Background: At school we find two major acoustic situations: (first) the "teacher is talking" being disturbed by the pupils making noise and (second) another "pupil is talking" disturbed by other pupils. The understanding of words and sentences in hearing impaired patients with a cochlear implant (CI) in a noisy situation can be improved by using a FM system. The aim of this study is to test speech understanding depending on mixing ratios between FM input and microphone input to the speech processor in different circumstances.
Methods: Speech understanding was evaluated using the adaptive Oldenburger sentence test (OLSA) in background noise. CI patients used the FM system Microlink for Freedom CIs together with a Campus transmitter (Phonak AG).
Patients: 17 postlingually deafened adults were tested, using unilateral Freedom cochlear implant systems (Cochlear Ltd). A group of eight normally hearing adults was used as a control group in the same setup.
Results: We found that the median value of L (50)=1.6 dB in CI patients without a FM system is higher than the median value of L(50)=-13 dB in normally hearing subjects. The sentence recognition in CI patients with FM system increased with increasing mixing ratio. The benefit using the FM system to understand the teacher is of high advantage in any mixing ratio. The difference between the L(50) values in situations with or without a FM-system is 15 dB for the mixing ratio 3:1 (FM to microphone). If we take into account an increase of 15% per dB in the OLSA (at L(50)) in CI patients, the difference of 15 dB means a calculated advantage of 225%. The speech understanding during the second condition ("pupil is talking") however remained nearly the same in all used mixing ratios. The calculations showed no statistical difference between these situations with and without a FM system.
Conclusion: The speaker comprehension for the two investigated listening conditions showed different results. Understanding in the "teacher is talking" situation increased with increasing mixing ratio (FM to microphone) and in the "pupil is talking" situation remained on the same level. We could not find an optimal FM setting for both listening conditions. This leads to different suggestions for different listening conditions. All patients showed an increased speech understanding in noisy environments. This result strongly encourages the use of a FM-system in a classroom.