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PubMedDate not supplied

Limiting high-frequency hearing aid gain in listeners with and without suspected cochlear dead regions.

The purpose of this study was to compare threshold-matched ears with and without suspected cochlear dead regions in terms of the speech perception benefit from high-frequency amplification. The Threshold Equalizing Noise Test (TEN) was used to assess the presence of dead regions. Speech perception was measured while participants were wearing a hearing aid fit to approximate DSL[i/o] targets. Consonant identification of nonsense vowel-consonant-vowel combinations was measured in quiet using a forced-choice procedure. Phoneme recognition was measured at signal-to-noise ratios ranging from 0 to +15 dB using the Computer-Assisted Speech Perception Assessment test (CASPA). Recognition scores were obtained for unfiltered stimuli and stimuli that were low-pass filtered at the estimated boundary of the suspected dead regions, 1/2 octave above and 1 octave above the boundary. Filter settings for the ears without suspected dead regions were the same as settings of the threshold-matched counterpart. In quiet and in low levels of noise, speech perception scores were significantly higher for the wide-band (unfiltered) condition than for the filtered conditions, and performance was similar for the ears with and without suspected dead regions. In high levels of noise, mean scores were highest in the wide-band condition for the ears without suspected dead regions, but performance reached an asymptote for the ears with suspected dead regions. These results suggest that patients with cochlear dead regions may experience speech perception benefit from wide-band high-frequency gain in quiet and low levels of noise, but not in high levels of noise.

Adult↗

PubMed2005

The effect of spatial separation on informational masking of speech in normal-hearing and hearing-impaired listeners.

The ability to understand speech in a multi-source environment containing informational masking may depend on the perceptual arrangement of signal and masker objects in space. In normal-hearing listeners, Arbogast et al. [J. Acoust. Soc. Am. 112, 2086-2098 (2002)] found an 18-dB spatial release from a primarily informational masker, compared to 7 dB for a primarily energetic masker. This article extends the earlier work to include the study of listeners with sensorineural hearing loss. Listeners performed closed-set speech recognition in two spatial conditions: 0 degrees and 90 degrees separation between signal and masker. Three maskers were tested: (1) the different-band sentence masker was designed to be primarily informational; (2) the different-band noise masker was a control for the different-band sentence; and (3) the same-band noise masker was designed to be primarily energetic. The spatial release from the different-band sentence was larger than for the other maskers, but was smaller (10 dB) for the hearing-impaired group than for the normal-hearing group (15 dB). The smaller benefit for the hearing-impaired listeners can be partially explained by masker sensation level. However, the results suggest that hearing-impaired listeners can use the perceptual effect of spatial separation to improve speech recognition in the presence of a primarily informational masker.

Adult↗

PubMed2004

Predictability of speech-in-noise performance from real ear measures of directional hearing AIDS.

OBJECTIVE: Inability to understand speech in noise has been cited repeatedly as the principal complaint of hearing aid users. While data exist documenting the benefit provided by hearing aids with directional microphones when listening to speech in noise, little work has been done to develop a standard clinical protocol for fitting these hearing aids. Our goal was to evaluate a clinical measure of the acoustic directivity of a directional hearing aid, including its association with a test of speech perception in noise. DESIGN: The performance of two commercially available directional behind-the-ear (BTE) hearing aids was evaluated using the Hearing in Noise Test (HINT) and the Real Ear Aided Response (REAR) on 24 adult participants with symmetric, mild to moderately severe, sensorineural hearing loss. The HINT was conducted with the speech signal presented from 0 degrees and the noise from 180 degrees and either 135 degrees or 225 degrees, depending on the ear tested. REAR was measured at the above three angles using swept pure tones, and these measures were used to compute in situ directivity for each subject and hearing aid. CONCLUSIONS: Directional benefit for the HINT was greatest when noise was presented from the azimuth of the published polar diagram null of a given hearing aid in its directional mode (180 or 135/225 degrees). The only significant correlation between HINT and REAR results, however, was found when the noise source was at 180 degrees. These results confirm the validity of using real ear measures as a way to assess directionality in situ, but also indicate the complexity of predicting perceptual benefit from them. These data suggest that factors beyond acoustic directionality may contribute to improvement in speech perception in noise when such improvements are found.

Adult↗

PubMed2005

Speech and melody recognition in binaurally combined acoustic and electric hearing.

Speech recognition in noise and music perception is especially challenging for current cochlear implant users. The present study utilizes the residual acoustic hearing in the nonimplanted ear in five cochlear implant users to elucidate the role of temporal fine structure at low frequencies in auditory perception and to test the hypothesis that combined acoustic and electric hearing produces better performance than either mode alone. The first experiment measured speech recognition in the presence of competing noise. It was found that, although the residual low-frequency (<1000 Hz) acoustic hearing produced essentially no recognition for speech recognition in noise, it significantly enhanced performance when combined with the electric hearing. The second experiment measured melody recognition in the same group of subjects and found that, contrary to the speech recognition result, the low-frequency acoustic hearing produced significantly better performance than the electric hearing. It is hypothesized that listeners with combined acoustic and electric hearing might use the correlation between the salient pitch in low-frequency acoustic hearing and the weak pitch in the envelope to enhance segregation between signal and noise. The present study suggests the importance and urgency of accurately encoding the fine-structure cue in cochlear implants.

Acoustic Stimulation↗

PubMed1990

Frequency selectivity and psychoacoustic tuning curves in old age.

Frequency selectivity represents an important contributory factor in the understanding of human speech. It refers to the ability of the ear to discriminate between two simultaneously occurring sounds of different spectral composition. The capabilities of frequency selection, time pattern analysis, and information processing can be determined generally only by speech audiometry. Schorn and co-workers (1977) published a simplified method for audiological investigations whereby results obtained at two different frequency values are sufficient. The test tone frequencies of 0.5 and 4 kHz were selected because they are representative of the frequency range of normal speech. To determine the influence of ageing on frequency selectivity we investigated three groups of patients between the ages of 20-30, 40-50 and 60-70 years. All of the subjects had normal hearing according to ISO 7029 standards. The measurements of pure-tone audiometry, speech audiometry, and the psychoacoustic tuning curves were performed sequentially on the same day. The influence of ageing on frequency selectivity mainly concerns frequencies above 2 kHz. This is related to the progressive loss of outer hair cells in the basal parts of the cochlea in old age. Our investigations show that particular attention must be paid to a loss of frequency selectivity in old age. This becomes evident mainly after the 60th year. Frequency selectivity is not significantly disturbed before that age, although pure tone audiograms show high frequency inner ear hearing loss earlier in life.

Adult↗

PubMed2005

An investigation of speech perception in children with specific language impairment on a continuum of formant transition duration.

Fifteen children diagnosed with specific language impairment (SLI) and 15 typically developing (TD) children were tested for identification performance on 2 synthetic speech continua varying in formant transition durations (FTDs). One continuum varied from /ba/ to /wa/, and the other varied from /da/ to /ja/. Various d'-related measures from signal detection theory were used to compare category boundaries and indirectly derive sensitivity to phonetic changes in category tokens along each continuum. The SLI group showed less consistent identification performance along the /ba/-/wa/ series relative to the TD group, as well as reduced sensitivity to phonetic changes along the continuum. On the /da/-/ja/ series, the SLI group revealed less consistent identification performance on the short FTD end but similar identification levels to the TD group at the long FTD end. The overall results support the contention that children with SLI reveal a deficiency in the processing of speech sounds at the level of segmental identity.

Child↗

PubMed1992

Relations among different measures of speech reception in subjects using a cochlear implant.

A comprehensive set of speech reception measures were obtained in a group of about 20 postlingually deafened adult users of the Ineraid multichannel cochlear implant. The measures included audio, visual, and audiovisual recognition of words embedded in two types of sentences (with differing degrees of difficulty) and audio-only recognition of isolated monosyllabic words, consonant identification (12 alternatives, /Ca/), and vowel identification (8 alternatives, /bVt/). For most implantees, the audiovisual gains in the sentence tests were very high. Quantitative relations among audio-only scores were assessed using power-law transformations suggested by Boothroyd and Nittrouer [J. Acoust. Soc. Am. 84, 101-114 (1988)] that can account for the benefit of sentence context (via a factor k) and the relation between word and phoneme recognition (via a factor j). Across the broad range of performance that existed among the subjects, substantial order was observed among measures of speech reception along the continuum from recognition of words in sentences, words in isolation, speech segments, and the retrieval of underlying phonetic features. Correlations exceeded 0.85 among direct and sentence-derived measures of isolated word recognition as well as among direct and word-derived measures of segmental recognition. Results from a variety of other studies involving presentation of limited auditory signals, single-channel and multichannel implants, and tactual systems revealed a similar pattern among word recognition, overall consonant identification performance, and consonantal feature recruitment. Finally, improving the reception of consonantal place cues was identified as key to producing the greatest potential gains in speech reception.

Adult↗

PubMed1992

Consistent within-session measures of tinnitus.

Two psychophysical methods, a method of adjustment (MOA) and a forced-choice double-staircase adaptive procedure (FCDS) (Jesteadt, 1980), were used to measure the predominant pitch and loudness of tinnitus for 11 subjects during one test session. The FCDS within-session variability of matches to tinnitus pitch was smaller than for the MOA and comparable to the within-session variability obtained when the FCDS procedure was used to match objective stimuli that approximated the frequency and level of the tinnitus. The within-session variability of matches to tinnitus loudness was nearly identical for the FCDS and the MOA and comparable to the within-session variability obtained when the FCDS procedure was used to match objective stimuli that approximated the frequency and level of the tinnitus. For 3 subjects who participated in 20 sessions, the two psychophysical methods produced correlated measures of tinnitus that tracked each other between sessions. This suggests that tinnitus may be stable within a brief time span but fluctuant in the long run.

Adult↗

PubMed2001

Vowel formant discrimination II: Effects of stimulus uncertainty, consonantal context, and training.

This study is one in a series that has examined factors contributing to vowel perception in everyday listening. Four experimental variables have been manipulated to examine systematical differences between optimal laboratory testing conditions and those characterizing everyday listening. These include length of phonetic context, level of stimulus uncertainty, linguistic meaning, and amount of subject training. The present study investigated the effects of stimulus uncertainty from minimal to high uncertainty in two phonetic contexts, /V/ or /bVd/, when listeners had either little or extensive training. Thresholds for discriminating a small change in a formant for synthetic female vowels /I,E,ae,a,inverted v,o/ were obtained using adaptive tracking procedures. Experiment I optimized extensive training for five listeners by beginning under minimal uncertainty (only one formant tested per block) and then increasing uncertainty from 8-to-16-to-22 formants per block. Effects of higher uncertainty were less than expected; performance only decreased by about 30%. Thresholds for CVCs were 25% poorer than for isolated vowels. A previous study using similar stimuli [Kewley-Port and Zheng. J. Acoust. Soc. Am. 106, 2945-2958 (1999)] determined that the ability to discriminate formants was degraded by longer phonetic context. A comparison of those results with the present ones indicates that longer phonetic context degrades formant frequency discrimination more than higher levels of stimulus uncertainty. In experiment 2, performance in the 22-formant condition was tracked over 1 h for 37 typical listeners without formal laboratory training. Performance for typical listeners was initially about 230% worse than for trained listeners. Individual listeners' performance ranged widely with some listeners occasionally achieving performance similar to that of the trained listeners in just one hour.

Adult↗

PubMed2002

Effects of low pass filtering on the intelligibility of speech in noise for people with and without dead regions at high frequencies.

People with high-frequency sensorineural hearing loss differ in the benefit they gain from amplification of high frequencies when listening to speech. Using vowel-consonant-vowel (VCV) stimuli in quiet that were amplified and then low pass filtered with various cutoff frequencies, Vickers et aL [J. Acoust. Soc. Am. 110, 1164-1175 (2001)] found that the benefit from amplification of high-frequency components was related to the presence or absence of a cochlear dead region at high frequencies. For hearing-impaired subjects without dead regions, performance improved with increasing cutoff frequency up to 7.5 kHz (the highest value tested). Subjects with high-frequency dead regions showed no improvement when the cutoff frequency was increased above about 1.7 times the edge frequency of the dead region. The present study was similar to that of Vickers et al. but used VCV stimuli presented in background noise. Ten subjects with high-frequency hearing loss, including eight from the study of Vickers et al., were tested. Five had dead regions starting below 2 kHz, and five had no dead regions. Speech stimuli at a nominal level of 65 dB were mixed with spectrally matched noise, amplified according to the "Cambridge" prescriptive formula for each subject and then low pass filtered. The noise level was chosen separately for each subject to give a moderate reduction in intelligibility relative to listening in quiet. For subjects without dead regions, performance generally improved with increasing cutoff frequency up to 7.5 kHz, on average more so in noise than in quiet. For most subjects with dead regions, performance improved with cutoff frequency up to 1.5-2 times the edge frequency of the dead region, but hardly changed with further increases. Calculations of speech audibility using a modified version of the articulation index showed that application of the Cambridge formula was at least partially successful in making high-frequency components of the speech audible for subjects with dead regions, and that such subjects often failed to benefit from increased audibility of the speech at high frequencies.

Aged↗

PubMed2004

Verbal communication in MR environments: effect of MR system acoustic noise on speech understanding.

PURPOSE: To assess the masking effect of magnetic resonance (MR)-related acoustic noise and the effect of passive hearing protection on speech understanding. MATERIALS AND METHODS: Acoustic recordings were made at 1.5 T at patient and operator (interventionalist in the MR suite) locations for relevant pulse sequences. In an audiologic laboratory, speech-to-noise ratios (STNRs) were determined, defined as the difference between the absolute sound pressure levels of MR noise and speech. The recorded noise of the MR sequences was played simultaneously with the recorded sentences at various intensities, and 15 healthy volunteers (seven women, eight men; median age, 27 years) repeated these sentences as accurately as possible. The STNR that corresponded with a 50% correct repetition was used as the measure for speech intelligibility. In addition, the effect of passive hearing protection on speech intelligibility was tested by using an earplug model. RESULTS: Overall, speech understanding was reduced more at operator than at patient location. Most problematic were fast gradient-recalled-echo train and spiral k-space sequences. As the absolute sound pressure level of these sequences was approximately 100 dB at patient location, the vocal effort needed to attain 50% intelligibility was shouting (>77 dB). At operator location, less effort was required because of the lower sound pressure levels of the MR noise. Fast spoiled gradient-recalled-echo and echo-planar imaging sequences showed relatively favorable results with raised voice at operator location and loud speaking at patient location. The use of hearing protection slightly improved STNR. CONCLUSION: At 1.5 T, the level of MR noise requires that large vocal effort is used, at the operator and especially at the patient location. Depending on the specific MR sequence used, loud speaking or shouting is needed to achieve adequate bidirectional communication with the patient. The wearing of earplugs improves speech intelligibility.

Acoustics↗

PubMed2001

Variation in speech perception scores among children with cochlear implants.

OBJECTIVE: The objective of this study was to identify common factors affecting speech perception scores in children with cochlear implants. DESIGN: Speech perception data for 167 implanted children were collected at two cochlear implant centres in Melbourne and Sydney. The data comprised audition-alone scores on open-set word and sentence tests. Children were selected on the basis that they had a Nucleus 22-electrode cochlear implant. The average age of the children was 5 yr. Information was also collected about 12 factors that may have influenced speech perception scores for each child. Analysis of covariance was used to identify factors that significantly affected speech perception scores. Pearson pairwise correlation coefficients were also calculated for all factors analyzed. RESULTS: The analyses in this study identified factors that accounted for 51%, 34%, and 45% of the variance in phoneme, word and sentence perception scores. Scores decreased by 1.4 to 2.4% per year of profound deafness prior to implantation. Children who normally use oral communication scored significantly higher than children normally using sign or simultaneous oral and sign communication. Children implanted in Sydney scored higher on average than children implanted in Melbourne. CONCLUSIONS: The results show that a significant part of the variation in speech perception scores is systematically related to audiological and environmental factors for each child. The reasons for significant differences between children using different communication modes or from different clinics were not identified.

Adolescent↗

PubMedDate not supplied

Prediction and statistical evaluation of speech recognition test scores.

A speech test evaluation and presentation system is described. The test presentation subsystem has the flexibility and speed of live-voice testing while using recorded test materials. The speech test evaluation subsystem compares an individual subject's test performance on a monosyllabic word test with that of an average person with the same hearing loss. The elements needed to make such evaluations are discussed. Also, a trial of the procedure is described. The primary purpose of the trial was to obtain data that would provide a basis for statistical probability statements about individual monosyllabic word test results obtained in clinical settings. Data were collected from three audiology clinics in three different types of settings. Except for a few cases with highly asymmetric speech scores, all nonconductive hearing losses were included. Subject ages ranged from 8 to 92 years. Importance-weighted average pure-tone hearing losses ranged from 0.4 to 97.6 dB HL. Fifty-word recognition scores and audiograms for 2609 ears were included in the main analysis. Twenty-five-word recognition scores and audiograms for another 932 ears from one clinic were used in a subsidiary analysis. Results indicated that distributions of absolute speech recognition scores in hearing-impaired samples are highly skewed. However, after transformation of the scores into rationalized arcsine units (rau), the differences between individual subject scores and scores predicted from the audiogram were reasonably well described by the normal distribution. The standard deviation of this distribution of differences, for the data combined across the three audiology clinics, was approximately 13 rau.

Adolescent↗

PubMedDate not supplied

Auditory deprivation in adults with asymmetric, sensorineural hearing impairment.

The purpose of this investigation was to prospectively examine performance on the pure-tone air-conduction threshold, speech-recognition threshold, and suprathreshold word-recognition tests over time in 21 monaurally aided (experimental group) and 28 unaided adults (control group) with asymmetric, sensorineural hearing impairment. The results revealed significant declines on the mean suprathreshold word-recognition scores over time at one and two years post-baseline for the worse ears of the control participants; no declines occurred in the worse ears of the experimental participants or in the better ears of either group. A slight, significant increase in the pure-tone average occurred for the better ears of both groups. The findings are consistent with the presence of an auditory deprivation effect on suprathreshold word-recognition ability in the control group, suggesting that lack of amplification leads to decline in word-recognition performance over time in the worse ears of adults with asymmetric sensorineural hearing impairment.

Adult↗

PubMed2005

A psychophysical evaluation of spectral enhancement.

Listeners with sensorineural hearing loss have well-documented elevated hearing thresholds; reduced auditory dynamic ranges; and reduced spectral (or frequency) resolution that may reduce speech intelligibility, especially in the presence of competing sounds. Amplification and amplitude compression partially compensate for elevated thresholds and reduced dynamic ranges but do not remediate the loss in spectral resolution. Spectral-enhancement processing algorithms have been developed that putatively compensate for decreased spectral resolution by increasing the spectral contrast, or the peak-to-trough ratio, of the speech spectrum. Several implementations have been proposed, with mixed success. It is unclear whether the lack of strong success was due to specific implementation parameters or whether the concept of spectral enhancement is fundamentally flawed. The goal of this study was to resolve this ambiguity by testing the effects of spectral enhancement on detection and discrimination of simple, well-defined signals. To that end, groups of normal-hearing (NH) and hearing-impaired (HI) participants listened in 2 psychophysical experiments, including detection and frequency discrimination of narrowband noise signals in the presence of broadband noise. The NH and HI listeners showed an improved ability to detect and discriminate narrowband increments when there were spectral decrements (notches) surrounding the narrowband signals. Spectral enhancements restored increment detection thresholds to within the normal range when both energy and spectral-profile cues were available to listeners. When only spectral-profile cues were available for frequency discrimination tasks, performance improved for HI listeners, but not all HI listeners reached normal levels of discrimination. These results suggest that listeners are able to take advantage of the local improvement in signal-to-noise ratio provided by the spectral decrements.

Acoustic Stimulation↗

PubMed2001

Two families with phenotypically different hereditary low frequency hearing impairment: longitudinal data and linkage analysis.

Two families with low frequency hearing impairment have been described previously. Family A (Danish) presented a sensorineural hearing impairment most pronounced for frequencies below 2 kHz and a pedigree typical for an autosomal dominant trait with complete penetrance (Königsmark type). Family B, originating from the Faroe Islands, showed conflicting audiological test results, making a valid classification impossible. The pedigree suggested autosomal dominant inheritance with incomplete penetrance. The objectives of the present study are to acquire longitudinal audiometric data, to clarify the mode of transmission, and to localize the mutant gene by reevaluation of the two families. The methods used are evaluation of the family history, audiological examination and linkage analysis. In family A, update of the pedigree fitted the assumption of an autosomal dominant mode of transmission. In six examined subjects audiological data were available from the previous study. The median progression over a 13-21-year period was 13.8 dB HL for the thresholds, averaged across 0.5, 1, 2 and 4 kHz and 17.5 dB HL for the thresholds, averaged across 2 and 4kHz. In family B, the probable mode of transmission is autosomal dominant with reduced penetrance. In this family no progression of the hearing impairment was found. Linkage analysis of family A showed a lod score of 3.53, indicating significant linkage to the loci DFNA6 and DFNA14 on chromosome 4, previously found to be involved in low frequency hearing impairment. Family B was not linked to the region on chromosome 4, further adding to the genetic heterogeneity in low frequency sensorineural hearing impairment.

Adult↗

PubMed2006

Residual hearing conservation and electroacoustic stimulation with the nucleus 24 contour advance cochlear implant.

OBJECTIVE: To assess the conservation of residual hearing in recipients of the Nucleus 24 Contour Advance cochlear implant (CI) and the benefits of combined electrical and acoustic stimulation. STUDY DESIGN: Prospective multicenter study. SETTING: CI clinics in Western Europe. PATIENTS: Adult candidates for conventional cochlear implantation with a minimum preoperative word recognition score of 10% in the ear to be implanted. INTERVENTION: "Soft-surgery" protocol, including a 1- to 1.2-mm anterior and inferior cochleostomy hole with the electrode array, inserted 17 mm using the "advance-off-stylet" technique. Patients with postoperative pure-tone hearing threshold levels (HTLs) of 80 dB hearing loss or less at 125 and 250 Hz and 90 dB hearing loss or less at 500 Hz were refitted with an in-the-ear hearing aid for combined ipsilateral electrical and acoustic (El-Ac) stimulation. MAIN OUTCOME MEASURES: A questionnaire to collect information regarding surgery. Pure-tone HTLs measured at intervals. Word recognition tested in quiet and sentence recognition tested in noise at 10 and 5 dB signal-to-noise ratio (SNR). HEARING CONSERVATION RESULTS: HTL data were available for 27 patients. HTLs were conserved within 20 dB of preoperative levels for 33, 26, and 19% of patients for 125, 250, and 500 Hz, respectively. However, the recommended soft-surgery protocol was strictly followed in only 12 of 27 patients. For these 12 patients, hearing thresholds were conserved within 20 dB for 50, 50, and 33% of patients. Median threshold increases were 40 dB (range, 250-500 Hz) for the whole group and 23 dB for the strict surgery group. Ten patients retained sufficient HTLs to enter the El-Ac user group. SPEECH RECOGNITION RESULTS: Group mean recognition scores for nine El-Ac users for words presented at 65 dB sound pressure level were 45% for CI alone and 55% for CI + ipsilateral hearing aid (p < 0.05, paired t). For sentences presented in noise at 5 dB SNR, mean word scores were 46% CI alone and 56% CI + ipsilateral hearing aid (p < 0.01, paired t). CONCLUSION: Hearing was conserved for conventional candidates for cochlear implantation where the recommended soft-surgery protocol was strictly adhered. Combined ipsilateral electrical and acoustic stimulation provided considerable benefits for speech recognition in noise, equivalent to between 3 and 5 dB SNR, compared with CI alone.

Acoustic Stimulation↗

PubMed2006

Simultaneous bilateral cochlear implantation in adults: a multicenter clinical study.

OBJECTIVE: To determine the efficacy of "simultaneous" bilateral cochlear implantation (both implants placed during a single surgical procedure) by comparing bilateral and unilateral implant use in a large number of adult subjects tested at multiple sites. DESIGN: Prospective study of 37 adults with postlinguistic onset of bilateral, severe to profound sensorineural hearing loss. Performance with the bilateral cochlear implants, using the same speech processor type and speech processing strategy, was compared with performance using the left implant alone and the right implant alone. Speech understanding in quiet (CNCs and HINT sentences) and in noise (BKB-SIN Test) were evaluated at several postactivation time intervals, with speech presented at 0 degrees azimuth, and noise at either 0 degrees , 90 degrees right, or 90 degrees left in the horizontal plane. APHAB questionnaire data were collected after each subject underwent a 3-wk "bilateral deprivation" period, during which they wore only the speech processor that produced the best score during unilateral testing, and also after a period of listening again with the bilateral implants. RESULTS: By 6-mo postactivation, a significant advantage for speech understanding in quiet was found in the bilateral listening mode compared with either unilateral listening modes. For speech understanding in noise, the largest and most robust bilateral benefit was when the subject was able to take advantage of the head shadow effect; i.e., results were significantly better for bilateral listening compared with the unilateral condition when the ear opposite to the side of the noise was added to create the bilateral condition. This bilateral benefit was seen on at least one of the two unilateral ear comparisons for nearly all (32/34) subjects. Bilateral benefit was also found for a few subjects in spatial configurations that evaluated binaural redundancy and binaural squelch effects. A subgroup of subjects who had asymmetrical unilateral implant performances were, overall, similar in performance to subjects with symmetrical hearing. The questionnaire data indicated that bilateral users perceive their own performance to be better with bilateral cochlear implants than when using a single device. CONCLUSIONS: Findings with a large patient group are in agreement with previous reports on smaller groups, showing that, overall, bilateral implantation offers the majority of patients advantages when listening in simulated adverse conditions.

Adult↗