Publications by authors named "Cas Smits"

59 Publications

Binaural summation, binaural unmasking and fluctuating masker benefit in bimodal and bilateral adult cochlear implant users.

Cochlear Implants Int 2021 Apr 8:1-12. Epub 2021 Apr 8.

Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology - Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam, Netherlands.

Objectives: The number of bilateral adult cochlear implant (CI) users and bimodal CI users is expanding worldwide. The addition of a hearing aid (HA) in the contralateral non-implanted ear (bimodal) or a second CI (bilateral) can provide CI users with some of the benefits associated with listening with two ears. Our was to examine whether bilateral and bimodal CI users demonstrate binaural summation, binaural unmasking and a fluctuating masker benefit.

Methods: Direct audio input was used to present stimuli to 10 bilateral and 10 bimodal Cochlear CI users. Speech recognition in noise (speech reception threshold, SRT) was assessed monaurally, diotically (identical signals in both devices) and dichotically (antiphasic speech) with different masking noises (steady-state and interrupted), using the digits-in-noise test.

Results: Bilateral CI users demonstrated a trend towards better SRTs with both CIs than with one CI. Bimodal CI users showed no difference between the bimodal SRT and the SRT for CI alone. No significant differences in SRT were found between the diotic and dichotic conditions for either group. Analyses of electrodograms created from bilateral stimuli demonstrated that substantial parts of the interaural speech cues were preserved in the Advanced Combination Encoder, an n-of-m channel selection speech coding strategy, used by the CI users. Speech recognition in noise was significantly better with interrupted noise than with steady-state masking noise for both bilateral and bimodal CI users.

Conclusion: Bilateral CI users demonstrated a trend towards binaural summation, but bimodal CI users did not. No binaural unmasking was demonstrated for either group of CI users. A large fluctuating masker benefit was found in both bilateral and bimodal CI users.
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http://dx.doi.org/10.1080/14670100.2021.1894686DOI Listing
April 2021

Cochlear Implant Magnet Dislocation: Simulations and Measurements of Force and Torque at 1.5T Magnetic Resonance Imaging.

Ear Hear 2021 Mar 2. Epub 2021 Mar 2.

Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Objectives: Dislocation of the magnet inside the implanted component of a cochlear implant (CI) can be a serious risk for patients undergoing a magnetic resonance imaging (MRI) exam. CI manufacturers aim to reduce this risk either via the design of the implant magnet or magnet housing, or by advising a compression bandage and cover over the magnet. The aim of this study is to measure forces and torque on the magnet for different CI models and assess the effectiveness of the design and preventative measures on the probability of magnet dislocation.

Design: Six CI models from four manufacturers covering all the current CI brands were included. Each model was positioned on a polystyrene head with compression bandage and magnet cover according to the recommendations of the manufacturer and tested for dislocation in a 1.5T whole-body MRI system. In addition, measurements of the displacement force in front of the MRI scanner and torque at the MRI scanner isocenter were obtained.

Results: Chance of CI magnet dislocation was observed for two CI models. The design of the magnet or magnet housing of the other models proved sufficient to prevent displacement of the magnet. The main cause for magnet dislocation was found to be the rotational force resulting from the torque experienced inside the magnet bore, which ranges from 2.4 to 16.2 N between the models, with the displacement force being lower, ranging from 1.0 to 1.8 N.

Conclusions: In vitro testing shows that two CI models are prone to the risk of magnet dislocation. In these CI models, preparation before MRI with special compression bandage and a stiff cover are of importance. But these do not eliminate the risk of pain and dislocation requiring patient consulting before an MRI exam. Newer models show a better design resulting in a significantly reduced risk of magnet dislocation.
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http://dx.doi.org/10.1097/AUD.0000000000001013DOI Listing
March 2021

Association between Speech Recognition in Noise and Risk Factors of Cardiovascular Disease.

Audiol Neurootol 2021 Mar 2:1-10. Epub 2021 Mar 2.

Department of Otolaryngology-Head and Neck surgery, Section Ear and Hearing, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Introduction: Risk factors for cardiovascular disease (CVD) are associated with sensorineural hearing loss. CVD risk factors are known to cluster and interact, thereby increasing the cumulative risk for CVD. Previously, using the database of the Netherlands Longitudinal Study on Hearing (NL-SH), an association was found between a history of smoking and an increased decline in speech recognition in noise over 10 years of follow-up. Prospectively limited data are available on the association between CVD risk factors, interactions of these risk factors, and hearing loss. In this study, data from the NL-SH were used to study the association between CVD risk factors and speech recognition in noise longitudinally.

Methods: Baseline, 5-year, and 10-year follow-up data of the NL-SH were included. The NL-SH is a web-based prospective cohort study which started in 2006. Participants were aged 18-70 years at baseline. Speech recognition in noise was determined with an online digit-triplet speech-in-noise test. In addition, participants completed online questionnaires on demographic, lifestyle, and health-related characteristics. The association of the ability to recognize speech in noise with CVD risk factors (i.e., obesity, rheumatoid arthritis [RA], hypertension, diabetes mellitus, and dyslipidemia) was analyzed longitudinally. We also analyzed the interaction between these risk factors (including age, sex, and history of smoking) and speech recognition in noise.

Results: None of the CVD risk factors or interactions of 2 CVD risk factors was significantly associated with a decline in SRT over time. Obesity (p = 0.016), RA (p = 0.027), and hypertension (p = 0.044) were associated with overall higher (more unfavorable) SRTs. No overall interactions between CVD risk factors were found.

Conclusion: Obesity, RA, and hypertension were overall associated with a higher SRT, but no longitudinal associations between these or other CVD factors with SRTs were found. Also, no interactions between 2 CVD risk factors and SRTs were found. Although no longitudinal associations between CVD risk factors and decline in SRTs were found, clinicians should be alert about the concurrent association between CVD risk factors and hearing loss.
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http://dx.doi.org/10.1159/000513551DOI Listing
March 2021

Approaches to mathematical modeling of context effects in sentence recognition.

J Acoust Soc Am 2021 Feb;149(2):1371

Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, Netherlands.

Probabilistic models to quantify context effects in speech recognition have proven their value in audiology. Boothroyd and Nittrouer [J. Acoust. Soc. Am. 84, 101-114 (1988)] introduced a model with the j-factor and k-factor as context parameters. Later, Bronkhorst, Bosman, and Smoorenburg [J. Acoust. Soc. Am. 93, 499-509 (1993)] proposed an elaborated mathematical model to quantify context effects. The present study explores existing models and proposes a new model to quantify the effect of context in sentence recognition. The effect of context is modeled by parameters that represent the change in the probability that a certain number of words in a sentence are correctly recognized. Data from two studies using a Dutch sentence-in-noise test were analyzed. The most accurate fit was obtained when using signal-to-noise ratio-dependent context parameters. Furthermore, reducing the number of context parameters from five to one had only a small effect on the goodness of fit for the present context model. An analysis of the relationships between context parameters from the different models showed that for a change in word recognition probability, the different context parameters can change in opposite directions, suggesting opposite effects of sentence context. This demonstrates the importance of controlling for the recognition probability of words in isolation when comparing the use of sentence context between different groups of listeners.
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http://dx.doi.org/10.1121/10.0003580DOI Listing
February 2021

Rationale, Theoretical Underpinnings, and Design of HEAR-aware: Providing Adults With Hearing Loss With Tailored Support to Self-Manage Their Hearing Problems via a Smartphone App, as an Alternative to Hearing Aids.

Am J Audiol 2020 Sep 18;29(3S):648-660. Epub 2020 Sep 18.

Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health Research Institute, the Netherlands.

Purpose An alarming two thirds of adults aged 50 years or over with hearing impairment who could benefit from hearing aids do not own any, leaving these adults with no support to self-manage their hearing problems. In the HEAR-aware project, it is hypothesized that self-management can be facilitated via a smartphone app if its educational content is tailored to a person's dynamic stage of readiness to take action on their hearing (stage of change) and to a person's dynamic acoustical situations (as measured via a wearable microphone) and associated challenges (as captured via ecological momentary assessment). As such, the HEAR-aware app would be an ecological momentary intervention. This research note describes the rationale and theoretical underpinnings of the app, as well as the rationale for planning a series of studies to develop and evaluate it. Study Designs After a preparatory phase, Study 1 includes qualitative group interviews to assess user needs. Next, a creative session will be held, in which all stakeholders involved will work toward a specified version of the app. Subsequently, prototypes of the app will be developed and pilot-tested (Pilot Studies 2A and 2B). Users' usage and ratings (usability and quality indicators) of the app's elements will be examined and processed in the app. Lastly, the effectiveness of the app's final version will be examined in a randomized controlled trial (Study 3). Discussion The project's merits and challenges will be discussed.
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http://dx.doi.org/10.1044/2020_AJA-19-00079DOI Listing
September 2020

Collaboration Around Rare Bone Diseases Leads to the Unique Organizational Incentive of the Amsterdam Bone Center.

Front Endocrinol (Lausanne) 2020 11;11:481. Epub 2020 Aug 11.

Amsterdam UMC, Department of Oral and MaxilloFacial Surgery/Oral Pathology, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam, Netherlands.

In the field of rare bone diseases in particular, a broad care team of specialists embedded in multidisciplinary clinical and research environment is essential to generate new therapeutic solutions and approaches to care. Collaboration among clinical and research departments within a University Medical Center is often difficult to establish, and may be hindered by competition and non-equivalent cooperation inherent in a hierarchical structure. Here we describe the "collaborative organizational model" of the Amsterdam Bone Center (ABC), which emerged from and benefited the rare bone disease team. This team is often confronted with pathologically complex and under-investigated diseases. We describe the benefits of this model that still guarantees the autonomy of each team member, but combines and focuses our collective expertise on a clear shared goal, enabling us to capture synergistic and innovative opportunities for the patient, while avoiding self-interest and possible harmful competition.
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http://dx.doi.org/10.3389/fendo.2020.00481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431598PMC
August 2020

Pure-tone audiometry without bone-conduction thresholds: using the digits-in-noise test to detect conductive hearing loss.

Int J Audiol 2020 10 1;59(10):801-808. Epub 2020 Jul 1.

Department of Speech-Language Pathology and Audiology, University of Pretoria, Gauteng, South Africa.

COVID-19 has been prohibitive to traditional audiological services. No- or low-touch audiological assessment outside a sound-booth precludes test batteries including bone conduction audiometry. This study investigated whether conductive hearing loss (CHL) can be differentiated from sensorineural hearing loss (SNHL) using pure-tone air conduction audiometry and a digits-in-noise (DIN) test. A retrospective sample was analysed using binomial logistic regressions, which determined the effects of pure tone thresholds or averages, speech recognition threshold (SRT), and age on the likelihood that participants had CHL or bilateral SNHL. Data of 158 adults with bilateral SNHL ( = 122; PTA > 25 dB HL bilaterally) or CHL ( = 36; air conduction PTA > 25 dB HL and ≥20 dB air bone gap in the affected ears) were included. The model which best discriminated between CHL and bilateral SNHL used low-frequency pure-tone average (PTA), diotic DIN SRT, and age with an area under the ROC curve of 0.98 and sensitivity and specificity of 97.2 and 93.4%, respectively. CHL can be accurately distinguished from SNHL using pure-tone air conduction audiometry and a diotic DIN. Restrictions on traditional audiological assessment due to COVID-19 require lower touch audiological care which reduces infection risk.
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http://dx.doi.org/10.1080/14992027.2020.1783585DOI Listing
October 2020

Characteristics and Help-Seeking Behavior of People Failing a Smart Device Self-Test for Hearing.

Am J Audiol 2020 Sep 8;29(3):365-374. Epub 2020 Jun 8.

Department of Speech-Language Pathology and Audiology, University of Pretoria, Gauteng, South Africa.

Purpose This study investigated user characteristics, help-seeking behavior, and follow-up actions of people who failed an app-based digits-in-noise hearing screening test, considering their stage of change. Method Test and user characteristics of 3,092 listeners who failed the test were retrospectively analyzed. A posttest survey determining follow-up (verb) actions was sent to listeners who failed the test ( = 1,007), of which 59 responded. Results The majority of listeners were in the precontemplation stage (75.5%). Age and stage of change were significant ( < .05) predictors of the digits-in-noise speech recognition threshold (DIN SRT). Listeners in the precontemplation stage were significantly younger than in other stages ( < .05). Posttest survey response rate was low (5.9%). Of those, most (82.4%) did not think they had a hearing loss. Only 13.6% followed up with an audiologist. Conclusion Older people presented with poorer DIN SRTs and were typically in a more advanced stage of change. The majority of those who did not follow up after failing the screening test did not believe they had a hearing loss. A combination of factors, including poor DIN SRT, older age, and a more advanced stage of change inclined participants to follow up with audiological care.
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http://dx.doi.org/10.1044/2020_AJA-19-00098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842847PMC
September 2020

Relationship Between Speech Recognition in Quiet and Noise and Fitting Parameters, Impedances and ECAP Thresholds in Adult Cochlear Implant Users.

Ear Hear 2020 Jul/Aug;41(4):935-947

Otolaryngology - Head and Neck Surgery, Ear and Hearing, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.

Objectives: The objective of this study was to identify parameters which are related to speech recognition in quiet and in noise of cochlear implant (CI) users. These parameters may be important to improve current fitting practices.

Design: Adult CI users who visited the Amsterdam UMC, location VUmc, for their annual follow-up between January 2015 and December 2017 were retrospectively identified. After applying inclusion criteria, the final study population consisted of 138 postlingually deaf adult Cochlear CI users. Prediction models were built with speech recognition in quiet and in noise as the outcome measures, and aided sound field thresholds, and parameters related to fitting (i.e., T and C levels, dynamic range [DR]), evoked compound action potential thresholds and impedances as the independent variables. A total of 33 parameters were considered. Separate analyses were performed for postlingually deafened CI users with late onset (LO) and CI users with early onset (EO) of severe hearing impairment.

Results: Speech recognition in quiet was not significantly different between the LO and EO groups. Speech recognition in noise was better for the LO group compared with the EO group. For CI users in the LO group, mean aided thresholds, mean electrical DR, and measures to express the impedance profile across the electrode array were identified as predictors of speech recognition in quiet and in noise. For CI users in the EO group, the mean T level appeared to be a significant predictor in the models for speech recognition in quiet and in noise, such that CI users with elevated T levels had worse speech recognition in quiet and in noise.

Conclusions: Significant parameters related to speech recognition in quiet and in noise were identified: aided thresholds, electrical DR, T levels, and impedance profiles. The results of this study are consistent with previous study findings and may guide audiologists in their fitting practices to improve the performance of CI users. The best performance was found for CI users with aided thresholds around the target level of 25 dB HL, and an electrical DR between 40 and 60 CL. However, adjustments of T and/or C levels to obtain aided thresholds around the target level and the preferred DR may not always be acceptable for individual CI users. Finally, clinicians should pay attention to profiles of impedances other than a flat profile with mild variations.
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http://dx.doi.org/10.1097/AUD.0000000000000814DOI Listing
November 2019

Mobile applications to detect hearing impairment: opportunities and challenges.

Bull World Health Organ 2019 Oct 3;97(10):717-718. Epub 2019 Sep 3.

Communication Sciences Research Center, Cincinnati Children's Hospital, Ohio, United States of America.

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http://dx.doi.org/10.2471/BLT.18.227728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796675PMC
October 2019

Improving Sensitivity of the Digits-In-Noise Test Using Antiphasic Stimuli.

Ear Hear 2020 Mar/Apr;41(2):442-450

Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.

Objectives: The digits-in-noise test (DIN) has become increasingly popular as a consumer-based method to screen for hearing loss. Current versions of all DINs either test ears monaurally or present identical stimuli binaurally (i.e., diotic noise and speech, NoSo). Unfortunately, presentation of identical stimuli to each ear inhibits detection of unilateral sensorineural hearing loss (SNHL), and neither diotic nor monaural presentation sensitively detects conductive hearing loss (CHL). After an earlier finding of enhanced sensitivity in normally hearing listeners, this study tested the hypothesis that interaural antiphasic digit presentation (NoSπ) would improve sensitivity to hearing loss caused by unilateral or asymmetric SNHL, symmetric SNHL, or CHL.

Design: This cross-sectional study recruited adults (18 to 84 years) with various levels of hearing based on a 4-frequency pure-tone average (PTA) at 0.5, 1, 2, and 4 kHz. The study sample was comprised of listeners with normal hearing (n = 41; PTA ≤ 25 dB HL in both ears), symmetric SNHL (n = 57; PTA > 25 dB HL), unilateral or asymmetric SNHL (n = 24; PTA > 25 dB HL in the poorer ear), and CHL (n = 23; PTA > 25 dB HL and PTA air-bone gap ≥ 20 dB HL in the poorer ear). Antiphasic and diotic speech reception thresholds (SRTs) were compared using a repeated-measures design.

Results: Antiphasic DIN was significantly more sensitive to all three forms of hearing loss than the diotic DIN. SRT test-retest reliability was high for all tests (intraclass correlation coefficient r > 0.89). Area under the receiver operating characteristics curve for detection of hearing loss (>25 dB HL) was higher for antiphasic DIN (0.94) than for diotic DIN (0.77) presentation. After correcting for age, PTA of listeners with normal hearing or symmetric SNHL was more strongly correlated with antiphasic (rpartial[96] = 0.69) than diotic (rpartial = 0.54) SRTs. Slope of fitted regression lines predicting SRT from PTA was significantly steeper for antiphasic than diotic DIN. For listeners with normal hearing or CHL, antiphasic SRTs were more strongly correlated with PTA (rpartial[62] = 0.92) than diotic SRTs (rpartial[62] = 0.64). Slope of the regression line with PTA was also significantly steeper for antiphasic than diotic DIN. The severity of asymmetric hearing loss (poorer ear PTA) was unrelated to SRT. No effect of self-reported English competence on either antiphasic or diotic DIN among the mixed first-language participants was observed.

Conclusions: Antiphasic digit presentation markedly improved the sensitivity of the DIN test to detect SNHL, either symmetric or asymmetric, while keeping test duration to a minimum by testing binaurally. In addition, the antiphasic DIN was able to detect CHL, a shortcoming of previous monaural or binaurally diotic DIN versions. The antiphasic DIN is thus a powerful tool for population-based screening. This enhanced functionality combined with smartphone delivery could make the antiphasic DIN suitable as a primary screen that is accessible to a large global audience.
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http://dx.doi.org/10.1097/AUD.0000000000000775DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015780PMC
August 2019

10-Year Follow-Up Results of The Netherlands Longitudinal Study on Hearing: Trends of Longitudinal Change in Speech Recognition in Noise.

Ear Hear 2020 May/Jun;41(3):491-499

Department of Otolaryngology/Head and Neck Surgery, Section Ear & Hearing, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.

Objectives: Previous findings of longitudinal cohort studies indicate that acceleration in age-related hearing decline may occur. Five-year follow-up data of the Netherlands Longitudinal Study on Hearing (NL-SH) showed that around the age of 50 years, the decline in speech recognition in noise accelerates compared with the change in hearing in younger participants. Other longitudinal studies confirm an accelerated loss in speech recognition in noise but mostly use older age groups as a reference. In the present study, we determined the change in speech recognition in noise over a period of 10 years in participants aged 18 to 70 years at baseline. We additionally investigated the effects of age, sex, educational level, history of tobacco smoking, and alcohol use on the decline of speech recognition in noise.

Design: Baseline (T0), 5-year (T1), and 10-year (T2) follow-up data of the NL-SH collected until May 2017 were included. The NL-SH is a web-based prospective cohort study which started in 2006. Central to the NL-SH is the National Hearing test (NHT) which was administered to the participants at all three measurement rounds. The NHT uses three-digit sequences which are presented in a background of stationary noise. The listener is asked to enter the digits using the computer keyboard. The outcome of the NHT is the speech reception threshold in noise (SRT) (i.e., the signal to noise ratio where a listener recognizes 50% of the digit triplets correctly). In addition to the NHT, participants completed online questionnaires on demographic, lifestyle, and health-related characteristics at T0, T1, and T2. A linear mixed model was used for the analysis of longitudinal changes in SRT.

Results: Data of 1349 participants were included. At the start of the study, the mean age of the participants was 45 years (SD 13 years) and 61% of the participants were categorized as having good hearing ability in noise. SRTs significantly increased (worsened) over 10 years (p < 0.001). After adjustment for age, sex, and a history of tobacco smoking, the mean decline over 10 years was 0.89 dB signal to noise ratio. The decline in speech recognition in noise was significantly larger in groups aged 51 to 60 and 61 to 70 years compared with younger age groups (18 to 30, 31 to 40, and 41 to 50 years) (p < 0.001). Speech recognition in noise in participants with a history of smoking declined significantly faster during the 10-year follow-up interval (p = 0.003). Sex, educational level, and alcohol use did not appear to influence the decline of speech recognition in noise.

Conclusions: This study indicated that speech recognition in noise declines significantly over a 10-year follow-up period in adults aged 18 to 70 years at baseline. It is the first longitudinal study with a 10-year follow-up to reveal that the increased rate of decline in speech recognition ability in noise already starts at the age of 50 years. Having a history of tobacco smoking increases the decline of speech recognition in noise. Hearing health care professionals should be aware of an accelerated decline of speech recognition in noise in adults aged 50 years and over.
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http://dx.doi.org/10.1097/AUD.0000000000000780DOI Listing
August 2019

Effect of cochlear implant n-of-m strategy on signal-to-noise ratio below which noise hinders speech recognition.

J Acoust Soc Am 2019 05;145(5):EL417

Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam,

Speech recognition was measured in 24 normal-hearing subjects for unprocessed speech and for speech processed by a cochlear implant Advanced Combination Encoder (ACE) coding strategy in quiet and at various signal-to noise ratios (SNRs). All signals were low- or high-pass filtered to avoid ceiling effects. Surprisingly, speech recognition performance plateaus at approximately 22 dB SNR for both speech types, implying that ACE processing has no effect on the upper limit of the effective SNR range. Speech recognition improved significantly above 15 dB SNR, suggesting that the upper limit used in the Speech Intelligibility Index should be reconsidered.
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http://dx.doi.org/10.1121/1.5107430DOI Listing
May 2019

[MRI in patients with a cochlear implant: how to proceed].

Ned Tijdschr Geneeskd 2019 05 3;163. Epub 2019 May 3.

Amsterdam UMC, locatie VUmc, afd. Keel-, Neus-, Oorheelkunde en Hoofd-Halschirurgie, Amsterdam.

MRI in patients with a cochlear implant: how to proceed An increasing number of cochlear implantations are being performed for the treatment of severe sensorineural hearing loss. Implant-associated complications leading to malfunction are of major importance since patients are strongly dependent on their cochlear implant (CI) for communication. Here we describe two patients with a CI who underwent MRI for diagnostic purposes and which resulted in dislocation of the internal CI magnet. CIs are generally non-compatible with MRI. However, by taking precautionary measures it is possible to perform MRI under certain conditions, depending on the type of CI and the magnetic flux density of the MRI scanner. When using 1.5 Tesla equipment, a firm bandage is required to prevent the CI magnet from dislocating. If 3 Tesla equipment is used, almost all CIs must be surgically removed prior to scanning. Despite these precautionary measures, the risk of complications still exists. Patient, referring physician and radiologist should be aware of the risks and disadvantages of performing MRI in patients with a CI.
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May 2019

Longitudinal Relationships Between Decline in Speech-in-Noise Recognition Ability and Cognitive Functioning: The Longitudinal Aging Study Amsterdam.

J Speech Lang Hear Res 2019 04;62(4S):1167-1187

Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology - Head and Neck surgery, Ear & Hearing, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands.

Purpose Various directional hypotheses for the observed links between aging, hearing, and cognition have been proposed: (a) cognitive load on perception hypothesis, (b) information degradation hypothesis, (c) sensory deprivation hypothesis, and (d) common cause hypothesis. Supporting evidence for all 4 hypotheses has been reported. No studies have modeled the corresponding 4 causal pathways into 1 single model, which would be required to evidence that multiple directional hypotheses apply. The aim of the current study was to tease out which pathways apply for 5 different cognitive measures. Method Data from 1,029 respondents of the Longitudinal Aging Study Amsterdam were used spanning a maximum follow-up of 7 years (3 measurements). Speech-in-noise recognition ability (digit triplet speech-in-noise test) was included as a measure of auditory function. Cognitive measures included global cognitive functioning, fluid intelligence, information processing speed, and verbal memory (immediate recall and retention). Bivariate dual change score modeling was used to model the causal pathways between hearing, cognition, and baseline age. Results For information processing speed, global cognitive functioning, fluid intelligence, and memory-immediate recall, all pathways except for the sensory deprivation pathway were supported. For memory-retention, only the common cause and the sensory deprivation pathways were supported. Conclusions Causal pathways corresponding to all 4 hypotheses were supported. Support for the common cause hypothesis, the information degradation hypothesis, and the cognitive load on perception hypotheses was found for 4 of 5 cognitive measures. This was unexpected in some cases (e.g., support for the information degradation pathway for cognitive measures that do not rely on auditory stimuli). The sensory deprivation pathway that emerged for memory-retention might point toward processes related to early stages of dementia. In summary, the results show that the links between decline in auditory function, cognition, and aging are complex and most likely are captured by pathways belonging to various directional hypotheses.
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http://dx.doi.org/10.1044/2018_JSLHR-H-ASCC7-18-0120DOI Listing
April 2019

Our experience with home self-assessment of speech recognition in the care pathway of 10 newly implanted adult cochlear implant users.

Clin Otolaryngol 2019 05 6;44(3):446-451. Epub 2019 Mar 6.

Otolaryngology - Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

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http://dx.doi.org/10.1111/coa.13307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850507PMC
May 2019

A Smartphone National Hearing Test: Performance and Characteristics of Users.

Am J Audiol 2018 Nov;27(3S):448-454

Department of Otolaryngology/Head & Neck Surgery, Section Ear & Hearing, and Amsterdam Public Health Research Institute, VU University Medical Center, the Netherlands.

Purpose: The smartphone digits-in-noise hearing test, called hearZA, was made available as a self-test in South Africa in March 2016. This study determined characteristics and test performance of the listeners who took the test.

Method: A retrospective analysis of 24,072 persons who completed a test between March 2016 and August 2017 was conducted. User characteristics, including age, English-speaking competence, and self-reported hearing difficulty, were analyzed. Regression analyses were conducted to determine predictors of the speech reception threshold.

Results: Overall referral rate of the hearZA test was 22.4%, and 37% of these reported a known hearing difficulty. Age distributions showed that 33.2% of listeners were ages 30 years and younger, 40.5% were between ages 31 and 50 years, and 26.4% were older than 50 years. Age, self-reported English-speaking competence, and self-reported hearing difficulty were significant predictors of the speech reception threshold.

Conclusions: High test uptake, particularly among younger users, and high overall referral rate indicates that the hearZA app addresses a public health need. The test also reaches target audiences, including those with self-reported hearing difficulty and those with normal hearing who should monitor their hearing ability.
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http://dx.doi.org/10.1044/2018_AJA-IMIA3-18-0016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437705PMC
November 2018

Empowering Senior Cochlear Implant Users at Home via a Tablet Computer Application.

Am J Audiol 2018 Nov;27(3S):417-430

Cochlear Technology Center, Mechelen, Belgium.

Purpose: The introduction of connectivity technologies in hearing implants allows new ways to support cochlear implant (CI) users remotely. Some functionalities and services that are traditionally only available in an in-clinic care model can now also be accessed at home. This study explores the feasibility of a prototype of a tablet computer application (MyHearingApp [MHA]) in a group of senior experienced CI users at home, evaluating usability and user motivation.

Method: Based on user feedback, a tablet computer application (MHA) for the Cochlear Nucleus 6 CP910 sound processor was designed implementing six different functionalities: (a) My Hearing Tests, (b) My Environment, (c) My Hearing Journey, (d) Tip of the Day, (e) Recipient Portal, and (f) Program Use and Events. The clinical evaluation design was a prospective study of the MHA in 16 senior experienced CI users. During 4 weeks, participants could freely explore the functionalities. At the end, the usability and their motivation for uptake and adherence were measured using a baseline and follow-up questionnaire.

Results: Based on the System Usability Score (as part of the follow-up questionnaire), a good level of usability was indicated (M = 75.6, range: 62.5-92.5, SD = 8.6). The ability to perform hearing tests at home is ranked as the most relevant functionality within the MHA. According to the Intrinsic Motivation Inventory (Deci, Eghrari, Patrick, & Leone, 1994) questionnaire (as part of the follow-up questionnaire), participants reported high levels of interest and enjoyment, found themselves competent, and did not experience pressure while working with the app.

Conclusions: This study evaluated a tablet computer application (MHA) for experienced senior CI users by means of a prospective design, which provided novel insights into delivering CI care into the home of the CI user. The user feedback from this small-scale study suggests that the participants are open to take more responsibility for and to become a more active actor in their own hearing care, if only this is facilitated with the right tools. This may foster the evolution from a clinic-led to a more patient-centered care model, where CI users feel more empowered in the self-management of their hearing implant device.
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http://dx.doi.org/10.1044/2018_AJA-IMIA3-18-0014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018449PMC
November 2018

Assessment of speech recognition abilities in quiet and in noise: a comparison between self-administered home testing and testing in the clinic for adult cochlear implant users.

Int J Audiol 2018 11 27;57(11):872-880. Epub 2018 Sep 27.

a Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology - Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health research institute , De Boelelaan 1117 , Amsterdam , Netherlands.

Self speech recognition tests in quiet and noise at home are compared to the standard tests performed in the clinic. Potential effects of stimuli presentation modes (loudspeaker or audio cable) and assessment (clinician or self-assessment at home) on test results were investigated. Speech recognition in quiet was assessed using the standard Dutch test with monosyllabic words. Speech recognition in noise was assessed with the digits-in-noise test. Sixteen experienced CI users (aged between 44 and 83 years) participated. No significant difference was observed in speech recognition in quiet between and presentation modes. Speech recognition in noise was significantly better with the audio cable than with the loudspeaker. There was no significant difference in speech recognition in quiet at 65 dB and in speech recognition in noise between self-assessment at home and testing in the clinic. At 55 dB, speech recognition assessed at home was slightly but significantly better than that assessed in the clinic. The results demonstrate that it is feasible for experienced CI users to perform self-administered speech recognition tests at home. Self-assessment by CI users of speech recognition in quiet and noise within the home environment could serve as an alternative to the tests performed in the clinic.
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http://dx.doi.org/10.1080/14992027.2018.1506168DOI Listing
November 2018

Evaluating a smartphone digits-in-noise test as part of the audiometric test battery.

S Afr J Commun Disord 2018 May 21;65(1):e1-e6. Epub 2018 May 21.

Department of Speech-Language Pathology and Audiology, University of Pretoria.

Background:  Speech-in-noise tests have become a valuable part of the audiometric test battery providing an indication of a listener's ability to function in background noise. A simple digits-in-noise (DIN) test could be valuable to support diagnostic hearing assessments, hearing aid fittings and counselling for both paediatric and adult populations. Objective: The objective of this study was to evaluate the South African English smartphone DIN test's performance as part of the audiometric test battery. Design: This descriptive study evaluated 109 adult subjects (43 male and 66 female subjects) with and without sensorineural hearing loss by comparing pure-tone air conduction thresholds, speech recognition monaural performance scores (SRS dB) and the DIN speech reception threshold (SRT). An additional nine adult hearing aid users (four male and five female subjects) were included in a subset to determine aided and unaided DIN SRTs. Results: The DIN SRT is strongly associated with the best ear 4 frequency pure-tone average (4FPTA) (rs = 0.81) and maximum SRS dB (r = 0.72). The DIN test had high sensitivity and specificity to identify abnormal pure-tone (0.88 and 0.88, respectively) and SRS dB (0.76 and 0.88, respectively) results. There was a mean signal-to-noise ratio (SNR) improvement in the aided condition that demonstrated an overall benefit of 0.84 SNR dB. Conclusion: The DIN SRT was significantly correlated with the best ear 4FPTA and maximum SRS dB. The DIN SRT provides a useful measure of speech recognition in noise that can evaluate hearing aid fittings, manage counselling and hearing expectations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968873PMC
http://dx.doi.org/10.4102/sajcd.v65i1.574DOI Listing
May 2018

Speech Recognition Abilities in Normal-Hearing Children 4 to 12 Years of Age in Stationary and Interrupted Noise.

Ear Hear 2018 Nov/Dec;39(6):1091-1103

Department of Otolaryngology-Head and Neck Surgery, Section Ear and Hearing, VU University Medical Center, Amsterdam, The Netherlands.

Objectives: The main purpose of this study was to examine developmental effects for speech recognition in noise abilities for normal-hearing children in several listening conditions, relevant for daily life. Our aim was to study the auditory component in these listening abilities by using a test that was designed to minimize the dependency on nonauditory factors, the digits-in-noise (DIN) test. Secondary aims were to examine the feasibility of the DIN test for children, and to establish age-dependent normative data for diotic and dichotic listening conditions in both stationary and interrupted noise.

Design: In experiment 1, a newly designed pediatric DIN (pDIN) test was compared with the standard DIN test. Major differences with the DIN test are that the pDIN test uses 79% correct instead of 50% correct as a target point, single digits (except 0) instead of triplets, and animations in the test procedure. In this experiment, 43 normal-hearing subjects between 4 and 12 years of age and 10 adult subjects participated. The authors measured the monaural speech reception threshold for both DIN test and pDIN test using headphones. Experiment 2 used the standard DIN test to measure speech reception thresholds in noise in 112 normal-hearing children between 4 and 12 years of age and 33 adults. The DIN test was applied using headphones in stationary and interrupted noise, and in diotic and dichotic conditions, to study also binaural unmasking and the benefit of listening in the gaps.

Results: Most children could reliably do both pDIN test and DIN test, and measurement errors for the pDIN test were comparable between children and adults. There was no significant difference between the score for the pDIN test and that of the DIN test. Speech recognition scores increase with age for all conditions tested, and performance is adult-like by 10 to 12 years of age in stationary noise but not interrupted noise. The youngest, 4-year-old children have speech reception thresholds 3 to 7 dB less favorable than adults, depending on test conditions. The authors found significant age effects on binaural unmasking and fluctuating masker benefit, even after correction for the lower baseline speech reception threshold of adults in stationary noise.

Conclusions: Speech recognition in noise abilities develop well into adolescence, and young children need a more favorable signal-to-noise ratio than adults for all listening conditions. Speech recognition abilities in children in stationary and interrupted noise can accurately and reliably be tested using the DIN test. A pediatric version of the test was shown to be unnecessary. Normative data were established for the DIN test in stationary and fluctuating maskers, and in diotic and dichotic conditions. The DIN test can thus be used to test speech recognition abilities for normal-hearing children from the age of 4 years and older.
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http://dx.doi.org/10.1097/AUD.0000000000000569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7664447PMC
April 2019

Comment on "Sensitivity of the Speech Intelligibility Index to the Assumed Dynamic Range," by Jin et al. (2017).

J Speech Lang Hear Res 2018 01;61(1):186-188

Ear & Hearing, Department of Otolaryngology-Head and Neck Surgery and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands.

Purpose: This letter to the editor is in response to a research note by Jin, Kates, and Arehart (2017), "Sensitivity of the Speech Intelligibility Index to the Assumed Dynamic Range," published in June 2017 by the Journal of Speech, Language, and Hearing Research.

Conclusion: The authors argue that the approach and line of reasoning in the Jin et al. (2017) research note suggest new findings but do not lead to essentially new insights.
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http://dx.doi.org/10.1044/2017_JSLHR-H-17-0271DOI Listing
January 2018

Lexical-Access Ability and Cognitive Predictors of Speech Recognition in Noise in Adult Cochlear Implant Users.

Trends Hear 2017 Jan-Dec;21:2331216517743887

1 Department of Otolaryngology-Head and Neck Surgery, Section Ear & Hearing and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.

Not all of the variance in speech-recognition performance of cochlear implant (CI) users can be explained by biographic and auditory factors. In normal-hearing listeners, linguistic and cognitive factors determine most of speech-in-noise performance. The current study explored specifically the influence of visually measured lexical-access ability compared with other cognitive factors on speech recognition of 24 postlingually deafened CI users. Speech-recognition performance was measured with monosyllables in quiet (consonant-vowel-consonant [CVC]), sentences-in-noise (SIN), and digit-triplets in noise (DIN). In addition to a composite variable of lexical-access ability (LA), measured with a lexical-decision test (LDT) and word-naming task, vocabulary size, working-memory capacity (Reading Span test [RSpan]), and a visual analogue of the SIN test (text reception threshold test) were measured. The DIN test was used to correct for auditory factors in SIN thresholds by taking the difference between SIN and DIN: SRT. Correlation analyses revealed that duration of hearing loss (dHL) was related to SIN thresholds. Better working-memory capacity was related to SIN and SRT scores. LDT reaction time was positively correlated with SRT scores. No significant relationships were found for CVC or DIN scores with the predictor variables. Regression analyses showed that together with dHL, RSpan explained 55% of the variance in SIN thresholds. When controlling for auditory performance, LA, LDT, and RSpan separately explained, together with dHL, respectively 37%, 36%, and 46% of the variance in SRT outcome. The results suggest that poor verbal working-memory capacity and to a lesser extent poor lexical-access ability limit speech-recognition ability in listeners with a CI.
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http://dx.doi.org/10.1177/2331216517743887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721962PMC
January 2019

The South African English Smartphone Digits-in-Noise Hearing Test: Effect of Age, Hearing Loss, and Speaking Competence.

Ear Hear 2018 Jul/Aug;39(4):656-663

Department of Otolaryngology - Head and Neck Surgery, Section Ear and Hearing, and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.

Objectives: This study determined the effect of hearing loss and English-speaking competency on the South African English digits-in-noise hearing test to evaluate its suitability for use across native (N) and non-native (NN) speakers.

Design: A prospective cross-sectional cohort study of N and NN English adults with and without sensorineural hearing loss compared pure-tone air conduction thresholds to the speech reception threshold (SRT) recorded with the smartphone digits-in-noise hearing test. A rating scale was used for NN English listeners' self-reported competence in speaking English. This study consisted of 454 adult listeners (164 male, 290 female; range 16 to 90 years), of whom 337 listeners had a best ear four-frequency pure-tone average (4FPTA; 0.5, 1, 2, and 4 kHz) of ≤25 dB HL.

Results: A linear regression model identified three predictors of the digits-in-noise SRT, namely, 4FPTA, age, and self-reported English-speaking competence. The NN group with poor self-reported English-speaking competence (≤5/10) performed significantly (p < 0.01) poorer than the N and NN (≥6/10) groups on the digits-in-noise test. Screening characteristics of the test improved with separate cutoff values depending on English-speaking competence for the N and NN groups (≥6/10) and NN group alone (≤5/10). Logistic regression models, which include age in the analysis, showed a further improvement in sensitivity and specificity for both groups (area under the receiver operating characteristic curve, 0.962 and 0.903, respectively).

Conclusions: Self-reported English-speaking competence had a significant influence on the SRT obtained with the smartphone digits- in-noise test. A logistic regression approach considering SRT, self-reported English-speaking competence, and age as predictors of best ear 4FPTA >25 dB HL showed that the test can be used as an accurate hearing screening tool for N and NN English speakers. The smartphone digits-in-noise test, therefore, allows testing in a multilingual population familiar with English digits using dynamic cutoff values that can be chosen according to self-reported English-speaking competence and age.
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http://dx.doi.org/10.1097/AUD.0000000000000522DOI Listing
March 2019

Is there evidence for the added value and correct use of manual and automatically switching multimemory hearing devices? A scoping review.

Int J Audiol 2018 03 10;57(3):176-183. Epub 2017 Oct 10.

a Department of Otolaryngology - Head and Neck Surgery, Section Ear & Hearing , and Amsterdam Public Health Research Institute, VU University Medical Center , Amsterdam , The Netherlands and.

Objectives: To review literature on the use of manual and automatically switching multimemory devices by hearing aid and CI recipients, and to investigate if recipients appreciate and adequately use the ability to switch between programmes in various listening environments.

Design: Literature was searched using PubMed, Embase and ISI/Web of Science. Additional studies were identified by screening reference and citation lists, and by contacting experts.

Study Sample: The search yielded 1109 records that were screened on title and abstract. This resulted in the full-text assessment of 37 articles.

Results: Sixteen articles reported on the use of multiple programmes for various listening environments, three articles reported on the use of an automatic switching mode. All studies reported on hearing aid recipients only, no study with CI recipients fulfilled the selection criteria.

Conclusions: Despite the high number of manual and automatically switching multimemory devices sold each year, there are remarkably few studies about the use of multiple programmes or automatic switching modes for various listening environments. No studies were found that examined the accuracy of the use of programmes for specific listening environments. An automatic switching device might be a solution if recipients are not able, or willing, to switch manually between programmes.
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http://dx.doi.org/10.1080/14992027.2017.1385864DOI Listing
March 2018

Improving the Efficiency of Speech-In-Noise Hearing Screening Tests.

Authors:
Cas Smits

Ear Hear 2017 Nov/Dec;38(6):e385-e388

Department of Otolaryngology-Head and Neck Surgery, Section Ear & Hearing, and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.

Objective: Speech-in-noise hearing screening tests have become increasingly popular. These tests follow an adaptive procedure with a fixed number of presentations to estimate the speech reception threshold. The speech reception threshold is compared with an established cutoff signal to noise ratio (SNR) for a pass result or refer result. A fixed SNR procedure was developed to improve the efficiency of speech-in-noise hearing screening tests.

Design: The cutoff SNR is used for all presentations in the fixed-SNR procedure. After each response a reliable test result is given (pass/refer) or an extra stimulus is presented. The efficiency and pass/refer rates between the adaptive procedure and the fixed-SNR procedure were compared.

Results: An average reduction of 67% in the number of presentations can be achieved (from 25 to an average of 8.3 presentations per test).

Conclusions: The fixed-SNR procedure is superior in efficiency to the adaptive procedure while having nearly equal refer and pass rates.
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http://dx.doi.org/10.1097/AUD.0000000000000446DOI Listing
June 2018

Cochlear Implantation in Adults With Asymmetric Hearing Loss: Benefits of Bimodal Stimulation.

Otol Neurotol 2017 07;38(6):e100-e106

*Department of Otolaryngology-Head and Neck Surgery, Section Ear & Hearing, VU University Medical Center †The EMGO Institute for Health and Care Research, VU University, Amsterdam, the Netherlands.

Objective: This study addresses the outcome of cochlear implantation in addition to hearing aid use in patients with asymmetric sensorineural hearing loss.

Study Design: Prospective longitudinal study.

Setting: Tertiary referral center.

Patients: Seven adults with asymmetric sensorineural hearing loss, i.e., less than 30% aided speech recognition in their worst hearing ear and 60 to 85% speech recognition in their best hearing ear. All patients had a postlingual onset of their hearing loss and less than 20 years of auditory deprivation of their worst hearing ear.

Intervention: Cochlear implantation in the functionally deaf ear.

Main Outcome Measures: Speech recognition in quiet, speech recognition in noise, spatial speech recognition, localization abilities, music appreciation, and quality of life. Measurements were performed before cochlear implantation and 3, 6, and 12 months after cochlear implantation.

Results: Before cochlear implantation, the average speech recognition of the ear fitted with a hearing aid was 74%. Cochlear implantation eventually resulted in an average speech recognition of 75%. Bimodal stimulation yielded speech recognition scores of 82, 86, and 88% after 3, 6, and 12 months, respectively. At all time intervals, bimodal stimulation resulted in a significantly better speech recognition as compared with stimulation with only hearing aid or only cochlear implant (CI). Speech recognition in noise and spatial speech recognition significantly improved as well as the ability to localize sounds and the quality of life.

Conclusion: This study demonstrated that patients are able to successfully integrate electrical stimulation with contralateral acoustic amplification and benefit from bimodal stimulation. Therefore, we think that cochlear implantation should be considered in this particular group of patients, even in the presence of substantial residual hearing on the contralateral side.
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http://dx.doi.org/10.1097/MAO.0000000000001418DOI Listing
July 2017

The Development of Remote Speech Recognition Tests for Adult Cochlear Implant Users: The Effect of Presentation Mode of the Noise and a Reliable Method to Deliver Sound in Home Environments.

Audiol Neurootol 2016 3;21 Suppl 1:48-54. Epub 2016 Nov 3.

Section Ear and Hearing, Department of Otolaryngology, Head and Neck Surgery, and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.

The number of cochlear implant (CI) users is increasing annually, resulting in an increase in the workload of implant centers in ongoing patient management and evaluation. Remote testing of speech recognition could be time-saving for both the implant centers as well as the patient. This study addresses two methodological challenges we encountered in the development of a remote speech recognition tool for adult CI users. First, we examined whether speech recognition in noise performance differed when the steady-state masking noise was presented throughout the test (i.e. continuous) instead of the standard clinical use for evaluation where the masking noise stops after each stimulus (i.e. discontinuous). A direct coupling between the audio port of a tablet computer to the accessory input of the sound processor with a personal audio cable was used. The setup was calibrated to facilitate presentation of stimuli at a predefined sound level. Finally, differences in frequency response between the audio cable and microphones were investigated.
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http://dx.doi.org/10.1159/000448355DOI Listing
February 2018

Change in Psychosocial Health Status Over 5 Years in Relation to Adults' Hearing Ability in Noise.

Ear Hear 2016 Nov/Dec;37(6):680-689

1Section Ear & Hearing, Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; 2Department of Psychiatry, VU University Medical Center/GGZ inGeest and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; 3Department of Epidemiology and Biostatistics, VU University Medical Center and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; and 4Phonak AG, Science and Technology, Stäfa, Switzerland.

Objectives: The aim of this study was to establish the longitudinal relationship between hearing ability in noise and psychosocial health outcomes (i.e., loneliness, anxiety, depression, distress, and somatization) in adults aged 18 to 70 years. An additional objective was to determine whether a change in hearing ability in noise over a period of 5 years was associated with a change in psychosocial functioning. Subgroup effects for a range of factors were investigated.

Design: Longitudinal data of the web-based Netherlands Longitudinal Study on Hearing (NL-SH) (N = 508) were analyzed. The ability to recognize speech in noise (i.e., the speech-reception-threshold [SRTn]) was measured with an online digit triplet test at baseline and at 5-year follow-up. Psychosocial health status was assessed by online questionnaires. Multiple linear regression analyses and longitudinal statistical analyses (i.e., generalized estimating equations) were performed.

Results: Poorer SRTn was associated longitudinally with more feelings of emotional and social loneliness. For participants with a high educational level, the longitudinal association between SRTn and social loneliness was significant. Changes in hearing ability and loneliness appeared significantly associated only for specific subgroups: those with stable pattern of hearing aid nonuse (increased emotional and social loneliness), who entered matrimony (increased social loneliness), and low educational level (less emotional loneliness). No significant longitudinal associations were found between hearing ability and anxiety, depression, distress, or somatization.

Conclusions: Hearing ability in noise was longitudinally associated with loneliness. Decline in hearing ability in noise was related to increase in loneliness for specific subgroups of participants. One of these subgroups included participants whose hearing deteriorated over 5 years, but who continued to report nonuse of hearing aids. This is an important and alarming finding that needs further investigation.
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http://dx.doi.org/10.1097/AUD.0000000000000332DOI Listing
January 2018

Benefits of simultaneous bilateral cochlear implantation on verbal reasoning skills in prelingually deaf children.

Res Dev Disabil 2016 Nov 5;58:104-13. Epub 2016 Sep 5.

Department of Otorhinolaryngology, Head and Neck Surgery, Hearing and Implants, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands. Electronic address:

Background: Impaired auditory speech perception abilities in deaf children with hearing aids compromised their verbal intelligence enormously. The availability of unilateral cochlear implantation (CI) auditory speech perception and spoken vocabulary enabled them to reach near ageappropriate levels. This holds especially for children in spoken language environments. However, speech perception in complex listening situations and the acquisition of complex verbal skills remains difficult. Bilateral CI was expected to enhance the acquisition of verbal intelligence by improved understanding of speech in noise.

Methods: This study examined the effect of bilateral CI on verbal intelligence of 49 deaf children (3;5-8;0 years). Relations between speech perception in noise, auditory short-term memory and verbal intelligence were analysed with multiple linear regressions. In addition, the interaction of educational setting, mainstream or special, on these relations was analysed.

Results: Children with bilateral CI obtained higher scores on verbal intelligence. Significant associations were present between speech perception in noise, auditory short-term memory and verbal intelligence.

Conclusion: Children with simultaneous bilateral CIs showed better speech perception in noise than children with unilateral CIs, which mediated by the auditory short-term memory capacity, enhanced the ability to acquire more complex verbal skills for BICI children in mainstream education.
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http://dx.doi.org/10.1016/j.ridd.2016.08.016DOI Listing
November 2016