Effects of Cochlear Implantation and Steroids on the Aging Guinea Pig Cochlea.

OBJECTIVE: The objective was to determine the effects of older age on hearing preservation after cochlear implantation (CI), and whether steroids improve hearing preservation in older animals. We hypothesized greater hearing preservation would be observed in (1) young animals compared to older animals and (2) older animals receiving steroids compared to no steroids. The secondary objective was to assess levels of fibrosis utilizing optical coherence tomography (OCT). STUDY DESIGN: Experimental Animal Study. SETTING: Laboratory. METHODS: Three groups of guinea pigs: young (YCI; 8.5 ± 0.5 weeks; n = 10), old (OCI; 19.1 ± 1.0 months; n = 9) and old + steroids (OCI+S; 19.1 ± 1.0 months; n = 9) underwent CI. The OCI+S group received a steroid taper over 7 days starting 2 days before surgery to 4 days after. Auditory brainstem response (ABR) measurements were performed preoperatively and postoperatively. OCT imaging was performed to assess cochleae for extent of fibrotic tissue growth in the scala tympani. RESULTS: The YCI group had significantly better hearing preservation as measured by smaller increases in ABR thresholds [mean shift: 2.79 ± 0.66] compared to the OCI group [mean shift = 12.44 ± 5.6]. The OCI+S group had significantly better hearing preservation [2.66 ± 1.50] compared to the OCI group. No significant differences was seen in fibrosis across groups. CONCLUSIONS: Young animals and older animals that received steroids had better hearing after CI than older animals not given steroids, but hearing preservation was not correlated with the level of fibrosis assessed using OCT. This work is the first to investigate differences in hearing preservation by age in an animal model, and supports the protective effects of steroids on hearing preservation in older individuals.

Fusion of dichotic consonants in normal-hearing and hearing-impaired listenersa).

Hearing-impaired (HI) listeners have been shown to exhibit increased fusion of dichotic vowels, even with different fundamental frequency (F0), leading to binaural spectral averaging and interference. To determine if similar fusion and averaging occurs for consonants, four natural and synthesized stop consonants (/pa/, /ba/, /ka/, /ga/) at three F0s of 74, 106, and 185 Hz were presented dichotically-with ΔF0 varied-to normal-hearing (NH) and HI listeners. Listeners identified the one or two consonants perceived, and response options included /ta/ and /da/ as fused percepts. As ΔF0 increased, both groups showed decreases in fusion and increases in percent correct identification of both consonants, with HI listeners displaying similar fusion but poorer identification. Both groups exhibited spectral averaging (psychoacoustic fusion) of place of articulation but phonetic feature fusion for differences in voicing. With synthetic consonants, NH subjects showed increased fusion and decreased identification. Most HI listeners were unable to discriminate the synthetic consonants. The findings suggest smaller differences between groups in consonant fusion than vowel fusion, possibly due to the presence of more cues for segregation in natural speech or reduced reliance on spectral cues for consonant perception. The inability of HI listeners to discriminate synthetic consonants suggests a reliance on cues other than formant transitions for consonant discrimination.

Caregiver Experiences With Oral Bilingualism in Children Who Are Deaf and Hard of Hearing in the United States: Impact on Child Language Proficiency.

PURPOSE: Best practices recommend promoting the use of the home language and allowing caregivers to choose the language(s) that they want to use with their child who is deaf or hard of hearing (DHH). We examined whether Spanish-speaking caregivers of children who are DHH receive professional recommendations on oral bilingualism that follow best practices. We also assessed whether professional recommendations, caregiver beliefs, and language practices had an impact on child language(s) proficiency. METHOD: Sixty caregivers completed a questionnaire on demographic questions, language(s) use and recommendations, beliefs on bilingualism, and child language proficiency measures in English, Spanish, and American Sign Language (ASL). Professional recommendations on oral bilingualism were reported descriptively, and linear regression was used to identify the predictors of child language(s) proficiency. RESULTS: We found that only 23.3% of the caregivers were actively encouraged to raise their child orally bilingual. Language practices predicted child proficiency in each language (English, Spanish, and ASL), but professional recommendations and caregiver beliefs did not. CONCLUSIONS: Our results revealed that most caregivers received recommendations that do not follow current best practices. Professional training is still needed to promote bilingualism and increase cultural competence when providing services to caregivers who speak languages different from English. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21644846.

Differential Effects of Binaural Pitch Fusion Range on the Benefits of Voice Gender Differences in a "Cocktail Party" Environment for Bimodal and Bilateral Cochlear Implant Users.

OBJECTIVES: Some cochlear implant (CI) users are fitted with a CI in each ear ("bilateral"), while others have a CI in one ear and a hearing aid in the other ("bimodal"). Presently, evaluation of the benefits of bilateral or bimodal CI fitting does not take into account the integration of frequency information across the ears. This study tests the hypothesis that CI listeners, especially bimodal CI users, with a more precise integration of frequency information across ears ("sharp binaural pitch fusion") will derive greater benefit from voice gender differences in a multi-talker listening environment. DESIGN: Twelve bimodal CI users and twelve bilateral CI users participated. First, binaural pitch fusion ranges were measured using the simultaneous, dichotic presentation of reference and comparison stimuli (electric pulse trains for CI ears and acoustic tones for HA ears) in opposite ears, with reference stimuli fixed and comparison stimuli varied in frequency/electrode to find the range perceived as a single sound. Direct electrical stimulation was used in implanted ears through the research interface, which allowed selective stimulation of one electrode at a time, and acoustic stimulation was used in the non-implanted ears through the headphone. Second, speech-on-speech masking performance was measured to estimate masking release by voice gender difference between target and maskers (VGRM). The VGRM was calculated as the difference in speech recognition thresholds of target sounds in the presence of same-gender or different-gender maskers. RESULTS: Voice gender differences between target and masker talkers improved speech recognition performance for the bimodal CI group, but not the bilateral CI group. The bimodal CI users who benefited the most from voice gender differences were those who had the narrowest range of acoustic frequencies that fused into a single sound with stimulation from a single electrode from the CI in the opposite ear. There was no similar voice gender difference benefit of narrow binaural fusion range for the bilateral CI users. CONCLUSIONS: The findings suggest that broad binaural fusion reduces the acoustical information available for differentiating individual talkers in bimodal CI users, but not for bilateral CI users. In addition, for bimodal CI users with narrow binaural fusion who benefit from voice gender differences, bilateral implantation could lead to a loss of that benefit and impair their ability to selectively attend to one talker in the presence of multiple competing talkers. The results suggest that binaural pitch fusion, along with an assessment of residual hearing and other factors, could be important for assessing bimodal and bilateral CI users.

Factors underlying masking release by voice-gender differences and spatial separation cues in multi-talker listening environments in listeners with and without hearing loss.

Voice-gender differences and spatial separation are important cues for auditory object segregation. The goal of this study was to investigate the relationship of voice-gender difference benefit to the breadth of binaural pitch fusion, the perceptual integration of dichotic stimuli that evoke different pitches across ears, and the relationship of spatial separation benefit to localization acuity, the ability to identify the direction of a sound source. Twelve bilateral hearing aid (HA) users (age from 30 to 75 years) and eleven normal hearing (NH) listeners (age from 36 to 67 years) were tested in the following three experiments. First, speech-on-speech masking performance was measured as the threshold target-to-masker ratio (TMR) needed to understand a target talker in the presence of either same- or different-gender masker talkers. These target-masker gender combinations were tested with two spatial configurations (maskers co-located or 60° symmetrically spatially separated from the target) in both monaural and binaural listening conditions. Second, binaural pitch fusion range measurements were conducted using harmonic tone complexes around a 200-Hz fundamental frequency. Third, absolute localization acuity was measured using broadband (125-8000 Hz) noise and one-third octave noise bands centered at 500 and 3000 Hz. Voice-gender differences between target and maskers improved TMR thresholds for both listener groups in the binaural condition as well as both monaural (left ear and right ear) conditions, with greater benefit in co-located than spatially separated conditions. Voice-gender difference benefit was correlated with the breadth of binaural pitch fusion in the binaural condition, but not the monaural conditions, ruling out a role of monaural abilities in the relationship between binaural fusion and voice-gender difference benefits. Spatial separation benefit was not significantly correlated with absolute localization acuity. In addition, greater spatial separation benefit was observed in NH listeners than in bilateral HA users, indicating a decreased ability of HA users to benefit from spatial release from masking (SRM). These findings suggest that sharp binaural pitch fusion may be important for maximal speech perception in multi-talker environments for both NH listeners and bilateral HA users.

Animal Models of Hearing Loss after Cochlear Implantation and Electrical Stimulation.

Many hearing-impaired patients may significantly benefit from the Hybrid or electro-acoustic stimulation (EAS) cochlear implant (CI). However, as much as 30-55% of CI recipients lose residual hearing after implantation and the potential for associated benefits of EAS over traditional electric-only stimulation. The cause of this post-implantation hearing loss may be immediate or delayed and result from several factors, including surgical trauma, electric stimulation, and the foreign body response. Clinical and post-mortem studies have helped identify factors effecting EAS performance. Animal CI models are an essential translational tool to further investigate these pertinent issues through histopathological investigation with greater control of biological and stimulation variables as well as other unique research tools not available in clinical and post-mortem research. Additionally, animal CI models may provide useful preclinical data for potential therapeutic strategies aimed at improving EAS outcomes. Here we review the parameters required for rigorous study of mechanisms of post-implantation hearing loss, including selection of animal model, hearing loss model, age and sex considerations, surgical technique, and chronic electrical stimulation.

Level differences impact the fusion of concurrent vowels dissimilarly within versus across ears.

This study investigated how level differences affect the fusion and identification of dichotically and monaurally presented concurrent vowel pairs where the vowels differed in level by 0, 4, 8, or 12 dB. With dichotic presentation, there was minimal variation in fusion and identification-vowels were nearly always fused and were identified consistently across level differences. Conversely, with monaural presentation, fusion and identification varied systematically across level differences-with the more intense vowel dominating fused percepts. The dissimilar effect of level difference for dichotic versus monaural presentation may arise from differences in energetic masking and/or divergent mechanisms underlying sound segregation and integration.

Onset Asynchrony: Cue to Aid Dichotic Vowel Segregation in Listeners With Normal Hearing and Hearing Loss.

PURPOSE: The effect of onset asynchrony on dichotic vowel segregation and identification in normal-hearing (NH) and hearing-impaired (HI) listeners was examined. We hypothesized that fusion would decrease and identification performance would improve with increasing onset asynchrony. Additionally, we hypothesized that HI listeners would gain more benefit from onset asynchrony. METHOD: A total of 18 adult subjects (nine NH, nine HI) participated. Testing included dichotic presentation of synthetic vowels, /i/, /u/, /a/, and /ae/. Vowel pairs were presented with the same or different fundamental frequency (f o; f o = 106.9, 151.2, or 201.8 Hz) across the two ears and one onset asynchrony of 0, 1, 2, 4, 10, or 20 ms throughout a block (one block = 80 runs). Subjects identified the one or two vowels that they perceived on a touchscreen. Subjects were not informed that two vowels were always presented or that there was onset asynchrony. RESULTS: The effect of onset asynchrony on fusion and vowel identification was greatest in both groups when Δf o = 0 Hz. Mean fusion scores across increasing onset asynchronies differed significantly between the two groups with HI listeners exhibiting less fusion across pooled Δf o. There was no significant difference with identification performance. CONCLUSIONS: As onset asynchrony increased, dichotic vowel fusion decreased and identification performance improved. Onset asynchrony exerted a greater effect on fusion and identification of vowels when Δf o = 0, especially in HI listeners. Therefore, the temporal cue promotes segregation in both groups of listeners, especially in HI listeners when the f o cue was unavailable.

Supporting Equity and Inclusion of Deaf and Hard-of-Hearing Individuals in Professional Organizations.

Disability is an important and often overlooked component of diversity. Individuals with disabilities bring a rare perspective to science, technology, engineering, mathematics, and medicine (STEMM) because of their unique experiences approaching complex issues related to health and disability, navigating the healthcare system, creatively solving problems unfamiliar to many individuals without disabilities, managing time and resources that are limited by physical or mental constraints, and advocating for themselves and others in the disabled community. Yet, individuals with disabilities are underrepresented in STEMM. Professional organizations can address this underrepresentation by recruiting individuals with disabilities for leadership opportunities, easing financial burdens, providing equal access, fostering peer-mentor groups, and establishing a culture of equity and inclusion spanning all facets of diversity. We are a group of deaf and hard-of-hearing (D/HH) engineers, scientists, and clinicians, most of whom are active in clinical practice and/or auditory research. We have worked within our professional societies to improve access and inclusion for D/HH individuals and others with disabilities. We describe how different models of disability inform our understanding of disability as a form of diversity. We address heterogeneity within disabled communities, including intersectionality between disability and other forms of diversity. We highlight how the Association for Research in Otolaryngology has supported our efforts to reduce ableism and promote access and inclusion for D/HH individuals. We also discuss future directions and challenges. The tools and approaches discussed here can be applied by other professional organizations to include individuals with all forms of diversity in STEMM.

An Alternative Explanation for Difficulties with Speech in Background Talkers: Abnormal Fusion of Vowels Across Fundamental Frequency and Ears.

Normal-hearing (NH) listeners use frequency cues, such as fundamental frequency (voice pitch), to segregate sounds into discrete auditory streams. However, many hearing-impaired (HI) individuals have abnormally broad binaural pitch fusion which leads to fusion and averaging of the original monaural pitches into the same stream instead of segregating the two streams (Oh and Reiss, 2017) and may similarly lead to fusion and averaging of speech streams across ears. In this study, using dichotic speech stimuli, we examined the relationship between speech fusion and vowel identification. Dichotic vowel perception was measured in NH and HI listeners, with across-ear fundamental frequency differences varied. Synthetic vowels /i/, /u/, /a/, and /ae/ were generated with three fundamental frequencies (F0) of 106.9, 151.2, and 201.8 Hz and presented dichotically through headphones. For HI listeners, stimuli were shaped according to NAL-NL2 prescriptive targets. Although the dichotic vowels presented were always different across ears, listeners were not informed that there were no single vowel trials and could identify one vowel or two different vowels on each trial. When there was no F0 difference between the ears, both NH and HI listeners were more likely to fuse the vowels and identify only one vowel. As ΔF0 increased, NH listeners increased the percentage of two-vowel responses, but HI listeners were more likely to continue to fuse vowels even with large ΔF0. Binaural tone fusion range was significantly correlated with vowel fusion rates in both NH and HI listeners. Confusion patterns with dichotic vowels differed from those seen with concurrent monaural vowels, suggesting different mechanisms behind the errors. Together, the findings suggest that broad fusion leads to spectral blending across ears, even for different ΔF0, and may hinder the stream segregation and understanding of speech in the presence of competing talkers.

Effect of Cochlear Implantation on the Endocochlear Potential and Stria Vascularis.

HYPOTHESIS: Animals with cochlear implantation-induced hearing loss will have a lower endocochlear potential (EP) and decreased strial vascular density. BACKGROUND: The cause of residual hearing loss following cochlear implantation remains poorly understood. Recent work from our lab has shown a correlation between vascular changes in the cochlear lateral wall and postimplantation hearing loss, suggesting a role of the stria vascularis and EP. METHODS: Fourteen young, normal-hearing male albino guinea pigs underwent cochlear implantation using either a cochleostomy (CI-c, n = 9) or an extended round window (CI-eRW, n = 5) approach. Hearing sensitivity was assessed pre- and postoperatively using auditory brainstem response thresholds. Three weeks after implantation, EP measurements were obtained from the first and second turns. Hair cell counts and stria vascularis capillary density measurements were also obtained. RESULTS: The implanted group experienced significant threshold elevations at 8 to 24 kHz (mean threshold shift 9.1 ±â€Š1.1 dB), with a more robust threshold shift observed in the CI-eRW group compared to the CI-c group. Implanted animals had a significantly lower first turn EP (81.4 ±â€Š5.1 mV) compared with controls (87.9 ±â€Š6.1 mV). No differences were observed in the second turn (75.8 ±â€Š12.0 mV for implanted animals compared to 76.5 ±â€Š7.0 mV for controls). There were no significant correlations between turn-specific threshold shifts, EP measurements, or strial blood vessel density. CONCLUSIONS: Reliable EP measurements can be obtained in chronically implanted guinea pigs. Hearing loss after implantation is not explained by changes in strial vascular density or reductions in EP.

Binaural Pitch Fusion: Binaural Pitch Averaging in Cochlear Implant Users With Broad Binaural Fusion.

OBJECTIVES: Individuals who use hearing aids (HAs) or cochlear implants (CIs) can experience broad binaural pitch fusion, such that sounds differing in pitch by as much as 3 to 4 octaves are perceptually integrated across ears. Previously, it was shown in HA users that the fused pitch is a weighted average of the two monaural pitches, ranging from equal weighting to dominance by the lower pitch. The goal of this study was to systematically measure the fused pitches in adult CI users, and determine whether CI users experience similar pitch averaging effects as observed in HA users. DESIGN: Twelve adult CI users (Cochlear Ltd, Sydney, Australia) participated in this study: six bimodal CI users, who wear a CI with a contralateral HA, and six bilateral CI users. Stimuli to HA ears were acoustic pure tones, and stimuli to CI ears were biphasic pulse trains delivered to individual electrodes. Fusion ranges, the ranges of frequencies/electrodes in the comparison ear that were fused with a single electrode (electrode 22, 18, 12, or 6) in the reference ear, were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus. Once the fusion ranges were measured, the fused binaural pitch of a reference-pair stimulus combination was measured by finding a pitch match to monaural comparison stimuli presented to the paired stimulus ear. RESULTS: Fusion pitch weighting in CI users varied depending on the pitch difference of the reference-pair stimulus combination, with equal pitch averaging occurring for stimuli closer in pitch and lower pitch dominance occurring for stimuli farther apart in pitch. The averaging region was typically 0.5 to 2.3 octaves around the reference for bimodal CI users and 0.4 to 1.5 octaves for bilateral CI users. In some cases, a bias in the averaging region was observed toward the ear with greater stimulus variability. CONCLUSIONS: Fusion pitch weighting effects in CI users were similar to those observed previously in HA users. However, CI users showed greater inter-subject variability in both pitch averaging ranges and bias effects. These findings suggest that binaural pitch averaging could be a common underlying mechanism in hearing-impaired listeners.

Binaural Pitch Fusion in Children With Normal Hearing, Hearing Aids, and Cochlear Implants.

OBJECTIVES: Binaural pitch fusion is the perceptual integration of stimuli that evoke different pitches between the ears into a single auditory image. Adults who use hearing aids (HAs) or cochlear implants (CIs) often experience abnormally broad binaural pitch fusion, such that sounds differing in pitch by as much as 3 to 4 octaves are fused across ears, leading to spectral averaging and speech perception interference. The main goal of this study was to measure binaural pitch fusion in children with different hearing device combinations and compare results across groups and with adults. A second goal was to examine the relationship of binaural pitch fusion to interaural pitch differences or pitch match range, a measure of sequential pitch discriminability. DESIGN: Binaural pitch fusion was measured in children between the ages of 6.1 and 11.1 years with bilateral HAs (n = 9), bimodal CI (n = 10), bilateral CIs (n = 17), as well as normal-hearing (NH) children (n = 21). Depending on device combination, stimuli were pure tones or electric pulse trains delivered to individual electrodes. Fusion ranges were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus to find the range that fused with the reference stimulus. Interaural pitch match functions were measured using sequential presentation of reference and comparison stimuli, and varying the comparison stimulus to find the pitch match center and range. RESULTS: Children with bilateral HAs had significantly broader binaural pitch fusion than children with NH, bimodal CI, or bilateral CIs. Children with NH and bilateral HAs, but not children with bimodal or bilateral CIs, had significantly broader fusion than adults with the same hearing status and device configuration. In children with bilateral CIs, fusion range was correlated with several variables that were also correlated with each other: pure-tone average in the second implanted ear before CI, and duration of prior bilateral HA, bimodal CI, or bilateral CI experience. No relationship was observed between fusion range and pitch match differences or range. CONCLUSIONS: The findings suggest that binaural pitch fusion is still developing in this age range and depends on hearing device combination but not on interaural pitch differences or discriminability.

Binaural pitch fusion: Effects of sound level in listeners with normal hearing.

Pitch is an important cue that allows the auditory system to distinguish between sound sources. Pitch cues are less useful when listeners are not able to discriminate different pitches between the two ears, a problem encountered by listeners with hearing impairment (HI). Many listeners with HI will fuse the pitch of two dichotically presented tones over a larger range of interaural frequency disparities, i.e., have a broader fusion range, than listeners with normal hearing (NH). One potential explanation for broader fusion in listeners with HI is that hearing aids stimulate at high sound levels. The present study investigated effects of overall sound levels on pitch fusion in listeners with NH. It was hypothesized that if sound level increased, then fusion range would increase. Fusion ranges were measured by presenting a fixed frequency tone to a reference ear simultaneously with a variable frequency tone to the opposite ear and finding the range of frequencies that were fused with the reference frequency. No significant effects of sound level (comfortable level ± 15 dB) on fusion range were found, even when tested within the range of levels where some listeners with HI show large fusion ranges. Results suggest that increased sound level does not explain increased fusion range in listeners with HI and imply that other factors associated with hearing loss might play a larger role.

Cochlear implants and other inner ear prostheses: today and tomorrow.

Cochlear implants (CIs) are implantable auditory prostheses designed to restore access to sound in deaf individuals via direct electrical stimulation of the auditory nerve. While CIs have been successful in restoring speech perception to many deaf patients, outcomes are variable and speech recognition in noise remains a problem. This chapter will review the factors underlying this variability, and discuss significant recent innovations to address these issues including neural health preservation, characterization, and regeneration, and other inner ear prostheses. The emerging role of central auditory plasticity will also be discussed. Together, these advances will point to the likely future directions for advancing the next generation of CIs and other inner ear prostheses.

Binaural Pitch Fusion: Effects of Amplitude Modulation.

Hearing-impaired adults, including both cochlear implant and bilateral hearing aid (HA) users, often exhibit broad binaural pitch fusion, meaning that they fuse dichotically presented tones with large pitch differences between ears. The current study was designed to investigate how binaural pitch fusion can be influenced by amplitude modulation (AM) of the stimuli and whether effects differ with hearing loss. Fusion ranges, the frequency ranges over which binaural pitch fusion occurs, were measured in both normal-hearing (NH) listeners and HA users with various coherent AM rates (2, 4, and 8 Hz); AM depths (20%, 40%, 60%, 80%, and 100%); and interaural AM phase and AM rate differences. The averaged results show that coherent AM increased binaural pitch fusion ranges to about 2 to 4 times wider than those in the unmodulated condition in both NH and bilateral HA subjects. Even shallow temporal envelope fluctuations (20% AM depth) significantly increased fusion ranges in all three coherent AM rate conditions. Incoherent AM introduced through interaural differences in AM phase or AM rate led to smaller increases in binaural pitch fusion range compared with those observed with coherent AM. Significant differences between groups were observed only in the coherent AM conditions. The influence of AM cues on binaural pitch fusion shows that binaural fusion is mediated in part by central processes involved in auditory grouping.

Binaural Pitch Fusion in Bilateral Cochlear Implant Users.

OBJECTIVES: Binaural pitch fusion is the fusion of stimuli that evoke different pitches between the ears into a single auditory image. Individuals who use hearing aids or bimodal cochlear implants (CIs) experience abnormally broad binaural pitch fusion, such that sounds differing in pitch by as much as 3-4 octaves are fused across ears, leading to spectral averaging and speech perception interference. The goal of this study was to determine if adult bilateral CI users also experience broad binaural pitch fusion. DESIGN: Stimuli were pulse trains delivered to individual electrodes. Fusion ranges were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus to find the range that fused with the reference stimulus. RESULTS: Bilateral CI listeners had binaural pitch fusion ranges varying from 0 to 12 mm (average 6.1 ± 3.9 mm), where 12 mm indicates fusion over all electrodes in the array. No significant correlations of fusion range were observed with any subject factors related to age, hearing loss history, or hearing device history, or with any electrode factors including interaural electrode pitch mismatch, pitch match bandwidth, or within-ear electrode discrimination abilities. CONCLUSIONS: Bilateral CI listeners have abnormally broad fusion, similar to hearing aid and bimodal CI listeners. This broad fusion may explain the variability of binaural benefits for speech perception in quiet and in noise in bilateral CI users.

Binaural pitch fusion: Pitch averaging and dominance in hearing-impaired listeners with broad fusion.

Both bimodal cochlear implant and bilateral hearing aid users can exhibit broad binaural pitch fusion, the fusion of dichotically presented tones over a broad range of pitch differences between ears [Reiss, Ito, Eggleston, and Wozny. (2014). J. Assoc. Res. Otolaryngol. 15(2), 235-248; Reiss, Eggleston, Walker, and Oh. (2016). J. Assoc. Res. Otolaryngol. 17(4), 341-356; Reiss, Shayman, Walker, Bennett, Fowler, Hartling, Glickman, Lasarev, and Oh. (2017). J. Acoust. Soc. Am. 143(3), 1909-1920]. Further, the fused binaural pitch is often a weighted average of the different pitches perceived in the two ears. The current study was designed to systematically measure these pitch averaging phenomena in bilateral hearing aid users with broad fusion. The fused binaural pitch of the reference-pair tone combination was initially measured by pitch-matching to monaural comparison tones presented to the pair tone ear. The averaged results for all subjects showed two distinct trends: (1) The fused binaural pitch was dominated by the lower-pitch component when the pair tone was either 0.14 octaves below or 0.78 octaves above the reference tone; (2) pitch averaging occurred when the pair tone was between the two boundaries above, with the most equal weighting at 0.38 octaves above the reference tone. Findings from two subjects suggest that randomization or alternation of the comparison ear can eliminate this asymmetry in the pitch averaging range. Overall, these pitch averaging phenomena suggest that spectral distortions and thus binaural interference may arise during binaural stimulation in hearing-impaired listeners with broad fusion.