Tinnitus Activities Treatment with Total and Partial Masking.

BACKGROUND: There are many counseling and sound therapy approaches to treat tinnitus. Counseling approaches range from providing information using directive or collaborative approaches. Sound therapies include strategies that use background sounds to totally or partially mask tinnitus to reduce the prominence of or decrease the loudness or annoyance of the tinnitus. PURPOSE: We evaluated the effectiveness of tinnitus activities treatment (TAT) in two groups, those without hearing aids (HA) and those who were provided with HA. In both groups, comparisons were made among those receiving (1) counseling only, (2) counseling and partial masking, and (3) counseling and total masking. RESEARCH DESIGN: Participants were provided with HA or not, based on their choice, and then randomly assigned to one of the three groups. The Tinnitus Handicap Questionnaire (THQ) was used as the primary measure. RESULTS: For those without HA, significant benefits were obtained for 8 out of 22 participants in the counseling group, 8 of 13 in the total masking group, and 8 of 24 in the partial mask group. The average decrease in the THQ was 15% for the counseling group, 25% for the total mask, and 14% for the partial masking group. For those with HA; significant benefits were obtained for 5 of 16 in the counseling group, 3 of 14 in the total mask group, and 6 of 13 in the partial mask group. The average decrease in the THQ score was 12% for counseling, 13% for total masking, and 16% for partial masking. No significant differences among groups were observed. CONCLUSION: Individual differences were large. Many benefited from their treatment, but some did not. We believe this was likely influenced by their expectations.

Reliability of the Minimum Masking Level as Outcome Variable in Tinnitus Clinical Research.

Purpose The minimum masking level (MML) is the minimum intensity of a stimulus required to just totally mask the tinnitus. Treatments aimed at reducing the tinnitus itself should attempt to measure the magnitude of the tinnitus. The objective of this study was to evaluate the reliability of the MML. Method Sample consisted of 59 tinnitus patients who reported stable tinnitus. We obtained MML measures on two visits, separated by about 2-3 weeks. We used two noise types: speech-shaped noise and high-frequency emphasis noise. We also investigated the relationship between the MML and tinnitus loudness estimates and the Tinnitus Handicap Questionnaire (THQ). Results There were differences across the different noise types. The within-session standard deviation averaged across subjects varied between 1.3 and 1.8 dB. Across the two sessions, the Pearson correlation coefficients, range was r = .84. There was a weak relationship between the dB SL MML and loudness, and between the MML and the THQ. A moderate correlation (r = .44) was found between the THQ and loudness estimates. Conclusions We conclude that the dB SL MML can be a reliable estimate of tinnitus magnitude, with expected standard deviations in trained subjects of about 1.5 dB. It appears that the dB SL MML and loudness estimates are not closely related.

Establishing a Group Educational Session for Hyperacusis Patients.

Purpose Audiologists should be treating hyperacusis patients. However, it can be difficult to know where to begin because treatment protocols and evidence-based treatment studies are lacking. A good place to start in any tinnitus and hyperacusis clinic is to incorporate a group educational session. Method Here, we outline our approach to establishing a hyperacusis group educational session that includes specific aspects of getting to know each patient to best meet their needs, understanding the problems associated with hyperacusis, explaining the auditory system and the relationship of hyperacusis to hearing loss and tinnitus, describing the influence of hyperacusis on daily life, and introducing treatment options. Subjective responses from 11 adults with hyperacusis, who participated in a recent clinical group education session, were discussed to illustrate examples from actual patients. Conclusions Due to the devastating nature of hyperacusis, patients need to be reassured that they are not alone and that they can rely on audiologists to provide support and guidance. A group approach can facilitate the therapeutic process by connecting patients with others who are also affected by hyperacusis, and by educating patients and significant others on hyperacusis and its treatment options. Supplemental Material https://doi.org/10.23641/asha.8121197.

Survey on the Effectiveness of Dietary Supplements to Treat Tinnitus.

PURPOSE: We surveyed the benefit of dietary supplements to treat tinnitus and reported adverse effects. METHOD: A website was created for people with tinnitus to complete a variety of questions. RESULTS: The 1,788 subjects who responded to questionnaires came from 53 different countries; 413 (23.1%) reported taking supplements. No effect on tinnitus was reported in 70.7%, improvement in 19.0%, and worsening in 10.3%. Adverse effects were reported in 6% (n = 36), including bleeding, diarrhea, headache, and others. Supplements were reported to be helpful for sleep: melatonin (effect size, d = 1.228) and lipoflavonoid (d = 0.5244); emotional reactions: melatonin (d = 0.6138) and lipoflavonoid (d = 0.457); hearing: Ginkgo biloba (d = 0.3758); and concentration Ginkgo biloba (d = 0.3611). The positive, subjective reports should be interpreted cautiously; many might have reported a positive effect because they were committed to treatment and expected a benefit. Users of supplements were more likely to have loudness hyperacusis and to have a louder tinnitus. CONCLUSIONS: The use of dietary supplements to treat tinnitus is common, particularly with Ginkgo biloba, lipoflavonoids, magnesium, melatonin, vitamin B12, and zinc. It is likely that some supplements will help with sleep for some patients. However, they are generally not effective, and many produced adverse effects. We concluded that dietary supplements should not be recommended to treat tinnitus but could have a positive outcome on tinnitus reactions in some people.

Manganese and Lipoflavonoid Plus(®) to Treat Tinnitus: A Randomized Controlled Trial.

BACKGROUND: Several tinnitus sufferers suggest that manganese has been helpful with their tinnitus. PURPOSE: We tested this in a controlled experiment where participants were committed to taking manganese and Lipoflavonoid Plus(®) to treat their tinnitus. RESEARCH DESIGN: Randomized controlled trial. STUDY SAMPLE: 40 participants were randomized to receive both manganese and Lipoflavonoid Plus(®) for 6 months, or Lipoflavonoid Plus(®) only (as the control). DATA COLLECTION AND ANALYSIS: Pre- and postmeasures were obtained with the Tinnitus Handicap Questionnaire, Tinnitus Primary Functions Questionnaire, and tinnitus loudness and annoyance ratings. An audiologist performed the audiogram, the tinnitus loudness match, and minimal masking level. RESULTS: Twelve participants were dropped out of the study because of the side effects or were lost to follow-up. In the manganese group, 1 participant (out of 12) showed a decrease in the questionnaires, and another showed a decrease in the loudness and annoyance ratings. No participants from the control group (total 16) showed a decrease in the questionnaires ratings. Two participants in the control group reported a loudness decrement and one reported an annoyance decrement. CONCLUSIONS: We were not able to conclude that either manganese or Lipoflavonoid Plus(®) is an effective treatment for tinnitus.

A Series of Case Studies of Tinnitus Suppression With Mixed Background Stimuli in a Cochlear Implant.

PURPOSE: Background sounds provided by a wearable sound playback device were mixed with the acoustical input picked up by a cochlear implant speech processor in an attempt to suppress tinnitus. METHOD: First, patients were allowed to listen to several sounds and to select up to 4 sounds that they thought might be effective. These stimuli were programmed to loop continuously in the wearable playback device. Second, subjects were instructed to use 1 background sound each day on the wearable device, and they sequenced the selected background sounds during a 28-day trial. Patients were instructed to go to a website at the end of each day and rate the loudness and annoyance of the tinnitus as well as the acceptability of the background sound. Patients completed the Tinnitus Primary Function Questionnaire (Tyler, Stocking, Secor, & Slattery, 2014) at the beginning of the trial. RESULTS: Results indicated that background sounds were very effective at suppressing tinnitus. There was considerable variability in sounds preferred by the subjects. CONCLUSION: The study shows that a background sound mixed with the microphone input can be effective for suppressing tinnitus during daily use of the sound processor in selected cochlear implant users.

Development and validation of the tinnitus primary function questionnaire.

PURPOSE: To create a questionnaire focused on the primary activities impaired by tinnitus and therefore more sensitive to treatments. METHOD: Questions were developed on (a) emotions, (b) hearing, (c) sleep, and (d) concentration. A 20-item questionnaire was administered to 158 patients. First, confirmatory factor analysis was used to select 3 questions per domain. Second, factor analysis was used to evaluate the appropriateness of the 12-item questionnaire. RESULTS: The analysis indicated that the selected questions successfully represented 4 independent domains. Scores were correlated with the Tinnitus Handicap Questionnaire ( r = .77, p < .01) and loudness ( r = .40, p < .01). The Sleep subscale correlated with the Pittsburgh Sleep Index ( r = .68, p < .01); the Emotion subscale correlated with the Beck Inventory ( r = .66, p < .01) and the Trait Anxiety questionnaire ( r = .67, p < .01). The average scores went from 51% to 38% following treatment. CONCLUSION: The Tinnitus Primary Function Questionnaire is valid, reliable, and sensitive and can be used to determine the efficacy of clinical trials.

Sequential bilateral cochlear implantation: speech perception and localization pre- and post-second cochlear implantation.

PURPOSE: In this study, the authors sought to compare speech perception and localization in subjects who wear 1 cochlear implant (unilateral CI) or 1 cochlear implant and hearing aid (CI+HA) and then receive a second cochlear implant (bilateral CI), and to evaluate the importance of the duration between implant surgeries and duration of deafness. METHOD: Nine subjects were tested on speech perception in quiet, and 13 subjects were tested on speech perception and localization in noise using an array of 8 loudspeakers. All subjects were tested with unilateral CI prior to bilateral implantation and then again with bilateral CI after at least 3 months of bilateral experience. RESULTS: No significant difference was found between bilateral CI and unilateral CI on averaged speech perception in quiet performance. A significant benefit was found for bilateral CI on averaged speech perception in noise and on localization. Nonsignificant correlations were found for duration between surgeries, duration of deafness, and duration of bilateral use. CONCLUSIONS: Improvements for speech perception and localization played in background noise were indicated for most subjects after they received their 2nd implant. The correlations should be reassessed with a larger number of subjects to appropriately evaluate the effects of duration between surgeries, duration of deafness, and duration of bilateral use.

Initial development of a spatially separated speech-in-noise and localization training program.

OBJECTIVE: This article describes the initial development of a novel approach for training hearing-impaired listeners to improve their ability to understand speech in the presence of background noise and to also improve their ability to localize sounds. DESIGN: Most people with hearing loss, even those well fit with hearing devices, still experience significant problems understanding speech in noise. Prior research suggests that at least some subjects can experience improved speech understanding with training. However, all training systems that we are aware of have one basic, critical limitation. They do not provide spatial separation of the speech and noise, therefore ignoring the potential benefits of training binaural hearing. In this paper we describe our initial experience with a home-based training system that includes spatially separated speech-in-noise and localization training. RESULTS: Throughout the development of this system patient input, training and preliminary pilot data from individuals with bilateral cochlear implants were utilized. Positive feedback from subjective reports indicated that some individuals were engaged in the treatment, and formal testing showed benefit. Feedback and practical issues resulted from the reduction of an eight-loudspeaker to a two-loudspeaker system. CONCLUSIONS: These preliminary findings suggest we have successfully developed a viable spatial hearing training system that can improve binaural hearing in noise and localization. Applications include, but are not limited to, hearing with hearing aids and cochlear implants.

The effect of reducing the number of electrodes on spatial hearing tasks for bilateral cochlear implant recipients.

BACKGROUND: Many studies have documented the effect of reducing spectral information for speech perception in listeners with normal hearing and hearing impairment. While it is understood that more spectral bands are needed for unilateral cochlear implant listeners to perform well on more challenging listening tasks such as speech perception in noise, it is unclear how reducing the number of spectral bands or electrodes in cochlear implants influences the ability to localize sound or understand speech with spatially separate noise sources. PURPOSE: The purpose of this study was to measure the effect of reducing the number of electrodes for patients with bilateral cochlear implants on spatial hearing tasks. RESEARCH DESIGN: Performance on spatial hearing tasks was examined as the number of bilateral electrodes in the speech processor was deactivated equally across ears and the full frequency spectrum was reallocated to a reduced number of active electrodes. Program parameters (i.e., pulse width, stimulation rate) were held constant among the programs and set identically between the right and left cochlear implants so that only the number of electrodes varied. STUDY SAMPLE: Nine subjects had used bilateral Nucleus or Advanced Bionics cochlear implants for at least 12 mo prior to beginning the study. Only those subjects with full insertion of the electrode arrays with all electrodes active in both ears were eligible to participate. DATA COLLECTION AND ANALYSIS: Two test measures were utilized to evaluate the effect of reducing the number of electrodes, including a speech-perception-in-noise test with spatially separated sources and a sound source localization test. RESULTS: Reducing the number of electrodes had different effects across individuals. Three patterns emerged: (1) no effect on localization (two of nine subjects), (2) at least two to four bilateral electrodes were required for maximal performance (five of nine subjects), and (3) performance gradually decreased across conditions as electrode number was reduced (two of nine subjects). For the test of speech perception in spatially separated noise, performance was affected as the number of electrodes was reduced for all subjects. Two categories of performance were found: (1) at least three or four bilateral electrodes were needed for maximum performance (five of seven subjects) and (2) as the number of electrodes were reduced, performance gradually decreased across conditions (two of seven subjects). CONCLUSION: Large individual differences exist in determining maximum performance using bilateral electrodes for localization and speech perception in noise. For some bilateral cochlear implant users, as few as three to four electrodes can be used to obtain maximal performance on localization and speech-in-noise tests. However, other listeners show a gradual decrement in performance on both tasks when the number of electrodes is reduced.

Performance over time on adults with simultaneous bilateral cochlear implants.

BACKGROUND: Maximum performance and long-term stability of bilateral cochlear implants has become an important topic because there has been increasing numbers of recipients of bilateral cochlear implants. PURPOSE: To determine the performance over time (up to 6yr) of subjects with simultaneous bilateral cochlear implants (CI+CI) on word recognition and localization. RESEARCH DESIGN: Over-time investigation of word recognition in quiet (CNC) and sound localization in quiet (Everyday Sounds Localization Test). STUDY SAMPLE: The subjects were 48 adults who simultaneously received their cochlear implants at the University of Iowa. RESULTS: For word recognition, percent correct scores continuously improved up to 1 yr postimplantation with the most benefit occurring within the first month of implantation. In observing up to 72 mo, the averaged scores reached to the plateau of about 63% correct in CNC after 2 yr (N = 31). But, when we followed 17 subjects who have complete data set between 12 mo and 48+ months, word recognition scores were significantly different from 12 mo to 48 + months, which implies binaural advantages need more time to be developed. Localization test results suggested that the root mean square (RMS) error scores continuously improved up to 1 yr postimplantation with most benefits occurring within the first 3 mo. After 2 yr, the averaged scores reached to the plateau of about 20 degrees RMS error (N = 27). When we followed 10 subjects who have complete data set between 12 mo and 48+ months, localization scores were not improved from 12 mo to 48+ months. There were large individual differences in performance over time. CONCLUSIONS: In general, substantial benefits in both word recognition and localization were found over the first 1-12 mo postimplantation for subjects who received simultaneous bilateral cochlear implants. These benefits were maintained over time up to 6yr postimplantation.

An attempt to improve bilateral cochlear implants by increasing the distance between electrodes and providing complementary information to the two ears.

OBJECTIVES: The purpose of this investigation was to determine if adult bilateral cochlear implant recipients could benefit from using a speech processing strategy in which the input spectrum was interleaved among electrodes across the two implants. DESIGN: Two separate experiments were conducted. In both experiments, subjects were tested using a control speech processing strategy and a strategy in which the full input spectrum was filtered so that only the output of half of the filters was audible to one implant, while the output of the alternative filters was audible to the other implant. The filters were interleaved in a way that created alternate frequency "holes" between the two cochlear implants. RESULTS: In experiment one, four subjects were tested on consonant recognition. Results indicated that one of the four subjects performed better with the interleaved strategy, one subject received a binaural advantage with the interleaved strategy that they did not receive with the control strategy, and two subjects showed no decrement in performance when using the interleaved strategy. In the second experiment, 11 subjects were tested on word recognition, sentences in noise, and localization (it should be noted that not all subjects participated in all tests). Results showed that for speech perception testing one subject achieved significantly better scores with the interleaved strategy on all tests, and seven subjects showed a significant improvement with the interleaved strategy on at least one test. Only one subject showed a decrement in performance on all speech perception tests with the interleaved strategy. Out of nine subjects, one subject preferred the sound quality of the interleaved strategy. No one performed better on localization with the interleaved strategy. CONCLUSION: Data from this study indicate that some adult bilateral cochlear implant recipients can benefit from using a speech processing strategy in which the input spectrum is interleaved among electrodes across the two implants. It is possible that the subjects in this study who showed a significant improvement with the interleaved strategy did so because of less channel interaction; however, this hypothesis was not directly tested.

A daily alternating method for comparing different signal-processing strategies in hearing aids and in cochlear implants.

BACKGROUND: Although we always want to select the best signal-processing strategy for our hearing-aid and cochlear-implant patients, no efficient and valid procedure is available. Comparisons in the office are without listening experience, and short-term take-home trials are likely influenced by the order of strategies tried. PURPOSE: The purpose of this study was to evaluate a new procedure for comparing signal-processing strategies whereby patients listen with one strategy one day and another strategy the next day. They continue this daily comparison for several weeks. We determined (1) if differences existed between strategies without prior listening experience and (2) if performance differences (or lack there of) obtained at the first listening experience are consistent with performance after two to three months of alternating between strategies on a daily basis (equal listening experience). RESEARCH DESIGN: Eight subjects were tested pretrial with a vowel, sentence, and spondee recognition test, a localization task, and a quality rating test. They were required to listen to one of two different signal processing strategies alternating between strategies on a daily basis. After one to three months of listening, subjects returned for follow-up testing. Additionally, subjects were asked to make daily ratings and comments in a diary. RESULTS: Pre-trial (no previous listening experience), a clear trend favoring one strategy was observed in four subjects. Four other subjects showed no clear advantage. Post-trial (after alternating daily between strategies), of the four subjects who showed a clear advantage for one signal processing strategy, only one subject showed that same advantage. One subject ended up with an advantage for the other strategy. Post-trial, of the four subjects who showed no advantage for a particular signal processing strategy, three did show an advantage for one strategy over the other. CONCLUSION: Patients are willing to alternate between signal processing strategies on a daily basis for up to three months in an attempt to determine their optimal strategy. Although some patients showed superior performance with initial fittings (and some did not), the results of pre-trial comparison did not always persist after having equal listening experience. We recommend this daily alternating listening technique when there is interest in determining optimal performance among different signal processing strategies when fitting hearing aids or cochlear implants.

Selection strategies for binaural and monaural cochlear implantation.

PURPOSE: We propose theoretical guidelines for cochlear implant selection criteria in adults and children that emphasize the contribution of each ear to the binaural advantage. The guidelines outline options for implanting one ear only, implanting one ear plus use of a contralateral hearing aid, and implanting both ears. METHOD: Our method for selecting the best cochlear implant or hearing aid outcome is derived from the amount of usable hearing of the patient. This approach requires the measurement of aided speech perception with each ear separately and then bilaterally. Guidelines are based on the following: (a) overall level of performance with hearing aids relative to what is expected from a cochlear implant, (b) the contributions from each ear, and (c) whether there is a binaural advantage. CONCLUSIONS: Our general recommendation is to provide the patient with the best opportunity for binaural hearing. Since the guidelines put forth in this article are theoretically based, future efforts should be aimed at examining the validity of these guidelines.

Long-term performance of Clarion 1.0 cochlear implant users.

OBJECTIVE/HYPOTHESIS: To evaluate the long-term performance of adult Clarion 1.0 cochlear implant users. STUDY DESIGN: This was a retrospective, longitudinal study evaluating word discrimination in quiet for 31 adult cochlear implant patients with preimplantation sentence scores of less than 10%. METHODS: The length of the study was 135 months with a mean follow-up length of 93 (median, 96) months. For the duration of the study, all subjects used the Clarion 1.0 cochlear implant with speech processors programmed for the use of the continuous interleaved sampling strategy. RESULTS: There was no significant growth or decline in speech perception after 24 months postimplantation unless adverse medical events were experienced. Age at implantation was significantly and substantially negatively correlated (-11% word score per decade, r = 0.68) with most recent score, maximum score, time to maximum score, range of performance, 24- to 130-month mean score, and for any longitudinal data point tested: 3 to 6 months, 6 months, 1 year, 2 years, 5 years, and 10 years. There were no age-related declines in performance. There were no observed correlations between duration of deafness and any of the variables listed above. CONCLUSIONS: The lack of correlation between duration of deafness and performance in a cohort without residual hearing suggests the presence of a strong correlation between age and speech performance with a cochlear implant. That the cochlear implant is a safe therapy for the treatment of profound deafness is supported by the stability of scores through the 10-year study period as well as a zero rate of device failures or explantation.

Speech perception and localization with adults with bilateral sequential cochlear implants.

This investigation reports measures of binaural hearing of all of our seven adults who have received sequential bilateral cochlear implants (range of time between implantation of 6 yr/8 mo and 17 yr). All subjects used both devices in everyday life. The internal array, number of channels, rate, and signal processing strategies were usually quite different between devices. Speech recognition was tested by using words in quiet and sentences in noise with the sentence stimuli presented from the front and the noise presented from the front, the right, or the left at a 90 degrees angle. Bilateral localization was tested by using an everyday sounds test with stimuli presented from one of eight loudspeakers. Results showed that all subjects received a significant bilateral improvement on at least one speech perception test compared to either implant alone. Four of seven subjects with bilateral devices demonstrated some (root-mean-square error below 30 degrees ) localization abilities. The two subjects tested unilaterally before receiving a second implant showed a bilateral improvement on localization after implantation of the second side. We conclude that sequential implants can be beneficial even after many years of monaural use and even with very different cochlear implants.

Some benefits and limitations of binaural cochlear implants and our ability to measure them.

We review new recognition and localization skills in patients using one or two cochlear implant(s). We observed one unilateral patient who showed localization performance above chance. We also provide evidence for binaural processing in bilateral cochlear implant patients, even when tested with speech from the front without noise. We unsuccessfully attempted to find correlations between localization and squelch, between these variables and pre-implant threshold differences, or these variables and post-implant recognition differences. We strongly believe that new tests are needed to examine the potential benefit of two implants. We describe three tests that we use to show a binaural advantage: cued recognition, movement direction, and recognition with multiple jammers.

Effects of converting bilateral cochlear implant subjects to a strategy with increased rate and number of channels.

OBJECTIVES: Three different Advanced Bionics processing strategies were evaluated: 1) 8-channel, 813 pulses per second (pps), Continuous Interleaved Sampling (CIS); 2) 16-channel, 5,100 pps, HiResolution Paired (HiRes P); and 3) 16-channel, 2,900 pps, HiResolution Sequential (HiRes S). METHODS: Seven adult bilateral Clarion CII cochlear implant recipients who had been using a CIS processing strategy for at least 18 months participated in this study. Sentence recognition in multitalker babble from the front was collected on subjects using their CIS strategy and after subjects were programmed for the first time with HiRes P and HiRes S strategies. An ABAB design was implemented for 1 month whereby subjects used each HiResolution strategy every other day. Sentence recognition testing was repeated at the 1- and 3-month post-HiResolution test intervals. RESULTS: Comparisons between the CIS and HiResolution strategies showed immediate improvements for 5 subjects in favor of the HiResolution strategies. After 1 month of alternating between the HiRes P and HiRes S strategies, remarkably, 2 subjects showed improvements of 60%, 2 subjects showed improvements of 40%, and 2 subjects showed improvements of 30% over the CIS strategy that they had previously used for at least 18 months. The results after 3 months of use were consistent with those obtained at 1 month. CONCLUSIONS: The HiRes S and HiRes P strategies resulted in dramatic improvements in speech perception in noise for a subset of subjects who had been using the CIS strategy bilaterally. This finding demonstrates that these subjects were able to tolerate a more difficult signal-to-noise ratio. Further work is needed to determine the independent effects of rate versus number of channels.

Benefit of wearing a hearing aid on the unimplanted ear in adult users of a cochlear implant.

The purpose of this investigation was to document performance of participants wearing a cochlear implant and hearing aid in opposite ears on speech-perception and localization tests. Twelve individuals who wore a cochlear implant and a hearing aid on contralateral ears were tested on their abilities to understand words in quiet and sentences in noise, and to localize everyday sounds. All speech stimuli were presented from the front, with the noise stimuli presented from the front, the right, or the left at a 90 degrees angle. Binaural summation in quiet and in noise, binaural squelch effects, and localization were studied to determine bilateral advantages. The magnitude of the monaural head shadow effect (the difference in unilateral performance when noise was facing the unilateral device vs. when the noise was opposite the unilateral device) also was studied. The test setup for localization was composed of an 8-speaker array spanning an arc of approximately 108 degrees in front of each participant. Group results yielded a statistically significant combined benefit of wearing a hearing aid in conjunction with a cochlear implant on opposite ears in noise conditions. Those participants who received a binaural advantage in 1 condition did not necessarily show a binaural advantage in another. Only 2 participants out of 12 were able to localize when wearing 2 devices. Further efforts are required to improve the integration of information from combined use of cochlear implant and hearing aid devices for enhancement of speech perception in noise and localization.

Recognition of "real-world" musical excerpts by cochlear implant recipients and normal-hearing adults.

OBJECTIVE: The purposes of this study were (a) to compare recognition of "real-world" music excerpts by postlingually deafened adults using cochlear implants and normal-hearing adults; (b) to compare the performance of cochlear implant recipients using different devices and processing strategies; and (c) to examine the variability among implant recipients in recognition of musical selections in relation to performance on speech perception tests, performance on cognitive tests, and demographic variables. DESIGN: Seventy-nine cochlear implant users and 30 normal-hearing adults were tested on open-set recognition of systematically selected excerpts from musical recordings heard in real life. The recognition accuracy of the two groups was compared for three musical genre: classical, country, and pop. Recognition accuracy was correlated with speech recognition scores, cognitive measures, and demographic measures, including musical background. RESULTS: Cochlear implant recipients were significantly less accurate in recognition of previously familiar (known before hearing loss) musical excerpts than normal-hearing adults (p < 0.001) for all three genre. Implant recipients were most accurate in the recognition of country items and least accurate in the recognition of classical items. There were no significant differences among implant recipients due to implant type (Nucleus, Clarion, or Ineraid), or programming strategy (SPEAK, CIS, or ACE). For cochlear implant recipients, correlations between melody recognition and other measures were moderate to weak in strength; those with statistically significant correlations included age at time of testing (negatively correlated), performance on selected speech perception tests, and the amount of focused music listening following implantation. CONCLUSIONS: Current-day cochlear implants are not effective in transmitting several key structural features (i.e., pitch, harmony, timbral blends) of music essential to open-set recognition of well-known musical selections. Consequently, implant recipients must rely on extracting those musical features most accessible through the implant, such as song lyrics or a characteristic rhythm pattern, to identify the sorts of musical selections heard in everyday life.