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Evaluation of Speech Recognition of Cochlear Implant Recipients Using a Personal Digital Adaptive Radio Frequency System
Abstract
Background:
Previous research supports the use of frequency modulation (FM) systems for improving speech recognition in noise of individuals with cochlear implants (CIs). However, at this time, there is no published research on the potential speech recognition benefit of new digital adaptive wireless radio transmission systems.
Purpose:
The goal of this study was to compare speech recognition in quiet and in noise of CI recipients while using traditional, fixed-gain analog FM systems, adaptive analog FM systems, and adaptive digital wireless radio frequency transmission systems.
Research design:
A three-way repeated-measures design was used to examine performance differences among devices, among speech recognition conditions in quiet and in increasing levels of background noise, and between users of Advanced Bionics and Cochlear CIs.
Study sample:
Seventeen users of Advanced Bionics Harmony CI sound processors and 20 users of Cochlear Nucleus 5 sound processors were included in the study.
Data collection and analysis:
Participants were tested in a total of 32 speech-recognition-in noise-test conditions, which included one no-FM and three device conditions (fixed-gain FM, adaptive FM, and adaptive digital) at the following signal levels: 64 dBA speech (at the location of the participant) in quiet and 64 dBA speech with competing noise at 50, 55, 60, 65, 70, 75, and 80 dBA noise levels.
Results:
No significant differences were detected between the users of Advanced Bionics and Cochlear CIs. All of the radio frequency system conditions (i.e., fixed-gain FM, adaptive FM, and adaptive digital) outperformed the no-FM conditions in test situations with competing noise. Specifically, in conditions with 70, 75, and 80 dBA of competing noise, the adaptive digital system provided better performance than the fixed-gain and adaptive FM systems. The adaptive FM system did provide better performance than the fixed-gain FM system at 70 and 75 dBA of competing noise. At the lower noise levels of 50, 55, 60, and 65 dBA, no significant differences were detected across the three systems, and no significant differences were found across the quiet conditions. In all conditions, performance became poorer as the competing noise level increased.
Conclusions:
In high levels of noise, the adaptive digital system provides superior performance when compared to adaptive analog FM and fixed-gain FM systems.
... Significant benefits of remote wireless microphone systems were also shown in adult participants with bilateral hearing loss using CI(s) or HA(s). Wolfe et al (2013) showed that Roger significantly improved speech recognition in noise in bilateral CI and bimodal recipients at higher noise levels (70, 75, and 80 dB[A]). In this study, Roger also outperformed fixed-gain and adaptive-gain analog FM systems. ...
... SSD CI recipients and bilaterally hearing-impaired participants with unilateral or bilateral CI or bimodal CI-HA have difficulties in speech recognition for distant speakers in noise. For bilaterally hearing-impaired CI recipients, the benefit of remote wireless technology and Roger in particular has been shown in previous work (Wolfe et al, 2013;Thibodeau, 2014). To our knowledge, there are no studies on the application of any remote wireless microphone system in SSD CI recipients. ...
... As competing noise, the classroom noise established and applied in the study of Schafer and Thibodeau (2006) was used. This noise was a digitally edited first-, second-, third-and fourthgrade school classroom noise, which matches the longterm average spectrum of the speech material used in their study (Hearing in Noise Test). Figure 1 shows the room dimensions and experimental setup which are comparable with the settings used by Wolfe et al (2013) and Thibodeau (2014). A Dell Optiplex 790 PC (Dell Inc., Round Rock, TX) with a Fireface UC soundcard (Audio AG, Haimhausen, Germany) was used to deliver the speech stimuli and competing noise. ...
Background Previous research demonstrated benefits of adaptive digital microphone technologies (ADMTs) in adults with single-sided deafness (SSD) having a cochlear implant (CI). Children with SSD are especially affected by background noise because of their noise exposure in kindergarten and school.
Purpose This article aims to evaluate possible effects of ADMT on speech recognition in background noise in children with SSD who use a CI.
Study Sample Ten children between 5 and 11 years of age were included.
Data Collection and Analysis Speech recognition in noise was assessed for one frontal distant and two lateral speakers. The speech stimulus was presented at a speech level of 65 dB(A) and noise at a level of 55 dB(A). For the presentation condition with one frontal speaker, four listening conditions were assessed: (1) normal-hearing (NH) ear and CI turned off; (2) NH ear and CI; (3) NH ear and CI with ADMT; and (4) NH ear with ADMT and CI. Listening conditions (2) to (4) were also tested for each lateral speaker. The frontal speaker was positioned directly in front of the participant, whereas the lateral speakers were positioned at angles of 90 degrees and –90 degrees to the participant's head.
Results Children with SSD who use a CI significantly benefit from the application of ADMT in speech recognition in noise for frontal distant and for lateral speakers. Speech recognition improved significantly with ADMT at the CI and the NH ears.
Conclusion Application of ADMT significantly improves speech recognition in noise in children with SSD who use a CI and can therefore be highly recommended. The decision of whether to apply ADMT at the CI NH ear or bilaterally should be made for each child individually.
... Benefits of remote wireless technology in participants with bilateral hearing loss using HA(s) or/and CI(s) were shown in former studies. Wolfe et al (2013) 30 revealed that Roger™ significantly improved speech recognition at higher noise levels (70, 75, and 80 dB(A)) and outperformed fixed-gain and adaptive-gain analogue FM systems in adult bilateral CI recipients and bimodal CI-HA recipients. These results were confirmed by Thibodeau (2014), 21 demonstrating a significant benefit of Roger™ compared with FM technology (fixed-and adaptive-gain) in bilateral HA users. ...
... According to the Clinical Practice Guidelines (American Academy of Audiology, 2011 1 ), fixed levels of speech and noise, i. e., a fixed SNR, were used in the present study instead of adaptive speech-in-noise testing. In addition, the application of fixed levels of speech and noise was chosen to allow for comparison of the present study with many previous studies (Wolfe et al, 2013; 30 Thibodeau, 2014 21 ), including our study published in Wesarg et al (2019). 27 However, fixed SNR have resulted in floor as well as ceiling effects in speech recognition in both the present study and the study by Wesarg et al (2019). ...
... According to the Clinical Practice Guidelines (American Academy of Audiology, 2011 1 ), fixed levels of speech and noise, i. e., a fixed SNR, were used in the present study instead of adaptive speech-in-noise testing. In addition, the application of fixed levels of speech and noise was chosen to allow for comparison of the present study with many previous studies (Wolfe et al, 2013; 30 Thibodeau, 2014 21 ), including our study published in Wesarg et al (2019). 27 However, fixed SNR have resulted in floor as well as ceiling effects in speech recognition in both the present study and the study by Wesarg et al (2019). ...
Background:
Previous research showed benefits of remote wireless technology in bilaterally moderate-to-severe hearing-impaired participants provided with hearing aid(s), cochlear implant(s) (CIs), or bimodal devices as well as in single-sided deaf (SSD) cochlear implant recipients (with CI from Cochlear™) and normal-hearing (NH) participants.
Purpose:
To evaluate the effect of the digital remote wireless microphone system, Roger™, on speech recognition at different levels of multisource noise in SSD CI recipients using MED-EL CI sound processor OPUS 2. Outcomes were assessed as a function of the listening condition (NH only, NH + CI, NH + CIRog, NHRog + CI, and NHRog + CIRog), Roger™ receiver type (Roger™ Focus for NH; Roger™ X and Roger™ MyLink for CI) and accessory mixing ratio.
Study sample:
Eleven adult, SSD participants aided with CI from MED-EL.
Data collection and analysis:
Speech recognition in noise was assessed in two no-Roger™ conditions, one Roger™ X condition, and two Roger™ MyLink conditions. For the Roger™ X and no-Roger™ conditions, speech recognition was tested at 60.3 dB(A) with the Oldenburg Sentence Test in classroom noise at levels of 55, 65, and 75 dB(A). For the two Roger™ MyLink conditions, speech recognition at 60.3 dB(A) was measured at a noise level of 75 dB(A). Roger™ X was assessed with an accessory mixing ratio of 1:1 (summation of unattenuated microphone and audio accessory input). For Roger™ MyLink, two accessory mixing ratios were investigated, MT (1:1, summation of unattenuated microphone and telecoil input) and T with maximum attenuation of microphone input.
Results:
Speech recognition at higher noise levels (65 and 75 dB(A)) improved significantly with Roger™ in both unilateral use conditions (NH + CIRog and NHRog + CI) as well as bilateral use condition (NHRog + CIRog). Both the bilateral application of Roger™ and the unilateral Roger™ application on the NH ear outperformed the Roger™ application on CI alone. There was no statistically significant effect of type of CI Roger™ receiver (Roger™ X or Roger™ MyLink) and the accessory mixing ratio (MT or T) on speech recognition.
Conclusions:
Speech recognition for distant speakers in multisource noise improved significantly with the application of Roger™ in SSD CI recipients. Both the unilateral Roger™ application on the NH ear or the CI as well as the bilateral Roger™ application can be recommended.
... Significant benefits of remote wireless microphone systems were also shown in adult participants with bilateral hearing loss using CI(s) or HA(s). Wolfe et al (2013) showed that Roger significantly improved speech recognition in noise in bilateral CI and bimodal recipients at higher noise levels (70, 75, and 80 dB[A]). In this study, Roger also outperformed fixed-gain and adaptive-gain analog FM systems. ...
... SSD CI recipients and bilaterally hearing-impaired participants with unilateral or bilateral CI or bimodal CI-HA have difficulties in speech recognition for distant speakers in noise. For bilaterally hearing-impaired CI recipients, the benefit of remote wireless technology and Roger in particular has been shown in previous work (Wolfe et al, 2013;Thibodeau, 2014). To our knowledge, there are no studies on the application of any remote wireless microphone system in SSD CI recipients. ...
... As competing noise, the classroom noise established and applied in the study of Schafer and Thibodeau (2006) was used. This noise was a digitally edited first-, second-, third-and fourthgrade school classroom noise, which matches the longterm average spectrum of the speech material used in their study (Hearing in Noise Test). Figure 1 shows the room dimensions and experimental setup which are comparable with the settings used by Wolfe et al (2013) and Thibodeau (2014). A Dell Optiplex 790 PC (Dell Inc., Round Rock, TX) with a Fireface UC soundcard (Audio AG, Haimhausen, Germany) was used to deliver the speech stimuli and competing noise. ...
Background:
Previous research in cochlear implant (CI) recipients with bilateral severe-to-profound sensorineural hearing loss showed improvements in speech recognition in noise using remote wireless microphone systems. However, to our knowledge, no previous studies have addressed the benefit of these systems in CI recipients with single-sided deafness.
Purpose:
The objective of this study was to evaluate the potential improvement in speech recognition in noise for distant speakers in single-sided deaf (SSD) CI recipients obtained using the digital remote wireless microphone system, Roger. In addition, we evaluated the potential benefit in normal hearing (NH) participants gained by applying this system.
Research design:
Speech recognition in noise for a distant speaker in different conditions with and without Roger was evaluated with a two-way repeated-measures design in each group, SSD CI recipients, and NH participants. Post hoc analyses were conducted using pairwise comparison t-tests with Bonferroni correction.
Study sample:
Eleven adult SSD participants aided with CIs and eleven adult NH participants were included in this study.
Data collection and analysis:
All participants were assessed in 15 test conditions (5 listening conditions × 3 noise levels) each. The listening conditions for SSD CI recipients included the following: (I) only NH ear and CI turned off, (II) NH ear and CI (turned on), (III) NH ear and CI with Roger 14, (IV) NH ear with Roger Focus and CI, and (V) NH ear with Roger Focus and CI with Roger 14. For the NH participants, five corresponding listening conditions were chosen: (I) only better ear and weaker ear masked, (II) both ears, (III) better ear and weaker ear with Roger Focus, (IV) better ear with Roger Focus and weaker ear, and (V) both ears with Roger Focus. The speech level was fixed at 65 dB(A) at 1 meter from the speech-presenting loudspeaker, yielding a speech level of 56.5 dB(A) at the recipient's head. Noise levels were 55, 65, and 75 dB(A). Digitally altered noise recorded in school classrooms was used as competing noise. Speech recognition was measured in percent correct using the Oldenburg sentence test.
Results:
In SSD CI recipients, a significant improvement in speech recognition was found for all listening conditions with Roger (III, IV, and V) versus all no-Roger conditions (I and II) at the higher noise levels (65 and 75 dB[A]). NH participants significantly benefited from the application of Roger in noise for higher levels, too. In both groups, no significant difference was detected between any of the different listening conditions at 55 dB(A) competing noise. There was also no significant difference between any of the Roger conditions III, IV, and V across all noise levels.
Conclusions:
The application of the advanced remote wireless microphone system, Roger, in SSD CI recipients provided significant benefits in speech recognition for distant speakers at higher noise levels. In NH participants, the application of Roger also produced a significant benefit in speech recognition in noise.
... FM systems consist of a transmitter with a microphone that is worn by the talker of interest (i.e., classroom teacher), which transmits the speech signal to a receiver that is coupled to the listener's (i.e., student) device (i.e., CI sound processor). The signal can be delivered via FM radio frequency or a digital radio signal (Wolfe et al, 2013). ...
... Research has proven that DM systems improve speech recognition as noise levels in the environment increase. Wolfe et al (2013) compared speech recognition in noise performance for individuals with Cochlear N5 and Advanced Bionics (AB; Valencia, CA) Harmony CI sound processors using Phonak fixed-gain FM, adaptive FM, and Roger DM technology. Results revealed that Roger DM technology provided significantly improved speech-in-noise recognition in the testing conditions with 70-80 dBA of background noise compared to the two Phonak FM configurations (Wolfe et al, 2013). ...
... Wolfe et al (2013) compared speech recognition in noise performance for individuals with Cochlear N5 and Advanced Bionics (AB; Valencia, CA) Harmony CI sound processors using Phonak fixed-gain FM, adaptive FM, and Roger DM technology. Results revealed that Roger DM technology provided significantly improved speech-in-noise recognition in the testing conditions with 70-80 dBA of background noise compared to the two Phonak FM configurations (Wolfe et al, 2013). ...
Background:
Guidelines established by the AAA currently recommend behavioral testing when fitting frequency modulated (FM) systems to individuals with cochlear implants (CIs). A protocol for completing electroacoustic measures has not yet been validated for personal FM systems or digital modulation (DM) systems coupled to CI sound processors. In response, some professionals have used or altered the AAA electroacoustic verification steps for fitting FM systems to hearing aids when fitting FM systems to CI sound processors. More recently steps were outlined in a proposed protocol.
Purpose:
The purpose of this research is to review and compare the electroacoustic test measures outlined in a 2013 article by Schafer and colleagues in the Journal of the American Academy of Audiology titled "A Proposed Electroacoustic Test Protocol for Personal FM Receivers Coupled to Cochlear Implant Sound Processors" to the AAA electroacoustic verification steps for fitting FM systems to hearing aids when fitting DM systems to CI users.
Research design:
Electroacoustic measures were conducted on 71 CI sound processors and Phonak Roger DM systems using a proposed protocol and an adapted AAA protocol. Phonak's recommended default receiver gain setting was used for each CI sound processor manufacturer and adjusted if necessary to achieve transparency.
Study sample:
Electroacoustic measures were conducted on Cochlear and Advanced Bionics (AB) sound processors. In this study, 28 Cochlear Nucleus 5/CP810 sound processors, 26 Cochlear Nucleus 6/CP910 sound processors, and 17 AB Naida CI Q70 sound processors were coupled in various combinations to Phonak Roger DM dedicated receivers (25 Phonak Roger 14 receivers-Cochlear dedicated receiver-and 9 Phonak Roger 17 receivers-AB dedicated receiver) and 20 Phonak Roger Inspiro transmitters.
Data collection and analysis:
Employing both the AAA and the Schafer et al protocols, electroacoustic measurements were conducted with the Audioscan Verifit in a clinical setting on 71 CI sound processors and Phonak Roger DM systems to determine transparency and verify FM advantage, comparing speech inputs (65 dB SPL) in an effort to achieve equal outputs. If transparency was not achieved at Phonak's recommended default receiver gain, adjustments were made to the receiver gain. The integrity of the signal was monitored with the appropriate manufacturer's monitor earphones.
Results:
Using the AAA hearing aid protocol, 50 of the 71 CI sound processors achieved transparency, and 59 of the 71 CI sound processors achieved transparency when using the proposed protocol at Phonak's recommended default receiver gain. After the receiver gain was adjusted, 3 of 21 CI sound processors still did not meet transparency using the AAA protocol, and 2 of 12 CI sound processors still did not meet transparency using the Schafer et al proposed protocol.
Conclusions:
Both protocols were shown to be effective in taking reliable electroacoustic measurements and demonstrate transparency. Both protocols are felt to be clinically feasible and to address the needs of populations that are unable to reliably report regarding the integrity of their personal DM systems.
... Given that technology advances at a rapid rate, it can often be difficult to know which device will provide the optimum benefit. One of the latest trends in the ALD industry is adaptive wireless digital transmission systems (Wolfe et al, 2013). These systems have a number of advantages over the traditional adaptive frequency-modulated systems currently available on the market. ...
... These systems have a number of advantages over the traditional adaptive frequency-modulated systems currently available on the market. These advantages include increased audio bandwidth (up to 7300 Hz) and the utilisation of frequency-hopping, which acts to prevent electromagnetic interference (Wolfe et al, 2013). Moreover, these digital systems sample the noise level in the surrounding environment and alter the gain accordingly, with the intent of improving the SNR for the listener (Wolfe et al, 2013). ...
... These advantages include increased audio bandwidth (up to 7300 Hz) and the utilisation of frequency-hopping, which acts to prevent electromagnetic interference (Wolfe et al, 2013). Moreover, these digital systems sample the noise level in the surrounding environment and alter the gain accordingly, with the intent of improving the SNR for the listener (Wolfe et al, 2013). This technology is currently available in both soundfield amplification systems and remote microphones. ...
Objective:
To assess the benefit of assistive listening devices (ALDs) for students with hearing impairment in mainstream schools.
Design:
Speech recognition (CNC words) in background noise was assessed in a typical classroom. Participants underwent testing using four device configurations: (1) HA(s)/CI(s) alone, (2) soundfield amplification, (3) remote microphone (Roger Pen) on desk and (4) remote microphone at the loudspeaker. A sub-group of students subsequently underwent a 2-week classroom trial of each ALD. Degree of improvement from baseline [HA(s)/CI(s)] alone was assessed using teacher and student Listening Inventory for Education-Revised (LIFE-R) questionnaires.
Study sample:
In all, 20 students, aged 12.5-18.9 years, underwent speech recognition assessment. In total, 10 of these participated in the classroom trial. Hearing loss ranged from mild-to-profound levels.
Results:
Performance in each ALD configuration was higher than for HAs/CIs alone (p < 0.001). Teacher and student LIFE-R results indicated significant improvement in listening/communication when using the remote microphone in conjunction with HAs/CIs (p < 0.05). There was no difference between the soundfield system and the baseline measurement (p > 0.05).
Conclusion:
Speech recognition improvements were demonstrated with the implementation of both remote microphones and soundfield systems. Both students and teachers reported functional hearing advantages in the classroom when using the remote microphone in concert with their standard hearing devices.
... There are currently various systems that are able to transmit a remote microphone signal to the APs, e.g., traditional telecoil or FM transmission systems [14], [15] and new state of the art digital wireless transmission systems [16]. However, these systems either disable the local microphones or significantly amplify the remote microphone signal to provide the HI individuals with a clean, high SNR signal [16]. ...
... There are currently various systems that are able to transmit a remote microphone signal to the APs, e.g., traditional telecoil or FM transmission systems [14], [15] and new state of the art digital wireless transmission systems [16]. However, these systems either disable the local microphones or significantly amplify the remote microphone signal to provide the HI individuals with a clean, high SNR signal [16]. Unfortunately, by disabling the local microphones, the binaural cues become degraded, or in the worst case, completely lost. ...
... We note that while (16) and (17) only hold for a noise correlation matrix as defined in (14), this will be used to motivate some limiting cases of . The original definition of (see (13)) can be used in all other cases. ...
A general binaural noise reduction system is considered that employs the multichannel Wiener filter with partial noise estimation (MWF eta) allowing for an explicit tradeoff between noise reduction and binaural noise cue preservation. In this paper, it is assumed that along with the general binaural system, a remote microphone signal with a high input signal-to-noise ratio (SNR) is available for inclusion in the MWF eta. The use of this remote microphone signal with a high input SNR allows for a simultaneous increase in both noise reduction performance and preservation of the binaural noise cues. To further increase the performance, a modification to the partial noise estimation (PNE) variable, eta, is proposed which relies on exploiting the aforementioned trade-off by either constraining the output SNR or binaural noise cues to the same level before and after the addition of the remote microphone signal. The validity of the theoretical results are supplemented via simulations using a binaural setup with a single speech and noise source.
... A personal RM system comprises a microphone that captures the signal of interest and a transmitter that transports the signal via radio frequency (RF) transmission to a receiver that is coupled to a hearing instrument. At SNRs commonly found in real-world settings (0 to +5 dB), use of a personal RM may improve speech recognition by an average 40 to 60 percentage points compared with performance with a hearing instrument alone (Wolfe, Morais, Neumann, et al., 2013;Wolfe, Morais, Schafer, et al., 2013). ...
... The primary objective of adaptive systems is to provide greater gain to the signal delivered from the RM while the listener is attempting to communicate in situations with moderate-to high-level noise with the goal of enhancing the salience of the signal of interest. Previous studies have shown that use of adaptive systems provides better speech recognition in moderateto high-level noise compared with fixed-gain RM systems (Thibodeau, 2010(Thibodeau, , 2014Wolfe, Morais, Schafer, et al., 2013;Wolfe, Schafer, Heldner, Mulder, & Vincent, 2009). ...
... When using adaptive RF systems, digital signal processing potentially allows for better analysis of the competing noise signal and a more accurate provision of receiver gain in noise compared with analog processing. Research has shown that use of digital adaptive RM systems provides better speech recognition in moderate-to high-level noise compared with performance with analog adaptive FM systems (Thibodeau, 2014;Wolfe, Morais, Schafer, et al., 2013). ...
Purpose:
One purpose of this study was to evaluate the improvement in speech recognition obtained with use of 2 different remote microphone technologies. Another purpose of this study was to determine whether a battery of audiometric measures could predict benefit from use of these technologies.
Method:
Sentence recognition was evaluated while 17 adults used each of 2 different hearing aids. Performance was evaluated with and without 2 different remote microphone systems. A variety of audiologic measures were administered to determine whether prefitting assessment may predict benefit from remote microphone technology.
Results:
Use of both remote microphone systems resulted in improvement in speech recognition in quiet and in noise. There were no differences in performance obtained with the 2 different remote microphone technologies in quiet and at low competing noise levels, but use of the digital adaptive remote microphone system provided better speech recognition in the presence of moderate- to high-level noise. The Listening in Spatialized Noise-Sentence Test Prescribed Gain Amplifier (Cameron & Dillon, 2010) measure served as a good predictor of benefit from remote microphone technology.
Conclusions:
Each remote microphone system improved sentence recognition in noise, but greater improvement was obtained with the digital adaptive system. The Listening in Spatialized Noise-Sentence Test Prescribed Gain Amplifier may serve as a good indicator of benefit from remote microphone technology.
... A further study by Wolfe et al. [11] looked at the latest technology in this area-digital transmission of the signal between the transmitter and receiver. This system no longer uses frequency modulation, and therefore technically speaking can no longer be referred to as an FM system. ...
... The Phonak Roger system (Mülder, Roger: The new wireless technology standard, Phonak Insight 2013) features an adaptive gain adjustment similar to the Phonak MLxi system, but using a digital signal transmission and digital signal processing to manipulate the gain increases. This system was compared to the MLxS fixed gain receiver as well as to the MLxi in a classroom-like setup with a single talker [11]. Subjects were16 CI recipients fitted with an Advanced Bionics Harmony speech processor and 21 recipients fitted with a Cochlear CP810 processor. ...
... This is the first study to test a multiple talker network with adult CI users in a realistic everyday situation. Previous studies have focused on the use of single transmitters in a classroom situation with large distances between the talker and the listener (5-6 m), a scenario more representative of FM use in children at school [9,11,21]. The test setup created here was specifically designed to be relevant for adults and the situations in which that they would be more likely to use a Roger system, i.e., in small group conversations or discussions. ...
Roger is a digital adaptive multi-channel remote microphone technology that wirelessly transmits a speaker's voice directly to a hearing instrument or cochlear implant sound processor. Frequency hopping between channels, in combination with repeated broadcast, avoids interference issues that have limited earlier generation FM systems. This study evaluated the benefit of the Roger Pen transmitter microphone in a multiple talker network (MTN) for cochlear implant users in a simulated noisy conversation setting. Twelve post-lingually deafened adult Advanced Bionics CII/HiRes 90K recipients were recruited. Subjects used a Naida CI Q70 processor with integrated Roger 17 receiver. The test environment simulated four people having a meal in a noisy restaurant, one the CI user (listener), and three companions (talkers) talking non-simultaneously in a diffuse field of multi-talker babble. Speech reception thresholds (SRTs) were determined without the Roger Pen, with one Roger Pen, and with three Roger Pens in an MTN. Using three Roger Pens in an MTN improved the SRT by 14.8 dB over using no Roger Pen, and by 13.1 dB over using a single Roger Pen (p < 0.0001). The Roger Pen in an MTN provided statistically and clinically significant improvement in speech perception in noise for Advanced Bionics cochlear implant recipients. The integrated Roger 17 receiver made it easy for users of the Naida CI Q70 processor to take advantage of the Roger system. The listening advantage and ease of use should encourage more clinicians to recommend and fit Roger in adult cochlear implant patients.
... Use of personal remote microphone wireless digital radio frequency (RF)/frequency modulation (FM) systems provides substantial improvement in speech recognition in noise (Schafer and Thibodeau, 2004;Wolfe et al, 2009;Wolfe, Morais, et al, 2013). Recent studies have shown that remote microphone RF technology allows for an improvement of up to 12 dB in the SNR (between 29-75% improvement in intelligibility) for older children and adults with cochlear implants Thibodeau, 2003, 2004;Wolfe et al, 2009;Wolfe, Morais, et al, 2013). ...
... Use of personal remote microphone wireless digital radio frequency (RF)/frequency modulation (FM) systems provides substantial improvement in speech recognition in noise (Schafer and Thibodeau, 2004;Wolfe et al, 2009;Wolfe, Morais, et al, 2013). Recent studies have shown that remote microphone RF technology allows for an improvement of up to 12 dB in the SNR (between 29-75% improvement in intelligibility) for older children and adults with cochlear implants Thibodeau, 2003, 2004;Wolfe et al, 2009;Wolfe, Morais, et al, 2013). These systems also improve sound quality, perceptual clarity, and ease of listening for both children and adults with cochlear implants (Schafer and Thibodeau, 2004;Fitzpatrick et al, 2010;Schafer et al, 2013). ...
... However, as the ambient noise approaches and exceeds a moderate level (e.g., 57 dB sound pressure level), the gain of the receiver increases with further increase in ambient noise. Wolfe and colleagues Wolfe, Morais et al, 2013) have evaluated adaptive RF technology in a large group of adult and pediatric AB cochlear implant recipients and found that adaptive technology improves speech recognition in noise by about 30% at moderate competing noise levels (e.g., 65 dBA) and almost 60% at high levels of competing noise (e.g., 70-75 dBA). ...
Cochlear implant recipients often experience difficulty with understanding speech in the presence of noise. Cochlear implant manufacturers have developed sound processing algorithms designed to improve speech recognition in noise, and research has shown these technologies to be effective. Remote microphone technology utilizing adaptive, digital wireless radio transmission has also been shown to provide significant improvement in speech recognition in noise. There are no studies examining the potential improvement in speech recognition in noise when these two technologies are used simultaneously.
The goal of this study was to evaluate the potential benefits and limitations associated with the simultaneous use of a sound processing algorithm designed to improve performance in noise (Advanced Bionics ClearVoice) and a remote microphone system that incorporates adaptive, digital wireless radio transmission (Phonak Roger).
A two-by-two way repeated measures design was used to examine performance differences obtained without these technologies compared to the use of each technology separately as well as the simultaneous use of both technologies.
Eleven Advanced Bionics (AB) cochlear implant recipients, ages 11 to 68 yr.
AzBio sentence recognition was measured in quiet and in the presence of classroom noise ranging in level from 50 to 80 dBA in 5-dB steps. Performance was evaluated in four conditions: (1) No ClearVoice and no Roger, (2) ClearVoice enabled without the use of Roger, (3) ClearVoice disabled with Roger enabled, and (4) simultaneous use of ClearVoice and Roger.
Speech recognition in quiet was better than speech recognition in noise for all conditions. Use of ClearVoice and Roger each provided significant improvement in speech recognition in noise. The best performance in noise was obtained with the simultaneous use of ClearVoice and Roger.
ClearVoice and Roger technology each improves speech recognition in noise, particularly when used at the same time. Because ClearVoice does not degrade performance in quiet settings, clinicians should consider recommending ClearVoice for routine, full-time use for AB implant recipients. Roger should be used in all instances in which remote microphone technology may assist the user in understanding speech in the presence of noise.
American Academy of Audiology.
... The purpose of the additional 10 dB is to emphasize the voice of a teacher in a class in advantage to the peers' voices in class, for example. FM systems have shown significant benefit for both HA users (Anderson & Goldstein, 2004;Thibodeau, 2014) and cochlear implant (CI) users (Wolfe et al., 2009(Wolfe et al., , 2013. Digital wireless systems are able to provide an additional SNR improvement compared with analogue FM systems. ...
... Digital wireless systems are able to provide an additional SNR improvement compared with analogue FM systems. Wolfe et al. (2013) found that CI users performed better with adaptive digital wireless systems compared with analogue and fixed-gain FM systems in high levels of noise. With CI users, the general benefit from digital RM was confirmed in recent studies by Wolfe et al. (2015) andDe Ceulaer et al. (2016) or Vroegop, Dingemanse, Homans, and Goedegebure (2017) for bimodal CI users. ...
Remote microphones (RMs) have been developed to support hearing aid (HA) users in understanding distant talkers. In traditional clinical applications, a drawback of these systems is the deteriorated speech intelligibility in the near field. This study investigates advantages and disadvantages of clinical RM usage and the effects of different directionality settings of the HAs in complex listening situations in the laboratory. Speech intelligibility was investigated in 15 experienced severely hearing impaired participants in a noisy environment using a dual-task test paradigm where the tasks were presented from either a near field or a far field loudspeaker. Primary and secondary tasks were presented simultaneously so attention had to be shared on both tasks. In a second experiment, two speech intelligibility tests were presented from either the near field or the far field loudspeaker. The tests were interleaved to simulate a complex listening situation with shifting attention. Directional HA microphones yielded better performance than omnidirectional microphones (both combined with a RM) in near field when analyzing both tasks of the dual-task experiment separately. Furthermore, the integrated dual-task test results showed better performance with directional HA microphones compared with the omnidirectional setting (both cases in combination with a RM). These findings were confirmed by the results of the interleaved speech intelligibility test.
... The most direct approach to improving the speech-recognition defi cits in noise of children with hearing loss is the use of remotemicrophone technology, such as a frequency modulation (FM) system (Pittman, Lewis, Hoover, Stelmachowicz, 1999;Wolfe et al., 2013). FM systems consist of a microphone and transmitter for the talker and a receiver for the listener. ...
... Children with hearing loss show signifi cantly better speechrecognition performance when using FM systems as compared to their hearing aids or cochlear implants alone in noisy situations (Pittman et al., 1999;Wolfe et al., 2013). Even with the addition of advanced features in hearing aids, such as directional microphones, speech-recognition performance with FM systems is superior to performance with hearing aids alone (Lewis, Crandell, Valente, & Horn, 2004). ...
Recently introduced frequency modulation (FM) systems provide an adaptive adjustment to the emphasis of the FM system through the user’s hearing aid via VoicePriority i™ (VPi). VPi measures the noise level at the listener’s hearing aid microphone and adds gain to the FM signal when the background noise increases to a detrimental level. However, the potential benefit of VPi technology has yet to be determined. Therefore, the goals of this investigation were to determine behavioral performance and subjective ratings with VPi as compared to traditional, fixed-gain FM systems or hearing aids alone. According to speech recognition
performance in noise, VPi provided significantly better scores when compared to the traditional FM system in
conditions with high levels of noise. Acceptable noise levels were also significantly better with VPi over the traditional FM system and the study hearing aids alone. Speech intelligibility ratings with both FM systems were significantly higher than ratings with study aids alone. Parent and child questionnaires yielded similar findings to the behavioral results, with significantly higher ratings for the FM system with VPi over the study and personal hearing aids alone. In conclusion, the FM systems with VPi provided superior performance and subjective ratings relative to traditional, fixed-gain FM systems or hearing aids alone.
... The evolution of frequency modulation (FM) technology for digital transmitters furnished further benefits to the users, as it enables better speech recognition in noise and diminishes interferences, making sound transmission more constant (11) . We chose to use the term remote microphone because it encompasses all such technologies. ...
Purpose:
To identify relationships between Remote Microphone System (RMS) use in the classroom and the schools' and teachers' characteristics.
Methods:
We analyzed 120 subjects aged 5 to 17 years with hearing loss who had received an RMS from a health service accredited by the Unified Health System (SUS). The teachers of RMS users were the other subjects in the study. We analyzed the patients' medical records and interviewed their parents/guardians at the follow-up visit to verify issues related to the RMS and its use at school. We contacted the schools over the phone and visited some of them.
Results:
Of the students, 54% used the device at school; 22% involuntarily did not use it; and 24% voluntarily did not use it. The Speech Intelligibility Index pattern of those who used the RMS was similar to those who involuntarily did not use it. There was a significant difference between the type of school and educational level - 86% of regular school students and elementary school students tend to use the device more often (62%).
Conclusion:
Most subjects use the RMS at school. The students' educational level also interfered with the adherence to RMS use, as elementary school students had a higher adherence. The data suggest that the coordination between health services and schools favors RMS use. However, when the parents mediate this relationship, other factors interfere with the systematic RMS use in the school routine.
... The Oldenburg Inventory addressed different daily hearing situations: Particularly, in silent conditions patients indicated high satisfaction rates, whereas hearing in noise and directional hearing reached medium satisfaction. This observation is a general hindrance for patients with cochlear implants [37][38][39]. Both PM RH and noRH patients benefited to a similar extent at the end of the observation period (6-12 months) (Suppl. ...
Purpose
Numerous endeavors have been undertaken to preserve hearing in cochlear implant (CI) patients. Particularly, optimization of electrode array design aims at preservation of residual hearing (RH). This study examines whether a slim perimodiolar (PM) electrode array could bear the capability to preserve hearing.
Methods
A total of 47 patients underwent cochlear implantation receiving the PM electrode. (i) Patients with pure tone audiogram (PTA) thresholds better than 85 dB and/or hearing loss for Freiburg speech test numbers less than 60 dB and more than 50% maximum monosyllabic understanding were assigned to the RH group ( n = 17), while all others belonged to the noRH group ( n = 30). (ii) Another group implanted with a slim straight, lateral wall (LW) electrode was recruited for comparison.
Results
We compared 17 RH–30 noRH patients all receiving the PM electrode. RH in PM recipients decreased faster than in LW recipients. No significant differences were observed between both (RH v/s noRH) groups in NRT thresholds, Freiburg speech test and A§E ® phonemes. Analogous satisfaction levels were indicated through the questionnaires in terms of sound quality, hearing in silence, noise and directional hearing in both groups.
Conclusions
The results suggest that hearing preservation is influenced not only by electrode shape but various factors. This study opens an avenue for further investigations to elucidate and enumerate the causes for progressive hearing loss.
... These modern RMs can eliminate interference from other nearby RF systems, reduce noise and static which occasionally accompanies FM signals, offer a wider bandwidth, increase the sophistication of processing applied to transmitted signals, and produce excellent speech recognition in noise. 28,29 Some RM users' SIN results approach those obtained by people with relatively normalhearing ability. 30 RM systems can be coupled to many commercially available hearing aids and will significantly improve speech recognition in noise relative to the "no RM" condition at SNRs commonly encountered in real-world situations. ...
... Palabras clave: Audición; Audífonos; Tecnología inalámbrica; Equipo de autoayuda; Padres; Pérdida de la audición Nos últimos anos, a tecnologia de frequência modulada evolui para a de transmissão digital, e estão sendo disponibilizadas com o mesmo objetivo de facilitar a comunicação em ambientes ruidosos. Esses dispositivos, embora com outra tecnologia, têm a mesma função e mesmas vantagens do sistema FM 23 . A diferença entre as tecnologias é a transmissão do sinal digital e adaptativa, significando uma melhora na qualidade do acesso à informação de fala, independente do ruído de fundo, e mais facilidade durante o uso. ...
Introdução: A relação sinal-ruído na sala de aula pode ser um vilão na inclusão na escola regular de alunos com deficiência auditiva, usuários de dispositivos eletrônicos, que utilizam a língua oral para se comunicar. Os recursos tecnológicos são determinantes para a melhor audibilidade de sons de fala em ambientes ruidosos e sua efetividade depende da adesão ao uso do dispositivo. Esse processo é determinado pela parceria entre profissionais da saúde, família e escola. Objetivo: Identificar a relação entre a utilização consistente do sistema de microfone remoto (SMR) em estudantes com deficiência auditiva e o uso pelos professores, que favoreceram ou dificultaram sua adaptação e o desenvolvimento escolar desses estudantes. Método: Foram analisados 175 sujeitos entre 5 e 17 anos que receberam o SMR num serviço de saúde auditiva entre os anos de 2017 e 2018. Pais e professores de usuários também foram sujeitos do estudo. O funcionamento do SMR e a classificação quanto ao seu uso foram verificados. Resultado: Os indivíduos que mais ‘usam’ o SMR estão no ensino fundamental I, e os que ‘não usam voluntariamente’ estão no ensino médio e fundamental II. Considerando-se o tipo de escola, a maioria que ‘não usa voluntariamente’ o SMR está em escola ou sala para surdos com uso de libras e/ou tem intérprete na sala da escola regular. Conclusão: Houve associação entre uso do SMR e tipo de escola. Recomenda-se que o tipo de escola seja um critério de indicação do dispositivo. O nível educacional também foi uma variável determinante no uso do dispositivo na escola.
... The benefits of Roger technology have been well-documented in adults and pediatric CI recipients. [2][3][4][5][6] A second technological approach that produces large gains in speech understanding in noise is on-ear adaptive beamforming. Dual microphones mounted on a hearing aid or a CI sound processor allow phase, or time of arrival, at the two mics to be compared; maximum sensitivity is steered to the front of the listener and the null, or maximum attenuation, is steered adaptively toward the dominant noise source(s) located on the sides and back of the device user. ...
Background Both the Roger remote microphone and on-ear, adaptive beamforming technologies (e.g., Phonak UltraZoom) have been shown to improve speech understanding in noise for cochlear implant (CI) listeners when tested in audio-only (A-only) test environments.
Purpose Our aim was to determine if adult and pediatric CI recipients benefited from these technologies in a more common environment—one in which both audio and visual cues were available and when overall performance was high.
Study Sample Ten adult CI listeners (Experiment 1) and seven pediatric CI listeners (Experiment 2) were tested.
Design Adults were tested in quiet and in two levels of noise (level 1 and level 2) in A-only and audio-visual (AV) environments. There were four device conditions: (1) an ear canal-level, omnidirectional microphone (T-mic) in quiet, (2) the T-mic in noise, (3) an adaptive directional mic (UltraZoom) in noise, and (4) a wireless, remote mic (Roger Pen) in noise. Pediatric listeners were tested in quiet and in level 1 noise in A-only and AV environments. The test conditions were: (1) a behind-the-ear level omnidirectional mic (processor mic) in quiet, (2) the processor mic in noise, (3) the T-mic in noise, and (4) the Roger Pen in noise.
Data Collection and Analyses In each test condition, sentence understanding was assessed (percent correct) and ease of listening ratings were obtained. The sentence understanding data were entered into repeated-measures analyses of variance.
Results For both adult and pediatric listeners in the AV test conditions in level 1 noise, performance with the Roger Pen was significantly higher than with the T-mic. For both populations, performance in level 1 noise with the Roger Pen approached the level of baseline performance in quiet. Ease of listening in noise was rated higher in the Roger Pen conditions than in the T-mic or processor mic conditions in both A-only and AV test conditions.
Conclusion The Roger remote mic and on-ear directional mic technologies benefit both speech understanding and ease of listening in a realistic laboratory test environment and are likely do the same in real-world listening environments.
... Children with hearing loss have more difficulties listening in noisy environments when compared to children with normal hearing, and often require higher signal-to-noise ratio (SNR) values [4,5]. Listening in the classroom is particularly challenging due to the effects of noise, distance, and reverberation [6,7]. A SNR of at least +15 dB is recommended to allow children with hearing loss appropriate and consistent access to the information being presented [8,9]. ...
Objectives
For children with hearing loss, remote microphone (RM) technology can significantly improve access to speech in environments with poor signal-to-noise ratios (SNRs), such as classrooms. Yet, this has never been studied in bone conduction device (BCD) users, a common treatment for children with irresolvable conductive hearing loss resulting from anatomical malformations of the outer ear. The objective of this study was to investigate the benefits of RM technology on speech perception in noise in pediatric BCD users with Microtia/Atresia. A secondary aim was to assess parent and child perceptions of RM technology before and after exposure to RM technology.
Methods
Participants included 10 pediatric bone conduction implant users with unilateral conductive hearing loss ages 7–17 years, and their guardians. Speech perception in noise for soft and moderate inputs was assessed with and without RM technology. Guardians actively observed the child's hearing performance with and without the RM and were asked to complete a questionnaire assessing their perceptions about their child's performance. Children were also administered the questionnaire prior to and immediately following exposure to the RM technology.
Results
Participants showed improved speech understanding in noise for both soft and moderate speech inputs when using the RM with their BCD compared to their BCD alone. Questionnaire results indicated good parent-child agreement. Further, significant improvements were reported for child understanding speech, parent hearing domains after exposure to the RM. No significant differences were noted for ease of use/likability.
Conclusions
Significant hearing in noise benefits were observed with RM technology for children using BCDs. Consistent with objective findings, children reported improved speech understanding with the RM. Improved parental perceptions of hearing benefit following exposure to the RM suggests that active participation may serve as an effective strategy to help improve parent understanding of the benefits of RM technology for their child.
... Nesse sentido, aliás, diversos estudos já comprovaram que o Sistema FM permite que o estudante com deficiência auditiva tenha acesso consistente e de boa qualidade à voz do professor, independentemente do nível de ruído de fundo, ou da distância entre o locutor e o ouvinte (18)(19)(20) . ...
Objetivo
conhecer como se deu o processo de criação de políticas públicas em saúde auditiva no Brasil, bem como a influência do Poder Judiciário na concretização do acesso, pela pessoa com deficiência auditiva, ao Sistema de Frequência Modulada (Sistema FM) e para utilização em ambiente escolar.
Métodos
estudo qualitativo exploratório, por meio do qual foi realizado, inicialmente, um levantamento normativo nos sítios eletrônicos da Presidência da República, Câmara dos Deputados e Ministério da Saúde, visando identificar, no período compreendido entre outubro de 1988 e outubro de 2019, a existência de normas que versassem sobre a criação de políticas públicas em saúde auditiva. Foi realizado, em complemento, levantamento jurisprudencial nos sítios eletrônicos de Tribunais de Justiça, Tribunais Regionais Federais e Tribunais Superiores, visando identificar, no período compreendido entre janeiro de 2000 e outubro de 2019, a existência de decisões judiciais que versassem sobre acesso ao Sistema FM, via Sistema Único de Saúde (SUS).
Resultados
foi possível identificar dez instrumentos normativos que tratavam, especificamente, da criação de políticas públicas em saúde auditiva, além de seis decisões judiciais, cujos méritos consistiam, propriamente, no acesso ao Sistema FM, via SUS.
Conclusão
o Poder Judiciário tem papel fundamental na concretização do acesso ao Sistema FM pela pessoa com deficiência auditiva, uma vez que sua atuação suprime omissões dos outros Poderes e impede que políticas públicas já concebidas contemplem restrições contrárias à Constituição Federal.
... A further study by Wolfe et al. [20] looked at the latest technology in the area of digital transmission of the signal between the transmitter and the receiver. This system no longer uses FM, and therefore technically speaking can no longer be referred to as an FM system. ...
Introduction
Hearing is the principal sensory modality by which language and speech are acquired. For that reason, a child with hearing loss whose family chooses an auditory approach for learning language must have as much exposure to high-quality auditory stimulation as possible. Both hearing aids and cochlear implants (CI) are best in quiet and close places, but not so good at a distance, in noise or when sounds bounce around. Children with CI have significant difficulty in hearing conversational speech in the presence of background noise. They may have difficulty understanding soft speech signals due to distance and reverberation. Assistive listening technology is impressive and can be a big help for CI children. So, if CI children have unique needs that are not addressed by his CI, assistive listening devices (ALDs) can be the answer. Using the Roger inspiro system as a wireless communication accessory provides a significant increase in speech understanding in high levels of noise, by its wireless remote microphone.
Aims
The aim of the study is to monitor the effect of digital wireless technology (Roger inspiro) on the language development of children with cochlear implants.
Participants and methods
The present randomized case–control study included 20 children with CI using Roger inspiro during rehabilitation sessions as an ALD (11 boys and nine girls) with ages range from 5.3 to 11.6 years with a mean age of 5.9 years as well as 20 age- and sex-matched CI controls without ALD (10 boys and 10 girls). All children in the study or the control groups had bilateral severe to profound sensory neural hearing loss and they used advanced Bionics CI. Phoniatrics and Audiological assessment was done before auditory and language therapy for both groups. Reassessment was done after 6 months of therapy.
Result
Results show that there is a statistically significant improvement in The Word Intelligibility by Picture Identification (WIPI) scores after rehabilitation and with Roger. However, there is no significant difference between study and control groups as regards receptive, expressive, and total language. Highly significant correlation between WIPI results and expressive language results after therapy with Roger was found.
Conclusion
Coupling of wireless technology to CIs might help children improving their auditory access. The study supports the use Roger inspiro in enhancing speech perception for children with CI. The preliminary results also show the usefulness of wireless technology in the development of language skills in these children.
... In the groups with predominant exposure to speech in noise ("school age") and noise ("working age"), the use of assistive listening devices such as frequency modulation devices and digital remote wireless microphone technology should be especially encouraged to enhance the signal-to noise-ratio for speech comprehension [Wolfe et al., 2013;Wesarg et al., 2018] [2017] showed that although many CI patients have a frequency modulation device, they used it very rarely, emphasizing the need for counselling patients on the use of assistive devices. ...
Purpose:
This study analyses data logs in order to investigate the usage pattern of cochlear implant (CI) recipients with single-sided deafness (SSD-CI) and bilaterally deaf, uni- or bilaterally implanted CI recipients (Uni-CI and Bil-CI). Data logging is available from SCAN, an automated auditory scene classifier which categorizes auditory input into 6 listening environments.
Methods:
CI usage data were retrospectively available from data logs of 206 CI recipients using the Nucleus 6 system obtained between January 2013 and June 2015. For all recipients, we analysed time on air and time spent in the listening environments. For statistical analysis, we matched the CI recipients according to age and duration of CI experience and classified them into 4 age groups.
Results:
SSD-CI showed a similar time on air compared to Uni- and Bil-CI. Usage behaviour of SSD-CI was comparable to Uni- and Bil-CI regarding exposure to music, speech in quiet and speech in noise. With increasing age, exposure to quiet increased and exposure to music decreased across all CI recipient groups in relation to time on air.
Conclusion:
In total, the CI usage pattern of SSD-CI is comparable for the majority of listening environments and age groups to that of Uni- and Bil-CI. The results of our study show that SSD-CI benefit equally from CI implantation.
... The audio bandwidth in DM systems is wider than in FM systems, thus providing more access to high-frequency information (Wolfe, Morais, Schafer, Agrawal, & Koch, 2015), although the HA may still impose bandwidth restrictions as the transducer (Kimlinger, McCreery, & Lewis, 2015). Digital signal processing also provides better speech recognition in moderate-to-high noise levels compared with FM systems because of the adaptive gain capacities that are available in DM (Thibodeau, 2014;Wolfe et al., 2013). These improvements may make RM technology even more beneficial to use in home and community settings, allowing greater utilization with children who have mild-to-severe hearing loss. ...
Purpose
Children who are hard of hearing (CHH) have restricted access to acoustic and linguistic information. Increased audibility provided by hearing aids influences language outcomes, but the benefits of hearing aids are often limited by acoustic factors and distance. Remote microphone (RM) systems further increase auditory access by reducing the negative consequences of these factors. The purpose of this article was to identify factors that influence likelihood of RM system receipt and to investigate the effects of RM systems in home settings on later language outcomes. We used propensity score matching to compare language outcomes between children with and without access to personal RM systems in home settings. This article provides a description of how and why to perform propensity score–matching analyses with clinical populations.
Method
Participants were 132 CHH. Through parent report, we identified children who received RM systems for home use by 4 years of age. Logistic regression was used to determine factors that predict likelihood of RM system receipt in home settings. Propensity score matching was conducted on a subgroup of 104 participants. Performance on language measures at age 5 years was compared across propensity-matched children who did and did not receive RMs for personal use.
Results
Likelihood of RM receipt was associated with degree of hearing loss, maternal education, and location (recruitment site). Comparisons between matched pairs of children with and without RM systems in early childhood indicated significantly better discourse skills for children whose families owned RM systems, but no significant differences for vocabulary or morphosyntax.
Conclusion
Results provide preliminary evidence that the provision of personal RM systems for preschool-age CHH enhances higher-level language skills. The propensity score–matching technique enabled us to use an observational, longitudinal data set to examine a question of clinical interest.
... The audio bandwidth in DM systems is wider than FM systems, thus providing more access to high-frequency information (Wolfe et al. 2015), although the hearing aid may still impose bandwidth restrictions as the transducer (Kimlinger, McCreery, and Lewis 2015). Digital signal processing also provides better speech recognition in moderate-to-high noise levels compared to FM systems, due to the adaptive gain capacities that are available in DM (Thibodeau 2014;Wolfe et al. 2013). These improvements may make RM technology even more beneficial to use in the classroom, allowing greater utilisation with children who have mild-to-severe hearing loss. ...
Objectives: Children who are hard of hearing (CHH) have restricted access to auditory-linguistic information. Remote-microphone (RM) systems reduce the negative consequences of limited auditory access. The purpose of this study was to characterise receipt and use of RM systems in young CHH in home and school settings.
Design: Through a combination of parent, teacher, and audiologist report, we identified children who received RM systems for home and/or school use by 4 years of age or younger. With cross-sectional surveys, parents estimated the amount of time the child used RM systems at home and school per day.
Study Sample: The participants included 217 CHH.
Results: Thirty-six percent of the children had personal RMs for home use and 50% had RM systems for school. Approximately, half of the parents reported that their children used RM systems for home use for 1–2 hours per use and RM systems for school use for 2-4 hours per day.
Conclusions: Results indicated that the majority of the CHH in the current study did not receive RM systems for home use in early childhood, but half had access to RM technology in the educational setting. High-quality research studies are needed to determine ways in which RM systems benefit pre-school-age CHH.
... Regardless, our data emphasize that listening in noise is the rule rather than the exception for people with CIs, and are a reminder to support these people with soundcleaning technologies such as directional microphones and noise reduction. Furthermore, assistive listening technologies (such as FM or t-coil) can support speech understanding in difficult listening situations (Fitzpatrick, Séguin, Schramm, Armstrong, & Chénier, 2009;Iglehart, 2004;Wolfe et al., 2013). ...
Purpose:
We describe the natural auditory environment of people with cochlear implants (CIs), how it changes across the life span, and how it varies between individuals.
Method:
We performed a retrospective cross-sectional analysis of Cochlear Nucleus 6 CI sound-processor data logs. The logs were obtained from 1,501 people with CIs (ages 0-96 years). They covered over 2.4 million hr of implant use and indicated how much time the CI users had spent in various acoustical environments. We investigated exposure to spoken language, noise, music, and quiet, and analyzed variation between age groups, users, and countries.
Results:
CI users spent a substantial part of their daily life in noisy environments. As a consequence, most speech was presented in background noise. We found significant differences between age groups for all auditory scenes. Yet even within the same age group and country, variability between individuals was substantial.
Conclusions:
Regardless of their age, people with CIs face challenging acoustical environments in their daily life. Our results underline the importance of supporting them with assistive listening technology. Moreover, we found large differences between individuals' auditory diets that might contribute to differences in rehabilitation outcomes. Their causes and effects should be investigated further.
... The distance between the talker and the listener is decreased, consequently mitigating the effects of noise and reverberation on speech understanding. These systems are used alone or in conjunction with hearing aids or cochlear implants, and their benefits have been widely published (Harkins & Tucker, 2007;Rodemerk & Galster, 2015;Thibodeau, 2014;Wolfe et al., 2013). ...
Purpose:
The purpose of this research note is to describe the development and technical validation of the Mobile Based Assistive Listening System (MoBALS), a free-of-charge smartphone-based remote microphone application.
Method:
MoBALS Version 1.0 was developed for Android (Version 2.1 or higher) and was coded with Java using Eclipse Indigo with the Android Software Development Kit. A Wi-Fi router with background traffic and 2 affordable smartphones were used for debugging and technical validation comprising, among other things, multicasting capability, data packet loss, and battery consumption.
Results:
MoBALS requires at least 2 smartphones connected to the same Wi-Fi router for signal transmission and reception. Subscriber identity module cards or Internet connections are not needed. MoBALS can be used alone or connected to a hearing aid or cochlear implant via direct audio input. Maximum data packet loss was 99.28%, and minimum battery life was 5 hr. Other relevant design specifications and their implementation are described.
Conclusions:
MoBALS performed as a remote microphone with enhanced accessibility features and avoids overhead expenses by using already-available and affordable technology. The further development and technical revalidation of MoBALS will be followed by clinical evaluation with persons with hearing impairment.
Purpose
The COVID-19 pandemic introduced new educational challenges for students, teachers, and caregivers due to the changed and varied learning environments, use of face masks, and social distancing requirements. These challenges are particularly pronounced for students with hearing loss who often require specific accommodations to allow for equal access to the curriculum. The purpose of this study was to document the potential difficulties that students with hearing loss faced during the pandemic and to generate recommendations to promote learning and engagement based on findings.
Method
A qualitative survey was designed to document the frequency of various learning situations (i.e., in person, remote virtual, and blended), examine the accessibility of technology and course content, and quantify hearing issues associated with safety measures and technology use in school-age students with hearing loss. Survey questions were informed from key educational issues reported in published articles and guidelines. The survey was completed by 416 educational personnel who work with students with hearing loss.
Results
Respondents indicated that most of their schools were providing remote or blended (in-person and remote) learning consisting of synchronous and asynchronous learning. Common accommodations for students with hearing loss were only provided some of the time with the exception of sign language interpreters, which were provided for almost all students who required them. According to the respondents, both students and caregivers reported issues or discomfort with the technology required for remote learning.
Conclusion
To ensure that students with hearing loss are provided equal access to the curriculum, additional accommodations should be considered to address issues arising from pandemic-related changes to school and learning practices including closed captioning, transcripts/notes, recordings of lectures, sign language interpreters, student check-ins, and family-directed resources to assist with technology issues.
As part of a National Institutes of Health–National Institute on Deafness and Other communication Disorders (NIH-NIDCD)–supported project to develop open-source research and smartphone-based apps for enhancing speech recognition in noise, an app called Smartphone Hearing Aid Research Project Version 2 (SHARP-2) was tested with persons with normal and impaired hearing when using three sets of hearing aids (HAs) with wireless connectivity to an iPhone. Participants were asked to type sentences presented from a speaker in front of them while hearing noise from behind in two conditions, HA alone and HA + SHARP-2 app running on the iPhone. The signal was presented at a constant level of 65 dBA and the signal-to-noise ratio varied from −10 to +10, so that the task was difficult when listening through the bilateral HAs alone. This was important to allow for improvement to be measured when the HAs were connected to the SHARP-2 app on the smartphone. Benefit was achieved for most listeners with all three manufacturer HAs with the greatest improvements recorded for persons with normal (33.56%) and impaired hearing (22.21%) when using the SHARP-2 app with one manufacturer's made-for-all phones HAs. These results support the continued development of smartphone-based apps as an economical solution for enhancing speech recognition in noise for both persons with normal and impaired hearing.
Purpose
The purpose of this article was to provide a review for hearing care providers of the need for improving the auditory signal for older adults who are often faced with hearing challenges in medical settings. Personal devices worn at the ear level may not reduce communication challenges that result from noise, reverberation, and distance. The use of a remote microphone may greatly enhance the audibility of the health care provider's voice and reduce the stress caused by miscommunication. Suggestions for optimal use of remote microphone technology in medical settings are provided in 3 settings: office appointment, hospital stays, and living with caregivers/nurses.
Conclusions
Use of remote microphone technology in conjunction with personal ear-level technology may significantly facilitate communication in the health care setting. In addition to providing a higher quality signal when worn by a speaker, the microphone may serve as a reminder to the health care provider to speak more slowly and clearly, as well as to ask for confirmation that the correct information was received.
Cochlear implants (CIs) have proven to be a useful treatment option for individuals with severe-to-profound hearing loss by providing improved access to one's surrounding auditory environment. CIs differ from traditional acoustic amplification by providing information to the auditory system via electrical stimulation. Both postlingually deafened adults and prelingually deafened children can benefit from a CI; however, outcomes with a CI can vary. Numerous factors can impact performance outcomes with a CI. It is important for the audiologist to understand what factors might play a role and impact performance outcomes with a CI so that they can effectively counsel the recipient and their family, as well as establish appropriate and realistic expectations with a CI. This review article will discuss the CI candidacy process, CI programming and postoperative follow-up care, as well as considerations across the lifespan that may affect performance outcomes with a CI.
Currently, there are no studies assessing everyday use of cochlear implant (CI) processors by recipients by means of objective tools. The Nucleus 6 sound processor features a data logging system capable of real-time recording of CI use in different acoustic environments and under various categories of loudness levels. In this study, we report data logged for the different scenes and different loudness levels of 1,366 CI patients, as recorded by SCAN. Monitoring device use in cochlear implant recipients of all ages provides important information about the listening conditions encountered in recipients' daily lives that may support counseling and assist in the further management of their device settings. The findings for this large cohort of active CI users confirm differences between age groups concerning device use and exposure to various noise environments, especially between the youngest and oldest age groups, while similar levels of loudness were observed.
This systematic review describes the published evidence related to the effectiveness of frequency modulation (FM) devices in improving academic outcomes in children with auditory processing difficulties. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were used to identify articles published between January 2003 and March 2014. The Cochrane Population, Intervention, Control, Outcome, Study Design approach and the American Occupational Therapy Association process forms were used to guide the article selection and evaluation process. Of the 83 articles screened, 7 matched the systematic review inclusion criteria. Findings were consistently positive, although limitations were identified. Results of this review indicate moderate support for the use of FM devices to improve children's ability to listen and attend in the classroom and mixed evidence to improve specific academic performance areas. FM technology should be considered for school-age children with auditory processing impairments who are receiving occupational therapy services to improve functioning in the school setting.
A recent study by Dr. Jace Wolfe of Hearts for Hearing Foundation, Oklahoma City, revealed that the usage of Roger systems in combination with cochlear implants resulted in significant improvements in speech recognition at high noise levels (70, 80 dB (A)) over traditional and Dynamic FM technologies.
Cochlear implant recipients often experience difficulty understanding speech in noise. The primary objective of this study was to evaluate the potential improvement in speech recognition in noise provided by an adaptive, commercially available sound processor that performs acoustic scene classification and automatically adjusts input signal processing to maximize performance in noise.
Within-subjects, repeated-measures design.
This multicenter study was conducted across five sites in the U.S.A. and Australia.
Ninety-three adults and children with Nucleus Freedom, CI422, and CI512 cochlear implants.
Subjects (previous users of the Nucleus 5 sound processor) were fitted with the Nucleus 6 sound processor. Performance was assessed while these subjects used each sound processor in the manufacturer's recommended default program (standard directionality, ASC + ADRO for the Nucleus 5 processor and ASC + ADRO and SNR-NR with SCAN for the Nucleus 6 sound processor). The subjects were also evaluated with the Nucleus 6 with standard directionality, ASC + ADRO and SNR-NR enabled but SCAN disabled.
Speech recognition in noise was assessed with AzBio sentences.
Sentence recognition in noise was significantly better with the Nucleus 6 sound processor when used with the default input processing (ASC + ADRO, SNR-NR, and SCAN) compared to performance with the Nucleus 5 sound processor and default input processing (standard directionality, ASC + ADRO). Specifically, use of the Nucleus 6 at default settings resulted in a mean improvement in sentence recognition in noise of 27 percentage points relative to performance with the Nucleus 5 sound processor. Use of the Nucleus 6 sound processor using standard directionality, ASC + ADRO and SNR-NR (SCAN disabled) resulted in a mean improvement of 9 percentage points in sentence recognition in noise compared to performance with the Nucleus 5.
The results of this study suggest that the Nucleus 6 sound processor with acoustic scene classification, automatic, adaptive directionality, and speech enhancement in noise processing provides significantly better speech recognition in noise when compared to performance with the Nucleus 5 processor.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
Advances in cochlear implant (CI) technology have allowed for impressive outcomes for implant recipients. In fact, many CI recipients achieve ceiling-level scores (i.e., near 100%) on sentence-recognition tests in quiet used in clinical settings. It is, however, well known that CI users often continue to experience difficulty with speech understanding in noisy and reverberant environments (e.g., classroom, restaurant, etc.). Recent research has indicated that performance in these difficult situations may be improved through the use of wireless remote microphone technology. In this article, a review will be provided of several studies that have explored the use of wireless remote microphones for CI users. Specifically, this review will focus on studies that have addressed both induction neckloop and directly coupled radiofrequency (RF) systems, fixed receiver gain settings, audio mixing ratio, adaptive frequency-modulated (FM) systems, cochlear implant signal processing, and digital RF systems. The effect of each of these items on a CI recipient's performance will be discussed. Additionally, clinical tips to optimize hearing assistance technology benefit for CI users will be provided as well as a protocol for fitting and verifying the appropriateness of wireless remote microphone technology for CI users and for optimizing user benefit.
Wireless technology for persons with hearing loss began with cumbersome body-worn systems that nevertheless provided speech-recognition benefits in noisy environments. The first ear-level wireless systems were welcomed despite the awkward antenna that extended from the behind-the-ear case. The next-generation, removable, multichannel receiver provided a cost-effective means for school districts to maintain a stock of equipment to be used across students and classrooms. More recently, the advances have been less focused on physical size reductions and more focused on improvements to the signal quality in increasingly noisier environments. Two studies were designed to evaluate the new technological features by Phonak (Phonak, Warrenville, IL) known as adaptive FM and later adaptive digital processing. Each advance in technology resulted in greater gains in speech recognition in noise such that with the adaptive digital system, persons were able to achieve 48% correct in 80- decibels A weighted (dBA) noise levels. Persons with hearing loss using this technology are likely to hear more than persons with normal hearing in high-noise environments.
Although cochlear implant patients are achieving increasingly higher levels of performance, speech perception in noise continues to be problematic. The newest generations of implant speech processors are equipped with preprocessing and/or external accessories that are purported to improve listening in noise. Most speech perception measures in the clinical setting, however, do not provide a close approximation to real-world listening environments.
To assess speech perception for adult cochlear implant recipients in the presence of a realistic restaurant simulation generated by an eight-loudspeaker (R-SPACE) array in order to determine whether commercially available preprocessing strategies and/or external accessories yield improved sentence recognition in noise.
Single-subject, repeated-measures design with two groups of participants: Advanced Bionics and Cochlear Corporation recipients.
Thirty-four subjects, ranging in age from 18 to 90 yr (mean 54.5 yr), participated in this prospective study. Fourteen subjects were Advanced Bionics recipients, and 20 subjects were Cochlear Corporation recipients.
Speech reception thresholds (SRTs) in semidiffuse restaurant noise originating from an eight-loudspeaker array were assessed with the subjects' preferred listening programs as well as with the addition of either Beam preprocessing (Cochlear Corporation) or the T-Mic accessory option (Advanced Bionics).
In Experiment 1, adaptive SRTs with the Hearing in Noise Test sentences were obtained for all 34 subjects. For Cochlear Corporation recipients, SRTs were obtained with their preferred everyday listening program as well as with the addition of Focus preprocessing. For Advanced Bionics recipients, SRTs were obtained with the integrated behind-the-ear (BTE) mic as well as with the T-Mic. Statistical analysis using a repeated-measures analysis of variance (ANOVA) evaluated the effects of the preprocessing strategy or external accessory in reducing the SRT in noise. In addition, a standard t-test was run to evaluate effectiveness across manufacturer for improving the SRT in noise. In Experiment 2, 16 of the 20 Cochlear Corporation subjects were reassessed obtaining an SRT in noise using the manufacturer-suggested "Everyday," "Noise," and "Focus" preprocessing strategies. A repeated-measures ANOVA was employed to assess the effects of preprocessing.
The primary findings were (i) both Noise and Focus preprocessing strategies (Cochlear Corporation) significantly improved the SRT in noise as compared to Everyday preprocessing, (ii) the T-Mic accessory option (Advanced Bionics) significantly improved the SRT as compared to the BTE mic, and (iii) Focus preprocessing and the T-Mic resulted in similar degrees of improvement that were not found to be significantly different from one another.
Options available in current cochlear implant sound processors are able to significantly improve speech understanding in a realistic, semidiffuse noise with both Cochlear Corporation and Advanced Bionics systems. For Cochlear Corporation recipients, Focus preprocessing yields the best speech-recognition performance in a complex listening environment; however, it is recommended that Noise preprocessing be used as the new default for everyday listening environments to avoid the need for switching programs throughout the day. For Advanced Bionics recipients, the T-Mic offers significantly improved performance in noise and is recommended for everyday use in all listening environments.
Use of personal frequency-modulated (FM) systems significantly improves speech recognition in noise for users of cochlear implants (CIs). Previous studies have shown that the most appropriate gain setting on the FM receiver may vary based on the listening situation and the manufacturer of the CI system. Unlike traditional FM systems with fixed-gain settings, Dynamic FM automatically varies the gain of the FM receiver with changes in the ambient noise level. There are no published reports describing the benefits of Dynamic FM use for CI recipients or how Dynamic FM performance varies as a function of CI manufacturer.
To evaluate speech recognition of Advanced Bionics Corporation or Cochlear Corporation CI recipients using Dynamic FM vs. a traditional FM system and to examine the effects of Autosensitivity on the FM performance of Cochlear Corporation recipients.
A two-group repeated-measures design. Participants were assigned to a group according to their type of CI.
Twenty-five subjects, ranging in age from 8 to 82 years, met the inclusion criteria for one or more of the experiments. Thirteen subjects used Advanced Bionics Corporation, and 12 used Cochlear Corporation implants.
Speech recognition was assessed while subjects used traditional, fixed-gain FM systems and Dynamic FM systems.
In Experiments 1 and 2, speech recognition was evaluated with a traditional, fixed-gain FM system and a Dynamic FM system using the Hearing in Noise Test sentences in quiet and in classroom noise. A repeated-measures analysis of variance (ANOVA) was used to evaluate effects of CI manufacturer (Advanced Bionics and Cochlear Corporation), type of FM system (traditional and dynamic), noise level, and use of Autosensitivity for users of Cochlear Corporation implants. Experiment 3 determined the effects of Autosensitivity on speech recognition of Cochlear Corporation implant recipients when listening through the speech processor microphone with the FM system muted. A repeated-measures ANOVA was used to examine the effects of signal-to-noise ratio and Autosensitivity.
In Experiment 1, use of Dynamic FM resulted in better speech recognition in noise for Advanced Bionics recipients relative to traditional FM at noise levels of 65, 70, and 75 dB SPL. Advanced Bionics recipients obtained better speech recognition in noise with FM use when compared to Cochlear Corporation recipients. When Autosensitivity was enabled in Experiment 2, the performance of Cochlear Corporation recipients was equivalent to that of Advanced Bionics recipients, and Dynamic FM was significantly better than traditional FM. Results of Experiment 3 indicate that use of Autosensitivity improves speech recognition in noise of signals directed to the speech processor relative to no Autosensitivity.
Dynamic FM should be considered for use with persons with CIs to improve speech recognition in noise. At default CI settings, FM performance is better for Advanced Bionics recipients when compared to Cochlear Corporation recipients, but use of Autosensitivity by Cochlear Corporation users results in equivalent group performance.
A large set of sentence materials, chosen for their uniformity in length and representation of natural speech, has been developed for the measurement of sentence speech reception thresholds (sSRTs). The mean-squared level of each digitally recorded sentence was adjusted to equate intelligibility when presented in spectrally matched noise to normal-hearing listeners. These materials were cast into 25 phonemically balanced lists of ten sentences for adaptive measurement of sentence sSRTs. The 95% confidence interval for these measurements is +/- 2.98 dB for sSRTs in quiet and +/- 2.41 dB for sSRTs in noise, as defined by the variability of repeated measures with different lists. Average sSRTs in quiet were 23.91 dB(A). Average sSRTs in 72 dB(A) noise were 69.08 dB(A), or -2.92 dB signal/noise ratio. Low-pass filtering increased sSRTs slightly in quiet and noise as the 4- and 8-kHz octave bands were eliminated. Much larger increases in SRT occurred when the 2-kHz octave band was eliminated, and bandwidth dropped below 2.5 kHz. Reliability was not degraded substantially until bandwidth dropped below 2.5 kHz. The statistical reliability and efficiency of the test suit it to practical applications in which measures of speech intelligibility are required.
This article presents a simple method of analysing speech test scores which are biased through ceiling effects. Eighty postlingually deafened adults implanted with a MED-EL COMBI 40/40+ cochlear implant (CI) were administered a numbers test and a sentence test at initial device activation and at 1, 3, 6, 12 and 24 months thereafter. As a measure for speech recognition performance, the number of patients who scored at the 'ceiling level' (i.e. at least 95% correct answers) was counted at each test interval. Results showed a quick increase in this number soon after device activation as well as a continuous improvement over time (numbers test: 1 month: 51%; 6 months: 73%; 24 months: 88%; sentence test: 1 month: 33%; 6 months: 49%; 24 months: 64%). The new method allows for the detection of speech recognition progress in CI patient samples even at late test intervals, where improvement curves based on averaged scores are usually assuming a flat shape.
Speech recognition performance in noise was examined in children with cochlear implants (CIs) when using (a) a second CI (bilateral group), (b) a hearing aid (HA) on the nonimplant ear (bimodal group), and (c) a frequency modulation (FM) system on 1 or both sides.
While always maintaining use of the first CI, 2 groups participated in 6 conditions each using various listening arrangements with the second CI, HA, or FM system. Speech-in-noise thresholds were determined using simple phrases, classroom noise, and a method-of-limits approach.
No group differences were detected across any conditions. In the no-FM-system conditions, no significant benefit of bilateral or bimodal input was found relative to a single CI. In the FM-system conditions, thresholds were significantly lower (up to 20 dB) relative to all other conditions when FM-system input was provided to the first-implanted side or to both sides simultaneously.
Children's speech-in-noise thresholds did not improve when providing input to the second side with a CI or an HA relative to a single CI. However, children with CIs had better speech recognition in noise with the use of an FM system on one or both sides relative to the conditions with no FM system. Binaural conditions with a single FM receiver on the second CI or HA yielded significantly poorer performance than any other FM condition.
Objectives:
The objective of this study was to compare speech recognition in quiet and in noise for cochlear implant recipients using two different types of personal frequency modulation (FM) systems (directly coupled [direct auditory input] versus induction neckloop) with each of two sound processors (Cochlear Nucleus Freedom versus Cochlear Nucleus 5). Two different experiments were conducted within this study. In both these experiments, mixing of the FM signal within the Freedom processor was implemented via the same scheme used clinically for the Freedom sound processor. In Experiment 1, the aforementioned comparisons were conducted with the Nucleus 5 programmed so that the microphone and FM signals were mixed and then the mixed signals were subjected to autosensitivity control (ASC). In Experiment 2, comparisons between the two FM systems and processors were conducted again with the Nucleus 5 programmed to provide a more complex multistage implementation of ASC during the preprocessing stage.
Design:
This study was a within-subject, repeated-measures design. Subjects were recruited from the patient population at the Hearts for Hearing Foundation in Oklahoma City, OK. Fifteen subjects participated in Experiment 1, and 16 subjects participated in Experiment 2. Subjects were adults who had used either unilateral or bilateral cochlear implants for at least 1 year.
Results:
In this experiment, no differences were found in speech recognition in quiet obtained with the two different FM systems or the various sound-processor conditions. With each sound processor, speech recognition in noise was better with the directly coupled direct auditory input system relative to the neckloop system. The multistage ASC processing of the Nucleus 5 sound processor provided better performance than the single-stage approach for the Nucleus 5 and the Nucleus Freedom sound processor.
Conclusions:
Speech recognition in noise is substantially affected by the type of sound processor, FM system, and implementation of ASC used by a Cochlear implant recipient.
Previous research shows that cochlear implant users experience significant difficulty with speech perception in noisy listening situations. There is a paucity of research evaluating the potential improvement in speech recognition in noise provided by a dual-microphone directional system in a commercial implant sound processor. The primary objective of this study was to compare speech recognition in quiet and in noise for the Nucleus Freedom and Nucleus 5 CP810 sound processors set to the manufacturer's default user programs for quiet and noisy environments.
Crossover with repeated-measures design.
This multi-center study was conducted across four cochlear implant clinics in the United States.
Thirty-five adults with unilateral Nucleus Freedom cochlear implants. All subjects had used their cochlear implant for at least 6 months and had substantial open-set word recognition as evidenced by a score of at least 40% correct on the Consonant-Nucleus-Consonant (CNC) monosyllabic word recognition test in quiet.
All subjects (previous users of the Nucleus Freedom sound processor) were fitted with the Nucleus 5 sound processor. Performance was assessed while these subjects used each sound processor in the default user program the manufacturer recommends for quiet and noisy conditions.
Speech recognition was assessed with CNC monosyllabic words in quiet and sentences in noise from the BKB-SIN (Bamford-Kowal-Bench Sentences in Noise) test. The data were analyzed with descriptive statistics and performance with each processor in each listening condition was compared using a repeated-measures analysis of variance.
Word recognition in quiet was significantly better with the Nucleus 5 sound processor when compared to performance with the Nucleus Freedom processor. In noise, the Nucleus 5 sound processor also provided a significant improvement in speech recognition relative to the performance with the Nucleus Freedom.
The results of the study suggest that the Nucleus 5 sound processor provides significantly better speech recognition in quiet and in noise when compared with performance with the Nucleus Freedom processor.
Previous research shows that children using cochlear implants experience significant difficulty with speech perception in noisy listening situations. There are several types of input signal processing available for the cochlear implant sound processor; however, there is a paucity of research to support this technology for children. The primary objective of this study was to examine the potential benefits of 2 types of input signal processing, adaptive dynamic range optimization (ADRO) as compared with autosensitivity (ASC) plus ADRO for children using Cochlear Corporation implants.
Cross-sectional repeated-measures design.
Outpatient nonprofit foundation providing audiology services and auditory-verbal therapy.
Eleven children, aged 4 years 4 months to 12 years, with unilateral or bilateral Cochlear Limited implants. All children used their cochlear implant(s) for at least 1 year, had no additional disabilities, were enrolled in preschool or elementary school, and had age-appropriate receptive and expressive language.
All children used Cochlear Limited cochlear implants with either the Nucleus Freedom or Nucleus 5 cochlear implant sound processor. Performance was assessed while these children used ADRO-only input processing and ASC+ADRO input processing.
Speech perception of PBK-50 monosyllabic words in quiet and BKB-SIN sentences in noise was measured for each child. In the noise conditions, children were using the ADRO-only or ASC+ADRO input signal processing strategies. The data in quiet were analyzed with descriptive statistics, and the conditions in noise were compared using a 1-way repeated-measures analysis of variance.
All children demonstrated word recognition in quiet at or above 90% correct. In noise, sentence-perception performance in the ASC+ADRO condition was significantly better than that in the ADRO-alone condition.
The results of the study suggest substantial benefit from combining 2 types of input signal processing, ASC and ADRO, for children with unilateral and bilateral cochlear implants. Specifically, signal processing to adjust the sensitivity of the sound processor microphone automatically has substantial positive effects on speech-perception thresholds in noise.
Previous research has indicated that children with moderate hearing loss experience difficulty with recognition of high-frequency speech sounds, such as fricatives and affricates. Conventional behind-the-ear (BTE) amplification typically does not provide ample output in the high frequencies (4000 Hz and beyond) to ensure optimal audibility for these sounds.
To evaluate nonlinear frequency compression (NLFC) as a means to improve speech recognition for children with moderate to moderately severe hearing loss.
Within subject, crossover design with repeated measures across test conditions.
Fifteen children, aged 5-13 yr, with moderate to moderately severe high-frequency sensorineural hearing loss were fitted with Phonak Nios, microsized, BTE hearing aids. These children were previous users of digital hearing aids and communicated via spoken language. Their speech and language abilities were age-appropriate.
Aided thresholds and speech recognition in quiet and in noise were assessed after 6 wk of use with NLFC and 6 wk of use without NLFC. Participants were randomly assigned to counter-balanced groups so that eight participants began the first 6 wk trial with NLFC enabled and the other seven participants started with NLFC disabled. Then, the provision of NLFC was switched for the second 6 wk trial. Speech recognition in quiet was assessed via word recognition assessments with the University of Western Ontario (UWO) Plural Test and recognition of vowel-consonant-vowel nonsense syllables with the Phonak Logatome test. Speech recognition in noise was assessed by evaluating the signal-to-noise ratio in dB for 50% correct performance on the Bamford-Kowal-Bench Speech-in-Noise (BKB-SIN) test, an adaptive test of speech perception in a multitalker babble background.
Aided thresholds for high-frequency stimuli were significantly better when NLFC was enabled, and use of NLFC resulted in significantly better speech recognition in quiet for the UWO Plural Test and for the phonemes /d/ and /s/ on the Phonak Logatome test. There was not a statistically significant difference in performance on the BKB-SIN test between the NLFC enabled and disabled conditions.
These results indicate that NLFC improves audibility for and recognition of high-frequency speech sounds for children with moderate to moderately severe hearing loss in quiet listening situations.
Cochlear implant users still experience severe limitations regarding sound quality, music appreciation, and speech perception in adverse listening situation. To improve hearing in noisy environments, the incorporation of signal enhancement algorithms was initiated.
The study group consisted of 13 postlingually deafened adults using HiRes 120. Participants were fitted with 2 versions of the noise reduction algorithm: a moderate and a strong setting. In an immediate session, the HSM sentence test in speech-shaped noise was administered using the clinical program as well as both noise reduction programs. Participants were asked to try all 3 programs in everyday listening situations at home and provide a rating of sound quality and speech perception via a questionnaire (Abbreviated Profile of Hearing Aid Benefit).
During the fitting, no difficulties were encountered, and all participants accepted the noise reduction programs without any acclimatization. All participants achieved better results with both noise reduction programs in the HSM sentence test in noise compared with the clinical program. Group mean speech perception scores were highly significantly better for the ClearVoice settings compared with the clinical program score. The majority preferred one of the ClearVoice conditions, with 4 participants for the strong and 3 for the moderate setting.
Our results demonstrate a real potential benefit for noise reduction algorithms in cochlear implant processors. Although algorithm parameters were not optimized individually, a significant improvement could still be achieved. Further investigation is required to develop fitting guidelines and achieve parameter optimization.
To compare the benefits of adaptive FM and fixed FM systems through measurement of speech recognition in noise with adults and students in clinical and real-world settings.
Five adults and 5 students with moderate-to-severe hearing loss completed objective and subjective speech recognition in noise measures with the 2 types of FM processing. Sentence recognition was evaluated in a classroom for 5 competing noise levels ranging from 54 to 80 dBA while the FM microphone was positioned 6 in. from the signal loudspeaker to receive input at 84 dB SPL. The subjective measures included 2 classroom activities and 6 auditory lessons in a noisy, public aquarium.
On the objective measures, adaptive FM processing resulted in significantly better speech recognition in noise than fixed FM processing for 68- and 73-dBA noise levels. On the subjective measures, all individuals preferred adaptive over fixed processing for half of the activities. Adaptive processing was also preferred by most (8-9) individuals for the remaining 4 activities.
The adaptive FM processing resulted in significant improvements at the higher noise levels and was preferred by the majority of participants in most of the conditions.
Use of personal frequency modulated (FM) systems significantly improves speech recognition in noise for users of cochlear implants (CI). There are, however, a number of adjustable parameters of the cochlear implant and FM receiver that may affect performance and benefit, and there is limited evidence to guide audiologists in optimizing these parameters.
This study examined the effect of two sound processor audio-mixing ratios (30/70 and 50/50) on speech recognition and functional benefit for adults with CIs using the Advanced Bionics Auria sound processors.
Fully-repeated repeated measures experimental design. Each subject participated in every speech-recognition condition in the study, and qualitative data was collected with subject questionnaires.
Twelve adults using Advanced Bionics Auria sound processors. Participants had greater than 20% correct speech recognition on consonant-nucleus-consonant (CNC) monosyllabic words in quiet and had used their CIs for at least six months.
Performance was assessed at two audio-mixing ratios (30/70 and 50/50). For the 50/50 mixing ratio, equal emphasis is placed on the signals from the sound processor and the FM system. For the 30/70 mixing ratio, the signal from the microphone of the sound processor is attenuated by 10 dB.
Speech recognition was assessed at two audio-mixing ratios (30/70 and 50/50) in quiet (35 and 50 dB HL) and in noise (+5 signal-to-noise ratio) with and without the personal FM system. After two weeks of using each audio-mixing ratio, the participants completed subjective questionnaires.
Study results suggested that use of a personal FM system resulted in significant improvements in speech recognition in quiet at low-presentation levels, speech recognition in noise, and perceived benefit in noise. Use of the 30/70 mixing ratio resulted in significantly poorer speech recognition for low-level speech that was not directed to the FM transmitter. There was no significant difference in speech recognition in noise or functional benefit between the two audio-mixing ratios.
Use of a 50/50 audio-mixing ratio is recommended for optimal performance with an FM system in quiet and noisy listening situations.
This study compared the speech recognition performance of 12 hearing-impaired listeners fit with three commercially available behind-the-ear hearing aids in both directional and omnidirectional modes. One digitally programmable analog and two "true digital" hearing aids were selected as test instruments. Testing was completed in both "living room" and anechoic room environments. Speech recognition was examined using modified forms of the Hearing in Noise Test and the Nonsense Syllable Test. The single competing stimuli of these tests were replaced with five uncorrelated competing sources. Results revealed a significant speech recognition in noise advantage for all directional hearing aids in comparison to their omnidirectional counterparts. Maximum performance of the directional hearing aids did not significantly vary across circuit type, suggesting that processing differences did not affect maximum directional hearing aid performance. In addition, the results suggest that performance in one reverberant environment cannot be used to accurately predict performance in an environment with differing reverberation.
Abbreviations: A = Phonak Piconet P2 AZ™ omnidirectional; AD = Phonak Piconet P2 AZ™ directional; BTE = behind the ear; HINT = Hearing in Noise Test; KEMAR = Knowles Electronics Manikin for Acoustic Research; NST = Nonsense Syllable Test; Ρ = Siemens Prisma omnidirectional; PD = Siemens PrismaTM directional; PV = Siemens Prisma omnidirectional with maximum VAD; S = Widex Senso™ omnidirectional; SD = Widex Senso directional; SNR = signal-to-noise ratio; TD = threshold of discomfort; VAD = voice activity detector; WDRC = wide dynamic range compression
The overall goal of this study was to determine the accuracy with which hearing-impaired children can detect the inflectional morphemes /s/ and /z/ when listening to speech through hearing aids.
In the first part of the study a perceptual test was developed with equal numbers of singular and plural nouns spoken by both a male and female talker. Thirty-six normal-hearing children (3 to 5 yr) were tested to determine the age at which children could perform this test without difficulty. In the second part of the study, 40 children with bilateral sensorineural hearing losses (5 to 13 yr) were tested while wearing personal hearing aids. Stimuli were presented in the sound field at 65 dB SPL.
For the normal-hearing children, mean performance increased and inter-subject variability decreased through age 5 yr 3 mo when performance reached >or=90% for all children. No significant talker or form (plural versus singular) effects were noted for this group. For the hearing-impaired children, performance varied considerably across all ages. For these subjects, significant effects of talker and form were observed. Specifically, plural test items spoken by the female talker showed the highest error rate.
In general, mid-frequency audibility (2 to 4 kHz) appeared to be most important for perception of the fricative noise for the male talker while a somewhat wider frequency range (2 to 8 kHz) was important for the female talker.
The purpose of this study was to conduct a large-scale investigation with adult recipients of the Clarion, Med-El, and Nucleus cochlear implant systems to (1) determine average scores and ranges of performance for word and sentence stimuli presented at three intensity levels (70, 60, and 50 dB SPL); (2) provide information on the variability of scores for each subject by obtaining test-retest measures for all test conditions; and (3) further evaluate the potential use of lower speech presentation levels (i.e., 60 and/or 50 dB SPL) in cochlear implant candidacy assessment.
Seventy-eight adult cochlear implant recipients, 26 with each of the three cochlear implant systems, participated in the study. To ensure that the data collected reflect the range of performance of adult recipients using recent technology for the three implant systems (Clarion HiFocus I or II, Med-El Combi 40+, Nucleus 24M or 24R), a composite range and distribution of consonant-nucleus-consonant (CNC) monosyllabic word scores was determined. Subjects using each device were selected to closely represent this range and distribution of CNC performance. During test sessions, subjects were administered the Hearing in Noise Test (HINT) sentence test and the CNC word test at three presentation levels (70, 60, and 50 dB SPL). HINT sentences also were administered at 60 dB SPL with a signal-to-noise ratio (SNR) of +8 dB. Warble tones were used to determine sound-field threshold levels from 250 to 4000 Hz. Test-retest measures were obtained for each of the speech recognition tests as well as for warble-tone sound-field thresholds.
Cochlear implant recipients using the Clarion, Med-El, or Nucleus devices performed on average equally as well at 60 compared with 70 dB SPL when listening for words and sentences. Additionally, subjects had substantial open-set speech perception performance at the softer level of 50 dB SPL for the same stimuli; however, subjects' ability to understand speech was poorer when listening in noise to signals of greater intensity (60 dB SPL + 8 SNR) than when listening to signals presented at a soft presentation level (50 dB SPL) in quiet. A significant correlation was found between sound-field thresholds and speech recognition scores for presentation levels below 70 dB SPL. The results demonstrated a high test-retest reliability with cochlear implant users for these presentation levels and stimuli. Average sound-field thresholds were between 24 and 29 dB HL for frequencies of 250 to 4000 Hz, and results across sessions were essentially the same.
Speech perception measures used with cochlear implant candidates and recipients should reflect the listening challenges that individuals encounter in natural communication situations. These data provide the basis for recommending new candidacy criteria based on speech recognition tests presented at 60 and/or 50 dB SPL, intensity levels that reflect real-life listening, rather than 70 dB SPL.
Speech recognition was evaluated for ten adults with normal hearing and eight adults with Nucleus cochlear implants (CIs) at several different signal-to-noise ratios (SNRs) and with three frequency modulated (FM) system arrangements: desktop, body worn, and miniature direct connect. Participants were asked to repeat Hearing in Noise Test (HINT) sentences presented with speech noise in a classroom setting and percent correct word repetition was determined. Performance was evaluated for both normal-hearing and CI participants with the desktop soundfield system. In addition, speech recognition for the CI participants was evaluated using two FM systems electrically coupled to their speech processors. When comparing the desktop sound field and the No-FM condition, only the listeners with normal hearing made significant improvements in speech recognition in noise. When comparing the performance across the three FM conditions for the CI listeners, the two electrically coupled FM systems resulted in significantly greater improvements in speech recognition in noise relative to the desktop soundfield system.
To determine, for patients who had identical levels of performance on a monosyllabic word test presented in quiet, whether device differences would affect performance when tested with other materials and in other test conditions.
For Experiment 1, from a test population of 76 patients, three groups (N = 13 in each group) were created. Patients in the first group used the CII Bionic Ear behind-the-ear (BTE) speech processor, patients in the second group used the Esprit3G BTE speech processor, and patients in the third group used the Tempo+ BTE speech processor. The patients in each group were matched on (i) monosyllabic word scores in quiet, (ii) age at testing, (iii) duration of deafness, and (iv) experience with their device. Performance of the three groups was compared on a battery of tests of speech understanding, voice discrimination, and melody recognition. In Experiments 2 (N = 10) and 3 (N = 10) the effects of increasing input dynamic range in the 3G and CII devices, respectively, was assessed with sentence material presented at conversational levels in quiet, conversational levels in noise, and soft levels in quiet.
Experiment 1 revealed that patients fit with the CII processor achieved higher scores than Esprit3G and Tempo+ patients on tests of vowel recognition. CII and Tempo+ patients achieved higher scores than Esprit3G patients on difficult sentence material presented in noise at +10 and +5 dB SNR. CII patients achieved higher scores than Esprit3G patients on difficult sentence material presented at a soft level (54 dB SPL). Experiment 2 revealed that increasing input dynamic range in the Esprit3G device had (i) no effect at conversational levels in quiet, (ii) degraded performance in noise, and (iii) improved performance at soft levels. Experiment 3 revealed that increasing input dynamic range in the CII device improved performance in all conditions.
Differences in implant design can affect patient performance, especially in difficult listening situations. Input dynamic range and the method by which compression is implemented appear to be the major factors that account for our results.
Cochlear implant recipients have demonstrated remarkable increases in speech perception since US FDA approval was granted in 1984. Improved performance is due to a number of factors including improved cochlear implant technology, evolving speech coding strategies, and individuals with increasingly more residual hearing receiving implants. Despite this evolution, the same recommendations for pre- and postimplant speech recognition testing have been in place for over 10 years in the United States. To determine whether new recommendations are warranted, speech perception performance was assessed for 156 adult, postlingually deafened implant recipients as well as 50 hearing aid users on monosyllabic word recognition (CNC) and sentence recognition in quiet (HINT and AzBio sentences) and in noise (BKB-SIN). Results demonstrated that for HINT sentences in quiet, 28% of the subjects tested achieved maximum performance of 100% correct and that scores did not agree well with monosyllables (CNC) or sentence recognition in noise (BKB-SIN). For a more difficult sentence recognition material (AzBio), only 0.7% of the subjects achieved 100% performance and scores were in much better agreement with monosyllables and sentence recognition in noise. These results suggest that more difficult materials are needed to assess speech perception performance of postimplant patients - and perhaps also for determining implant candidacy.
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