Hearing Preservation Cochlear Implantation: Benefits of Bilateral Acoustic Hearing

Transcription

1 Hearing Preservation Cochlear Implantation: Benefits of Bilateral Acoustic Hearing Kelly Jahn, B.S. Vanderbilt University TAASLP Convention October 29, 2015

2 Background 80% of CI candidates now have bilateral residual LF hearing before surgery 1,2,3 Preserved acoustic hearing in the implanted ear is possible Both long 4,5,6 (16-30 mm) and short 7 (6-10 mm) electrode arrays Allows for use of a hearing aid (HA) and CI in the same ear Ipsilateral electroacoustic stimulation (ipsi EAS) First FDA-approved hybrid CI in the US Cochlear Nucleus L24 (16 mm) March Balkany et al, 2006; 2 Gifford et al, 2007; 3 Dorman and Gifford, 2010; 4 Gstoettner et al, 2008; 5 Lenarz et al, 2009; 6 Skarzynski et al, 2012; 7 Gantz et al., 2009

3 FDA Criteria Hybrid CI Unilateral Adults Implanted Ear: Normal to moderate LF SNHL through 500 Hz (</= 60 db HL) Severe to profound mid to HF SNHL Aided CNC word recognition 10-60% Non-Implanted Ear: Moderately-severe to severe mid- to HF SNHL Aided CNC word recognition </= 80% Limited benefit from appropriately-fit amplification U.S. Food and Drug Administration, 2015

4 Background Many patients now have the option to wear a HA in addition to CI in either or both ears Speech perception benefit with addition of HA in either ear % show improved speech perception High variability: 5-65% percentage point improvement across studies 1,2,3,4,5 Correlations between degree of HL and benefit of adding a HA 6,7,8 Degree of audibility Usable frequency bandwidth 9,10 1 Dunn et al, 2005; 2 Mok et al, 2006; 3 Gifford et al, 2007; 4 Brown and Bacon, 2009; 5 Visram et al, 2012; 6 Mok et al, 2010; 7 Sheffield and Zeng, 2012; 8 Yoon et al, 2012; 9 Gifford et al, 2007; 10 Gifford et al, 2014

5 Background Guidelines exist for HA fitting in non-implanted ear 15-30% benefit in speech perception if aidable hearing at frequencies </= 250 Hz 1,2 What about a HA in the implanted ear? Effect of frequency bandwidth in the implanted ear on speech perception benefit is unknown Thus, no guidelines exist that outline audiometric criteria for recommending amplification in the implanted ear Few studies have examined the benefit of aiding two ears vs. one ear in patients with a unilateral CI 1 Zhang et al., 2010a; 2 Sheffield & Gifford, 2014

6 Research Questions 1. Does acoustic hearing in an ear with a CI provide as much speech perception benefit as the same bandwidth of acoustic hearing in the non-implanted ear? 2. Does acoustic hearing in both ears provide more benefit than acoustic hearing in just one ear? Sheffield, Jahn, & Gifford (2015)

7 Participants 7 adult unilateral CI recipients with bilateral LF acoustic hearing (aidable through 500 Hz) At least 15 months experience with the CI and bilateral HAs Sheffield, Jahn, & Gifford (2015)

8 Methods Speech perception assessed via CNC words in quiet and in multitalker babble (+10 db SNR) 4 Listening Conditions CI alone CI + Implanted ear acoustic hearing (ipsieas) CI + Non-implanted ear acoustic hearing (bimodal) CI + bilateral acoustic hearing (EASall) Low-pass filters applied to the acoustic signals to simulate varying acoustic hearing bandwidth <125 Hz, <250 Hz, <500 Hz, <750 Hz Acoustic outputs matched to NAL-NL1 targets Sheffield, Jahn, & Gifford (2015)

9 Results Question 1 Does acoustic hearing in the CI ear provide as much speech perception benefit as the same bandwidth of acoustic hearing in the non-ci ear? Quiet Increasing acoustic benefit as filter bandwidth increases No difference in acoustic benefit across ears Acoustic hearing in each ear provides similar speech perception benefit Noise Sheffield, Jahn, & Gifford (2015)

10 Results Question 2 Does acoustic hearing in both ears provide more benefit than acoustic hearing in just one ear? Limited to no additional benefit from acoustic hearing in the implanted ear when added to the bimodal condition Both in quiet and in multitalker babble originating from a single loudspeaker Sheffield, Jahn, & Gifford (2015)

11 Conclusions If CI recipient has aidable hearing (</= 80 db HL) through 500 Hz in both ears, he or she should obtain equal speech perception benefit via acoustic amplification in either ear If hearing is fairly symmetrical* No additional speech perception benefit from acoustic hearing in the implanted ear when added to the bimodal condition What are the benefits of bilateral acoustic hearing? Sheffield, Jahn, & Gifford (2015)

12 Where is bilateral acoustic benefit observed? 5 subjects tested in semi-diffuse restaurant noise (+5 db SNR) Significant benefit (8.8%) of bilateral acoustic hearing observed Gifford et al. (2014) 38 subjects Significant bilateral acoustic benefit in restaurant environment (diffuse noise) 10.2% at +2 db SNR Significant benefit in reverberant environments 6.2% Largest improvements in the most challenging listening situations (poorest SNRs) Significant correlation between ITD thresholds and degree of EASrelated benefit for speech recognition in diffuse noise Binaural timing cues can be preserved. This is associated with higher levels of EAS-related benefit for speech recognition in complex listening environments.

13 Recommendations If a unilateral CI recipient can only wear one hearing aid, amplify the ear with the better acoustic hearing Verify fittings i.e. NAL-NL1 prescriptive targets Attempt to provide acoustic amplification to both ears for frequencies with thresholds up to 80 db HL Benefits in complex listening environments (i.e. diffuse noise) Preservation of binaural cues (i.e. ITD) Test environment should involve spatially-separated signal and noise (allows use of ITD cues) More realistic, everyday listening situation Counseling

14 References Balkany TJ, Connell SS, Hodges AV, et al. (2006) Conservation of residual acoustic hearing after cochlear implantation. Otol Neuro- tol 27(8): Brown CA, Bacon SP. (2009) Achieving electric-acoustic benefit with a modulated tone. Ear Hear 30(5): Devices@FDA. (2015, October 19). Retrieved October 24, 2015, from Dorman MF, Gifford RH. (2010) Combining acoustic and electric stimulation in the service of speech recognition. Int J Audiol 49(12): Dunn CC, Tyler RS, Witt SA. (2005) Benefit of wearing a hearing aid on the unimplanted ear in adult users of a cochlear implant. J Speech Lang Hear Res 48(3): Gantz BJ, Hansen MR, Turner CW, Oleson JJ, Reiss LA, Parkinson AJ. (2009) Hybrid 10 clinical trial: preliminary results. Audiol Neurootol 14(Suppl 1): Gifford RH, Dorman MF, McKarns SA, Spahr AJ. (2007) Com- bined electric and contralateral acoustic hearing: word and sen- tence recognition with bimodal hearing. J Speech Lang Hear Res 50(4): Gifford RH, Dorman MF, Sheffield SW, Teece K, Olund AP. (2014) Availability of binaural cues for bilateral implant recipients and bimodal listeners with and without preserved hearing in the implanted ear. Audiol Neurootol 19(1): Gstoettner WK, van de Heyning P, O Connor AF, et al. (2008) Elec- tric acoustic stimulation of the auditory system: results of a multicentre investigation. Acta Otolaryngol 128(9): Lenarz T, Sto ver T, Buechner A, Lesinski-Schiedat A, Patrick J, Pesch J. (2009) Hearing conservation surgery using the Hybrid-L electrode. Results from the first clinical trial at the Medical Uni- versity of Hannover. Audiol Neurootol 14(Suppl 1): Mok M, Galvin KL, Dowell RC, McKay CM. (2010) Speech percep- tion benefit for children with a cochlear implant and a hearing aid in opposite ears and children with bilateral cochlear implants. Audiol Neurootol 15(1): Mok M, Grayden D, Dowell RC, Lawrence D. (2006) Speech per- ception for adults who use hearing aids in conjunction with coch- lear implants in opposite ears. J Speech Lang Hear Res 49(2): Sheffield BM, Zeng FG. (2012) The relative phonetic contributions of a cochlear implant and residual acoustic hearing to bimodal speech perception. J Acoust Soc Am 131(1): Sheffield SW, Gifford RH. (2014) The benefits of bimodal hearing: effect of frequency region and acoustic bandwidth. Audiol Neuro- otol 19(3): Sheffield SW, Jahn K, Gifford RH. (2015) Preserved acoustic hearing in cochlear implantation improves speech perception. J Am Acad Audiol 26:1-10. Skarzynski H, Lorens A, Matusiak M, Porowski M, Skarzynski PH, James CJ. (2012) Partial deafness treatment with the nucleus straight research array cochlear implant. Audiol Neurootol 17(2): Visram AS, Azadpour M, Kluk K, McKay CM. (2012) Beneficial acoustic speech cues for cochlear implant users with residual acoustic hearing. J Acoust Soc Am 131(5): Yoon YS, Li Y, Fu Q-J. (2012) Speech recognition and acoustic fea- tures in combined electric and acoustic stimulation. J Speech Lang Hear Res 55(1): Zhang T, Dorman MF, Spahr AJ. (2010a) Information from the voice fundamental frequency (F0) region accounts for the majority of the benefit when acoustic stimulation is added to electric stim- ulation. Ear Hear 31(1):63 69.

15 Questions?