Cochlear Dead Regions in Typical Hearing Aid Candidates: Prevalence and Implications for Use of High-Frequency Speech Cues

Cox, Robyn M.; Alexander, Genevieve C.; Johnson, Jani A.; Rivera, Izel M.

doi:10.1097/aud.0b013e318202e982

Cited by 40 publications

(45 citation statements)

References 33 publications

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“…While the same relationship was observed when NFC was compared to RBW, this relationship was only statistically significant with the removal of one outlier. Our results support the notion that listeners with greater hearing loss in the high frequencies are less able to take advantage of greater bandwidth, potentially due to factors such as dead regions (Mackersie et al, 2004 but see Cox, 2011; Preminger et al, 2005) or less contribution of audibility to speech recognition for listeners with greater hearing loss (Ching et al, 1998, 2001; Hogan & Turner, 1998; Hornsby et al, 2011). However, our data differ from Souza et al (2013) who found that those with greater hearing loss were more likely to show improved speech recognition with NFC.…”

Section: Discussionsupporting

confidence: 84%

Listening Effort and Speech Recognition with Frequency Compression Amplification for Children and Adults with Hearing Loss

et al. 2017

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Background Nonlinear frequency compression (NFC) can improve the audibility of high frequency sounds by lowering them to a frequency where audibility is better; however, this lowering results in spectral distortion. Consequently, performance is a combination of the effects of increased access to high frequency sounds and the detrimental effects of spectral distortion. Previous work has demonstrated positive benefits of NFC on speech recognition when NFC is set to improve audibility while minimizing distortion. However, the extent to which NFC impacts listening effort is not well understood, especially for children with hearing loss. Purpose To examine the impact of NFC on recognition and listening effort for speech in adults and children with hearing loss. Research Design Within-subject, quasi-experimental study. Participants listened to amplified nonsense words that were 1) frequency-lowered using NFC, 2) low-pass filtered at 5 kHz to simulate the restricted bandwidth (RBW) of conventional hearing aid processing, or 3) low-pass filtered at 10 kHz to simulate extended bandwidth (EBW) amplification. Participants were blinded to the type of processing. Participants’ responses to each nonsense word were analyzed for accuracy and verbal response time (listening effort). Study Sample Fourteen children (8–16 years) and 14 adults (19–65 years) with mild-to-severe sensorineural hearing loss. Intervention Participants listened to speech processed by a hearing aid simulator that amplified input signals to fit a prescriptive target fitting procedure. Results Both the children and adults identified the nonsense words and initial consonants better with EBW and NFC than with RBW. The type of processing did not affect the identification of the vowels or final consonants. There was no effect of age for recognition of the nonsense words, initial consonants, medial vowels or final consonants. Verbal response time did not change significantly with the type of processing or age. Conclusion Both the adults and children demonstrated improved speech recognition with access to the high-frequency sounds in speech. Listening effort as measured by verbal response time was not affected by access to high-frequency sounds.

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Section: Discussionsupporting

confidence: 84%

Listening Effort and Speech Recognition with Frequency Compression Amplification for Children and Adults with Hearing Loss

et al. 2017

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“…The gain in music quality with band-limited amplification was much greater, from 4.4 to 8.2. These findings are consistent with results from previous studies (e.g., Yanz 2002; Hornsby & Ricketts, 2006; Hornsby & Ricketts, 2006; Gordo & Lorio 2007; Moore 2009; Cox et al 2011; Hornsby et al, 2011) showing that if sufficient gain is applied to the high-frequency components of speech, those components may mask the lower-frequency components due to downward spread of masking (e.g., Yanz 2002; Hornsby & Ricketts, 2006; Gordo & Lorio 2007; Moore 2009; Cox et al 2011). In this case of bimodal stimulation, this may limit the bimodal benefit.…”

Section: Discussionsupporting

confidence: 92%

“…These listeners typically have a dead region, or regions, in the parts of the non-implanted cochlea responding to medium and high frequencies. Amplification of frequencies inside the dead region(s) sufficient to restore audibility, may cause downward spread of masking, unwanted distortion, and increased acoustic feedback (e.g., Yanz 2002; Hornsby & Ricketts, 2006; Gordo & Lorio 2007; Moore 2009; Cox et al 2011), which may compromise the benefit of combining the amplified, acoustic signal and the electric signal. At issue in this project was the frequency range over which acoustic amplification should be provided to yield the best speech understanding and speech/sound quality for listeners receiving bimodal stimulation.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of dead regions in listeners with moderate-to-profound high-frequency hearing loss is quite high (Ching et al 1998; Hogan & Turner 1998; Vinay & Moore 2007). It has been reported in several studies that the amplification of frequencies well inside a high-frequency dead region usually (1) does not improve speech understanding and may degrade speech understanding due to downward spread of masking; and (2) creates increased feedback and unwanted distortion (e.g., Yanz 2002; Hornsby & Ricketts, 2006; Gordo & Lorio 2007; Moore 2009; Cox et al 2011). …”

Section: Introductionmentioning

confidence: 99%

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Cochlear Dead Regions Constrain the Benefit of Combining Acoustic Stimulation With Electric Stimulation

et al. 2014

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Objective The aims of this study were to (i) detect the presence and edge frequency (fe) of a cochlear dead region in the ear with residual acoustic hearing for bimodal cochlear implant (CI) users, and (ii) determine whether amplification based on the presence or absence of a dead region would improve speech understanding and sound quality. Design Twenty two listeners with a CI in one ear and residual acoustic hearing in the non-implanted ear were tested. Eleven listeners had a cochlear dead region in the acoustic-hearing ear and eleven did not. Dead regions were assessed with the threshold equalizing noise (TEN) and the sweeping noise, psychophysical tuning curve (SWPTC) tests. Speech understanding was assessed with monosyllabic words and the AzBio sentences at +10 dB signal-to-noise ratio. Speech and music quality judgments were obtained with the Judgment of Sound Quality questionnaire. Results For this population, using shifted tips of the PTCs as a basis for diagnosis, the TEN had high sensitivity (0.91) and poor specificity (0.55). The value of fe was lower when estimated with the SWPTC test than with the TEN test. For the listeners with cochlear dead regions, speech understanding, speech quality and music quality were best when no amplification was applied for frequencies within the dead region. For listeners without dead regions, speech understanding was best with full-bandwidth amplification and was reduced when amplification was not applied when the audiometric threshold exceeded 80 dB HL. Conclusion Our data suggest that, to improve bimodal benefit for listeners who combine electric and acoustic stimulation, audiologists should routinely test for the presence of cochlear dead regions and determine amplification bandwidth accordingly.

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“…Using the TEN test the number of subjects with DRs among our screened subjects with HFloss (n=105) was 15 (unilateral DRs) and 33 (bilateral DRs); which is in total 46 % Differences in study design and subjects make a direct comparison with earlier studies difficult, but the prevalence of DRs seems similar to that reported by Preminger et al (2005) and Cox et al (2011).…”

Section: Discussionmentioning

confidence: 83%

Frequency discrimination in ears with and without contralateral cochlear dead regions

Heggdal

Lind

Brännström

2013

International Journal of Audiology

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Objective: The purpose of this study was to test the ability to discriminate low-frequency pure-tone stimuli for ears with and without contralateral dead regions, in subjects with bilateral high-frequency hearing loss; we examined associations between hearing loss characteristics and frequency discrimination of low-frequency stimuli in subjects with highfrequency hearing loss. Design: Cochlear dead regions were diagnosed using the TEN-HL test. A frequency discrimination test utilizing an adaptive three-alternative forced choice method provided difference limens for reference frequencies 0.25 kHz and 0.5 kHz. Study sample: Among 105 subjects with bilateral high-frequency hearing loss, unilateral dead regions were found in 15 subjects. These, and an additional 15 matched control subjects without dead regions, were included in the study. Results: Ears with dead regions performed best at the frequency discrimination test. Ears with a contralateral dead region performed significantly better than ears without a contralateral dead region at 0.5 kHz, the reference frequency closest to the mean audiogram cut-off, while the opposite result was obtained at 0.25 kHz. Conclusions: Results may be seen as sign of a contralateral effect of unilateral dead regions on the discrimination of stimuli with frequencies well below the audiogram cut-off in adult subjects with bilateral high-frequency hearing loss.Heggdal: Contralateral dead regions and frequency discrimination 1

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Cochlear Dead Regions in Typical Hearing Aid Candidates: Prevalence and Implications for Use of High-Frequency Speech Cues

Cited by 40 publications

References 33 publications

Listening Effort and Speech Recognition with Frequency Compression Amplification for Children and Adults with Hearing Loss

Listening Effort and Speech Recognition with Frequency Compression Amplification for Children and Adults with Hearing Loss

Cochlear Dead Regions Constrain the Benefit of Combining Acoustic Stimulation With Electric Stimulation

Frequency discrimination in ears with and without contralateral cochlear dead regions

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