Interaction Between Electric and Acoustic Stimulation Influences Speech Perception in Ipsilateral EAS Users

Interaction Between Electric and Acoustic Stimulation Influences Speech Perception in Ipsilateral EAS Users: Objectives:

The aim of this study was to determine electric-acoustic masking in cochlear implant users with ipsilateral residual hearing and different electrode insertion depths and to investigate the influence on speech reception. The effects of different fitting strategies—meet, overlap, and a newly developed masking adjusted fitting (UNMASKfit)—on speech reception are compared. If electric-acoustic masking has a detrimental effect on speech reception, the individualized UNMASKfit map might be able to reduce masking and thereby enhance speech reception.

Design:

Fifteen experienced MED-EL Flex electrode recipients with ipsilateral residual hearing participated in a crosssover design study using three fitting strategies for 4 weeks each. The following strategies were compared: (1) a meet fitting, dividing the frequency range between electric and acoustic stimulation, (2) an overlap fitting, delivering part of the frequency range both acoustically and electrically, and (3) the UNMASKfit, reducing the electric stimulation according to the individual electric-on-acoustic masking strength. A psychoacoustic masking procedure was used to measure the changes in acoustic thresholds due to the presence of electric maskers. Speech reception was measured in noise with the Oldenburg Matrix Sentence test.

Results:

Behavioral thresholds of acoustic probe tones were significantly elevated in the presence of electric maskers. A maximum of masking was observed when the difference in location between the electric and acoustic stimulation was around one octave in place frequency. Speech reception scores and strength of masking showed a dependency on residual hearing, and speech reception was significantly reduced in the overlap fitting strategy. Electric- acoustic stimulation significantly improved speech reception over electric stimulation alone, with a tendency toward a larger benefit with the UNMASKfit map. In addition, masking was significantly inversely correlated to the speech reception performance difference between the overlap and the meet fitting.

Conclusions:

(1) This study confirmed the interaction between ipsilateral electric and acoustic stimulation in a psychoacoustic masking experiment. (2) The overlap fitting yielded poorer speech reception performance in stationary noise especially in subjects with strong masking. (3) The newly developed UNMASKfit strategy yielded similar speech reception thresholds with an enhanced acoustic benefit, while at the same time reducing the electric stimulation. This could be beneficial in the long-term if applied as a standard fitting, as hair cells are exposed to less possibly adverse electric stimulation. In this study, the UNMASKfit allowed the participants a better use of their natural hearing even after 1 month of adaptation. It might be feasible to transfer these results to the clinic, by fitting patients with the UNMASKfit upon their first fitting appointment, so that longer adaptation times can further improve speech reception.

ACKNOWLEDGMENTS: The authors thank the subjects who dedicated their time and effort to this study.

W.N. and M.I. received funding for this research from the DFG (German Research Foundation) Cluster of Excellence EXC 1077/1 ‘Hearing4all,' the DFG project Number 396932747 and MED-EL Medical Electronics.

M.I. designed and performed experiments, co-designed the fitting rule, analyzed data and wrote the article. W.N. designed the experiments, co-designed the fitting rule, provided analysis, and contributed to the writing of the article. B.K. designed the experiments, provided analysis, and critical revision of the manuscript. T.L. and A.B. provided critical revision for experimental design and manuscript.

The remaining authors have no conflicts of interest to disclose.

Received March 12, 2019; accepted August 30, 2019.

Address for correspondence: Marina Imsiecke, Deutsches HörZentrum Hannover, Department of Otorhinolaryngology, Karl-Wiechert-Allee 3, 30625 Hannover, Germany. E-mail: imsiecke.marina@mh-hannover.de

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