Study of Music and Speech Perception in New Cochlear Implanted Subjects Using or Not a Tonotopy Based Fitting

Study Overview
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Brief Summary
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Main objective: Show the superiority of tonotopy based fitting strategy compared to default fitting strategy on the perception speech in noise. Secondary objectives: Show the superiority of tonotopy based fitting strategy compared to default fitting strategy on the perception of musical elements (contour test). Show the non inferiority of tonotopy based fitting strategy compared to default fitting strategy on the perception of speech elements in quiet. Show the superiority of tonotopy based fitting strategy compared to default fitting strategy on the qualitative preference for the listening of musical pieces.

Detailed Description
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Introduction: Cochlear implantation allows the rehabilitation of profound bilateral deafness, restoring speech perception and verbal communication when the traditional hearing aid no longer provides satisfactory hearing gain (Nimmons et al.). A cochlear implant includes an electrode array and its functioning is based on the principle of cochlear tonotopy: each electrode encodes a frequency spectrum according to its position in the cochlea (high frequencies are assigned to the basal electrodes and low frequencies to the apical electrodes). The cochlear implant thus breaks down the frequency spectrum into a number of frequency bands via bandpass filters corresponding to the number of electrodes in the implant. During the fitting these bands can be modified by the audiologist. The fitting software developed by the manufacturers proposed a default fitting with a lower limit between 100 and 250 Hz according to the brands and an upper limit of about 8500 Hz. The frequency bands assigned to each electrode follow a logarithmic scale with the high frequencies for the basal electrodes and the low frequencies for the apical electrodes. This distribution takes into account the number of active electrodes but does not take into account the anatomy and the natural cochlear tonotopy specific to each patient. Several studies have analyzed the anatomical variations of the cochlear dimensions: size of the cochlea and the ratio between the contact surfaces of the electrodes with the cochlea are variable from one patient to another (Stakhovskaya O et al., P. Pelliccia et al.). The insertion depth during surgery is also variable due to parameters related to the patients as well as to the operator, which seems to impact the understanding of speech in noise (Deep electrode insertion and sound coding in cochlear implants - Ingeborg Hochmair et al.). Mathematical algorithms have recently been developed to estimate the cochlear tonotopy of each patient from a CT scan assessment (Jiam et al., Sridhar et al.). CT imaging of the implanted ear combined with 3D reconstruction software, provides cochlear length measurements (Cochlear length determination using Cone Beam Computed Tomography in a clinical setting - Würfel et al .) Using this approach it is possible to measure the position of each electrode relative to the cochlear apex. These measurements are applied to the modified Greenwood equation to obtain the tonotopic frequency for each electrode and to determine for each patient a fitting based on the tonotopy of each electrode. Main objective: Show the superiority of tonotopy based fitting strategy compared to default fitting strategy on the perception speech in noise. Secondary objectives: Show the superiority of tonotopy based fitting strategy compared to default fitting strategy on the perception of musical elements (contour test). Show the non inferiority of tonotopy based fitting strategy compared to default fitting strategy on the perception of speech elements in quiet. Show the superiority of tonotopy based fitting strategy compared to default fitting strategy on the qualitative preference for the listening of musical pieces. Plan of the study: It is a prospective open monocentric randomized crossover study: measures will be done on the patient at 6 weeks and 12 weeks post-activation.

Official Title
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Evaluation of the Impact of a Tonotopy Based Fitting on the Speech and Musical Perception in New Cochlear Implanted Subjects. Prospective Randomized Crossover Study.

Conditions
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Sensorineural Hearing Loss, Bilateral

Intervention / Treatment
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* Device: tonotopy based fitting then default fitting
* Device: default fitting then tonotopy based fitting


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patient (>= 18 years old) speaking French Patient who fulfils the criteria for cochlear implantation Exclusion Criteria: retro-cochlear pathology: auditory neuropathy, vestibular schwannoma patient with residual hearing < 60 dB HL at 250 Hz and < 80 dB HL at 500 Hz

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Two arms A and B: Arm A: patient's fitting with default fitting --> 6 weeks use --> tests and patient's fitting with tonotopy based fitting --> 6 weeks use --> tests Arm B: patient's fitting with tonotopy based fitting --> 6 weeks use --> tests and patient's fitting with default fitting --> 6 weeks use --> tests
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Cochlear Implant (CI) with default fitting then tonotopy based fitting<br>Cochlear Implant with default fitting first during 6 weeks then with tonotopy based fitting during 6 weeks | Device: tonotopy based fitting then default fitting<br>* Cochlear implant with default fitting then tonotopy based fitting<br>Device: default fitting then tonotopy based fitting<br>* Cochlear implant with tonotopy based fitting then default fitting<br>|
| Active Comparator: Cochlear Implant (CI) with tonotopy based fitting then default fitting<br>Cochlear Implant with tonotopy based fitting during 6 weeks then with default fitting during 6 weeks | Device: tonotopy based fitting then default fitting<br>* Cochlear implant with default fitting then tonotopy based fitting<br>Device: default fitting then tonotopy based fitting<br>* Cochlear implant with tonotopy based fitting then default fitting<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| speech recognition in noise | The speech recognition in noise is evaluated with syllabic list of 40 phonemes. The patient has to recognize 20 syllables. The phonemes are scored: each good answer is scored 1 yielding a total between 0 and 1 (or 0% and 100%). Signal-noise-ratios of 9, 6, 3 and 0 dB will be tested with speech at 65 dB SPL. | at 6 weeks post-activation | 
| speech recognition in noise | The speech recognition in noise is evaluated with syllabic list of 40 phonemes. The patient has to recognize 20 syllables. The phonemes are scored: each good answer is scored 1 yielding a total between 0 and 1 (or 0% and 100%). Signal-noise-ratios of 9, 6, 3 and 0 dB will be tested with speech at 65 dB SPL. | at 12 weeks post-activation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| speech recognition in quiet | The speech recognition in quiet is evaluated with syllabic list of 40 phonemes. The patient has to recognize 20 syllables. The phonemes are scored: each good answer is scored 1 yielding a total between 0 and 1 (or 0% and 100%). | at 6 weeks post-activation | 
| speech recognition in quiet | The speech recognition in quiet is evaluated with syllabic list of 40 phonemes. The patient has to recognize 20 syllables. The phonemes are scored: each good answer is scored 1 yielding a total between 0 and 1 (or 0% and 100%). | at 12 weeks post-activation | 
| Melodic contour test | The test stimuli of the melodic contour test (Galvin et al. 2007) are melodic contours composed of 5 notes of equal duration whose frequencies correspond to musical intervals. Nine distinct musical patterns have to be identified by the patient. Each good answer is scored 1 yielding a total between 0 and 1 (or 0% and 100%). | at 6 weeks post-activation | 
| Melodic contour test | The test stimuli of the melodic contour test (Galvin et al. 2007) are melodic contours composed of 5 notes of equal duration whose frequencies correspond to musical intervals. Nine distinct musical patterns have to be identified by the patient. Each good answer is scored 1 yielding a total between 0 and 1 (or 0% and 100%). | at 12 weeks post-activation | 
| Qualitative measure of music | The Gabrielsson scale (1988) is used to evaluate perceived sound quality as a multidimensional phenomenon, that is composed of a number of separate perceptual dimensions. Eight perceptual dimensions are evaluated: clarity, fullness, brightness vs dullness, hardness/sharpness vs softness, spaciousness, nearness, extraneous sound, loudness. Visual analog scales (VAS) are used for each dimension and the patient has to score the dimension on a 10 cm VAS (between 0 to 10). | at 6 weeks post-activation | 
| Qualitative measure of music | The Gabrielsson scale (1988) is used to evaluate perceived sound quality as a multidimensional phenomenon, that is composed of a number of separate perceptual dimensions. Eight perceptual dimensions are evaluated: clarity, fullness, brightness vs dullness, hardness/sharpness vs softness, spaciousness, nearness, extraneous sound, loudness. Visual analog scales (VAS) are used for each dimension and the patient has to score the dimension on a 10 cm VAS (between 0 to 10). | at 12 weeks post-activation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cochlear implant strategy, tonotopy based fitting