Search Results (32)

Background/Objectives: Cochlear implants (CIs) are a common treatment of severe-to-profound hearing loss and provide reasonable speech understanding, at least in quiet situations. However, their limited spectro-temporal resolution restricts sound quality, which is especially crucial for music appraisal. Many CI recipients wear a hearing aid (HA) on the non-implanted ear (bimodal users), which may enhance music perception by adding acoustic fine structure cues. Since it is unclear how the HA should be fitted in conjunction with the CI to achieve optimal benefit, this study aimed to systematically vary HA fitting parameters and assess their impact on music sound quality in bimodal users. Methods: Thirteen bimodal CI recipients participated in a listening experiment using a master hearing aid that allowed controlled manipulation of HA settings. Participants evaluated three music excerpts (pop with vocals, pop without vocals, classical) using the multiple-stimulus with hidden reference and anchor (MUSHRA) test. To assess the reliability of individual judgments, each participant repeated the test, and responses were analyzed with the eGauge method. Results: Most participants provided reliable and consistent sound quality ratings. Compared to a standard DSL v5.0 prescriptive fitting, modifications in compression settings and low-frequency gain significantly influenced perceived music quality. The effect of low-frequency gain adjustments was especially pronounced for pop music with vocals, indicating stimulus-dependent benefits. Conclusions: The study demonstrates that HA fitting for bimodal CI users can be optimized beyond standard prescriptive rules to enhance music sound quality by increasing low-frequency gain, particularly for vocal-rich pieces. Additionally, the testing method shows promise for clinical application, enabling individualized HA adjustments based on patient-specific listening preferences, hence fostering personalized audiology care. Full article

Background: Cochlear implants (CIs) are transformative neuroprosthetics that restore speech perception for individuals with severe-to-profound hearing loss. However, temporal envelope cues are well-represented within the signal processing, while spectral envelope cues are poorly accessed by CI users, resulting in substantial deficits compared to normal-hearing individuals. This profoundly impairs the perception of complex auditory stimuli like music and vocal prosody, significantly impacting users’ quality of life, social engagement, and artistic expression. Methods: This narrative review synthesizes research on CI signal-processing limitations, perceptual and production challenges in music and singing, the role of the auditory–motor feedback loop, and strategies for improvement, including rehabilitation, technology, and the influence of neuroplasticity and sensitive developmental periods. Results: The degraded signal causes marked deficits in pitch, timbre, and vocal emotion perception. Critically, this impoverished input functionally breaks the high-fidelity auditory–motor feedback loop essential for vocal control, transforming it from a precise fine-tuner into a gross error detector sensitive only to massive pitch shifts (~6 semitones). This neurophysiological breakdown directly causes pervasive pitch inaccuracies and melodic distortion in singing. Despite these challenges, improvements are possible through advanced sound-processing strategies, targeted auditory–motor training that leverages neuroplasticity, and capitalizing on sensitive periods for auditory development. Conclusions: The standard CI signal creates a fundamental neurophysiological barrier to singing. Overcoming this requires a paradigm shift toward holistic, patient-centered care that moves beyond speech-centric goals. Integrating personalized, music-based rehabilitation with advanced CI programming is essential for improving vocal production, fostering musical engagement, and ultimately enhancing the overall quality of life for CI users. Full article

Purpose: The present study aimed to describe the adaptation and validation process of the MuRQoL (Music Related Quality of Life questionnaire) from English to Hebrew and to describe normative data from a cohort of adults with normal hearing versus those with hearing aids or cochlear implants. Methods: After thoroughly translating and adapting to Hebrew, the participants completed the questionnaire online. We calculated the Cronbach’s alpha and McDonald’s omega scores for all scales and subscales. The construct validity of the questionnaire was evaluated using Confirmatory Factor Analysis (CFA) and the “known group” method. A total of 310 adults participated in this study. Fifty-four participants were deaf or hard of hearing, and 256 had normal hearing. Results: Internal consistency of the MuRQoL-He scales and subscales demonstrated good-to-excellent reliability. The goodness-of-fit indices for the frequency and importance scales were within acceptable standards. We found a significant difference in the frequency scale, where the normal-hearing group scores were significantly higher than those of the deaf and hard-of-hearing groups. Conclusions: The validity and reliability of the MuRQoL-He have been confirmed, indicating that it is suitable for guiding music rehabilitation for Hebrew-speaking deaf and hard-of-hearing adults. Full article

Background: Cochlear implants (CIs) serve diverse populations with hearing loss, but patients with single-sided deafness (SSD) often show lower post-implantation usage and satisfaction than bilateral CI users. This disparity may stem from their normal contralateral ear providing sufficient auditory input for many daily situations, reducing the perceived need for consistent CI use. Consequently, uniform screening and evaluations, typically designed for bilateral hearing loss, often fail to address SSD’s unique needs. Methods: This narrative review synthesizes the current literature to explore patient and device factors shaping CI integration, outcomes, and experience in SSD. It highlights implications for developing personalized care strategies distinct from those used in bilateral hearing loss. Results: SSD patients face unique challenges: reliance on compensatory behaviors and significant auditory processing difficulties like acoustic–electric mismatch and place–pitch discrepancy. Anatomical factors and deafness of duration also impact outcomes. Traditional measures are often insufficient due to ceiling effects. Music perception offers a sensitive metric and rehabilitation tool, while big data and machine learning show promise for predicting outcomes and tailoring interventions. Conclusions: Optimizing CI care for SSD necessitates a personalized approach across candidacy, counseling, and rehabilitation. Tailored strategies, including individualized frequency mapping, adaptive auditory training, advanced outcome metrics like music perception, and leveraging big data for precise, data-driven predictions, are crucial for improving consistent CI usage and overall patient satisfaction. Full article

Background: Ear advantage (EA) reflects hemispheric asymmetries in auditory processing. While a right-ear advantage (REA) for speech and a left-ear advantage (LEA) for music are well documented in typically developing individuals, it is unclear how these patterns manifest in young children with cochlear implants (CIs). This study investigated whether pupillometry could reveal asymmetric listening efforts in toddlers with bilateral CIs when listening to speech and music under monaural stimulation. Methods: Thirteen toddlers (mean age = 36.2 months) with early bilateral CIs participated. Pupillary responses were recorded during passive listening to speech and music stimuli, presented in quiet or with background noise. Each child was tested twice, once with only the left CI active and once with only the right CI active. Linear mixed-effects models assessed the influence of session (left/right CI), signal type (speech/music), and background noise. Results: A significant interaction between session and signal type was observed (p = 0.047). Speech elicited larger pupil sizes when processed through the left CI, while music showed no significant lateralized effects. Age and speech therapy frequency moderated pupil responses in speech and music trials, respectively. Conclusions: Pupillometry reveals subtle asymmetric listening effort in young CI users depending on the listening ear, suggesting early emerging functional lateralization despite sensory deprivation and device-mediated hearing. Full article

Background/Objectives: This study investigated the association between cochlear implant (CI) users’ assessed perception of musical sound quality and their subjective music perception and music-related quality of life (QoL). The aim was to provide a comprehensive evaluation by integrating a relatively objective Turkish Multiple Stimulus with Hidden Reference and Anchor (TR-MUSHRA) test and a subjective music questionnaire. Methods: Thirty CI users and thirty normal-hearing (NH) adults were assessed. Perception of sound quality was measured using the TR-MUSHRA test. Subjective assessments were conducted with the Music-Related Quality of Life Questionnaire (MuRQoL). Results: TR-MUSHRA results showed that while NH participants rated all filtered stimuli as perceptually different from the original, CI users provided similar ratings for stimuli with adjacent high-pass filter settings, indicating less differentiation in perceived sound quality. On the MuRQoL, groups differed on the Frequency subscale but not the Importance subscale. Critically, no significant correlation was found between the TR-MUSHRA scores and the MuRQoL subscale scores in either group. Conclusions: The findings demonstrate that TR-MUSHRA is an effective tool for assessing perceived sound quality relatively objectively, but there is no relationship between perceiving sound quality differences and measures of self-reported musical engagement and its importance. Subjective music experience may represent different domains beyond the perception of sound quality. Therefore, successful auditory rehabilitation requires personalized strategies that consider the multifaceted nature of music perception beyond simple perceptual judgments. Full article

Background/Objectives: Cochlear implants (CIs) and hearing aids (HAs) have enhanced auditory rehabilitation in elderly individuals, yet limitations in musical perception and psychosocial integration persist. This systematic review aimed to evaluate the effects of music therapy (MT) on the quality of life (QoL), self-esteem, auditory perception, and cognition in older CI and HA users. Methods: A comprehensive search of PubMed was conducted up to March 2022 following PRISMA guidelines. Studies involving participants aged ≥ 60 years with CIs and/or HAs were included. Ten studies (n = 21,632) met eligibility criteria. Data were extracted and assessed using the Newcastle–Ottawa Scale. Results: MT led to improved sound quality, with HISQUI19 scores rising from 60.0 ± 21.8 to 74.2 ± 27.5. Early MT exposure was associated with significantly better MUMU outcomes (p = 0.02). Bilateral CI users showed enhanced stereo detection (52% to 86%), and CI + HA users achieved CNC scores exceeding 95%. Postlingual CI users outperformed prelingual peers in musical discrimination (9.81 vs. 3.48; p < 0.001). Long-term HA use was linked to better a QoL and reduced loneliness. Conclusions: While music therapy appears to support auditory and psychosocial functioning in hearing-impaired older adults, the absence of randomized controlled trials limits causal inference regarding its effects. These results support its integration into hearing rehabilitation strategies for older adults. Full article

This paper presents a novel cochlear implant (CI) sound coding strategy called Spectral Feature Extraction (SFE). The SFE is a novel Fast Fourier Transform (FFT)-based Continuous Interleaved Sampling (CIS) strategy that provides less-smeared spectral cues to CI patients compared to Crystalis, a predecessor strategy used in Oticon Medical devices. The study also explores how the SFE can be enhanced into a Temporal Fine Structure (TFS)-based strategy named Spectral Event Extraction (SEE), combining spectral sharpness with temporal cues. Background/Objectives: Many CI recipients understand speech in quiet settings but struggle with music and complex environments, increasing cognitive effort. De-smearing the power spectrum and extracting spectral peak features can reduce this load. The SFE targets feature extraction from spectral peaks, while the SEE enhances TFS-based coding by tracking these features across frames. Methods: The SFE strategy extracts spectral peaks and models them with synthetic pure tone spectra characterized by instantaneous frequency, phase, energy, and peak resemblance. This deblurs input peaks by estimating their center frequency. In SEE, synthetic peaks are tracked across frames to yield reliable temporal cues (e.g., zero-crossings) aligned with stimulation pulses. Strategy characteristics are analyzed using electrodograms. Results: A flexible Frequency Allocation Map (FAM) can be applied to both SFE and SEE strategies without being limited by FFT bandwidth constraints. Electrodograms of Crystalis and SFE strategies showed that SFE reduces spectral blurring and provides detailed temporal information of harmonics in speech and music. Conclusions: SFE and SEE are expected to enhance speech understanding, lower listening effort, and improve temporal feature coding. These strategies could benefit CI users, especially in challenging acoustic environments. Full article

Hearing loss is one of the most common and undertreated medical conditions worldwide, with an estimated 466 million people (5% of the world’s population) reporting disabling hearing impairment. The implications are significant; untreated hearing loss increases the risk of depression, social isolation, unemployment, cognitive decline, and falls. Cochlear implants (CIs) are surgically implanted electrical devices that allow people with severe hearing loss to process sound. Over the past 50 years, CI development has made remarkable ground, such that most CI users have adequate speech perception in a silent environment. These language achievements, while significant milestones, fall short of perfect sensory restoration. Many of these limitations with complex sound perception are due to our one-size-fits-all approach towards CIs and speech-based metrics for evaluating implant performance. In the past decade, there has been exponential interest in improving CI-mediated music perception, as it serves as a key conduit to restoring normal hearing. The present literature demonstrates the need for a personalized approach towards cochlear implantation and management. Our proposed narrative review illustrates the limitations of CI-mediated sound processing and discusses ways in which precision medicine can be introduced into the ever-expanding hearing loss population. Full article

Background: The Music-Related Quality of Life (MuRQoL) was launched in 2017 as a valid psychometric measure of Cochlear Implant (CI) users’ music experience and its impact on Quality of Life (QoL). This scoping review aimed to explore the implementation and effectiveness of the instrument since its introduction. Methods: PubMed and Google Scholar databases were searched for publications written in English reporting a translation, validation or application of the MuRQoL. Results: Eleven publications were found, including three validated versions and eight studies that applied the MuRQoL in Italy, Turkey, Spain and the US in research and clinical settings for various purposes. The review showcases the reliability, validity and potential clinical utility of the tool underscoring its growing adoption and integration with other assessment tools. Based on the findings, we make recommendations and provide a roadmap for optimizing the use of MuRQoL globally, including naming and terminology conventions. Anecdotal evidence, such as forthcoming or non-English publications offer further insights into the tool’s future potential. Conclusions: The MuRQoL is currently available in four languages and applicable across diverse cultural contexts, populations and settings. It is a versatile, patient-centered tool providing a deep understanding of CI users’ music experiences. As research and validation efforts continue, the instrument has the potential to set a benchmark for assessing the broader impacts of CIs beyond speech perception, emphasizing the significance of music in enriching the lives of individuals with Hearing Loss (HL). Full article

Aim: The aim of this study was to assess the subjective experiences of adults with different cochlear implant (CI) configurations—unilateral cochlear implant (UCI), bilateral cochlear implant (BCI), and bimodal stimulation (BM)—focusing on their perception of speech in quiet and noisy environments, music, environmental sounds, people’s voices and tinnitus. Methods: A cross-sectional survey of 130 adults who had undergone UCI, BCI, or BM was conducted. Participants completed a six-item online questionnaire, assessing difficulty levels and psychological impact across auditory domains, with responses measured on a 10-point scale. Statistical analyses were performed to compare the subjective experiences of the three groups. Results: Patients reported that understanding speech in noise and tinnitus perception were their main concerns. BCI users experienced fewer difficulties with understanding speech in both quiet (p < 0.001) and noisy (p = 0.008) environments and with perceiving non-vocal sounds (p = 0.038) compared to UCI and BM users; no significant differences were found for music perception (p = 0.099), tinnitus perception (p = 0.397), or voice naturalness (p = 0.157). BCI users also reported less annoyance in quiet (p = 0.004) and noisy (p = 0.047) environments, and in the perception of voices (p = 0.009) and non-vocal sounds (p = 0.019). Tinnitus-related psychological impact showed no significant differences between groups (p = 0.090). Conclusions: Although speech perception in noise and tinnitus remain major problems for CI users, the results of our study suggest that bilateral cochlear implantation offers significant subjective advantages over unilateral implantation and bimodal stimulation in adults, particularly in difficult listening environments. Full article

Background/Objectives: Bimodal stimulation (BS), which combines the use of a cochlear implant (CI) in one ear and a hearing aid (HA) in the opposite ear, is an established strategy to treat hearing loss by exploiting the unique capabilities of each device. CIs stimulate the auditory nerve by bypassing damaged hair cells, while HAs amplify sounds by requiring a functional hearing residual. The aim of this systematic review is to investigate the advantages and disadvantages of BS such as speech perception in noise. Methods: We examined clinical studies published from October 2020 to July 2024, following the PRISMA guidelines, focusing on the advantages and disadvantages of BS on speech perception in noise in adulthood. Results: BS in adult patients significantly improves speech perception in quiet and noisy environments, especially for those with increased residual hearing. Unilateral CIs and BS perform similarly in quiet conditions, but BS significantly improves speech discrimination in noisy environments if loudness between the two devices is appropriately balanced. Conclusions: Directional microphones and programming software are new technologies that succeed in reducing environmental noise and improving verbal perception outcomes, although their features in the literature are controversial. In addition, the individuals using BS may face temporal mismatches mainly due to differing device latencies, affecting sound localization. Compensating for these mismatches can enhance localization accuracy. However, modulated noise remains a significant obstacle to verbal perception in noise. Valuable assessment tools such as music tests provide further information on hearing performance and quality of life. More research is needed to define certain selection criteria. Full article

Background/Objectives: Given the importance of emotion recognition for communication purposes, and the impairment for such skill in CI users despite impressive language performances, the aim of the present study was to investigate the neural correlates of emotion recognition skills, apart from language, in adult unilateral CI (UCI) users during a music in noise (happy/sad) recognition task. Furthermore, asymmetry was investigated through electroencephalographic (EEG) rhythm, given the traditional concept of hemispheric lateralization for emotional processing, and the intrinsic asymmetry due to the clinical UCI condition. Methods: Twenty adult UCI users and eight normal hearing (NH) controls were recruited. EEG gamma and alpha band power was assessed as there is evidence of a relationship between gamma and emotional response and between alpha asymmetry and tendency to approach or withdraw from stimuli. The TAS-20 questionnaire (alexithymia) was completed by the participants. Results: The results showed no effect of background noise, while supporting that gamma activity related to emotion processing shows alterations in the UCI group compared to the NH group, and that these alterations are also modulated by the etiology of deafness. In particular, relative higher gamma activity in the CI side corresponds to positive processes, correlated with higher emotion recognition abilities, whereas gamma activity in the non-CI side may be related to positive processes inversely correlated with alexithymia and also inversely correlated with age; a correlation between TAS-20 scores and age was found only in the NH group. Conclusions: EEG gamma activity appears to be fundamental to the processing of the emotional aspect of music and also to the psychocognitive emotion-related component in adults with CI. Full article

Background: A cochlear implant (CI) enables deaf people to understand speech but due to technical restrictions, users face great limitations in noisy conditions. Music training has been shown to augment shared auditory and cognitive neural networks for processing speech and music and to improve auditory–motor coupling, which benefits speech perception in noisy listening conditions. These are promising prerequisites for studying multi-modal neurologic music training (NMT) for speech-in-noise (SIN) perception in adult cochlear implant (CI) users. Furthermore, a better understanding of the neurophysiological correlates when performing working memory (WM) and SIN tasks after multi-modal music training with CI users may provide clinicians with a better understanding of optimal rehabilitation. Methods: Within 3 months, 81 post-lingual deafened adult CI recipients will undergo electrophysiological recordings and a four-week neurologic music therapy multi-modal training randomly assigned to one of three training focusses (pitch, rhythm, and timbre). Pre- and post-tests will analyze behavioral outcomes and apply a novel electrophysiological measurement approach that includes neural tracking to speech and alpha oscillation modulations to the sentence-final-word-identification-and-recall test (SWIR-EEG). Expected outcome: Short-term multi-modal music training will enhance WM and SIN performance in post-lingual deafened adult CI recipients and will be reflected in greater neural tracking and alpha oscillation modulations in prefrontal areas. Prospectively, outcomes could contribute to understanding the relationship between cognitive functioning and SIN besides the technical deficits of the CI. Targeted clinical application of music training for post-lingual deafened adult CI carriers to significantly improve SIN and positively impact the quality of life can be realized. Full article