to promote adaptation to altered auditory cues.

When localising sounds in space the brain relies on internal models that specify the correspondence between the auditory input reaching the ears, initial head-position and coordinates in external space. These models can be updated throughout life, setting the basis for re-learning spatial hearing abilities in adulthood. In addition, strategic behavioural adjustments allow people to quickly adapt to atypical listening situations. Until recently, the potential role of dynamic listening, involving head-movements or reaching to sounds, have remained largely overlooked. Here, we exploited visual virtual reality (VR) and real-time kinematic tracking, to study the role of active multisensory-motor interactions when hearing individuals adapt to altered binaural cues (one ear plugged and muffed). Participants were immersed in a VR scenario showing 17 virtual speakers at ear-level. In each trial, they heard a sound delivered from a real speaker aligned with one of the virtual ones and were instructed to either reach-to-touch the perceived sound source (Reaching group), or read the label associated with the speaker (Naming group). Participants were free to move their heads during the task and received audio-visual feedback on their performance. Most importantly, they performed the task under binaural or monaural listening. Results show that both groups adapted rapidly to monaural listening, improving sound localisation performance across trials and changing their head-movement behaviour. Reaching the sounds induced faster and larger sound localisation improvements, compared to just naming its position. This benefit was linked to progressively wider head-movements to explore auditory space, selectively in the Reaching group. In conclusion, reaching to sounds in an immersive visual VR context proved most effective for adapting to altered binaural listening. Head-movements played an important role in adaptation, pointing to the importance of dynamic listening when implementing training protocols for improving spatial hearing.

Natural ITD statistics predict human auditory spatial perception.

A neural code adapted to the statistical structure of sensory cues may optimize perception. We investigated whether interaural time difference (ITD) statistics inherent in natural acoustic scenes are parameters determining spatial discriminability. The natural ITD rate of change across azimuth (ITDrc) and ITD variability over time (ITDv) were combined in a Fisher information statistic to assess the amount of azimuthal information conveyed by this sensory cue. We hypothesized that natural ITD statistics underlie the neural code for ITD and thus influence spatial perception. To test this hypothesis, sounds with invariant statistics were presented to measure human spatial discriminability and spatial novelty detection. Human auditory spatial perception showed correlation with natural ITD statistics, supporting our hypothesis. Further analysis showed that these results are consistent with classic models of ITD coding and can explain the ITD tuning distribution observed in the mammalian brainstem.

When a person hears a sound, how do they work out where it is coming from? A sound coming from your right will reach your right ear a few fractions of a millisecond earlier than your left. The brain uses this difference, known as the interaural time difference or ITD, to locate the sound. But humans are also much better at localizing sounds that come from sources in front of them than from sources by their sides. This may be due in part to differences in the number of neurons available to detect sounds from these different locations. It may also reflect differences in the rates at which those neurons fire in response to sounds. But these factors alone cannot explain why humans are so much better at localizing sounds in front of them. Pavão et al. showed that the brain has evolved the ability to detect natural patterns that exist in sounds as a result of their location, and to use those patterns to optimize the spatial perception of sounds. Pavão et al. showed that the way in which the head and inner ear filter incoming sounds has two consequences for how we perceive them. Firstly, the change in ITD for sounds coming from different sources in front of a person is greater than for sounds coming from their sides. And secondly, the ITD for sounds that originate in front of a person varies more over time than the ITD for sounds coming from the periphery. By playing sounds to healthy volunteers while removing these differences, Pavão et al. found that natural ITD statistics were correlated with a person's ability to tell where a sound was coming from. By revealing the features the brain uses to determine the location of sounds, the work of Pavão et al. could ultimately lead to the development of more effective hearing aids. The results also provide clues to how other senses, including vision, may have evolved to respond optimally to the environment.

Binaural cue sensitivity in cochlear implant recipients with acoustic hearing preservation.

Bilateral acoustic hearing in cochlear implant (CI) recipients with hearing preservation may allow access to binaural cues. Sensitivity to acoustic binaural cues has been shown in some listeners combining electric and acoustic stimulation (EAS), yet remains poorly understood and may be subject to limitations imposed by the electrical stimulation and/or amplification asymmetries. The purpose of this study was to investigate the effect of stimulus level, frequency-dependent gain, and the addition of unilateral electrical stimulation on sensitivity to low-frequency binaural cues. Thresholds were measured for interaural time and level differences (ITD and ILD) carried by a low-frequency, bandpass noise (100-800 Hz). 16 adult CI EAS listeners (mean age = 50.2 years) each participated in three listening conditions: acoustic hearing only at 90 dB SPL, acoustic hearing only at 60 dB SPL with frequency-dependent gain, and acoustic hearing plus unilateral CI at 60 dB SPL with frequency-dependent gain applied to the acoustic channels only. Results revealed thresholds within the ecologically relevant ITD and/or ILD range for most EAS listeners. No significant effects of presentation level, frequency-dependent gain, or the addition of unilateral electrical stimulation on the resultant thresholds for ITDs or ILDs were observed at the group level. Correlational analyses related ITD and ILD thresholds to the degree of EAS benefit (i.e., advantage of acoustic hearing in the implanted ear) for speech recognition in diffuse noise. There was a significant relationship between EAS benefit and ITD thresholds, but no statistically significant relationship between EAS benefit and ILD thresholds. In summary, the results of this study are not consistent with our previous data obtained with simulated EAS in normal-hearing listeners, which showed significant binaural interference by a unilateral electrical "distractor" (Van Ginkel et al., 2019). The difference between studies suggests that chronic exposure to unilateral electrical stimulation combined with bilateral acoustic stimulation may reduce interference effects, perhaps because listeners adapt to the presence of the constant but binaurally incongruous CI stimulus. These results are consistent with past studies that demonstrated no interference in spatial hearing tasks due to the addition of a unilateral CI in adult EAS listeners.

Resolving front-back ambiguity with head rotation: The role of level dynamics.

Making small head movements facilitates spatial hearing by resolving front-back confusions, otherwise common in free field sound source localization. The changes in interaural time difference (ITD) in response to head rotation provide a robust front-back cue, but whether interaural level difference (ILD) can be used as a dynamic cue is not clear. Therefore, the purpose of the present study was to assess the usefulness of dynamic ILD as a localization cue. The results show that human listeners were capable of correctly indicating the front-back dimension of high-frequency sinusoids based on level dynamics in free field conditions, but only if a wide movement range was allowed (±40∘). When the free field conditions were replaced by simplistic headphone stimulation, front-back responses were in agreement with the simulated source directions even with relatively small movement ranges (±5∘), whenever monaural sound level and ILD changed monotonically in response to head rotation. In conclusion, human listeners can use level dynamics as a front-back localization cue when the dynamics are monotonic. However, in free field conditions and particularly for narrowband target signals, this is often not the case. Therefore, the primary limiting factor in the use of dynamic level cues resides in the acoustic domain behavior of the cue itself, rather than in potential processing limitations or strategies of the human auditory system.

Coherent Coding of Enhanced Interaural Cues Improves Sound Localization in Noise With Bilateral Cochlear Implants.

Bilateral cochlear implant (BCI) users only have very limited spatial hearing abilities. Speech coding strategies transmit interaural level differences (ILDs) but in a distorted manner. Interaural time difference (ITD) information transmission is even more limited. With these cues, most BCI users can coarsely localize a single source in quiet, but performance quickly declines in the presence of other sound. This proof-of-concept study presents a novel signal processing algorithm specific for BCIs, with the aim to improve sound localization in noise. The core part of the BCI algorithm duplicates a monophonic electrode pulse pattern and applies quasistationary natural or artificial ITDs or ILDs based on the estimated direction of the dominant source. Three experiments were conducted to evaluate different algorithm variants: Experiment 1 tested if ITD transmission alone enables BCI subjects to lateralize speech. Results showed that six out of nine BCI subjects were able to lateralize intelligible speech in quiet solely based on ITDs. Experiments 2 and 3 assessed azimuthal angle discrimination in noise with natural or modified ILDs and ITDs. Angle discrimination for frontal locations was possible with all variants, including the pure ITD case, but for lateral reference angles, it was only possible with a linearized ILD mapping. Speech intelligibility in noise, limitations, and challenges of this interaural cue transmission approach are discussed alongside suggestions for modifying and further improving the BCI algorithm.

Evidence for cue-independent spatial representation in the human auditory cortex during active listening.

Few auditory functions are as important or as universal as the capacity for auditory spatial awareness (e.g., sound localization). That ability relies on sensitivity to acoustical cues-particularly interaural time and level differences (ITD and ILD)-that correlate with sound-source locations. Under nonspatial listening conditions, cortical sensitivity to ITD and ILD takes the form of broad contralaterally dominated response functions. It is unknown, however, whether that sensitivity reflects representations of the specific physical cues or a higher-order representation of auditory space (i.e., integrated cue processing), nor is it known whether responses to spatial cues are modulated by active spatial listening. To investigate, sensitivity to parametrically varied ITD or ILD cues was measured using fMRI during spatial and nonspatial listening tasks. Task type varied across blocks where targets were presented in one of three dimensions: auditory location, pitch, or visual brightness. Task effects were localized primarily to lateral posterior superior temporal gyrus (pSTG) and modulated binaural-cue response functions differently in the two hemispheres. Active spatial listening (location tasks) enhanced both contralateral and ipsilateral responses in the right hemisphere but maintained or enhanced contralateral dominance in the left hemisphere. Two observations suggest integrated processing of ITD and ILD. First, overlapping regions in medial pSTG exhibited significant sensitivity to both cues. Second, successful classification of multivoxel patterns was observed for both cue types and-critically-for cross-cue classification. Together, these results suggest a higher-order representation of auditory space in the human auditory cortex that at least partly integrates the specific underlying cues.

Horizontal sound localization in cochlear implant users with a contralateral hearing aid.

Interaural differences in sound arrival time (ITD) and in level (ILD) enable us to localize sounds in the horizontal plane, and can support source segregation and speech understanding in noisy environments. It is uncertain whether these cues are also available to hearing-impaired listeners who are bimodally fitted, i.e. with a cochlear implant (CI) and a contralateral hearing aid (HA). Here, we assessed sound localization behavior of fourteen bimodal listeners, all using the same Phonak HA and an Advanced Bionics CI processor, matched with respect to loudness growth. We aimed to determine the availability and contribution of binaural (ILDs, temporal fine structure and envelope ITDs) and monaural (loudness, spectral) cues to horizontal sound localization in bimodal listeners, by systematically varying the frequency band, level and envelope of the stimuli. The sound bandwidth had a strong effect on the localization bias of bimodal listeners, although localization performance was typically poor for all conditions. Responses could be systematically changed by adjusting the frequency range of the stimulus, or by simply switching the HA and CI on and off. Localization responses were largely biased to one side, typically the CI side for broadband and high-pass filtered sounds, and occasionally to the HA side for low-pass filtered sounds. HA-aided thresholds better than 45 dB HL in the frequency range of the stimulus appeared to be a prerequisite, but not a guarantee, for the ability to indicate sound source direction. We argue that bimodal sound localization is likely based on ILD cues, even at frequencies below 1500 Hz for which the natural ILDs are small. These cues are typically perturbed in bimodal listeners, leading to a biased localization percept of sounds. The high accuracy of some listeners could result from a combination of sufficient spectral overlap and loudness balance in bimodal hearing.

Mechanisms of Sound Localization in Two Functionally Distinct Regions of the Auditory Cortex.

The auditory cortex is necessary for sound localization. The mechanisms that shape bicoordinate spatial representation in the auditory cortex remain unclear. Here, we addressed this issue by quantifying spatial receptive fields (SRFs) in two functionally distinct cortical regions in the pallid bat. The pallid bat uses echolocation for obstacle avoidance and listens to prey-generated noise to localize prey. Its cortex contains two segregated regions of response selectivity that serve echolocation and localization of prey-generated noise. The main aim of this study was to compare 2D SRFs between neurons in the noise-selective region (NSR) and the echolocation region [frequency-modulated sweep-selective region (FMSR)]. The data reveal the following major differences between these two regions: (1) compared with NSR neurons, SRF properties of FMSR neurons were more strongly dependent on sound level; (2) as a population, NSR neurons represent a broad region of contralateral space, while FMSR selectivity was focused near the midline at sound levels near threshold and expanded considerably with increasing sound levels; and (3) the SRF size and centroid elevation were correlated with the characteristic frequency in the NSR, but not the FMSR. These data suggest different mechanisms of sound localization for two different behaviors. Previously, we reported that azimuth is represented by predictable changes in the extent of activated cortex. The present data indicate how elevation constrains this activity pattern. These data suggest a novel model for bicoordinate spatial representation that is based on the extent of activated cortex resulting from the overlap of binaural and tonotopic maps. SIGNIFICANCE STATEMENT: Unlike the visual and somatosensory systems, spatial information is not directly represented at the sensory receptor epithelium in the auditory system. Spatial locations are computed by integrating neural binaural properties and frequency-dependent pinna filtering, providing a useful model to study how neural properties and peripheral structures are adapted for sensory encoding. Although auditory cortex is necessary for sound localization, our understanding of how the cortex represents space remains rudimentary. Here we show that two functionally distinct regions of the pallid bat auditory cortex represent 2D space using different mechanisms. In addition, we suggest a novel hypothesis on how the nature of overlap between systematic maps of binaural and frequency selectivity leads to representation of both azimuth and elevation.