UNASSIGNED: The purpose of this exploratory study was to (a) construct a virtual reality (VR) test environment to measure speech recognition in noise (SIN) and localization, and (b) use the VR test environment to establish degree of binaural hearing benefit among a small number of adults with single-sided deafness (SSD) using a cochlear implant (CI).
UNASSIGNED: This pilot study included five adults implanted for SSD. The test environment was composed of an eight-speaker array that delivered restaurant noise and Institute of Electrical and Electronics Engineers sentences. VR head-mounted display goggles delivered a video recording of a busy restaurant. Participants completed SIN and localization in two conditions: (a) normal-hearing ear and a CI on the contralateral SSD side (CI-ON) and (b) normal-hearing ear and unaided on the contralateral SSD side (CI-OFF).
UNASSIGNED: Overall, CI benefits for SIN and localization within the VR test environment were improved for some participants, although not all. CI benefit for SIN and localization was dependent on speaker location.
UNASSIGNED: VR test environments present new opportunities for studying SIN and localization abilities in participants with CIs. This pilot study shows that, within a VR test environment, degree of CI benefit among SSD participants for SIN and localization varies across speaker location and across participants.

OBJECTIVE: Sound localization plays a crucial role in our daily lives, enabling us to recognize voices, respond to alarming situations, avoid dangers, and navigate towards specific signals. However, this ability is compromised in patients with Single-Sided Deafness (SSD) and Asymmetric Hearing Loss (AHL), negatively impacting their daily functioning. The main objective of the study was to quantify the degree of sound source localization in patients with single-sided deafness or asymmetric hearing loss using a Cochlear Implant (CI) and to compare between the two subgroups.
METHODS: This was a prospective, longitudinal, observational, single-center study involving adult patients diagnosed with profound unilateral or asymmetric sensorineural hearing loss who underwent cochlear implantation. Sound localization was assessed in a chamber equipped with seven speakers evenly distributed from -90º to 90º. Stimuli were presented at 1000 Hz and intensities of 65 dB, 70 dB, and 75 dB. Each stimulus was presented only once per speaker, totaling 21 presentations. The number of correct responses at different intensities was recorded, and angular error in degrees was calculated to determine the mean angular distance between the patient-indicated speaker and the speaker presenting the stimulus. Both assessments were conducted preoperatively without a cochlear implant and two years post-implantation.
RESULTS: The total sample comprised 20 patients, with 9 assigned to the SSD group and 11 to the AHL group. The Preoperative Pure Tone Average (PTA) in free field was 31.7 dB in the SSD group and 41.8 dB in the AHL group. There was a statistically significant improvement in sound localization ability and angular error with the use of the cochlear implant at all intensities in both SSD and AHL subgroups.
CONCLUSIONS: Cochlear implantation in patients with SSD and AHL enhances sound localization, reducing mean angular error and increasing the number of correct sound localization responses.

Bayesian models have proven effective in characterizing perception, behavior, and neural encoding across diverse species and systems. The neural implementation of Bayesian inference in the barn owl\'s sound localization system and behavior has been previously explained by a non-uniform population code model. This model specifies the neural population activity pattern required for a population vector readout to match the optimal Bayesian estimate. While prior analyses focused on trial-averaged comparisons of model predictions with behavior and single-neuron responses, it remains unknown whether this model can accurately approximate Bayesian inference on single trials under varying sensory reliability, a fundamental condition for natural perception and behavior. In this study, we utilized mathematical analysis and simulations to demonstrate that decoding a non-uniform population code via a population vector readout approximates the Bayesian estimate on single trials for varying sensory reliabilities. Our findings provide additional support for the non-uniform population code model as a viable explanation for the barn owl\'s sound localization pathway and behavior.

OBJECTIVE: To investigate if cartilage conduction (CC) rerouting devices are noninferior to air-conduction (AC) rerouting devices for single-sided deafness (SSD) patients by measuring objective and subjective performance using speech-in-noise tests that resemble a realistic hearing environment, sound localization tests, and standardized questionnaires.
METHODS: Prospective, single-subject randomized, crossover study.
METHODS: Anechoic room inside a university.
METHODS: Nine adults between 21 and 58 years of age with severe or profound unilateral sensorineural hearing loss.
METHODS: Patients\' baseline hearing was assessed; they then used both the cartilage conduction contralateral routing of signals device (CC-CROS) and an air-conduction CROS hearing aid (AC-CROS). Patients wore each device for 2 weeks in a randomly assigned order.
METHODS: Three main outcome measures were 1) speech-in-noise tests, measuring speech reception thresholds; 2) proportion of correct sound localization responses; and 3) scores on the questionnaires, \"Abbreviated Profile of Hearing Aid Benefit\" (APHAB) and \"Speech, Spatial, and Qualities of Hearing Scale\" with 12 questions (SSQ-12).
RESULTS: Speech reception threshold improved significantly when noise was ambient, and speech was presented from the front or the poor-ear side with both CC-CROS and AC-CROS. When speech was delivered from the better-ear side, AC-CROS significantly improved performance, whereas CC-CROS had no significant effect. Both devices mainly worsened sound localization, whereas the APHAB and SSQ-12 scores showed benefits.
CONCLUSIONS: CC-CROS has noninferior hearing-in-noise performance except when the speech was presented to the better ear under ambient noise. Subjective measures showed that the patients realized the effectiveness of both devices.

Binaural reproduction aims at recreating a realistic sound scene at the ears of the listener using headphones. Unfortunately, externalization for frontal and rear sources is often poor (virtual sources are perceived inside the head, instead of outside the head). Nevertheless, previous studies have shown that large head-tracked movements could substantially improve externalization and that this improvement persisted once the subject had stopped moving his/her head. The present study investigates the relation between externalization and evoked response potentials (ERPs) by performing behavioral and EEG measurements in the same experimental conditions. Different degrees of externalization were achieved by preceding measurements with 1) head-tracked movements, 2) untracked head movements, and 3) no head movement. Results showed that performing a head movement, whether the head tracking was active or not, increased the amplitude of ERP components after 100 ms, which suggests that preceding head movements alters the auditory processing. Moreover, untracked head movements gave a stronger amplitude on the N1 component, which might be a marker of a consistency break in regards to the real world. While externalization scores were higher after head-tracked movements in the behavioral experiment, no marker of externalization could be found in the EEG results.

The human auditory system can localize multiple sound sources using time, intensity, and frequency cues in the sound received by the two ears. Being able to spatially segregate the sources helps perception in a challenging condition when multiple sounds coexist. This study used model simulations to explore an algorithm for localizing multiple sources in azimuth with binaural (i.e., two) microphones. The algorithm relies on the \"sparseness\" property of daily signals in the time-frequency domain, and sound coming from different locations carrying unique spatial features will form clusters. Based on an interaural normalization procedure, the model generated spiral patterns for sound sources in the frontal hemifield. The model itself was created using broadband noise for better accuracy, because speech typically has sporadic energy at high frequencies. The model at an arbitrary frequency can be used to predict locations of speech and music that occurred alone or concurrently, and a classification algorithm was applied to measure the localization error. Under anechoic conditions, averaged errors in azimuth increased from 4.5° to 19° with RMS errors ranging from 6.4° to 26.7° as model frequency increased from 300 to 3000 Hz. The low-frequency model performance using short speech sound was notably better than the generalized cross-correlation model. Two types of room reverberations were then introduced to simulate difficult listening conditions. Model performance under reverberation was more resilient at low frequencies than at high frequencies. Overall, our study presented a spiral model for rapidly predicting horizontal locations of concurrent sound that is suitable for real-world scenarios.

Despite normal hearing in one ear, individuals with congenital unilateral aural atresia may perceive difficulties in everyday listening conditions typically containing multiple sound sources. While previous work shows that intervention with bone conduction devices may aid spatial hearing for some children, testing conditions are often arranged to maximize any benefit and are not very similar to daily life. The benefit from amplification on spatial tasks has been found to vary between individuals, for reasons not entirely clear. This study has sought to expand on the limited knowledge on how children with unilateral aural atresia recognize speech masked by competing speech, and how horizontal sound localization accuracy is affected by the degree of unilateral hearing loss and by amplification using unilateral bone conduction devices when fitted before 3 years of age. In a within-subject, repeated measures design, including 11 children (mean age = 7.9 years), bone conduction hearing device (BCD) amplification did not negatively affect horizontal sound localization accuracy. The effect on speech recognition scores showed greater inter-individual variability. No benefit from amplification on a group level was found. There was no association between age at fitting and the benefit of the BCD. For children with poor unaided sound localization accuracy, there was a greater BCD benefit. Unaided localization accuracy increased as a function of decreasing hearing thresholds in the atretic ear. While it is possible that low sound levels in the atretic ear provided access to interaural localization cues for the children with the lowest hearing thresholds, the association has to be further investigated in a larger sample of children.

Cochlear implant (CI) and hearing aid (HA) in a bimodal solution (CI+HA) is compared with bilateral HAs (HA+HA) to test if the bimodal solution results in better speech intelligibility and self-reported quality of life.
This randomised controlled trial is conducted in Odense University Hospital, Denmark. Sixty adult bilateral HA users referred for CI surgery are enrolled if eligible and undergo: audiometry, speech perception in noise (HINT: Hearing in Noise Test), Speech Identification Scores and video head impulse test. All participants will receive new replacement HAs. After 1 month they will be randomly assigned (1:1) to the intervention group (CI+HA) or to the delayed intervention control group (HA+HA). The intervention group (CI+HA) will receive a CI on the ear with a poorer speech recognition score and continue using the HA on the other ear. The control group (HA+HA) will receive a CI after a total of 4 months of bilateral HA use.The primary outcome measures are speech intelligibility measured objectively with HINT (sentences in noise) and DANTALE I (words) and subjectively with the Speech, Spatial and Qualities of Hearing scale questionnaire. Secondary outcomes are patient reported Health-Related Quality of Life scores assessed with the Nijmegen Cochlear Implant Questionnaire, the Tinnitus Handicap Inventory and Dizziness Handicap Inventory. Third outcome is listening effort assessed with pupil dilation during HINT.In conclusion, the purpose is to improve the clinical decision-making for CI candidacy and optimise bimodal solutions.
This study protocol was approved by the Ethics Committee Southern Denmark project ID S-20200074G. All participants are required to sign an informed consent form.This study will be published on completion in peer-reviewed publications and scientific conferences.
NCT04919928.

The aim of this study was to evaluate the feasibility of a virtual reality-based spatial hearing training protocol in bilateral cochlear implant (CI) users and to provide pilot data on the impact of this training on different qualities of hearing.
Twelve bilateral CI adults aged between 19 and 69 followed an intensive 10-week rehabilitation program comprised eight virtual reality training sessions (two per week) interspersed with several evaluation sessions (2 weeks before training started, after four and eight training sessions, and 1 month after the end of training). During each 45-minute training session, participants localized a sound source whose position varied in azimuth and/or in elevation. At the start of each trial, CI users received no information about sound location, but after each response, feedback was given to enable error correction. Participants were divided into two groups: a multisensory feedback group (audiovisual spatial cue) and an unisensory group (visual spatial cue) who only received feedback in a wholly intact sensory modality. Training benefits were measured at each evaluation point using three tests: 3D sound localization in virtual reality, the French Matrix test, and the Speech, Spatial and other Qualities of Hearing questionnaire.
The training was well accepted and all participants attended the whole rehabilitation program. Four training sessions spread across 2 weeks were insufficient to induce significant performance changes, whereas performance on all three tests improved after eight training sessions. Front-back confusions decreased from 32% to 14.1% ( p = 0.017); speech recognition threshold score from 1.5 dB to -0.7 dB signal-to-noise ratio ( p = 0.029) and eight CI users successfully achieved a negative signal-to-noise ratio. One month after the end of structured training, these performance improvements were still present, and quality of life was significantly improved for both self-reports of sound localization (from 5.3 to 6.7, p = 0.015) and speech understanding (from 5.2 to 5.9, p = 0.048).
This pilot study shows the feasibility and potential clinical relevance of this type of intervention involving a sensorial immersive environment and could pave the way for more systematic rehabilitation programs after cochlear implantation.

In asymmetric hearing loss (AHL), the normal pattern of contralateral hemispheric dominance for monaural stimulation is modified, with a shift towards the hemisphere ipsilateral to the better ear. The extent of this shift has been shown to relate to sound localization deficits. In this study, we examined whether cochlear implantation to treat postlingual AHL can restore the normal functional pattern of auditory cortical activity and whether this relates to improved sound localization. The auditory cortical activity was found to be lower in the AHL cochlear implanted (AHL-CI) participants. A cortical asymmetry index was calculated and showed that a normal contralateral dominance was restored in the AHL-CI patients for the nonimplanted ear, but not for the ear with the cochlear implant. It was found that the contralateral dominance for the nonimplanted ear strongly correlated with sound localization performance (rho = 0.8, P < 0.05). We conclude that the reorganization of binaural mechanisms in AHL-CI subjects reverses the abnormal lateralization pattern induced by the deafness, and that this leads to improved spatial hearing. Our results suggest that cochlear implantation enables the reconstruction of the cortical mechanisms of spatial selectivity needed for sound localization.