0 50 100 150 200 250 300 350 400 450 500 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 0 10 20 30 40 50 60 70 80 90 100 A dult C hildren C enters Chronological changes of CI cases Chronological changes of CI cases and CI centers in Japan and CI centers in Japan (120 (120 million population) million population)
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BENEFIT OF BINAURAL HEARING WITH COCHLEAR IMPLANT AND HEARING AID Osaka Prefecture (840 million population) Takeshi Kubo, M.D. Department of Otolaryngology.
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Chronological changes of CI cases and CI Chronological changes of CI cases and CI centers in Japan centers in Japan (120 million population)(120 million population)
Bilateral Cochlear Implantation on the Bilateral Cochlear Implantation on the same daysame day
1) Sound direction 1) Sound direction identificationidentification
2) Speech perception in 2) Speech perception in quietquiet
3) Speech perception in 3) Speech perception in noise noise
a) Noise from fronta) Noise from front b) Noise from right and b) Noise from right and
leftleft
Binaural hearing with CI/HA or CI/CIBinaural hearing with CI/HA or CI/CI
Mechanism of sound source detection Mechanism of sound source detection Inter-aural time difference (IInter-aural time difference (I
Comparison of sound direction identification Comparison of sound direction identification scores in CI, CI-HA, HA conditionsscores in CI, CI-HA, HA conditions
100100
00
5050
HAHACI+HACI+HACICI
P=0.001P=0.001
**P=0.0197P=0.0197
******
CI/HA groupCI/HA group
Binaural hearing with Binaural hearing with
CI and HA showed CI and HA showed
significantly better significantly better
score than monaural score than monaural
hearing (CI or HA hearing (CI or HA
alone) condition.alone) condition.
Binaural hearing with Binaural hearing with
CI and HA showed CI and HA showed
significantly better significantly better
score than monaural score than monaural
hearing (CI or HA hearing (CI or HA
alone) condition.alone) condition.
Comparison of sound direction identification Comparison of sound direction identification scores in CI alone and bilateral CI conditionsscores in CI alone and bilateral CI conditions
100100
00
5050
Lt CILt CI Bil CIBil CI Rt CIRt CI
**n.s.n.s.
CI/CI groupCI/CI group
Bilateral CI subjects Bilateral CI subjects
showed better score showed better score
than monaural listening than monaural listening
with poorer CI, but with poorer CI, but
showed similar showed similar
performance when performance when
listening with the better listening with the better
CI.CI.
Bilateral CI subjects Bilateral CI subjects
showed better score showed better score
than monaural listening than monaural listening
with poorer CI, but with poorer CI, but
showed similar showed similar
performance when performance when
listening with the better listening with the better
CI.CI.
Summary for sound direction Summary for sound direction identification studyidentification study
Binaural hearing with CI/HA had advantages Binaural hearing with CI/HA had advantages
for sound direction identification.for sound direction identification.
Benefits: Aware for the direction
of alarm sign. Can identify the speakerCan identify the speaker
Advantages of binaural hearingAdvantages of binaural hearing
Mechanisms of better hearing with two earsMechanisms of better hearing with two ears Summation effectSummation effect Binaural unmasking effect Binaural unmasking effect
Mechanisms of better hearing with two earsMechanisms of better hearing with two ears Summation effectSummation effect Binaural unmasking effect Binaural unmasking effect
Hearing in noise test (HINT) in binaural Hearing in noise test (HINT) in binaural hearing subjectshearing subjects
Sound and NoiseSound and Noisefrom frontfrom front
CICIHAHA
NNSS
●
●
●
●
●
●●
●
○
●
●
●●
○ ○
○○
●
○
○ ○
○ ○
○
11
11
11
11 33
22 44 8866
55 77 99
1010
1111
1212
1313
1616 1818
17171515
1414 2020
191911
Intensity of Intensity of noisenoise (dB)(dB)
Speech Sound: Speech Sound: 65dB65dB
Multi-talker noise Multi-talker noise with variable with variable intensities at 2 dB intensities at 2 dB steps.steps.
Bil-CI Rt-CI Lt-CI0
2
4
6
8
10
12
14
16
18
HINT under the noise and speech from HINT under the noise and speech from the frontthe front
Binaural performance was better or as good as performance with the better ear alone under the condition with the speech and noise from front:
binaural unmasking (squelch) effect !!
S/N ratio (dB)S/N ratio (dB)
CI+HA CI0
5
10
15
20
25
P=0.04P=0.04
S/N ratio (dB)S/N ratio (dB)
**
3) Speech perception 3) Speech perception in noisein noise
b) Noise from b) Noise from different directionsdifferent directions
- examination for head - examination for head shadow effect -shadow effect -
Binaural hearing with CI/HA or CI/CIBinaural hearing with CI/HA or CI/CI
0
2
4
6
8
10
12
14
16
Rt-CI Lt-CI
S/N (dB)S/N (dB)
Noise from LtNoise from Lt
NN
CICI
CICI
SS
0
2
4
6
8
10
12
Rt-CI Lt-CI
S/N (dB)S/N (dB)
Noise from RtNoise from Rt
CICI
CICI
NNSS
“ “ Head shadow Head shadow advantage”advantage”
Monaural hearing under the noise Monaural hearing under the noise from right or leftfrom right or left
Front CI-side HA-side0
4
8
12
****
S/N (dB)S/N (dB)
Binaural hearing (CI/HA) under the noise Binaural hearing (CI/HA) under the noise from three directionsfrom three directions
For noise on the left or right side, binaural performance For noise on the left or right side, binaural performance can utilize can utilize “Head shadow advantage”.“Head shadow advantage”.
CICI
HAHA
SSNN
NN
NN
For noise on the left or right side, binaural performance For noise on the left or right side, binaural performance can utilize can utilize “Head shadow advantage”.“Head shadow advantage”.
NNSS
CICI
CICI
NN
NN
Binaural hearing (CI/CI) under the noise Binaural hearing (CI/CI) under the noise from three directionsfrom three directions
0
2
4
6
8
10
N-Front N-better N-poorer
S/N (dB)S/N (dB)
Conclusion -2-Conclusion -2-For the binaural hearing under the For the binaural hearing under the
noise condition “the head shadow noise condition “the head shadow
advantage” was large, while “binaural advantage” was large, while “binaural