The Sound of Music, As Reported By Adult

The Sound of Music, As Reported By Adult

The Sound of Music, As Reported By Adult Cochlear Implant Users. Valerie LOOI (PhD; RMT; MAudSA-CC) & Jennifer SHE Dept. of Communication Disorders, The University of Canterbury, Christchurch, NZ. THE HEARING SYSTEM Conductive Hearing Loss Outer Ear Middle Ear Sensorineural Hearing Loss

Inner Ear 8th Nerve Frequency (Hz) 125 0 250 500 1000 2000 NORMAL HEARING

I n t e n s i t y 10 40 MODERATE

d B 50 MODERATELY-SEVERE 20 MILD 30 60 70 SEVERE

80 90 100 110 + PROFOUND 4000 8000 HEARING AIDS AIM: To improve communicati

on by making it audible Behind-The-Ear In-TheEar COCHLEAR IMPLANTS Electronic listening device with surgically implanted electrodes coupled to external components. Suitable for moderately-severe to profound sensorineural hearing losses. Both adults & children. Speech Processors

Behind-TheEar -Esprit3G -Freedom BodyLevel - SPRint - Freedom Pictures courtesy: F CI vs HA A powerful hearing aid (HA) may not allow access to all of the speech sounds. CI considered if allows greater access to speech sounds.

Assessments conducted to establish if CI has better potential than HAs. CURRENT CI CRITERIA Moderately-severe to profound bilateral sensorineural loss. Speech: <40% in worse ear (& <70% in better ear). No middle ear complications. Background Postlingually deafened adult CI users are less accurate at perceiving musical sounds, and rate music to be less enjoyable post-CI than pre-CI.

(Gfellar et al. 1998, 2000, 2002, 2003, Mirza et al., 2003). However CI users rate music to sound more pleasant than HA users with the same level of hearing loss. (Looi et al., 2007, 2008). Spend less time listening to music post-surgery. Some report that they avoid listening to music. However existing studies have insufficient detail on factors CI users feel contribute to their poor ratings for music. WHY dont they like it? Aim To develop & administer a questionnaire that collects unique and detailed information on CI users music perception & appreciation.

UCMLQ The University of Canterbury Music Listening Questionnaire. 48 questions divided into 7 sections: o Music Listening & Musical Background o The Sound Quality of Musical Instruments, o o o o o Instrumental Families & Voice Musical Styles Music Preferences Music Recognition Factors Affecting Music Listening Enjoyment

Music Training Program ~ 1 hr hr to complete. 1) Music Listening & Bground Subject Factors. Difference CI made. Time spent listening to music, and enjoyment of music: Pre-hearing loss, Time just prior to getting CI, Now with CI. Formal music training, and music participation: Pre-CI, & Post-CI. Device(s) used for listening to music (e.g. CI+HA, CI-only, HA-only). Music listening preferences (e.g. style).

2) Sound Quality - Instruments Rate the sound quality of: Piano String Family Woodwind Family Brass Family Drum Kit Guitar

Male Singer Female Singer 2) Sound Quality - Instruments Rating Scales: o Unpleasant Pleasant o Unnatural Natural o Emptier As Expected Fuller o Duller As Expected Sharper o More Noisy As Expected Less Noisy o Tinnier As Expected Richer o Rougher As Expected Smooth

(As expect it to sound to someone with NH). 3) Sound Quality - Styles Orchestra Pop/Rock Classical Small Group Country & Western Classical Choir Jazz Unpleasant Pleasant; Simple Complex; Can never follow melody line Can always follow

melody line; Can never identify this style by listening-alone Can always identify this style by listening-alone; Sounds nothing like I would expect it to sound to a person with NH Sounds exactly as I would expect it to sound to a person with NH . UCMLQ Part 4-6 Part 4: Music Preferences o Preferences for different instruments, voices, instrumentations & group sizes. Part 5: Music Recognition o Instruments & tunes can always recognise. o Instruments & tunes would like to be able to

recognise. Part 6: Factors Affecting Listening Enjoyment o If certain variables make music listening more enjoyable, less enjoyable, or no difference. Part 7: Questions on the Music Training Program Response Rate The questionnaire was sent to 221 adult CI users. 133 (60%) questionnaires were returned. Of these: o 100 were completed (45%). Subject characteristics (n=100):

o Age: M = 62.1y (R: 18-88y); o Length CI use: M = 4.11y (R: 10mths-19y). Results Music Listening time spent listening to music AND enjoyment levels now with CI than pre-hearing loss (p<0.001; paired t-test). time spent listening to music AND enjoyment levels now with CI than just prior to getting CI (p=0.003; paired t-test). Post-surgery - Only 1/100 had formal music training, and 9/100 participated in musical activities. 57% hadnt tried to improve music listening or enjoyment since getting CI. Devices for music listening 37/93 (40%) noticed difference between CIonly & CI+HA. Of these 37 subjects, 93%

preferred CI+HA. 31/81 (38%) noticed difference between CIonly & HA-only. Of these 31 subjects, 82% preferred CI-only. Instrument Ratings Instruments rated most pleasant & natural: 1) Guitar 2) Male Singer 3) Piano Least pleasant & natural: Brass Instrument Ratings

For scales with as expected as a mid-point, 1-sample t-test used to see if ratings were significantly different to how subjects expect the instrument(s) to sound to a NH person. Emptier Sharper Noisier Tinnier Rougher Piano Strings Guitar Male Female

Drum Kit Piano Strings Woodwind Brass Guitar Female Strings Brass Drum Kit Male Female Piano

Drum Kit Guitar Female Instrumental Preferences No Preference Male Singer Female Singer N=88 No

Preference High Pitch Inst. Low Pitch Inst. N=88 Instrumental Preferences Instrumental only No preference

Voice only Voice with Instrument N=86 Preferred Group Size Asked to rank preferred group size (1, 2, 3 performers, Small group, Large group). 63/89 ranked 1 performer as most preferred. 59 ranked Large group as least preferred. Post-hoc Tukey test: Significantly preferred less performers to more. (e.g. 1 performer preferred to 2 or 3 performers or groups). Musical Styles

Highest rated style Country & Western. Lowest rated style Orchestra. Factors affecting listening Echoey room Loud volume Live concert, outdoors Soft volume Live concert, indoors Know context Medium volume Follow score or words Watch performer Know song title Quiet environment Familiar lyrics

Familiar music -100 -90 -80 -70 -60 -50 -40 -30

-20 -10 0 10 20 30 40 50 60

70 80 90 100 Skills important for MTP Skills most often rated as the most important to help music listening enjoyment: 1. 2. 3.

4. 5. Recognising tunes known prior to implantation. Recognising commonly-known tunes. Recognising commonly-known instruments. Being able to hear pitch changes. Being able to pick out the tune when presented with accompaniment. Overall findings CI+HA better than CI-only for music listening. Generally, instruments tend to sound emptier, noisier, tinnier & rougher than CI users expect that theyd sound to a person with NH. Low pitch range preferred to high pitch range. Fewer performers preferred to larger groups.

Country & Western highest-rated style; Orchestra poorest rated. Implications for RMTs Music may not sound normal. May not hear pitch in the same way as we do. May not hear melodies correctly, or may not recognise melodies they say they know. Low pitch instruments/music may be better Start simple: Clear rhythm & words. 1 instrument. Assess ability to perceive music & pitch. May not enjoy music. Check the listening environment & acoustics. Children are different to adults learnt to hear music through the CI. The implant has given me so much,

but I still really grieve for real music. Music can elicit so many emotions and bring such pleasure, it is like having a large part of life missing!...It does not bring the same pleasure or emotion that it did when I was fully hearing (Sbjt #183) References Gfeller, K., Christ, A., Knutson, J., Witt, S., & Mehr, M. (2003). The effects of familiarity and complexity on appraisal of complex songs by cochlear implant recipients and normal hearing adults. Journal of Music Therapy, 40, 78-112. Gfeller, K., Christ, A., Knutson, J. F., Witt, S., Murray, K. T., & Tyler, R. S. (2000). Musical backgrounds, listening habits, and aesthetic enjoyment of adult cochlear implant recipients. Journal of the American Academy of Audiology, 11, 390-406. Gfeller, K., Witt, S., Adamek, M., Mehr, M., Rogers, J., Stordahl, J., et al. (2002). Effects of training on timbre

recognition and appraisal by postlingually deafened cochlear implant recipients. Journal of the American Academy of Audiology, 13(3), 132-145. Gfeller, K., Witt, S., Stordahl, J., Mehr, M., & Woodworth, G. (2000). The effects of training on melody recognition and appraisal by adult cochlear implant recipients. Journal of the Academy of Rehabilitative Audiology, 33, 115138. Looi, V., McDermott H. J., McKay, C. M., & Hickson, L. M. (2008). Music perception of cochlear implant users compared to that of hearing aid users. Ear and Hearing, 29(3), 421-434. Looi, V., McDermott H. J., McKay, C. M., & Hickson, L. M. (2008). The effect of cochlear implantation on music perception by adults with usable pre-operative acoustic hearing. The International Journal of Audiology, 47(5), 257-268. Looi, V., McDermott H. J., McKay, C. M., & Hickson, L. M. (2007). Comparisons of quality ratings for music by cochlear implant and hearing aid users. Ear and Hearing, 28(2 Supplement), 59S-61S. Mirza, S., Douglas, S.A., Lindsey, P., Hildreth, T., & Hawthorne, M. (2003). Appreciation of music in adult patients with cochlear implants: a patient questionnaire. Cochlear Implants International, 4 (2.) Acknowledgements Funding: Co-operative Research Centre for Cochlear

Implant & Hearing Aid Innovation (Melbourne, Australia). Dr Peter Busby & Dr Pam Dawson from Cochlear Ltd. for advice and assistance. Ms Prue Humber for administrative assistance.

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