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PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva (Institute of Otolaryngology, St. Petersburg) Elena A. Ogorodnikova (Pavlov Institute of Physiology, St. Petersburg)
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PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

Jan 11, 2016

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Page 1: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn)Inna V. Koroleva (Institute of Otolaryngology, St. Petersburg)Elena A. Ogorodnikova (Pavlov Institute of Physiology, St. Petersburg)

Page 2: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Cochlear implantation (1)Cochlear implantation is one of the most perspective directions in

the rehabilitation of patients with significant hearing losses

Cochlear implant is a surgically implantable device that provides hearing sensation to individuals with severe-to-profound hearing loss who do not benefit from hearing aids

People with hearing losses in such range have absent or malfunctioning sensory cells in the cochlea

Page 3: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Cochlear implantation (2)In a normal ear, sound energy is converted to mechanical energy by the middle ear, which is then converted to mechanical fluid motion in the cochlea. Within the cochlea, the sensory cells (the inner and outer hair cells) are sensitive transducers that convert that mechanical fluid motion into electrical impulses in the auditory nerve.

Page 4: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Cochlear implantation (3)

Cochlear implants are designed to substitute for the function of the middle ear, cochlear mechanical motion, and sensory cells, transforming sound energy into electrical energy that will initiate impulses in the auditory nerve

Implant systems consist of both consist of both internal and external componentsinternal and external components

Page 5: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Cochlear implantation (4)

The external components (over or next to the ear) include (1) a microphone, which converts sound into an electrical signal, (2) a speech processor, which manipulates and converts the signal into a special code and (3) a transmitter, which sends the coded electrical signal to the internal components

The surgically implanted components include (A) a receiver, which decodes the signal from the speech processor, and (B) an electrode array, which stimulates the cochlea with electrical current

The systems are powered by batteries located in the speech processor

Page 6: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Rehabilitation (1)Rehabilitation is the very important post-surgical stage of

cochlear implantation

It is a complex and long process which essentially depends on individual characteristics of the patient (auditory experience, general abilities and the absence of mental defects)

It is accepted to distinguish between the two groups of patients with cochlear implants :

pre-lingual - the hearing loss occurred before the patient has learned to speak (in general, before the second year of life) and

post-lingual - when the hearing loss occurred in the age of four years or later (after the patient has learned to speak)

Page 7: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Rehabilitation (2)The main task of rehabilitation : for post-lingual patients - the regeneration of the ability to

perceive and to understand spoken language (the forming of connections between the distorted auditory information and previous internal patterns of speech and other sounds)

for pre-lingual patients - the development of the foundations of auditory perception from the beginning (includes the basic elementary operations - detection and discrimination of sounds) and building up the whole system of spoken language

So for all listeners with cochlear implants – a primary rehabilitation problem is the creation or correction of «new» auditory patterns

Page 8: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Rehabilitation and music cochlear implants have been designed primarily to

enhance speech perception many implant recipients anticipate enjoying music

following the implantation in fact, up to 38 per cent of implant recipients report

they do not enjoy listening to music with their device (Leal et al., Acta Otolaryngology 123, 826 (2003))

up to 86 per cent of post-lingual recipients report lower scores of listening habits after implantation

Page 9: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Hypothesis pitch has been reported to be recognized with

more difficulty than rhythm or timbre by implant recipients (because frequency encoding is robust in an implant), therefore temporal aspects of music are expected to be perceived better than pitch

Page 10: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Method about 150 cochlear implant receivers in St.

Petersburg area by 2005 (Combi40 or Combi 40+ by MED-EL)

they are interviewed in order to study their post-surgical adaptation to listening music

interviews are conducted at the Institute of Otolaryngology in St. Petersburg as a part of general rehabilitation program

selected interviews are videotaped

Page 11: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Interview Did you listen to speech, music, or noise? If this was music, was it singing or playing an

instrument? If this was singing, was there just one performer or

many of them? Were the singers male or female? If this was playing an instrument, was there just one

instrument or many? String, wind, or percussion? Was this music joyful or sad? Fast or slow? Pleasant

or not? Simple or complicated? Did this music sound in high, medium or low

register?

Page 12: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Choice of music for the interviewFour excerpts from world music, with different sound

characteristics: Japanese bamboo flute shakuhachi: one voice, long

notes, timing plays little role Saami jojk (Mari Boine): female singing, one voice,

heterogeneous rhythm Lithuanian sutartine: polyphonic female singing

(facilitates harmonic dissonances), repetitive rhythm Tuvan overtone singing (xöömij): a low fundamental

of special timbre, with higher overtones made audible one-by-one

Page 13: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Long-term spectra of (1) Japanese bamboo flute shakuhachi (top left), (2) Saami jojk (top right), (3) Lithuanian dissonant polyphony (bottom left), and (4) Tuvan overtone singing (bottom right)

Frequency (Hz)0 5000

20

40

60

0 1000 2000 3000 4000 5000Frequency (Hz)

0 5000

20

40

60

0 1000 2000 3000 4000 5000

Frequency (Hz)0 5000

20

40

60

0 1000 2000 3000 4000 5000 Frequency (Hz)0 5000

20

40

60

0 1000 2000 3000 4000 5000

Page 14: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Interview results for 10 CI-recipients (age 10 to 55 years, post-surgical experience from 2 weeks to 4 years)

flute jojk sutartine xöömijmusic 10 10 10 7singing 2 10 10 6female singing 1 7 7 2joyful 0 0 8 1fast 0 0 8 0pleasant 8 8 8 0low pitch 2 3 1 8medium pitch 3 1 1 4high pitch 2 0 6 1

Page 15: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Listening preference score for ten CI-recipients

Page 16: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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List of instruments for the timbre recognition task (those in yellow recognized more easily)

MUSICAL INSTRUMENT ESTIMATED FREQUENCY RANGE

1 violin 180-8000

2 cello 70-8000

3 double bass 40-5000

4 harp 30-15000

5 piano 22-6000

6 flute 250-9600

7 organ 22-16000

8 trumpet 160-8000

9 cymbals 500-16000

10 triangle 1200-16000

11 kettledrum 16-350

12 big drum 16-350

Page 17: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Recognition of musical timbres before and after a training session

Page 18: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Long-term improvement of timbre recognition by cochlear implant recipients (without special training)

Page 19: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Excerpts from an interview (1) a post-lingual patient has used the implant for a couple

of weeks describes Tuvan overtone

singing as sound of a Jewish harp

describes shakuhachi sound as singing

confuses Saami jojk with Lithuanian polyphony

noticeable progress during the interview

admits using extramusical features (sound volume) to solve the task

Page 20: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Excerpts from an interview (2)- a post-lingual patient- has used the implant for

4 years- recognizes Lithuanian

polyphonic and Tuvan overtone singing

- confuses a shakuhachi sound with Saami jojk

- claims to prefer the jojk to other excerpts

Page 21: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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General conclusion Many post-lingual patients with cochlear

implants are and pre-lingual patients become strongly motivated to attend music even when its perceived acoustical characteristics only remotely resemble the patterns they expect to hear. This may be explained by an ecologically important function music fulfills in people’s everyday life.

Page 22: PERCEPTION OF MUSIC BY PATIENTS WITH COCHLEAR IMPLANTS Jaan Ross (University of Tartu and Estonian Academy of Music and Theatre, Tallinn) Inna V. Koroleva.

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Thanks to Elvira I. Stoljarova of the Pavlov Institute of

Physiology, St. Petersburg, for video recording of the interviews