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Biomedical subjects

Mark E Lutman

Publications and source records attributed to Mark E Lutman.

At least 19 recordsLinked to original sources

Learning to discriminate interaural time differences: an exploratory study with amplitude-modulated stimuli.

The advent of bilateral cochlear implants (CIs) has increased interest in learning on binaural tasks, and studies in normal-hearing listeners provide important background information. However, few studies have considered learning with discrimination of interaural time difference (ITD). Here, learning with ITD was explored using stimuli that are more relevant to bilateral CIs than used previously. Inexperienced listeners were trained with envelope-based ITD using high-frequency amplitude-modulated tones with or without an interaural carrier frequency difference (IFD), the former to simulate asymmetrical bilateral CI insertions. All were tested with and without IFD before and after training. In most listeners, ITD thresholds improved substantially with training, not necessarily reaching asymptote after 3,000 trials. In these, the magnitude and time-course of learning was larger than anticipated from a previous study with low-frequency ITD. Learning generalized across IFD and the effect of IFD on ITD thresholds at post-test was smaller than reported previously. These results have implications for studies of bilateral CIs, such as the need to provide extensive training to avoid over-estimating any apparent 'impairment'.

Acoustic Stimulation↗

Mechanisms of generation of the 2f2-f1 distortion product otoacoustic emission in humans.

The 2f1-f2 distortion product otoacoustic emission (DPOAE) is considered to consist of two components in normally hearing ears, one having constant phase with changing DP frequency (wave fixed) and one having an increasing phase lag with increasing frequency (place fixed). The aim was to identify the wave-fixed and place-fixed components of both 2f1-f2 and 2f2-f1 DPs, and, in particular, to show whether a wave-fixed 2f2-f1 DP exists in normally hearing adults. DPOAE recordings were made in 20 ears of normally hearing young adults. Four frequency ratios were used and recording entailed fixed frequency-ratio sweeps. A separation into wave-fixed and place-fixed components was carried out using a time-window separation method. A method for estimating the noise floor after data processing was developed. Results confirmed the presence of wave-fixed and place-fixed components for 2f1-f2, consistent with previous studies. Both components were also present for 2f2-f1 in virtually all subjects. This latter finding conflicts with current models of DPOAE generation, and so a modified model is proposed. Unlike the 2f1-f2 emission, which has a wave-fixed component that is strongly dependent on the frequency ratio, neither component of the 2f2-f1 emission showed such a dependence. The proposed model explains these findings in terms of the overlap of the primary frequency traveling waves.

Adult↗

The auditory middle latency response, evoked using maximum length sequences and chirps, as an indicator of adequacy of anesthesia.

The auditory evoked potential known as the middle latency response (MLR), evoked with regular click stimulation at around 5 Hz, has been suggested as an indicator of adequacy of anesthesia. The MLR is a very small signal embedded in high levels of background noise, so it can take a long time to acquire. However, using a stimulus paradigm of chirps presented in a maximum length sequence, the acquisition of the MLR can be improved compared to using conventional click stimulation. In this pilot study, we investigated this new technique in a clinical environment. Significant changes in MLR amplitude, but not latency, were measured for six of seven subjects in association with changes in responsiveness to command using the isolated forearm technique. The absence of any latency shift differs from other studies of the MLR during anesthesia and highlights the limited understanding of the relationship between anesthesia and the MLR.

Acoustic Stimulation↗

Dynamic nonlinear cochlear model predictions of click-evoked otoacoustic emission suppression.

A comprehensive set of results from 2-click suppression experiments on otoacoustic emissions (OAEs) have been presented by Kapadia and Lutman [Kapadia, S., Lutman, M.E., 2000a. Nonlinear temporal interactions in click-evoked otoacoustic emissions. I. Assumed model and polarity-symmetry. Hear. Res. 146, 89-100]. They found that the degree of suppression of an OAE evoked by a test click varied systematically with the timing and the level of a suppressor click, being greatest for suppressor clicks occurring some time before the test click, particularly at lower levels of suppression. Kapadia and Lutman also showed that although the general shape of the graph of suppression against suppressor click timing could be predicted by a static power law model, this did not predict the asymmetry with respect to the timing of the suppressor click. A generalised automatic gain control (AGC) is presented as a simple example of a dynamic nonlinear system. Its steady state nonlinear behaviour, as quantified by its level curve, and its dynamic behaviour, as quantified by its transient response, can be independently set by the feedback gain law and detector time constant, respectively. The previously reported suppression results, with the asymmetry in the timing, are found to be predicted better by such an AGC having a level curve with a slope of about 0.5 dB/dB, and a detector time constant of about twice the period at the characteristic frequency. Although this gives adequate predictions for high suppression levels, it under predicts the suppression and the asymmetry for lower levels. Further research is required to establish whether simple peripheral feedback models can explain OAE suppression of this type.

Acoustic Stimulation↗

Sound quality judgements of new hearing instrument users over a 24-week post-fitting period.

The time course of changes in perceived sound quality after hearing instrument fitting has not been studied systematically It is possible, for example, that patients may object to additional high frequency gain when fitted, but not after a period of auditory acclimatisation. The aim of this study was to utilise sound quality judgements to compare two frequency responses in new users at 4-week intervals over a 24-week post-fitting period. The null hypothesis was that there would be no change in sound quality judgements over time. A total of 16 elderly subjects were fitted monaurally with the same model of linear, programmable hearing instrument. This was set to a standard response that provided 26-29 dB of real-ear insertion gain at 2000 4000 Hz. This program was worn by the subjects for the duration of the study. All subjects reported greater than four hours of daily use. The alternative response which was used in a paired comparison paradigm, provided a mean gain reduction of 3, 8, 13, and 16 dB at 2000, 3000, 4000 and 6000 Hz, respectively. Subjects compared the standard and the alternative responses for sound quality along dimensions of comfort, clarity, and overall preference while listening to running speech presented in quiet, steady noise, and speech babble. At the time of fitting there was a small preference for the standard response when judging clarity, but the alternative response was preferred for comfort and preferred overall. Repeated-measures analysis of variance (ANOVA) for each quality dimension did not reveal any statistically significant change over time. It is concluded that this pattern of preference is unaffected by acclimatisation to amplification, at least over the initial 24 weeks of instrument use.

Acoustics↗

Methodology for quantifying perceptual effects from noise suppression systems.

Methodology is proposed for perceptual assessment of both subjective sound quality and speech recognition in such way that results can be compared between these two aspects. Validation is performed with a noise suppression system applied to hearing instruments. A method termed Interpolated Paired Comparison Rating (IPCR) was developed for time efficient assessment of subjective impression of different aspects of sound quality for a variety of noise conditions. The method is based on paired comparisons between processed and unprocessed stimuli, and the results are expressed as the difference in signal-to-noise ratio (dB) between these that give equal subjective impression. For tests of speech recognition in noise, validated adaptive test methods can be used that give results in terms of speech-to-noise ratio. The methodology was shown to be sensitive enough to detect significant mean differences between processed and unprocessed speech in noise, both regarding subjective sound quality and speech recognition ability in groups consisting of 30 subjects. An effect on sound quality from the noise suppression equivalent to about 3-4 dB is required to be statistically significant for a single subject. A corresponding effect of 3-6 dB is required for speech recognition (one-sided test). The magnitude of difference that occurred in the present study for sound quality was sufficient to show significant differences for sound quality within individuals, but this was not the case for speech recognition.

Acoustic Stimulation↗

The influence of visual feedback on closed-set word test performance over time.

Closed-set word tests can be implemented with or without trial-by-trial visual feedback. Feedback is considered to increase subject motivation yet its influence on performance is unknown. The aim of this study was to compare performance on the Four Alternative Auditory Feature (FAAF) test with and without visual feedback over a 24-week period following fitting of a hearing aid. A total of 32 elderly subjects were recruited as new users and fitted monaurally with the same model of linear, programmable hearing aid that provided in excess of 20 dB insertion gain at 2-4 kHz. Half of the subjects were provided with visual feedback. In these subjects, mean performance increased by 5% across the study period. The improvement in performance over time was statistically significant on analysis of variance (p < 0.05). Mean performance did not increase in the remaining subjects who were not provided with feedback. If closed-set word tests are to be used with visual feedback to measure changes over time, the potentially confounding effects of practice must be controlled carefully. Alternatively, omitting feedback leads to simpler experimental designs.

Aged↗

Speech recognition and comfort using hearing instruments with adaptive directional characteristics in asymmetric listening conditions.

OBJECTIVE: Hearing instruments with adaptive directional microphone systems attempt to maximize speech-to-noise ratio (SNR) and thereby improve speech recognition in noisy backgrounds. When instruments with adaptive systems are fitted bilaterally, there is the potential for adverse effects as they operate independently and may give confusing cues or disturbing effects. The present study compared speech recognition performance in 16 listeners fitted bilaterally with the Phonak Claro hearing instrument using omni-directional, fixed directional, and adaptive directional microphone settings as well as mixed microphone settings (an omni-directional microphone on one side and an adaptive directional microphone on the other). DESIGN: Under anechoic conditions, speech was always presented from a loudspeaker directly in front of the listener (0 degree azimuth) whereas noise was presented from one or two loudspeakers arranged either symmetrically (0, 180, 90 + 270 degrees) or asymmetrically (170 + 240 degrees and 120 + 190 degrees) in the horizontal plane. Adaptive sentence recognition in noise measurement was supplemented by quality ratings. RESULTS: With symmetrical omni-directional settings (Omni/Omni), performance was poorer than a control group of 14 listeners with normal hearing tested unaided: Aided listeners required 4.3 dB more favorable SNR for criterion performance. In all loudspeaker arrangements in which directional characteristics could be exploited, performance with symmetrical adaptive microphones (Adapt/Adapt) was similar to the control group. The mixed microphone settings did not appear to confer any particular disadvantage for speech recognition from their asymmetric nature, always giving scores significantly better than Omni/Omni. Quality rating scores were consistent with speech recognition performance, showing benefits in terms of clarity and comfort for the Adapt/Adapt and Fixed/Fixed microphone conditions over the Omni/Omni and mixed microphone conditions wherever directional characteristics could be used. Similarly, the mixed microphone conditions were rated more comfortable and quieter for the noise than Omni/Omni. CONCLUSIONS: It is concluded that bilateral hearing instruments with adaptive directional microphones confer benefits in terms of speech recognition in noise and sound quality. Independence of the two adaptive control systems does not appear to cause untoward effects.

Aged↗

Auditory localization abilities in bilateral cochlear implant recipients.

OBJECTIVE: To quantify binaural advantage for auditory localization in the horizontal plane by bilateral cochlear implant (CI) recipients. Also, to determine whether the use of dual microphones with one implant improves localization. METHODS: Twenty subjects from the UK multicenter trial of bilateral cochlear implantation with Nucleus 24 K/M device were recruited. Sound localization was assessed in an anechoic room with an 11-loudspeaker array under four test conditions: right CI, left CI, binaural CI, and dual microphone. Two runs were undertaken for each of five stimuli (speech, tones, noise, transients, and reverberant speech). Order of conditions was counterbalanced across subjects. RESULTS: Mean localization error with bilateral implants was 24 degrees compared with 67 degrees for monaural implant and dual microphone conditions (chance performance is 65 degrees). Normal controls average 2 to 3 degrees in similar conditions. Binaural performance was significantly better than monaural performance for all subjects, for all stimulus types, and for different sound sources. Only small differences in performance with different stimuli were observed. CONCLUSIONS: Bilateral cochlear implantation with the Nucleus 24 device provides marked improvement in horizontal plane localization abilities compared with unilateral CI use for a range of stimuli having different spectral and temporal characteristics. Benefit was obtained by all subjects, for all stimulus types, and for all sound directions. However, binaural performance was still worse than that obtained by normal hearing listeners and hearing aid users with the same methodology. Monaural localization performance was at chance. There is no benefit for localization with dual microphones.

Acoustic Stimulation↗

Transducer hysteresis contributes to "stimulus artifact" in the measurement of click-evoked otoacoustic emissions (L).

Click-evoked otoacoustic emissions from the human ear are typically several orders of magnitude smaller than the stimuli that elicit them--a measurement technique that attempts to cancel the stimulus signal from the recorded waveform is therefore typically employed. In practice, an imperfect cancellation of the stimulus is achieved, leaving a "stimulus artifact" that obscures the early part of the emission. Input-output nonlinearities of the transducers used in recording emissions are acknowledged as one source of the stimulus artifact. Here an additional source of this artifact, related to hysteresis in the magnetic "receivers" (loudspeakers) used in such recordings, is identified and discussed.

Acoustic Stimulation↗

Parents and their cochlear implanted child: questionnaire development to assess parental views and experiences.

OBJECTIVES: To test the reliability of a validated closed-format questionnaire assessing parental views following cochlear implantation of their child. DESIGN: Parents were surveyed using a closed-format questionnaire developed in earlier work. The same parents were surveyed 1 month later and responses compared. Test-retest reliability was thereby assessed. SETTING: Tertiary referral Pediatric Cochlear Implant Centre in the UK. SUBJECTS AND METHODS: The parents of 20 children who had been born deaf or were deafened by age 3 years and who had been implanted for at least 2 years were drawn at random from patient lists. Parents were surveyed using a closed-format questionnaire whose validity had been previously assessed and re-surveyed 1 month later. Responses over time were compared. RESULTS: For the majority of items in the questionnaire, the replication of the item would lead to the same response on at least 95% of occasions. The text of the closed-format questionnaire is reproduced in full. CONCLUSION: This validated closed-format questionnaire appears to be unique in respect of cochlear implantation, being based explicitly on issues thought important by the parents. The high test-retest reliability indicates that it is capable of eliciting parental views in a meaningful manner. This information that is not currently available by other means can then be used as part of an overall assessment of outcomes, to inform efforts aimed at quality improvement as well as demonstrating accountability to purchasers and policymakers. Moreover, a wider use of this instrument can result in valid comparisons of outcomes among different cochlear implant centres.

Adult↗

Does static ear canal pressure influence pure tone pitch perception?

OBJECTIVE: That static ear canal air pressure (ECP) influences the frequency of spontaneous otoacoustic emissions (SOAEs) suggests that it may influence intracochlear, in addition to middle ear, processes. A previous study suggested that ECP influences pure tone pitch perception at 1,000 Hz, which was interpreted as indicating an effect on the cochlear place-frequency map. The present study extended investigations of this effect to 500 and 4,000 Hz. MATERIAL AND METHODS: Nine normal-hearing listeners performed interaural pitch matching with monaural ECPs of 0 and -300 daPa. RESULTS: Some indications of a small downward pitch shift (mean 0.2%) at 500 Hz were observed, which were marginally statistically significant at the 5% level. No pitch shifts were observed at 4,000 Hz. CONCLUSIONS: ECP does not influence pitch to the extent suggested previously or by SOAE frequency shifts. No evidence was found to support the notion that ECP influences the place-frequency map.

Acoustic Stimulation↗

Relative benefits of linear analogue and advanced digital hearing aids.

Speech recognition performance and self-reported benefit from linear analogue and advanced (digital) hearing aids were compared in 100 first-time hearing aid users with mild-to-moderate sensorineural hearing loss fitted monaurally with a behind-the-ear (BTE) hearing aid in a single-blind randomized crossover trial. Subjects used each aid for 5 weeks in turn, with aid order balanced across subjects. Three alternative models of digital hearing aid were assigned to subjects according to a balanced design. Aid type was disguised to keep subjects blind within practical limitations. Aided speech recognition performance in noise was measured at speech levels of 65 and 75dB at a speech-to-noise ratio (SNR) of +2dB for closed sets of single words. Self-rated benefit was measured using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Glasgow Hearing Aid Benefit Profile (GHABP). Quality of life, hearing aid use and user preferences were also assessed. Speech recognition scores with the digital aids were significantly better at 75dB than with the analogue aids Self-reported benefit (APHAB, GHABP) and improvement in quality of life were generally not significantly different between analogue and digital aids, although aversiveness measured with the APHAB was significantly lower with digital aids, and satisfaction measured with the GHABP was greater. The digital aids were preferred significantly more often than the analogue aids, with 61 subjects choosing their digital aid, 26 choosing the analogue aid, and nine being equivocal. Overall, this study shows advantages for advanced digital over simple linear analogue aids in terms of both objective and subjective outcomes, although average differences are not large.

Adult↗

The effect of speech presentation level on measurement of auditory acclimatization to amplified speech.

A systematic improvement in auditory performance over time, following a change in the acoustic information available to the listener (that cannot be attributed to task, procedural or training effects) is known as auditory acclimatization. However, there is conflicting evidence concerning the existence of auditory acclimatization; some studies show an improvement in performance over time while other studies show no change. In an attempt to resolve this conflict, speech recognition abilities of 16 subjects with bilateral sensorineural hearing impairments were measured over a 12-week period following provision of a monaural hearing instrument for the first time. The not-fitted ear was used as the control. Three presentation levels were used representing quiet, normal, and raised speech. The results confirm the presence of acclimatization. In addition, the results show that acclimatization is evident at the higher presentation levels but not at the lowest.

Aged↗

Modeling the effect of suppression on the periodicity of stimulus frequency otoacoustic emissions.

The distributed roughness theory of the origins of spectral periodicity in stimulus frequency otoacoustic emissions (SFOAEs) predicts that the spectral period will be altered by suppression of the traveling wave (TW) [Zweig and Shera, J. Acoust. Soc. Am. 98, 2018-2047 (1995)]. In order to investigate this effect in more detail, simulations of the variation of the spectral period under conditions of self-suppression and two-tone suppression are obtained from nonlinear cochlear models based on this theory. The results show that during self-suppression the spectral period is increased, while during high-side two-tone suppression, the period is reduced, indicating that the detailed pattern of disruption of the cochlear amplifier must be examined if the nonlinear behavior of SFOAEs is to be understood. The model results suggest that the SFOAE spectral period may be sensitive to changes in the state of the cochlear amplifier. A companion paper [Lineton and Lutman, J. Acoust. Soc. Am. 114, 871-882 (2003)] presents experimental data which are compared with the results of the above models with a view to testing the underlying theory of Zweig and Shera.

Cochlea↗

A parametric model of the spectral periodicity of stimulus frequency otoacoustic emissions.

A model for estimating the spectral period of stimulus frequency otoacoustic emissions (SFOAEs) is presented. The model characterizes the frequency spectrum of an SFOAE in terms of four parameters which can be directly related to cochlear mechanical quantities featuring in the theory of SFOAE generation proposed by Zweig and Shera [J. Acoust. Soc. Am. 98, 2018-2047 (1995)]. The results of applying the parametric model to SFOAEs generated by cochlear models suggest that it gives a sensitive measure of spectral period. It is concluded that the parametric model may be a useful tool for detecting small changes in cochlear function using SFOAE measurements.

Acoustic Stimulation↗

The effect of suppression on the periodicity of stimulus frequency otoacoustic emissions: experimental data.

In a companion paper [Lineton and Lutman, J. Acoust. Soc. Am. 114, 859-870 (2003)], changes in the spectral period of stimulus frequency otoacoustic emissions (SFOAEs) during self-suppression and two-tone suppression were simulated using a nonlinear cochlear model based on the distributed roughness theory of otoacoustic emission generation [Zweig and Shera, J. Acoust. Soc. Am. 98, 2018-2047 (1995)1. The current paper presents the results of an experimental investigation of SFOAE suppression obtained from 20 human subjects. It was found that, in most subjects, the spectral period increased during self-suppression, but reduced during high-side two-tone suppression. This pattern of results is in close agreement with the predictions of the cochlear model, and therefore strongly supports the distributed roughness theory of Zweig and Shera. In addition, the results suggest that the SFOAE spectral period is sensitive to changes in the state of the cochlear amplifier.

Adolescent↗

Optimizing the acquisition time of the middle latency response using maximum length sequences and chirps.

The middle latency response (MLR) may be used as an indicator of anesthetic depth but has been criticized due to its long acquisition time. This study explores methods for optimizing recording of the MLR to maximize signal-to-noise ratio (SNR) and hence reduce acquisition time. The first experiment investigates the effects of increasing stimulation rate beyond conventional values and also using higher rates by means of maximum length sequences (MLS). The second experiment compares the use of click and chirp stimuli to elicit the MLR, both at conventional and MLS stimulation rates. For all conditions total recording duration is fixed at 185 s and stimulation level is fixed at 60 dB SL. It was found that SNR increases progressively with rate using conventional click stimulation until the theoretical rate limit is reached at the reciprocal of the response duration. The SNR improvement is equivalent to increasing test speed by a factor of 3. Using MLS stimulation, the SNR increases further until a maximum is reached at a rate of 167 clicks/s, equivalent to a fivefold test speed improvement relative to a conventional recording at 5 clicks/s. The use of chirp stimuli designed to compensate for the frequency dependent cochlear traveling wave delay produces an increase in wave V-Na amplitude at all recording rates. For the later latency waves of the response an increase in amplitude is seen for MLS, but not for conventional chirp trains. The optimum SNR was obtained using chirp stimuli at a MLS rate of 167 opportunities/s. It is concluded that the combination of chirps and MLS can reduce acquisition time to less than one-tenth of that required for conventional stimulation at 5 clicks/s for the same SNR. This would confer material benefits for estimating anesthetic depth using MLR.

Adult↗