Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
March 24th, 2023
This paper describes a battery of tests used to clinically assess the hearing performance of adolescent, Mandarin-speaking, experienced cochlear implant users upgraded to a new fine structure coding strategy. The battery of tests include speech in quiet conditions, speech in noisy conditions, lexical tone, and music perception.
This paper describes a battery of tests used to clinically assess the hearing performance of experienced cochlear implant users upgraded to a new fine structure coding strategy. The tests provide guidance for both CI users and candidates and doctors to choose different technologies as well as to steer their clinical rehabilitation. Prepare the participants for the experiment by positioning them a meter from the loudspeaker at a 45 degree angle to the cochlear implant side in the sound booth.
Remove any hearing aids from the contralateral ear and make sure the earplug or muff masking is effective for participants with residual hearing. Inform the participants that practice test sessions will be conducted followed by formal testing. Take the participants and their guardians to the mapping room.
Seat the participants in the room. Enter the password to unlock the mapping software. Remove the speech processor and connect it to the max box with a programming cable.
Choose the participant's name on the software and then click on the impedance option. Test the electrode impedance to ensure it is within the normal range of 2.2-12 kiloohm. Ensure the coding strategy is FS4 and a standard pulse rate of 12 pulses per second is used.
Set the single electrode stimulation to dynamic with three sweeps. Let the participants distinguish the volume of each electrode by pointing to the appropriate image on a loud comfort pictorial scale. Using up and down testing methods, perform the same results as the final electrical stimulation result.
To set the maximum comfortable level, activate the map by pressing the Live button. Activate the shift and tilt function to return the participants to the fitting mode. Press Strategy to set the stimulation rate at 1, 274 pulses per second and the channel specific sampling sequence to 4.
Set the biphasic pulse interface gap at 2.1 microseconds. Finally set the compression ratio to 3:1 and sensitivity to 75%Check that the threshold value for each channel is the frequency range of 70-8, 500 hertz. Test the speech perception in this order.
Once the participants are seated, as demonstrated previously, launch the speech software. Ask the participants to clearly repeat the content they hear. Turn on the audiometer and select the hearing options.
Set the sound loudness to 70 decibels hearing level above the average pure threshold of 500, 1, 000, 2, 000, and 4, 000 hertz. For the formal testing, present the participants with practice tests. Ask the participants to repeat the words and sentences for each testing.
Keeping the order of contents random and playing it once. To test sentence recognition in noisy conditions, perform a tone test with the software set at 60 decibels and set the signal to noise ratio to 10 decibels using four-talker babble. Then in the same booth, interpret the results carefully.
After confirming that all the participants are familiar with the testing vocabulary, present the practice tests simultaneously with the formal test. Direct the participants to say what they have heard once. Press Test followed by ToneID to choose the tone in which the participants repeat the content, keeping the order random.
To perform the music test, click on the music software and choose the Pitch selection in the same booth. After presenting both practice and formal tests, instruct the participants to listen to the sequentially presented stimuli and determine which of the two has a falling or rising pitch contour. Record the participant answers and repeat.
Spondee recognition in quiet conditions significantly improved from pre-upgrade to three months post-upgrade. The improvement was insignificant from pre-upgrade to six weeks post-upgrade or from pre-upgrade to immediate post-upgrade. Significant improvement in monosyllable recognition under quiet conditions was seen from pre-upgrade to immediately post-upgrade subjects.
Improvement from 59.6%at pre-upgrade to 71.4%at six weeks post-upgrade was observed, while an increase to 82.1%was observed at three months post-upgrade. Sentence recognition in quiet conditions significantly improved from pre-upgrade to three months post-upgrade. The other groups did not show any significant improvements.
In noisy conditions, sentence recognition increased from pre-upgrade to three months post-upgrade. Significant improvement was seen in tone recognition from pre-upgrade to six weeks post-upgrade and three months post-upgrade, whereas no significant improvement was observed immediately post-upgrade. Non-significant improvement was seen in musical pitch perception from 16.5 limen at pre-upgrade to 23.7 limen.
This procedure provides effective evaluation methods for clinical rehabilitation and will be used in the next stage of related research to evaluate the clinical effects in CI patients.
Overview
This study evaluates the hearing performance of adolescent Mandarin-speaking cochlear implant users after upgrading to a new fine structure coding strategy. A series of tests were conducted to assess speech recognition in various conditions, including quiet and noisy environments.
Key Study Components
Area of Science
- Neuroscience
- Clinical Rehabilitation
- Audiology
Background
- Cochlear implants are used to improve hearing in individuals with severe hearing loss.
- Upgrading coding strategies can enhance auditory perception.
- Assessing performance through standardized tests is crucial for clinical outcomes.
- This study focuses on Mandarin-speaking adolescents, a specific demographic in cochlear implant research.
Purpose of Study
- To evaluate the effectiveness of a new fine structure coding strategy in cochlear implant users.
- To provide guidance for clinical rehabilitation and technology selection.
- To assess improvements in speech and music perception post-upgrade.
Methods Used
- Participants were positioned in a sound booth for testing.
- Tests included speech recognition in quiet and noisy conditions, tone recognition, and music perception.
- Impedance testing and mapping of the cochlear implant were performed prior to assessments.
- Results were analyzed to determine improvements in auditory performance.
Main Results
- Significant improvement in spondee and monosyllable recognition in quiet conditions post-upgrade.
- Sentence recognition improved in both quiet and noisy conditions over time.
- Tone recognition showed significant enhancement from pre-upgrade to three months post-upgrade.
- Musical pitch perception improvement was noted but not statistically significant.
Conclusions
- The new coding strategy effectively enhances auditory performance in cochlear implant users.
- Standardized testing provides valuable insights for clinical rehabilitation.
- Further research is needed to explore long-term effects and additional improvements.
Frequently Asked Questions
Executive Industry Relevance
Systematic evaluation of hearing performance in adolescent cochlear implant users is critical for optimizing device programming and rehabilitation strategies. Quantitative assessment across speech, tone, and music perception domains enables data-driven decisions on coding strategy upgrades and technology selection. This workflow supports predictive confidence in auditory outcome improvements and informs cross-functional clinical teams.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables objective interrogation of auditory pathway function following device intervention.
- Supports functional validation of new coding strategies in disease-relevant populations.
- Provides quantitative endpoints for mechanistic de-risking of auditory rehabilitation approaches.
Screening & Assay Development
- Establishes standardized test batteries for reproducible assessment of hearing performance.
- Facilitates assay readiness for evaluating speech, tone, and music perception in controlled environments.
- Delivers quantitative outputs suitable for benchmarking device and strategy performance.
Translational & Preclinical Research
- Aligns clinical test outputs with translational endpoints relevant to auditory function restoration.
- Enables continuity from device programming through longitudinal outcome tracking.
- Supports risk-adjusted advancement of new auditory coding strategies.
Pipeline & Workflow Integration
This evaluation process integrates from device programming and mapping through to post-upgrade outcome measurement, supporting iterative improvement in cochlear implant technology and rehabilitation protocols.
- Discovery Biology: Provides a framework for hypothesis testing on auditory pathway responsiveness to coding changes.
- Screening: Delivers reproducible, quantitative test outputs for cross-cohort comparison.
- Analytics: Enables statistical analysis of speech, tone, and music perception improvements over time.
- Translational Research: Bridges device-level interventions with clinically meaningful auditory outcomes.
- Enterprise Reuse: Offers a reusable clinical workflow adaptable to future coding strategies and patient populations.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in auditory rehabilitation outcomes and target validation for new coding strategies.
- Operational Value: Standardizes assessment protocols for reproducibility and scalability across clinical sites.
- Strategic Value: Informs go/no-go decisions for technology upgrades and rehabilitation investments.
- Portfolio Impact: Supports risk-adjusted prioritization of device and strategy development programs.
Implementation Considerations
- Requires audiological and clinical expertise for test administration and device programming.
- Demands access to calibrated sound booths, mapping software, and standardized test materials.
- Necessitates cross-team alignment on test protocols and data interpretation standards.
- Adaptable to different languages and patient demographics with appropriate material validation.
- Dependent on participant cooperation and familiarity with test vocabulary for reliable results.
