The Association of Hearing Loss With Active Music Enjoyment in Hearing Aid Users.

OBJECTIVE: Hearing aids (HAs) are designed for speech rather than music listening. The impact of HAs on music enjoyment is poorly studied. We examine the effect of HAs on active music enjoyment in individuals with varying levels of hearing loss (HL). STUDY DESIGN: Cross-sectional study. SETTING: Tertiary medical center and community. METHODS: Adult (≥18 years) bilateral HA users and normal hearing (NH) controls actively listened to musical stimuli and rated their enjoyment across 3 measures (pleasantness, musicality, naturalness) with and without HAs using a visual analog scale. Multivariable linear regression was used to assess the association between HL (measured by a pure-tone average [PTA] and word recognition score [WRS] of the better ear) and music enjoyment with and without HAs, adjusting for covariates. Music enjoyment was compared between HA users and NH controls, and HA users with and without their HAs. RESULTS: One hundred bilateral HA users (mean age 66.0 years, 52% female, better ear mean [SD] PTA 50.2 [13.5] dBHL, mean WRS 84.5 [16.5]%) completed the study. Increasing severity of HL (PTA) was independently associated with decreased music enjoyment (pleasantness, musicality, naturalness) with and without HAs (p < .05). HA usage increased music enjoyment (musicality) in those with moderate to moderately severe HL. Music enjoyment in NH controls (n = 20) was significantly greater across all measures compared to HA users. CONCLUSION: Increased severity of HL is associated with decreased music enjoyment that can be enhanced with HA usage. Thus, HA usage can positively enhance both speech and music appreciation.

Hearing Aids Enhance Music Enjoyment in Individuals With Hearing Loss.

OBJECTIVE: To investigate music appreciation in hearing aid (HA) users with varying levels of hearing loss (HL). STUDY DESIGN: Cross-sectional, within-subjects design. SETTING: Tertiary medical center, community. PATIENTS: Adults (≥18 yr) bilateral HA users. INTERVENTIONS: HA usage. MAIN OUTCOME MEASURES: Outcome variables included self-reported music enjoyment measures (pleasantness, musicality, naturalness) with and without HAs assessed with visual analogue scales (10 indicates highest level of enjoyment, 0 the least). Exposure variables include HL (better ear pure-tone average) and speech discrimination (word recognition scores [WRS]). Demographic information was collected. RESULTS: One hundred nine bilateral HA users completed the study. Mean (standard deviation) age was 66.6 years (16.8 yr); 52.3% were female patients. Mean (standard deviation) better ear pure-tone average was 51.1 dB (16.3 dB) HL. Increased severity of HL and worse WRS were associated with decreased music enjoyment ( p < 0.05) across all measures without HAs, adjusting for sex, age, education, race, HA type, age of HL diagnosis, duration of HL, duration of HA use, musical preference, and musical experience. However, these associations were attenuated or no longer significant with HA usage. Moreover, among all subjects, HAs (vs. no HAs) provided increased music enjoyment in pleasantness (HA, 6.94, no HA, 5.74; p < 0.01), musicality (HA, 7.35; no HA, 6.13, p < 0.01), and naturalness (HA, 6.75; no HA, 6.02; p = 0.02). CONCLUSION: HA users report increased music enjoyment with HAs compared with without HAs. Increased severity of HL and worse WRS were independently associated with decreased unaided music enjoyment. HA usage seems to mitigate this effect, particularly for those with worse HL.

Novel Web-Based Music Re-Engineering Software for Enhancement of Music Enjoyment Among Cochlear Implantees.

OBJECTIVES: Cochlear implant (CI) listeners experience diminished music perception and enjoyment from a variety of patient-related and implant-related factors. We investigate the hypothesis that patient-directed music re-engineering may enhance music enjoyment with CI. STUDY DESIGN: Prospective cohort study. SETTING: Academic cochlear implant center. SUBJECTS AND METHODS: A multidisciplinary team of neurotologists, audiologists, and a sound/audio engineer collaborated with a web developer to create a music re-engineering application. Experienced adult CI listeners rated original excerpts from five major genres of music on enjoyment using a visual analog scale (VAS). Subjects were then allowed to re-engineer the original by adjusting treble frequencies, bass frequencies, percussion emphasis, and reverberation and again rated on enjoyment. RESULTS: Total of 46 subjects, with a mean age of 57.6 years (SD = 16; range, 18-90) participated in the study. User-mixed audio was rated higher across all measures of enjoyment than original recordings (mean difference +0.92; p < 0.05, CI [0.22, 1.62]), an effect that was seen across all genres except for country music. Subjects preferred louder bass frequencies (mean difference +7.1 dB; p < 0.01, CI [2.15, 24.3]) and more reverberation (mean difference +6.6 ms; p < 0.01, CI [2.85, 10.7]). Re-engineered music increased enjoyment in 57%, and 79% reported an interest in being able to mix music of their own choosing. CONCLUSION: User-directed music re-engineering increases music enjoyment for CI listeners. The cochlear implantee preferred heightened bass, reverberation, and treble across musical genres. These findings support the implementation of patient-directed music re-engineering to enhance music enjoyment with technology that is readily available today.

The development and validation of the speech quality instrument.

OBJECTIVE: Although speech perception tests are available to evaluate hearing, there is no standardized validated tool to quantify speech quality. The objective of this study is to develop a validated tool to measure quality of speech heard. STUDY DESIGN: Prospective instrument validation study of 35 normal hearing adults recruited at a tertiary referral center. METHODS: Participants listened to 44 speech clips of male/female voices reciting the Rainbow Passage. Speech clips included original and manipulated excerpts capturing goal qualities such as mechanical and garbled. Listeners rated clips on a 10-point visual analog scale (VAS) of 18 characteristics (e.g. cartoonish, garbled). RESULTS: Skewed distribution analysis identified mean ratings in the upper and lower 2-point limits of the VAS (ratings of 8-10, 0-2, respectively); items with inconsistent responses were eliminated. The test was pruned to a final instrument of nine speech clips that clearly define qualities of interest: speech-like, male/female, cartoonish, echo-y, garbled, tinny, mechanical, rough, breathy, soothing, hoarse, like, pleasant, natural. Mean ratings were highest for original female clips (8.8) and lowest for not-speech manipulation (2.1). Factor analysis identified two subsets of characteristics: internal consistency demonstrated Cronbach's alpha of 0.95 and 0.82 per subset. Test-retest reliability of total scores was high, with an intraclass correlation coefficient of 0.76. CONCLUSION: The Speech Quality Instrument (SQI) is a concise, valid tool for assessing speech quality as an indicator for hearing performance. SQI may be a valuable outcome measure for cochlear implant recipients who, despite achieving excellent speech perception, often experience poor speech quality. LEVEL OF EVIDENCE: 2b. Laryngoscope, 128:1622-1627, 2018.

Skin Necrosis After Implantation With the BAHA Attract: A Case Report and Review of the Literature.

OBJECTIVE: The bone-anchored hearing aid (BAHA) Attract is a transcutaneous bone conduction hearing aid that uses magnetic coupling to enable sound conduction. We report the first case of skin necrosis associated with the BAHA Attract and perform a literature review of soft tissue complications related to the device. PATIENT: A single patient who was found to develop skin necrosis 2 weeks after being fitted for the BAHA Attract speech processor. INTERVENTION: After the patient developed skin necrosis from the device, she was advised to immediately discontinue use of the Attract to allow complete wound healing, upon which the Attract was successfully converted to a percutaneous BAHA. MAIN OUTCOME AND RESULTS: We monitored for the development of skin complications from the BAHA Attract. The patient's immediate postoperative course was unremarkable and she was fitted with a speech processor of M5 magnet strength at 1 month postoperatively. After 1 week of use, she reported discomfort and was advised to downgrade to an M4 magnet; however, she continued to use the M5 and the following week was found to have developed skin necrosis around the device. CONCLUSION: Despite the infrequency of skin necrosis related to the BAHA Attract, it must be considered in counseling and managing candidates for the device.

Reduction of the Harmonic Series Influences Musical Enjoyment With Cochlear Implants.

OBJECTIVE: Cochlear implantation is associated with poor music perception and enjoyment. Reducing music complexity has been shown to enhance music enjoyment in cochlear implant (CI) recipients. In this study, we assess the impact of harmonic series reduction on music enjoyment. STUDY DESIGN: Prospective analysis of music enjoyment in normal-hearing (NH) individuals and CI recipients. SETTING: Single tertiary academic medical center. PATIENTS: NH adults (N = 20) and CI users (N = 8) rated the Happy Birthday song on three validated enjoyment modalities-musicality, pleasantness, and naturalness. INTERVENTION: Subjective rating of music excerpts. MAIN OUTCOME MEASURES: Participants listened to seven different instruments play the melody, each with five levels of harmonic reduction (Full, F3+F2+F1+F0, F2+F1+F0, F1+F0, F0). NH participants listened to the segments both with and without CI simulation. Linear mixed effect models (LME) and likelihood ratio tests were used to assess the impact of harmonic reduction on enjoyment. RESULTS: NH listeners without simulation rated segments with the first four harmonics (F3+F2+F1+F0) most pleasant and natural (p <0.001, p = 0.004). NH listeners with simulation rated the first harmonic alone (F0) most pleasant and natural (p <0.001, p = 0.003). Their ratings demonstrated a positive linear relationship between harmonic reduction and both pleasantness (slope estimate = 0.030, SE = 0.004, p <0.001, LME) and naturalness (slope estimate = 0.012, SE = 0.003, p = 0.003, LME). CI recipients also found the first harmonic alone (F0) to be most pleasant (p = 0.003), with a positive linear relationship between harmonic reduction and pleasantness (slope estimate = 0.029, SE = 0.008, p <0.001, LME). CONCLUSION: Harmonic series reduction increases music enjoyment in CI and NH individuals with or without CI simulation. Therefore, minimization of the harmonics may be a useful strategy for enhancing musical enjoyment among both NH and CI listeners.

Impact of Noise Reduction Algorithm in Cochlear Implant Processing on Music Enjoyment.

OBJECTIVE: Noise reduction algorithm (NRA) in speech processing strategy has positive impact on speech perception among cochlear implant (CI) listeners. We sought to evaluate the effect of NRA on music enjoyment. STUDY DESIGN: Prospective analysis of music enjoyment. SETTING: Academic medical center. PATIENTS: Normal-hearing (NH) adults (N = 16) and CI listeners (N = 9). INTERVENTION: Subjective rating of music excerpts. MAIN OUTCOME MEASURES: NH and CI listeners evaluated country music piece on three enjoyment modalities: pleasantness, musicality, and naturalness. Participants listened to the original version and 20 modified, less complex versions created by including subsets of musical instruments from the original song. NH participants listened to the segments through CI simulation and CI listeners listened to the segments with their usual speech processing strategy, with and without NRA. RESULTS: Decreasing the number of instruments was significantly associated with increase in the pleasantness and naturalness in both NH and CI subjects (p < 0.05). However, there was no difference in music enjoyment with or without NRA for either NH listeners with CI simulation or CI listeners across all three modalities of pleasantness, musicality, and naturalness (p > 0.05): this was true for the original and the modified music segments with one to three instruments (p > 0.05). CONCLUSION: NRA does not affect music enjoyment in CI listener or NH individual with CI simulation. This suggests that strategies to enhance speech processing will not necessarily have a positive impact on music enjoyment. However, reducing the complexity of music shows promise in enhancing music enjoyment and should be further explored.

Music Engineering as a Novel Strategy for Enhancing Music Enjoyment in the Cochlear Implant Recipient.

OBJECTIVE: Enjoyment of music remains an elusive goal following cochlear implantation. We test the hypothesis that reengineering music to reduce its complexity can enhance the listening experience for the cochlear implant (CI) listener. METHODS: Normal hearing (NH) adults (N = 16) and CI listeners (N = 9) evaluated a piece of country music on three enjoyment modalities: pleasantness, musicality, and naturalness. Participants listened to the original version along with 20 modified, less complex, versions created by including subsets of the musical instruments from the original song. NH participants listened to the segments both with and without CI simulation processing. RESULTS: Compared to the original song, modified versions containing only 1-3 instruments were less enjoyable to the NH listeners but more enjoyable to the CI listeners and the NH listeners with CI simulation. Excluding vocals and including rhythmic instruments improved enjoyment for NH listeners with CI simulation but made no difference for CI listeners. CONCLUSIONS: Reengineering a piece of music to reduce its complexity has the potential to enhance music enjoyment for the cochlear implantee. Thus, in addition to improvements in software and hardware, engineering music specifically for the CI listener may be an alternative means to enhance their listening experience.

Reverberation time influences musical enjoyment with cochlear implants.

OBJECTIVE: To identify factors that enhance the enjoyment of music in cochlear implant (CI) recipients. Specifically, we assessed the hypothesis that variations in reverberation time (RT60) may be linked to variations in the level of musical enjoyment in CI users. STUDY DESIGN: Prospective analysis of music enjoyment in normal-hearing individuals. SETTING: Single tertiary academic medical center. PATIENTS: Normal-hearing adults (N = 20) were asked to rate a novel 20-second melody on three enjoyment modalities: musicality, pleasantness, and naturalness. INTERVENTION: Subjective rating of music excerpts. MAIN OUTCOME MEASURES: Participants listened to seven different instruments play the melody, each with five levels (0.2, 1.6, 3.0, 5.0, 10.0 s) of RT60, both with and without CI simulation processing. Linear regression analysis with analysis of variance was used to assess the impact of RT60 on music enjoyment. RESULTS: Without CI simulation, music samples with RT60 = 3.0 seconds were ranked most pleasant and most musical, whereas those with RT60 = 1.6 seconds and RT60 = 3.0 seconds were ranked equally most natural (all p < 0.05). With CI simulation, music samples with RT60 = 0.2 seconds were ranked most pleasant, most musical, and most natural (all p < 0.05). Samples without CI simulation show a preference for middle-range RT60, whereas samples with CI simulation show a negative linear relationship between RT60 and musical enjoyment, with preference for minimal reverberation. CONCLUSION: Minimization of RT60 may be a useful strategy for increasing musical enjoyment under CI conditions, both in altering existing music as well as in composition of new music.

Reliability measure of a clinical test: Appreciation of Music in Cochlear Implantees (AMICI).

PURPOSE: The goals of this study were (1) to investigate the reliability of a clinical music perception test, Appreciation of Music in Cochlear Implantees (AMICI), and (2) examine associations between the perception of music and speech. AMICI was developed as a clinical instrument for assessing music perception in persons with cochlear implants (CIs). The test consists of four subtests: (1) music versus environmental noise discrimination, (2) musical instrument identification (closed-set), (3) musical style identification (closed-set), and (4) identification of musical pieces (open-set). To be clinically useful, it is crucial for AMICI to demonstrate high test-retest reliability, so that CI users can be assessed and retested after changes in maps or programming strategies. RESEARCH DESIGN: Thirteen CI subjects were tested with AMICI for the initial visit and retested again 10-14 days later. Two speech perception tests (consonant-nucleus-consonant [CNC] and Bamford-Kowal-Bench Speech-in-Noise [BKB-SIN]) were also administered. DATA ANALYSIS: Test-retest reliability and equivalence of the test's three forms were analyzed using paired t-tests and correlation coefficients, respectively. Correlation analysis was also conducted between results from the music and speech perception tests. RESULTS: Results showed no significant difference between test and retest (p > 0.05) with adequate power (0.9) as well as high correlations between the three forms (Forms A and B, r = 0.91; Forms A and C, r = 0.91; Forms B and C, r = 0.95). Correlation analysis showed high correlation between AMICI and BKB-SIN (r = -0.71), and moderate correlation between AMICI and CNC (r = 0.4). CONCLUSIONS: The study showed AMICI is highly reliable for assessing musical perception in CI users.

Development of a clinical test of musical perception: appreciation of music in cochlear implantees (AMICI).

The purpose of this study was to develop a test to assess the ability of persons with cochlear implants (CIs) to interpret musical signals. Up to this time, the main direction in outcomes studies of cochlear implantation has been in relation to speech recognition abilities. With improvement in CI hardware and processing strategies, there has been a growing interest in musical perception as a dimension that could improve greatly users' quality of life. The Appreciation of Music in Cochlear Implantees (AMICI) test was designed to measure the following abilities: discrimination of music versus noise; identification of musical instruments (from a closed set); identification of musical styles (from a closed set); and recognition of individual musical pieces (open set). The first phase of the study was test development and recording. The second phase entailed presentation of a large set of stimuli to normal listeners. Based on phase 2 findings, an item analysis was performed to eliminate stimuli that were confusing or resulted in high error rates in normals. In phase 3, hearing-impaired participants, using cochlear Implants, were assessed using the beta version of the AMICI test.