Title | Association Between Flat-Panel Computed Tomographic Imaging-Guided Place-Pitch Mapping and Speech and Pitch Perception in Cochlear Implant Users. |
Publication Type | Journal Article |
Year of Publication | 2019 |
Authors | Jiam NT, Gilbert M, Cooke D, Jiradejvong P, Barrett K, Caldwell M, Limb CJ |
Journal | JAMA Otolaryngol Head Neck Surg |
Volume | 145 |
Issue | 2 |
Pagination | 109-116 |
Date Published | 2019 Feb 01 |
ISSN | 2168-619X |
Keywords | Aged, Cochlear Implantation, Cochlear Implants, Female, Hearing Loss, Humans, Male, Middle Aged, Pitch Perception, Prospective Studies, Speech Perception, Surgery, Computer-Assisted, Tomography, X-Ray Computed |
Abstract | IMPORTANCE: Cochlear implant users generally display poor pitch perception. Flat-panel computed tomography (FPCT) has recently emerged as a modality capable of localizing individual electrode contacts within the cochlea in vivo. Significant place-pitch mismatch between the clinical implant processing settings given to patients and the theoretical maps based on FPCT imaging has previously been noted. OBJECTIVE: To assess whether place-pitch mismatch is associated with poor cochlear implant-mediated pitch perception through evaluation of an individualized, image-guided approach toward cochlear implant programming on speech and music perception among cochlear implant users. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study of 17 cochlear implant users with MED-EL electrode arrays was performed at a tertiary referral center. The study was conducted from June 2016 to July 2017. INTERVENTIONS: Theoretical place-pitch maps using FPCT secondary reconstructions and 3-dimensional curved planar re-formation software were developed. The clinical map settings (eg, strategy, rate, volume, frequency band range) were modified to keep factors constant between the 2 maps and minimize confounding. The acclimation period to the maps was 30 minutes. MAIN OUTCOMES AND MEASURES: Participants performed speech perception tasks (eg, consonant-nucleus-consonant, Bamford-Kowal-Bench Speech-in-Noise, vowel identification) and a pitch-scaling task while using the image-guided place-pitch map (intervention) and the modified clinical map (control). Performance scores between the 2 interventions were measured. RESULTS: Of the 17 participants, 10 (58.8%) were women; mean (SD) was 59 (11.3) years. A significant median increase in pitch scaling accuracy was noted when using the experimental map compared with the control map (4 more correct answers; 95% CI, 0-8). Specifically, the number of pitch-scaling reversals for notes spaced at 1.65 semitones or greater decreased when an image-based approach to cochlear implant programming was used vs the modified clinical map (4 mistakes; 95% CI, 0.5-7). Although there was no observable median improvement in speech perception during use of an image-based map, the acute changes in frequency allocation and electrode channel deactivations used with the image-guided maps did not worsen consonant-nucleus-consonant (-1% correct phonemes, 95% CI, -2.5% to 6%) and Bamford-Kowal-Bench Speech-in-Noise (0.5-dB difference; 95% CI, -0.75 to 2.25 dB) median performance results relative to the clinical maps used by the patients. CONCLUSIONS AND RELEVANCE: An image-based approach toward ochlear implant mapping may improve pitch perception outcomes by reducing place-pitch mismatch. Studies using a longer acclimation period with chronic stimulation over months may help assess the full range of the benefits associated with personalized image-guided cochlear implant mapping. |
DOI | 10.1001/jamaoto.2018.3096 |
Alternate Journal | JAMA Otolaryngol Head Neck Surg |
PubMed ID | 30477013 |
PubMed Central ID | PMC6440220 |