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Background: Although good speech perception in quiet is achievable with cochlear implants (CIs), speech perception in noise is severely impaired compared to normal hearing (NH). In the case of a bimodal CI fitting with a hearing aid (HA) in the opposite ear, the amount of residual acoustic hearing influences speech perception in noise., Objective: The aim of this work was to investigate speech perception in noise in a group of bimodal CI users and compare the results to age-matched HA users and people without subjective hearing loss, as well as with a young NH group., Materials and Methods: Study participants comprised 19 bimodal CI users, 39 HA users, and 40 subjectively NH subjects in the age group 60-90 years and 14 young NH subjects. Speech reception thresholds (SRTs) in noise were adaptively measured using the Oldenburg Sentence Test for the two spatial test conditions S0N0 (speech and noise from the front) and multisource-noise field (MSNF; speech from the front, four spatially distributed noise sources) in continuous noise of the Oldenburg Sentence Test (Ol-noise) and amplitude-modulated Fastl noise (Fastl-noise)., Results: With increasing hearing loss, the median SRT worsened significantly in all conditions. In test condition S0N0, the SRT of the CI group was 5.6 dB worse in Ol-noise than in the young NH group (mean age 26.4 years) and 22.5 dB worse in Fastl-noise; in MSNF, the differences were 6.6 dB (Ol-noise) and 17.3 dB (Fastl-noise), respectively. In the young NH group, median SRT in condition S0N0 improved by 11 dB due to gap listening; in the older NH group, SRTs improved by only 3.1 dB. In the HA and bimodal CI groups there was no gap listening effect and SRTs in Fastl-noise were even worse than in Ol-noise., Conclusion: With increasing hearing loss, speech perception in modulated noise is even more impaired than in continuous noise., (© 2023. The Author(s).)

Background: Although good speech perception in quiet is achievable with cochlear implants (CIs), speech perception in noise is severely impaired compared to normal hearing (NH). In the case of a bimodal CI fitting with a hearing aid (HA) in the opposite ear, the amount of residual acoustic hearing influences speech perception in noise., Objective: The aim of this work was to investigate speech perception in noise in a group of bimodal CI users and compare the results to age-matched HA users and people without subjective hearing loss, as well as with a young NH group., Materials and Methods: Study participants comprised 19 bimodal CI users, 39 HA users, and 40 subjectively NH subjects in the age group 60-90 years and 14 young NH subjects. Speech reception thresholds (SRTs) in noise were adaptively measured using the Oldenburg Sentence Test for the two spatial test conditions S0N0 (speech and noise from the front) and multisource-noise field (MSNF; speech from the front, four spatially distributed noise sources) in continuous noise of the Oldenburg Sentence Test (Ol-noise) and amplitude-modulated Fastl noise (Fastl-noise)., Results: With increasing hearing loss, the median SRT worsened significantly in all conditions. In test condition S0N0, the SRT of the CI group was 5.6 dB worse in Ol-noise than in the young NH group (mean age 26.4 years) and 22.5 dB worse in Fastl-noise; in MSNF, the differences were 6.6 dB (Ol-noise) and 17.3 dB (Fastl-noise), respectively. In the young NH group, median SRT in condition S0N0 improved by 11 dB due to gap listening; in the older NH group, SRTs improved by only 3.1 dB. In the HA and bimodal CI groups there was no gap listening effect and SRTs in Fastl-noise were even worse than in Ol-noise., Conclusion: With increasing hearing loss, speech perception in modulated noise is even more impaired than in continuous noise., (© 2023. The Author(s).)

The aim of this study was to assess the ability of elderly test subjects without self-reported hearing loss to perceive, hear and comprehend speech in quiet and noise. Furthermore, the effects of age and cognitive performance on hearing were also investigated.The study included 40 subjects aged over 60 years (average age: 69.3 ± 7.1 years). The subjects were screened for dementia (DemTect test) to test for any signs of cognitive deficiencies. Average hearing loss (PTA_4) and average high-frequency hearing loss (PTA_HT) were determined. Speech perception in quiet was tested by means of the Freiburg monosyllabic speech test and in noise by means of the Oldenburg sentence test with two different types of noise (temporally continuous and amplitude modulated). While the results of the DemTect test were age-appropriate for 65 % of the subjects, the remaining 35 % showed signs of mild cognitive impairments. The parameters of cognitive performance decreased significantly with age. The hearing loss (PTA_4 and PTA_HT) of the subjects correlated significantly with both age and DemTect score. Speech perception in both quiet and noise decreased significantly with age as well as within the parameters to assess cognitive performance.Seniors should undergo routine hearing screenings in order to detect hearing disorders as soon as possible so that hearing aids can be prescribed at an early stage. This would also allow, patients to get accustomed to their hearing aids early on and to achieve better hearing, thereby improving their quality of life., Competing Interests: Diese Studie wurde unterstützt von der Cochlear Deutschland GmbH und Co. KG, Hannover., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: Combined electric-acoustic stimulation (EAS) is a well-accepted therapeutic treatment for cochlear implant (CI) users with residual hearing in the low frequencies but severe to profound hearing loss in the high frequencies. The recently introduced SONNETeas audio processor offers different microphone directionality (MD) settings and wind noise reduction (WNR) as front-end processing. The aim of this study was to compare speech perception in quiet and noise between two EAS audio processors DUET 2 and SONNETeas, to assess the impact of MD and WNR on speech perception in EAS users in the absence of wind. Furthermore, subjective rating of hearing performance was registered., Method: Speech perception and subjective rating with SONNETeas or DUET 2 audio processor were assessed in 10 experienced EAS users. Speech perception was measured in quiet and in a diffuse noise setup (MSNF). The SONNETeas processor was tested with three MD settings omnidirectional/natural/adaptive and with different intensities of WNR. Subjective rating of auditory benefit and sound quality was rated using two questionnaires., Results: There was no significant difference between DUET 2 and SONNETeas processor using the omnidirectional microphone in quiet and in noise. There was a significant improvement in SRT with MD settings natural (2.2 dB) and adaptive (3.6 dB). No detrimental effect of the WNR algorithm on speech perception was found in the absence of wind. Sound quality was rated as "moderate" for both audio processors., Conclusions: The different MD settings of the SONNETeas can provide EAS users with better speech perception compared to an omnidirectional microphone. Concerning speech perception in quiet and quality of life, the performance of the DUET 2 and SONNETeas audio processors was comparable., Competing Interests: This work was funded by MED-EL Elektromedizinische Geraete GmbH Innsbruck, Austria. The study protocol was designed in collaboration with MED-EL corporation. All testing was conducted at University Frankfurt by employees and all data were analyzed by the authors. The funders had no role in data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

In the group of people over the age of 65, hearing loss is one of the most common health problems. To maintain communication skills in this population, adequate hearing aid fitting is essential. The aim of the present study is to review the quality of hearing aid provision in the elderly. Furthermore, the influence of age and cognitive performance on speech perception should be considered. Forty subjects between the ages of 66 and 88 years were examined with unilateral or bilateral hearing aids. Average hearing loss (frequencies 0.5-1-2-4 kHz), averaged high-frequency hearing loss (frequencies 2-4-6 kHz), maximum monosyllable recognition score (German: maximales Einsilberverstehen, mEV) and aided speech intelligibility at 65 dB HL speech level were considered. To determine the potential cognitive impact on speech perception, a screening for dementia (DemTect test) and a working memory test were used. Although hearing aids showed benefit in 82% of the reviewed cases, an improvement of at least 20% compared with the unaided condition as required by the German "Hilfsmittelrichtlinie" was not achieved in 56% of the cases. Individual mEV with a maximum standard deviation of 10 % was not achieved in 81 % of the cases.Correlations between working memory performance or DemTect-test score and mEV were not of significance. Mild cognitive impairment and degraded working memory or age did not affect speech perception with hearing aids in our study cohort., Competing Interests: Diese Studie wurde unterstützt von der Cochlear Deutschland GmbH und Co. KG., (Georg Thieme Verlag KG Stuttgart · New York.)

There is currently no standardized method for reporting audiological, surgical and subjective outcome measures in clinical trials with active middle ear implants (AMEIs). It is often difficult to compare studies due to data incompatibility and to perform meta-analyses across different centres is almost impossible. A committee of ENT and audiological experts from Germany, Austria and Switzerland decided to address this issue by developing new minimal standards for reporting the outcomes of AMEI clinical trials. The consensus presented here aims to provide a recommendation to enable better inter-study comparability., (The Author(s). Published by S. Karger AG, Basel.)

The aim of this study was to examine the functional hearing results regarding speech perception and auditory sound localization in a high-resolution directional hearing setup following implantation with a new bone conduction device (MED-EL Bonebridge, Innsbruck, Austria). In addition, we assessed the patient acceptance of the Bonebridge system using a questionnaire. The study design is retrospective study. The setting is University Hospital Frankfurt. 18 patients implanted with a Bonebridge device from May 2012 to January 2015 were participated in this study. Speech perception in quiet was tested with the Freiburg monosyllable test at a presentation level of 65 dB SPL. Speech perception in noise was tested post-operatively with the Oldenburg sentence test (OLSA) in best-aided condition. We assessed auditory sound localization with a high-resolution directional hearing setup. To evaluate the acceptance by patients using the Bonebridge in daily life, we used a modified questionnaire. The overall average of functional hearing gain (n = 18) was 29.3 dB (±20.7 dB). Speech perception of monosyllabic words in quiet improved by 20.7% on average, compared with the pre-operative aided condition. Mean speech reception thresholds (SRTs) of the Oldenburg sentence test (OLSA) improved significantly from -3.8 dB SNR (range -5.7 to 5.8 dB SNR) to -5.2 dB SNR (range -6.3 to -0.6 dB SNR) after implantation. Regarding localization abilities, no significant difference was found between the unaided and aided conditions following Bonebridge implantation. A survey of patients' acceptance and handling of the Bonebridge implant in daily life revealed high patient satisfaction. All patients accepted and benefited from the implanted system. No infections or adverse surgical effects occurred. Speech perception significantly improved in quiet and in noise. No significant difference in sound localization was observed. Acceptance of the Bonebridge implant, tested with a modified questionnaire, was high.

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., (© 2017 The Author(s) Published by S. Karger AG, Basel.)

Objective: The aim of the study was to measure and compare speech perception in users of electric-acoustic stimulation (EAS) supported by a hearing aid in the unimplanted ear and in bilateral cochlear implant (CI) users under different noise and sound field conditions. Gap listening was assessed by comparing performance in unmodulated and modulated Comité Consultatif International Téléphonique et Télégraphique (CCITT) noise conditions, and binaural interaction was investigated by comparing single source and multisource sound fields., Methods: Speech perception in noise was measured using a closed-set sentence test (Oldenburg Sentence Test, OLSA) in a multisource noise field (MSNF) consisting of a four-loudspeaker array with independent noise sources and a single source in frontal position (S0N0). Speech simulating noise (Fastl-noise), CCITT-noise (continuous), and OLSA-noise (pseudo continuous) served as noise sources with different temporal patterns. Speech tests were performed in two groups of subjects who were using either EAS (n = 12) or bilateral CIs (n = 10). All subjects in the EAS group were fitted with a high-power hearing aid in the opposite ear (bimodal EAS). The average group score on monosyllable in quiet was 68.8% (EAS) and 80.5% (bilateral CI). A group of 22 listeners with normal hearing served as controls to compare and evaluate potential gap listening effects in implanted patients., Results: Average speech reception thresholds in the EAS group were significantly lower than those for the bilateral CI group in all test conditions (CCITT 6.1 dB, p = 0.001; Fastl-noise 5.4 dB, p < 0.01; Oldenburg-(OL)-noise 1.6 dB, p < 0.05). Bilateral CI and EAS user groups showed a significant improvement of 4.3 dB (p = 0.004) and 5.4 dB (p = 0.002) between S0N0 and MSNF sound field conditions respectively, which signifies advantages caused by bilateral interaction in both groups. Performance in the control group showed a significant gap listening effect with a difference of 6.5 dB between modulated and unmodulated noise in S0N0, and a difference of 3.0 dB in MSNF. The ability to "glimpse" into short temporal masker gaps was absent in both groups of implanted subjects., Conclusions: Combined EAS in one ear supported by a hearing aid on the contralateral ear provided significantly improved speech perception compared with bilateral cochlear implantation. Although the scores for monosyllable words in quiet were higher in the bilateral CI group, the EAS group performed better in different noise and sound field conditions. Furthermore, the results indicated that binaural interaction between EAS in one ear and residual acoustic hearing in the opposite ear enhances speech perception in complex noise situations. Both bilateral CI and bimodal EAS users did not benefit from short temporal masker gaps, therefore the better performance of the EAS group in modulated noise conditions could be explained by the improved transmission of fundamental frequency cues in the lower-frequency region of acoustic hearing, which might foster the grouping of auditory objects.

Background/aims: In speech audiometry, sentence tests have the advantage of assessing more words within a given period of time than single-word tests do. Consequently, greater accuracy (steeper discrimination function) is achieved. The recently developed German Oldenburg Sentence Test for Children (OlKiSa) has been evaluated thus far for school-aged children in noise, and normative data for younger children in a quiet environment have been established. In this study, the focus is on its applicability in hearing-impaired children fitted with hearing aids or cochlear implants., Methods: The use of the OlKiSa in a quiet environment in hearing-impaired children aged 4 years or older was evaluated. One hundred and nineteen hearing-impaired children aged between 4 and 10 years performed the OlKiSa in a quiet environment. Individual speech reception thresholds (SRT) were measured aided and unaided and the slopes of the discrimination functions were calculated., Results: Independent of age, the mean slope of the discrimination function for SRT was about 7%/dB in both conditions, which is a high value of steepness for a speech audiometric test in a quiet environment., Conclusion: The OlKiSa in quiet is a reliable test procedure for hearing-impaired children aged 4 years and older., (Copyright © 2012 S. Karger AG, Basel.)

Objective: Combined electric-acoustic stimulation (EAS) is a therapeutic option for patients with severe to profound mid- and high-frequency hearing loss while low-frequency hearing is mostly unaffected. The present study investigates bimodal pitch matching in EAS users as a function of the angular placement of electrodes. Results are compared with data obtained from previous pitch matching studies. Knowledge of electric and acoustic pitch mapping may be important for effective fitting to control the frequency range of acoustic and electric processing., Design: Pitch adjustment experiments were conducted in eight subjects with residual hearing in the opposite ear as well as in the implanted ear. Four subjects received a standard 31.5-mm electrode array and four subjects received the shorter, more flexible 24-mm FLEX electrode array (PULSARCI100 or SONATATI100 stimulator, MED-EL, Innsbruck, Austria). The subjects' task was to listen to single-electrode stimuli presented at a fixed rate (800 pulses per second) via the cochlear implant and to adjust the frequency of the acoustic stimulus until the perceived pitch matched the perception of the electrically conveyed stimulus. Two to four of the most apical electrodes were tested depending on the range of the individual's residual hearing. Postoperative x rays (modified Stenver's view) were analyzed to compare individual pitch matching data in terms of the electrode arrays' insertion angle., Results: The average mean frequency match for the most apical electrode 1 in EAS subjects implanted with the FLEX array was 583 Hz, while for the two subjects with a deep insertion of the 31.5-mm standard electrode array, the matches were 128 and 223 Hz. Because the residual hearing in the EAS subgroup was rather limited in the high-frequency range, a limited number of basal electrodes were assessed to determine the slope of the electric place/pitch function. A considerable variation in terms of the individual pitch function was observed. The slope of the pitch function varied to a large extent among subjects. The differences between contra- and ipsilateral adjustments were very small (mean average 14 Hz) and within the range of the variance (average SD 124 Hz)., Conclusions: The application of a pitch matching procedure to assess the electric/acoustic crossover frequency is feasible. In the present study, ipsi- and contralateral pitch matches made by EAS patients were nearly equal; therefore, a severe alteration in the excitation pattern of the basilar membrane in the implanted ear can be ruled out.

Conclusion: This study demonstrates that electric-acoustic stimulation (EAS) significantly decreases the subjective impairment in speech perception., Objectives: To assess the subjective benefit of EAS over the first 12 months after EAS fitting using the Abbreviated Profile of Hearing Aid Benefit (APHAB)., Method: Twenty-three EAS users, implanted with either the PULSAR(CI)(100) FLEX(EAS) provided with the DUET EAS processor or the COMBI40+ Medium provided with the TEMPO+ speech processor, were included. Electric stimulation was activated about 1 month postoperatively; ipsilateral acoustic stimulation was added 2 months thereafter. EAS benefit was measured preoperatively with only a hearing aid and postoperatively at EAS fitting and then 3, 6 and 12 months after EAS fitting using the APHAB., Results: Subjects reported significant improvements in the global score with a mean decrease in impairment from 74% preoperatively to 45% after 3 months of EAS use. Furthermore, clinical relevance was demonstrated in multiple subscales between preoperative and first fitting reflecting a true benefit of EAS with a probability of 95%., (Copyright © 2011 S. Karger AG, Basel.)

After successful cochlear implantation in one ear, some patients continue to use a hearing aid at the contralateral ear. They report an improved reception of speech, especially in noise, as well as a better perception of music when the hearing aid and cochlear implant are used in this bimodal combination. Some individuals in this bimodal patient group also report the impression of an improved localization ability. Similar experiences are reported by the group of bilateral cochlear implantees. In this study, a survey of 11 bimodally and 4 bilaterally equipped cochlear implant users was carried out to assess localization ability. Individuals in the bimodal implant group were all provided with the same type of hearing aid in the opposite ear, and subjects in the bilateral implant group used cochlear implants of the same manufacturer on each ear. Subjects adjusted the spot of a computer-controlled laser-pointer to the perceived direction of sound incidence in the frontal horizontal plane by rotating a trackball. Two subjects of the bimodal group who had substantial residual hearing showed localization ability in the bimodal configuration, whereas using each single device only the subject with better residual hearing was able to discriminate the side of sound origin. Five other subjects with more pronounced hearing loss displayed an ability for side discrimination through the use of bimodal aids, while four of them were already able to discriminate the side with a single device. Of the bilateral cochlear implant group one subject showed localization accuracy close to that of normal hearing subjects. This subject was also able to discriminate the side of sound origin using the first implanted device alone. The other three bilaterally equipped subjects showed limited localization ability using both devices. Among them one subject demonstrated a side-discrimination ability using only the first implanted device.

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Patients suffering from severe to profound hearing loss or even deafness can achieve a hearing improvement with a cochlear implant (CI) treatment that is significantly higher than the results achieved with conventional hearing aids. The CI system consists of an implantable stimulator, which is inserted retro-auricularly into the mastoid, and an externally worn processor unit, which provides the pickup of sound and processing of acoustic information as well as the power supply for the stimulator and internal current sources. The stimulator has an electrode array that is inserted into the cochlea. This is a descriptive overview of MED-EL's multichannel CI system (MED-EL, Innsbruck, Austria), which was introduced to the European market in 1994. The continuing development of the implant as well as the external components is outlined and various other aspects (stimulation strategy, adaptation, results, reliability) are discussed. The strength of the company is the continuous pursuit of innovative ideas. This is evidenced by numerous innovations. The reliability of the implants has been continuously improved. The current SYNCHRONY models of the manufacturer show no indication of technically caused failures over an observation period of 5 years. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies investigating speech perception in noise have typically been conducted with static masker positions. The aim of this study was to investigate the effect of spatial separation of source and masker (spatial release from masking, SRM) in a moving masker setup and to evaluate the impact of adaptive beamforming in comparison with fixed directional microphones in cochlear implant (CI) users. Design: Speech reception thresholds (SRT) were measured in S0N0 and in a moving masker setup (S0Nmove) in 12 normal hearing participants and 14 CI users (7 subjects bilateral, 7 bimodal with a hearing aid in the contralateral ear). Speech processor settings were a moderately directional microphone, a fixed beamformer, or an adaptive beamformer. The moving noise source was generated by means of wave field synthesis and was smoothly moved in a shape of a half-circle from one ear to the contralateral ear. Noise was presented in either of two conditions: continuous or modulated. Results: SRTs in the S0Nmove setup were significantly improved compared to the S0N0 setup for both the normal hearing control group and the bilateral group in continuous noise, and for the control group in modulated noise. There was no effect of subject group. A significant effect of directional sensitivity was found in the S0Nmove setup. In the bilateral group, the adaptive beamformer achieved lower SRTs than the fixed beamformer setting. Adaptive beamforming improved SRT in both CI user groups substantially by about 3 dB (bimodal group) and 8 dB (bilateral group) depending on masker type. Conclusions: CI users showed SRM that was comparable to normal hearing subjects. In listening situations of everyday life with spatial separation of source and masker, directional microphones significantly improved speech perception with individual improvements of up to 15 dB SNR. Users of bilateral speech processors with both directional microphones obtained the highest benefit. [ABSTRACT FROM AUTHOR]

Electric-acoustic stimulation (EAS) was developed for individuals with a profound hearing loss in the high frequencies and a substantial residual low-frequency hearing (LFH). For this group of candidates, conventional hearing aids often neither provided sufficient amplification nor were they considered suitable for cochlear implantation due to the possible destruction of residual hearing capabilities. With EAS, combining electric stimulation with an ipsilateral acoustic stimulation, preservation of residual LFH and the development of a new speech processor uniting both strategies became essential. Over the last years, EAS has developed further and advanced in electrode design and surgery techniques. This paper summarizes the history of EAS and acknowledges the tremendous work of the many research groups who contributed to the success of EAS. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Electrical auditory brainstem responses (E-ABRs) of subjects with cochlear implants are used for monitoring the physiologic responses of early signal processing of the auditory system. Additionally, E-ABR measurements allow the diagnosis of retro-cochlear diseases. Therefore, E-ABR should be available in every cochlear implant center as a diagnostic tool. In this paper, we introduce a low-cost setup designed to perform an E-ABR as well as a conventional ABR for research purposes. The distributable form was developed with Matlab and the Matlab Compiler (The Mathworks Inc.). For the ABR, only a PC with a soundcard, conventional system headphones, and an EEG pre-amplifier are necessary; for E-ABR, in addition, an interface to the cochlea implant is required. For our purposes, we implemented an interface for the Combi 40+/Pulsar implant (MED-EL, Innsbruck). [Copyright &y& Elsevier]