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Subjects utilizing a cochlear implant (CI) in one ear and a hearing aid (HA) on the contralateral ear suffer from mismatches in stimulation timing due to different processing latencies of both devices. This device delay mismatch leads to a temporal mismatch in auditory nerve stimulation. Compensating for this auditory nerve stimulation mismatch by compensating for the device delay mismatch can significantly improve sound source localization accuracy. One CI manufacturer has already implemented the possibility of mismatch compensation in its current fitting software. This study investigated if this fitting parameter can be readily used in clinical settings and determined the effects of familiarization to a compensated device delay mismatch over a period of 3–4 weeks. Sound localization accuracy and speech understanding in noise were measured in eleven bimodal CI/HA users, with and without a compensation of the device delay mismatch. The results showed that sound localization bias improved to 0°, implying that the localization bias towards the CI was eliminated when the device delay mismatch was compensated. The RMS error was improved by 18% with this improvement not reaching statistical significance. The effects were acute and did not further improve after 3 weeks of familiarization. For the speech tests, spatial release from masking did not improve with a compensated mismatch. The results show that this fitting parameter can be readily used by clinicians to improve sound localization ability in bimodal users. Further, our findings suggest that subjects with poor sound localization ability benefit the most from the device delay mismatch compensation.
Users of a cochlear implant (CI) in one ear, who are provided with a hearing aid (HA) in the contralateral ear, so-called bimodal listeners, are typically affected by a constant and relatively large interaural time delay offset due to differences in signal processing and differences in stimulation. For HA stimulation, the cochlear travelling wave delay is added to the processing delay, while for CI stimulation, the auditory nerve fibers are stimulated directly. In case of MED-EL CI systems in combination with different HA types, the CI stimulation precedes the acoustic HA stimulation by 3 to 10 ms. A self-designed, battery-powered, portable, and programmable delay line was applied to the CI to reduce the device delay mismatch in nine bimodal listeners. We used an A-B-B-A test design and determined if sound source localization improves when the device delay mismatch is reduced by delaying the CI stimulation by the HA processing delay (τ HA ). Results revealed that every subject in our group of nine bimodal listeners benefited from the approach. The root-mean-square error of sound localization improved significantly from 52.6° to 37.9°. The signed bias also improved significantly from 25.2° to 10.5°, with positive values indicating a bias toward the CI. Furthermore, two other delay values (τ HA –1 ms and τ HA +1 ms) were applied, and with the latter value, the signed bias was further reduced in some test subjects. We conclude that sound source localization accuracy in bimodal listeners improves instantaneously and sustainably when the device delay mismatch is reduced.
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.