Music, Hearing Loss, and Cochlear Implants The Next Frontier - PDF document

Music, Hearing Loss, and Cochlear Implants The Next Frontier Charles J. Limb, M.D. Francis A. Sooy Professor Chief of Otology, Neurotology and Skull Base Surgery Director, Douglas Grant Cochlear Implant Center Department of Otolaryngology-Head and Neck Surgery and Neurological Surgery University of California San Francisco San Francisco, CA Disclosures • Advanced Bionics Corporation – Consultant (2006-present) – Research support • Med-El Corporation – Research grants (2012-present) – Research support (2016) • Oticon Medical – Conference chair/consultant, cochlear implants and music (2016) • Frequency Therapeutics, Inc. – Consultant (2016) 1

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Treatment for hearing loss has evolved 1800s 2000s Methods Secondary Reconstruction 3

Why music? 4

First musical instrument? Bird bone flute Recovered from southern Germany ( Giessenklösterle) ~35,000 years old ‘Snowball’ gets his groove on Patel, et al., 2009 Current ‘Snowball’ gets his groove on Patel, et al., 2009 Current 5

Despite success in language perception, most cochlear implant users cannot hear music well. Percentage Correct Doesn’t Work For Music! 500-1500 Hz BPF unfiltered stimuli 6

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What does music sound like for a CI user? In normal hearing, place and rate pitch mechanisms are seamlessly integrated and support one another. In electric hearing, place and rate pitch mechanisms are both disrupted. Pitch perception is the single biggest obstacle for CI-mediated perception of music Relative pitch > absolute pitch Difference between middle C and one semitone above or below ~15 Hz 8

PURE TONES REAL TIME SPECTROGRAM SUPERSTITION - REAL TIME SPECTROGRAM 9

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Typical CI frequency map covers range of 60+ semitones Rachmaninoff Prelude Op. 3, No. 2 in C# minor: original Rachmaninoff Prelude Op. 3, No. 2 in C# minor: original 11

Rachmaninoff Prelude Op. 3, No. 2 in C# minor: +/- 1 s.t. Rachmaninoff Prelude Op. 3, No. 2 in C# minor: +/- 1 s.t. Caldwell M. et al, 2015. 12

CI Users Utilize Tempo Rather Than Mode to Interpret Musical Emotion Caldwell M. et al, 2015. 13

Caldwell MT et al. 2016 14

CI Users Demonstrate Fusion of Polyphonic Pitch CI Confusion Matrix NH Confusion Matrix Presented Identified Presented Identified Cnt Cor Cnt Cor Class. % Single Interval Chord Class. % Single Interval Chord 199 63 26 260 24 2 Single Single 69.1% 21.9% 9.0% 90.3% 8.3% 0.7% 136 84 67 63 174 53 Interval Interval 47.2% 29.2% 23.3% 21.9% 60.4% 18.4% 112 86 89 23 122 143 Chord Chord 38.9% 29.9% 30.9% 8.0% 42.4% 49.7% Donnelly et al., 2009 15

How do we measure musical sound quality in CI users? Musical Sound Quality is Poor in CI Users • CI users subjectively report poorer musical sound quality following implantation (Gfeller et al 2002; Lassaletta et al 2008) • Sound quality traditionally assessed via questionnaires or rating scales (Lassaletta et al 2008; Gfeller et al 2008; Looi et al 2008, 2011) • Assessment of sound quality can be used as a tool, not an indicator of preference or enjoyment 16

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C ochlear I mplant- MU ltiple S timulus with H idden R eference and A nchor ( CI-MUSHRA ) • 25 full quality musical stimuli are increasingly degraded: – Example: Removal of bass frequencies No Alterations – Hidden reference (best sound quality) – 200 Hz HPF – 400 Hz HPF – 600 Hz HPF – 800 Hz HPF – 1000 Hz HPF – Anchor (1000-1200Hz band-pass filter) Highly Altered 18

MUSHRA: ITU-R Recommendation BS.1534 For evaluation of lossy audio compression algorithms CI-MUSHRA Roy et al., 2012 25 excerpts, from 5 genres (pop/rock, country, jazz, classical, hip hop) Roy et al., 2012 19

How do we improve music for CI users? • Change the CI • Change the brain • Change the music Can we tune cochlear implants? 20

FPCT distinguishes all 216 individual electrode contacts Jiam NT et al. Otol Neurotol 2016 (In press) Frequency-place mismatch increases in apical and basal electrodes Jiam NT et al. Otol Neurotol 2016 (In press) 21

Kretzmer, E. A. et al. Arch Otolaryngol Head Neck Surg 2004;130:499-508. A radiograph of a cat with a cochlear implant shows the 6 electrode contacts (electrode 1 at white arrowhead) within the cochlea Kretzmer, E. A. et al. Arch Otolaryngol Head Neck Surg 2004;130:499- 508. Courtesy of the Ryugo laboratory, Center for Hearing Sciences 22

PET is quiet, non-magnetic Parsons LM, 2001 Positron Emission Tomography H2-[15]O molecules Positron-emitting [15]O atom Positron Emission Tomography 23

Is CI listening similar to normal listening? Normal listeners CI listeners Limb et al., 2010 10 postlingual CI users / 10 controls 24

Roy et al., 2014 25

Conclusions • Music is the pinnacle of hearing • Critical impairments in pitch, timbre and sound quality are observed in CI users • These impairments reveal limitations of CI processing that speech testing does not • Cochlear implants are severely out of tune • We must work to improve CI designs, processing strategy, musical training, and even the music itself Thank You • Johns Hopkins University School of Medicine • The Dana Foundation • NIDCD/NIH • The Brain Science Institute • National Endowment for the Arts • Peabody Conservatory of Music • University of California San Francisco • Baltimore Symphony Orchestra • San Francisco Jazz Center • San Francisco Conservatory of Music • Advanced Bionics Corporation • Cochlear Corporation • Med El Corporation • Oticon 26

Thank You • Judy Doong • Nicholas Ryugo • Alice He • Gabriela Cantarero • Nicole Jiam • Monica Lopez-Gonzalez • Tina Munjal • Lindsay Scattergood • Meredith Caldwell • Jonathan Zwi • Patpong Jiradejvong • Juan Huang • Joseph Heng • Michael Williams • Mickael Deroche • Patrick Donnelly • Gabe Donnay • Summer Rankin • Stephen Dunlap • Malinda McPherson • Diane Hwang • Andrew Landau • Irene Kim • Fred Barrett • Matthew Sachs • Alexis Roy • Karen Barrett Chan • Melanie Gilbert Music, Hearing Loss, and Cochlear Implants The Next Frontier Charles J. Limb, M.D. Francis A. Sooy Professor Chief of Otology, Neurotology and Skull Base Surgery Director, Douglas Grant Cochlear Implant Center Department of Otolaryngology-Head and Neck Surgery and Neurological Surgery University of California San Francisco San Francisco, CA 27