Relationships Between Health-Related Quality of Life and Speech Perception in Bimodal and Bilateral Cochlear Implant Users.

Purpose: Previous studies examining the relationship between health-related quality of life (HRQoL) and speech perception ability in cochlear implant (CI) users have yielded variable results, due to a range of factors, such as a variety of different HRQoL questionnaires and CI speech testing materials in addition to CI configuration. In order to decrease inherent variability and better understand the relationship between these measures in CI users, we administered a commonly used clinical CI speech testing battery as well as two popular HRQoL questionnaires in bimodal and bilateral CI users. Methods: The Glasgow Benefit Inventory (GBI), a modified five-factor version of the GBI (GBI-5F), and the Nijmegen Cochlear Implant Questionnaire (NCIQ) were administered to 25 CI users (17 bimodal and 8 bilateral). Speech perception abilities were measured with the AzBio sentence test in several conditions (e.g., quiet and noise, binaural, and first-ear CI only). Results: Higher performance scores on the GBI general subscore were related to greater binaural speech perception ability in noise. There were no other relationships between the GBI or NCIQ and speech perception ability under any condition. Scores on many of the GBI-5F factors were substantially skewed and asymmetrical; therefore, correlational analyses could not be applied. Across all participants, binaural speech perception scores were greater than first-ear CI only scores. Conclusion: The GBI general subscore was related to binaural speech perception, which is considered the everyday listening condition of bimodal and bilateral CI users, in noise; while the more CI-specific NCIQ did not relate to speech perception ability in any listening condition. Future research exploring the relationships between the GBI, GBI-5F, and NCIQ considering bimodal and bilateral CI configurations separately is warranted.

Examining Delayed Recall in Cochlear Implant Users Using the Montreal Cognitive Assessment, California Verbal Learning Test, Third Edition, and Item Specific Deficit Approach: Preliminary Results.

Purpose: Recent studies using the Montreal Cognitive Assessment (MoCA) suggest delayed recall is challenging for cochlear implant (CI) users. To better understand the underlying processes associated with delayed recall in CI users, we administered the MoCA and the California Verbal Learning Test, Third Edition (CVLT-3), which provides a more comprehensive assessment of delayed recall ability. Methods: The MoCA and CVLT-3 were administered to 18 high-performing CI users. For the CVLT-3, both the traditional scoring and a newer scoring method, the Item-Specific Deficit Approach (ISDA), were employed. Results: The original MoCA score and MoCA delayed recall subtest score did not relate to performance on any CVLT-3 measures regardless of scoring metric applied (i.e., traditional or ISDA). Encoding performance for both the CVLT-3 and ISDA were related. Consolidation, which is only distinctly defined by the ISDA, related to CVLT-3 cued delay recall performance but not free delay recall performance. Lastly, ISDA retrieval only related to CVLT-3 measures when modified. Conclusion: Performance on the MoCA and CVLT-3 in a high performing CI patient population were not related. We demonstrate that the ISDA can be successfully applied to CI users for the quantification and characterization of delayed recall ability; however, future work addressing lower performing CI users, and comparing to normal hearing controls is needed to determine the extent of potential translational applications. Our work also indicates that a modified ISDA retrieval score may be beneficial for evaluating CI users although additional work addressing the clinical relevance of this is still needed.

Supporting Equity and Inclusion of Deaf and Hard-of-Hearing Individuals in Professional Organizations.

Disability is an important and often overlooked component of diversity. Individuals with disabilities bring a rare perspective to science, technology, engineering, mathematics, and medicine (STEMM) because of their unique experiences approaching complex issues related to health and disability, navigating the healthcare system, creatively solving problems unfamiliar to many individuals without disabilities, managing time and resources that are limited by physical or mental constraints, and advocating for themselves and others in the disabled community. Yet, individuals with disabilities are underrepresented in STEMM. Professional organizations can address this underrepresentation by recruiting individuals with disabilities for leadership opportunities, easing financial burdens, providing equal access, fostering peer-mentor groups, and establishing a culture of equity and inclusion spanning all facets of diversity. We are a group of deaf and hard-of-hearing (D/HH) engineers, scientists, and clinicians, most of whom are active in clinical practice and/or auditory research. We have worked within our professional societies to improve access and inclusion for D/HH individuals and others with disabilities. We describe how different models of disability inform our understanding of disability as a form of diversity. We address heterogeneity within disabled communities, including intersectionality between disability and other forms of diversity. We highlight how the Association for Research in Otolaryngology has supported our efforts to reduce ableism and promote access and inclusion for D/HH individuals. We also discuss future directions and challenges. The tools and approaches discussed here can be applied by other professional organizations to include individuals with all forms of diversity in STEMM.

Estimating Real-World Performance of Percutaneously Coupled Bone-Conduction Device Users With Severe-to-Profound Unilateral Hearing Loss.

Purpose The bone-conduction device attached to a percutaneous screw (BCD) is an important treatment option for individuals with severe-to-profound unilateral hearing loss (UHL). Clinicians may use subjective questionnaires and speech-in-noise measures to evaluate BCD use in this patient population; however, the translation of these metrics to real-world aided performance is unclear. The purpose of this study was twofold: first, to measure speech-in-noise performance in BCD users with severe-to-profound UHL in a simulated real-world environment, relative to individuals with normal hearing bilaterally; second, to determine if BCD users' subjective reports of aided performance relate to simulated real-world performance. Method A between-subjects design with two groups was conducted with 14 adults with severe-to-profound UHL (BCD group) and 10 age-matched participants with normal hearing bilaterally (control group). Speech-in-noise tests were administered in an eight-speaker R-Space simulating a real-world environment. To further explore speech-in-noise evaluation methods for this population, testing was also completed in a clinically common two-speaker array. The effects of various microphone settings on performance were explored for BCD users. Subjective performance was measured with the Abbreviated Profile of Hearing Aid Benefit (APHAB; Cox & Alexander, 1995) and the Speech, Spatial and Qualities of Hearing Scale (Gatehouse & Noble, 2004). Statistical analyses to explore relationships between variables included repeated-measures analysis of variance, regression analyses, independent-samples t tests, nonparametric Mann-Whitney tests, and correlations. Results In the simulated real-world environment, BCD group participants struggled with speech-in-noise understanding compared to control group participants. BCD benefit was observed for all microphone settings when speech stimuli were presented to the side with the BCD. When adaptive directional or fixed directional microphone settings were used, a relationship was noted between simulated real-world speech-in-noise performance for speech stimuli presented to the side with the BCD and subjective reports on the Background Noise subscale of the APHAB. Conclusions The Background Noise subscale of the APHAB may help estimate real-world speech-in-noise performance for BCD users with severe-to-profound UHL for signals of interest presented to the implanted side, specifically when adaptive or fixed directional microphone settings are used. This subscale may provide an efficient and accessible alternative to assessing real-world speech-in-noise performance in lieu of less clinically available measurement tools, such as an R-Space.

Performance on the standard and hearing-impaired Montreal Cognitive Assessment in cochlear implant users.

OBJECTIVES: Commonly used cognitive screening tools were not originally developed for patients with hearing loss (HL) and rely heavily on the ability to hear the instructions and test stimuli. Recently, the Montreal Cognitive Assessment (MoCA) was modified for use with hearing-impaired populations (ie, HI-MoCA). In order to investigate the clinical utility of the HI-MoCA, we assessed performance between the standard MoCA and HI-MoCA among postlingually deafened cochlear implant (CI) users. METHODS: We administered the standard MoCA and HI-MoCA to 21 CI users and compared their performance. We assessed differences in pass/fail status when items from the attention and language sections and the delayed recall task were removed. RESULTS: There was no significant difference in performance between the standard MoCA and HI-MoCA. Participants scored higher on both test versions when the delayed recall task was removed. Participants also performed better on the delayed recall task on the HI-MoCA than on the standard MoCA. CONCLUSIONS: While our findings suggest that the modality of presentation for the MoCA does not influence overall performance for postlingually deafened CI users, visual presentation of stimuli impacted performance on delayed recall. Furthermore, irrespective of presentation modality, our participants scored higher on both MoCA versions when the delayed recall task was removed. Clinically, modifications to the presentation of the MoCA might not be necessary for CI users; however, clinicians should be aware that the delayed recall task is inherently harder for these patients.

Assessing performance on the Montreal Cognitive Assessment (MoCA) in experienced cochlear implant users: use of alternative scoring guidelines.

Although research suggests a relationship between hearing impairment and cognitive decline in older adults, nuances of this relationship remain unclear. This uncertainty could be attributed to verbal administration of standardized cognitive measures to hearing-impaired (HI) individuals. Various strategies for testing HI populations have been suggested. We tested the efficacy of applying alternative scoring methods that systematically removed auditory-based items on the Montreal Cognitive Assessment (MoCA) in 27 cochlear implant patients. We calculated the original MoCA score and three alternative scores. The first alternative removed items from the Attention and Language sections; the second alternative removed the Delayed Recall task, and the third alternative removed the Attention, Language, and Delayed Recall items. QoL was assessed using the Glasgow Benefit Inventory and Nijmegen Cochlear Implant Questionnaire. Results indicate a significant difference in MoCA scores with two alternative scoring methods. The second alternative MoCA score related to self-reported performance on the GBI.

Assessing Cognitive Abilities in High-Performing Cochlear Implant Users.

Despite being considered one of the most successful neural prostheses, cochlear implants (CIs) provide recipients with a wide range of speech perception performance. While some CI users can understand speech in the absence of visual cues, other recipients exhibit more limited speech perception. Cognitive skills have been documented as a contributor to complex auditory processing, such as language understanding; however, there are no normative data for existing standardized clinical tests assessing cognitive abilities in CI users. Here, we assess the impact of modality of presentation (i.e., auditory-visual versus visual) for the administration of working memory tests in high-performing CI users in addition to measuring processing speed, cognitive efficiency and intelligence quotient (IQ). Second, we relate performance on these cognitive measures to clinical CI speech perception outcomes. Methods: Twenty one post-lingually deafened, high-performing, adult CI users [age range: 52-88 years; 3 unilateral CI, 13 bimodal (i.e., CI with contralateral hearing aid), 5 bilateral CI] with clinical speech perception scores (i.e., AzBio sentences in quiet for the first-ear CI) of ≥60% were recruited. A cognitive test battery assessing auditory-visual working memory (AVWM), visual working memory (VWM), processing speed, cognitive efficiency and IQ was administered, in addition to clinical measures of speech perception in quiet (i.e., AzBio sentences in quiet). AzBio sentences were assessed in two conditions: first-ear CI only, and best-aided everyday wearing condition. Subjects also provided self-reported measures of performance and benefit from their CI using standardized materials, including the Glasgow Benefit Inventory (GBI) and the Nijmegen Cochlear Implant questionnaire (NCIQ). Results: High-performing CI users demonstrated greater VWM than AVWM recall. VWM was positively related to AzBio scores when measured in the first-ear CI only. AVWM, processing speed, cognitive efficiency, and IQ did not relate to either measure of speech perception (i.e., first-ear CI or best-aided conditions). Subjects' self-reported benefit as measured by the GBI predicted best-aided CI speech perception performance. Conclusion: In high-performing CI recipients, visual presentation of working memory tests may improve our assessment of cognitive function.

Modification of Osseointegrated Device Parameters to Improve Speech in Noise and Localization Ability: Clinical Recommendations.

OBJECTIVE: To determine how best to modify osseointegrated (OI) devices or environmental settings to maximize hearing performance. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary referral center. PATIENTS: Fourteen adults with single-sided deafness (SSD) with a minimum of 6 months OI usage and nine bilaterally normal hearing controls INTERVENTIONS: : Speech in noise (SIN) and localization ability were assessed in a multi-speaker array (R-Space) with patients repeating sentences embedded in competing noise and verbally indicating the source speaker, respectively. MAIN OUTCOME MEASURES: SIN and localization were assessed with multiple OI microphone settings-fixed-directional, omnidirectional, and adaptive-as well as an unaided (OI off) condition. Participants completed the Abbreviated Profile of Hearing Aid Benefit questionnaire. RESULTS: Localization performance remains compromised for OI users with a high number of front-back confusions, but rapid learning using the fixed-directional microphone setting improved localization of sounds on the device side despite poorer localization of sounds on the normal-hearing side. SIN performance is greatly enhanced with speech presented to the contra hearing ear rather than the OI device side. Subjective report of hearing ability is highly predictive of objective SIN measures. CONCLUSIONS: Clinicians should consider implementing a fixed-directional microphone setting for improved localization for sounds behind the OI device, but inform patients of the trade-off in performance on the normal-hearing side. For better hearing in noise, clinicians should counsel OI recipients to orient the speech signal to their normal hearing ear rather than their OI device. The background noise subscale of the abbreviated profile of hearing aid benefit (APHAB) provides a meaningful metric by which to assess SIN performance of OI device users.

Development of subcortical speech representation in human infants.

Previous studies have evaluated representation of the fundamental frequency (F0) in the frequency following response (FFR) of infants, but the development of other aspects of the FFR, such as timing and harmonics, has not yet been examined. Here, FFRs were recorded to a speech syllable in 28 infants, ages three to ten months. The F0 amplitude of the response was variable among individuals but was strongly represented in some infants as young as three months of age. The harmonics, however, showed a systematic increase in amplitude with age. In the time domain, onset, offset, and inter-peak latencies decreased with age. These results are consistent with neurophysiological studies indicating that (1) phase locking to lower frequency sounds emerges earlier in life than phase locking to higher frequency sounds and (2) myelination continues to increase in the first year of life. Early representation of low frequencies may reflect greater exposure to low frequency stimulation in utero. The improvement in temporal precision likely parallels an increase in the efficiency of neural transmission accompanied by exposure to speech during the first year of life.

Musicians' enhanced neural differentiation of speech sounds arises early in life: developmental evidence from ages 3 to 30.

The perception and neural representation of acoustically similar speech sounds underlie language development. Music training hones the perception of minute acoustic differences that distinguish sounds; this training may generalize to speech processing given that adult musicians have enhanced neural differentiation of similar speech syllables compared with nonmusicians. Here, we asked whether this neural advantage in musicians is present early in life by assessing musically trained and untrained children as young as age 3. We assessed auditory brainstem responses to the speech syllables /ba/ and /ga/ as well as auditory and visual cognitive abilities in musicians and nonmusicians across 3 developmental time-points: preschoolers, school-aged children, and adults. Cross-phase analyses objectively measured the degree to which subcortical responses differed to these speech syllables in musicians and nonmusicians for each age group. Results reveal that musicians exhibit enhanced neural differentiation of stop consonants early in life and with as little as a few years of training. Furthermore, the extent of subcortical stop consonant distinction correlates with auditory-specific cognitive abilities (i.e., auditory working memory and attention). Results are interpreted according to a corticofugal framework for auditory learning in which subcortical processing enhancements are engendered by strengthened cognitive control over auditory function in musicians.

Musical training enhances neural processing of binaural sounds.

While hearing in noise is a complex task, even in high levels of noise humans demonstrate remarkable hearing ability. Binaural hearing, which involves the integration and analysis of incoming sounds from both ears, is an important mechanism that promotes hearing in complex listening environments. Analyzing inter-ear differences helps differentiate between sound sources--a key mechanism that facilitates hearing in noise. Even when both ears receive the same input, known as diotic hearing, speech intelligibility in noise is improved. Although musicians have better speech-in-noise perception compared with non-musicians, we do not know to what extent binaural processing contributes to this advantage. Musicians often demonstrate enhanced neural responses to sound, however, which may undergird their speech-in-noise perceptual enhancements. Here, we recorded auditory brainstem responses in young adult musicians and non-musicians to a speech stimulus for which there was no musician advantage when presented monaurally. When presented diotically, musicians demonstrated faster neural timing and greater intertrial response consistency relative to non-musicians. Furthermore, musicians' enhancements to the diotically presented stimulus correlated with speech-in-noise perception. These data provide evidence for musical training's impact on biological processes and suggest binaural processing as a possible contributor to more proficient hearing in noise.

Biological impact of preschool music classes on processing speech in noise.

Musicians have increased resilience to the effects of noise on speech perception and its neural underpinnings. We do not know, however, how early in life these enhancements arise. We compared auditory brainstem responses to speech in noise in 32 preschool children, half of whom were engaged in music training. Thirteen children returned for testing one year later, permitting the first longitudinal assessment of subcortical auditory function with music training. Results indicate emerging neural enhancements in musically trained preschoolers for processing speech in noise. Longitudinal outcomes reveal that children enrolled in music classes experience further increased neural resilience to background noise following one year of continued training compared to nonmusician peers. Together, these data reveal enhanced development of neural mechanisms undergirding speech-in-noise perception in preschoolers undergoing music training and may indicate a biological impact of music training on auditory function during early childhood.

Effects of hearing loss on the subcortical representation of speech cues.

Individuals with sensorineural hearing loss often report frustration with speech being loud but not clear, especially in background noise. Despite advanced digital technology, hearing aid users may resort to removing their hearing aids in noisy environments due to the perception of excessive loudness. In an animal model, sensorineural hearing loss results in greater auditory nerve coding of the stimulus envelope, leading to a relative deficit of stimulus fine structure. Based on the hypothesis that brainstem encoding of the temporal envelope is greater in humans with sensorineural hearing loss, speech-evoked brainstem responses were recorded in normal hearing and hearing impaired age-matched groups of older adults. In the hearing impaired group, there was a disruption in the balance of envelope-to-fine structure representation compared to that of the normal hearing group. This imbalance may underlie the difficulty experienced by individuals with sensorineural hearing loss when trying to understand speech in background noise. This finding advances the understanding of the effects of sensorineural hearing loss on central auditory processing of speech in humans. Moreover, this finding has clinical potential for developing new amplification or implantation technologies, and in developing new training regimens to address this relative deficit of fine structure representation.

Musicians change their tune: how hearing loss alters the neural code.

Individuals with sensorineural hearing loss have difficulty understanding speech, especially in background noise. This deficit remains even when audibility is restored through amplification, suggesting that mechanisms beyond a reduction in peripheral sensitivity contribute to the perceptual difficulties associated with hearing loss. Given that normal-hearing musicians have enhanced auditory perceptual skills, including speech-in-noise perception, coupled with heightened subcortical responses to speech, we aimed to determine whether similar advantages could be observed in middle-aged adults with hearing loss. Results indicate that musicians with hearing loss, despite self-perceptions of average performance for understanding speech in noise, have a greater ability to hear in noise relative to nonmusicians. This is accompanied by more robust subcortical encoding of sound (e.g., stimulus-to-response correlations and response consistency) as well as more resilient neural responses to speech in the presence of background noise (e.g., neural timing). Musicians with hearing loss also demonstrate unique neural signatures of spectral encoding relative to nonmusicians: enhanced neural encoding of the speech-sound's fundamental frequency but not of its upper harmonics. This stands in contrast to previous outcomes in normal-hearing musicians, who have enhanced encoding of the harmonics but not the fundamental frequency. Taken together, our data suggest that although hearing loss modifies a musician's spectral encoding of speech, the musician advantage for perceiving speech in noise persists in a hearing-impaired population by adaptively strengthening underlying neural mechanisms for speech-in-noise perception.

A dynamic auditory-cognitive system supports speech-in-noise perception in older adults.

Understanding speech in noise is one of the most complex activities encountered in everyday life, relying on peripheral hearing, central auditory processing, and cognition. These abilities decline with age, and so older adults are often frustrated by a reduced ability to communicate effectively in noisy environments. Many studies have examined these factors independently; in the last decade, however, the idea of an auditory-cognitive system has emerged, recognizing the need to consider the processing of complex sounds in the context of dynamic neural circuits. Here, we used structural equation modeling to evaluate the interacting contributions of peripheral hearing, central processing, cognitive ability, and life experiences to understanding speech in noise. We recruited 120 older adults (ages 55-79) and evaluated their peripheral hearing status, cognitive skills, and central processing. We also collected demographic measures of life experiences, such as physical activity, intellectual engagement, and musical training. In our model, central processing and cognitive function predicted a significant proportion of variance in the ability to understand speech in noise. To a lesser extent, life experience predicted hearing-in-noise ability through modulation of brainstem function. Peripheral hearing levels did not significantly contribute to the model. Previous musical experience modulated the relative contributions of cognitive ability and lifestyle factors to hearing in noise. Our models demonstrate the complex interactions required to hear in noise and the importance of targeting cognitive function, lifestyle, and central auditory processing in the management of individuals who are having difficulty hearing in noise.

Reversal of age-related neural timing delays with training.

Neural slowing is commonly noted in older adults, with consequences for sensory, motor, and cognitive domains. One of the deleterious effects of neural slowing is impairment of temporal resolution; older adults, therefore, have reduced ability to process the rapid events that characterize speech, especially in noisy environments. Although hearing aids provide increased audibility, they cannot compensate for deficits in auditory temporal processing. Auditory training may provide a strategy to address these deficits. To that end, we evaluated the effects of auditory-based cognitive training on the temporal precision of subcortical processing of speech in noise. After training, older adults exhibited faster neural timing and experienced gains in memory, speed of processing, and speech-in-noise perception, whereas a matched control group showed no changes. Training was also associated with decreased variability of brainstem response peaks, suggesting a decrease in temporal jitter in response to a speech signal. These results demonstrate that auditory-based cognitive training can partially restore age-related deficits in temporal processing in the brain; this plasticity in turn promotes better cognitive and perceptual skills.

Auditory brainstem response to complex sounds predicts self-reported speech-in-noise performance.

PURPOSE: To compare the ability of the auditory brainstem response to complex sounds (cABR) to predict subjective ratings of speech understanding in noise on the Speech, Spatial, and Qualities of Hearing Scale (SSQ; Gatehouse & Noble, 2004) relative to the predictive ability of the Quick Speech-in-Noise test (QuickSIN; Killion, Niquette, Gudmundsen, Revit, & Banerjee, 2004) and pure-tone hearing thresholds. METHOD: Participants included 111 middle- to older-age adults (range = 45-78) with audiometric configurations ranging from normal hearing levels to moderate sensorineural hearing loss. In addition to using audiometric testing, the authors also used such evaluation measures as the QuickSIN, the SSQ, and the cABR. RESULTS: Multiple linear regression analysis indicated that the inclusion of brainstem variables in a model with QuickSIN, hearing thresholds, and age accounted for 30% of the variance in the Speech subtest of the SSQ, compared with significantly less variance (19%) when brainstem variables were not included. CONCLUSION: The authors' results demonstrate the cABR's efficacy for predicting self-reported speech-in-noise perception difficulties. The fact that the cABR predicts more variance in self-reported speech-in-noise (SIN) perception than either the QuickSIN or hearing thresholds indicates that the cABR provides additional insight into an individual's ability to hear in background noise. In addition, the findings underscore the link between the cABR and hearing in noise.

Musical experience strengthens the neural representation of sounds important for communication in middle-aged adults.

Older adults frequently complain that while they can hear a person talking, they cannot understand what is being said; this difficulty is exacerbated by background noise. Peripheral hearing loss cannot fully account for this age-related decline in speech-in-noise ability, as declines in central processing also contribute to this problem. Given that musicians have enhanced speech-in-noise perception, we aimed to define the effects of musical experience on subcortical responses to speech and speech-in-noise perception in middle-aged adults. Results reveal that musicians have enhanced neural encoding of speech in quiet and noisy settings. Enhancements include faster neural response timing, higher neural response consistency, more robust encoding of speech harmonics, and greater neural precision. Taken together, we suggest that musical experience provides perceptual benefits in an aging population by strengthening the underlying neural pathways necessary for the accurate representation of important temporal and spectral features of sound.

Aging affects neural precision of speech encoding.

Older adults frequently report they can hear what is said but cannot understand the meaning, especially in noise. This difficulty may arise from the inability to process rapidly changing elements of speech. Aging is accompanied by a general slowing of neural processing and decreased neural inhibition, both of which likely interfere with temporal processing in auditory and other sensory domains. Age-related reductions in inhibitory neurotransmitter levels and delayed neural recovery can contribute to decreases in the temporal precision of the auditory system. Decreased precision may lead to neural timing delays, reductions in neural response magnitude, and a disadvantage in processing the rapid acoustic changes in speech. The auditory brainstem response (ABR), a scalp-recorded electrical potential, is known for its ability to capture precise neural synchrony within subcortical auditory nuclei; therefore, we hypothesized that a loss of temporal precision results in subcortical timing delays and decreases in response consistency and magnitude. To assess this hypothesis, we recorded ABRs to the speech syllable /da/ in normal hearing younger (18-30 years old) and older (60-67 years old) adult humans. Older adults had delayed ABRs, especially in response to the rapidly changing formant transition, and greater response variability. We also found that older adults had decreased phase locking and smaller response magnitudes than younger adults. Together, our results support the theory that older adults have a loss of temporal precision in the subcortical encoding of sound, which may account, at least in part, for their difficulties with speech perception.

Musical training during early childhood enhances the neural encoding of speech in noise.

For children, learning often occurs in the presence of background noise. As such, there is growing desire to improve a child's access to a target signal in noise. Given adult musicians' perceptual and neural speech-in-noise enhancements, we asked whether similar effects are present in musically-trained children. We assessed the perception and subcortical processing of speech in noise and related cognitive abilities in musician and nonmusician children that were matched for a variety of overarching factors. Outcomes reveal that musicians' advantages for processing speech in noise are present during pivotal developmental years. Supported by correlations between auditory working memory and attention and auditory brainstem response properties, we propose that musicians' perceptual and neural enhancements are driven in a top-down manner by strengthened cognitive abilities with training. Our results may be considered by professionals involved in the remediation of language-based learning deficits, which are often characterized by poor speech perception in noise.