The relationship between the speech perception and the degree of satisfaction among adult users of cochlear implants

Introduction: In recent years, the benefits associated with the use of cochlear implants (CIs), especially with regard to speech perception, have proven to surpass those produced by the use of hearing aids, making CIs a highly efficient resource for patients with severe/profound hearing loss. However, few studies so far have assessed the satisfaction of adult users of CIs. Objective: To analyze the relationship between the level of speech perception and degree of satisfaction of adult users of CI. Method: This was a prospective cross-sectional study conducted in the Audiological Research Center (CPA) of the Hospital of Craniofacial Anomalies, University of São Paulo (HRAC/USP), in Bauru, São Paulo, Brazil. A total of 12 users of CIs with pre-lingual or post-lingual hearing loss participated in this study. The following tools were used in the assessment: a questionnaire, "Satisfaction with Amplification in Daily Life" (SADL), culturally adapted to Brazilian Portuguese, as well as its relationship with the speech perception results; a speech perception test under quiet conditions; and the Hearing in Noise Test (HINT)Brazil under free field conditions. Results: The participants in the study were on the whole satisfied with their devices, and the degree of satisfaction correlated positively with the ability to perceive monosyllabic words under quiet conditions. The satisfaction did not correlate with the level of speech perception in noisy environments. Conclusion: Assessments of satisfaction may help professionals to predict what other factors, in addition to speech perception, may contribute to the satisfaction of CI users in order to reorganize the intervention process to improve the users' quality of life.

Neurolinguistic analysis: aspects of language and speech deviations in Palestinian Arabic aphasics

The characteristics of aphasics’ speech in various languages have been the core of numerous studies, but Arabic in general, and Palestinian Arabic in particular, is still a virgin field in this respect. However, it is of vital importance to have a clear picture of the specific aspects of Palestinian Arabic that might be affected in the speech of aphasics in order to establish screening, diagnosis and therapy programs based on a clinical linguistic database. Hence the central questions of this study are what are the main neurolinguistic features of the Palestinian aphasics’ speech at the phonetic-acoustic level and to what extent are the results similar or not to those obtained from other languages. In general, this study is a survey of the most prominent features of Palestinian Broca’s aphasics’ speech. The main acoustic parameters of vowels and consonants are analysed such as vowel duration, formant frequency, Voice Onset Time (VOT), intensity and frication duration. The deviant patterns among the Broca’s aphasics are displayed and compared with those of normal speakers. The nature of deficit, whether phonetic or phonological, is also discussed. Moreover, the coarticulatory characteristics and some prosodic patterns of Broca’s aphasics are addressed. Samples were collected from six Broca’s aphasics from the same local region. The acoustic analysis conducted on a range of consonant and vowel parameters displayed differences between the speech patterns of Broca’s aphasics and normal speakers. For example, impairments in voicing contrast between the voiced and voiceless stops were found in Broca’s aphasics. This feature does not exist for the fricatives produced by the Palestinian Broca’s aphasics and hence deviates from data obtained for aphasics’ speech from other languages. The Palestinian Broca’s aphasics displayed particular problems with the emphatic sounds. They exhibited deviant coarticulation patterns, another feature that is inconsistent with data obtained from studies from other languages. However, several other findings are in accordance with those reported from various other languages such as impairments in the VOT. The results are in accordance with the suggestions that speech production deficits in Broca’s aphasics are not related to phoneme selection but rather to articulatory implementation and some speech output impairments are related to timing and planning deficits.

Factors influencing the decision for Baha in unilateral deafness: the Bern benefit in single-sided deafness questionnaire

The data of 46 adults with single-sided sensorineural deafness who were candidates for bone-anchored hearing aids (Baha) CROS (contralateral routing of signals) were analyzed. All candidates tested a Baha with a headband in their normal environment. Subsequently, 29 of the candidates chose a permanent Baha CROS fitting, and 17 declined, thus forming the two study groups. No significant difference regarding age, sex or duration of deafness was found between the two groups. Similarly, the transcranial attenuation was not significantly different between those who accepted and declined a Baha. Subjects with some residual hearing in their poorer ear tended to decline a Baha, but the effect was not statistically significant. For a subset of 28 subjects, the Bern Benefit in Single-Sided Deafness questionnaire was administered. The questionnaire consists of 10 visual analogue scales rating the subjectively perceived benefit of the Baha or any other CROS device in different situations. Scores were found to be significantly higher for speech understanding at some distance (p = 0.026), for speech understanding in noise (p = 0.037), for group conversations (p < 0.01), and for the overall benefit (p < 0.01) for those candidates who chose to use a Baha as a CROS device permanently.

Audiological results with Baha in conductive and mixed hearing loss

The level of improvement in the audiological results of Baha(®) users mainly depends on the patient's preoperative hearing thresholds and the type of Baha sound processor used. This investigation shows correlations between the preoperative hearing threshold and postoperative aided thresholds and audiological results in speech understanding in quiet of 84 Baha users with unilateral conductive hearing loss, bilateral conductive hearing loss and bilateral mixed hearing loss. Secondly, speech understanding in noise of 26 Baha users with different Baha sound processors (Compact, Divino, and BP100) is investigated. Linear regression between aided sound field thresholds and bone conduction (BC) thresholds of the better ear shows highest correlation coefficients and the steepest slope. Differences between better BC thresholds and aided sound field thresholds are smallest for mid-frequencies (1 and 2 kHz) and become larger at 0.5 and 4 kHz. For Baha users, the gain in speech recognition in quiet can be expected to lie in the order of magnitude of the gain in their hearing threshold. Compared to its predecessor sound processors Baha(®) Compact and Baha(®) Divino, Baha(®) BP100 improves speech understanding in noise significantly by +0.9 to +4.6 dB signal-to-noise ratio, depending on the setting and the use of directional microphone. For Baha users with unilateral and bilateral conductive hearing loss and bilateral mixed hearing loss, audiological results in aided sound field thresholds can be estimated with the better BC hearing threshold. The benefit in speech understanding in quiet can be expected to be similar to the gain in their sound field hearing threshold. The most recent technology of Baha sound processor improves speech understanding in noise by an order of magnitude that is well perceived by users and which can be very useful in everyday life.

Formal speech stylistics and type A behavior in 38 subjects during nonstress interviews

Open-ended interviews of 90 min length of 38 patients were analyzed with respect to speech stylistics, shown by Schucker and Jacobs to differentiate individuals with type A personality features from those with type B. In our patients, Type A/B had been assessed by the Bortner Personality Inventory. The stylistics studied were: repeated words swallowed words, interruptions, simultaneous speech, silence latency (between question and answer) (SL), speed of speech, uneven speed of speech (USS), explosive words (PW), uneven speech volume (USV), and speech volume. Correlations between both raters for all speech categories were high. Positive correlations between extent of type A and SL (r = 0.33; p = 0.022), USS (r = 0.51; p = 0.002), PW (r = 0.46; p = 0.003) and USV (r = 0.39; p = 0.012) were found. Our results indicate that the speech in nonstress open-ended interviews of type A individuals tends to show a higher emotional tension (positive correlations for USS PW and USV) and is more controlled in conversation (positive correlation for SL).

A two-microphone noise reduction system for cochlear implant users with nearby microphones. Part II: Performance Evaluation

Users of cochlear implants (auditory aids, which stimulate the auditory nerve electrically at the inner ear) often suffer from poor speech understanding in noise. We evaluate a small (intermicrophone distance 7 mm) and computationally inexpensive adaptive noise reduction system suitable for behind-the-ear cochlear implant speech processors. The system is evaluated in simulated and real, anechoic and reverberant environments. Results from simulations show improvements of 3.4 to 9.3 dB in signal to noise ratio for rooms with realistic reverberation and more than 18 dB under anechoic conditions. Speech understanding in noise is measured in 6 adult cochlear implant users in a reverberant room, showing average improvements of 7.9–9.6 dB, when compared to a single omnidirectional microphone or 1.3–5.6 dB, when compared to a simple directional two-microphone device. Subjective evaluation in a cafeteria at lunchtime shows a preference of the cochlear implant users for the evaluated device in terms of speech understanding and sound quality.

Speech outcome in complete unilateral cleft lip and palate - a comparison of three methods of the hard palate closure.

The aim of this study was to compare the speech in subjects with cleft lip and palate, in whom three methods of the hard palate closure were used. One hundred and thirty-seven children (96 boys, 41 girls; mean age = 12 years, SD = 1·2) with complete unilateral cleft lip and palate (CUCLP) operated by a single surgeon with a one-stage method were evaluated. The management of the cleft lip and soft palate was comparable in all subjects; for hard palate repair, three different methods were used: bilateral von Langenbeck closure (b-vL group, n = 39), unilateral von Langenbeck closure (u-vL group, n = 56) and vomerplasty (v-p group, n = 42). Speech was assessed: (i) perceptually for the presence of a) hypernasality, b) compensatory articulations (CAs), c) audible nasal air emissions (ANE) and d) speech intelligibility; (ii) for the presence of compensatory facial grimacing, (iii) with clinical intra-oral evaluation and (iv) with videonasendoscopy. A total rate of hypernasality requiring pharyngoplasty was 5·1%; total incidence post-oral compensatory articulations (CAs) was 2·2%. The overall speech intelligibility was good in 84·7% of cases. Oronasal fistulas (ONFs) occurred in 15·7% b-vL subjects, 7·1% u-vL subjects and 50% v-p subjects (P < 0·001). No statistically significant intergroup differences for hypernasality, CAs and intelligibility were found (P > 0·1). In conclusion, the speech after early one-stage repair of CUCLP was satisfactory. The method of hard palate repair affected the incidence of ONFs, which, however, caused relatively mild and inconsistent speech errors.

Speech Understanding with a New Implant Technology: A Comparative Study with a New Nonskin Penetrating Baha System

Objective. To compare hearing and speech understanding between a new, nonskin penetrating Baha system (Baha Attract) to the current Baha system using a skin-penetrating abutment. Methods. Hearing and speech understanding were measured in 16 experienced Baha users. The transmission path via the abutment was compared to a simulated Baha Attract transmission path by attaching the implantable magnet to the abutment and then by adding a sample of artificial skin and the external parts of the Baha Attract system. Four different measurements were performed: bone conduction thresholds directly through the sound processor (BC Direct), aided sound field thresholds, aided speech understanding in quiet, and aided speech understanding in noise. Results. The simulated Baha Attract transmission path introduced an attenuation starting from approximately 5 dB at 1000 Hz, increasing to 20–25 dB above 6000 Hz. However, aided sound field threshold shows smaller differences and aided speech understanding in quiet and in noise does not differ significantly between the two transmission paths. Conclusion. The Baha Attract system transmission path introduces predominately high frequency attenuation. This attenuation can be partially compensated by adequate fitting of the speech processor. No significant decrease in speech understanding in either quiet or in noise was found.

Estimating the benefit of a second bone anchored hearing implant in unilaterally implanted users with a testband.

Conclusion Using a second bone anchored hearing implant (BAHI) mounted on a testband in unilaterally implanted BAHI users to test its potential advantage pre-operatively under-estimates the advantage of two BAHIs placed on two implants. Objectives To investigate how well speech understanding with a second BAHI mounted on a testband approaches the benefit of bilaterally implanted BAHIs. Method Prospective study with 16 BAHI users. Eight were implanted unilaterally (group A) and eight were implanted bilaterally (group B). Aided speech understanding was measured. Speech was presented from the front and noise came either from the left, right, or from the front in two conditions for group A (with one BAHI, and with two BAHIs, where the second device was mounted on a testband) and in three conditions for group B (same two conditions as group A, and in addition with both BAHIs mounted on implants). Results Speech understanding in noise improved with the additional device for noise from the side of the first BAHI (+0.7 to +2.1 dB) and decreased for noise from the other side (-1.8 dB to -3.9 dB). Improvements were highest (+2.1 dB, p = 0.016) and disadvantages were smallest (-1.8 dB, p = 0.047) with both BAHIs mounted on implants. Testbands yielded smaller advantages and higher disadvantages of the additional BAHI (average difference = -0.9 dB).

Intensive care noise and mean arterial blood pressure in ELBW neonates

Objective. Loud noises in neonatal intensive care units (NICUs) may impede growth and development for extremely low birthweight (ELBW, < 1000 grams) newborns. The objective of this study was to measure the association between NICU sound levels and ELBW neonates' arterial blood pressure to determine whether these newborns experience noise-induced stress. ^ Methods. Noise and arterial blood pressure recordings were collected for 9 ELBW neonates during the first week of life. Sound levels were measured inside the incubator, and each subject's arterial blood pressures were simultaneously recorded for 15 minutes (at 1 sec intervals). Time series cross-correlation functions were calculated for NICU noise and mean arterial blood pressure (MABP) recordings for each subject. The grand mean noise-MABP cross-correlation was calculated for all subjects and for lower and higher birthweight groups for comparison. ^ Results. The grand mean noise-MABP cross-correlation for all subjects was mostly negative (through 300 sec lag time) and nearly reached significance at the 95% level at 111 sec lag (mean r = -0.062). Lower birthweight newborns (454-709 g) experienced significant decreases in blood pressure with increasing NICU noise after 145 sec lag (peak r = -0.074). Higher birthweight newborns had an immediate negative correlation with NICU sound levels (at 3 sec lag, r = -0.071), but arterial blood pressures increased to a positive correlation with noise levels at 197 sec lag (r = 0.075). ^ Conclusions. ELBW newborns' arterial blood pressure was influenced by NICU noise levels during the first week of life. Lower birthweight newborns may have experienced an orienting reflex to NICU sounds. Higher birthweight newborns experienced an immediate orienting reflex to increasing sound levels, but arterial blood pressure increased approximately 3 minutes after increases in noise levels. Increases in arterial blood pressure following increased NICU sound levels may result from a stress response to noise. ^

Synthesis of Nature Sounds for Speech Masking

The introduction of open-plan offices in the 1960s with the intent of making the workplace more flexible, efficient, and team-oriented resulted in a higher noise floor level, which not only made concentrated work more difficult, but also caused physiological problems, such as increased stress, in addition to a loss of speech privacy. Irrelevant background human speech, in particular, has proven to be a major factor in disrupting concentration and lowering performance. Therefore, reducing the intelligibility of speech and has been a goal of increasing importance in recent years. One method employed to do so is the use of masking noises, which consists in emitting a continuous noise signal over a loudspeaker system that conceals the perturbing speech. Studies have shown that while effective, the maskers employed to date – normally filtered pink noise – are generally poorly accepted by users. The collaborative "Private Workspace" project, within the scope of which this thesis was carried out, attempts to develop a coupled, adaptive noise masking system along with a physical structure to be used for open-plan offices so as to combat these issues. There is evidence to suggest that nature sounds might be more accepted as masker, in part because they can have a visual object that acts as the source for the sound. Direct audio recordings are not recommended for various reasons, and thus the nature sounds must be synthesized. This work done consists of the synthesis of a sound texture to be used as a masker as well as its evaluation. The sound texture is composed of two parts: a wind-like noise synthesized with subtractive synthesis, and a leaf-like noise synthesized through granular synthesis. Different combinations of these two noises produced five variations of the masker, which were evaluated at different levels along with white noise and pink noise using a modified version of an Oldenburger Satztest to test for an affect on speech intelligibility and a questionnaire to asses its subjective acceptance. The goal was to find which of the synthesized noises works best as a speech masker. This thesis first uses a theoretical introduction to establish the basics of sound perception, psychoacoustic masking, and sound texture synthesis. The design of each of the noises, as well as their respective implementations in MATLAB, is explained, followed by the procedures used to evaluate the maskers. The results obtained in the evaluation are analyzed. Lastly, conclusions are drawn and future work is and modifications to the masker are proposed. RESUMEN. La introducción de las oficinas abiertas en los años 60 tenía como objeto flexibilizar el ambiente laboral, hacerlo más eficiente y que estuviera más orientado al trabajo en equipo. Como consecuencia, subió el nivel de ruido de fondo, que no sólo dificulta la concentración, sino que causa problemas fisiológicos, como el aumento del estrés, además de reducir la privacidad. Hay estudios que prueban que las conversaciones de fondo en particular tienen un efecto negativo en el nivel de concentración y disminuyen el rendimiento de los trabajadores. Por lo tanto, reducir la inteligibilidad del habla es uno de los principales objetivos en la actualidad. Un método empleado para hacerlo ha sido el uso de ruido enmascarante, que consiste en reproducir señales continuas de ruido a través de un sistema de altavoces que enmascare el habla. Aunque diversos estudios demuestran que es un método eficaz, los ruidos utilizados hasta la fecha (normalmente ruido rosa filtrado), no son muy bien aceptados por los usuarios. El proyecto colaborativo "Private Workspace", dentro del cual se engloba el trabajo realizado en este Proyecto Fin de Grado, tiene por objeto desarrollar un sistema de ruido enmascarador acoplado y adaptativo, además de una estructura física, para su uso en oficinas abiertas con el fin de combatir los problemas descritos anteriormente. Existen indicios de que los sonidos naturales son mejor aceptados, en parte porque pueden tener una estructura física que simule ser la fuente de los mismos. La utilización de grabaciones directas de estos sonidos no está recomendada por varios motivos, y por lo tanto los sonidos naturales deben ser sintetizados. El presente trabajo consiste en la síntesis de una textura de sonido (en inglés sound texture) para ser usada como ruido enmascarador, además de su evaluación. La textura está compuesta de dos partes: un sonido de viento sintetizado mediante síntesis sustractiva y un sonido de hojas sintetizado mediante síntesis granular. Diferentes combinaciones de estos dos sonidos producen cinco variaciones de ruido enmascarador. Estos cinco ruidos han sido evaluados a diferentes niveles, junto con ruido blanco y ruido rosa, mediante una versión modificada de un Oldenburger Satztest para comprobar cómo afectan a la inteligibilidad del habla, y mediante un cuestionario para una evaluación subjetiva de su aceptación. El objetivo era encontrar qué ruido de los que se han sintetizado funciona mejor como enmascarador del habla. El proyecto consiste en una introducción teórica que establece las bases de la percepción del sonido, el enmascaramiento psicoacústico, y la síntesis de texturas de sonido. Se explica a continuación el diseño de cada uno de los ruidos, así como su implementación en MATLAB. Posteriormente se detallan los procedimientos empleados para evaluarlos. Los resultados obtenidos se analizan y se extraen conclusiones. Por último, se propone un posible trabajo futuro y mejoras al ruido sintetizado.

Verbal contents of repetitions in Swedish child-directed speech

Repetitions in child-directed speech (CDS) have been shown to vary over time, and are suggested to affect first language acquisition. Correlations between verbal contents of repetitions in CDS and children’s language development have been suggested. The verbal contents of repetitions in Swedish CDS have not yet been investigated. The aim of this study was to examine the verbal contents of repetitions in Swedish CDS during the child’s first 2 years and possible changes in proportions of repetitions during the same time span. Verbal contents of repetitions in parents’ speech in 10 parent-child dyads as the children were 3, 6, 9, 12 and 24 months old were investigated focusing on word classes, sentence types and whole-constituent change. The results were compared to the children’s productive vocabularies at the age of 30 months. Possible occurrences of item-based constructions and frequent frames in the repetitions were also examined. The overall results revealed patterns concerning change in verbal contents in repetitions over time and correlations between verbal contents in repetitions and child language development. Two proposals were made: parents adjust the complexity of their speech to linguistic developmental stages of their children, and linguistic variation in the input increases as the child grows older.

Harmonic Encoding in Cochlear Implants

Thesis (Master's)--University of Washington, 2016-06

Contrast masking in strabismic amblyopia: attenuation, noise, interocular suppression and binocular summation

To investigate amblyopic contrast vision at threshold and above we performed pedestal-masking (contrastdiscrimination) experiments with a group of eight strabismic amblyopes using horizontal sinusoidal gratings (mainly 3 c/deg) in monocular, binocular and dichoptic configurations balanced across eye (i.e. five conditions). With some exceptions in some observers, the four main results were as follows. (1) For the monocular and dichoptic conditions, sensitivity was less in the amblyopic eye than in the good eye at all mask contrasts. (2) Binocular and monocular dipper functions superimposed in the good eye. (3) Monocular masking functions had a normal dipper shape in the good eye, but facilitation was diminished in the amblyopic eye. (4) A less consistent result was normal facilitation in dichoptic masking when testing the good eye, but a loss of this when testing the amblyopic eye. This pattern of amblyopic results was replicated in a normal observer by placing a neutral density filter in front of one eye. The two-stage model of binocular contrast gain control [Meese, T.S., Georgeson, M.A. & Baker, D.H. (2006). Binocular contrast vision at and above threshold. Journal of Vision 6, 1224--1243.] was `lesioned' in several ways to assess the form of the amblyopic deficit. The most successful model involves attenuation of signal and an increase in noise in the amblyopic eye, and intact stages of interocular suppression and binocular summation. This implies a behavioural influence from monocular noise in the amblyopic visual system as well as in normal observers with an ND filter over one eye.