Classification of Acoustic Hearing Preservation After Cochlear Implantation Using Electrocochleography.

The objective to preserve residual hearing during cochlear implantation has recently led to the use of intracochlear electrocochleography (ECochG) as an intraoperative monitoring tool. Currently, a decrease in the amplitude of the difference between responses to alternating-polarity stimuli (DIF response), predominantly reflecting the hair cell response, is used for providing feedback. Including other ECochG response components, such as phase changes and harmonic distortions, could improve the accuracy of surgical feedback. The objectives of the present study were (1) to compare simultaneously recorded stepwise intracochlear and extracochlear ECochG responses to 500 Hz tone bursts, (2) to explore patterns in features extracted from the intracochlear ECochG recordings relating to hearing preservation or hearing loss, and (3) to design support vector machine (SVM) and random forest (RF) classifiers of acoustic hearing preservation that treat each subject as a sample and use all intracochlear ECochG recordings made during electrode array insertion for classification. Forty subjects undergoing cochlear implant (CI) surgery at the Oslo University Hospital, St. Thomas' Hearing Implant Centre, or the University Hospital of Zurich were prospectively enrolled. In this cohort, DIF response amplitude decreases did not relate to postoperative acoustic hearing preservation. Exploratory analysis of the feature set extracted from the ECochG responses and preoperative audiogram showed that the features were not discriminative between outcome classes. The SVM and RF classifiers that were trained on these features could not distinguish cases with hearing loss and hearing preservation. These findings suggest that hearing loss following CI surgery is not always reflected in intraoperative ECochG recordings.

Three-Dimensional Force Profile During Cochlear Implantation Depends on Individual Geometry and Insertion Trauma.

OBJECTIVES: To preserve the acoustic hearing, cochlear implantation has to be as atraumatic as possible. Therefore, understanding the impact of the cochlear geometry on insertion forces and intracochlear trauma might help to adapt and improve the electrode insertion and reduce the probability of intracochlear trauma. DESIGN: The study was conducted on 10 fresh-frozen human temporal bones. The inner ear was removed from the temporal bone. The bony capsule covering the scala vestibuli was removed and the dissected inner ear was mounted on the three-dimensional (3D) force measurement system (Agilent technologies, Nano UTM, Santa Clare, CA). A lateral wall electrode array was inserted, and the forces were recorded in three dimensions with a sensitivity of 2 µN. Afterwards, the bones were scanned using a Skyscan 1173 micro-computed tomography (micro-CT). The obtained 3D force profiles were correlated with the videos of the insertions recorded through the microscope, and the micro-CT images. RESULTS: A correlation was found between intracochlear force profiles measured in three different directions with intracochlear trauma detected with micro-CT imaging. The angle of insertion and the cochlear geometry had a significant impact on the electrode array insertion forces and possible insertion trauma. Intracochlear trauma occurred frequently within the first 180° from the round window, where buckling of the proximal part of the electrode carrier inside the cochlea, and rupturing of the spiral ligament was observed. CONCLUSIONS: The combination of the 3D force measurement system and micro-CT can be used to characterize the mechanical behavior of a CI electrode array and some forms of insertion trauma. Intracochlear trauma does not always correlate with higher force amplitudes, but rather with an abrupt change of force directions.

Transient Noise Reduction in Cochlear Implant Users: a Multi-Band Approach.

A previously-tested transient noise reduction (TNR) algorithm for cochlear implant (CI) users was modified to detect and attenuate transients independently across multiple frequency-bands. Since speech and transient noise are often spectrally distinct, we hypothesized that benefits in speech intelligibility can be achieved over the earlier single-band design. Fifteen experienced CI users (49 to 72 years) were tested unilaterally using pre-processed stimuli delivered directly to a speech processor. Speech intelligibility in transient and soft stationary noise, subjective sound quality and the recognition of warning signals was investigated in three processing conditions: no TNR (TNRoff), single-band TNR (TNRsgl) and multi-band TNR (TNRmult). Notably, TNRmult improved speech reception thresholds (SRTs) in cafeteria noise and office noise by up to 3 dB over both TNRoff and TNRsgl, and yielded higher comfort and clarity ratings in cafeteria noise. Our results indicate that multi-band transient noise reduction may be advantageous compared to a single-band approach, and reveal a substantial overall potential for TNR to improve speech perception and listening comfort in CI users.

Evaluation of a Transient Noise Reduction Algorithm in Cochlear Implant Users.

Dealing with environmental noises presents a major issue for cochlear implant (CI) users. Hence, digital noise reduction (DNR) schemes have become important features of CI systems. Many noises like for example clinking glasses or slamming doors, have impulsive onsets and decay quickly. Common DNR algorithms cannot handle this type of noise in an appropriate way. In this study, we investigated the effect of an algorithm specially designed for such noises with 12 CI users (age range: 45 to 75 years). Speech scores in noise and quiet as well as subjective ratings of speech clarity, comfort and overall preference were measured. The main finding was a significant improvement of up to 1.7 dB of the speech reception threshold in noise as well as increased speech clarity. Speech in quiet was not negatively affected by the algorithm. The study revealed that the tested algorithm has the potential to improve CI listening. However, further research is needed regarding the effectiveness and suitability of the algorithm in daily use.

Speech reception threshold benefits in cochlear implant users with an adaptive beamformer in real life situations.

OBJECTIVES: To compare the Naida CI UltraZoom adaptive beamformer and T-Mic settings in a real life environment. METHODS: Speech reception thresholds (SRTs) were measured in a moderately reverberant room, using the German Oldenburger sentence test. The speech signal was always presented from the front loudspeaker at 0° azimuth and fixed masking noise was presented either simultaneously from all eight loudspeakers around the subject at 0°, ±45°, ±90°, ±135°, and 180° azimuth or from five loudspeakers positioned at ±70°, ±135°, and 180° azimuth. In the third test setup, an additional roving noise was added to the six loudspeaker arrangement. RESULTS: There was a significant difference in mean SRTs between the Naida CI T-Mic and UltraZoom in each of the three test setups. The largest improvements were seen in the six speaker roving and fixed noise conditions. Adding ClearVoice to the Naida CI T-Mic setting significantly improved the SRT in both fixed noise conditions, but not in the roving noise condition. In each setup, the lowest SRTs were obtained with the UltraZoom plus ClearVoice setting. DISCUSSION: The degree of improvement was consistent with previous beamforming studies. In the most challenging listening situation, with noise from eight speakers and speech and noise presented coincidentally from the front, UltraZoom still provided a significant benefit. When a moving noise source was added, the improvement in SRT provided by UltraZoom was maintained. CONCLUSION: When tested in challenging and realistic noise environments, the Naida CI UltraZoom adaptive beamformer resulted in significantly lower mean SRTs than when the T-Mic alone was used.

Variations in microanatomy of the human cochlea.

The human cochlea shows considerable interindividual variability in size and morphology. In order to develop atraumatic cochlear implant (CI) electrodes, high-precision details of the variability of human anatomy are required. Sixteen human temporal bones were cut around the cochlea in blocks of approximately 3.5 × 3.5 cm. The bones were scanned by using a Skyscan 1173 micro-computed tomography (µCT) device. Mimics software (Materialise, Leuven, Belgium) was used to segment out the scala tympani (ST) from the µCT images. A three-dimensional surface model of the segmented area was generated for each cochlea. Cross-sectional images were taken and analyzed by custom-designed software in MATLAB. Comparison of different STs showed large variability in cross-sectional diameter (CSD), vertical trajectory, and height of the ST. Relative standard deviations of the CSD were between 9 and 15%. Heights measured at the center of the ST exceeded those in the modiolar and lateral regions of the scala. At the lateral region, the height decreased significantly at the beginning of the second turn. In the vertical trajectory, critical anatomic features were observed, such as dips, vertical jumps, and peaks. Rosenthal's canal (RC) extended to between 560 and 650°. We found a correlation between the length of the RC and that of the ST. The ST was segmented and the internal dimensions measured by using µCT. We observed large dimensional variability between different STs. These differences could have considerable implications for approaches to the design of CI arrays, especially in terms of their ability to preserve residual hearing during insertion of the electrode array.

A self-developed and constructed robot for minimally invasive cochlear implantation.

CONCLUSION: A robot built specifically for stereotactic cochlear implantation provides equal or better accuracy levels together with a better integration into a clinical environment, when compared with existing approaches based on industrial robots. OBJECTIVES: To evaluate the technical accuracy of a robotic system developed specifically for lateral skull base surgery in an experimental set-up reflecting the intended clinical application. The invasiveness of cochlear electrode implantation procedures may be reduced by replacing the traditional mastoidectomy with a small tunnel slightly larger in diameter than the electrode itself. METHODS: The end-to-end accuracy of the robot system and associated image-guided procedure was evaluated on 15 temporal bones of whole head cadaver specimens. The main components of the procedure were as follows: reference screw placement, cone beam CT scan, computer-aided planning, pair-point matching of the surgical plan, robotic drilling of the direct access tunnel, and postoperative cone beam CT scan for accuracy assessment. RESULTS: The mean accuracy at the target point (round window) was 0.56 ± 0.41 mm with an angular misalignment of 0.88 ± 0.40°. The procedural time for the registration process through the completion of the drilling procedure was 25 ± 11 min. The robot was fully operational in a clinical environment.

The effect of multi-channel wide dynamic range compression, noise reduction, and the directional microphone on horizontal localization performance in hearing aid wearers.

This study examined the effect that signal processing strategies used in modern hearing aids, such as multi-channel WDRC, noise reduction, and directional microphones have on interaural difference cues and horizontal localization performance relative to linear, time-invariant amplification. Twelve participants were bilaterally fitted with BTE devices. Horizontal localization testing using a 360 degrees loudspeaker array and broadband pulsed pink noise was performed two weeks, and two months, post-fitting. The effect of noise reduction was measured with a constant noise present at 80 degrees azimuth. Data were analysed independently in the left/right and front/back dimension and showed that of the three signal processing strategies, directional microphones had the most significant effect on horizontal localization performance and over time. Specifically, a cardioid microphone could decrease front/back errors over time, whereas left/right errors increased when different microphones were fitted to left and right ears. Front/back confusions were generally prominent. Objective measurements of interaural differences on KEMAR explained significant shifts in left/right errors. In conclusion, there is scope for improving the sense of localization in hearing aid users.

Advantages of Frequency Specific Tri-microphone Binaural Wireless Hearing Aid Technology / 听力学及言语疾病杂志

Objective To examine adult speech recognition for words presented in different background noise when the adults used 4-band tri-microphone and traditional tri-microphone hearing aid technology,and to examine the ability of sound location when using wireless remote control.Methods A total 40(female 29,male 11) subjects with moderate to severe bilateral sensorineural hearing loss were encountered in this test,and were divided into two groups(group A and group B).With binaural fitting ACURIS P(frequency specific tri-microphone adaptive mode) and Triano 3 P(Tri-microphone adaptive mode),the patients were tested with speech recognition in two sound field through PB test and the accurateness of sound localization were investigated through questionnaire.Results Significant differences were found between the mean L50(the S/N at which 50% of running speech is correctly understood) obtained from group A versus group B in Tri-microphone adaptive directional condition in multiple sound fields(P