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Chronological changes of CI cases and CI centers in Japan (120 million population)

Chronological changes of CI cases and CI centers in Japan (120 million population). Bilateral Cochlear Implantation on the same day. Binaural hearing with CI/HA or CI/CI. 1) Sound direction identification 2) Speech perception in quiet 3) Speech perception in noise a) Noise from front

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Chronological changes of CI cases and CI centers in Japan (120 million population)

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  1. Chronological changes of CI cases and CI centers in Japan (120 million population)

  2. Bilateral Cochlear Implantation on the same day

  3. Binaural hearing with CI/HA or CI/CI 1) Sound direction identification 2) Speech perception in quiet 3) Speech perception in noise a) Noise from front b) Noise from right and left

  4. Bilateral cochlear implant subjects • ITD; 400 μsec-1msec • ILD; 1 dB • can detect the difference in 10-25º. Sound direction identification with bilateral ears • Mechanism of sound source detection • Inter-aural time difference (ITD) • Inter-aural level difference (ILD) • Normally hearing subjects • ITD; 10 μsec • ILD; 0.5 -1 dB • can detect the difference in 2º

  5. Sound direction identification in bimodal (CI/HA) hearing mode

  6. Audiometer SCB-40 ③ ② ④ ① ⑤ 1.3m 1.3m Methods • Stimulation: • 5 speakers at 45º separation • white noise with 65dB SPL for 1 sec • 20 times from each speakers at random sequence • Judgment: • correct 2 • near-miss 1 • error 0

  7. Result of bilateral HA users Speakers: trials (scores) M.K. T.S. L （- 90°） 19/20（39/40） 0dB Only 5 errors to the adjacent speakers out of 100 trials 19/20（39/40） LA （- 45°） × × ○ ○ ○ ○ × × × × ○ ○ × × × × × × ○ ○ × ○ ○ ○ ○ × × ○ ○ ○ ○ ○ ○ × × × F （0°） 20/20（40/40） × ○ × ○ × ○ × ○ ○ × ○ ○ 50dB × ○ × × × × × × × ○ ○ × ○ ○ ○ × × ○ ○ × ○ ○ RA （45°） ○ × ○ × × × 18/20（38/40） × ○ ○ × ○ × × ○ ○ ○ ○ R （90°） 19/20（39/40） × 100dB 95/100（195/200） Subjects: Two HA users whose hearing levels were symmetric.

  8. Subject Cause Deafness Time for use Duration deafness Threshold Gender Case Age CI HA C I H A 1 48 M Unknown 3 y 111.3 118.8 1y 4y 2 59 F Unknown １ ｙ S.O. 101.3 2y10m 20y 3 65 F Unknown ４ ｙ 106.3 92.5 1y6m 8y 4 M 71 Unknown １ ｙ 101.3 96.3 3y 4y 5 80 Unknown １ ｙ 108.8 107.5 1y10m 27ｙ F 6 84 M １ ｙ 98.8 112.5 3y4m 8y Labyrinthitis Cause Deafness Time for use Duration deafness Threshold Gender Case Age Lt Rt Lt Rt 1 62 M Unknown 5 y 111.3 118.8 6 y 3 y 3 y 2 32 F Unknown 17y S.O. 110.3 3 y CI/HA CI/CI

  9. CI alone: trials (scores) HA: trials (scores) 7/20（19/40） L （- 90°） L （- 90°） 4/20（15/40） LA （- 45°） 9/20（29/40） 4/20（16/40） LA （- 45°） F （0°） 8/20（240/40） F （0°） 7/20（23/40） RA （45°） 7/20（24/40） R （90°） 5/20（209/40） RA （45°） 5/20（19/40） 36/100（115/200） R （90°） 4/20（12/40） HA CI/HA: trials (scores) 25/100（85/200） CI/HA 11/20（28/40） L （- 90°） CI LA （- 45°） 11/20（30/40） F （0°） 10/20（29/40） 6/20（23/40） RA （45°） 9/20（26/40） R （90°） K.K. L-CI/R-HA 46/100（135/200） Sound direction identification in binaural (CI/HA ) subjects

  10. Comparison of sound direction identification scores in CI, CI-HA, HA conditions P=0.001 P=0.0197 100 ＊ ＊ CI/HA group ＊ ＊ 50 0 HA CI CI+HA Binaural hearing with CI and HA showed significantly better score than monaural hearing (CI or HA alone) condition.

  11. Comparison of sound direction identification scores in CI alone and bilateral CI conditions CI/CI group 100 n.s. ＊ 50 0 Lt CI Bil CI Rt CI Bilateral CI subjects showed better score than monaural listening with poorer CI, but showed similar performance when listening with the better CI.

  12. Summary for sound direction identification study Binaural hearing with CI/HA had advantages for sound direction identification. • Benefits: • Aware for the direction • of alarm sign. • Can identify the speaker while talking with many people.

  13. N S CI CI HA Advantages of binaural hearing 1) Sound source detection 2) Better speech perception especially in noisy circumstances • Mechanisms of better hearing with two ears • Summation effect • Binaural unmasking effect (binaural squelch effect) • Head shadow effect (advantage)

  14. Binaural hearing with CI/HA or CI/CI 2) Speech perception in quiet - summation effect – • Speech perception score (%) • Speech reception threshold (SRT in dB)

  15. Binmodal (CI/HA) hearing under quiet condition

  16. Comparison of speech perception sores in three conditions (HA, CI, CI/HA) 100 90 HA * * CI 80 70 CI/HA 60 * 50 40 * 30 * 20 10 0 90 35 40 45 50 55 60 65 70 75 80 85 (dB) * * * * * * * * * 100 * * * * 90 * * * * * * 80 * * 70 * 60 * 50 40 30 20 10 0 35 45 50 55 60 65 70 75 80 85 90 40 (dB)

  17. Correct % for mono-syllabic words in binaural and monaural conditions (CI/HA, CI-, HA-alone) (CI/CI, CI alone) (%) (%)

  18. Speech reception score (%) Speech reception threshold (dB) Two parameters for speech perception tests

  19. Speech reception threshold (SRT) for HINT sentences under quiet condition Six bimodal (CI/HA) subjects Two bilateral CI subjects dB(A) dB(A) *

  20. S HA CI Sound from front Summary for speech perception in quiet- Summation effect - Both speech perception score (%) and reception threshold (SRT) were better in listening with two ears than listening with CI alone condition. If SRT is better in 2dB, it corresponds to 10 15% better speech perception.

  21. Binaural hearing with CI/HA or CI/CI 3) Speech perception in noise a) Noise from front - examination for bilateral unmasking (squelch) effect -

  22. Binaural hearing (CI/HA) under noisy circumstance

  23. Speech perception scores (%) under the noise from front ** % 100 80 60 S N 40 20 0 HA CI CI Quiet CI Noise CI/HA Noise CI/HA Quiet Sound and Noise from front Binaural unmasking (squelch) effect Speech Sound: 65dBSPL Multi-talker noise: 60dBSPL

  24. Hearing in noise test (HINT) in binaural hearing subjects ○ ○ ○ ○ ○ ● ○ S N ● ● ○ ○ ○ ● ○ ○ ● ● ● ● ● ● ● ● ● HA CI Sound and Noise from front 1 4 6 8 1 2 10 12 14 18 20 16 13 17 19 1 1 3 5 7 9 11 1 15 Intensity of noise (dB) • Speech Sound: 65dB • Multi-talker noise with variable intensities at 2 dB steps.

  25. S/N ratio (dB) * P=0.04 HINT under the noise and speech from the front S/N ratio (dB) Binaural performance was better or as good as performance with the better ear alone under the condition with the speech and noise from front: • binaural unmasking (squelch) effect !!

  26. Binaural hearing with CI/HA or CI/CI 3) Speech perception in noise b) Noise from different directions - examination for head shadow effect -

  27. Monaural hearing under the noise from right or left S/N (dB) S N S S/N (dB) CI CI CI CI Noise from Rt Noise from Lt N “ Head shadow advantage”

  28. Binaural hearing (CI/HA) under the noise from three directions * S/N (dB) N N N * S CI HA For noise on the left or right side, binaural performance can utilize “Head shadow advantage”.

  29. S/N (dB) N N N S CI CI Binaural hearing (CI/CI) under the noise from three directions For noise on the left or right side, binaural performance can utilize “Head shadow advantage”.

  30. Karaoke bar in Osaka Conclusion -2- For the binaural hearing under the noise condition “the head shadow advantage” was large, while “binaural unmasking effect” contributed little.

  31. END OF PRESENTATION

  32. Auditory and visual information processing in auditory cortical areas of cochlear implant users． - PET activation study -

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