Speech Understanding and Subjective Listening Effort in Noise With Different OTEs and Sound Processing Technologies

Abstract

Objective To determine speech reception thresholds (SRTs) in noise and subjective listening effort (LE) in cochlear implant (CI) recipients for application of three sound processing (SP) technologies with two off-the-ear (OTE) CI sound processors, a fixed moderately directional microphone (Standard), an adaptive directional microphone (Beam), and the spatial noise-reduction setting ForwardFocus, with the Kanso 2 (OTE2), and Beam with the Kanso (OTE1). Study Design Prospective repeated measures, within-subject design. Setting Single tertiary-referral center. Patients Twenty CI recipients with bilateral severe-to-profound sensorineural hearing loss. Main Outcome Measures SRTs were assessed in two spatial configurations with frontal speech and noise from 90–180–270 degrees (S0N90–180–270) or from the CI side (S0NCI). SRTs were obtained for sentences of the Oldenburg sentence test presented in International Collegium of Rehabilitative Audiology (ICRA) noise ICRA5-250. LE for speech understanding in noise was evaluated in S0N90–180–270 and assessed in effort scale categorical units (ESCUs) by using Adaptive Categorical Listening Effort Scaling (ACALES). LEs at 5-dB signal-to-noise ratio (SNR) were calculated from fitted psychometric curves. Results With OTE2 in S0N90–180–270, SRT with ForwardFocus (−4.28 dB SNR) was better than with Beam (−3.13 dB SNR) and Standard (0.43 dB SNR). ForwardFocus showed lower LE5dB (2.61 ESCU) compared with Beam (4.60 ESCU) and Standard (5.32 ESCU). In a comparison of both OTEs in S0N90–180–270 regarding best-performing SP technology, ForwardFocus with OTE2 yielded a better SRT and better LE5dB than Beam with OTE1 (SRT: −1.70 dB SNR; LE5dB: 4.00 ESCU). With OTE2 in S0NCI, SRT was improved with ForwardFocus (−2.78 dB SNR) compared with Beam (−1.23 dB SNR) and Standard (1.83 dB SNR). Conclusion With respect to SP technology and OTE, CI recipients experience best SRT and lowest LE in S0N90–180–270 when using ForwardFocus with OTE2. ACALES is feasible for assessing subjective LE in CI recipients.