1. Different evaluations for different kinds of hearing Matthew B. Winn Au.D., Ph.D. Waisman Center, UW-Madison Dept. of Surgery

2. Different kinds of hearing? Using both ears together Listening for information / listening for clarity The ears as part of the brain & part of the whole person

3. The challenge of using a cochlear implant Sound distortion Pitch shifting Abnormal loudness Neural atrophy

4. Imagine the inner ear as a piano… Low notes High notes Middle notes

5. Imagine the inner ear as a piano… Low notes High notes Middle notes

6. Imagine the inner ear as a piano… Low notes High notes Middle notes

7. Imagine the inner ear as a piano… Low notes High notes Middle notes

8. In real life…

9. Listening for information, listening for clarity

10. Restaurant

11. Testing for clarity in hearing

12. Speech sounds are morphed from one sound to another Listeners label each sound as it is heard Labeling consistency and confidence is modeled statistically

13. Different listeners have different levels of clarity in their hearing (clarity)

14. Context and adaptation 14

15. Context and adaptation 15

16. Some voices have predictable patterns of differences Pitch, duration, voice quality, articulation, etc. We can form categories High / low pitch Creaky / smooth voice quality “eee” / “ooo” “sss” “sh”

17. Some voices have predictable patterns of differences A “low” pitch for one voice may be higher than a “high” pitch for another voice

18. Testing adjustment to different voices Low pitch / High pitch “sh” “ss” The difference between low “sh” and high “ss” depends on whether the voice is female or male. male voice sh ss female voice boundary

19. Testing for a boundary Focus on a region of interest Label the sounds “sh”“ss”

20. Accommodation to talker voice 20 (CI Listener data)

21. Accommodation to talker FACE 21 (CI Listener data)

22. Accommodation to talker voice with face 22 (CI Listener data)

23. A change of [this context] is worth [this much change] in auditory frequency boundary 23 Boundary shift (Hz)

24. Listeners with normal hearing adjust to the talker’s voice

25. Listeners with cochlear implants adjust to the talker’s voice and face

26. Adjusting on the fly Listeners with normal hearing can adjust to the speech of various talkers on-the-fly using their ears Listeners with cochlear implants can adjust using their ears AND their eyes, So they may benefit from learning some audio+visual associations between faces and vocal styles

27. Binaural and Bilateral People with normal hearing enjoy binaural hearing, which means the two ears work together and compare inputs. This lets us do many things, including locate a sound in space and separate speech from background noise

28. Using two cochlear implants Two cochlear implants are independent systems that may or may not work well together

29. Binaural and Bilateral People with bilateral cochlear implants generally report benefit from the second device Better sound localization Better hearing in noise

30. Some abilities are easily quantifiable… Word recognition over the first two years Sound localization

31. Other abilities are not-so-easily quantifiable. (From the Cochlear Corp. website) Benefits of bilateral implantation: More connected More confident More balanced and relaxed Peace of mind Bilateral implants make it “easier to hear everyday sounds… without the constant strain associated with a hearing loss.”

32. Listening fatigue and hearing loss: why it matters Individuals with hearing loss (HL) have to "work harder" cognitively to process sounds compared to people without hearing loss Increased reports of stress, tension & fatigue [1] Higher "need for recovery" from work [2] Individuals with HL are more likely to miss work due to "fatigue, strain or burnout" than individuals without HL working at a similar or the same job [3]

33. Effort  Pupil dilation Task-evoked pupil dilation corresponds to cognitive effort 33

34. Listening effort test Listen to sentences with the right implant only Listen to sentences with the left implant only Listen to sentences with both implants Hear the sentence, wait a moment, then repeat We measure pupil size as the sentence ends, and during the time before you repeat it back

35. Right ear CI only

36. Right and Left CIs

37. Bilateral CIs

38. New directions Technology exists to improve sound clarity Efforts can be made to synchronize both ears CI recipients undergo auditory training We can evaluate the effects of these efforts on the listener’s experience of mental effort required to listen

39. Questions and comments are welcome! Matthew Winn mwinn2@wisc.edu