Music, Hearing Loss, and Cochlear Implants The Next Frontier - - PDF document

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Music, Hearing Loss, and Cochlear Implants The Next Frontier - - PDF document

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Music, Hearing Loss, and Cochlear Implants The Next Frontier Charles J. Limb, M.D. Francis A. Sooy Professor Chief of Otology, Neurotology and Skull Base Surgery Director, Douglas Grant Cochlear Implant Center Department of

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Music, Hearing Loss, and Cochlear Implants The Next Frontier

Charles J. Limb, M.D.

Francis A. Sooy Professor Chief of Otology, Neurotology and Skull Base Surgery Director, Douglas Grant Cochlear Implant Center Department of Otolaryngology-Head and Neck Surgery and Neurological Surgery University of California San Francisco San Francisco, CA

Disclosures

  • Advanced Bionics Corporation

– Consultant (2006-present) – Research support

  • Med-El Corporation

– Research grants (2012-present) – Research support (2016)

  • Oticon Medical

– Conference chair/consultant, cochlear implants and music (2016)

  • Frequency Therapeutics, Inc.

– Consultant (2016)

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Treatment for hearing loss has evolved

1800s 2000s Methods Secondary Reconstruction

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Why music?

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First musical instrument? Bird bone flute Recovered from southern Germany (Giessenklösterle) ~35,000 years old Patel, et al., 2009 Current

‘Snowball’ gets his groove on

Patel, et al., 2009 Current

‘Snowball’ gets his groove on

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Despite success in language perception, most cochlear implant users cannot hear music well.

500-1500 Hz BPF unfiltered stimuli

Percentage Correct Doesn’t Work For Music!

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What does music sound like for a CI user?

In normal hearing, place and rate pitch mechanisms are seamlessly integrated and support one another. In electric hearing, place and rate pitch mechanisms are both disrupted. Difference between middle C and one semitone above or below ~15 Hz

Pitch perception is the single biggest obstacle for CI-mediated perception of music Relative pitch > absolute pitch

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PURE TONES REAL TIME SPECTROGRAM SUPERSTITION - REAL TIME SPECTROGRAM

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Typical CI frequency map covers range of 60+ semitones Rachmaninoff Prelude Op. 3, No. 2 in C# minor: original Rachmaninoff Prelude Op. 3, No. 2 in C# minor: original

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Rachmaninoff Prelude Op. 3, No. 2 in C# minor: +/- 1 s.t. Rachmaninoff Prelude Op. 3, No. 2 in C# minor: +/- 1 s.t.

Caldwell M. et al, 2015.

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CI Users Utilize Tempo Rather Than Mode to Interpret Musical Emotion

Caldwell M. et al, 2015.

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Caldwell MT et al. 2016

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NH Confusion Matrix Presented Identified Cnt Cor

  • Class. % Single Interval

Chord Single 260 90.3% 24 8.3% 2 0.7% Interval 63 21.9% 174 60.4% 53 18.4% Chord 23 8.0% 122 42.4% 143 49.7% CI Confusion Matrix Presented Identified Cnt Cor

  • Class. % Single Interval

Chord Single 199 69.1% 63 21.9% 26 9.0% Interval 136 47.2% 84 29.2% 67 23.3% Chord 112 38.9% 86 29.9% 89 30.9% Donnelly et al., 2009

CI Users Demonstrate Fusion of Polyphonic Pitch

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How do we measure musical sound quality in CI users?

Musical Sound Quality is Poor in CI Users

  • CI users subjectively report poorer musical sound

quality following implantation

(Gfeller et al 2002; Lassaletta et al 2008)

  • Sound quality traditionally assessed via

questionnaires or rating scales (Lassaletta et al 2008; Gfeller et al

2008; Looi et al 2008, 2011)

  • Assessment of sound quality can be used as a tool, not an

indicator of preference or enjoyment

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Cochlear Implant-MUltiple Stimulus with Hidden Reference and Anchor

(CI-MUSHRA)

  • 25 full quality musical stimuli are increasingly degraded:

– Example: Removal of bass frequencies – Hidden reference (best sound quality) – 200 Hz HPF – 400 Hz HPF – 600 Hz HPF – 800 Hz HPF – 1000 Hz HPF – Anchor (1000-1200Hz band-pass filter) No Alterations Highly Altered

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Roy et al., 2012

25 excerpts, from 5 genres (pop/rock, country, jazz, classical, hip hop)

CI-MUSHRA MUSHRA: ITU-R Recommendation BS.1534 For evaluation of lossy audio compression algorithms

Roy et al., 2012

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How do we improve music for CI users?

  • Change the CI
  • Change the brain
  • Change the music

Can we tune cochlear implants?

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FPCT distinguishes all 216 individual electrode contacts

Jiam NT et al. Otol Neurotol 2016 (In press)

Frequency-place mismatch increases in apical and basal electrodes

Jiam NT et al. Otol Neurotol 2016 (In press)

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Kretzmer, E. A. et al. Arch Otolaryngol Head Neck Surg 2004;130:499-508.

Kretzmer, E. A. et al. Arch Otolaryngol Head Neck Surg 2004;130:499- 508. A radiograph of a cat with a cochlear implant shows the 6 electrode contacts (electrode 1 at white arrowhead) within the cochlea

Courtesy of the Ryugo laboratory, Center for Hearing Sciences

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Parsons LM, 2001

PET is quiet, non-magnetic Positron Emission Tomography

Positron-emitting [15]O atom H2-[15]O molecules

Positron Emission Tomography

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CI listeners Normal listeners

Is CI listening similar to normal listening?

Limb et al., 2010

10 postlingual CI users / 10 controls

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Roy et al., 2014

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Conclusions

  • Music is the pinnacle of hearing
  • Critical impairments in pitch, timbre and sound quality

are observed in CI users

  • These impairments reveal limitations of CI processing

that speech testing does not

  • Cochlear implants are severely out of tune
  • We must work to improve CI designs, processing

strategy, musical training, and even the music itself

Thank You

  • Johns Hopkins University School of Medicine
  • The Dana Foundation
  • NIDCD/NIH
  • The Brain Science Institute
  • National Endowment for the Arts
  • Peabody Conservatory of Music
  • University of California San Francisco
  • Baltimore Symphony Orchestra
  • San Francisco Jazz Center
  • San Francisco Conservatory of Music
  • Advanced Bionics Corporation
  • Cochlear Corporation
  • Med El Corporation
  • Oticon
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Thank You

  • Judy Doong
  • Alice He
  • Nicole Jiam
  • Tina Munjal
  • Meredith Caldwell
  • Patpong Jiradejvong
  • Joseph Heng
  • Mickael Deroche
  • Gabe Donnay
  • Stephen Dunlap
  • Diane Hwang
  • Irene Kim
  • Matthew Sachs
  • Karen Barrett Chan
  • Nicholas Ryugo
  • Gabriela Cantarero
  • Monica Lopez-Gonzalez
  • Lindsay Scattergood
  • Jonathan Zwi
  • Juan Huang
  • Michael Williams
  • Patrick Donnelly
  • Summer Rankin
  • Malinda McPherson
  • Andrew Landau
  • Fred Barrett
  • Alexis Roy
  • Melanie Gilbert

Music, Hearing Loss, and Cochlear Implants The Next Frontier

Charles J. Limb, M.D.

Francis A. Sooy Professor Chief of Otology, Neurotology and Skull Base Surgery Director, Douglas Grant Cochlear Implant Center Department of Otolaryngology-Head and Neck Surgery and Neurological Surgery University of California San Francisco San Francisco, CA