The Use of Frequency Compression by Cochlear Implant Recipients with Postoperative Acoustic Hearing

2010 ◽  
Vol 21 (06) ◽  
pp. 380-389 ◽  
Author(s):  
Hugh McDermott ◽  
Katherine Henshall
Keyword(s):  
Speech Perception ◽  
Cochlear Implant ◽  
Hearing Aids ◽  
Repeated Measures ◽  
Signal To Noise Ratio ◽  
Speech Understanding ◽  
Closed Set ◽  
Frequency Compression ◽  
Acoustic Hearing ◽  
Perceptual Performance

Background: The number of cochlear implant (CI) recipients who have usable acoustic hearing in at least one ear is continuing to grow. Many such CI users gain perceptual benefits from the simultaneous use of acoustic and electric hearing. In particular, it has been shown previously that use of an acoustic hearing aid (HA) with a CI can often improve speech understanding in noise. Purpose: To determine whether the application of frequency compression in an HA would provide perceptual benefits to CI recipients with usable acoustic hearing, either when used in combination with the CI or when the HA was used by itself. Research Design: A repeated-measures experimental design was used to evaluate the effects on speech perception of using a CI either alone or simultaneously with an HA that had frequency compression either enabled or disabled. Study Sample: Eight adult CI recipients who were successful users of acoustic hearing aids in their nonimplanted ears participated as subjects. Intervention: The speech perception of each subject was assessed in seven conditions. These required each subject to listen with (1) their own HA alone; (2) the Phonak Naida HA with frequency compression (SoundRecover) enabled; (3) the Naida with SoundRecover disabled; (4) their CI alone; (5) their CI and their own HA; (6) their CI and the Naida with SoundRecover enabled; and (7) their CI and the Naida with SoundRecover disabled. Test sessions were scheduled over a period of about 10 wk. During part of that time, the subjects were asked to use the Phonak Naida HA with their CIs in place of their own HAs. Data Collection and Analysis: The speech perception tests included measures of consonant identification from a closed set of 12 items presented in quiet, and measures of sentence understanding in babble noise. The speech materials were presented at an average level of 60 dB SPL from a loudspeaker. Results: Speech perception was better, on average, in all conditions that included use of the CI in comparison with any condition in which only an HA was used. For example, consonant recognition improved by approximately 50 percentage points, on average, between the HA-alone listening conditions and the CI-alone condition. There were no statistically significant score differences between conditions with SoundRecover enabled and disabled. There was a small but significant improvement in the average signal-to-noise ratio (SNR) required to understand 50% of the words in the sentences presented in noise when an HA was used simultaneously with the CI. Conclusions: Although each of these CI users readily accepted the Phonak Naida HA with SoundRecover frequency compression, no benefits related specifically to the use of SoundRecover were found in the particular tests of speech understanding applied in this study. The relatively high levels of perceptual performance attained by these subjects with use of a CI by itself are consistent with the finding that the addition of an HA provided little further benefit. However, the use of an HA with the CI did provide better performance than the CI alone for understanding sentences in noise.

Improving Speech Perception in Noise for Children with Cochlear Implants

2011 ◽  
Vol 22 (09) ◽  
pp. 623-632 ◽  
Author(s):  
René H. Gifford ◽  
Amy P. Olund ◽  
Melissa DeJong
Keyword(s):  
Speech Recognition ◽  
Speech Perception ◽  
Cochlear Implant ◽  
Cochlear Implants ◽  
Repeated Measures ◽  
Background Noise ◽  
Normal Hearing ◽  
Speech Understanding ◽  
The Mean ◽  
Experimental Subjects

Background: Current cochlear implant recipients are achieving increasingly higher levels of speech recognition; however, the presence of background noise continues to significantly degrade speech understanding for even the best performers. Newer generation Nucleus cochlear implant sound processors can be programmed with SmartSound strategies that have been shown to improve speech understanding in noise for adult cochlear implant recipients. The applicability of these strategies for use in children, however, is not fully understood nor widely accepted. Purpose: To assess speech perception for pediatric cochlear implant recipients in the presence of a realistic restaurant simulation generated by an eight-loudspeaker (R-SPACE™) array in order to determine whether Nucleus sound processor SmartSound strategies yield improved sentence recognition in noise for children who learn language through the implant. Research Design: Single subject, repeated measures design. Study Sample: Twenty-two experimental subjects with cochlear implants (mean age 11.1 yr) and 25 control subjects with normal hearing (mean age 9.6 yr) participated in this prospective study. Intervention: Speech reception thresholds (SRT) in semidiffuse restaurant noise originating from an eight-loudspeaker array were assessed with the experimental subjects’ everyday program incorporating Adaptive Dynamic Range Optimization (ADRO) as well as with the addition of Autosensitivity control (ASC). Data Collection and Analysis: Adaptive SRTs with the Hearing In Noise Test (HINT) sentences were obtained for all 22 experimental subjects, and performance—in percent correct—was assessed in a fixed +6 dB SNR (signal-to-noise ratio) for a six-subject subset. Statistical analysis using a repeated-measures analysis of variance (ANOVA) evaluated the effects of the SmartSound setting on the SRT in noise. Results: The primary findings mirrored those reported previously with adult cochlear implant recipients in that the addition of ASC to ADRO significantly improved speech recognition in noise for pediatric cochlear implant recipients. The mean degree of improvement in the SRT with the addition of ASC to ADRO was 3.5 dB for a mean SRT of 10.9 dB SNR. Thus, despite the fact that these children have acquired auditory/oral speech and language through the use of their cochlear implant(s) equipped with ADRO, the addition of ASC significantly improved their ability to recognize speech in high levels of diffuse background noise. The mean SRT for the control subjects with normal hearing was 0.0 dB SNR. Given that the mean SRT for the experimental group was 10.9 dB SNR, despite the improvements in performance observed with the addition of ASC, cochlear implants still do not completely overcome the speech perception deficit encountered in noisy environments accompanying the diagnosis of severe-to-profound hearing loss. Conclusion: SmartSound strategies currently available in latest generation Nucleus cochlear implant sound processors are able to significantly improve speech understanding in a realistic, semidiffuse noise for pediatric cochlear implant recipients. Despite the reluctance of pediatric audiologists to utilize SmartSound settings for regular use, the results of the current study support the addition of ASC to ADRO for everyday listening environments to improve speech perception in a child's typical everyday program.

Effect of Microphone Location and Beamforming Technology on Speech Recognition in Pediatric Cochlear Implant Recipients

2020 ◽  
Author(s):  
Jourdan T. Holder ◽  
Adrian L. Taylor ◽  
Linsey W. Sunderhaus ◽  
Rene H. Gifford
Keyword(s):  
Speech Recognition ◽  
Cochlear Implant ◽  
Repeated Measures ◽  
Background Noise ◽  
Signal To Noise Ratio ◽  
Speech Understanding ◽  
Older Children ◽  
Space System ◽  
Directional Microphone ◽  
Basic English

Background: Despite improvements in cochlear implant (CI) technology, pediatric CI recipients continueto have more difficulty understanding speech than their typically hearing peers in background noise. Avariety of strategies have been evaluated to help mitigate this disparity, such as signal processing, remotemicrophone technology, and microphone placement. Previous studies regarding microphoneplacement used speech processors that are now dated, and most studies investigating the improvementof speech recognition in background noise included adult listeners only.Purpose: The purpose of the present study was to investigate the effects of microphone location andbeamforming technology on speech understanding for pediatric CI recipients in noise.Research Design: A prospective, repeated-measures, within-participant design was used to compareperformance across listening conditions.Study Sample: A total of nine children (aged 6.6 to 15.3 years) with at least one Advanced Bionics CIwere recruited for this study.Data Collection and Analysis: The Basic English Lexicon Sentences and AzBio Sentences were presentedat 0° azimuth at 65-dB SPL in +5 signal-to-noise ratio noise presented from seven speakers usingthe R-SPACE system (Advanced Bionics, Valencia, CA). Performance was compared across three omnidirectionalmicrophone configurations (processor microphone, T-Mic 2, and processor + T-Mic 2) andtwo directional microphone configurations (UltraZoom and auto UltraZoom). The two youngest participantswere not tested in the directional microphone configurations.Results: No significant differences were found between the various omnidirectional microphone configurations.UltraZoom provided significant benefit over all omnidirectional microphone configurations(T-Mic 2, p = 0.004, processor microphone, p < 0.001, and processor microphone + T-Mic 2, p = 0.018)but was not significantly different from auto UltraZoom (p = 0.176).Conclusions: All omnidirectional microphone configurations yielded similar performance, suggesting thata child’s listening performance in noise will not be compromised by choosing the microphone configurationbest suited for the child. UltraZoom (adaptive beamformer) yielded higher performance than all omnidirectional microphonesin moderate background noise for adolescents aged 9 to 15 years. The implicationsof these data suggest that for older children who are able to reliably use manual controls, UltraZoom willyield significantly higher performance in background noise when the target is in front of the listener.

The Contribution of a Frequency-Compression Hearing Aid to Contralateral Cochlear Implant Performance

2013 ◽  
Vol 24 (02) ◽  
pp. 105-120 ◽  
Author(s):  
Ann E. Perreau ◽  
Ruth A. Bentler ◽  
Richard S. Tyler
Keyword(s):  
Speech Perception ◽  
Cochlear Implant ◽  
Hearing Aids ◽  
Speech Intelligibility ◽  
Hearing Aid ◽  
Self Report ◽  
Vowel Perception ◽  
Frequency Compression ◽  
Significant Difference ◽  
The Impact

Background: Frequency-lowering signal processing in hearing aids has re-emerged as an option to improve audibility of the high frequencies by expanding the input bandwidth. Few studies have investigated the usefulness of the scheme as an option for bimodal users (i.e., combined use of a cochlear implant and a contralateral hearing aid). In this study, that question was posed. Purpose: The purposes of this study were (1) to determine if frequency compression was a better bimodal option than conventional amplification and (2) to determine the impact of a frequency-compression hearing aid on speech recognition abilities. Research Design: There were two separate experiments in this study. The first experiment investigated the contribution of a frequency-compression hearing aid to contralateral cochlear implant (CI) performance for localization and speech perception in noise. The second experiment assessed monaural consonant and vowel perception in quiet using the frequency-compression and conventional hearing aid without the use of a contralateral CI or hearing aid. Study Sample: Ten subjects fitted with a cochlear implant and hearing aid participated in the first experiment. Seventeen adult subjects with a cochlear implant and hearing aid or two hearing aids participated in the second experiment. To be included, subjects had to have a history of postlingual deafness, a moderate or moderate-to-severe hearing loss, and have not worn this type of frequency-lowering hearing aid previously. Data Collection and Analysis: In the first experiment, performance using the frequency-compression and conventional hearing aids was assessed on tests of sound localization, speech perception in a background of noise, and two self-report questionnaires. In the second experiment, consonant and vowel perception in quiet was assessed monaurally for the two conditions. In both experiments, subjects alternated daily between a frequency-compression and conventional hearing aid for 2 mo. The parameters of frequency compression were set individually for each subject, and audibility was measured for the frequency compression and conventional hearing aid programs by comparing estimations of the Speech Intelligibility Index (SII) using a modified algorithm (Bentler et al, 2011). In both experiments, the outcome measures were administered following the hearing aid fitting to assess performance at baseline and after 2 mo of use. Results: For this group of subjects, the results revealed no significant difference between the frequency-compression and conventional hearing aid on tests of localization and consonant recognition. Spondee-in-noise and vowel perception scores were significantly higher with the conventional hearing aid compared to the frequency-compression hearing aid after 2 mo of use. Conclusions: These results suggest that, for the subjects in this study, frequency compression is not a better bimodal option than conventional amplification. In addition, speech perception may be negatively influenced by frequency compression because formant frequencies are too severely compressed and can no longer be distinguished.

scholarly journals Bone-anchored hearing system, contralateral routing of signals hearing aid or cochlear implant: what is best in single-sided deafness?

2021 ◽  
Author(s):  
Till F. Jakob ◽  
Iva Speck ◽  
Ann-Kathrin Rauch ◽  
Frederike Hassepass ◽  
Manuel C. Ketterer ◽  
...  
Keyword(s):  
Speech Perception ◽  
Cochlear Implant ◽  
Hearing Aids ◽  
Long Term Results ◽  
Speech Perception In Noise ◽  
Sound Localisation ◽  
Therapy Option ◽  
Single Sided Deafness ◽  
Objective Hearing Tests

Abstract Purpose The aim of the study was to compare long-term results after 1 year in patients with single-sided deafness (SSD) who were fitted with different hearing aids. The participants tested contralateral routing of signals (CROS) hearing aids and bone-anchored hearing systems (BAHS). They were also informed about the possibility of a cochlear implant (CI) and chose one of the three devices. We also investigated which factors influenced the choice of device. Methods Prospective study with 89 SSD participants who were divided into three groups by choosing BAHS, CROS, or CI. All participants received test batteries with both objective hearing tests (speech perception in noise and sound localisation) and subjective questionnaires. Results 16 participants opted for BAHS-, 13 for CROS- and 30 for CI-treatment. The greater the subjective impairment caused by SSD, the more likely patients were to opt for surgical treatment (BAHS or CI). The best results in terms of speech perception in noise (especially when sound reaches the deaf ear and noise the hearing ear), sound localization, and subjective results were achieved with CI. Conclusion The best results regarding the therapy of SSD are achieved with a CI, followed by BAHS. This was evident both in objective tests and in the subjective questionnaires. Nevertheless, an individual decision is required in each case as to which SSD therapy option is best for the patient. Above all, the patient's subjective impairment and expectations should be included in the decision-making process.

A Role for Acoustic Stimulation in Advanced Otosclerosis: Direct Acoustic Cochlear Implant versus Cochlear Implant

2018 ◽  
Vol 23 (2) ◽  
pp. 89-97
Author(s):  
Nicolas Verhaert ◽  
Charlotte Borgers ◽  
Katleen De Voecht ◽  
Ellen Boon ◽  
Christian Desloovere
Keyword(s):  
Speech Perception ◽  
Cochlear Implant ◽  
Hearing Aids ◽  
Standard Treatment ◽  
Acoustic Stimulation ◽  
Grading System ◽  
Effective Treatment Option ◽  
Computed Tomographic ◽  
Direct Acoustic Cochlear Implant ◽  
Acoustic Component

Recent findings support the efficacy of the direct acoustic cochlear implant (DACI) in patients with advanced otosclerosis whose rehabilitation is very challenging. Standard treatment consists of stapes surgery combined with hearing aids or a cochlear implant (CI). CI surgery, however, is often challenging depending on the grade of otosclerosis. This study aims to compare speech perception scores in quiet and noise of 6 DACI and 12 CI patients with advanced otosclerosis at 3 and 12 months after fitting. Preoperative computed tomographic scans of all patients were scored by experts using an existing otosclerosis grading system (stages 1–3). Speech perception in quiet was significantly better for DACI compared to CI users at 3 months after fitting. At 12 months, no difference was found between DACI and CI patients. Speech perception scores in noise were significantly better in the DACI group. In summary, a DACI system seems to provide an effective treatment option as the acoustic component can be preserved in patients with advanced otosclerosis.

Improving Hearing Performance for Cochlear Implant Recipients with Use of a Digital, Wireless, Remote-Microphone, Audio-Streaming Accessory

2015 ◽  
Vol 26 (06) ◽  
pp. 532-539 ◽  
Author(s):  
Jace Wolfe ◽  
Mila Morais ◽  
Erin Schafer
Keyword(s):  
Speech Recognition ◽  
Cochlear Implant ◽  
Repeated Measures ◽  
Signal To Noise Ratio ◽  
Effective Means ◽  
Audio Signals ◽  
Noise Levels ◽  
Repeated Measures Design ◽  
Accessory Device ◽  
Sound Processor

Background: Cochlear implant (CI) recipients experience difficulty understanding speech in noise. Remote-microphone technology that improves the signal-to-noise ratio is recognized as an effective means to improve speech recognition in noise; however, there are no published studies evaluating the potential benefits of a wireless, remote-microphone, digital, audio-streaming accessory device (heretofore referred to as a remote-microphone accessory) designed to deliver audio signals directly to a CI sound processor. Purpose: The objective of this study was to compare speech recognition in quiet and in noise of recipients while using their CI alone and with a remote-microphone accessory. Research Design: A two-way repeated measures design was used to evaluate performance differences obtained in quiet and in increasing levels of competing noise with the CI sound processor alone and with the sound processor paired to the remote microphone accessory. Study Sample: Sixteen users of Cochlear Nucleus 24 Freedom, CI512, and CI422 implants were included in the study. Data Collection and Analysis: Participants were evaluated in 14 conditions including use of the sound processor alone and with the remote-microphone accessory in quiet and at the following signal levels: 65 dBA speech (at the location of the participant; 85 dBA at the location of the remote microphone) in quiet and competing noise at 50, 55, 60, 65, 70, and 75 dBA noise levels. Speech recognition was evaluated in each of these conditions with one full list of AzBio sentences. Results: Speech recognition in quiet and in all competing noise levels, except the 75 dBA condition, was significantly better with use of the remote-microphone accessory compared with participants’ performance with the CI sound processor alone. As expected, in all technology conditions, performance was significantly poorer as the competing noise level increased. Conclusions: Use of a remote-microphone accessory designed for a CI sound processor provides superior speech recognition in quiet and in noise when compared with performance obtained with the CI sound processor alone.

scholarly journals Bimodal Cochlear Implant Listeners’ Ability to Perceive Minimal Audible Angle Differences

2019 ◽  
Vol 30 (08) ◽  
pp. 659-671 ◽  
Author(s):  
Ashley Zaleski-King ◽  
Matthew J. Goupell ◽  
Dragana Barac-Cikoja ◽  
Matthew Bakke
Keyword(s):  
Cochlear Implant ◽  
Sound Localization ◽  
Repeated Measures ◽  
Free Field ◽  
Low Frequency ◽  
Spatial Location ◽  
Speech Understanding ◽  
Repeated Measures Design ◽  
Acoustic Environments ◽  
The Right

AbstractBilateral inputs should ideally improve sound localization and speech understanding in noise. However, for many bimodal listeners [i.e., individuals using a cochlear implant (CI) with a contralateral hearing aid (HA)], such bilateral benefits are at best, inconsistent. The degree to which clinically available HA and CI devices can function together to preserve interaural time and level differences (ITDs and ILDs, respectively) enough to support the localization of sound sources is a question with important ramifications for speech understanding in complex acoustic environments.To determine if bimodal listeners are sensitive to changes in spatial location in a minimum audible angle (MAA) task.Repeated-measures design.Seven adult bimodal CI users (28–62 years). All listeners reported regular use of digital HA technology in the nonimplanted ear.Seven bimodal listeners were asked to balance the loudness of prerecorded single syllable utterances. The loudness-balanced stimuli were then presented via direct audio inputs of the two devices with an ITD applied. The task of the listener was to determine the perceived difference in processing delay (the interdevice delay [IDD]) between the CI and HA devices. Finally, virtual free-field MAA performance was measured for different spatial locations both with and without inclusion of the IDD correction, which was added with the intent to perceptually synchronize the devices.During the loudness-balancing task, all listeners required increased acoustic input to the HA relative to the CI most comfortable level to achieve equal interaural loudness. During the ITD task, three listeners could perceive changes in intracranial position by distinguishing sounds coming from the left or from the right hemifield; when the CI was delayed by 0.73, 0.67, or 1.7 msec, the signal lateralized from one side to the other. When MAA localization performance was assessed, only three of the seven listeners consistently achieved above-chance performance, even when an IDD correction was included. It is not clear whether the listeners who were able to consistently complete the MAA task did so via binaural comparison or by extracting monaural loudness cues. Four listeners could not perform the MAA task, even though they could have used a monaural loudness cue strategy.These data suggest that sound localization is extremely difficult for most bimodal listeners. This difficulty does not seem to be caused by large loudness imbalances and IDDs. Sound localization is best when performed via a binaural comparison, where frequency-matched inputs convey ITD and ILD information. Although low-frequency acoustic amplification with a HA when combined with a CI may produce an overlapping region of frequency-matched inputs and thus provide an opportunity for binaural comparisons for some bimodal listeners, our study showed that this may not be beneficial or useful for spatial location discrimination tasks. The inability of our listeners to use monaural-level cues to perform the MAA task highlights the difficulty of using a HA and CI together to glean information on the direction of a sound source.

Speech perception for cochlear implant patients using hearing aids on the unimplanted ear

2004 ◽  
Vol 1273 ◽  
pp. 223-226
Author(s):  
Jane R. Madell ◽  
Nicole Sislian ◽  
Ronald Hoffman
Keyword(s):  
Speech Perception ◽  
Cochlear Implant ◽  
Hearing Aids

scholarly journals Sentence Recognition in Noise and Perceived Benefit of Noise Reduction on the Receiver and Transmitter Sides of a BICROS Hearing Aid

2013 ◽  
Vol 24 (10) ◽  
pp. 980-991 ◽  
Author(s):  
Kristi Oeding ◽  
Michael Valente
Keyword(s):  
Noise Reduction ◽  
Hearing Aids ◽  
Repeated Measures ◽  
Background Noise ◽  
Signal To Noise Ratio ◽  
Hearing Aid ◽  
Directional Microphones ◽  
Sentence Recognition ◽  
Clinically Significant ◽  
The Impact

Background: In the past, bilateral contralateral routing of signals (BICROS) amplification incorporated omnidirectional microphones on the transmitter and receiver sides and some models utilized noise reduction (NR) on the receiver side. Little research has examined the performance of BICROS amplification in background noise. However, previous studies examining contralateral routing of signals (CROS) amplification have reported that the presence of background noise on the transmitter side negatively affected speech recognition. Recently, NR was introduced as a feature on the receiver and transmitter sides of BICROS amplification, which has the potential to decrease the impact of noise on the wanted speech signal by decreasing unwanted noise directed to the transmitter side. Purpose: The primary goal of this study was to examine differences in the reception threshold for sentences (RTS in dB) using the Hearing in Noise Test (HINT) in a diffuse listening environment between unaided and three aided BICROS conditions (no NR, mild NR, and maximum NR) in the Tandem 16 BICROS. A secondary goal was to examine real-world subjective impressions of the Tandem 16 BICROS compared to unaided. Research Design: A randomized block repeated measures single blind design was used to assess differences between no NR, mild NR, and maximum NR listening conditions. Study Sample: Twenty-one adult participants with asymmetric sensorineural hearing loss (ASNHL) and experience with BICROS amplification were recruited from Washington University in St. Louis School of Medicine. Data Collection and Analysis: Participants were fit with the National Acoustic Laboratories’ Nonlinear version 1 prescriptive target (NAL-NL1) with the Tandem 16 BICROS at the initial visit and then verified using real-ear insertion gain (REIG) measures. Participants acclimatized to the Tandem 16 BICROS for 4 wk before returning for final testing. Participants were tested utilizing HINT sentences examining differences in RTS between unaided and three aided listening conditions. Subjective benefit was determined via the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire between the Tandem 16 BICROS and unaided. A repeated measures analysis of variance (ANOVA) was utilized to analyze the results of the HINT and APHAB. Results: Results revealed no significant differences in the RTS between unaided, no NR, mild NR, and maximum NR. Subjective impressions using the APHAB revealed statistically and clinically significant benefit with the Tandem 16 BICROS compared to unaided for the Ease of Communication (EC), Background Noise (BN), and Reverberation (RV) subscales. Conclusions: The RTS was not significantly different between unaided, no NR, mild NR, and maximum NR. None of the three aided listening conditions were significantly different from unaided performance as has been reported for previous studies examining CROS hearing aids. Further, based on comments from participants and previous research studies with conventional hearing aids, manufacturers of BICROS amplification should consider incorporating directional microphones and independent volume controls on the receiver and transmitter sides to potentially provide further improvement in signal-to-noise ratio (SNR) for patients with ASNHL.

scholarly journals Speech Perception for Adult Cochlear Implant Recipients in a Realistic Background Noise: Effectiveness of Preprocessing Strategies and External Options for Improving Speech Recognition in Noise

2010 ◽  
Vol 21 (07) ◽  
pp. 441-451 ◽  
Author(s):  
René H. Gifford ◽  
Lawrence J. Revit
Keyword(s):  
Speech Recognition ◽  
Speech Perception ◽  
Cochlear Implant ◽  
Repeated Measures ◽  
Recognition Performance ◽  
Single Subject ◽  
Repeated Measures Design ◽  
Listening Environments ◽  
Improved Performance ◽  
Listening In Noise

Background: Although cochlear implant patients are achieving increasingly higher levels of performance, speech perception in noise continues to be problematic. The newest generations of implant speech processors are equipped with preprocessing and/or external accessories that are purported to improve listening in noise. Most speech perception measures in the clinical setting, however, do not provide a close approximation to real-world listening environments. Purpose: To assess speech perception for adult cochlear implant recipients in the presence of a realistic restaurant simulation generated by an eight-loudspeaker (R-SPACE™) array in order to determine whether commercially available preprocessing strategies and/or external accessories yield improved sentence recognition in noise. Research Design: Single-subject, repeated-measures design with two groups of participants: Advanced Bionics and Cochlear Corporation recipients. Study Sample: Thirty-four subjects, ranging in age from 18 to 90 yr (mean 54.5 yr), participated in this prospective study. Fourteen subjects were Advanced Bionics recipients, and 20 subjects were Cochlear Corporation recipients. Intervention: Speech reception thresholds (SRTs) in semidiffuse restaurant noise originating from an eight-loudspeaker array were assessed with the subjects' preferred listening programs as well as with the addition of either Beam™ preprocessing (Cochlear Corporation) or the T-Mic® accessory option (Advanced Bionics). Data Collection and Analysis: In Experiment 1, adaptive SRTs with the Hearing in Noise Test sentences were obtained for all 34 subjects. For Cochlear Corporation recipients, SRTs were obtained with their preferred everyday listening program as well as with the addition of Focus preprocessing. For Advanced Bionics recipients, SRTs were obtained with the integrated behind-the-ear (BTE) mic as well as with the T-Mic. Statistical analysis using a repeated-measures analysis of variance (ANOVA) evaluated the effects of the preprocessing strategy or external accessory in reducing the SRT in noise. In addition, a standard t-test was run to evaluate effectiveness across manufacturer for improving the SRT in noise. In Experiment 2, 16 of the 20 Cochlear Corporation subjects were reassessed obtaining an SRT in noise using the manufacturer-suggested “Everyday,” “Noise,” and “Focus” preprocessing strategies. A repeated-measures ANOVA was employed to assess the effects of preprocessing. Results: The primary findings were (i) both Noise and Focus preprocessing strategies (Cochlear Corporation) significantly improved the SRT in noise as compared to Everyday preprocessing, (ii) the T-Mic accessory option (Advanced Bionics) significantly improved the SRT as compared to the BTE mic, and (iii) Focus preprocessing and the T-Mic resulted in similar degrees of improvement that were not found to be significantly different from one another. Conclusion: Options available in current cochlear implant sound processors are able to significantly improve speech understanding in a realistic, semidiffuse noise with both Cochlear Corporation and Advanced Bionics systems. For Cochlear Corporation recipients, Focus preprocessing yields the best speech-recognition performance in a complex listening environment; however, it is recommended that Noise preprocessing be used as the new default for everyday listening environments to avoid the need for switching programs throughout the day. For Advanced Bionics recipients, the T-Mic offers significantly improved performance in noise and is recommended for everyday use in all listening environments.

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