I received my undergraduate degree in Communication Sciences and Disorders from The Wichita State University. I then traveled to Vanderbilt University to complete a M.S. in Audiology and Hearing Sciences, before completing a clinical fellowship at Henry Ford Hospital in Detroit, MI with Dr. Gary Jacobson. I subsequently completed a Ph.D. at Northwestern University in Communication Disorders with Dr. Beverly Wright exploring patterns of perceptual learning in individuals with normal hearing. Upon completion of my doctorate, I moved to the New York University School of Medicine for a post-doctoral fellowship in the Department of Otolaryngology. There, I worked with Dr. Mario Svirsky to identify recipients of cochlear implants who have not yet fully adapted to their device, and to provide tools which audiologists could use to modify the map to help these patients. I later joined the faculty at NYU, and also at Montclair State University. In 2015 I became the Chief of Audiology at Stanford, where I oversee the Audiology departments of both Stanford Hospital and the Lucille Packard Children’s Hospital.
Assistant Professor - Med Center Line, Otolaryngology - Head & Neck Surgery Divisions
Boards, Advisory Committees, Professional Organizations
Member, American Speech Language Hearing Association (1995 - Present)
Member, Association for Research in Otolaryngology (2005 - Present)
Member, American Auditory Society (2005 - Present)
Member, American Academy of Audiology (2015 - Present)
B.A., The Wichita State University, Communication Sciences and Disorders
M.S., Vanderbilt University, Audiology and Hearing Sciences
Ph.D., Northwestern University, Communication Sciences and Disorders
Current Research and Scholarly Interests
My research encompasses several translational projects. One focus is to modify the routine audiologic test battery such that it places equal weight on hearing acuity and hearing function. This work includes measures of speech in noise, or electrophysiologic responses such as the FFR. I also explore tools to better assess and maximize performance in users of hearing aids and cochlear implants. Finally, I am also investigating the benefits of telemedicine, and new treatments for tinnitus.
Med Scholar Project Advisor
Ocular Vestibular-Evoked Myogenic Potential Amplitudes Elicited at 4 kHz Optimize Detection of Superior Semicircular Canal Dehiscence.
Frontiers in neurology
2020; 11: 879
Introduction: High-resolution temporal bone computed tomography (CT) is considered the gold standard for diagnosing superior semicircular canal dehiscence (SCD). However, CT has been shown over-detect SCD and provide results that may not align with patient-reported symptoms. Ocular vestibular-evoked myogenic potentials (oVEMPs)-most commonly conducted at 500 Hz stimulation-are increasingly used to support the diagnosis and management of SCD. Previous research reported that stimulation at higher frequencies such as 4 kHz can have near-perfect sensitivity and specificity in detecting radiographic SCD. With a larger cohort, we seek to understand the sensitivity and specificity of 4 kHz oVEMPs for detecting clinically significant SCD, as well as subgroups of radiographic, symptomatic, and surgical SCD. We also investigate whether assessing the 4 kHz oVEMP n10-p15 amplitude rather than the binary n10 response alone would optimize the detection of SCD. Methods: We conducted a cross-sectional study of patients who have undergone oVEMP testing at 4 kHz. Using the diagnostic criteria proposed by Ward et al., patients were determined to have SCD if dehiscence was confirmed on temporal bone CT by two reviewers, patient-reported characteristic symptoms, and if they had at least one positive vestibular or audiometric test suggestive of SCD. Receiver operating characteristic (ROC) analysis was conducted to identify the optimal 4 kHz oVEMP amplitude cut-off. Comparison of 4 kHz oVEMP amplitude across radiographic, symptomatic, and surgical SCD subgroups was conducted using the Mann-Whitney U test. Results: Nine hundred two patients (n, ears = 1,804) underwent 4 kHz oVEMP testing. After evaluating 150 temporal bone CTs, we identified 49 patients (n, ears = 61) who had radiographic SCD. Of those, 33 patients (n, ears = 37) were determined to have clinically significant SCD. For this study cohort, 4 kHz oVEMP responses had a sensitivity of 86.5% and a specificity of 87.8%. ROC analysis demonstrated that accounting for the inter-amplitude of 4 kHz oVEMP was more accurate in detecting SCD than the presence of n10 response alone (AUC 91 vs. 87%). Additionally, using an amplitude cut-off of 15uV reduces false positive results and improves specificity to 96.8%. Assessing 4 kHz oVEMP response across SCD subgroups demonstrated that surgical and symptomatic SCD cases had significantly higher amplitudes, while radiographic SCD cases without characteristic symptoms had similar amplitudes compared to cases without evidence of SCD. Conclusion: Our results suggest that accounting for 4 kHz oVEMP amplitude can improve detection of SCD compared to the binary presence of n10 response. The 4 kHz oVEMP amplitude cut-off that maximizes sensitivity and specificity for our cohort is 15 uV. Our results also suggest that 4 kHz oVEMP amplitudes align better with symptomatic SCD cases compared to cases in which there is radiographic SCD but no characteristic symptoms.
View details for DOI 10.3389/fneur.2020.00879
View details for PubMedID 32982915
View details for PubMedCentralID PMC7477389
Factors influencing classification of frequency following responses to speech and music stimuli.
2020; 398: 108101
Successful mapping of meaningful labels to sound input requires accurate representation of that sound's acoustic variances in time and spectrum. For some individuals, such as children or those with hearing loss, having an objective measure of the integrity of this representation could be useful. Classification is a promising machine learning approach which can be used to objectively predict a stimulus label from the brain response. This approach has been previously used with auditory evoked potentials (AEP) such as the frequency following response (FFR), but a number of key issues remain unresolved before classification can be translated into clinical practice. Specifically, past efforts at FFR classification have used data from a given subject for both training and testing the classifier. It is also unclear which components of the FFR elicit optimal classification accuracy. To address these issues, we recorded FFRs from 13 adults with normal hearing in response to speech and music stimuli. We compared labeling accuracy of two cross-validation classification approaches using FFR data: (1) a more traditional method combining subject data in both the training and testing set, and (2) a "leave-one-out" approach, in which subject data is classified based on a model built exclusively from the data of other individuals. We also examined classification accuracy on decomposed and time-segmented FFRs. Our results indicate that the accuracy of leave-one-subject-out cross validation approaches that obtained in the more conventional cross-validation classifications while allowing a subject's results to be analysed with respect to normative data pooled from a separate population. In addition, we demonstrate that classification accuracy is highest when the entire FFR is used to train the classifier. Taken together, these efforts contribute key steps toward translation of classification-based machine learning approaches into clinical practice.
View details for DOI 10.1016/j.heares.2020.108101
View details for PubMedID 33142106
Rhythmic Wave Patterns on Ambient Pressure Tympanometry in Patients With Objective Tinnitus-associated Pathologies.
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
OBJECTIVE: To introduce the concept of ambient pressure tympanometry (APT) and its association with pathologies that may present with objective tinnitus.STUDY DESIGN: Retrospective case series.SETTING: Tertiary referral center.SUBJECTS AND METHODS: Audiologists performed APT on adult patients as part of routine audiological testing. Ears with myoclonus and patulous Eustachian tube (PET) were identified via review of patient history and physical examination. All other conditions were verified via computed tomography (CT) temporal bone imaging. Ears with conditions that could impair tympanic membrane compliance, such as otosclerosis or tympanic membrane perforation, were excluded. APT findings were analyzed via a novel algorithm.RESULTS: A radiographic finding associated with objective tinnitus was confirmed in 67 ears that underwent CT imaging; 45 (67%) of these ears displayed rhythmic APT wave patterns. These included 28 ears with superior semicircular canal dehiscence, 4 ears with sigmoid sinus dehiscence, 6 ears with internal carotid artery dehiscence, 4 ears with glomus tumor, and 3 ears with encephalocele. In addition, we identified three ears with myoclonus and one ear with PET. In a subset of 30 ears with objective tinnitus symptoms that underwent CT imaging, 22 displayed rhythmic waves; of these 22 ears, 20 (91%) had a radiographic finding associated with objective tinnitus.CONCLUSIONS: Rhythmic APT wave patterns are common and may be associated with numerous temporal bone pathologies that may present with objective tinnitus. APT is a simple, rapid, and widely available tool that warrants further study to determine its value in screening of these otologic conditions.
View details for DOI 10.1097/MAO.0000000000002526
View details for PubMedID 31868782
Frequency-following response among neonates with progressive moderate hyperbilirubinemia.
Journal of perinatology : official journal of the California Perinatal Association
OBJECTIVE: To evaluate the feasibility of auditory monitoring of neurophysiological status using frequency-following response (FFR) in neonates with progressive moderate hyperbilirubinemia, measured by transcutaneous (TcB) levels.STUDY DESIGN: ABR and FFR measures were compared and correlated with TcB levels across three groups. Group I was a healthy cohort (n=13). Group II (n=28) consisted of neonates with progressive, moderate hyperbilirubinemia and Group III consisted of the same neonates, post physician-ordered phototherapy.RESULT: FFR amplitudes in Group I controls (TcB=83.1±32.5mol/L; 4.9±1.9mg/dL) were greater than Group II (TcB=209.3±48.0mol/L; 12.1±2.8mg/dL). After TcB was lowered by phototherapy, FFR amplitudes in Group III were similar to controls. Lower TcB levels correlated with larger FFR amplitudes (r=-0.291, p=0.015), but not with ABR wave amplitude or latencies.CONCLUSION: The FFR is a promising measure of the dynamic neurophysiological status in neonates, and may be useful in tracking neurotoxicity in infants with hyperbilirubinemia.
View details for DOI 10.1038/s41372-019-0421-y
View details for PubMedID 31263204
Occupational Noise Exposure and Risk for Noise-Induced Hearing Loss Due to Temporal Bone Drilling.
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
2018; 39 (6): 693–99
BACKGROUND: Noise-induced hearing loss is one of the most common occupational hazards in the United States. Several studies have described noise-induced hearing loss in patients following mastoidectomy. Although otolaryngologists care for patients with noise-induced hearing loss, few studies in the English literature have examined surgeons' occupational risk.METHODS: Noise dosimeters and sound level meters with octave band analyzers were used to assess noise exposure during drilling of temporal bones intraoperatively and in a lab setting. Frequency specific sound intensities were recorded. Sound produced using burrs of varying size and type were compared. Differences while drilling varying anatomic structures were assessed using drills from two manufacturers. Pure tone audiometry was performed on 7 to 10 otolaryngology residents before and after a temporal bone practicum to assess for threshold shifts.RESULTS: Noise exposure during otologic drilling can exceed over 100 dB for short periods of time, and is especially loud using large diameter burrs > 4 mm, with cutting as compared with diamond burrs, and while drilling denser bone such as the cortex. Intensity peaks were found at 2.5, 5, and 6.3 kHz. Drilling on the tegmen and sigmoid sinus revealed peaks at 10 and 12.5 kHz. No temporary threshold shifts were found at 3 to 6 kHz, but were found at 8 to 16 kHz, though this did not reach statistical significance.CONCLUSION: This article examines noise exposure and threshold shifts during temporal bone drilling. We were unable to find previous descriptions in the literature of measurements done while multiple people drilling simultaneously, during tranlabyrinthine surgery and a specific frequency characterization of the change in peach that appears while drilling on the tegmen. Hearing protection should be considered, which would still allow the surgeon to appreciate pitch changes associated with drilling on sensitive structures and communication with surgical team members. As professionals who specialize in promoting the restoration and preservation of hearing for others, otologic surgeons should not neglect hearing protection for themselves.
View details for PubMedID 29889779
Assessment of Hearing During the Early Years of the American Otological Society.
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
2018; 39 (4S Suppl 1): S30–S42
To describe the manner in which hearing was evaluated in American Otological Practice during the late 19th and early 20th centuries before introduction of the electric audiometer.Primary sources were the Transactions of the American Otological Society and American textbooks, especially those authored by Presidents of the Society.In the era before electric audiometry multiple methods were used for evaluating the thresholds of different frequencies. Tuning forks were important for lower frequencies, whisper, and speech for mid-frequencies, and Galton's whistle and Konig's rod evaluated high frequencies. Hearing threshold was often recorded as in terms of duration of a sound, or distance from the source, rather than intensity. Hearing ability was often recorded a fraction, for example, with the distance a watch tick could be heard over the distance of a normal hearing individual. A variety of devices, such as Politzer's Acoumeter, attempted to deliver sound in a calibrated manner, thus enhancing the accuracy and reproducibility of test results.The early years of the American Otological Society were marked by a number of ingenious efforts to standardize hearing assessment despite the technical limitations. These efforts facilitated the development of the audiometer, and continue to influence clinical practice even today.
View details for PubMedID 29533374
Self-Selection of Frequency Tables with Bilateral Mismatches in an Acoustic Simulation of a Cochlear Implant
JOURNAL OF THE AMERICAN ACADEMY OF AUDIOLOGY
2017; 28 (5): 385-394
Many recipients of bilateral cochlear implants (CIs) may have differences in electrode insertion depth. Previous reports indicate that when a bilateral mismatch is imposed, performance on tests of speech understanding or sound localization becomes worse. If recipients of bilateral CIs cannot adjust to a difference in insertion depth, adjustments to the frequency table may be necessary to maximize bilateral performance.The purpose of this study was to examine the feasibility of using real-time manipulations of the frequency table to offset any decrements in performance resulting from a bilateral mismatch.A simulation of a CI was used because it allows for explicit control of the size of a bilateral mismatch. Such control is not available with users of CIs.A total of 31 normal-hearing young adults participated in this study.Using a CI simulation, four bilateral mismatch conditions (0, 0.75, 1.5, and 3 mm) were created. In the left ear, the analysis filters and noise bands of the CI simulation were the same. In the right ear, the noise bands were shifted higher in frequency to simulate a bilateral mismatch. Then, listeners selected a frequency table in the right ear that was perceived as maximizing bilateral speech intelligibility. Word-recognition scores were then assessed for each bilateral mismatch condition. Listeners were tested with both a standard frequency table, which preserved a bilateral mismatch, or with their self-selected frequency table.Consistent with previous reports, bilateral mismatches of 1.5 and 3 mm yielded decrements in word recognition when the standard table was used in both ears. However, when listeners used the self-selected frequency table, performance was the same regardless of the size of the bilateral mismatch.Self-selection of a frequency table appears to be a feasible method for ameliorating the negative effects of a bilateral mismatch. These data may have implications for recipients of bilateral CIs who cannot adapt to a bilateral mismatch, because they suggest that (1) such individuals may benefit from modification of the frequency table in one ear and (2) self-selection of a "most intelligible" frequency table may be a useful tool for determining how the frequency table should be altered to optimize speech recognition.
View details for DOI 10.3766/jaaa.15077
View details for Web of Science ID 000401497100003
View details for PubMedID 28534729
Detection of tones of unexpected frequency in amplitude-modulated noise.
The Journal of the Acoustical Society of America
2017; 142 (4): 2043
Detection of a tonal signal in amplitude-modulated noise can improve with increases in noise bandwidth if the pattern of amplitude fluctuations is uniform across frequency, a phenomenon termed comodulation masking release (CMR). Most explanations for CMR rely on an assumption that listeners monitor frequency channels both at and remote from the signal frequency in conditions that yield the effect. To test this assumption, detectability was assessed for signals presented at expected and unexpected frequencies in wideband amplitude-modulated noise. Detection performance was high even for signals of unexpected frequency, suggesting that listeners were monitoring multiple frequency channels, as has been assumed.
View details for PubMedID 29092596
Bilateral Loudness Balancing and Distorted Spatial Perception in Recipients of Bilateral Cochlear Implants
EAR AND HEARING
2015; 36 (5): E225-E236
To determine whether bilateral loudness balancing during mapping of bilateral cochlear implants (CIs) produces fused, punctate, and centered auditory images that facilitate lateralization with stimulation on single-electrode pairs.Adopting procedures similar to those that are practiced clinically, direct stimulation was used to obtain most-comfortable levels (C levels) in recipients of bilateral CIs. Three pairs of electrodes, located in the base, middle, and apex of the electrode array, were tested. These electrode pairs were loudness-balanced by playing right-left electrode pairs sequentially. In experiment 1, the authors measured the location, number, and compactness of auditory images in 11 participants in a subjective fusion experiment. In experiment 2, the authors measured the location and number of the auditory images while imposing a range of interaural level differences (ILDs) in 13 participants in a lateralization experiment. Six of these participants repeated the mapping process and lateralization experiment over three separate days to determine the variability in the procedure.In approximately 80% of instances, bilateral loudness balancing was achieved from relatively small adjustments to the C levels (≤3 clinical current units). More important, however, was the observation that in 4 of 11 participants, simultaneous bilateral stimulation regularly elicited percepts that were not fused into a single auditory object. Across all participants, approximately 23% of percepts were not perceived as fused; this contrasts with the 1 to 2% incidence of diplacusis observed with normal-hearing individuals. In addition to the unfused images, the perceived location was often offset from the physical ILD. On the whole, only 45% of percepts presented with an ILD of 0 clinical current units were perceived as fused and heard in the center of the head. Taken together, these results suggest that distortions to the spatial map remain common in bilateral CI recipients even after careful bilateral loudness balancing.The primary conclusion from these experiments is that, even after bilateral loudness balancing, bilateral CI recipients still regularly perceive stimuli that are unfused, offset from the assumed zero ILD, or both. Thus, while current clinical mapping procedures for bilateral CIs are sufficient to enable many of the benefits of bilateral hearing, they may not elicit percepts that are thought to be optimal for sound-source location. As a result, in the absence of new developments in signal processing for CIs, new mapping procedures may need to be developed for bilateral CI recipients to maximize the benefits of bilateral hearing.
View details for DOI 10.1097/AUD.0000000000000174
View details for Web of Science ID 000360630800003
View details for PubMedID 25985017
Bilateral cochlear implants with large asymmetries in electrode insertion depth: implications for the study of auditory plasticity
2015; 135 (4): 354-363
The human frequency-to-place map may be modified by experience, even in adult listeners. However, such plasticity has limitations. Knowledge of the extent and the limitations of human auditory plasticity can help optimize parameter settings in users of auditory prostheses.To what extent can adults adapt to sharply different frequency-to-place maps across ears? This question was investigated in two bilateral cochlear implant users who had a full electrode insertion in one ear, a much shallower insertion in the other ear, and standard frequency-to-electrode maps in both ears.Three methods were used to assess adaptation to the frequency-to-electrode maps in each ear: (1) pitch matching of electrodes in opposite ears, (2) listener-driven selection of the most intelligible frequency-to-electrode map, and (3) speech perception tests. Based on these measurements, one subject was fitted with an alternative frequency-to-electrode map, which sought to compensate for her incomplete adaptation to the standard frequency-to-electrode map.Both listeners showed remarkable ability to adapt, but such adaptation remained incomplete for the ear with the shallower electrode insertion, even after extended experience. The alternative frequency-to-electrode map that was tested resulted in substantial increases in speech perception for one subject in the short insertion ear.
View details for DOI 10.3109/00016489.2014.1002052
View details for Web of Science ID 000351365500007
View details for PubMedID 25719506
Feasibility of Real-Time Selection of Frequency Tables in an Acoustic Simulation of a Cochlear Implant
EAR AND HEARING
2013; 34 (6): 763-772
Perception of spectrally degraded speech is particularly difficult when the signal is also distorted along the frequency axis. This might be particularly important for post-lingually deafened recipients of cochlear implants (CIs), who must adapt to a signal where there may be a mismatch between the frequencies of an input signal and the characteristic frequencies of the neurons stimulated by the CI. However, there is a lack of tools that can be used to identify whether an individual has adapted fully to a mismatch in the frequency-to-place relationship and if so, to find a frequency table that ameliorates any negative effects of an unadapted mismatch. The goal of the proposed investigation is to test the feasibility of whether real-time selection of frequency tables can be used to identify cases in which listeners have not fully adapted to a frequency mismatch. The assumption underlying this approach is that listeners who have not adapted to a frequency mismatch will select a frequency table that minimizes any such mismatches, even at the expense of reducing the information provided by this frequency table.Thirty-four normal-hearing adults listened to a noise-vocoded acoustic simulation of a CI and adjusted the frequency table in real time until they obtained a frequency table that sounded "most intelligible" to them. The use of an acoustic simulation was essential to this study because it allowed the authors to explicitly control the degree of frequency mismatch present in the simulation. None of the listeners had any previous experience with vocoded speech, in order to test the hypothesis that the real-time selection procedure could be used to identify cases in which a listener has not adapted to a frequency mismatch. After obtaining a self-selected table, the authors measured consonant nucleus consonant word-recognition scores with that self-selected table and two other frequency tables: a "frequency-matched" table that matched the analysis filters with the noisebands of the noise-vocoder simulation, and a "right information" table that is similar to that used in most CI speech processors, but in this simulation results in a frequency shift equivalent to 6.5 mm of cochlear space.Listeners tended to select a table that was very close to, but shifted slightly lower in frequency from the frequency-matched table. The real-time selection process took on average 2 to 3 min for each trial, and the between-trial variability was comparable with that previously observed with closely related procedures. The word-recognition scores with the self-selected table were clearly higher than with the right-information table and slightly higher than with the frequency-matched table.Real-time self-selection of frequency tables may be a viable tool for identifying listeners who have not adapted to a mismatch in the frequency-to-place relationship, and to find a frequency table that is more appropriate for them. Moreover, the small but significant improvements in word-recognition ability observed with the self-selected table suggest that these listeners based their selections on intelligibility rather than some other factor. The within-subject variability in the real-time selection procedure was comparable with that of a genetic algorithm, and the speed of the real-time procedure appeared to be faster than either a genetic algorithm or a simplex procedure.
View details for Web of Science ID 000330361200011
View details for PubMedID 23807089
Factors influencing consistent device use in pediatric recipients of bilateral cochlear implants.
Cochlear implants international
2013; 14 (5): 257-265
To determine which demographic or performance variables are associated with inconsistent use of a second implant in pediatric recipients of sequential bilateral cochlear implants (CIs).A retrospective chart review was conducted on pediatric recipients of sequential bilateral CIs. Children were divided into two age groups, 5-9 and 10-17 years of age. For each group, we examined whether inconsistent use of the second implant (CI-2) was associated with a variety of demographic variables, or speech-perception scores.In children aged 5-9 years, inconsistent use of CI-2 was not significantly associated with any demographic variable, but was related to both the word-recognition score with CI-2, and the difference in word-recognition scores between the first implant (CI-1) and CI-2. In children aged 10-17 years, these relationships were not significant due to smaller number of subjects. Finally, CI-2 word-recognition scores across all children were significantly correlated with the age of implantation for both CI-1 and CI-2, and the time between CI-1 and CI-2 surgeries.Speech-recognition scores obtained with CI-2, and the extent to which it differs from CI-1, are most closely related with inconsistent use of CI-2 in pediatric sequential implantees. These results are consistent with similar data previously reported by other investigators. While children implanted with CI-2 at a later age generally perform more poorly, most children still use both implants, and benefit from CI-2 even when receiving the implant as an adolescent.In pediatric recipients of sequential bilateral CIs, inconsistent use of CI-2 is related to the speech recognition scores with CI-2, and the difference in speech-recognition scores between CI-1 and CI-2. In addition, speech-recognition scores with CI-2 are related to the amount of time between CI-1 and CI-2 surgeries, and the age of implantation for both CI-1 and CI-2.
View details for DOI 10.1179/1754762812Y.0000000026
View details for PubMedID 23510638
Perceptual learning and generalization resulting from training on an auditory amplitude-modulation detection task
JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA
2011; 129 (2): 898-906
Fluctuations in sound amplitude provide important cues to the identity of many sounds including speech. Of interest here was whether the ability to detect these fluctuations can be improved with practice, and if so whether this learning generalizes to untrained cases. To address these issues, normal-hearing adults (n = 9) were trained to detect sinusoidal amplitude modulation (SAM; 80-Hz rate, 3-4 kHz bandpass carrier) 720 trials/day for 6-7 days and were tested before and after training on related SAM-detection and SAM-rate-discrimination conditions. Controls (n = 9) only participated in the pre- and post-tests. The trained listeners improved more than the controls on the trained condition between the pre- and post-tests, but different subgroups of trained listeners required different amounts of practice to reach asymptotic performance, ranging from 1 (n = 6) to 4-6 (n = 3) sessions. This training-induced learning did not generalize to detection with two untrained carrier spectra (5 kHz low-pass and 0.5-1.5 kHz bandpass) or to rate discrimination with the trained rate and carrier spectrum, but there was some indication that it generalized to detection with two untrained rates (30 and 150 Hz). Thus, practice improved the ability to detect amplitude modulation, but the generalization of this learning to untrained cases was somewhat limited.
View details for DOI 10.1121/1.3531841
View details for Web of Science ID 000287709700038
View details for PubMedID 21361447
A New Software Tool to Optimize Frequency Table Selection for Cochlear Implants
OTOLOGY & NEUROTOLOGY
2010; 31 (8): 1242-1247
When cochlear implant (CI) users are allowed to self-select the "most intelligible" frequency-to-electrode table, some of them choose one that differs from the default frequency table that is normally used in clinical practice.CIs reproduce the tonotopicity of normal cochleas using frequency-to-electrode tables that assign stimulation of more basal electrodes to higher frequencies and more apical electrodes to lower frequency sounds. Current audiologic practice uses a default frequency-to-electrode table for most patients. However, individual differences in cochlear size, neural survival, and electrode positioning may result in different tables sounding most intelligible to different patients. No clinical tools currently exist to facilitate this fitting.A software tool was designed that enables CI users to self-select a most intelligible frequency table. Users explore a 2-dimensional space that represents a range of different frequency tables. Unlike existing tools, this software enables users to interactively audition speech processed by different frequency tables and quickly identify a preferred one. Pilot testing was performed in 11 long-term, postlingually deaf CI users.The software tool was designed, developed, tested, and debugged. Patients successfully used the tool to sample frequency tables and to self-select tables deemed most intelligible, which for approximately half of the users differed from the clinical default.A software tool allowing CI users to self-select frequency-to-electrode tables may help in fitting postlingually deaf users. This novel approach may transform current methods of CI fitting.
View details for DOI 10.1097/MAO.0b013e3181f2063e
View details for Web of Science ID 000282306900013
View details for PubMedID 20729774
Enhancing Perceptual Learning by Combining Practice with Periods of Additional Sensory Stimulation
JOURNAL OF NEUROSCIENCE
2010; 30 (38): 12868-12877
Perceptual skills can be improved even in adulthood, but this learning seldom occurs by stimulus exposure alone. Instead, it requires considerable practice performing a perceptual task with relevant stimuli. It is thought that task performance permits the stimuli to drive learning. A corresponding assumption is that the same stimuli do not contribute to improvement when encountered separately from relevant task performance because of the absence of this permissive signal. However, these ideas are based on only two types of studies, in which the task was either always performed or not performed at all. Here we demonstrate enhanced perceptual learning on an auditory frequency-discrimination task in human listeners when practice on that target task was combined with additional stimulation. Learning was enhanced regardless of whether the periods of additional stimulation were interleaved with or provided exclusively before or after target-task performance, and even though that stimulation occurred during the performance of an irrelevant (auditory or written) task. The additional exposures were only beneficial when they shared the same frequency with, though they did not need to be identical to, those used during target-task performance. Their effectiveness also was diminished when they were presented 15 min after practice on the target task and was eliminated when that separation was increased to 4 h. These data show that exposure to an acoustic stimulus can facilitate learning when encountered outside of the time of practice on a perceptual task. By properly using additional stimulation one may markedly improve the efficiency of perceptual training regimens.
View details for DOI 10.1523/JNEUROSCI.0487-10.2010
View details for Web of Science ID 000282097600030
View details for PubMedID 20861390
Reimplantation of hybrid cochlear implant users with a full-length electrode after loss of residual hearing
OTOLOGY & NEUROTOLOGY
2008; 29 (2): 168-173
To assess word recognition and pitch-scaling abilities of cochlear implant users first implanted with a Nucleus 10-mm Hybrid electrode array and then reimplanted with a full length Nucleus Freedom array after loss of residual hearing.Although electroacoustic stimulation is a promising treatment for patients with residual low-frequency hearing,a small subset of them lose that residual hearing. It is not clear whether these patients would be better served by leaving in the 10-mm array and providing electric stimulation through it, or by replacing it with a standard full-length array.Word recognition and pitch-scaling abilities were measured in 2 users of hybrid cochlear implants who lost their residual hearing in the implanted ear after a few months. Tests were repeated over several months, first with a 10-mm array, and after, these patients were reimplanted with a full array. The word recognition task consisted of 2 50-word consonant nucleus consonant (CNC) lists. In the pitch-scaling task, 6 electrodes were stimulated in pseudorandom order, and patients assigned a pitch value to the sensation elicited by each electrode.Shortly after reimplantation with the full electrode array, speech understanding was much better than with the 10-mm array. Patients improved their ability to perform the pitch-scaling task over time with the full array, although their performance on that task was variable, and the improvements were often small.1) Short electrode arrays may help preserve residual hearing but may also provide less benefit than traditional cochlear implants for some patients. 2) Pitch percepts in response to electric stimulation may be modified by experience.
View details for Web of Science ID 000252840700012
View details for PubMedID 18165793
What matched comparisons can and cannot tell us: The case of cochlear implants
EAR AND HEARING
2007; 28 (4): 571-579
To examine the conclusions and possible misinterpretations that may or may not be drawn from the "outcome-matching method," a study design recently used in the cochlear implant literature. In this method, subject groups are matched not only on potentially confounding variables but also on an outcome measure that is closely related to the outcome measure under analysis. For example, subjects may be matched according to their speech perception scores in quiet, and their speech perception in noise is compared.The present study includes two components, a simulation study and a questionnaire. In the simulation study, the outcome-matching method was applied to pseudo-randomly generated data. Simulated speech perception scores in quiet and in noise were generated for two comparison groups, in two imaginary worlds. In both worlds, comparison group A performed only slightly worse in noise than in quiet, whereas comparison group B performed significantly worse in noise than in quiet. In Imaginary World 1, comparison group A had better speech perception scores than comparison group B. In Imaginary World 2, comparison group B had better speech perception scores than comparison group A. The outcome-matching method was applied to these data twice in each imaginary world: 1) matching scores in quiet and comparing in noise, and 2) matching scores in noise and comparing in quiet. This procedure was repeated 10,000 times. The second part of the study was conducted to address the level of misinterpretation that could arise from the outcome-matching method. A questionnaire was administered to 54 students in a senior level course on speech and hearing to assess their opinions about speech perception with two different models of cochlear implant devices. The students were instructed to fill out the questionnaire before and after reading a paper that used the outcome-matching method to examine speech perception in noise and in quiet with those two cochlear implant devices.When pseudorandom scores were matched in quiet, comparison group A's scores in noise were significantly better than comparison group B's scores. Results were different when scores were matched in noise: in this case, comparison group B's scores in quiet were significantly better than comparison group A's scores. Thus, the choice of outcome measure used for matching determined the result of the comparison. Additionally, results of the comparisons were identical regardless of whether they were conducted using data from Imaginary World 1 (where comparison group A is better) or from Imaginary World 2 (where comparison group B is better). After reading the paper that used the outcome-matching method, students' opinions about the two cochlear implants underwent a significant change even though, according to the simulation study, this opinion change was not warranted by the data.The outcome-matching method can provide important information about differences within a comparison group, but it cannot be used to determine whether a given device or clinical intervention is better than another one. Care must be used when interpreting the results of a study using the outcome-matching method.
View details for Web of Science ID 000247829000012
View details for PubMedID 17609617
The effect of perimodiolar placement on speech perception and frequency discrimination by cochlear implant users
2007; 127 (4): 378-383
Neither speech understanding nor frequency discrimination ability was better in Nucleus Contour users than in Nucleus 24 straight electrode users. Furthermore, perimodiolar electrode placement does not result in better frequency discrimination.We addressed three questions related to perimodiolar electrode placement. First, do patients implanted with the Contour electrode understand speech better than with an otherwise identical device that has a straight electrode? Second, do these groups have different frequency discrimination abilities? Third, is the distance of the electrode from the modiolus related to frequency discrimination ability?Contour and straight electrode users were matched on four important variables. We then tested these listeners on CNC word and HINT sentence identification tasks, and on a formant frequency discrimination task. We also examined X-rays and measured the distance of the electrodes from the modiolus to determine whether there is a relationship between this factor and frequency discrimination ability.Both speech understanding and frequency discrimination abilities were similar for listeners implanted with the Contour vs a straight electrode. Furthermore, there was no linear relationship between electrode-modiolus distance and frequency discrimination ability. However, we did note a second-order relationship between these variables, suggesting that frequency discrimination is worse when the electrodes are either too close or too far away from the modiolus.
View details for DOI 10.1080/00016480701258671
View details for Web of Science ID 000246298700007
View details for PubMedID 17453457
Perceptual-learning evidence for separate processing of asynchrony and order tasks
JOURNAL OF NEUROSCIENCE
2006; 26 (49): 12708-12716
Normal perception depends, in part, on accurate judgments of the temporal relationships between sensory events. Two such relative-timing skills are the ability to detect stimulus asynchrony and to discriminate stimulus order. Here we investigated the neural processes contributing to the performance of auditory asynchrony and order tasks in humans, using a perceptual-learning paradigm. In each of two parallel experiments, we tested listeners on a pretest and a posttest consisting of auditory relative-timing conditions. Between these two tests, we trained a subset of listeners approximately 1 h/d for 6-8 d on a single relative-timing condition. The trained listeners practiced asynchrony detection in one experiment and order discrimination in the other. Both groups were trained at sound onset with tones at 0.25 and 4.0 kHz. The remaining listeners in each experiment, who served as controls, did not receive multihour training during the 8-10 d between the pretest and posttest. These controls improved even without intervening training, adding to evidence that a single session of exposure to perceptual tasks can yield learning. Most importantly, each of the two groups of trained listeners learned more on their respective trained conditions than controls, but this learning occurred only on the two trained conditions. Neither group of trained listeners generalized their learning to the other task (order or asynchrony), an untrained temporal position (sound offset), or untrained frequency pairs. Thus, it appears that multihour training on relative-timing skills affects task-specific neural circuits that are tuned to a given temporal position and combination of stimulus components.
View details for DOI 10.1523/JNEUROSCI.2254-06.2006
View details for Web of Science ID 000242626100011
View details for PubMedID 17151274
Customized selection of frequency maps in an acoustic simulation of a cochlear implant.
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference
2006; 1: 3596-3599
Cochlear implants can restore hearing to deaf individuals by electrically stimulating the auditory nerve. They do so by assigning different frequencies to different stimulating electrodes via a frequency map. We have developed a device that enables us to change the frequency map in real time. Here, in normal-hearing adults listening to an acoustic simulation of a cochlear implant, we investigate what frequency maps are initially preferred, and how the ability to understand speech with that preferred map compares with two other maps. We show that naive listeners prefer a map that balances the need for low-frequency information with the desire for a naturally-sounding stimulus, and that initial performance with this listener-selected map is better than that with a map that distorts the signal to provide low-frequency information.
View details for PubMedID 17946188
A perceptual learning investigation of the pitch elicited by amplitude-modulated noise
JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA
2005; 118 (6): 3794-3803
Noise that is amplitude modulated at rates ranging from 40 to 850 Hz can elicit a sensation of pitch. Here, the processing of this temporally based pitch was investigated using a perceptual-learning paradigm. Nine listeners were trained (1 hour per day for 6-8 days) to discriminate a standard rate of sinusoidal amplitude modulation (SAM) from a faster rate in a single condition (150 Hz SAM rate, 5 kHz low-pass carrier). All trained listeners improved significantly on that condition. These trained listeners subsequently showed no more improvement than nine untrained controls on pure-tone and rippled-noise discrimination with the same pitch, and on SAM-rate discrimination with a 30 Hz rate, although they did show some improvement with a 300 Hz rate. In addition, most trained, but not control, listeners were worse at detecting SAM at 150 Hz after, compared to before training. These results indicate that listeners can learn to improve their ability to discriminate SAM rate with multiple-hour training and that the mechanism that is modified by learning encodes (1) the pitch of SAM noise but not that of pure tones and rippled noise, (2) different SAM rates separately, and (3) differences in SAM rate more effectively than cues for SAM detection.
View details for DOI 10.1121/1.2074687
View details for Web of Science ID 000234101000042
View details for PubMedID 16419824
The time course of attention in a simple auditory detection task
PERCEPTION & PSYCHOPHYSICS
2004; 66 (3): 508-516
What is the time course of human attention in a simple auditory detection task? To investigate this question, we determined the detectability of a 20-msec, 1000-Hz tone presented at expected and unexpected times. Twelve listeners who expected the tone to occur at a specific time after a 300-msec narrowband noise rarely detected signals presented 150-375 msec before or 100-200 msec after that expected time. The shape of this temporal-attention window depended on the expected presentation time of the tone and the temporal markers available in the trials. Further, though expecting the signal to occur in silence, listeners often detected signals presented at unexpected times during the noise. Combined with previous data, these results further clarify the listening strategy humans use when trying to detect an expected sound: Humans seem to listen specifically for that sound, while ignoring the background in which it is presented, around the time when the sound is expected to occur.
View details for Web of Science ID 000222163300013
View details for PubMedID 15283074
Different patterns of human discrimination learning for two interaural cues to sound-source location
PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA
2001; 98 (21): 12307-12312
Two of the primary cues used to localize the sources of sounds are interaural level differences (ILDs) and interaural time differences (ITDs). We conducted two experiments to explore how practice affects the human discrimination of values of ILDs and ongoing ITDs presented over headphones. We measured discrimination thresholds of 13 to 32 naive listeners in a variety of conditions during a pretest and again, 2 weeks later, during a posttest. Between those two tests, we trained a subset of listeners 1 h per day for 9 days on a single ILD or ITD condition. Listeners improved on both ILD and ITD discrimination. Improvement was initially rapid for both cue types and appeared to generalize broadly across conditions, indicating conceptual or procedural learning. A subsequent slower-improvement stage, which occurred solely for the ILD cue, only affected conditions with the trained stimulus frequency, suggesting that stimulus processing had fundamentally changed. These different learning patterns indicate that practice affects the attention to, or low-level encoding of, ILDs and ITDs at sites at which the two cue types are processed separately. Thus, these data reveal differences in the effect of practice on ILD and ITD discrimination, and provide insight into the encoding of these two cues to sound-source location in humans.
View details for Web of Science ID 000171558900087
View details for PubMedID 11593048