Speech Recognition of Bimodal Cochlear Implant Recipients Using a Wireless Audio Streaming Accessory for the Telephone.

OBJECTIVE: The goals of the present investigation were (1) to evaluate recognition of recorded speech presented over a mobile telephone for a group of adult bimodal cochlear implant users, and (2) to measure the potential benefits of wireless hearing assistance technology (HAT) for mobile telephone speech recognition using bimodal stimulation (i.e., a cochlear implant in one ear and a hearing aid on the other ear). STUDY DESIGN: A three-by-two-way repeated measures design was used to evaluate mobile telephone sentence-recognition performance differences obtained in quiet and in noise with and without the wireless HAT accessory coupled to the hearing aid alone, CI sound processor alone, and in the bimodal condition. SETTING: Outpatient cochlear implant clinic. SUBJECTS: Sixteen bimodal users with Nucleus 24, Freedom, CI512, or CI422 cochlear implants participated in this study. INTERVENTION (S): Performance was measured with and without the use of a wireless HAT for the telephone used with the hearing aid alone, CI alone, and bimodal condition. MAIN OUTCOME MEASURE(S): CNC word recognition in quiet and in noise with and without the use of a wireless HAT telephone accessory in the hearing aid alone, CI alone, and bimodal conditions. RESULTS: Results suggested that the bimodal condition gave significantly better speech recognition on the mobile telephone with the wireless HAT. CONCLUSIONS: A wireless HAT for the mobile telephone provides bimodal users with significant improvement in word recognition in quiet and in noise over the mobile telephone.

Improving Hearing Performance for Cochlear Implant Recipients with Use of a Digital, Wireless, Remote-Microphone, Audio-Streaming Accessory.

BACKGROUND: Cochlear implant (CI) recipients experience difficulty understanding speech in noise. Remote-microphone technology that improves the signal-to-noise ratio is recognized as an effective means to improve speech recognition in noise; however, there are no published studies evaluating the potential benefits of a wireless, remote-microphone, digital, audio-streaming accessory device (heretofore referred to as a remote-microphone accessory) designed to deliver audio signals directly to a CI sound processor. PURPOSE: The objective of this study was to compare speech recognition in quiet and in noise of recipients while using their CI alone and with a remote-microphone accessory. RESEARCH DESIGN: A two-way repeated measures design was used to evaluate performance differences obtained in quiet and in increasing levels of competing noise with the CI sound processor alone and with the sound processor paired to the remote microphone accessory. STUDY SAMPLE: Sixteen users of Cochlear Nucleus 24 Freedom, CI512, and CI422 implants were included in the study. DATA COLLECTION AND ANALYSIS: Participants were evaluated in 14 conditions including use of the sound processor alone and with the remote-microphone accessory in quiet and at the following signal levels: 65 dBA speech (at the location of the participant; 85 dBA at the location of the remote microphone) in quiet and competing noise at 50, 55, 60, 65, 70, and 75 dBA noise levels. Speech recognition was evaluated in each of these conditions with one full list of AzBio sentences. RESULTS: Speech recognition in quiet and in all competing noise levels, except the 75 dBA condition, was significantly better with use of the remote-microphone accessory compared with participants' performance with the CI sound processor alone. As expected, in all technology conditions, performance was significantly poorer as the competing noise level increased. CONCLUSIONS: Use of a remote-microphone accessory designed for a CI sound processor provides superior speech recognition in quiet and in noise when compared with performance obtained with the CI sound processor alone.

Evaluation of Extended-Wear Hearing Technology for Children with Hearing Loss.

BACKGROUND: Research shows that many older children and teenagers who have mild to moderately severe sensorineural hearing loss do not use their hearing instruments during all waking hours. A variety of reasons may contribute toward this problem, including concerns about cosmetics associated with hearing aid use and the inconvenience of daily maintenance associated with hearing instruments. Extended-wear hearing instruments are inserted into the wearer's ear canal by an audiologist and are essentially invisible to outside observers. PURPOSE: The goal of this study was to evaluate the potential benefits and limitations associated with use of extended-wear hearing instruments in a group of children with hearing loss. RESEARCH DESIGN: A two-way repeated measures design was used to examine performance differences obtained with the participants' daily-wear hearing instruments versus that obtained with extended-wear hearing instruments. STUDY SAMPLE: Sixteen children, ages 10-17 yr old, with sensorineural hearing loss ranging from mild to moderately severe. DATA COLLECTION AND ANALYSIS: Probe microphone measures were completed to evaluate the aided output of device. Behavioral test measures included word recognition in quiet, sentence recognition in noise, aided warble-tone thresholds, and psychophysical loudness scaling. Questionnaires were also administered to evaluate subjective performance with each hearing technology. RESULTS: Data logging suggested that many participants were not using their daily-wear hearing instruments during all waking hours (mean use was less than 6 h/day). Real ear probe microphone measurements indicated that a closer fit to the Desired Sensation Level Version 5 prescriptive targets was achieved with the children's daily-wear instruments when compared to the extended-wear instruments. There was no statistically significant difference in monosyllabic word recognition at 50 or 60 dBA obtained with the two hearing technologies. Sentence recognition in noise obtained with use of the extended-wear devices was, however, significantly better than what was obtained with the daily-wear hearing aids. Aided warble-tone thresholds indicated significantly better audibility for low-level sounds with use of the daily-wear hearing technology, but loudness scaling results produced mixed results. Specifically, the participants generally reported greater loudness perception with use of their daily-wear hearing aids at 2000 Hz, but use of the extended-wear hearing technology provided greater loudness perception at 4000 Hz. Finally, the participants reported higher levels of subjective performance with use of the extended-wear hearing instruments. CONCLUSIONS: Although some measures suggested that daily-wear hearing instruments provided better audibility than the extended-wear hearing devices, word recognition in quiet was similar with use of the two technologies, and sentence recognition in noise was better with the extended-wear hearing technology. In addition, the participants in this study reported better subjective benefit associated with the use of extended-wear hearing technology. Collectively, the results of this study suggest that extended-wear hearing technology is a viable option for older children and teenagers with mild to moderately severe hearing loss.

Evaluation of Speech Recognition of Cochlear Implant Recipients Using Adaptive, Digital Remote Microphone Technology and a Speech Enhancement Sound Processing Algorithm.

BACKGROUND: Cochlear implant recipients often experience difficulty with understanding speech in the presence of noise. Cochlear implant manufacturers have developed sound processing algorithms designed to improve speech recognition in noise, and research has shown these technologies to be effective. Remote microphone technology utilizing adaptive, digital wireless radio transmission has also been shown to provide significant improvement in speech recognition in noise. There are no studies examining the potential improvement in speech recognition in noise when these two technologies are used simultaneously. PURPOSE: The goal of this study was to evaluate the potential benefits and limitations associated with the simultaneous use of a sound processing algorithm designed to improve performance in noise (Advanced Bionics ClearVoice) and a remote microphone system that incorporates adaptive, digital wireless radio transmission (Phonak Roger). RESEARCH DESIGN: A two-by-two way repeated measures design was used to examine performance differences obtained without these technologies compared to the use of each technology separately as well as the simultaneous use of both technologies. STUDY SAMPLE: Eleven Advanced Bionics (AB) cochlear implant recipients, ages 11 to 68 yr. DATA COLLECTION AND ANALYSIS: AzBio sentence recognition was measured in quiet and in the presence of classroom noise ranging in level from 50 to 80 dBA in 5-dB steps. Performance was evaluated in four conditions: (1) No ClearVoice and no Roger, (2) ClearVoice enabled without the use of Roger, (3) ClearVoice disabled with Roger enabled, and (4) simultaneous use of ClearVoice and Roger. RESULTS: Speech recognition in quiet was better than speech recognition in noise for all conditions. Use of ClearVoice and Roger each provided significant improvement in speech recognition in noise. The best performance in noise was obtained with the simultaneous use of ClearVoice and Roger. CONCLUSIONS: ClearVoice and Roger technology each improves speech recognition in noise, particularly when used at the same time. Because ClearVoice does not degrade performance in quiet settings, clinicians should consider recommending ClearVoice for routine, full-time use for AB implant recipients. Roger should be used in all instances in which remote microphone technology may assist the user in understanding speech in the presence of noise.

Evaluation of speech recognition of cochlear implant recipients using a personal digital adaptive radio frequency system.

BACKGROUND: Previous research supports the use of frequency modulation (FM) systems for improving speech recognition in noise of individuals with cochlear implants (CIs). However, at this time, there is no published research on the potential speech recognition benefit of new digital adaptive wireless radio transmission systems. PURPOSE: The goal of this study was to compare speech recognition in quiet and in noise of CI recipients while using traditional, fixed-gain analog FM systems, adaptive analog FM systems, and adaptive digital wireless radio frequency transmission systems. RESEARCH DESIGN: A three-way repeated-measures design was used to examine performance differences among devices, among speech recognition conditions in quiet and in increasing levels of background noise, and between users of Advanced Bionics and Cochlear CIs. STUDY SAMPLE: Seventeen users of Advanced Bionics Harmony CI sound processors and 20 users of Cochlear Nucleus 5 sound processors were included in the study. DATA COLLECTION AND ANALYSIS: Participants were tested in a total of 32 speech-recognition-in noise-test conditions, which included one no-FM and three device conditions (fixed-gain FM, adaptive FM, and adaptive digital) at the following signal levels: 64 dBA speech (at the location of the participant) in quiet and 64 dBA speech with competing noise at 50, 55, 60, 65, 70, 75, and 80 dBA noise levels. RESULTS: No significant differences were detected between the users of Advanced Bionics and Cochlear CIs. All of the radio frequency system conditions (i.e., fixed-gain FM, adaptive FM, and adaptive digital) outperformed the no-FM conditions in test situations with competing noise. Specifically, in conditions with 70, 75, and 80 dBA of competing noise, the adaptive digital system provided better performance than the fixed-gain and adaptive FM systems. The adaptive FM system did provide better performance than the fixed-gain FM system at 70 and 75 dBA of competing noise. At the lower noise levels of 50, 55, 60, and 65 dBA, no significant differences were detected across the three systems, and no significant differences were found across the quiet conditions. In all conditions, performance became poorer as the competing noise level increased. CONCLUSIONS: In high levels of noise, the adaptive digital system provides superior performance when compared to adaptive analog FM and fixed-gain FM systems.

Developmental effects and spatial hearing in young children with normal-hearing sensitivity.

OBJECTIVES: Previous research suggests that young children have significant difficulty recognizing speech in the presence of background noise as compared with older children and adults. However, limited research exists that examines the developmental effects of speech recognition in noise in separate age groups of young children, especially in a classroom setting. The lack of research may relate to the limited number of tests with multiple, equally intelligible lists in noise that are also appropriate for young children. As a result, the goals of the present study include investigating (1) effects of age and (2) benefits of spatial separation of speech and noise sources on the speech recognition in noise performance of young children with normal-hearing sensitivity. A secondary goal of the study was to establish the validity and reliability of the Phrases in Noise Test (PINT) for assessing the 50% correct speech-in-noise threshold of young children. DESIGN: The investigators used a two-way repeated measures design to examine the main effects of age and spatial separation. Sixty-eight children in separate groups of 3-, 4-, 5-, and 6-year-olds and 17 adults completed two speech-recognition conditions with (1) speech and noise from the same loudspeaker at 0-degree azimuth (S0/N0) and (2) speech and noise from separate loudspeakers at 0- and 180-degree azimuth (S0/N180). Recruiting sites included local preschools and school districts for children and a university for adults. RESULTS: The results of this investigation suggest that younger children (<4 years of age) have significantly poorer speech-in-noise thresholds than older children and adults, and 4- and 5-year-old children also have significantly poorer performance than adults when speech and noise are presented from the same spatial location. All participants obtained significant spatial release from masking. On a parent and teacher screening questionnaire to assess educational risk, five of 12 children with at-risk behaviors had poor speech-in-noise thresholds relative to their peers. When two lists of the PINT are used, the test seems to be a valid and reliable measure for assessing young children's speech-in-noise thresholds. CONCLUSIONS: Young children exhibit significantly poorer speech recognition than do older children and adults in a classroom, especially when speech and noise are presented from the same location. Given the poor acoustics of typical classrooms, and the earlier age at which many children are educated, special modifications to classrooms may be necessary to improve listening through acoustic modifications or classroom amplification. A combination of a parent or teacher questionnaire and the PINT may be helpful in identifying children who are at risk for educational delays and listening difficulties in classrooms with typically poor acoustics.