title: Subjective assessment of cochlear implant users' signal-to-noise ratio requirements for different levels of wireless device usability.
abstract: BACKGROUND
  In order to better inform the development and revision of the American National Standards Institute C63.19 and American National Standards Institute/Telecommunications Industry Association-1083 hearing aid compatibility standards, a previous study examined the signal strength and signal (speech)-to-noise (interference) ratio needs of hearing aid users when using wireless and cordless phones in the telecoil coupling mode. This study expands that examination to cochlear implant (CI) users, in both telecoil and microphone modes of use.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the magnetic and acoustic signal levels needed by CI users for comfortable telephone communication and the users' tolerance relative to the speech levels of various interfering wireless communication-related noise types.
  
  
  METHODS
  Design was a descriptive and correlational study. Simulated telephone speech and eight interfering noise types presented as continuous signals were linearly combined and were presented together either acoustically or magnetically to the participants' CIs. The participants could adjust the loudness of the telephone speech and the interfering noises based on several assigned criteria.
  
  
  METHODS
  The 21 test participants ranged in age from 23-81 yr. All used wireless phones with their CIs, and 15 also used cordless phones at home. There were 12 participants who normally used the telecoil mode for telephone communication, whereas 9 used the implant's microphone; all were tested accordingly.
  
  
  METHODS
  A guided-intake questionnaire yielded general background information for each participant. A custom-built test control box fed by prepared speech-and-noise files enabled the tester or test participant, as appropriate, to switch between the various test signals and to precisely control the speech-and-noise levels independently. The tester, but not the test participant, could read and record the selected levels. Subsequent analysis revealed the preferred speech levels, speech (signal)-to-noise ratios, and the effect of possible noise-measurement weighting functions.
  
  
  RESULTS
  The participants' preferred telephone speech levels subjectively matched or were somewhat lower than the level that they heard from a 65 dB SPL wideband reference. The mean speech (signal)-to-noise ratio requirement for them to consider their telephone experience "acceptable for normal use" was 20 dB, very similar to the results for the hearing aid users of the previous study. Significant differences in the participants' apparent levels of noise tolerance among the noise types when the noise level was determined using A-weighting were eliminated when a CI-specific noise-measurement weighting was applied.
  
  
  CONCLUSIONS
  The results for the CI users in terms of both preferred levels for wireless and cordless phone communication and signal-to-noise requirements closely paralleled the corresponding results for hearing aid users from the previous study, and showed no significant differences between the microphone and telecoil modes of use. Signal-to-noise requirements were directly related to the participants' noise audibility threshold and were independent of noise type when appropriate noise-measurement weighting was applied. Extending the investigation to include noncontinuous interfering noises and forms of radiofrequency interference other than additive audiofrequency noise could be areas of future study.
authors.affiliation: Rehabilitation Engineering Research Center on Hearing Enhancement, Julstrom Consulting and Development, Chicago, IL.
authors.forename: Stephen
authors.initials: S
authors.lastname: Julstrom
authors.affiliation: Rehabilitation Engineering Research Center on Hearing Enhancement, Technology Access Program, Gallaudet University, Washington, DC.
authors.forename: Linda
authors.initials: L
authors.lastname: Kozma-Spytek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001309:Auditory Threshold; D019929:Cochlear Implantation / Q000379:methods*; D003054:Cochlear Implants; D006801:Humans; D008875:Middle Aged; D059629:Signal-To-Noise Ratio; D013067:Speech Perception; D059015:Wireless Technology / Q000295:instrumentation*; D055815:Young Adult