Does Bilateral Experience Lead to Improved Spatial Unmasking of Speech in Children Who Use Bilateral Cochlear Implants?

Litovsky, Ruth Y.; Misurelli, Sara M.

doi:10.1097/mao.0000000000000905

Cited by 8 publications

(2 citation statements)

References 33 publications

(51 reference statements)

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“…Whether later implantation of a congenital, unilaterally deaf ear is as viable as early implantation of that ear is unknown at this time. Bilaterally implanted children and adults with delayed second-ear implantation have reduced binaural benefits due to extended periods of unilateral hearing (Gordon et al 2013; Litovsky and Gordon 2016; Litovsky and Misurelli 2016; Ramsden et al 2005; Reeder et al 2016; Reeder et al 2014). Collectively, these studies suggest potential compromises to binaural benefits of cochlear implantation for individuals with prolonged unilateral deafness.…”

Section: Discussionmentioning

confidence: 99%

Unilateral Hearing Loss: Understanding Speech Recognition and Localization Variability—Implications for Cochlear Implant Candidacy

2017

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Objectives At a minimum, unilateral hearing loss (UHL) impairs sound localization ability and understanding speech in noisy environments, particularly if the loss is severe to profound. Accompanying the numerous negative consequences of UHL is considerable unexplained individual variability in the magnitude of its effects. Identification of co-variables that affect outcome and contribute to variability in UHLs could augment counseling, treatment options, and rehabilitation. Cochlear implantation as a treatment for UHL is on the rise yet little is known about factors that could impact performance or whether there is a group at risk for poor cochlear implant outcomes when hearing is near-normal in one ear. The overall goal of our research is to investigate the range and source of variability in speech recognition in noise and localization among individuals with severe to profound UHL and thereby help determine factors relevant to decisions regarding cochlear implantation in this population. Design The present study evaluated adults with severe to profound UHL and adults with bilateral normal hearing. Measures included adaptive sentence understanding in diffuse restaurant noise, localization, roving-source speech recognition (words from 1 of 15 speakers in a 140° arc) and an adaptive speech-reception threshold psychoacoustic task with varied noise types and noise-source locations. There were three age-gender-matched groups: UHL (severe to profound hearing loss in one ear and normal hearing in the contralateral ear), normal hearing listening bilaterally, and normal hearing listening unilaterally. Results Although the normal-hearing-bilateral group scored significantly better and had less performance variability than UHLs on all measures, some UHL participants scored within the range of the normal-hearing-bilateral group on all measures. The normal-hearing participants listening unilaterally had better monosyllabic word understanding than UHLs for words presented on the blocked/deaf side but not the open/hearing side. In contrast, UHLs localized better than the normal hearing unilateral listeners for stimuli on the open/hearing side but not the blocked/deaf side. This suggests that UHLs had learned strategies for improved localization on the side of the intact ear. The UHL and unilateral normal hearing participant groups were not significantly different for speech-in-noise measures. UHL participants with childhood rather than recent hearing loss onset localized significantly better; however, these two groups did not differ for speech recognition in noise. Age at onset in UHL adults appears to affect localization ability differently than understanding speech in noise. Hearing thresholds were significantly correlated with speech recognition for UHL participants but not the other two groups. Conclusions Auditory abilities of UHLs varied widely and could be explained only in part by hearing threshold levels. Age at onset and length of hearing loss influenced performance on some, but not all measures. Results suppo...

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Section: Discussionmentioning

confidence: 99%

Unilateral Hearing Loss: Understanding Speech Recognition and Localization Variability—Implications for Cochlear Implant Candidacy

2017

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“…For example, adult listeners who were simultaneously implanted demonstrated significant differences in performance between ears that emerged only after 1 year of experience ( Mosnier et al, 2009 ). Children with BiCIs tend to have the best outcomes over time when they are implanted shortly after onset of deafness, improving over time for sound source localization or lateralization ( Killan et al, 2019 ; Steffens et al, 2008 ; Strøm-Roum et al, 2012 ; Zheng et al, 2015 ) and speech understanding ( Dunn et al, 2014 ), but not spatial release from masking ( Litovsky & Misurelli, 2016 ). These factors are often interrelated in children with BiCIs, so it is difficult to discern exactly how deafness and cochlear implantation interact with the normal developmental trajectory.…”

Section: Top-down Processing: Predictive Codingmentioning

confidence: 99%

Review of Binaural Processing With Asymmetrical Hearing Outcomes in Patients With Bilateral Cochlear Implants

Anderson,

Burg,

Suveg

et al. 2024

Trends in Hearing

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Bilateral cochlear implants (BiCIs) result in several benefits, including improvements in speech understanding in noise and sound source localization. However, the benefit bilateral implants provide among recipients varies considerably across individuals. Here we consider one of the reasons for this variability: difference in hearing function between the two ears, that is, interaural asymmetry. Thus far, investigations of interaural asymmetry have been highly specialized within various research areas. The goal of this review is to integrate these studies in one place, motivating future research in the area of interaural asymmetry. We first consider bottom-up processing, where binaural cues are represented using excitation-inhibition of signals from the left ear and right ear, varying with the location of the sound in space, and represented by the lateral superior olive in the auditory brainstem. We then consider top-down processing via predictive coding, which assumes that perception stems from expectations based on context and prior sensory experience, represented by cascading series of cortical circuits. An internal, perceptual model is maintained and updated in light of incoming sensory input. Together, we hope that this amalgamation of physiological, behavioral, and modeling studies will help bridge gaps in the field of binaural hearing and promote a clearer understanding of the implications of interaural asymmetry for future research on optimal patient interventions.

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Hearing with Cochlear Implants and Hearing Aids in Complex Auditory Scenes

Litovsky

Goupell

Misurelli

et al. 2017

Springer Handbook of Auditory Research

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Does Bilateral Experience Lead to Improved Spatial Unmasking of Speech in Children Who Use Bilateral Cochlear Implants?

Cited by 8 publications

References 33 publications

Unilateral Hearing Loss: Understanding Speech Recognition and Localization Variability—Implications for Cochlear Implant Candidacy

Unilateral Hearing Loss: Understanding Speech Recognition and Localization Variability—Implications for Cochlear Implant Candidacy

Review of Binaural Processing With Asymmetrical Hearing Outcomes in Patients With Bilateral Cochlear Implants

Hearing with Cochlear Implants and Hearing Aids in Complex Auditory Scenes

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