Electro-Tactile Stimulation Enhances Cochlear-Implant Melody Recognition: Effects of Rhythm and Musical Training.

OBJECTIVES: Electro-acoustic stimulation (EAS) enhances speech and music perception in cochlear-implant (CI) users who have residual low-frequency acoustic hearing. For CI users who do not have low-frequency acoustic hearing, tactile stimulation may be used in a similar fashion as residual low-frequency acoustic hearing to enhance CI performance. Previous studies showed that electro-tactile stimulation (ETS) enhanced speech recognition in noise and tonal language perception for CI listeners. Here, we examined the effect of ETS on melody recognition in both musician and nonmusician CI users. DESIGN: Nine musician and eight nonmusician CI users were tested in a melody recognition task with or without rhythmic cues in three testing conditions: CI only (E), tactile only (T), and combined CI and tactile stimulation (ETS). RESULTS: Overall, the combined electrical and tactile stimulation enhanced the melody recognition performance in CI users by 9% points. Two additional findings were observed. First, musician CI users outperformed nonmusicians CI users in melody recognition, but the size of the enhancement effect was similar between the two groups. Second, the ETS enhancement was significantly higher with nonrhythmic melodies than rhythmic melodies in both groups. CONCLUSIONS: These findings suggest that, independent of musical experience, the size of the ETS enhancement depends on integration efficiency between tactile and auditory stimulation, and that the mechanism of the ETS enhancement is improved electric pitch perception. The present study supports the hypothesis that tactile stimulation can be used to improve pitch perception in CI users.

Development of a Test Battery for Evaluating Speech Perception in Complex Listening Environments: Effects of Sensorineural Hearing Loss.

OBJECTIVE: To evaluate the speech-in-noise performance of listeners with different levels of hearing loss in a variety of complex listening environments. DESIGN: The quick speech-in-noise (QuickSIN)-based test battery was used to measure the speech recognition performance of listeners with different levels of hearing loss. Subjective estimates of speech reception thresholds (SRTs) corresponding to 100% and 0% speech intelligibility, respectively, were obtained using a method of adjustment before objective measurement of the actual SRT corresponding to 50% speech intelligibility in every listening condition. RESULTS: Of the seven alternative listening conditions, two conditions, one involving time-compressed, reverberant speech (TC+Rev), and the other (N0Sπ) having in-phase noise masker (N0) and out-of-phase target (Sπ), were found to be substantially more sensitive to the effect of hearing loss than the standard QuickSIN test. The performance in these two conditions also correlated with self-reported difficulties in attention/concentration during speech communication and in localizing the sound source, respectively. Hearing thresholds could account for about 50% or less variance in SRTs in any listening condition. Subjectively estimated SRTs (SRTs corresponding to 0% and 100% speech intelligibility) were highly correlated with the objective SRT measurements (SRT corresponding to 50% speech intelligibility). CONCLUSIONS: A test battery that includes the TC+Rev and the N0Sπ conditions would be useful in identifying individuals with hearing loss with speech-in-noise deficits in everyday communication.

Pre- and Postoperative Binaural Unmasking for Bimodal Cochlear Implant Listeners.

OBJECTIVES: Cochlear implants (CIs) are increasingly recommended to individuals with residual bilateral acoustic hearing. Although new hearing-preserving electrode designs and surgical approaches show great promise, CI recipients are still at risk to lose acoustic hearing in the implanted ear, which could prevent the ability to take advantage of binaural unmasking to aid speech recognition in noise. This study examined the tradeoff between the benefits of a CI for speech understanding in noise and the potential loss of binaural unmasking for CI recipients with some bilateral preoperative acoustic hearing. DESIGN: Binaural unmasking is difficult to evaluate in CI candidates because speech perception in noise is generally too poor to measure reliably in the range of signal to noise ratios (SNRs) where binaural intelligibility level differences (BILDs) are typically observed (<5 dB). Thus, a test of audiovisual speech perception in noise was employed to increase performance to measureable levels. BILDs were measured preoperatively for 11 CI candidates and at least 5 months post-activation for 10 of these individuals (1 individual elected not to receive a CI). Audiovisual sentences were presented in speech-shaped masking noise between -10 and +15 dB SNR. The noise was always correlated between the ears, while the speech signal was either correlated (N0S0) or inversely correlated (N0Sπ). Stimuli were delivered via headphones to the unaided ear(s) and, where applicable, via auxiliary input to the CI speech processor. A z test evaluated performance differences between the N0S0 and N0Sπ conditions for each listener pre- and postoperatively. For listeners showing a significant difference, the magnitude of the BILD was characterized as the difference in SNRs required to achieve 50% correct performance. One listener who underwent hearing-preservation surgery received additional postoperative tests, which presented sound directly to both ears and to the CI speech processor. RESULTS: Five of 11 listeners showed a significant preoperative BILD (range: 2.0 to 7.3 dB). Only 2 of these 5 showed a significant postoperative BILD, but the mean BILD was smaller (1.3 dB) than that observed preoperatively (3.1 dB). Despite the fact that some listeners lost the preoperative binaural benefit, 9 out of 10 listeners tested postoperatively had performance equal to or better than their best pre-CI performance. The listener who retained functional acoustic hearing in the implanted ear also demonstrated a preserved acoustic BILD postoperatively. CONCLUSIONS: Approximately half of the CI candidates in this study demonstrated preoperative binaural hearing benefits for audiovisual speech perception in noise. Most of these listeners lost their acoustic hearing in the implanted ear after surgery (using nonhearing-preservation techniques), and therefore lost access to this binaural benefit. In all but one case, any loss of binaural benefit was compensated for or exceeded by an improvement in speech perception with the CI. Evidence of a preoperative BILD suggests that certain CI candidates might further benefit from hearing-preservation surgery to retain acoustic binaural unmasking, as demonstrated for the listener who underwent hearing-preservation surgery. This test of binaural audiovisual speech perception in noise could serve as a diagnostic tool to identify CI candidates who are most likely to receive functional benefits from their bilateral acoustic hearing.

Performance in noise: Impact of reduced speech intelligibility on Sailor performance in a Navy command and control environment.

Noise, hearing loss, and electronic signal distortion, which are common problems in military environments, can impair speech intelligibility and thereby jeopardize mission success. The current study investigated the impact that impaired communication has on operational performance in a command and control environment by parametrically degrading speech intelligibility in a simulated shipborne Combat Information Center. Experienced U.S. Navy personnel served as the study participants and were required to monitor information from multiple sources and respond appropriately to communications initiated by investigators playing the roles of other personnel involved in a realistic Naval scenario. In each block of the scenario, an adaptive intelligibility modification system employing automatic gain control was used to adjust the signal-to-noise ratio to achieve one of four speech intelligibility levels on a Modified Rhyme Test: No Loss, 80%, 60%, or 40%. Objective and subjective measures of operational performance suggested that performance systematically degraded with decreasing speech intelligibility, with the largest drop occurring between 80% and 60%. These results confirm the importance of noise reduction, good communication design, and effective hearing conservation programs to maximize the operational effectiveness of military personnel.

The effects of elevated hearing thresholds on performance in a paintball simulation of individual dismounted combat.

OBJECTIVE: To examine the relationship between hearing acuity and operational performance in simulated dismounted combat. DESIGN: Individuals wearing hearing loss simulation systems competed in a paintball-based exercise where the objective was to be the last player remaining. Four hearing loss profiles were tested in each round (no hearing loss, mild, moderate and severe) and four rounds were played to make up a match. This allowed counterbalancing of simulated hearing loss across participants. STUDY SAMPLE: Forty-three participants across two data collection sites (Fort Detrick, Maryland and the United States Military Academy, New York). All participants self-reported normal hearing except for two who reported mild hearing loss. RESULTS: Impaired hearing had a greater impact on the offensive capabilities of participants than it did on their "survival", likely due to the tendency for individuals with simulated impairment to adopt a more conservative behavioural strategy than those with normal hearing. CONCLUSIONS: These preliminary results provide valuable insights into the impact of impaired hearing on combat effectiveness, with implications for the development of improved auditory fitness-for-duty standards, the establishment of performance requirements for hearing protection technologies, and the refinement of strategies to train military personnel on how to use hearing protection in combat environments.

Development of a test battery for evaluating speech perception in complex listening environments.

In the real world, spoken communication occurs in complex environments that involve audiovisual speech cues, spatially separated sound sources, reverberant listening spaces, and other complicating factors that influence speech understanding. However, most clinical tools for assessing speech perception are based on simplified listening environments that do not reflect the complexities of real-world listening. In this study, speech materials from the QuickSIN speech-in-noise test by Killion, Niquette, Gudmundsen, Revit, and Banerjee [J. Acoust. Soc. Am. 116, 2395-2405 (2004)] were modified to simulate eight listening conditions spanning the range of auditory environments listeners encounter in everyday life. The standard QuickSIN test method was used to estimate 50% speech reception thresholds (SRT50) in each condition. A method of adjustment procedure was also used to obtain subjective estimates of the lowest signal-to-noise ratio (SNR) where the listeners were able to understand 100% of the speech (SRT100) and the highest SNR where they could detect the speech but could not understand any of the words (SRT0). The results show that the modified materials maintained most of the efficiency of the QuickSIN test procedure while capturing performance differences across listening conditions comparable to those reported in previous studies that have examined the effects of audiovisual cues, binaural cues, room reverberation, and time compression on the intelligibility of speech.