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BACKGROUND:
While hearing aids for a contralateral routing of signals (CROS-HA) and bone conduction devices have been the traditional treatment for single-sided deafness (SSD) and asymmetric hearing loss (AHL), in recent years, cochlear implants (CIs) have increasingly become a viable treatment choice, particularly in countries where regulatory approval and reimbursement schemes are in place. Part of the reason for this shift is that the CI is the only device capable of restoring bilateral input to the auditory system and hence of possibly reinstating binaural hearing. Although several studies have independently shown that the CI is a safe and effective treatment for SSD and AHL, clinical outcome measures in those studies and across CI centers vary greatly. Only with a consistent use of defined and agreed-upon outcome measures across centers can high-level evidence be generated to assess the safety and efficacy of CIs and alternative treatments in recipients with SSD and AHL.
METHODS:
This paper presents a comparative study design and minimum outcome measures for the assessment of current treatment options in patients with SSD/AHL. The protocol was developed, discussed, and eventually agreed upon by expert panels that convened at the 2015 APSCI conference in Beijing, China, and at the CI 2016 conference in Toronto, Canada.
RESULTS:
A longitudinal study design comparing CROS-HA, BCD, and CI treatments is proposed. The recommended outcome measures include (1) speech in noise testing, using the same set of 3 spatial configurations to compare binaural benefits such as summation, squelch, and head shadow across devices; (2) localization testing, using stimuli that rove in both level and spectral content; (3) questionnaires to collect quality of life measures and the frequency of device use; and (4) questionnaires for assessing the impact of tinnitus before and after treatment, if applicable.
CONCLUSION:
A protocol for the assessment of treatment options and outcomes in recipients with SSD and AHL is presented. The proposed set of minimum outcome measures aims at harmonizing assessment methods across centers and thus at generating a growing body of high-level evidence for those treatment options.
Die Hersteller von Cochlea-Implantat (CI)-Systemen sehen für klinische Audiologen die Möglichkeit vor, die Mikrofonleistung der meisten aktuellen CI-Sprachprozessoren mittels anschließbarer Monitorkopfhörer zu prüfen. Nähere Angaben dazu, nach welchem Prozedere diese Prüfung stattfinden soll, z. B. welche Stimuli mit welchen Pegeln verwendet werden sollen, sind nach Wissen der Autoren seitens der CI-Hersteller nicht verfügbar. Auf der Basis dieser subjektiven Prüfung entscheidet dann der Audiologe, ob der betreffende Sprachprozessor an den Hersteller eingeschickt wird oder nicht. Wir haben eine Messbox entwickelt, mit der die Mikrofonleistung aller abhörbaren CI-Sprachprozessoren der Hersteller Advanced Bionics, Cochlear und MED-EL objektiv geprüft werden kann. Die Box wurde im 3-D-Druckverfahren hergestellt. Der zu prüfende Sprachprozessor wird in die Messbox eingehängt und über einen verbauten Lautsprecher mit definierten Prüfsignalen (Sinustönen unterschiedlicher Frequenz) beschallt. Das Signal des Mikronfons bzw. der Mikrofone wird über das in der Audio-/Abhörbuchse des Prozessors eingesteckte Kabel der Monitorkopfhörer herausgeführt und mit einer Shifting and Scaling-Schaltung in einen Spannungsbereich transformiert, der für die A/D-Wandlung mit einem Mikrokontroller (ATmega1280 verbaut auf einem Arduino Mega) geeignet ist. Derselbe Mikrokontroller übernimmt über einen eigens gebauten D/AWandler die Ausgabe der Prüfsignale über den Lautsprecher. Signalaufnahme und –wiedergabe erfolgt jeweils mit einer Samplingrate von 38,5 kHz. Der frequenzspezifische Effektivwert des abgegriffenen Mikrofonsignals wird mit einem Referenzwert verglichen. Die (frequenzspezifischen) Referenzwerte wurden mit einem neuwertigen Sprachprozessor gleichen Typs ermittelt und im Speicher des Mikrokontrollers abgelegt. Das Ergebnis wird nach Abschluss der Messung grafisch auf einem Touchscreen ausgegeben. Derzeit läuft eine erste Datenerhebung mit in der Klinik subjektiv auffällig gewordenen CI-Sprachprozessoren, die anschließend in der Messbox untersucht werden. Längerfristiges Ziel ist es, die hit und false alarm Raten der subjektiven Prüfung zu ermitteln.
The effect of fluctuating maskers on speech understanding of high-performing cochlear implant users
(2016)
Objective: The present study evaluated whether the poorer baseline performance of cochlear implant (CI) users or the technical and/or physiological properties of CI stimulation are responsible for the absence of masking release. Design: This study measured speech reception thresholds (SRTs) in continuous and modulated noise as a function of signal to noise ratio (SNR). Study sample: A total of 24 subjects participated: 12 normal-hearing (NH) listeners and 12 subjects provided with recent MED-EL CI systems. Results: The mean SRT of CI users in continuous noise was −3.0 ± 1.5 dB SNR (mean ± SEM), while the normal-hearing group reached −5.9 ± 0.8 dB SNR. In modulated noise, the difference across groups increased considerably. For CI users, the mean SRT worsened to −1.4 ± 2.3 dB SNR, while it improved for normal-hearing listeners to −18.9 ± 3.8 dB SNR. Conclusions: The detrimental effect of fluctuating maskers on SRTs in CI users shown by prior studies was confirmed by the current study. Concluding, the absence of masking release is mainly caused by the technical and/or physiological properties of CI stimulation, not just the poorer baseline performance of many CI users compared to normal-hearing subjects. Speech understanding in modulated noise was more robust in CI users who had a relatively large electrical dynamic range.
Unterschiedliche Stimulationszeitpunkte bei bimodaler Versorgung mit Hörgerät und Cochleaimplantat
(2023)
Die bimodale Versorgung von Patienten mit Hörgerät (HG) ipsilateral und Cochleaimplantat (CI) kontralateral bei asymmetrischem Hörverlust ist aufgrund vieler inhärenter Variablen die komplizierteste Versorgungsart im Kontext der Versorgung mit CI. Im vorliegenden Übersichtsartikel werden alle systematischen interauralen Unterschiede zwischen elektrischer und akustischer Stimulation dargestellt, die bei dieser Versorgungsart auftreten können. Darüber hinaus werden Methoden zur Quantifizierung des interauralen Latenzoffsets, also des Zeitunterschieds zwischen der akustischen und elektrischen Stimulation des Hörnervs, mittels Registrierung auditorisch evozierter Potenziale – erzeugt durch akustische bzw. elektrische Stimulation – und Messungen an den Sprachprozessoren und Hörgeräten vorgestellt. Die technische Kompensation des interauralen Latenzoffsets und ihre positive Auswirkung auf die Schalllokalisationsfähigkeit bimodal mit CI und HG versorgter Patienten wird ebenfalls beschrieben. Zuletzt werden neueste Erkenntnisse diskutiert, die Gründe dafür aufzeigen, warum die Kompensation des interauralen Latenzoffsets das Sprachverstehen im Störgeräusch bei bimodal versorgten CI-/HG-Trägern nicht verbessert.
The ability to detect a target signal masked by noise is improved in normal-hearing listeners when interaural phase differences (IPDs) between the ear signals exist either in the masker or in the signal. To improve binaural hearing in bilaterally implanted cochlear implant (BiCI) users, a coding strategy providing the best possible access to IPD is highly desirable. In this study, we compared two coding strategies in BiCI users provided with CI systems from MED-EL (Innsbruck, Austria). The CI systems were bilaterally programmed either with the fine structure processing strategy FS4 or with the constant rate strategy high definition continuous interleaved sampling (HDCIS). Familiarization periods between 6 and 12 weeks were considered. The effect of IPD was measured in two types of experiments: (a) IPD detection thresholds with tonal signals addressing mainly one apical interaural electrode pair and (b) with speech in noise in terms of binaural speech intelligibility level differences (BILD) addressing multiple electrodes bilaterally. The results in (a) showed improved IPD detection thresholds with FS4 compared with HDCIS in four out of the seven BiCI users. In contrast, 12 BiCI users in (b) showed similar BILD with FS4 (0.6 ± 1.9 dB) and HDCIS (0.5 ± 2.0 dB). However, no correlation between results in (a) and (b) both obtained with FS4 was found. In conclusion, the degree of IPD sensitivity determined on an apical interaural electrode pair was not an indicator for BILD based on bilateral multielectrode stimulation.
In users of a cochlear implant (CI) together with a contralateral hearing aid (HA), so-called bimodal listeners, differences in processing latencies between digital HA and CI up to 9 ms constantly superimpose interaural time differences. In the present study, the effect of this device delay mismatch on sound localization accuracy was investigated. For this purpose, localization accuracy in the frontal horizontal plane was measured with the original and minimized device delay mismatch. The reduction was achieved by delaying the CI stimulation according to the delay of the individually worn HA. For this, a portable, programmable, battery-powered delay line based on a ring buffer running on a microcontroller was designed and assembled. After an acclimatization period to the delayed CI stimulation of 1 hr, the nine bimodal study participants showed a highly significant improvement in localization accuracy of 11.6% compared with the everyday situation without the delay line (p < .01). Concluding, delaying CI stimulation to minimize the device delay mismatch seems to be a promising method to increase sound localization accuracy in bimodal listeners.
Objectives: Speech recognition on the telephone poses a challenge for patients with cochlear implants (CIs) due to a reduced bandwidth of transmission. This trial evaluates a home-based auditory training with telephone-specific filtered speech material to improve sentence recognition. Design: Randomised controlled parallel double-blind. Setting: One tertiary referral centre. Participants: A total of 20 postlingually deafened patients with CIs. Main outcome measures: Primary outcome measure was sentence recognition assessed by a modified version of the Oldenburg Sentence Test filtered to the telephone bandwidth of 0.3-3.4 kHz. Additionally, pure tone thresholds, recognition of monosyllables and subjective hearing benefit were acquired at two separate visits before and after a home-based training period of 10-14 weeks. For training, patients received a CD with speech material, either unmodified for the unfiltered training group or filtered to the telephone bandwidth in the filtered group. Results: Patients in the unfiltered training group achieved an average sentence recognition score of 70.0%±13.6% (mean±SD) before and 73.6%±16.5% after training. Patients in the filtered training group achieved 70.7%±13.8% and 78.9%±7.0%, a statistically significant difference (P=.034, t10 =2.292; two-way RM ANOVA/Bonferroni). An increase in the recognition of monosyllabic words was noted in both groups. The subjective benefit was positive for filtered and negative for unfiltered training. Conclusions: Auditory training with specifically filtered speech material provided an improvement in sentence recognition on the telephone compared to training with unfiltered material.
This paper presents a streaming-based E-Learning environment where closer integration between learning and work is achieved by integrating multimedia services into manufacturing processes. It contains a comprehensive and detailed explanation of the proposed E-Learning streaming framework, especially the adaption of streaming services to mobile environments. We first analyze several scenarios where E-Learning streaming services can be integrated into manufacturing processes. To allow systematic and tailor-made integration, we develop a model and a specification language for E-Learning streaming services and apply the model using practical scenarios from real manufacturing processes. Adaption of multimedia streaming services to mobile devices is discussed based on Synchronized Multimedia Integration Language (SMIL). Last, we comment on the benefits of using E-Learning streaming services as part of manufacturing processes and analyze the acceptance of the developed system. The key components of our E-Learning environment are 1) an xml based streaming service specification language, 2) adaption of multimedia E-Learning services to mobile environments, and 3) Web Services for searching, registration, and creation of E-Learning streaming services.
A physical unclonable function (PUF) is a hardware circuit that produces a random sequence based on its manufacturing-induced intrinsic characteristics. In the past decade, silicon-based PUFs have been extensively studied as a security primitive for identification and authentication. The emerging field of printed electronics (PE) enables novel application fields in the scope of the Internet of Things (IoT) and smart sensors. In this paper, we design and evaluate a printed differential circuit PUF (DiffC-PUF). The simulation data are verified by Monte Carlo analysis. Our design is highly scalable while consisting of a low number of printed transistors. Furthermore, we investigate the best operating point by varying the PUF challenge configuration and analyzing the PUF security metrics in order to achieve high robustness. At the best operating point, the results show areliability of 98.37% and a uniqueness of 50.02%, respectively. This analysis also provides useful and comprehensive insights into the design of hybrid or fully printed PUF circuits. In addition, the proposed printed DiffC-PUF core has been fabricated with electrolyte-gated field-effect transistor technology to verify our design in hardware.