Different evaluationsfor different kinds of hearingMatthew B. Winn Au.D., Ph.D.Waisman Center,UW-Madison Dept. of Surgery

Different kinds of hearing?• Using both ears together

• Listening for information / listening for clarity

• The ears as part of the brain & part of the whole person

The challenge of using a cochlear implant•Sound distortion•Pitch shifting•Abnormal loudness•Neural atrophy

Imagine the inner ear as a piano…

Low notes High notesMiddle notes

Imagine the inner ear as a piano…

Low notes High notesMiddle notes

Imagine the inner ear as a piano…

Low notes High notesMiddle notes

Imagine the inner ear as a piano…

Low notes High notesMiddle notes

In real life…

Listening for information,listening for clarity

Listening for information,listening for clarity

Restaurant

Restaurant

RestaurantRestaurant

Testing for clarity in hearing

Testing for clarity in hearing• Speech sounds are morphed from one sound to another• Listeners label each sound as it is heard• Labeling consistency and confidence is modeled statistically

Different listeners have different levels of clarity in their hearing

(clarity)

Context and adaptation

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Context and adaptation

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Some voices have predictable patterns of differences• Pitch, duration, voice quality, articulation, etc.

• We can form categories• High / low pitch • Creaky / smooth voice quality• “eee” / “ooo”• “sss” “sh”

Some voices have predictable patterns of differences

A “low” pitch for one voice may be higher than a “high” pitch for another voice

Testing adjustment to different voices• Low pitch / High pitch

“sh” “ss”

• The difference between low “sh” and high “ss” depends on whether the voice is female or male.

male voicesh ss

female voice

boundary

Testing for a boundaryFocus on a region of interest

Label the sounds

“sh” “ss”

Accommodation to talker voice

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Accommodation to talker FACE

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Accommodation to talker voice with face

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A change of [this context]is worth [this much change]in auditory frequency boundary

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Bou

ndar

y sh

ift (H

z)

Listeners with normal hearing adjust to the talker’s voice

Listeners with cochlear implants adjust to the talker’s voice and face

Adjusting on the fly• Listeners with normal hearing can adjust to the

speech of various talkers on-the-fly using their ears

• Listeners with cochlear implants can adjust using their ears AND their eyes,• So they may benefit from learning some audio+visual

associations between faces and vocal styles

Binaural and Bilateral• People with normal hearing enjoy binaural hearing,

which means the two ears work together and compare inputs.

• This lets us do many things, including locate a sound in space and separate speech from background noise

Using two cochlear implants

• Two cochlear implants are independent systems that may or may not work well together

Binaural and Bilateral• People with bilateral cochlear implants

generally report benefit from the second device• Better sound localization• Better hearing in noise

Some abilities are easily quantifiable…• Word recognition over the first two years

• Sound localization

Other abilities are not-so-easily quantifiable.(From the Cochlear Corp. website)Benefits of bilateral implantation:• More connected• More confident• More balanced and relaxed• Peace of mind

Bilateral implants make it “easier to hear everyday sounds… without the constant strain associated with a hearing loss.”

Listening fatigue and hearing loss:why it matters

• Individuals with hearing loss (HL) have to "work harder" cognitively to process sounds compared to people without hearing loss

• Increased reports of stress, tension & fatigue [1]

• Higher "need for recovery" from work [2]

• Individuals with HL are more likely to miss work due to "fatigue, strain or burnout" than individuals without HL working at a similar or the same job [3]

Effort Pupil dilation • Task-evoked pupil dilation corresponds to cognitive effort

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Listening effort test• Listen to sentences with the right implant only

• Listen to sentences with the left implant only

• Listen to sentences with both implants

• Hear the sentence, wait a moment, then repeat

• We measure pupil size as the sentence ends, and during the time before you repeat it back

Right ear CI only

Right and Left CIs

Bilateral CIs

New directions• Technology exists to improve sound clarity

• Efforts can be made to synchronize both ears

• CI recipients undergo auditory training

• We can evaluate the effects of these efforts on the listener’s experience of mental effort required to listen

Questions and comments are welcome!• Matthew Winn• mwinn2@wisc.edu