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The Benefit of Bilateral Versus Unilateral Cochlear Implantation to Speech Intelligibility in Noise

Culling, John F.1; Jelfs, Sam2; Talbert, Alice1; Grange, Jacques A.1; Backhouse, Steven S.3

doi: 10.1097/AUD.0b013e3182587356
Research Articles

Objectives: To develop a predictive model of spatial release from masking (SRM) for cochlear implantees, and validate this model against data from the literature. To establish the spatial configurations for which the model predicts a large advantage of bilateral over unilateral implantation. To collect data to support these predictions and generate predictions of more typical advantages of bilateral implantation.

Design: The model initially assumed that bilateral cochlear implantees had equally effective implants on each side, with which they could perform optimal better-ear listening. Predictions were compared with measurements of SRM, using one and two implants with up to three interfering noises. The effect of relaxing the assumption of equally effective implants was explored. Novel measurements of SRM for eight unilateral implantees were collected, including measurements using speech and noise at azimuths of ± 60 degrees, and compared with prediction. A spatial map of bilateral implant benefit was generated for a situation with one interfering noise in anechoic conditions, and predictions of benefit were generated from binaural room impulse responses in a variety of real rooms.

Results: The model accurately predicted data from a previous study for multiple interfering noises in a variety of spatial configurations, even when implants were assumed to be equally effective (r = 0.97). It predicted that the maximum benefit of bilateral implantation was 18 dB. Predictions were little affected if the implants were not assumed to be equally effective. The new measurements supported the 18 dB advantage prediction. The spatial map of predicted benefit showed that, for a listener facing the target voice, bilateral implantees could enjoy an advantage of about 10 dB over unilateral implantees in a wide range of situations. Predictions based on real-room measurements with speech and noise at 1 m showed that large benefits can occur even in reverberant spaces.

Conclusions: In optimal conditions, the benefit of bilateral implantation to speech intelligibility in noise can be much larger than has previously been reported. This benefit is thus considerably larger than reported benefits of summation or squelch and is robust in reverberation when the interfering source is close.

A combination of modeling and measurement was used to explore the maximum potential benefit of a second cochlear implant (CI) for spatial release from masking. The optimal spatial configuration was selected using the model and used to design an experiment using unilateral CI users. Both model and experiment concurred that the maximum benefit should be around 18 dB. This figure can be compared with the 4 to10 dB benefits that have been reported up to now. It is argued that benefits of the order of 10 dB are typical of many situations, and that both interaural differences in the effectiveness of CIs and room reverberations have only a minor impact on this conclusion.

1School of Psychology, Cardiff University, Park Place, Cardiff, United Kingdom;

2Philips Research Europe, High Tech Campus, Eindhoven, The Netherlands;

3South Wales Cochlear Implant Programme (Bridgend), Princess of Wales Hospital, Bridgend, United Kingdom.

ACKNOWLEDGMENTS: This work supported by the U.K. Engineering and Physical Sciences Research Council and by Action on Hearing Loss. The authors are grateful to Philip Loizou, Roland Laszig, and Roman Laske for providing raw data from their experiments.

Address for correspondence: John F. Culling, School of Psychology, Cardiff University, Park Place, Cardiff, CF10, United Kingdom. E-mail:

Received June 8, 2011

Accepted March 18, 2012

© 2012 Lippincott Williams & Wilkins, Inc.