Evaluation of the Optimized Pitch and Language Strategy in Cochlear Implant Recipients.

OBJECTIVES: The Optimized Pitch and Language (OPAL) strategy enhances pitch perception through coding of fundamental frequency (F0) amplitude modulation information in the stimulus envelope delivered to a cochlear implant. Previous research using a prototype of the strategy demonstrated significant benefits in musical pitch and lexical tone discrimination tasks with no degradation in speech recognition when compared with the clinical Advanced Combination Encoder (ACE) strategy in a small group of subjects. Based on those studies, a modified version of the strategy was implemented in the commercial Nucleus CP900 series processor. The aims of the present study were to establish whether the CP900 OPAL implementation continued to provide improved F0 pitch perception in a speech intonation task with no degradation to speech perception in quiet and noise, when compared with the clinical ACE strategy in a larger cohort of subjects. Further aims were to evaluate fitting procedures and subject acclimatization to the strategy after take-home experience. DESIGN: Twenty experienced adult cochlear implant recipients were enrolled in the study. Two subjects withdrew during the study leaving 18 sets of data for analysis. A repeated-measures single-subject design with take-home experience was used to test for improved speech intonation perception using OPAL compared with ACE and for comparable performance between strategies for open-set word recognition in quiet at two presentation levels, sentence recognition in adaptive 4-talker babble noise, and speech intelligibility ratings. The stimulation rate employed for OPAL was 1200 pulses per second/channel which was higher than the default clinical rate of 900 pulses per second/channel used for ACE by all subjects in the present study. Two variations of the OPAL "F0 restore gain" (the gain applied to restore the loudness of modulated channels) were investigated: "custom" measured per subject and "default" which was the average of all subject custom gains. RESULTS: A significant group mean benefit on the intonation test of 8.5% points was shown for OPAL compared with ACE. There was a significant period of adaptation to OPAL with significantly poorer sentence in noise scores acutely and after only 2 weeks of take-home experience. After 4 weeks of take-home experience, comparable word perception in quiet and sentence perception in noise for OPAL were obtained. Furthermore, there was good subject acceptability in the field with comparable speech intelligibility ratings between strategies. Results of the fitting procedure showed that OPAL did not require any additional steps compared with fitting of ACE. A default F0 restore gain provided comparable outcomes to a custom gain setting. CONCLUSIONS: The CP900 OPAL implementation provided a significant benefit to perception of speech intonation when compared with ACE. Comparable speech perception (in quiet and noise) and subjective ratings of speech intelligibility between strategies were also achieved after a period of acclimatization. These outcomes are consistent with results of earlier studies using prototype versions of the strategy and reaffirm its potential for improvement of F0 pitch perception in speech while preserving coding of segmental speech information. Furthermore, the OPAL strategy can be programmed into subject's processors using the same fitting procedures used for ACE thereby simplifying its adoption in clinical settings.

Efficacy of a deficit specific auditory training program for remediation of temporal patterning deficits.

Objective: To determine the efficacy of a targeted auditory training programme as a remediation approach for children diagnosed with a temporal patterning disorder. Design: Temporal Patterning scores were determined at two-time points pre-intervention and again post-training. Measures were then repeated in half of the participants after a further non-training period to determine the sustainability of effects. Cognitive skills and outcome measures were assessed at all time-points. Study Sample: Ten children aged between 7 and 12 years of age, diagnosed with a temporal patterning processing disorder, were enrolled in the training programme. Results: A group mean of 9.2 hours training was completed. Conclusion: Significant, sustainable improvements on the Frequency Pattern Test were found (2.5 SD increase in score relative to mean of age matched-peers) at the completion of training. Duration of training did not predict the degree of improvement. Cognitive skills did not show significant changes in ability. Significant, sustainable improvements in temporal patterning ability were seen after completion of the training programme. No associated changes in cognitive skills were seen, suggesting independence of the skills. Deficit-specific approaches are available across the traditional test battery, however, determining the appropriate management plan for a child diagnosed with an auditory processing disorder requires a patient-centric approach.

Results using the OPAL strategy in Mandarin speaking cochlear implant recipients.

OBJECTIVE: To evaluate the effectiveness of an experimental pitch-coding strategy for improving recognition of Mandarin lexical tone in cochlear implant (CI) recipients. DESIGN: Adult CI recipients were tested on recognition of Mandarin tones in quiet and speech-shaped noise at a signal-to-noise ratio of +10 dB; Mandarin sentence speech-reception threshold (SRT) in speech-shaped noise; and pitch discrimination of synthetic complex-harmonic tones in quiet. Two versions of the experimental strategy were examined: (OPAL) linear (1:1) mapping of fundamental frequency (F0) to the coded modulation rate; and (OPAL+) transposed mapping of high F0s to a lower coded rate. Outcomes were compared to results using the clinical ACE™ strategy. STUDY SAMPLE: Five Mandarin speaking users of Nucleus® cochlear implants. RESULTS: A small but significant benefit in recognition of lexical tones was observed using OPAL compared to ACE in noise, but not in quiet, and not for OPAL+ compared to ACE or OPAL in quiet or noise. Sentence SRTs were significantly better using OPAL+ and comparable using OPAL to those using ACE. No differences in pitch discrimination thresholds were observed across strategies. CONCLUSIONS: OPAL can provide benefits to Mandarin lexical tone recognition in moderately noisy conditions and preserve perception of Mandarin sentences in challenging noise conditions.

Training of cochlear implant users to improve pitch perception in the presence of competing place cues.

OBJECTIVES: Perception of musical pitch in cochlear implant (CI) systems is relatively poor compared with normal hearing and can be adversely affected by changes in spectral timbre coded by stimulation place. In this study, we evaluated whether the perception of musical pitch could be improved through specific training designed to teach listeners to attend to fundamental frequency (F0) exclusively for judgment of pitch and to spectral envelope exclusively for discrimination of spectral timbre. DESIGN: A computer-based training program to improve musical pitch perception was developed that required listeners to match acoustic patterns of pitch and spectral timbre to visual patterns. Ten adult CI recipients participated: five used the training program and five acted as controls. Before training, F0 and center frequency discrimination for band-limited complex harmonic stimuli presented in the sound field were measured in all subjects using their standard clinical device(s). The F0 tests were conducted with and without spectral variations. The trainees subsequently used the training program at home for a period of 4 months, during which they were asked to train for approximately 30 min per day. The training schedule comprised two successive phases, each lasting 2 months. In the first phase, training employed a single cue (i.e., F0 for pitch or center frequency for spectral timbre) in the absence of other cue variations. In the second phase, training incorporated more complex sounds in which multiple cues were varied. Discrimination thresholds were remeasured in all subjects after each phase and again with trainees 3 months after training had ceased. RESULTS: Trainees obtained significant improvements in F0 and center frequency discrimination as compared with control subjects for tests conducted at 2 months. The improvements in F0 discrimination were observed both in the absence and presence of small variations in place. However, the effect of training diminished for large variations in place or for higher F0s. Neither group showed further improvement in tests after additional training in the second phase. Tests conducted with trainees after training had ceased showed that F0 discrimination improvements were retained. CONCLUSIONS: The results showed that performance on pitch and timbre discrimination can be improved by training with single cues (F0 and center frequency) in the absence of other cue variations. Although results indicated that training with single cues can improve F0 discrimination within more complex sounds in which multiple cues vary, little improvement was seen when large variations in place were present, which suggests a diminishing effect of the training with increased influence of place-pitch. These data imply that although such training techniques may help listeners to follow melody in music, changes in instrument are likely to affect perception of melody. Results of subsequent training with complex sounds in which multiple cues varied were less conclusive and showed no further improvement. Follow-up evaluations with trainees conducted well after training had ceased verified the robustness of the training effect on F0 but not center frequency discrimination. Further studies are needed, however, to determine whether and to what degree subject motivation may be an important factor in these outcomes.

Enhancement of temporal cues to pitch in cochlear implants: effects on pitch ranking.

The abilities to hear changes in pitch for sung vowels and understand speech using an experimental sound coding strategy (eTone) that enhanced coding of temporal fundamental frequency (F0) information were tested in six cochlear implant users, and compared with performance using their clinical (ACE) strategy. In addition, rate- and modulation rate-pitch difference limens (DLs) were measured using synthetic stimuli with F0s below 300 Hz to determine psychophysical abilities of each subject and to provide experience in attending to rate cues for the judgment of pitch. Sung-vowel pitch ranking tests for stimuli separated by three semitones presented across an F0 range of one octave (139-277 Hz) showed a significant benefit for the experimental strategy compared to ACE. Average d-prime (d') values for eTone (d' = 1.05) were approximately three time larger than for ACE (d' = 0.35). Similar scores for both strategies in the speech recognition tests showed that coding of segmental speech information by the experimental strategy was not degraded. Average F0 DLs were consistent with results from previous studies and for all subjects were less than or equal to approximately three semitones for F0s of 125 and 200 Hz.

Development of a temporal fundamental frequency coding strategy for cochlear implants.

A sound-coding strategy for users of cochlear implants, named enhanced-envelope-encoded tone (eTone), was developed to improve coding of fundamental frequency (F0) in the temporal envelopes of the electrical stimulus signals. It is based on the advanced combinational encoder (ACE) strategy and includes additional processing that explicitly applies F0 modulation to channel envelope signals that contain harmonics of prominent complex tones. Channels that contain only inharmonic signals retain envelopes normally produced by ACE. The strategy incorporates an F0 estimator to determine the frequency of modulation and a harmonic probability estimator to control the amount of modulation enhancement applied to each channel. The F0 estimator was designed to provide an accurate estimate of F0 with minimal processing lag and robustness to the effects of competing noise. Error rates for the F0 estimator and accuracy of the harmonic probability estimator were compared with previous approaches and outcomes demonstrated that the strategy operates effectively across a range of signals and conditions that are relevant to cochlear implant users.

Combined spectral and temporal enhancement to improve cochlear-implant speech perception.

The present study examined the effect of combined spectral and temporal enhancement on speech recognition by cochlear-implant (CI) users in quiet and in noise. The spectral enhancement was achieved by expanding the short-term Fourier amplitudes in the input signal. Additionally, a variation of the Transient Emphasis Spectral Maxima (TESM) strategy was applied to enhance the short-duration consonant cues that are otherwise suppressed when processed with spectral expansion. Nine CI users were tested on phoneme recognition tasks and ten CI users were tested on sentence recognition tasks both in quiet and in steady, speech-spectrum-shaped noise. Vowel and consonant recognition in noise were significantly improved with spectral expansion combined with TESM. Sentence recognition improved with both spectral expansion and spectral expansion combined with TESM. The amount of improvement varied with individual CI users. Overall the present results suggest that customized processing is needed to optimize performance according to not only individual users but also listening conditions.

Effects of stimulation rate on modulation detection and speech recognition by cochlear implant users.

OBJECTIVE: This study investigated the effect of low to moderate electrical stimulation rates (275, 350, 500 and 900 pps/ch) on modulation detection ability of cochlear implant subjects, and the relationship between modulation detection and speech perception as a function of rate. DESIGN: A repeated ABCD experimental design for the four rate conditions was employed. A sinusoidally amplitude modulated acoustic signal was presented to the audio input of a research processor. Stimuli were presented at an acoustic level that produced electrical levels close to the subjects' most comfortable level (MCL) of stimulation and at an acoustic level 20 dB below this. STUDY SAMPLE: Ten postlingually deaf adult users of the Nucleus CI24 cochlear implant participated. RESULTS: Acoustic modulation detection thresholds (MDTs), averaged across the subject group, were significantly better for rates of 500 pps/ch compared to the other rates examined for stimuli presented at MCL. In addition, there was a significant relation between speech perception in noise and acoustic MDTs at MCL. CONCLUSIONS: The benefits obtained in speech perception and modulation detection as a function of rate were attributed to an increased electrical dynamic range as a function of stimulation rate, at least for rates up to 500 pps/ch.

Electrical stimulation rate effects on speech perception in cochlear implants.

The objective of this study was to explore cochlear implant users' speech perception performance in quiet and in noise for low to moderate stimulation rates. Eight postlingually deaf adult users of the Nucleus CI24 cochlear implant (contour electrode array) using the ESPrit 3G speech processor participated in this study. Monosyllabic word recognition in quiet and sentence perception in noise was evaluated for low to moderate stimulation rates of 275, 350, 500, and 900 pulses-per-second/channel (pps/ch). All four stimulation rate programs were balanced for loudness. A repeated ABCD experimental design was employed. Take home practice was provided with each stimulation rate. Subjects also responded to a comparative questionnaire to examine their rate preference for a variety of listening situations. Results for six of the eight subjects showed no significant effect of rate for monosyllables in quiet. However, results for the sentence test in noise demonstrated improvements with 500 or 900 pps/ch stimulation rates in seven out of the eight subjects. Although there was not a close relationship between each subject's subjective preference and the rate program that provided best speech perception, most subjects indicated a preference for 500 pps/ch rate in noise.

Speech Perception Outcomes for Adult Cochlear Implant Recipients Using a Lateral Wall or Perimodiolar Array.

AIM: To assess the speech perception outcomes of adult CI recipients with significant preimplant low frequency hearing, examining differences between perimodiolar and lateral wall electrode placement in order to provide clinical guidance for clinicians and surgeons. METHODS: A prospective cohort study was undertaken identifying all adults who received a thin straight electrode array (TSEA) at the Royal Victorian Eye & Ear Hospital (RVEEH) from 2010 to 2015 and who had a preimplant low frequency pure tone median ≤70 dB HL (n = 63). A retrospective review was completed of the RVEEH database to identify a comparison group who had been implanted with a perimodiolar electrode array, comprising adults implanted between 2004 and 2011 (PM Group) with preimplant hearing equivalent to the TSEA group (n = 70). The TSEA Group were further divided into subgroups in which n = 19 used EAS (TSEA-EAS) and n = 44 who used electric-only hearing (TSEA-Standard). RESULTS: There was no significant difference in median speech perception outcomes between the TSEA and PM Groups (TSEA 61.7%, PM 67.3%, p = 0.954). A significant difference was found between the TSEA-EAS and TSEA-Standard subgroups for median speech perception outcome (TSEA-EAS median 73.5%, TSEA-Standard median 58.3%, p = 0.043). CONCLUSIONS: Significant speech perception benefit following cochlear implantation was achieved with both the perimodiolar and lateral wall electrode arrays and no significant difference was found between outcomes with those array types in this population of adults with functional low frequency hearing pre-implant. Those that received a TSEA, had preserved hearing, and utilised an EAS sound processor performed better than their peers with a TSEA and electric-only hearing.

Binaural speech unmasking and localization in noise with bilateral cochlear implants using envelope and fine-timing based strategies.

Four adult bilateral cochlear implant users, with good open-set sentence recognition, were tested with three different sound coding strategies for binaural speech unmasking and their ability to localize 100 and 500 Hz click trains in noise. Two of the strategies tested were envelope-based strategies that are clinically widely used. The third was a research strategy that additionally preserved fine-timing cues at low frequencies. Speech reception thresholds were determined in diotic noise for diotic and interaurally time-delayed speech using direct audio input to a bilateral research processor. Localization in noise was assessed in the free field. Overall results, for both speech and localization tests, were similar with all three strategies. None provided a binaural speech unmasking advantage due to the application of 700 micros interaural time delay to the speech signal, and localization results showed similar response patterns across strategies that were well accounted for by the use of broadband interaural level cues. The data from both experiments combined indicate that, in contrast to normal hearing, timing cues available from natural head-width delays do not offer binaural advantages with present methods of electrical stimulation, even when fine-timing cues are explicitly coded.

New cochlear implant coding strategy for tonal language speakers.

Accurate pitch perception on the basis of fundamental frequency patterns is essential for the processing of lexical tones in tonal languages such as Cantonese. Speech intelligibility in Cantonese-speaking CI recipients was compared using current signal processing strategies, which typically result in poor pitch perception, and a new strategy, known as the multi-channel envelope modulation (MEM) strategy, was designed to enhance temporal periodicity cues to the fundamental frequency. Performance of nine postlingually hearing-impaired adult cochlear implant users was measured twice using each strategy, initially after a four week trial, and again after two weeks of use with each strategy. Speech intelligibility in speech-spectrum shaped noise was measured using the Cantonese hearing in noise test. A fixed noise level of 65 dB A was used and the signal-to-noise ratios were fixed at either +10, +15, or +20 dB, depending on the baseline performance of individual subjects using the clinical processor. Self-reported benefit in 18 listening situations and overall preference for strategies were obtained at the end of these trial periods. Results showed poorer speech intelligibility with CIS while results obtained using ACE and MEM were comparable. Unfamiliar place coding might have contributed to poorer performance using CIS. Self-reported benefit across strategies did not differ in most listening situations. Participants preferred ACE for listening overall in daily situations, and a few preferred MEM in noise. Whilst the results did not demonstrate any advantages for speech recognition in noise when using MEM compared to ACE, no degradation in performance was observed. This implies that the form of processing employed by MEM retains similar segmental information to that provided by ACE and that potentially, future variations/optimizations of MEM may lead to some improvement in tone perception.

Speech recognition with the advanced combination encoder and transient emphasis spectral maxima strategies in nucleus 24 recipients.

One of the difficulties faced by cochlear implant (CI) recipients is perception of low-intensity speech cues. A. E. Vandali (2001) has developed the transient emphasis spectral maxima (TESM) strategy to amplify short-duration, low-level sounds. The aim of the present study was to determine whether speech scores would be significantly higher with TESM than with the advanced combination encoder (ACE) strategy fitted using procedures that optimize perception of soft speech and other sounds. Eight adult recipients of the Nucleus 24 CI system participated in this study. No significant differences in scores were seen between ACE and TESM for consonant-vowel nucleus-consonant (CNC) words presented at 55 and 65 dB SPL, for sentences in noise presented at 65 dB SPL at 2 different signal-to-noise ratios, or for closed-set vowels and consonants presented at 60 dB SPL. However, perception of stop consonants within CNC words presented at the lower level (55 dB SPL) was significantly higher with TESM than ACE. In addition, percentage of information transmitted for words at 55 dB SPL was significantly higher with TESM than with ACE for manner and voicing features for consonants in the initial word position. Analysis of closed-set consonants presented at 60 dB SPL revealed percentage of information transmitted for manner was significantly higher with TESM than with ACE. These improvements with TESM were small compared with those reported by Vandali for recipients of the Nucleus 22 CI system. It appears that mapping techniques used to program speech processors and improved processing capabilities of the Nucleus 24 system contributed to soft sounds being understood almost as well with ACE as with TESM. However, half of the participants preferred TESM to ACE for use in everyday life, and all but 1 used TESM in specific listening situations. Clinically, TESM may be useful to ensure the audibility of low-intensity, short-duration acoustic cues that are important for understanding speech, for recipients who are difficult to map, or if insufficient time precludes the use of mapping techniques to increase audibility of soft sound.

Parameter selection and programming recommendations for the ACE and CIS speech-processing strategies in the Nucleus 24 cochlear implant system.

This study evaluated a range of programming parameters available for the ACE and CIS speech-processing strategies in the Nucleus 24 cochlear implant system. Specifically, the effect on speech perception of adjustments to the number of channels and the stimulation rate in the CIS strategy, and the effect of adjustments to the number of maxima in the ACE strategy were investigated in a group of adult subjects. Based on these findings, and the results of a previous study (Vandali et al., 2000), a number of recommendations for programming were identified that could improve efficiency in the clinical setting where time may be limited. The results suggest that speech perception benefits may be maximized for an individual cochlear implant recipient through concentration on selection of the appropriate stimulation rate. When using the CIS strategy, the number of channels should also be optimized. Adjustment to the number of maxima in the ACE strategy was found to be less likely to provide improvements in speech recognition for a given individual when the number of maxima parameter is set to eight or 12.

Pitch and loudness matching of unmodulated and modulated stimuli in cochlear implantees.

The pitch elicited by unmodulated and amplitude modulated electrical pulse trains was examined with six adult cochlear implantees. In addition, for three of those subjects who had some hearing in their contralateral ear, the pitch of unmodulated electrical pulse trains was compared to that of complex harmonic acoustic tones. In the first experiment, pulse rate discrimination and the effects of place and level differences on pitch were examined for unmodulated pulse trains. General results were consistent with previous studies showing that variations in pulse rate, while holding loudness fixed, elicit changes in pitch at low rates, but become progressively harder to discriminate as rates approach approximately 300 pulses-per-second. Variations in place or level of stimulation generally produced changes in pitch consistent with tonotopic place and spread of excitation. In the second experiment, pitch and loudness of unmodulated pulse trains were compared with those of amplitude modulated stimuli as a function of modulation depth, rate, and shape, and presentation level. The pitch elicited by an amplitude modulated pulse train was generally higher than that of an unmodulated pulse train with a pulse rate equal to the modulation rate, and generally decreased toward that of the unmodulated pulse train as modulation depth or rate increased, or as presentation level decreased. Sharper/narrower modulation produced lower pitch. In the final experiment, the pitch heights of acoustic complex harmonic tones and unmodulated pulse trains were compared. When electrical pulse rate was equal to the fundamental frequency of the acoustic tone, similar pitch heights were elicited. The results from these experiments indicate that F0 rate pitch derived from the temporal envelope in existing clinical cochlear implant strategies may often be higher than that of acoustic harmonic tones at the same F0 in normal hearing, and that pitch growth with increasing F0 may be shallower. The relationship between F0 and rate pitch is expected to be more similar to acoustic stimulation for low F0 rates when using new pitch coding strategies that code F0 information via deep (narrow) amplitude modulation of the stimulus envelope. Although that similarity reduces as F0 approaches the upper limit of rate-pitch discrimination, that limit is reached sooner for the shallow (or broad) modulators used in existing clinical strategies.

Pitch ranking ability of cochlear implant recipients: a comparison of sound-processing strategies.

Pitch ranking of sung vowel stimuli, separated in fundamental frequency (F0) by half an octave, was measured with a group of eleven Nucleus 24 cochlear implant recipients using different sound coding strategies. In three consecutive studies, either two or three different sound coding strategies were compared to the Advanced Combinational Encoder (ACE) strategy. These strategies included Continuous Interleaved Sampling (CIS), Peak Derived Timing (PDT), Modulation Depth Enhancement (MDE), F0 Synchronized ACE (FOSync), and Multi-channel Envelope Modulation (MEM), the last four being experimental strategies. While pitch ranking results on average were poor compared to those expected for most normal hearing listeners, significantly higher scores were obtained using the MEM, MDE, and FOSync strategies compared to ACE. These strategies enhanced coding of temporal F0 cues by providing deeper modulation cues to F0 coincidentally in time across all activated electrodes. In the final study, speech recognition tests were also conducted using ACE, CIS, MDE, and MEM. Similar results among all strategies were obtained for word tests in quiet and between ACE and MEM for sentence tests in noise. These findings demonstrate that strategies such as MEM may aid perception of pitch and still adequately code segmental speech features as per existing coding strategies.