The effect of cochlear implantation on music perception by adults with usable pre-operative acoustic hearing

This study investigated the change in music perception of adults undergoing cochlear implantation. Nine adults scheduled for a cochlear implant (CI) were assessed on a music test battery both prior to implantation (whilst using hearing aids; HAs), and three months after activation of their CIs. The results were compared with data from a group of longer-term CI users and a group of HA-only users. The tests comprised assessments of rhythm, pitch, instrument, and melody perception. Pre-to-post surgery comparisons showed no significant difference in the rhythm, melody, and instrument identification scores. Subjects' scores were significantly lower post-implant for ranking pitch intervals of one octave and a quarter octave (p=0.007, and p<0.001, respectively), and were only at chance levels for the smaller interval. However, although pitch perception was generally poorer with a CI than with a HA, it is likely that the use of both devices simultaneously could have provided higher scores for these subjects. Analysis of the other tests' results provided insights into factors affecting music perception for adults with severe to profound hearing impairment.     

Contribution of hearing aids to music perception by cochlear implant users

Abstract

Objectives

Modern cochlear implant (CI) encoding strategies represent the temporal envelope of sounds well but provide limited spectral information. This deficit in spectral information has been implicated as a contributing factor to difficulty with speech perception in noisy conditions, discriminating between talkers and melody recognition. One way to supplement spectral information for CI users is by fitting a hearing aid (HA) to the non-implanted ear.

Methods

In this study 14 postlingually deaf adults (half with a unilateral CI and the other half with a CI and an HA (CI + HA)) were tested on measures of music perception and familiar melody recognition.

Results

CI + HA listeners performed significantly better than CI-only listeners on all pitch-based music perception tasks. The CI + HA group did not perform significantly better than the CI-only group in the two tasks that relied on duration cues. Recognition of familiar melodies was significantly enhanced for the group wearing an HA in addition to their CI. This advantage in melody recognition was increased when melodic sequences were presented with the addition of harmony.

Conclusion

These results show that, for CI recipients with aidable hearing in the non-implanted ear, using a HA in addition to their implant improves perception of musical pitch and recognition of real-world melodies.     

语后聋人工耳蜗患者音乐节奏与音色感知能力的评价

目的 评价成人语后聋人工耳蜗使用者感知音乐中节奏和音色的能力.方法 选取年龄与音乐经验相匹配的听力正常受试者与人工耳蜗使用者各12名,均为男5名,女7名.应用人工耳蜗音乐评估软件( Musical Sounds in Cochlear Implants,MuSIC)中的节奏辨别、乐器识别与乐器数辨别测试评价两组受试者的音乐节奏和音色感知能力.结果 12名人工耳蜗受试者平均节奏辨别率为84.4％,与听力正常受试者(85.1％)比较,差异无统计学意义(t=0.116,P＞0.05);人工耳蜗受试者平均乐器识别率为72.3％、乐器数辨别正确率为39.2％,均低于听力正常受试者平均88.3％和73.5％的正确率,差异具有统计学意义(t值分别为2.498和4.673,P值均＜0.05).结论 成人语后聋人工耳蜗使用者的节奏辨别能力与听力正常人相似,但音色感知能力明显差于听力正常人群.     

Ipsilateral acoustic electric pitch matching: A case study of cochlear implantation in an up-sloping hearing loss with preserved hearing across multiple frequencies

Abstract

Objectives

Determine ipsilateral acoustic electric pitch place match in a patient with preserved residual hearing across a broad frequency range.

Methods

Case report. Patient with up-sloping sensorineural hearing loss underwent implantation with a 680° insertion angle with preserved residual hearing. Pitch matching with variance of pulse rate was carried out.

Results

Electrical pitch percepts closely approximated the Greenwood map when compared to the acoustical pitch percepts and electrode position as determined by post-operative computed tomographic scan. The pitch matching results achieved from the deeply inserted electrodes, in the apical portion of the cochlea, suggest that the electrical stimulation may activate the dendritic extensions from the ganglion cell bodies that radiate from the terminal bulb. Stimulation rate influenced pitch perception in the apical turn but not in the mid- and basilar regions.

Discussion

Frequency to pitch allocation can potentially be improved by cochlear implants that access the apical third of the spiral ganglion. The ultimate goal of stimulating the apical third of the cochlea is to provide the maximum amount of spectral information to the user. We had the unique opportunity to work with a patient who presented with a severe sensorineural hearing loss rising to within normal limits and poor speech discrimination scores. Data from this study may aid our ability to give patients a broader spectrum of sound perception.     

Social hearing measured with the Performance Inventory for Profound and Severe Loss: a comparison between adult multichannel cochlear implant patients and users of acoustical hearing aids

The objective of this study was to investigate social hearing in successful users of multichannel cochlear implants (CIs) and to compare the scores with those of a group of hearing-impaired adults using acoustical hearing aids (HAs). Out of 88 patients who had undergone surgery, 75 CI users with a mean age of 55 years and a mean pre-operative hearing level of 113dB in the better ear were compared with 59 users of acoustical HAs with a mean age of 56 years and a mean hearing level of 82dB in the better ear. Seven CI patients were non-users and were excluded from the study. The Performance Inventory for Profound and Severe Loss, a questionnaire that measures different aspects of hearing handicap, was used. The CI group scored significantly better than the HA group in three of six evaluated categories, measuring subjective intensity of sounds, speech with visual cues, and response to auditory failure. Awareness of environmental sounds, speech with no visual cues and personal reactions did not differ significantly. The group of successful CI users scored higher on a self-report measure than did a group of users of acoustical HAs with moderate- severe-profound deafness. The best CI users scored better than the best HA users, and the worst CI users scored worse than the worst HA users.     

Multicentre evaluation of music perception in adult users of Advanced Bionics cochlear implants

Abstract

Objectives

To document musical listening and enjoyment in recipients of Advanced Bionics cochlear implants (CIs) and to compare musical perception in those using early coding strategies with subjects using the newer HiRes and HiRes 120 strategies.

Methods

A questionnaire was completed by 136 adult subjects, including questions on the ability to identify specific musical features. The subjects were in three groups: those using early coding strategies (n = 29), HiRes (n = 59), and HiRes 120 (n = 48), and results were compared with a group of 84 normally hearing (NH) subjects.

Results

Of the CI users, 79% reported listening to music. The NH group rated listening frequency and enjoyment higher than the CI users. Thirty-five users reported that they sang and this group had significantly higher overall performance. There were no significant differences in overall perception of specific musical features among the strategy groups, though some individual questions showed significantly higher performance in the HiRes 120 users.

Discussion

Users of current CI technology show a high level of musical appreciation, though still significantly less than NH subjects. Frequency of listening and enjoyment were significantly correlated and active participation in musical activities, specifically singing, resulted in significantly higher overall performance scores.     

Changes in sound-source localization for children with bilateral severe to profound hearing loss following simultaneous bilateral cochlear implantation

Background: Sound localization is a valuable skill that children can develop to some extent via bilateral cochlear implants (biCIs). However, little is known regarding the change that can be expected in sound-source localization accuracy (SLA) pre- and post-biCI for children with bilateral, severe-to-profound hearing impairment who spent their early years listening via bilateral hearing aids (biHAs). This study therefore aimed to prospectively assess SLA in a group of children before, and at one year after, receiving simultaneous biCIs.

Methods: Ten children aged 5–18 years were tested. SLA was assessed using loudspeakers positioned at ?60, ?30, 0, +30, and +60 degrees azimuth. Root mean square (RMS) errors and percentage correct scores were calculated. Changes in SLA were analysed via paired t-tests and potential relationships between hearing threshold levels (HTLs) and SLA via correlation analyses. Response distributions via biHAs and biCIs were examined via scatterplots.

Results: The mean within-subject changes in SLA were a significant improvement in RMS error of 11.9° (p?p?Conclusions: The findings of the present study demonstrate that simultaneous biCIs lead to improved sound localization in children with bilateral, severe to profound sensorineural hearing loss who previously used biHAs. SLA via biHAs or biCIs could not be predicted from children’s audiograms, and therefore should be measured directly.     

Children with hearing impairment--living with cochlear implants or hearing aids

Objective

The aim of this study was to enhance knowledge about the life circumstances of children with cochlear implants or hearing aids, regarding daily functioning and attitude to the impairment.

Methods

Data were obtained from 36 children with cochlear implants and 38 children with hearing aids via study-specific questionnaires with fixed answer alternatives. The questions covered (1) usage of aids and related factors, (2) hearing in different everyday situations, (3) thoughts about the children's own hearing and others’ attitudes to it, and (4) choice of language. The data were analyzed using SPSS, and presented via the theoretical frame of the International Classification of Functioning, Disability and Health, Child and Youth version (ICF-CY).

Results

Children with CI and HA functioned equally well in daily life, but there were also certain differences. Symptoms from neck and shoulders were more common among children with hearing aids than among children with cochlear implants (p < .001). Children with hearing aids used their aids significantly less often than those with cochlear implants (p < .001). The participation variables showed that children with hearing aids had significantly more hearing problems in team sports (p = .033) and outdoor activities (p = .019), in comparison to children with cochlear implants. The two groups had similar thoughts regarding their own hearing, mostly considering it not to be a problem. They also did not generally think that other people found their hearing to be a problem.

Conclusions

Children with cochlear implants and children with hearing aids have, in some aspects, equally good functioning in everyday life situations. However, certain differences were found in dimensions of functioning, regarding neck and shoulder pain, usage of aids and sign language, and hearing problems in some activities.     

Assessment of music experience after cochlear implantation: A review of current tools and their utilization

ObjectiveTo provide an overview of the current available music assessment tools after cochlear implantation (CI); to report on the utilization of music assessments in the literature; to propose potential future directions in music assessment after CI.MethodsA thorough search was performed in PubMed, Embase, and The Cochrane Library through October 31, 2020. MeSH search terms, keywords, and phrases included “cochlear implant,” “cochlear prosthesis,” “auditory prosthesis,” “music,” “music assessment,” “music questionnaire,” “music perception,” “music enjoyment, and “music experience.” Potentially relevant studies were reviewed for inclusion, with particular focus on assessments developed specifically for the cochlear implant population and intended for widespread use.Results/conclusionsSix hundred and forty-three studies were screened for relevance to assessment of music experience among cochlear implantees. Eighty-one studies ultimately met criteria for inclusion. There are multiple validated tools for assessment of music experience after cochlear implantation, each of which provide slightly differing insights into the patients’ subjective and/or objective post-activation experience. However, no single assessment tool has been adopted into widespread use and thus, much of the literature pertaining to this topic evaluates outcomes non-uniformly, including single-use assessments designed specifically for the study at hand. The lack of a widely accepted universal tool for assessment of music limits our collective understanding the contributory and mitigating factors applicable to current music experience of cochlear implantees, and limits our ability to uniformly evaluate the success of new implant technologies or music training paradigms.     

Value of pre-operative caloric test in predicting speech perception after cochlear implantation in adults with post-lingual hearing loss

Conclusion: This study shows that, in cochlear implantation (CI) surgery, pre-operative caloric test results are not correlated with post-operative outcomes of dizziness or speech perception.

Objectives: To determine the role of pre-operative caloric tests in CI.

Methods: The records of 95 patients who underwent unilateral CI were reviewed retrospectively. Patients were divided into four groups according to caloric response. Forty-six patients with normal caloric responses were classified as Group A, 19 patients who underwent CI in the ear with worse caloric responses as Group B, 18 patients with bilateral loss of caloric responses as Group C, and 12 patients who underwent CI in the ear with better caloric responses as Group D. Speech performance and post-operative dizziness were compared between the four groups. Speech perception was determined by evaluating consonant-vowel phoneme detection, closed-set word and open-set mono-syllabic and bi-syllabic word identification, and sentence comprehension test scores.

Results: The speech perception and aided pure-tone average (PTA) test results at 3 and 6 months and at 1, 2, and 3 years after implantation were not significantly different between Groups A, B, C, and D (p?>?0.05). Eight patients (8.4%) reported post-operative dizziness, but there was no significant difference between the four groups (p?=?0.627).     

Improving performance in noise for hearing aids and cochlear implants using coherent modulation filtering

This study evaluated the maximal attainable performance of speech enhancement strategies based on coherent modulation filtering. An optimal adaptive coherent modulation filtering algorithm was designed to enhance known signals from a target talker in two-talker babble noise. The algorithm was evaluated in a closed-set, speech-recognition-in-noise task. The speech reception threshold (SRT) was measured using a one-down, one-up adaptive procedure. Five hearing-impaired subjects and five cochlear implant users were tested in three processing conditions: (1) original sounds; (2) fixed coherent modulation filtered sounds; and (3) optimal coherent modulation filtered sounds. Six normal-hearing subjects were tested with a 6-channel cochlear implant simulation of sounds processed in the same three conditions. Significant improvements in SRTs were observed when the signal was processed with the optimal coherent modulation filtering algorithm. There was no benefit when the signal was processed with the fixed modulation filter. The current study suggested that coherent modulation filtering might be a promising method for front-end processing in hearing aids and cochlear implants. An approach such as hidden Markov models could be used to generalize the optimal coherent modulation filtering algorithm to unknown utterances and to extend it to open-set speech.     

Musical pitch and lexical tone perception with cochlear implants

Abstract

Objective: The purpose of the present study was to test the hypothesis that cochlear implant (CI) users’ music perception is correlated with their lexical tone perception, and the two types of perception share similar mechanisms in electric hearing. Design: A lexical tone perception test and a pitch interval discrimination test were administered to a group of CI users and a group of normal-hearing (NH) listeners. Sample study: Nineteen adult CI users and 10 NH listeners who are native-Mandarin-Chinese speakers participated in the study. Result: Tone-perception performance of the CI group was, on average, 58.3% correct (± 19.78% correct), and performance of the NH group was near perfect. The CI group had a mean threshold of 5.66 semitones (± 5.57 semitones) in pitch discrimination as compared to the threshold of 0.44 semitone from the NH group. There was a strong correlation between the CI users’ tone-perception performance and their pitch discrimination threshold (r = ?0.75, p < 0.001). Conclution: Musical and lexical pitch perceptions are strongly correlated with each other and they might share similar mechanisms in electric hearing.

Sumario

Objetivo: el objetivo de este estudio fue probar la hipótesis de que la percepción de la música en los usuarios de los implantes cocleares (CI) está correlacionada con la percepción del tono léxico y los dos tipos de percepción comparten mecanismos similares en la audición electrónica. Diseño: Una prueba de percepción del tono léxico y una prueba de la discriminación del intervalo de tono se administraron a un grupo de usuarios de implante coclear y a un grupo de sujetos normoyentes (NH). Muestra: Diecinueve adultos usuarios de CI y 10 sujetos normoyentes hablantes nativos del chino mandarín participaron en el estudio. Resultados: El desempeño en la percepción tonal en el grupo de CI fue en promedio 58.3% correcta (±19.78%) y el desempeño del grupo NH fue casi perfecto. El grupo CI tuvo un umbral promedio de 5.66 semitonos (±5.57 semitonos) en discriminación del tono comparado con el umbral de 0.44 semitonos del grupo NH. Hubo una fuerte correlación entre el desempeño de la percepción del tono en los usuarios de CI y su umbral de discriminación de tono (r = ?0.75, p < 0.001). Conclusión: El tono musical y el léxico están estrechamente correlacionados entre sí y puede ser que compartan mecanismos similares en la audición eléctrica.     

Pitch ranking of complex tones by normally hearing subjects and cochlear implant users

The ability of 10 normally hearing (NH) adults and eight cochlear implant (CI) users to pitch-rank pairs of complex tones was assessed. The acoustically presented stimuli differed in fundamental frequency (F0) by either one or six semitones (F0 range: 98 to 740 Hz). The NH group obtained significantly higher mean scores for both experiments: (NH: one semitone – 81.2%, six semitones – 89.0%; CI: one semitone – 49.0%, six semitones – 60.2%; p < 0.001). Prior musical experience was found to be associated with higher pitch-ranking scores for the NH subjects. Those with musical experience ratings <3 obtained significantly lower scores for both interval sizes (p < 0.001) than those with higher ratings. Nevertheless, the scores obtained by the musically inexperienced, NH adults were significantly higher than those obtained by the CI group for both the one-semitone (p = 0.022) and six-semitone (p = 0.018) intervals. These results suggest that the pitch information CI users obtain from their implant systems is less accurate than that obtained by NH listeners when listening to the same complex sounds. Furthermore, the relatively poor pitch-ranking ability of at least some CI users may be associated with a more-limited experience of music in general.     

Identifying emotions in music through electrical hearing in deaf children using cochlear implants

Abstract

Objective: Cochlear implant (CI) devices are the choice of treatment for individuals with severe to profound hearing loss. The CI devices provide the opportunity for children who are deaf to perceive sound by electrical stimulation of the auditory nerve, with the goal of optimizing oral communication. A natural benefit of acquiring hearing using CIs is the ability to hear, and perhaps enjoy, music. Music is a non-verbal auditory stimulus and a powerful tool for transmitting emotion. Identifying emotional cues is an important part of normal social development and communication and thus music may play an important role in establishing these skills during development. To date, it is not known whether children who use cochlear implants to hear can identify the emotional content carried in music. Our objective in the present study was to determine whether children who have been deaf from infancy and are experienced CI users have acquired the ability to identify emotion in musical phrases.

Method: Study participants were 18 CI users (ages 7–13 years) who received right unilateral CIs (mean age at CI activation of 2.9 years) and 18 age-and gender-matched controls. Participants were asked to judge 32 brief musical excerpts as happy or sad by pointing to simple graphics of a smiling or frowning face.

Results: Children using CIs were able to correctly distinguish happy versus sad music well above chance levels, but performed more poorly on this task than their peers with typical hearing. Age at CI activation and time since CI activation were both uncorrelated with outcome measures.

Conclusion: Children with CIs show the ability to perceive emotion in music but do so less accurately than typically hearing peers.     

成人人工耳蜗植入者音乐旋律和音色感知研究

目的评价成人人工耳蜗植入者对音乐旋律及音色的感知能力。方法对13例人工耳蜗植入者（男8例,女5例,平均年龄26．5±6．9岁）分别进行音乐聆听行为评估和旋律辨别、乐器辨别测试。实验使用慕尼黑音乐经验问卷MUMU（Munich music questionnaire）和人工耳蜗音乐评估软件Mu．S．I．C（musical sounds in cochlear implant）进行评估。对照组为40例听力正常受试者（男21例,女19例,平均年龄26．8±6．7岁）。结果①人工耳蜗组与听力正常组的年龄及音乐经验相互匹配。②人工耳蜗组旋律辨别平均正确率为69．3％,乐器辨别平均正确率为51．2％,听力正常组旋律辨别平均正确率为80．4％,乐器辨别平均正确率为85．3％。两组比较,差异存在统计学意义（P=0．000）。结论成人人工耳蜗植入者的旋律感知能力和音色感知能力明显落后于听力正常者。     

儿童人工耳蜗植入年龄下限降至9月龄的启示与应对

食品与药品管理局(FDA)批准将儿童人工耳蜗植入年龄下限降至9月龄表明：有必要更早地植入人工耳蜗,以收获聋儿植入后更佳的听力、言语和语言康复成效。在低龄婴幼儿中进行人工耳蜗植入,离不开一批训练有素的医护及麻醉团队提供围手术期支持,对诊断、麻醉风险、外科技术、术中测试和术后编程、长期安全等方面提出了更高要求。同时也对婴幼儿听力学诊断、干预和评估带来了挑战。9~24月龄儿童植入人工耳蜗的指征仍为双侧极重度感音神经性听力损失,围绕“先天聋儿植入人工耳蜗的指征和时机”“植入前是否试配助听器”等话题,耳外科专家与听力学专家应携起手来,审慎、稳妥、积极地开展低龄儿童人工耳蜗植入的循证医学研究。     

The knowledge and beliefs regarding practical aspects of cochlear implants: A study of otorhinolaryngologists in a secondary setting in a multi-country study

Objective: The main goal of this study was to determine the knowledge and beliefs of otorhinolaryngologists in a secondary setting in selected economically advanced European countries concerning severe hearing loss, hearing aids, and cochlear implants (CIs). Secondary goals of the study looked into the information sources of the otorhinolaryngologists and into key topics of importance for these professionals. In Europe, many adults, who could benefit from a CI, do not have one despite their availability via national health care systems. This lack of coverage might be due, in part, to the knowledge and beliefs of otorhinolaryngologists.

Methods: Otorhinolaryngologists in a secondary setting in Germany, England, France, Austria, and Sweden were emailed a custom-made questionnaire on their knowledge and beliefs regarding hearing loss and its treatments. Results were presented in relative frequencies (%) according to each nation.

Results: Two-hundred and forty otorhinolaryngologists responded (50 from each nation except Sweden). Each nation regarded rehabilitation and hearing preservation as particularly important in CIs. National and international conferences and conversations with colleagues were much more popular methods of keeping abreast of medical issues than other information sources such as online media or company information.

Conclusion: The otorhinolaryngologists of the surveyed nations share many common beliefs about hearing loss, hearing aids, and CIs, although some national variation in opinion is present. The otorhinolaryngologists of each nation are knowledgeable, but could still benefit from an increased knowledge and awareness of hearing loss treatment modalities.     

A comparison of the quality of life of parents of children using hearing aids and those using cochlear implants

ObjectiveThe goal of this study was to evaluate the quality of life of parents of children who use hearing aids (HA) with those who use cochlear implants (CI) in the Indian context and document any differences found.MethodsThe Kannada version of the AQoL-4D was administered in a modified fashion to 131 parents (87 HA and 44 CI). Sociodemographic details were collected for supplemental information on the intervention strategy used.ResultsA total of 49 parents (29 HA and 20 CI) responded to the questionnaire sent. The mean total scores for both the groups were similar (HA group = 17.9 (SD = 5.5), CI group = 17.2 (SD = 3.4)), as was the score for the first subscale (HA group = 8.6 (SD = 2.9); CI group = 8.5 (SD = 2.6)) of the AQoL-4D. No significant differences were found between the two groups on either scores [Total Score: U (N_HA = 29, N_CI = 20) = 280.5, z = ?0.194, p > 0.05; Subscale 1 Score: U (N_HA = 29, N_CI = 20) = 281.5, z = ?0.176, p > 0.05]. The degree of hearing loss in the hearing aid group was equivalent to that of the cochlear implant group but this did not appear to influence parental quality of life.ConclusionParents of children with hearing aids and cochlear implants appear to be similar on several psychosocial factors in the realms of functional, social, and psychological well-being. In terms of parental quality of life, hearing aids and cochlear implants appear to be equally effective intervention techniques.