Objective To assess improvements in sound source localization and speech understanding in complex listening environments following unilateral cochlear implantation for single-sided deafness (SSD). Study Design Non-randomized, open, prospective case series Setting Tertiary referral center Patients Nine subjects with a unilateral cochlear implant (CI) for SSD (SSD-CI) were tested. Reference groups for the task of sound source localization included young (n=45) and older (n=12) normal hearing (NH) subjects and 27 bilateral CI (BCI) subjects. Intervention Unilateral cochlear implantation Main outcome measures Sound source localization was tested with 13 loudspeakers in a 180 arc in front of the subject. Speech understanding was tested with the subject seated in an 8-loudspeaker sound system arrayed in a 360-degree pattern. Directionally appropriate noise, originally recorded in a restaurant, was played from each loudspeaker. Speech understanding in noise was tested using the Azbio sentence test and sound source localization quantified using root mean square error. Results All CI subjects showed poorer-than-normal sound source localization. SSD-CI subjects showed a bimodal distribution of scores - six subjects had scores near the mean of those obtained by BCI subjects, while three had scores just outside the 95th percentile of NH listeners. Speech understanding improved significantly in the restaurant environment when the signal was presented to the side of the CI. Conclusions Cochlear implantation for SSD can offer improved speech understanding in complex listening environments and improved sound source localization in both children and adults. On tasks of sound source localization, SSD-CI patients typically perform as well as BCI patients and, in some cases, achieve scores at the upper boundary of normal performance.

Bilateral implantation can offer CI listeners the ability to track dynamic auditory spatial difference cues and compare these changes to changes in their own head position, resulting in a reduced rate of front-back confusions. This suggests that, for these patients, estimates of auditory acuity based solely on static laboratory settings may underestimate their real-world localization abilities.

Objective The goal of the present study was to assess the sound quality of a cochlear implant for single-sided deaf (SSD) patients fit with a cochlear implant (CI) Background One of the fundamental, unanswered questions in CI research is “what does an implant sound like?” Conventional CI patients must use the memory of a clean signal, often decades old, to judge the sound quality of their CIs. In contrast, SSD-CI patients can rate the similarity of a clean signal presented to the CI ear and candidate, CI-like signals presented to the ear with normal hearing. Methods For Experiment 1 four types of stimuli were created for presentation to the normal hearing ear: Noise vocoded signals, sine vocoded signals, frequency shifted, sine vocoded signals and band-pass filtered, natural speech signals. Listeners rated the similarity of these signals to unmodified signals sent to the CI on a scale of 0 to 10 with 10 being a complete match to the CI signal. For Experiment 2 multitrack signal mixing was used to create natural speech signals that varied along multiple dimensions. Results In Experiment 1 for eight adult SSD-CI listeners, the best median similarity rating to the sound of the CI for noise vocoded signals was 1.9; for sine vocoded signals 2.9; for frequency upshifted signals, 1.9 and for band pass filtered signals, 5.5. In Experiment 2 for three young listeners, combinations of band pass filtering and spectral smearing lead to ratings of 10. Conclusion The sound quality of noise and sine vocoders does not generally correspond to the sound quality of cochlear implants fit to SSD patients. Our preliminary conclusion is that natural speech signals that have been muffled to one degree or another by band pass filtering and/or spectral smearing provide a close, but incomplete, match to CI sound quality for some patients.

Our data are consistent with the view that V information improves CI users' ability to identify syllables in the acoustic stream and to recognize their relative juxtaposed strengths. Enhanced syllable resolution allows better identification of word onsets, which, when combined with place-of-articulation information from visible consonants, improves lexical access.

The data support the use of the natural microphone setting as a default setting. The natural setting (1) provides better speech understanding in noise than the omni setting, (2) does not impair sound source localization, and (3) retains low-frequency sensitivity to signals from the rear. Moreover, bilateral CIs equipped with adaptive beamforming technology can engender speech understanding scores in noise that fall only a little short of scores for a single CI in quiet.