Binaural Hearing and Speech Laboratory. In un

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1 In un

2 Pitch ranking, pitch matching, and binaural fusion in children with bilateral cochlear implants: bringing research into clinical practice Co-authors: Ruth Litovsky, Ph.D. Professor, Depts. of Communication Sciences and Disorders and Surgery/Otolaryngology Director, Binaural Hearing and Speech Lab,, University of Wisconsin-Madison Melanie Buhr-Lawler, Au.D. Audiologist, Clinical Associate Professor Dept. of Communication Sciences and Disorders University of Wisconsin-Madison Shelly P. Godar, M.A., CCC-A Sr. Research Specialist, Lab Manager Erica Ehlers, B.S. Au.D./Ph.D. Graduate Student

3 Background Bilateral hearing binaural hearing Why does binaural hearing matter? Sound localization Hearing in complex listening environments

4 Binaural Hearing and Speech Laboratory Children with bilateral CIs show greater variability and poorer performance on localization and speech in noise tasks Response (degrees) NH1: 8.9º Can lateralize but can t localize Localizes with more error Can t localize or lateralize Target (degrees) Grieco-Calub and Litovsky (2010)

5 Investigating this variability and poorer performance on binaural tasks?

6 Binaural Hearing and Speech Laboratory Cochlear implant studies via direct stimulation Litovksy et al, 2010 C Nucleus Implant Communicator (NICs) Bilaterally synchronized implants in the two ears Direct and precise control over each pulse Loudness balanced Pitch matched Vary stimulation levels, interaural cues

7 Current research 16 children with bilateral CIs ages years 1. Pitch ranking Rank order pitch of various electrodes along array in one ear Pitch comparison Compare pitch of electrodes between the two ears 0 3. Binaural fusion Listen to simultaneous stimulation on the arrays in both ears and decide whether it produces one sound or two

8 Findings 16 children with bilateral CIs ages years 1. Pitch ranking: All children rank ordered pitch consistent with the high à low, base à apex. 2. Pitch comparison: Some children with bilateral CIs perform similarly to adults with CIs in direct pitch comparison tasks. 3. Binaural fusion: Most children did not form a single auditory image from simultaneous bilateral stimulation.

9 What can we (clinicians) do? 1. Raise clinical awareness: bilateral CIs do not necessarily equal use of binaural cues Electrodes may not be pitch-matched or loudness balanced between ears Binaural timing, level, and fine structure cues are not necessarily preserved by the devices Binaural pathways may have a critical period of development

10 What else can we (clinicians) do? 2. Use the bilateral mapping screens Loudness balancing Adjust for a centered auditory image 3. Aural (re) habilitation Potential for improved localization and fusion over time Practice localization 4. Counseling 5. Environmental modifications Continue use of remote microphone technology Quiet is ideal But unrealistic!

11 Future directions: our thoughts Processing strategies that aim to better preserve important binaural cues Fully synchronized processors Pitch matching in commercially available software Continue research on children throughout their lifespan If processors and strategies can provide binaural cues, are children able to use them successfully?

12 Acknowledgements Co-authors: Ruth Litovsky, Ph.D. Erica Ehlers, Au.D./Ph.D. student Shelly Godar, M.A., CCC-A Acknowledgement and thank you to: Yi Zheng, Ph.D. Alan Kan, Ph.D. Ann Todd, Ph.D. Corey Stoelb, AuD Graduate Student Tanvi Thakkar, PhD Graduate Student And, to NIH-NIDCD (R01 DC ) for supporting the research.

13 Resources Arnoff, J.M., Yoon, Y.-s., Freed, D.J.,Vermiglio, A. J., Pal, I., and Soli, S.D. (2010). The use of interaural time and level difference cues by bilateral cochlear implant users, J. Acoust. Soc. Am. 127, EL87-EL92. Brown, C. (2013). An algorithm to enhance the binaural cues available to bilateral cochlear implant users. Presented at the Conference for Implantable Auditory Prosthesis, Tahoe City, CA. Ehlers, E., Zheng, Y., Kan, A., Godar, S., Litovsky, R. (2013). Sensitivity to binaural cues in normal hearing children and children who use cochlear implants. Presented at the Conference for Implantable Auditory Prosthesis, Tahoe City, CA. Grieco-Calub, T.M., & Litovsky, R.Y. (2010). Sound localization skills in children who use bilateral cochlear implants and in children with normal acoustic hearing. Ear Hear. 31(5): Grantham, D.W., Ashmead, D.H., Ricketts, T.A., Labadie, R.F., and Haynes, D.S. (2007). Horizontal-plane localization of noise and speech signals by postlingually deafened adults fitted with bilateral cochlear implants, Ear Hear

14 Resources Kan, A., Stoelb, C., Litovsky, R., Goupell, M. (2013). Effect of mismatched place-of-stimulation on binaural fusion and lateralization in bilateral cochlear implant users, J. Acoust. Soc. Am. 134 (4): Kerber, S., and Seeber, B.U. (2012). Sound localization in noise by normalhearing listeners and cochlear implant users, Ear Hear. 33, Litovsky, R.Y., Goupell, M.J., Godar, S., Grieco-Calub, T., Jones, G.L., Garadat, S.N., Agrawal, S., Kan, A., Todd, A., Hess, C., & Misurelli, S. (2012). Studies on bilateral cochlear implants at the University of Wisconsin's Binaural Hearing and Speech Laboratory. J. Am. Acad. Audiol. 23(6): Litovsky, R.Y., Jones, G.L., Agrawal, S., & van Hoesel, R. (2010). Effect of age at onset of deafness on binaural sensitivity in electric hearing in humans. J. Acoust. Soc. Amer. 127: Litovsky, R.Y., Parkinson, A., and Acaroli, J. (2009). Spatial hearing and speech intelligibility in bilateral cochlear implant users, Ear Hear. 30, Long, C. J., Lakshmish, R.,Parkinson, W.S., Smith, Z.M. (2013) Improving localization by preservation of ILD cues. Presented at the Conference for Implantable Auditory Prosthesis, Tahoe City, CA.

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