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Fine structure information benefit for sound quality and speech-in-noise intelligibility in bimodal
cochlear implant users at six and twelve months post implantation
Curca I.A. , Macpherson E.A. , Parsa V. , Scollie S. , Agrawal S. , Vansevenant K. , Zimmerman K. , Lewis
Teeter J. , Kaminskas K.-A. , Allen P. , Parnes L.
Western University / National Centre for Audiology, London, Canada, 2Western University / Department of Otolaryngology - Head & Neck
Surgery, Schulich School of Medicine, London, Canada, 3Cochlear Implant Program, Department of Audiology and Vestibular Function,
London Health Sciences Centre, London, Canada
Intro: This study investigated the effect of the fine structure information provided by the MED-EL FSP strategy
(FS4) versus the alternative CIS strategy (HDCIS) on sound quality and hearing in noise in 14 adult bimodal CI
users, with bilateral severe to profound hearing loss, tested at 6 and 12 months post CI implantation. The 12month time data and larger sample size extend the results reported at CIAP 2013.
Methods: All participants used MED-EL OPUS 2 processors programmed with both FS4 and HDCIS strategies.
All tests were performed in bimodal and CI-only configurations and with both strategies. All participants chose to
use FS4 in daily life and wore a contralateral hearing aid (HA). For sound quality, the participants used a visual
analog scale to rate 6 short recordings of speech and music as the listening configuration and CI strategy were
varied. Stimuli were presented in a sound booth using specially designed headphones and a computer controlled
implant remote control that allowed trial-to-trial blind CI program selection. For spatial unmasking of speech
(SUS), 20-sentence HINT thresholds were compared between co-located (speech and noise in front) and
separated (speech in front and noise on the HA side) conditions.
Results: For sound quality, 6- and 12-month outcomes showed a significant overall preference for FS4 and for
the bimodal configurations. Between 6 and 12 months, ratings for some recordings improved significantly only in
FS4/CI-only and FS4/bimodal configurations. For spatial unmasking, at 6 months, SUS was significantly higher
for FS4 alone and for both bimodal FS4 and HDCIS than for HDCIS alone. SUS for FS4 alone was higher than
for FS4/bimodal. At 12 months,FS4/CI-alone, FS4/bimodal and HDCIS/CI-only SUS scores were the largest,
almost equal, and improved from 6 months. Although not significant, SUS in FS4/bimodal increased and in
HDCIS/bimodal decreased between 6 and 12 months.
Discussion: Sound quality was improved via the delivery of fine structure information via either the HA or CI at
both time points. Spatial unmasking was initially highest for the configurations that provided a single source of
low-frequency fine structure (FS4/CI-only and bimodal HDCIS), but HA benefit increased for FS4 and decreased
for HDCIS at 12 months.
Conclusion: Sound quality and SUS results indicate a benefit of the FS4 strategy for bimodal listeners. The
SUS results suggest a trend for gradual acclimatization to bimodally delivered fine-structure (FS4/bimodal) and
decline in effective integration of hearing-aid fine-structure with the non-preferred HDCIS strategy
Learning outcome: FS4 provided sufficient fine structure information to improve the perceived quality of speech
in quiet and the spatial unmasking of speech in noise at 6 and 12 months post CI implantation.
[This work was supported by grants from the MED-EL Corp. and the Canada Foundation for Innovation]