Integrated bimodal fitting and binaural streaming technology outcomes for unilateral cochlear implant users.

OBJECTIVE: Adults typically receive only one cochlear implant (CI) due to cost constraints, with a contralateral hearing aid recommended when there is aidable hearing. Standard hearing aids differ from a CI in terms of processing strategy and function as a separate entity, requiring the user to integrate the disparate signals. Integrated bimodal technology has recently been introduced to address this challenge. The aim of the study was to investigate the performance of unilateral CI users with and without an integrated bimodal fitting and determine whether binaural streaming technology offers additional benefit. STUDY SAMPLE: Twenty-six CI users using integrated bimodal technology. DESIGN: Repeated measures where outcomes and user experience were assessed using a functional test battery more representative of real life listening (speech perception in noise tests, localisation test, tracking test) and the speech, spatial and qualities-of-hearing scale (SSQ). RESULTS: Bimodal outcomes were significantly better than for CI alone. Speech perception in noise improvements ranged from 1.4 dB to 3.5 dB depending on the location of speech and noise. The localisation and tracking tests, and the SSQ also showed significant improvements. Binaural streaming offered additional improvement (1.2 dB to 6.1 dB on the different speech tests). CONCLUSIONS: Integrated bimodal and binaural streaming technology improved the performance of unilateral CI users.

Transient otoacoustic emissions and audiogram fine structure in the extended high-frequency region.

OBJECTIVE: Previous studies at conventional audiometric frequencies found associations between the ripple depth seen in audiogram fine structure (AFS) and amplitudes of both transient evoked otoacoustic emissions (TEOAEs) and overall hearing threshold levels (HTLs). These associations are explained by the cochlear mechanical theory of multiple coherent reflections of the travelling wave apically by reflections sites on the basilar membrane and basally by the stapes. DESIGN: The aim was to investigate whether a similar relationship is seen in the extended high-frequency (EHF) range from 8-16 kHz. Measurements from 8-16 kHz were obtained in normal-hearing subjects comprising EHF HTLs, EHF TEOAEs using a double evoked paradigm, and Bekesy audiometry to assess AFS ripple depth and spectral periodicity. STUDY SAMPLE: Twenty eight normal-hearing subjects participated. RESULTS: Results showed no significant correlation between AFS ripple depth and either frequency-averaged EHF HTLs or EHF TEOAE amplitudes. The amplitude of AFS ripple depth was also lower than that seen in the conventional frequency region and spectral periodicity in the ripple more difficult to discern. CONCLUSION: The results suggest a weaker interference pattern between forward and reverse cochlear travelling waves in the most basal region compared to more apical regions, or a difference in cochlear mechanical properties.

Deductive development and validation of a questionnaire to assess sensitivity to very low and very high frequency sounds: SISUS-Q (Sensitivity to Infra-Sound and Ultra-Sound Questionnaire).

OBJECTIVE: Auditory research and complaints about environmental noise indicate that there exists a significant, small subgroup within the population which is sensitive towards infra- and low-frequency or ultra- and high-frequency sounds (ILF/UHF). This paper reports on the development, factorization and validation of measures of sensitivity towards frequencies outside the common hearing range. DESIGN: A multinational, cross-sectional survey study was run. Principal component analyses and exploratory factor analyses were conducted in a sample of 267 Europeans (from the UK, Slovenia, and Germany). RESULTS: The factor analyses suggested that ILF versus UHF sensitivity constitute different factors, each characterized by sensory perception, stress-responsivity, and behavioral avoidance. A third factor comprising beliefs of dangerousness of ILF and UHF emerged. The factors explained 72% of the variance. The factor-solution was replicated separately for the English (n = 98) and German (n = 169) versions of the questionnaire (Slovenians and UK residents filled out the English version). Acceptable to excellent reliability was found. ILF and UHF sensitivity were moderately related to noise sensitivity in the normal hearing range, suggesting the new measures are not redundant. Correlations with psychiatric and somatic symptoms were small to moderate. ILF sensitivity correlated with neuroticism (small effect) and daytime sleepiness (moderate effect). ILF and UHF sensitivity were related to agreeableness (small effects). Overall, the novel ILF and UHF sensitivity scales seems to provide a solid tool for conducting further research on the role of sensitivity concerning adverse effects of ILF and UHF sound (e.g. health outcomes, annoyance ratings). The questionnaire consortium recommends using the new scales in combination with established measures of normal hearing range sensitivity.

COAST (Cisplatin ototoxicity attenuated by aspirin trial): A phase II double-blind, randomised controlled trial to establish if aspirin reduces cisplatin induced hearing-loss.

BACKGROUND: Cisplatin is one of the most ototoxic chemotherapy drugs, resulting in a permanent and irreversible hearing loss in up to 50% of patients. Cisplatin and gentamicin are thought to damage hearing through a common mechanism, involving reactive oxygen species in the inner ear. Aspirin has been shown to minimise gentamicin-induced ototoxicity. We, therefore, tested the hypothesis that aspirin could also reduce ototoxicity from cisplatin-based chemotherapy. METHODS: A total of 94 patients receiving cisplatin-based chemotherapy for multiple cancer types were recruited into a phase II, double-blind, placebo-controlled trial and randomised in a ratio of 1:1 to receive aspirin 975 mg tid and omeprazole 20 mg od, or matched placebos from the day before, to 2 days after, their cisplatin dose(s), for each treatment cycle. Patients underwent pure tone audiometry before and at 7 and 90 days after their final cisplatin dose. The primary end-point was combined hearing loss (cHL), the summed hearing loss at 6 kHz and 8 kHz, in both ears. RESULTS: Although aspirin was well tolerated, it did not protect hearing in patients receiving cisplatin (p-value = 0.233, 20% one-sided level of significance). In the aspirin arm, patients demonstrated mean cHL of 49 dB (standard deviation [SD] 61.41) following cisplatin compared with placebo patients who demonstrated mean cHL of 36 dB (SD 50.85). Women had greater average hearing loss than men, and patients treated for head and neck malignancy experienced the greatest cHL. CONCLUSIONS: Aspirin did not protect from cisplatin-related ototoxicity. Cisplatin and gentamicin may therefore have distinct ototoxic mechanisms, or cisplatin-induced ototoxicity may be refractory to the aspirin regimen used here.

Efficient time-domain simulation of nonlinear, state-space, transmission-line models of the cochlea (L).

Nonlinear models of the cochlea are best implemented in the time domain, but their computational demands usually limit the duration of the simulations that can reasonably be performed. This letter presents a modified state space method and its application to an example nonlinear one-dimensional transmission-line cochlear model. The sparsity pattern of the individual matrices for this alternative formulation allows the use of significantly faster numerical algorithms. Combined with a more efficient implementation of the saturating nonlinearity, the computational speed of this modified state space method is more than 40 times faster than that of the original formulation.

Fit for the frontline? A focus group exploration of auditory tasks carried out by infantry and combat support personnel.

In order to preserve their operational effectiveness and ultimately their survival, military personnel must be able to detect important acoustic signals and maintain situational awareness. The possession of sufficient hearing ability to perform job-specific auditory tasks is defined as auditory fitness for duty (AFFD). Pure tone audiometry (PTA) is used to assess AFFD in the UK military; however, it is unclear whether PTA is able to accurately predict performance on job-specific auditory tasks. The aim of the current study was to gather information about auditory tasks carried out by infantry personnel on the frontline and the environment these tasks are performed in. The study consisted of 16 focus group interviews with an average of five participants per group. Eighty British army personnel were recruited from five infantry regiments. The focus group guideline included seven open-ended questions designed to elicit information about the auditory tasks performed on operational duty. Content analysis of the data resulted in two main themes: (1) the auditory tasks personnel are expected to perform and (2) situations where personnel felt their hearing ability was reduced. Auditory tasks were divided into subthemes of sound detection, speech communication and sound localization. Reasons for reduced performance included background noise, hearing protection and attention difficulties. The current study provided an important and novel insight to the complex auditory environment experienced by British infantry personnel and identified 17 auditory tasks carried out by personnel on operational duties. These auditory tasks will be used to inform the development of a functional AFFD test for infantry personnel.

Theoretical analysis of signal-to-noise ratios for transient evoked otoacoustic emission recordings.

Recordings of transient-evoked otoacoustic emissions (TEOAEs) suffer from two main sources of contamination: Random noise and the stimulus artifact. The stimulus artifact can be substantially reduced by using a derived non-linear recording paradigm. Three such paradigms are analyzed, called here the level derived non-linear (LDNL), the double-evoked (DE), and the rate derived non-linear (RDNL) paradigms. While these methods successfully reduce the stimulus artifact, they lead to an increase in contamination by random noise. In this study, the signal-to-noise ratio (SNR) achievable by these three paradigms is compared using a common theoretical framework. This analysis also allows the optimization of the parameters of the RDNL paradigm to achieve the maximum SNR. Calculations based on the analysis with typical parameters used in practice suggest that when ranked in terms of their SNR for a given averaging time, RDNL performs best followed by the LDNL and DE paradigms.

A wave finite element analysis of the passive cochlea.

Current models of the cochlea can be characterized as being either based on the assumed propagation of a single slow wave, which provides good insight, or involve the solution of a numerical model, such as in the finite element method, which allows the incorporation of more detailed anatomical features. In this paper it is shown how the wave finite element method can be used to decompose the results of a finite element calculation in terms of wave components, which allows the insight of the wave approach to be brought to bear on more complicated numerical models. In order to illustrate the method, a simple box model is considered, of a passive, locally reacting, basilar membrane interacting via three-dimensional fluid coupling. An analytic formulation of the dispersion equation is used initially to illustrate the types of wave one would expect in such a model. The wave finite element is then used to calculate the wavenumbers of all the waves in the finite element model. It is shown that only a single wave type dominates the response until this peaks at the best place in the cochlea, where an evanescent, higher order fluid wave can make a significant contribution.

Effect of contralateral acoustic stimulation on cochlear tuning measured using stimulus frequency and distortion product OAEs.

OBJECTIVE: To study whether a change in cochlear tuning, measured using OAEs, could be detected due to contralateral activation of the efferent system using broadband noise. DESIGN: Cochlear tuning measures based on SFOAE phase gradients and SFOAE-2TS 'Q' were used to test this hypothesis. SFOAE magnitude and phase gradient were measured using a pure-tone sweep from 1248 to 2496 Hz at 50 dB SPL. 2TS curves of SFOAE were recorded with a suppressor frequency swept from 1120 to 2080 Hz at 50 dB SPL. DPOAE f2-sweep phase gradient was also obtained to allow comparisons with the literature. All three assays were performed across with- and no-CAS conditions. STUDY SAMPLE: Twenty-two young, normal-hearing adults. RESULTS: CAS did not produce a statistically significant change in the tuning metric in any of the OAE methods used, despite producing significant reductions in the OAE magnitude. CONCLUSION: It is unknown whether this insensitivity to CAS is due to an insensitivity of these three measures to cochlear mechanical tuning. The results suggest that any changes in tuning induced by CAS that may occur are small and difficult to detect using the OAE measurement paradigms used here.

Investigating the wave-fixed and place-fixed origins of the 2f(1)-f(2) distortion product otoacoustic emission within a micromechanical cochlear model.

The 2f(1)-f(2) distortion product otoacoustic emission (DPOAE) arises within the cochlea due to the nonlinear interaction of two stimulus tones (f(1) and f(2)). It is thought to comprise contributions from a wave-fixed source and a place-fixed source. The generation and transmission of the 2f(1)-f(2) DPOAE is investigated here using quasilinear solutions to an elemental model of the human cochlea with nonlinear micromechanics. The micromechanical parameters and nonlinearity are formulated to match the measured response of the cochlea to single- and two-tone stimulation. The controlled introduction of roughness into the active micromechanics of the model allows the wave- and place-fixed contributions to the DPOAE to be studied separately. It is also possible to manipulate the types of nonlinear suppression that occur within the quasilinear model to investigate the influence of stimulus parameters on DPOAE generation. The model predicts and explains a variety of 2f(1)-f(2) DPOAE phenomena: The dependence of emission amplitude on stimulus parameters, the weakness of experiments designed to quantify cochlear amplifier gain, and the predominant mechanism which gives rise to DPOAE fine structure. In addition, the model is used to investigate the properties of the wave-fixed source and how these properties are influenced by the stimulus parameters.

Fluid coupling in a discrete model of cochlear mechanics.

A discrete model of cochlear mechanics is introduced that includes a full, three-dimensional, description of fluid coupling. This formulation allows the fluid coupling and basilar membrane dynamics to be analyzed separately and then coupled together with a simple piece of linear algebra. The fluid coupling is initially analyzed using a wavenumber formulation and is separated into one component due to one-dimensional fluid coupling and one comprising all the other contributions. Using the theory of acoustic waves in a duct, however, these two components of the pressure can also be associated with a far field, due to the plane wave, and a near field, due to the evanescent, higher order, modes. The near field components are then seen as one of a number of sources of additional longitudinal coupling in the cochlea. The effects of non-uniformity and asymmetry in the fluid chamber areas can also be taken into account, to predict both the pressure difference between the chambers and the mean pressure. This allows the calculation, for example, of the effect of a short cochlear implant on the coupled response of the cochlea.

Spontaneous otoacoustic emissions measured using an open ear-canal recording technique.

Spontaneous otoacoustic emissions (SOAEs) and synchronized spontaneous otoacoustic emissions (SSOAEs) were recorded using both the standard closed-canal method of recording and a novel open-canal method which involved suspending the probe at the entrance to the ear canal with no occluding tip. In both conditions, a probe tube microphone was inserted down the ear canal to measure the acoustic pressure near the tympanic membrane. Open- and closed-canal recordings were obtained in twelve otologically normal ears, all of which exhibited SSOAEs, and 6 of which exhibited SOAEs. The results were analysed to identify any differences in response to frequency and amplitude. The different recording conditions appeared to have no significant effect on SOAE or SSOAE frequency, suggesting little effect on the SOAE generator within the cochlea. Below about 2 kHz, the amplitude for both types of emission was less for the open-canal recording when compared to the closed-canal recordings. Above 2 kHz, SSOAE amplitudes were greater in the open- than the closed-canal condition. Model stimulations of the ear canal and middle-ear acoustics are presented which were in qualitative agreement with the results shown for the effects on emission amplitudes.

The influence on predicted harmonic and distortion product generation of the position of the nonlinearity within cochlear micromechanical models.

Numerical techniques are used to explore the influence on the predicted basilar membrane (BM) response of the position of the nonlinearity within the micromechanical feedback loop of an active nonlinear cochlear model. This position is found to influence both the harmonic and distortion product spectra of the predicted BM response. The BM motion at the fundamental or primary frequencies is not significantly altered by the position of the nonlinearity, however, provided that the gain is appropriately adjusted. The observed effects are explained in terms of the frequency responses of the elements within the micromechanical feedback loop.

Limit cycle oscillations in a nonlinear state space model of the human cochlea.

It is somewhat surprising that linear analysis can account for so many features of the cochlea when it is inherently nonlinear. For example, the commonly detected spacing between adjacent spontaneous otoacoustic emissions (SOAEs) is often explained by a linear theory of "coherent reflection" [Zweig and Shera (1995). J. Acoust. Soc. Am. 98, 2018-2047]. The nonlinear saturation of the cochlear amplifier is, however, believed to be responsible for stabilizing the amplitude of a SOAE. In this investigation, a state space model is used to first predict the linear instabilities that arise, given distributions of cochlear inhomogeneities, and then subsequently to simulate the time-varying spectra of the nonlinear models. By comparing nonlinear simulation results to linear predictions, it is demonstrated that nonlinear effects can have a strong impact on the steady-state response of an unstable cochlear model. Sharply tuned components that decay away exponentially within 100 ms are shown to be due to linearly resonant modes of the model generated by the cochlear inhomogeneities. Some oscillations at linearly unstable frequencies are suppressed over a longer time scale, whereas those that persist are due to linear instabilities and their distortion products.

Comparing two proposed measures of cochlear mechanical filter bandwidth based on stimulus frequency otoacoustic emissions.

It has been hypothesized that the sharpness of the cochlear mechanical filter is related to two measures based on stimulus frequency otoacoustic emissions (SFOAEs). The first is the group delay of the SFOAE; the second is the bandwidth of the SFOAE two-tone suppression isoinput tuning characteristic. A corollary of this is that natural variability in cochlear mechanical bandwidth within a population would lead to a positive correlation between these two SFOAE-based measures of tuning within that population. To test this prediction, SFOAE group delay and SFOAE two-tone suppression isoinput tuning characteristics were measured in a sample of 16 audiometrically normal subjects. Contrary to the prediction, no statistically significant correlation was found between the two bandwidth measures. Cochlear model simulations were used to aid the interpretation of this result. These suggested that a positive correlation between the two measures is expected, but that it may well be too weak to detect with the given sample size, due to the influence on the SFOAE measures of random inhomogeneities in basilar membrane impedance.

Statistics of instabilities in a state space model of the human cochlea.

A state space model of the human cochlea is used to test Zweig and Shera's [(1995) "The origin of periodicity in the spectrum of evoked otoacoustic emissions," J. Acoust. Soc. Am. 98(4), 2018-2047 ] multiple-reflection theory of spontaneous otoacoustic emission (SOAE) generation. The state space formulation is especially well suited to this task as the unstable frequencies of an active model can be rapidly and unambiguously determined. The cochlear model includes a human middle ear boundary and matches human enhancement, tuning, and traveling wave characteristics. Linear instabilities can arise across a wide bandwidth of frequencies in the model when the smooth spatial variation of basilar membrane impedance is perturbed, though it is believed that only unstable frequencies near the middle ear's range of greatest transmissibility are detected as SOAEs in the ear canal. The salient features of Zweig and Shera's theory are observed in this active model given several classes of perturbations in the distribution of feedback gain along the cochlea. Spatially random gain variations are used to approximate what may exist in human cochleae. The statistics of the unstable frequencies for random, spatially dense variations in gain are presented; the average spacings of adjacent unstable frequencies agree with the preferred minimum distance observed in human SOAE data.

The effect of stimulus rate and time-separation on Volterra slices of otoacoustic emissions.

Volterra slices (VSs) of otoacoustic emissions are temporal non-linear interaction components which can be measured using the maximum length sequence technique of stimulation. Previous studies have found, but not explained, non-monotonic variations in the amplitude of VSs when stimulus rate is increased. In this study, a simple phenomenological model is investigated which provided possible insights into the effect of rate on VS amplitudes. Resulting theoretical considerations suggest that the effect of rate on VS amplitude is best examined when the time-separation parameter of the VS is held constant. To test these suggestions, data on VSs of order 2 and 3 were measured in 24 normal hearing ears in which the rate is varied while holding constant the time-separation. Under these conditions, the results reveal a monotonic reduction in the amplitude of the VSs with increasing rate. The phenomenological model offers a possible explanation of some of these results in terms of the derivatives of the input-output function of the non-linearity. In addition, measured cross-correlations between waveforms of VS of different order and slice number were obtained, revealing a complex dependence on time-separation that has not been explained.

Click-evoked otoacoustic emissions (CEOAEs) recorded from neonates under 13 hours old using conventional and maximum length sequence (MLS) stimulation.

Maximum length sequence (MLS) stimulation allows click evoked otoacoustic emissions (CEOAEs) to be averaged at very high stimulation rates. This enables a faster reduction of noise contamination of the response, and has been shown to improve the signal-to-noise ratio (SNR) of CEOAEs recorded from adult subjects. This study set out to investigate whether MLS averaging can enhance the SNR of CEOAEs recorded in newborns within the first day after birth, and so improve the pass rates for OAE screening in this period, when false alarm rates are very high. CEOAEs were recorded in a neonatal ward from 57 ears in 37 newborns ranging from 6 to 13h old, using both conventional (50/s) and high rate (5000/s) MLS averaging. SNR values and pass rates were compared for responses obtained within equal recording times at both rates. MLS averaging produced an SNR improvement of up to 3.8dB, with the greatest improvement found in higher frequency bands. This SNR advantage resulted in pass rate improvement between 5% and 10%, depending on pass criterion. A significant effect of age was found on both SNR and pass rate, with newborns between 6 and 10h old showing significantly lower values than those tested between 10 and 13h after birth, as well as a much greater improvement due to MLS averaging. The findings show that MLS averaging can reduce false alarm rates by up to 15% in very young neonates in a neonatal ward setting.

A state space model for cochlear mechanics.

The stability of a linear model of the active cochlea is difficult to determine from its calculated frequency response alone. A state space model of the cochlea is presented, which includes a discretized set of general micromechanical elements coupled via the cochlear fluid. The stability of this time domain model can be easily determined in the linear case, and the same framework used to simulate the time domain response of nonlinear models. Examples of stable and unstable behavior are illustrated using the active micromechanical model of Neely and Kim. The stability of this active cochlea is extremely sensitive to abrupt spatial inhomogeneities, while smoother inhomogeneities are less likely to cause instability. The model is a convenient tool for investigating the presence of instabilities due to random spatial inhomogeneities. The number of unstable poles is found to rise sharply with the relative amplitude of the inhomogeneities up to a few percent, but to be significantly reduced if the spatial variation is smoothed. In a saturating nonlinear model, such instabilities generate limit cycles that are thought to produce spontaneous otoacoustic emissions. An illustrative time domain simulation is presented, which shows how an unstable model evolves into a limit cycle, distributed along the cochlea.

Modeling the effect of suppression on the periodicity of stimulus frequency otoacoustic emissions.

The distributed roughness theory of the origins of spectral periodicity in stimulus frequency otoacoustic emissions (SFOAEs) predicts that the spectral period will be altered by suppression of the traveling wave (TW) [Zweig and Shera, J. Acoust. Soc. Am. 98, 2018-2047 (1995)]. In order to investigate this effect in more detail, simulations of the variation of the spectral period under conditions of self-suppression and two-tone suppression are obtained from nonlinear cochlear models based on this theory. The results show that during self-suppression the spectral period is increased, while during high-side two-tone suppression, the period is reduced, indicating that the detailed pattern of disruption of the cochlear amplifier must be examined if the nonlinear behavior of SFOAEs is to be understood. The model results suggest that the SFOAE spectral period may be sensitive to changes in the state of the cochlear amplifier. A companion paper [Lineton and Lutman, J. Acoust. Soc. Am. 114, 871-882 (2003)] presents experimental data which are compared with the results of the above models with a view to testing the underlying theory of Zweig and Shera.