Fine Tuning for Hearing Impaired -- In-Depth Doctor's Interview

How does the testing work?

Holmes: We can run about as many as 50 tests in about 30 minutes. It doesn’t look at just what the actual phonetic or sound errors are. With the sounds, if I were able to say "a ba" for "a ma," that would be wrong, but "a ba" for "a ma" is not necessarily more wrong than "a ba" for "a ta," or "a ba" for "a da" -- they’re much closer sounds. There are ways that you can divide each sound up into actually nine distinctive features, and what happens with that is we’re able to say, "Where is her error?" It’s almost like we’re going all the way down to the atom level rather than looking at the molecule level for listening to the speech. The computer makes suggestions on what is the next thing to do. With Mrs. Martin, what we did was we did change her programs based on that, and she not only reported that she did better, but she did better on all of her testing after running the two optimization sessions.

Is it individualized?

Holmes: Very individualized, and that’s really what it’s designed to do. Rather than setting people to what the average does, it sets it to what the individual’s responses are. For example, for Mrs. Martin, she may really kind of go with the trend for some parameters. Rather than having to set her to the default, you’re really setting her to the individual or to optimize her to her best level.

How did the testing work before?

Holmes: The way it worked before was audiologists would hook the system up, the patient would then listen to tones, or it would sound like a tone to the patient, but really what the patient was listening to was an electrical impulse going into each individual electrode. Then what they would do is, they’d tell us what the softest current value for each current was that they were able to return, and the loudest one that they would feel comfortable, and then we would program within them, but there are different things that you can change. The things that you can change are things like the rate of the pulses that go in, and it appears that the average person needs about a 900 rate of this particular implant -- that’s the default setting. However, we found in our optimization, when we ran 20 patients, that we did have about five patients that optimized to that, but we had some that optimized to 1800 and some to 250, so that’s one of the parameters that we wanted to test. The other thing is there are other values, like where you allocate pitches to the individual electrodes, and that’s another thing that we optimize for this. If you think there are 22 electrodes and we look at the different pitch ranges, there are multiple choices that can be done. It would be impossible to test 50 maps using standard protocol testing, going ahead and setting the map up, testing them, and then seeing that on some sort of speech signal of sentences or using individual words to test 50 maps. Rather than taking 30 minutes to do that, it would literally take you close to 20 hours, so it shortens the time and it also tells you the direction to go, because it doesn’t just say, "Well, let’s randomly pick this setting."

What are the differences?

Holmes: The difference is we saw they recorded. I had one patient that recorded that had never been able to really talk on the phone and it happened to be around Father’s Day when we did it. He came in the next week and said, "It was the first time I’ve been able to talk to my children and grandchildren on the phone for Father’s Day." They describe it as being clearer. We found significant improvements in their ability to hear speech and noise. One of the things you have to realize is, as Mrs. Martin said, when her implant is off, she’s deaf; she really can’t hear anything. The cochlear implant, it’s a wonderful device, but it’s not perfect, so the closer we can optimize the parameters, the better.

What kind of a difference can this make for patients?

Holmes: The nice thing about a system like this is, based on how experienced your audiologist is, it can really have an effect on how well you do with your implant. The software helps the audiologists that don’t have as much experience to program. It’s kind of like putting a lot of experience in a box and putting it into the system and making it easier for the professional to go ahead and program and individualize it to the patient.

We’re running a clinical trial right now with some hearing aids. Right now, we’re working with two different hearing aid companies to look at hearing aids. It has the possibility of going into a lot more things -- something like a cell phone, where you can individualize the response to what your listening abilities are -- whether you have normal hearing or whether you have hearing loss, where you could adjust the response of your cell phone to your hearing abilities by simply listening to a few phone calls, things like that. I really think that there are opportunities out there for any type of digital hearing device.

How did the idea develop?

Holmes: The idea actually started from a patient. Lee Krause is an engineer, and he’s been my patient for a number of years. I have to really give him credit for this. He’s a brilliant engineer. I went through the programming with him on the first day and he said, "This doesn’t make any sense. Why aren’t you using syllables to program me?" I said, "Lee, there are a lot of problems with that, there are so many parameters to have to adjust that it’s impossible for me to do that. On top of that, there are so many parameters that make up speech that it’s too much to use speech as the metric." He kind of insisted that he would probably do it a little bit differently, so I gave him a few things to read about cochlear implants and how to program it, gave him a couple chapters, and he came back the next week and said he could really do this. He said, "My company does department of defense contracts for optimization strategies and I really think we can do this." I also contacted two other professionals, two other colleagues through the University of Florida, then I contacted [a friend] who is now at East Carolina, he’s a neuroscientist. We had several meetings together. We finally came up with what we thought was a good idea. We applied for a patent and we ran through numerous iterations of the program with Lee as the patient because he’s also an implant user, and we were able to really get the process together. What was really interesting was about a year ago, we were at a professional meeting and we were talking with some of the people from Australia who actually developed the cochlear implant. He talked to them about the protocol and Lee and I were sitting and talking to one of the engineers from Melbourne, Australia, in an open area in the convention center. It was very loud, people walking back and forth, and at one point he said to this other engineer that it really sounds different in the optimized program. The engineer from Australia says, "Well, how do you know that? How do you do it? Do you simulate it?" Lee said, "I just listen to it." He said, "Did you actually simulate how the implant sounds?" Lee said, "I listen through my implant," and he says, "I can"t believe it. I forgot you had an implant." This was one of the ones that does a lot of the development for the company, so it does make a big difference, and it can make a huge difference.

What kind of a difference can this make?

Holmes: I feel like we can make an impact. We can change the way we fit hearing aids, the way we fit cochlear implants, and really improve the lives of a lot of patients. It’s the most exciting research I’ve done since I’ve been a professional.

END OF INTERVIEW

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.

If you would like more information, please contact:

University of Florida

Health Science Center

Jill Pease

(352) 273-5816

jpease@phhp.ufl.edu

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Read the full report, Fine Tuning for Hearing Impaired.