Book review.

Book review.

Int J Audiol. 2016 Mar;55(3):196

Authors: Gilbert J

PMID: 26862923 [PubMed - as supplied by publisher]

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Book Review.

Book Review.

Int J Audiol. 2016 Mar;55(3):195

Authors: Marc B

PMID: 26862922 [PubMed - as supplied by publisher]

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Measurement of dispersion curves of circumferential guided waves radiating from curved shells: Theory and numerical validation

A method is proposed to evaluate in a non-contact way the phase velocity dispersion curves of circumferential waves around a shell of arbitrary shape immersed in a fluid. No assumptions are made about the thickness or the material of the shell. A geometrical model is derived to describe the shape of the radiated wavefronts in the surrounding fluid, and predict the positions of its centers of curvature. Then the time-reversal principle is applied to recover these positions and to calculate the phase velocity of the circumferential waves. Numerical finite-difference simulations are performed to evaluate the method on a circular and on an elliptic thin shell. Different dispersion curves can be recovered with an error of less than 10%.

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Separation of non-stationary sound fields with single layer pressure-velocity measurementsa)

This paper examines the feasibility of extracting the non-stationary sound fieldgenerated by a target source in the presence of disturbing source from single layer pressure-velocity measurements. Unlike the method described in a previous paper [Bi, Geng, and Zhang, J. Acoust. Soc. Am. 135(6), 3474–3482 (2014)], the proposed method allows measurements of pressure and particle velocity signals on a single plane instead of pressure signals on two planes, and the time-dependent pressure generated by the target source is extracted by a simple superposition of the measured pressure and the convolution between the measuredparticle velocity and the corresponding impulse response function. Because the particle velocity here is measured directly, the error caused by the finite difference approximation can be avoided, which makes it possible to perform the separation better than the previous method. In this paper, a Microflown pressure-velocity probe is used to perform the experimental measurements, and the calibration procedure of the probe in the time domain is given. The experimental results demonstrate that the proposed method is effective in extracting the desired non-stationary sound fieldgenerated by the target source from the mixed one in both time and space domains, and it obtains more accurate results than the previous method.

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Assessment of the biomechanical stability of a dental implant with quantitative ultrasound: A three-dimensional finite element study

Dental implant stability is an important determinant of the surgical success. Quantitative ultrasound (QUS) techniques can be used to assess such properties using the implant acting as a waveguide. However, the interaction between an ultrasonicwave and the implant remains poorly understood. The aim of this study is to investigate the sensitivity of the ultrasonic response to the quality and quantity of bone tissue in contact with the implant surface. The 10 MHz ultrasonic response of an implant used in clinical practice was simulated using an axisymmetric three-dimensional finite element model, which was validated experimentally. The amplitude of the echographic response of the implant increases when the depth of a liquid layer located at the implant interface increases. The results show the sensitivity of the QUS technique to the amount of bone in contact with the implant. The quality of bone tissue around the implant is varied by modifying the bone biomechanicalproperties by 20%. The amplitude of the implant echographic response decreases when bone quality increases, which corresponds to bone healing. In all cases, the amplitude of the implant response decreased when the dental implant stability increased, which is consistent with the experimental results.

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Fano resonance scatterings in waveguides with impedance boundary conditions

The resonancescattering theory is used to study the sound propagation in a waveguide with a portion of its wall lined by a locally reacting material. The objective is to understand the effects of the mode coupling in the lined portion on the transmission. It is shown that a zero in the transmission is present when a real resonance frequency of the open system, i.e., the lined portion of the waveguide that is coupled to the two semi-infinite rigid ducts, is equal to the incident frequency. This transmission zero occurs as a Fano resonance—due to the excitation of a trapped mode in the open system. The trapped mode is formed by the interferences of two neighbored modes with complex resonance frequencies. It is also linked to the avoided crossing of eigenvalues of these two modes that occurs near an exceptional point (a subject that has attracted much attention in recent years in different physical domains). The real and complex resonance frequencies of the open system are determined by an equivalent eigenvalue problem of matrix , which describes the eigenvalue problem defined in the finite lined portion (scattering region). With the aid of the eigenvalues and eigenfunctions of matrix , the usual acoustic resonancescattering formula can be extended to describe the coupling effects between the scattering region and the rigid parts of the waveguide.

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An experimental application of aeroacoustic time-reversal to the Aeolian tone

This paper presents an experimental application of the aeroacoustic time-reversal (TR) source localization technique for studying flow-induced noise problems and compares the TR results with those obtained using conventional beamforming (CB). Experiments were conducted in an anechoic wind tunnel for the benchmark test-case of a full-span circular cylinder located in subsonic cross-flow wherein the far-field acoustic pressure was sampled using two line arrays (LAs) of microphones located above and below the cylinder. The source map obtained using the signals recorded at the two LAs without modeling the reflective surfaces of the contraction-outlet and cylinder during TR simulations revealed the lift-dipole nature of aeroacousticsourcegenerated at the Aeolian tone; however, it indicates an error of 3/20 of Aeolian tone wavelength in the predicted location. Modeling the reflective contraction-outlet during TR was shown to improve the focal-resolution of the source and reduce side-lobe levels, especially in the low-frequency range. The experimental TR results were shown to be comparable to (a) the simulation results of an idealized dipole at the cylinder location in wind-tunnel flow and (b) that obtained by monopole and dipole CB, thereby demonstrating the suitability of TR method as a diagnostic tool to analyze flow-induced noise generation mechanism.

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Spectral contrast enhancement improves speech intelligibility in noise for cochlear implants

Spectral smearing causes, at least partially, that cochlear implant(CI) users require a higher signal-to-noise ratio to obtain the same speech intelligibility as normal hearing listeners. A spectral contrast enhancement (SCE) algorithm has been designed and evaluated as an additional feature for a standard CI strategy. The algorithm keeps the most prominent peaks within a speech signal constant while attenuating valleys in the spectrum. The goal is to partly compensate for the spectral smearing produced by the limited number of stimulation electrodes and the overlap of electrical fields produced in CIs. Twelve CI users were tested for their speech reception threshold(SRT) using the standard CI coding strategy with and without SCE. No significant differences in SRT were observed between conditions. However, an analysis of the electrical stimulation patterns shows a reduction in stimulation current when using SCE. In a second evaluation, 12 CI users were tested in a similar configuration of the SCE strategy with the stimulation being balanced between the SCE and the non-SCE variants such that the loudness perception delivered by the strategies was the same. Results show a significant improvement in SRT of 0.57 dB (p 

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The effect of fluctuating maskers on speech understanding of high-performing cochlear implant users

10.3109/14992027.2015.1128124<br/>Stefan Zirn

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Defining the medial-lateral axis of an anatomical femur coordinate system using freehand 3D ultrasound imaging

Publication date: Available online 10 February 2016
Source:Gait & Posture
Author(s): Elyse Passmore, Morgan Sangeux
Hip rotation from gait analysis informs clinical decisions regarding correct of femoral torsional deformities. However, it is among the least repeatable due to discrepancies in determining the medial-lateral axis of the femur. Conventional or functional calibration methods may be used to define the axis but there is no benchmark to evaluate these methods. Freehand 3D ultrasound, the coupling of ultrasound with 3D motion capture, may provide such a benchmark.We measured the accuracy in vitro and repeatability in vivo of determining the femur condylar axis from freehand 3D ultrasound. The condylar axis provided the reference medial-lateral axis of the femur and was used to evaluate one conventional method and three functional calibration methods, applied to three calibration movements. Ten healthy subjects (20 limbs) underwent 3D gait analysis and freehand 3D ultrasound. The functional calibration methods were a transformation technique, a geometrical method and a method that minimises variance of knee varus-valgus kinematics (DynaKAD). The conventional method used markers over the femoral epicondyles.The condylar axis determined by ultrasound showed good accuracy in vitro, 1.6° (SD: 0.3°) and good repeatability in vivo, 0.2° (RSMD: 2.3°). The DynaKAD method applied to the walking calibration movement determined the medial-lateral axis closest to the ultrasound reference. The average angular difference in the transverse plane was 3.1° (SD: 6.1°).Freehand 3D ultrasound offers an accurate, non-invasive and relatively fast method to locate the medial-lateral axis of the femur for gait analysis.



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Age-independent and age-dependent sex differences in gait pattern determined by principal component analysis

Publication date: Available online 11 February 2016
Source:Gait & Posture
Author(s): Yoshiyuki Kobayashi, Hiroaki Hobara, Thijs A. Heldoorn, Makiko Kouchi, Masaaki Mochimaru
Although various studies have reported significant sex differences in pelvic and/or hip-joint motion during normal walking in healthy adults, it is still unclear whether such differences are among the most dominant age-independent sex differences. This study was conducted to analyze the whole waveform of lower-extremity joint kinematics obtained from 191 healthy adults using a 1212□principal component analysis (PCA). The PCA was conducted using a 955 input matrix constructed from the participants’ time-normalized pelvic and right-lower-limb-joint angles along three axes (five trials of 191 participants sex) analyses of□3 axes). Two-way (age□4 angles□101 data points□variance were conducted on the principal component scores (PCSs) of principal component vectors (PCVs) 1 through 6, each of which explained more than 5% of the variance. We identified a PCV that exhibits a significant age–sex interaction (PCV 1). The characteristics of sex differences reported in previous studies could be observed in the reconstructed waveforms of this PCV. Thus, we can conclude that the sex differences in the gaits reported in previous studies are not consistent across age groups. Furthermore, we also found a PCV that exhibited only a significant sex difference (PCV 6). This PCV was the first and only PCV to exhibit a sex difference without any age-related effect or age–sex interaction. Therefore, we concluded that the movement related to this PCV is age-independent and is the most dominant sex difference in the gaits observed during normal walking.



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Book review.

Book review.

Int J Audiol. 2016 Mar;55(3):196

Authors: Gilbert J

PMID: 26862923 [PubMed - as supplied by publisher]

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Book Review.

Book Review.

Int J Audiol. 2016 Mar;55(3):195

Authors: Marc B

PMID: 26862922 [PubMed - as supplied by publisher]

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The effect of fluctuating maskers on speech understanding of high-performing cochlear implant users

10.3109/14992027.2015.1128124<br/>Stefan Zirn

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Defining the medial-lateral axis of an anatomical femur coordinate system using freehand 3D ultrasound imaging

Publication date: Available online 10 February 2016
Source:Gait & Posture
Author(s): Elyse Passmore, Morgan Sangeux
Hip rotation from gait analysis informs clinical decisions regarding correct of femoral torsional deformities. However, it is among the least repeatable due to discrepancies in determining the medial-lateral axis of the femur. Conventional or functional calibration methods may be used to define the axis but there is no benchmark to evaluate these methods. Freehand 3D ultrasound, the coupling of ultrasound with 3D motion capture, may provide such a benchmark.We measured the accuracy in vitro and repeatability in vivo of determining the femur condylar axis from freehand 3D ultrasound. The condylar axis provided the reference medial-lateral axis of the femur and was used to evaluate one conventional method and three functional calibration methods, applied to three calibration movements. Ten healthy subjects (20 limbs) underwent 3D gait analysis and freehand 3D ultrasound. The functional calibration methods were a transformation technique, a geometrical method and a method that minimises variance of knee varus-valgus kinematics (DynaKAD). The conventional method used markers over the femoral epicondyles.The condylar axis determined by ultrasound showed good accuracy in vitro, 1.6° (SD: 0.3°) and good repeatability in vivo, 0.2° (RSMD: 2.3°). The DynaKAD method applied to the walking calibration movement determined the medial-lateral axis closest to the ultrasound reference. The average angular difference in the transverse plane was 3.1° (SD: 6.1°).Freehand 3D ultrasound offers an accurate, non-invasive and relatively fast method to locate the medial-lateral axis of the femur for gait analysis.



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Age-independent and age-dependent sex differences in gait pattern determined by principal component analysis

Publication date: Available online 11 February 2016
Source:Gait & Posture
Author(s): Yoshiyuki Kobayashi, Hiroaki Hobara, Thijs A. Heldoorn, Makiko Kouchi, Masaaki Mochimaru
Although various studies have reported significant sex differences in pelvic and/or hip-joint motion during normal walking in healthy adults, it is still unclear whether such differences are among the most dominant age-independent sex differences. This study was conducted to analyze the whole waveform of lower-extremity joint kinematics obtained from 191 healthy adults using a 1212□principal component analysis (PCA). The PCA was conducted using a 955 input matrix constructed from the participants’ time-normalized pelvic and right-lower-limb-joint angles along three axes (five trials of 191 participants sex) analyses of□3 axes). Two-way (age□4 angles□101 data points□variance were conducted on the principal component scores (PCSs) of principal component vectors (PCVs) 1 through 6, each of which explained more than 5% of the variance. We identified a PCV that exhibits a significant age–sex interaction (PCV 1). The characteristics of sex differences reported in previous studies could be observed in the reconstructed waveforms of this PCV. Thus, we can conclude that the sex differences in the gaits reported in previous studies are not consistent across age groups. Furthermore, we also found a PCV that exhibited only a significant sex difference (PCV 6). This PCV was the first and only PCV to exhibit a sex difference without any age-related effect or age–sex interaction. Therefore, we concluded that the movement related to this PCV is age-independent and is the most dominant sex difference in the gaits observed during normal walking.



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The effect of fluctuating maskers on speech understanding of high-performing cochlear implant users

10.3109/14992027.2015.1128124<br/>Stefan Zirn

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Whole-brain grey matter density predicts balance stability irrespective of age and protects older adults from falling

Publication date: March 2016
Source:Gait & Posture, Volume 45
Author(s): Matthieu P. Boisgontier, Boris Cheval, Peter van Ruitenbeek, Oron Levin, Olivier Renaud, Julien Chanal, Stephan P. Swinnen
Functional and structural imaging studies have demonstrated the involvement of the brain in balance control. Nevertheless, how decisive grey matter density and white matter microstructural organisation are in predicting balance stability, and especially when linked to the effects of ageing, remains unclear. Standing balance was tested on a platform moving at different frequencies and amplitudes in 30 young and 30 older adults, with eyes open and with eyes closed. Centre of pressure variance was used as an indicator of balance instability. The mean density of grey matter and mean white matter microstructural organisation were measured using voxel-based morphometry and diffusion tensor imaging, respectively. Mixed-effects models were built to analyse the extent to which age, grey matter density, and white matter microstructural organisation predicted balance instability. Results showed that both grey matter density and age independently predicted balance instability. These predictions were reinforced when the level of difficulty of the conditions increased. Furthermore, grey matter predicted balance instability beyond age and at least as consistently as age across conditions. In other words, for balance stability, the level of whole-brain grey matter density is at least as decisive as being young or old. Finally, brain grey matter appeared to be protective against falls in older adults as age increased the probability of losing balance in older adults with low, but not moderate or high grey matter density. No such results were observed for white matter microstructural organisation, thereby reinforcing the specificity of our grey matter findings.

Graphical abstract

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Defining the medial-lateral axis of an anatomical femur coordinate system using freehand 3D ultrasound imaging

Publication date: Available online 10 February 2016
Source:Gait & Posture
Author(s): Elyse Passmore, Morgan Sangeux
Hip rotation from gait analysis informs clinical decisions regarding correct of femoral torsional deformities. However, it is among the least repeatable due to discrepancies in determining the medial-lateral axis of the femur. Conventional or functional calibration methods may be used to define the axis but there is no benchmark to evaluate these methods. Freehand 3D ultrasound, the coupling of ultrasound with 3D motion capture, may provide such a benchmark.We measured the accuracy in vitro and repeatability in vivo of determining the femur condylar axis from freehand 3D ultrasound. The condylar axis provided the reference medial-lateral axis of the femur and was used to evaluate one conventional method and three functional calibration methods, applied to three calibration movements. Ten healthy subjects (20 limbs) underwent 3D gait analysis and freehand 3D ultrasound. The functional calibration methods were a transformation technique, a geometrical method and a method that minimises variance of knee varus-valgus kinematics (DynaKAD). The conventional method used markers over the femoral epicondyles.The condylar axis determined by ultrasound showed good accuracy in vitro, 1.6° (SD: 0.3°) and good repeatability in vivo, 0.2° (RSMD: 2.3°). The DynaKAD method applied to the walking calibration movement determined the medial-lateral axis closest to the ultrasound reference. The average angular difference in the transverse plane was 3.1° (SD: 6.1°).Freehand 3D ultrasound offers an accurate, non-invasive and relatively fast method to locate the medial-lateral axis of the femur for gait analysis.



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The effect of fluctuating maskers on speech understanding of high-performing cochlear implant users

10.3109/14992027.2015.1128124<br/>Stefan Zirn

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Book review.

Book review.

Int J Audiol. 2016 Mar;55(3):196

Authors: Gilbert J

PMID: 26862923 [PubMed - as supplied by publisher]

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Book Review.

Book Review.

Int J Audiol. 2016 Mar;55(3):195

Authors: Marc B

PMID: 26862922 [PubMed - as supplied by publisher]

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Meniett Therapy for Ménière's Disease: An Updated Meta-analysis

Objective: To re-evaluate the efficacy of Meniett therapy for the treatment of Ménière's disease (MD). Data Sources: PubMed, Embase, Cochrane Library, Clinicaltrials.gov, ChiCTR, and the CNKI database were searched for articles in English and Chinese published before August 31, 2015. Study Selection: Included in this meta-analysis were studies that dealt with outcomes of Meniett therapy for the treatment of MD, including randomized controlled clinical trials, case-control studies, and prospective or retrospective cohort studies, with sample sizes of ≥10 subjects. Data Extraction: Keywords included endolymphatic hydrops, Ménière's disease, pressure, Meniett, and transtympanic micropressure treatment. Data Synthesis: Fourteen studies were included, involving a total of 345 MD patients. Data were analyzed using the Meta package in R. Dichotomous outcomes were expressed as risk ratios with 95% confidence intervals, and weighted mean differences with 95% confidence intervals were used to present continuous outcomes. Heterogeneity of the included studies was quantitatively assessed by χ2 and I2 tests. Fixed-effects models were used for I2 

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American Otological Society Preliminary Program

No abstract available

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Objective and Subjective Outcome of a New Transcutaneous Bone Conduction Hearing Device: Half-year Follow-up of the First 12 Nordic Implantations

Objective: To examine the objective and subjective outcome of a new transcutaneous bone conduction hearing device. Study Design: Prospective, consecutive case series. Patients: Twelve patients were implanted. Eight patients had a conductive/mixed (con/mix) hearing loss. Four had single sided deafness. Main Outcome Measures: At half-year follow-up, aided and unaided sound field hearing was evaluated by 1) warble tone thresholds, 2) pure-tone average (PTA4), 3) speech discrimination score (SDS) in quiet, and 4) speech reception threshold 50% at 70 dB SPL noise level (SRT50%). Subjective outcome was evaluated by three questionnaires: 1) International Outcome Inventory for Hearing Aids, 2) Speech, Spatial and Qualities of Hearing Scale 12, and 3) a questionnaire on frequency and duration of use. Results: No major complications occurred. The mean aided PTA4 was lowered by 23 dB. SDS was increased by 40% at 50 dB, by 34% at 65 dB, and by 12% at 80 dB SPL. SRT50% in noise improved 5.2 dB. 58% of the patients used the device daily and 83% at least 5 days a week. 50% used the device ≥8 hours and 75% ≥ 4 hours a day. Mean International Outcome Inventory for Hearing Aids score was 3.7, corresponding to beneficial outcome. In Speech, Spatial and Qualities of Hearing Scale 12, “quality of hearing” scored especially high. The con/mix hearing loss group showed larger benefit especially in SDS, SRT50% in noise and the subjective evaluations, whereas frequency and duration of use were similar. Conclusion: This study on the first 12 Nordic patients implanted with a new transcutaneous bone conduction hearing device demonstrates significant objective, as well as subjective hearing benefit. Patient satisfaction was high, as was the frequency of use.

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Sensorineural Hearing Loss in Cholesteatoma

Objective: To determine whether middle ear cholesteatoma is associated with, sensorineural hearing loss, and whether patient age, cholesteatoma growth pattern, or, air bone gap size contribute to inner ear impairment. Study Design: Cross-sectional comparative. Setting: A tertiary hospital. Patients: The subjects were 115 patients with middle ear cholesteatoma in one ear, and normal video-otoscopy in the contralateral ear (CLE). Interventions: Otoendoscopy, pure-tone audiometry. Main Outcome Measures: Bone conduction (BC) threshold differences between the normal CLE and the cholesteatoma ear. Comparisons of these differences between different cholesteatoma growth patterns. Correlation between the air bone gap size in the ear with cholesteatoma and the difference in bone conduction thresholds between both ears. Results: The cholesteatoma ear was associated with greater BC thresholds than the CLE. With regard to different cholesteatoma growth patterns, the differences between associated BC thresholds were also significant in all groups at all frequencies, with the exception of the two routes of cholesteatoma group at 500 Hz. Comparing BC threshold differences, they were greater in the adult group at 500 Hz. The correlation between the air bone gap media in the ear with cholesteatoma and the difference in bone conduction thresholds between both ears was direct and moderate. Conclusion: Cholesteatoma was associated with greater BC thresholds at all frequencies tested. The differences were independent of cholesteatoma growth patterns. As bigger the air bone gap in the ear with cholesteatoma, greater the inner ear damage.

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Cerebellopontine Angle Mixed Tumor in Type 2 Neurofibromatosis

No abstract available

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Intracochlear Drug Delivery Through the Oval Window in Fresh Cadaveric Human Temporal Bones

Hypothesis: Drug delivered to the oval window can diffuse to the apex of the human cochlea. Background: We have previously demonstrated that zoledronate, a nitrogen-containing bisphosphonate, can arrest the sensorineural hearing loss in cochlear otosclerosis. We have also shown that, in animals, delivery of bisphosphonate into the cochlea can dramatically increase delivery efficiency. Intracochlear drug delivery has the potential to increase local concentration of drug while decreasing the risk of systemic toxicity. In the present study, a fluorescently labeled bisphosphonate compound (6-FAM-ZOL) was introduced into the human cochlea through the oval window and its distribution within the temporal bone was quantified. Methods: In three fresh human temporal bones, we introduced 6-FAM-ZOL via the oval window. We compared these specimens to control specimens treated with artificial perilymph alone. Specimens were then processed, embedded into methyl methacrylate, and ground to the mid-modiolar axis. We quantified the fluorescence in confocal images. Results: We found 6-FAM-ZOL to be distributed up to the apical cochlear turn. In specimens treated with 6-FAM-ZOL, we identified a strong baso-apical gradient of fluorescent signal along the lateral cochlear wall and the modiolus both in the scala vestibuli and in the scala tympani. Conclusion: Bisphosphonate introduced via the oval window in the human cochlea can be delivered up to the apical cochlear turn. Interscalar communication is likely to play an important role in determining patterns of drug delivery in the inner ear.

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Vestibular Migraine: Vestibular Symptom May Identify Different Subgroups

Objective: The objective of this study was to evaluate patients with vestibular migraine and analyze whether different vestibular symptoms were able to discriminate different subgroups. Patients: Eighty-three patients (73 women, mean age 42 yr) who fulfilled the criteria for vestibular migraine were selected. Intervention: Participants were divided into two groups according to their vestibular symptoms: spontaneous vertigo (SV) or triggered vertigo (TV). In each group, migraine subtype (migraine with aura and migraine without aura) was further analyzed. Results: The SV group comprised 40 patients (35 women, mean age 42.6 yr) of which 26 had migraine with aura. The TV group comprised 43 patients (38 women, mean age 41.3 yr) of which 34 had migraine without aura. A significant difference in the presence of spontaneous vertigo was noted, proving more frequent in the migraine with aura group, whereas TV was more frequent in the migraine without aura group (χ2 test, p 

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Computed Tomography Estimation of Cochlear Duct Length Can Predict Full Insertion in Cochlear Implantation

Objective: To compare the rates of full insertion of electrodes and hearing outcomes obtained with 28-mm and 31-mm cochlear implant electrode arrays. To assess whether cochlear duct length (CDL) estimated by preoperative computed tomography (CT) predicts whether an electrode is fully inserted. Study Design: A cohort study compared electrodes inserted and hearing outcomes after implantation with 28-mm or 31-mm arrays. CDL estimated from preoperative CT was compared in patients in whom full insertion of the 28-mm array was achieved compared with patients in whom at least one basal electrode was outside the cochlea. Setting: Tertiary referral cochlear implantation center. Patients: One hundred forty-eight patients implanted with 28-mm cochlear implant arrays (175 devices) and 74 patients implanted with 31-mm arrays (88 devices). Intervention: Cochlear implantation with 28-mm or 31-mm array. Main Outcome Measures: : Active electrodes at first programming, and at subsequent follow-ups. Bamford–Kowal–Bench sentence and auditory speech sound evaluation test results at 2 to 3 months in adult patients. CDL predicted by preoperative CT. Results: There was no difference in full insertion between the 28-mm and 31-mm array cohorts (p = 0.22). Early hearing outcomes at 2 to 3 months showed no difference in mean auditory speech sound evaluation (p = 0.19) or Bamford–Kowal–Bench results (p = 0.853) between the 28-mm and 31-mm cohorts. CDL was shorter in the 22 patients with less than full insertion of the array with a mean length of 28.7 mm compared with 29.6 mm in the 42 patients in whom full insertion was achieved (p = 0.046). Conclusion: CT estimation of CDL predicts full insertion after cochlear implantation. Insertion depth does not affect early hearing outcome.

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Teratoma of the Middle Ear With Cholesteatoma

No abstract available

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Impaired Perception of Sensory Consonance and Dissonance in Cochlear Implant Users

Hypothesis: In light of previous research demonstrating poor pitch perception in cochlear implant (CI) users, we hypothesized that the presence of consonant versus dissonant chord accompaniment in real-world musical stimuli would not impact subjective assessment of degree of pleasantness in CI users. Background: Consonance/dissonance are perceptual features of harmony resulting from pitch relationships between simultaneously presented musical notes. Generally, consonant sounds are perceived as pleasant and dissonant ones as unpleasant. CI users exhibit impairments in pitch perception, making music listening difficult and often unenjoyable. To our knowledge, consonance/dissonance perception has not been studied in the CI population. Methods: Twelve novel melodies were created for this study. By altering the harmonic structures of the accompanying chords, we created three permutations of varying dissonance for each melody (36 stimuli in all). Ten CI users and 12 NH listeners provided Likert scale ratings from −5 (very unpleasant) to +5 (very pleasant) for each of the stimuli. Results: A two-way ANOVA showed main effects for Dissonance Level and Subject Type as well as a two-way interaction between the two. Pairwise comparisons indicated that NH stimuli pleasantness ratings decreased with increasing dissonance, whereas CI ratings did not. NH pleasantness ratings were consistently lower than CI ratings. Conclusion: For CI users, consonant versus dissonant chord accompaniment had no significant impact on whether a melody was considered pleasant or unpleasant. This finding may be partially responsible for the decreased enjoyment of many CI users during music perception and is another manifestation of impaired pitch perception in CI users.

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American Neurotology Society Preliminary Program

No abstract available

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Hearing Preservation Outcomes With a Mid-Scala Electrode in Cochlear Implantation

Objective: To evaluate hearing preservation (HP) outcomes in adult cochlear implant recipients with a mid-scala electrode. Setting: Tertiary academic center. Patients: Adult patients implanted with a mid-scala electrode between May 2013 and July 2015. Interventions: Cochlear implantation. Main Outcome Measure(s): Age, sex, surgical approach, residual hearing changes post cochlear implantation, HP rates using different published classifications, and speech perception scores. Results: Fifty ears for 47 patients (mean age, 58.2 yr; range, 23–86) were implanted with the electrode. Recognizing that not all patients were true HP candidates and/or underwent generally accepted HP surgical techniques, 39 ears had preoperative low-frequency hearing (audiometric threshold ≤85 dB HL at 250 Hz), 24 preserved acoustic hearing postoperatively (75.0%). Patients who had preserved acoustic hearing were implanted via round window (N = 18), extended round window (N = 4), or via cochleostomy (N = 2) approaches. Mean threshold elevation for low-frequency pure-tone average (125, 250, and 500 Hz) was 20.2 dB after surgery. 43.8% of patients had aidable low-frequency hearing at activation, 30.0% at 6-months postoperatively, and 30.8% 1-year postoperatively. Using a formula outlined by Skarzynski and colleagues, at 6-months postoperatively, 15.0% of patients had complete HP, whereas 40.0% had partial HP. At 1-year, these percentages decreased to 0% and 38.5%, respectively. Age, type of approach, and perioperative steroid use were not correlated with HP outcomes at activation and 6-months postoperatively (p > 0.05). Conclusion: The mid-scala electrode evaluated allows preservation of low-frequency hearing in patients undergoing cochlear implantation at rates and degrees of preservation close to other reports in the cochlear implant literature.

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A Comparative Review of Osseointegration Failure Between Osseointegrated Bone Conduction Device Models in Pediatric Patients

Objective: Compare rates of osseointegration failure (OIF) between system 2 (200 series) and system 3 (BI300) osseointegrated bone conduction device (OCBD) models. Study Design: Case series with chart review. Setting: Tertiary referral center. Patients: Pediatric patients who were implanted with either system 2 or system 3 OCBD between May 2009 and July 2014 at Arkansas Children's Hospital. Interventions: Implantation with either system 2 or system 3 OCBD using 3- and 4-mm implants with 5.5- and 8.5-mm abutments (system 2) or 6- and 9-mm abutments (system 3). Main Outcome Measures: OIF with resulting loss of flange-fixture. Results: OIF occurred in 28.6% (14/49) of implanted fixtures in system 2 compared with 8.0% (2/25) of implanted fixtures in system 3 (p = 0.042). The average time to complication for system 2 was 13 months compared with 3 months for system 3. The causes of OIF in system 2 were trauma (n = 4), chronic soft tissue disease (n = 5), or idiopathic in nature (n = 5). System 3 failures were both because of trauma. Using the combined cohorts, the average age of patients who experienced OIF was 8.7 years, compared with 11.4 years in patients without OIF (p = 0.047). There was no difference in OIF among 3-mm and 4-mm screws (p = 0.876), linear and flap technique (p = 0.375), or surgeons (p = 0.211). Conclusion: System 3 OCBD showed a significantly reduced rate of OIF compared with system 2 in our study. Modification to the system 2 implant resulted in improved rate of OIF. Younger age was independently associated with a higher rate of OIF when evaluating both systems.

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Cochlear Implantation in a Patient With Pfeiffer Syndrome and Temporal Bone Vascular Anomalies

Objective: Pfeiffer syndrome is a rare craniosynostotic disorder resulting in premature bony fusion of the skull, which can result in abnormal temporal bone and vascular anatomy and hearing loss. Cochlear implantation in these patients requires thoughtful surgical planning given the potential for limited access to the cochlea because of subcutaneous or intratemporal vasculature. Herein, we present a patient with Pfeiffer syndrome who underwent successful cochlear implantation using preoperative Doppler ultrasound to identify large extracranial venous anatomy followed by a modified transcanal surgical approach. Patients: An adult female patient with Pfeiffer syndrome. Intervention(s): Preoperative axial computed tomography, catheter angiography, Doppler ultrasound, and right side cochlear implant. Main Outcome Measure(s): Surgical feasibility and audiometric outcomes including aided thresholds and word recognition score. Results: Successful cochlear implantation was performed via a modified transcanal approach with blind sac closure of the external auditory meatus. Full electrode insertion was obtained through a round window approach. No extracranial or intratemporal vessels were encountered during surgery. Conclusion: Patients with significant craniosynostoses and vascular malformations of the temporal bone can undergo successful cochlear implantation. Careful preoperative planning with high-resolution CT, MRA, and MRV, and/or traditional catheter angiography can assist in determining surgical feasibility and minimizing risk. We recommend preoperative Doppler ultrasound of abnormal extracranial vessels to assist in safe placement of incisions and hardware.

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Isolated Vestibular Suppression Impairment With Vestibular Migraine: A Phenotypic CANVAS Variant

Hypothesis: Cerebellar Ataxia with Neuropathy and Vestibular Areflexia (CANVAS) is likely to have a genetic basis. We describe the unique eye movement features of a possible phenotypic CANVAS variant. Background: The patient comes from a large CANVAS kindred (four out of nine siblings) and has sensory neuropathy, cerebellar eye signs, and vestibular migraine (VM), but otherwise normal vestibular function. Methods: We recorded eye and head movements using the gold standard scleral search coil technique: in the patient, a close relative with mild sensory neuropathy, and a normal control. Results: At ≥0.8 Hz vestibulo-ocular reflex suppression (VORS) was significantly smaller in the patient. At 1 Hz, the patient's VORS was almost two times worse than the control, and five times worse at 1.6 Hz. The patient's VORS deficiency was observed with the naked eye as an inability to keep the eye stationary during imposed sinusoidal head rotation at ∼1 Hz. At ≤0.8 Hz the patient had 10 to 20% lower smooth pursuit function compared with both the patient-relative and control subjects. This difference was difficult to detect by the naked eye. Saccadic oculomotor and vestibular function was normal. Conclusion: We propose that impaired VORS and VM are because of similar, but distinct, consequences of selective partial cerebellar dysfunction. The patient's VORS data are consistent with a CANVAS neuropathological study showing selective degeneration of the dorsal vermis of the cerebellum, a region thought to be important for VORS. Taken together our findings suggest the patient is a CANVAS variant. We hypothesise VORS impairment is part of CANVAS, but not revealed because of vestibular loss.

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Prevalence of Pulsatile Tinnitus Among Patients With Migraine

Objective: To examine the prevalence of pulsatile tinnitus (PT) among patients with a diagnosis of migraine and to determine if treatment of migraine improves symptoms. Study Design: Single-institution retrospective patient review. Setting: Academic tertiary referral center. Patients: Billing data capturing ICD-9 codes 346.xx and 388.3x was used to identify patients with history of migraine and tinnitus. Patients were excluded if the symptom of PT could be attributed to an alternate diagnosis. Data were extracted from the patients’ electronic medical records. Intervention(s): Therapeutic patients were prescribed a strict migraine diet with or without migraine medication. Main Outcome Measure(s): Subjective improvement in tinnitus as documented in electronic medical records. Results: One thousand two hundred four patients were identified with an ICD-9 code for migraine and of those patients, 12% (n = 145) had an ICD-9 code for tinnitus. After ruling out alternative causes, the prevalence of PT among all patients with migraine was 1.9%. Of migrainers with PT who underwent migraine treatment, 11 out of 16 reported resolution or improvement of their PT. Conclusion: PT can be observed in the context of migraine. Migraine treatment with avoidance of dietary triggers with or without medication can possibly lead to resolution of PT.

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Dickkopf-related Protein 3 as a Sensitive and Specific Marker for Cerebrospinal Fluid Leaks

Hypothesis: Cerebrospinal fluid (CSF) can be identified by using an enzyme-linked immunosorbent assay (ELISA) for Dickkopf-related protein 3 (DKK3). Background: Cerebrospinal fluid leakage from the subarachnoid space is a potentially alarming condition that, left unrepaired, may result in increased risk of meningitis and encephalitis. Current biochemical methods of CSF leak detection involve using beta-2-transferrin-based or beta trace protein-based assays, both of which, at present, have limitations that hinder practical clinical application. This study presents the immunological detection of the CSF-enriched protein DKK3 as a method for detection of a CSF leak. Methods: Antibodies against DKK3 were generated in rabbits and goats immunized with recombinant human DKK3. Varying dilutions and combinations of human CSF and serum were tested on immunoblots and sandwich ELISA using antibodies to DKK3. Results: ELISA data show that there is a negligible amount of detectable DKK3 in serum samples compared with CSF samples. Inclusion of sera (up to 30%) in a sample containing CSF failed to produce a positive signal, whereas concentrations of CSF as low as 1% produced a positive signal. The minimum concentration required for reliable CSF detection in a sandwich ELISA was determined to be 0.5 μl. Conclusion: ELISA sandwich assays for DKK3 can reliably detect the presence of as little as 0.5 μl of human CSF, even in the presence of excessive serum. This study provides quantitative evidence of the utility of DKK3 immunoreactivity as an assay for the presence of CSF in samples that contain contaminating sera. The robustness of this assay has allowed for the development of a rapid, point of care test for the detection of CSF in clinical and surgical setting.

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The Use of Temporoparietal Fascial Flap to Eliminate Wound Breakdown in Subtotal Petrosectomy for Chronic Discharging Ears

Objective: To find out if the use of the vascularized temporo-parietal fascial flap (TPFF) reduces postoperative infection or wound breakdown in subtotal petrosectomy for chronic discharging ears. Patients: A retrospective review on 26 subtotal petrosectomies with blind pit closures on chronic discharging ears performed by a single surgeon between 2000 and 2015 was performed. All patients had a minimum follow-up period of 6 months. Intervention: Eleven mastoid cavities were obliterated with abdominal fat, and 15 cavities were obliterated with TPFF. There was no concomitant cochlear implant or middle ear implant. Main Outcome Measure(s): All postoperative wound infections or delay in wound healing were recorded into a database. The complication rates of the fat obliteration group were compared using Fisher's exact test with those for the TPFF obliteration group. Results: In the fat obliteration group, 4 out of 11 patients had documented postoperative complications. Three had wound breakdown with exposure of the fat that required revision surgery. Another patient had postauricular abscess without the wound actually broken down. On the other hand, all the ears in the TPFF obliteration group (100%) were completely free of wound infection, wound breakdown, or any complication. The difference between the two groups was statistically significant (p = 0.022). Conclusion: Many authors have encountered postoperative infection or wound breakdown in subtotal petrosectomy with fat obliteration in the treatment of chronic otitis media. Using a richly vascularized temporo-temporal fascial flap to protect the blind pit closure in such patients reduces postoperative infection and wound breakdown.

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Minimal Growth of Intracochlear Schwannoma Over 7 Years

No abstract available

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Long-term Stability of the Active Middle-ear Implant with Floating-mass Transducer Technology: A Single-center Study

Objective: To examine the long-term results of an active middle-ear implant (AMEI) with floating-mass transducer (FMT) technology. Study Design: Prospective cohort study of German-speaking patients implanted with an AMEI between 2006 and 2013. Setting: Single-center study. Patients: Eighty-three patients. Intervention: AMEI with FMT technology implantation. Main Outcome Measures: Long-term outcome (27 mo; range, 12–84 mo) for FMT position in correlation with pure-tone audiometry, auditory thresholds for frequency-modulated (warble) tones, vibroplasty thresholds for pure tones, and speech audiometry in quiet and noise. Results: In 15.6% of patients, a revision surgery was necessary to improve functional performance of the AMEI, and the highest revision rate was found with FMT coupling to the round window not using couplers. A peak number of revision surgeries were observed 3 years after the initial surgery. Stable audiological results (pure-tone audiometry and speech audiometry in quiet and noise) were observed up to 84-month post-surgery. Incus vibroplasty (classic indication) showed a significantly lower functional gain compared with oval and round window vibroplasty. Vibroplasty in combined or conductive hearing loss showed no functional difference between forward and reverse stimulation of the cochlea; however, significantly lower vibroplasty thresholds were detected when using a coupler. Conclusions: The AMEI with FMT technology can be safely used in treatment of patients with mild-to-severe sensorineural, conductive, or mixed hearing loss. Optimized coupling, especially in incus vibroplasty, has to be developed to achieve enhanced audiological results.

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Testing Speech Recognition in Spanish-English Bilingual Children with the Computer-Assisted Speech Perception Assessment (CASPA): Initial Report.

This study evaluated the English version of Computer-Assisted Speech Perception Assessment (E-CASPA) with Spanish-English bilingual children. E-CASPA has been evaluated with monolingual English speakers ages 5 years and older, but it is unknown whether a separate norm is necessary for bilingual children. Eleven Spanish-English bilingual and 12 English monolingual children (6 to 12 years old) with normal hearing participated. Responses were scored by word, phoneme, consonant, and vowel. Regardless of scores, performance across three signal-to-noise ratio conditions was similar between groups, suggesting that the same norm can be used for both bilingual and monolingual children. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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A Binaural Cochlear Implant Sound Coding Strategy Inspired by the Contralateral Medial Olivocochlear Reflex.

Objectives: In natural hearing, cochlear mechanical compression is dynamically adjusted via the efferent medial olivocochlear reflex (MOCR). These adjustments probably help understanding speech in noisy environments and are not available to the users of current cochlear implants (CIs). The aims of the present study are to: (1) present a binaural CI sound processing strategy inspired by the control of cochlear compression provided by the contralateral MOCR in natural hearing; and (2) assess the benefits of the new strategy for understanding speech presented in competition with steady noise with a speech-like spectrum in various spatial configurations of the speech and noise sources. Design: Pairs of CI sound processors (one per ear) were constructed to mimic or not mimic the effects of the contralateral MOCR on compression. For the nonmimicking condition (standard strategy or STD), the two processors in a pair functioned similarly to standard clinical processors (i.e., with fixed back-end compression and independently of each other). When configured to mimic the effects of the MOCR (MOC strategy), the two processors communicated with each other and the amount of back-end compression in a given frequency channel of each processor in the pair decreased/increased dynamically (so that output levels dropped/increased) with increases/decreases in the output energy from the corresponding frequency channel in the contralateral processor. Speech reception thresholds in speech-shaped noise were measured for 3 bilateral CI users and 2 single-sided deaf unilateral CI users. Thresholds were compared for the STD and MOC strategies in unilateral and bilateral listening conditions and for three spatial configurations of the speech and noise sources in simulated free-field conditions: speech and noise sources colocated in front of the listener, speech on the left ear with noise in front of the listener, and speech on the left ear with noise on the right ear. In both bilateral and unilateral listening, the electrical stimulus delivered to the test ear(s) was always calculated as if the listeners were wearing bilateral processors. Results: In both unilateral and bilateral listening conditions, mean speech reception thresholds were comparable with the two strategies for colocated speech and noise sources, but were at least 2 dB lower (better) with the MOC than with the STD strategy for spatially separated speech and noise sources. In unilateral listening conditions, mean thresholds improved with increasing the spatial separation between the speech and noise sources regardless of the strategy but the improvement was significantly greater with the MOC strategy. In bilateral listening conditions, thresholds improved significantly with increasing the speech-noise spatial separation only with the MOC strategy. Conclusions: The MOC strategy (1) significantly improved the intelligibility of speech presented in competition with a spatially separated noise source, both in unilateral and bilateral listening conditions; (2) produced significant spatial release from masking in bilateral listening conditions, something that did not occur with fixed compression; and (3) enhanced spatial release from masking in unilateral listening conditions. The MOC strategy as implemented here, or a modified version of it, may be usefully applied in CIs and in hearing aids. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Testing Speech Recognition in Spanish-English Bilingual Children with the Computer-Assisted Speech Perception Assessment (CASPA): Initial Report.

This study evaluated the English version of Computer-Assisted Speech Perception Assessment (E-CASPA) with Spanish-English bilingual children. E-CASPA has been evaluated with monolingual English speakers ages 5 years and older, but it is unknown whether a separate norm is necessary for bilingual children. Eleven Spanish-English bilingual and 12 English monolingual children (6 to 12 years old) with normal hearing participated. Responses were scored by word, phoneme, consonant, and vowel. Regardless of scores, performance across three signal-to-noise ratio conditions was similar between groups, suggesting that the same norm can be used for both bilingual and monolingual children. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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A Binaural Cochlear Implant Sound Coding Strategy Inspired by the Contralateral Medial Olivocochlear Reflex.

Objectives: In natural hearing, cochlear mechanical compression is dynamically adjusted via the efferent medial olivocochlear reflex (MOCR). These adjustments probably help understanding speech in noisy environments and are not available to the users of current cochlear implants (CIs). The aims of the present study are to: (1) present a binaural CI sound processing strategy inspired by the control of cochlear compression provided by the contralateral MOCR in natural hearing; and (2) assess the benefits of the new strategy for understanding speech presented in competition with steady noise with a speech-like spectrum in various spatial configurations of the speech and noise sources. Design: Pairs of CI sound processors (one per ear) were constructed to mimic or not mimic the effects of the contralateral MOCR on compression. For the nonmimicking condition (standard strategy or STD), the two processors in a pair functioned similarly to standard clinical processors (i.e., with fixed back-end compression and independently of each other). When configured to mimic the effects of the MOCR (MOC strategy), the two processors communicated with each other and the amount of back-end compression in a given frequency channel of each processor in the pair decreased/increased dynamically (so that output levels dropped/increased) with increases/decreases in the output energy from the corresponding frequency channel in the contralateral processor. Speech reception thresholds in speech-shaped noise were measured for 3 bilateral CI users and 2 single-sided deaf unilateral CI users. Thresholds were compared for the STD and MOC strategies in unilateral and bilateral listening conditions and for three spatial configurations of the speech and noise sources in simulated free-field conditions: speech and noise sources colocated in front of the listener, speech on the left ear with noise in front of the listener, and speech on the left ear with noise on the right ear. In both bilateral and unilateral listening, the electrical stimulus delivered to the test ear(s) was always calculated as if the listeners were wearing bilateral processors. Results: In both unilateral and bilateral listening conditions, mean speech reception thresholds were comparable with the two strategies for colocated speech and noise sources, but were at least 2 dB lower (better) with the MOC than with the STD strategy for spatially separated speech and noise sources. In unilateral listening conditions, mean thresholds improved with increasing the spatial separation between the speech and noise sources regardless of the strategy but the improvement was significantly greater with the MOC strategy. In bilateral listening conditions, thresholds improved significantly with increasing the speech-noise spatial separation only with the MOC strategy. Conclusions: The MOC strategy (1) significantly improved the intelligibility of speech presented in competition with a spatially separated noise source, both in unilateral and bilateral listening conditions; (2) produced significant spatial release from masking in bilateral listening conditions, something that did not occur with fixed compression; and (3) enhanced spatial release from masking in unilateral listening conditions. The MOC strategy as implemented here, or a modified version of it, may be usefully applied in CIs and in hearing aids. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Testing Speech Recognition in Spanish-English Bilingual Children with the Computer-Assisted Speech Perception Assessment (CASPA): Initial Report.

This study evaluated the English version of Computer-Assisted Speech Perception Assessment (E-CASPA) with Spanish-English bilingual children. E-CASPA has been evaluated with monolingual English speakers ages 5 years and older, but it is unknown whether a separate norm is necessary for bilingual children. Eleven Spanish-English bilingual and 12 English monolingual children (6 to 12 years old) with normal hearing participated. Responses were scored by word, phoneme, consonant, and vowel. Regardless of scores, performance across three signal-to-noise ratio conditions was similar between groups, suggesting that the same norm can be used for both bilingual and monolingual children. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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A Binaural Cochlear Implant Sound Coding Strategy Inspired by the Contralateral Medial Olivocochlear Reflex.

Objectives: In natural hearing, cochlear mechanical compression is dynamically adjusted via the efferent medial olivocochlear reflex (MOCR). These adjustments probably help understanding speech in noisy environments and are not available to the users of current cochlear implants (CIs). The aims of the present study are to: (1) present a binaural CI sound processing strategy inspired by the control of cochlear compression provided by the contralateral MOCR in natural hearing; and (2) assess the benefits of the new strategy for understanding speech presented in competition with steady noise with a speech-like spectrum in various spatial configurations of the speech and noise sources. Design: Pairs of CI sound processors (one per ear) were constructed to mimic or not mimic the effects of the contralateral MOCR on compression. For the nonmimicking condition (standard strategy or STD), the two processors in a pair functioned similarly to standard clinical processors (i.e., with fixed back-end compression and independently of each other). When configured to mimic the effects of the MOCR (MOC strategy), the two processors communicated with each other and the amount of back-end compression in a given frequency channel of each processor in the pair decreased/increased dynamically (so that output levels dropped/increased) with increases/decreases in the output energy from the corresponding frequency channel in the contralateral processor. Speech reception thresholds in speech-shaped noise were measured for 3 bilateral CI users and 2 single-sided deaf unilateral CI users. Thresholds were compared for the STD and MOC strategies in unilateral and bilateral listening conditions and for three spatial configurations of the speech and noise sources in simulated free-field conditions: speech and noise sources colocated in front of the listener, speech on the left ear with noise in front of the listener, and speech on the left ear with noise on the right ear. In both bilateral and unilateral listening, the electrical stimulus delivered to the test ear(s) was always calculated as if the listeners were wearing bilateral processors. Results: In both unilateral and bilateral listening conditions, mean speech reception thresholds were comparable with the two strategies for colocated speech and noise sources, but were at least 2 dB lower (better) with the MOC than with the STD strategy for spatially separated speech and noise sources. In unilateral listening conditions, mean thresholds improved with increasing the spatial separation between the speech and noise sources regardless of the strategy but the improvement was significantly greater with the MOC strategy. In bilateral listening conditions, thresholds improved significantly with increasing the speech-noise spatial separation only with the MOC strategy. Conclusions: The MOC strategy (1) significantly improved the intelligibility of speech presented in competition with a spatially separated noise source, both in unilateral and bilateral listening conditions; (2) produced significant spatial release from masking in bilateral listening conditions, something that did not occur with fixed compression; and (3) enhanced spatial release from masking in unilateral listening conditions. The MOC strategy as implemented here, or a modified version of it, may be usefully applied in CIs and in hearing aids. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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