Amplitude-mapping effects on speech intelligibility with unilateral and bilateral cochlear implants

OBJECTIVE: A study was conducted examining the effects of amplitude-mapping adjustments on speech intelligibility with bilateral cochlear implant users, for both unilateral and bilateral device use. The main motivation for this study was the consideration that bilateral loudness summation may result in sounds becoming too loud if no adjustments are made to standard monaural amplitude-mapping functions (maps) when used bilaterally. In that case, reductions of the stimulation levels may be needed. The objective was to assess the impact of such adjustments on speech intelligibility in noise and in quiet. DESIGN: Four different maps were compared in eight bilateral users of the Nucleus 24 system. Each map variation was taken home for 1 week and used bilaterally. After each week, the map used was tested both unilaterally and bilaterally using an adaptive speech-in-noise test and bilaterally for low-level speech in quiet. For the tests in noise, both speech and noise were presented from the same loudspeaker placed directly in front of the listener (S0N0). One of the maps evaluated was a standard clinical map, fitted as if only one ear were to be used. The three other maps used stimulation levels that were reduced more near the maximal stimulation levels, near thresholds, or else by a similar amount over the entire dynamic range. RESULTS: The data showed a modest but statistically significant decrease in performance when stimulation levels were lowered. This was true both in noise and in quiet. For level reductions corresponding to binaural loudness summation effects, the performance decrease was on the order of 1 to 2 dB. Altering the slope of the map had relatively little effect on performance. Comparison of unilateral with bilateral performance using the same map (i.e., no compensation for bilateral loudness summation) and with speech and noise both presented from in front of the listeners showed a modest but statistically significant improvement in the bilateral condition. CONCLUSIONS: Using higher stimulation levels in amplitude-mapping functions can improve both monaural and binaural speech perception performance in quiet and in noise, even when the slope of the acoustic to electrical amplitude-mapping function is held constant (i.e., when the electrical signal-to-noise ratio remains constant). The results in noise can be understood if we assume that the relation between electrical stimulation levels and loudness grows faster at higher stimulation levels. When comparing the monaural better ear with binaural performance in noise (S0N0) by using the same map, that is to say, when no adjustments were made in the bilateral condition for bilateral loudness summation, an average signal-to-noise ratio benefit of 1.4 dB was found in the bilateral condition. These findings indicate that when fitting bilateral devices clinically, although binaural performance may decrease slightly if levels need to be reduced to compensate for binaural loudness summation, the binaural S0N0 advantage over the better ear will offset this. Consequently, performance with both ears after adjustment is likely to remain at least as good as for the better ear alone without level adjustment, even in the S0N0 condition where binaural advantages are minimized.