Beyond Audition: Psychosocial Benefits of Music Training for Children With Hearing Loss.

OBJECTIVES: Children with hearing loss tend to have poorer psychosocial and quality of life outcomes than their typical-hearing (TH) peers-particularly in the areas of peer relationships and school functioning. A small number of studies for TH children have suggested that group-based music activities are beneficial for prosocial outcomes and help develop a sense of belonging. While one might question whether perceptual limitations would impede satisfactory participation in musical activities, findings from a few studies have suggested that group music activities may have similar benefits for children with hearing loss as well. It is important to note that the effect of music on psychosocial outcomes has primarily been investigated at an anecdotal level. The objective of this study was to explore the effect of a music training program on psychosocial and quality of life outcomes for children with hearing loss. It was hypothesized that music training would provide benefits for domains centered upon peer relationships and prosocial measures. DESIGN: Fourteen children aged 6 to 9 years with prelingual sensorineural hearing loss (SNHL) participated in a 12-week music training program that consisted of group-based face-to-face music therapy supplemented by online music apps. The design was a pseudorandomized, longitudinal study (9 participants were waitlisted, initially serving as a passive control group). Psychosocial wellbeing and quality of life were assessed using a questionnaire battery comprised of the Strengths and Difficulty Questionnaire (SDQ), the Pediatric Quality of Life Inventory, the Hearing Environments and Reflection on Quality of Life (HEAR-QL), and the Glasgow Children's Benefit Inventory. For comparative purposes, responses were measured from 16 TH children that ranged in age from 6 to 9 years. RESULTS: At baseline, children with SNHL had poorer outcomes for internalizing problems, and all measures of the HEAR-QL compared with the TH children. There were no differences for general psychosocial and physical health. After music training, SDQ internalizing problems such as peer relationships and emotional regulation were significantly reduced for the children with SNHL. There were no changes for any outcomes for the passive control group. Additional benefits were noted for emotional and learning factors on the Glasgow Children's Benefit Inventory. However, there were no significant changes for any psychosocial and quality of life outcomes as measured by the Pediatric Quality of Life Inventory or HEAR-QL instruments. CONCLUSIONS: The present study provides initial evidence that music training has a positive effect on at least some psychosocial and quality of life outcomes for children with hearing loss. As they are at a greater risk of poorer psychosocial and quality of life outcomes, these findings are cause for cautious optimism. Children with hearing loss should be encouraged to participate in group-based musical activities.

The suitability and readability of cochlear implant information brochures for potential adult recipients.

OBJECTIVE: Adult cochlear implant (CI) candidates seeking to make an informed decision about cochlear implantation can find themselves needing to quickly understand large volumes of complex information provided by different professionals in different formats. This study investigates the suitability, within a health literacy context, of one of those sources of information: the CI brochure. DESIGN: A single-observation design. STUDY SAMPLE: Thirty English passages of approximately 100-words each were sampled from 15 sections of seven CI brochures. All brochures were readily available to the general public on the Australian websites of four CI manufacturers at the time of the analysis (June 2019). RESULTS: Analyses by two examiners using the Suitability Assessment of Materials (SAM) classified all 15 sections from all seven CI brochures as being "not suitable" for general, adult readers. Analyses by the same examiners using four readability formulae (Flesch Reading Ease Scale, Fry Readability Graph, Flesch-Kincaid Readability Formula, and the Fog index) showed sampled passages from the 15 sections were written at a level best suited for persons with 10 to 14 years of schooling. CONCLUSIONS: Brochures intended for adult CI candidates should be revised to improve their suitability and readability for adult CI candidates. Specific recommendations are suggested.

Music Appreciation of Adult Hearing Aid Users and the Impact of Different Levels of Hearing Loss.

OBJECTIVES: The main aim of this study was to collect information on music listening and music appreciation from postlingually deafened adults who use hearing aids (HAs). It also sought to investigate whether there were any differences in music ratings from HA users with different levels of hearing loss (HL; mild, versus moderate to moderately-severe, versus severe or worse. DESIGN: An existing published questionnaire developed for cochlear implant recipients was modified for this study. It had 51 questions divided into seven sections: (1) music listening and music background; (2) sound quality; (3) musical styles; (4) music preferences; (5) music recognition; (6) factors affecting music listening enjoyment; and (7) music training program. The questionnaire was posted out to adult HA users, who were subsequently divided into three groups: (i) HA users with a mild HL (Mild group); (ii) HA users with a moderate to moderately-severe HL (Moderate group); and (iii) HA users with a severe or worse (Severe group) HL. RESULTS: One hundred eleven questionnaires were completed; of these, 51 participants had a mild HL, 42 had a moderate to moderately-severe loss, and 18 a severe or worse loss. Overall, there were some significant differences noted, predominantly between the Mild and Severe groups, with fewer differences between the Mild and Moderate groups. The respondents with the greater levels of HL reported a greater reduction in their music enjoyment as a result of their HL and that HAs made music sound significantly less melodic for them. It was also observed that the Severe group's mean scores for both the pleasant rating as well as the combined rating for the six different musical styles were lower than both the Mild and Moderate groups' ratings for every style, with just one exception (pop/rock pleasantness rating). There were significant differences between the three groups for the styles of music that were reported to sound the best with HA(s), as well as differences between the ratings on more specific timbre rating scales used to rate different elements of each style. In rating the pleasantness and naturalness of different musical instruments or instrumental groups, there was no difference between the groups. There were also significant differences between the Mild and Severe groups in relation to musical preferences for the pitch range of music, with the Severe group significantly preferring male singers and lower pitched instruments. CONCLUSIONS: The overall results indicated little difference in music appreciation between those with a mild versus moderate loss. However, poorer appreciation scores were given by those with a severe or worse HL. This would suggest that HAs or HL have a negative impact on music listening, particularly when the HL becomes more significant. There was a large degree of variability in ratings, though, with music listening being satisfactory for some listeners and largely unsatisfactory for others, in all three groups. Music listening preferences also varied significantly, and the reported benefit (or otherwise) provided by the HA for music was also mixed. The overriding variability in listening preferences and ratings leads to the question as to the benefit and effectiveness of generic, manufacturer-derived music programs on HAs. Despite the heterogeneity in the listening habits, preferences, and ratings, it is clear that music appreciation and enjoyment is still challenging for many HA users and that level of HL is one, but not the only factor that impacts on music appreciation.

Referral rates of postlingually deafened adult hearing aid users for a cochlear implant candidacy assessment.

OBJECTIVE: The aims of this study were: to investigate the referral rates of postlingually deafened adult cochlear implant (CI) candidates from a hearing aid (HA) clinic for a CI candidacy assessment and to gain insight about factors influencing the referral pathways to CI assessments. DESIGN: Two methodologies were used: a retrospective cohort study reviewing clinical files and a questionnaire to clinicians. STUDY SAMPLE: The files of 1249 adult clients from the HA clinic who had average puretone hearing thresholds greater or equal to 65 dB HL in the better hearing ear and unaided phoneme recognition scores of less than 50% in both ears were reviewed. All of the clinicians completed the online questionnaire. RESULTS: Eighteen adults met the CI candidacy criteria, of whom 16 (89%) had a CI discussion with their audiologist, with 11 (61%) being referred for a CI evaluation. Of these 11, four proceeded to implantation. Questionnaire responses revealed the need for better information on candidacy and referral guidelines for HA audiologists, in addition to enhanced communication between HA and CI clinics. CONCLUSIONS: Overall the results indicate that the referral pathway to obtain a CI assessment is a barrier contributing to the low CI penetration rate in adults.

Music appreciation and music listening in prelingual and postlingually deaf adult cochlear implant recipients.

OBJECTIVE: To explore the music appreciation of prelingually deaf adults using cochlear implants (CIs). DESIGN: Cohort study. Adult CI recipients were recruited based on hearing history and asked to complete the University of Canterbury Music Listening Questionnaire (UCMLQ) to assess each individual's music listening and appreciation. Results were compared to previous responses to the UCMLQ from a large cohort of postlingually deaf CI recipients. STUDY SAMPLE: Fifteen prelingually deaf and 15 postlingually deaf adult cochlear implant recipients. RESULTS: No significant differences were found between the prelingual and postlingual participants for amount of music listening or music listening enjoyment with their CI. Sound quality of common instruments was favourable for both groups, with no significant difference in the pleasantness/naturalness of instrument sounds between the groups. Prelingually deaf CI recipients rated themselves as significantly less able to follow a melody line and identify instrument styles compared to their postlingual peers. CONCLUSIONS: The results suggest that the pre- and postlingually deaf CI recipients demonstrate equivalent levels of music appreciation. This finding is of clinical importance, as CI clinicians should be actively encouraging all of their recipients to explore music listening as a part of their rehabilitation.

A global patient outcomes registry: Cochlear paediatric implanted recipient observational study (Cochlear(™) P-IROS).

BACKGROUND: Currently, there is a paucity of data concerning the long-term outcomes, educational placement and quality of life of children implanted with hearing devices from large and representative samples of the population. To address this concern, a large, prospective, multicentre, multinational patient-outcomes registry for paediatric recipients of implantable hearing devices was developed. The benefits of this registry, its approach and methodology are described. METHODS/DESIGN: The Cochlear(™) Paediatric Implanted Recipient Observational Study (Cochlear P-IROS) is a prospective international patient-outcomes registry for children who are implanted in routine clinical practice with one or more hearing devices. The study aims to collect data on patient comorbidities, device use, auditory performance, quality of life and health-related utilities, across different types of implantable hearing devices from a range of manufacturers. Patients will be evaluated with a set of standardised and non-standardised questionnaires prior to initial device activation (baseline) and at six-monthly follow-up intervals up to 24 months and annually thereafter. The Cochlear P-IROS utilises a secure web interface to administer electronic case report forms to clinicians and families of implanted children. The web interface is currently available in five languages: English, Japanese, Korean, Mandarin and Russian. The interface also provides printable versions of the case report forms translated into 22 local languages for collection of data prior to entry online; additional languages may be added, as required. Participation in the Cochlear P-IROS registry is investigator-driven and voluntary. To date, the Cochlear P-IROS has recruited implant clinics across Australia, China, India, Indonesia, Turkey and Vietnam. The registry also aims to recruit multiple clinics in Cuba, Israel, Japan, Malaysia, Singapore, South Africa, South Korea and Russia. DISCUSSION: The use of a registry such as the Cochlear P-IROS will generate valuable data to support research interests of academics and clinicians around the globe. The data generated will be relevant for a wide range of stakeholders including regulators, payers, providers, policy makers, patients and their families, each with a different perspective for the acceptance and adoption of implantable hearing devices for the treatment of hearing loss.

From hearing aids to cochlear implants: The journey for private patients in New Zealand.

OBJECTIVES: To understand adults' journey from hearing aids to cochlear implants (CIs). METHODS: Qualitative, exploratory design using semi-structured interviews with twelve postlingually-deafened adults. RESULTS AND DISCUSSION: All participants reported social isolation and/or depression. 'Not hearing well enough' was the most-common motivator to seek a CI. Due to the long wait for a public CI, they opted to pay for their implant privately. Funding was the most prominent barrier identified, with most participants using their own savings. The biggest struggle was in the period 3-months post switch-on. Many participants felt progress was slow and that they should have been doing better. After this period, benefits were most noted in quiet, with environmental sounds, and in helping them become more sociable. Music and telephone use were still areas many struggled with. CONCLUSIONS: Participants reported the CI was worth the cost, that they would recommend it to others, and would do it again. Self-motivation was the biggest facilitator to success, with hearing professionals playing an integral role throughout the entire journey. There was a large variety of subthemes reflecting the diversity and individuality of the transition.

A music quality rating test battery for cochlear implant users to compare the FSP and HDCIS strategies for music appreciation.

OBJECTIVE: The purpose of this study was to develop a music quality rating test battery (MQRTB) and pilot test it by comparing appraisal ratings from cochlear implant (CI) recipients using the fine-structure processing (FSP) and high-definition continuous interleaved sampling (HDCIS) speech processing strategies. DESIGN: The development of the MQRTB involved three stages: (1) Selection of test items for the MQRTB; (2) Verification of its length and complexity with normally-hearing individuals; and (3) Pilot testing with CI recipients. STUDY SAMPLE: Part 1 involved 65 adult listeners, Part 2 involved 10 normally-hearing adults, and Part 3 involved five adult MED-EL CI recipients. RESULTS: The MQRTB consisted of ten songs, with ratings made on scales assessing pleasantness, naturalness, richness, fullness, sharpness, and roughness. Results of the pilot study, which compared FSP and HDCIS for music, indicated that acclimatization to a strategy had a significant effect on ratings (p < 0.05). When acclimatized to FSP, the group rated FSP as closer to 'exactly as I want it to sound' than HDCIS (p < 0.05), and that HDCIS sounded significantly sharper and rougher than FSP. However when acclimatized to HDCIS, there were no significant differences between ratings. There was no effect of song familiarity or genre on ratings. CONCLUSIONS: Overall the results suggest that the use of FSP as the default strategy for MED-EL recipients would have a positive effect on music appreciation, and that the MQRTB is an effective tool for assessing music sound quality.

Music perception of cochlear implant users: a questionnaire, and its implications for a music training program.

Current research has shown that although adult cochlear implant (CI) users generally find music to be less enjoyable following implantation, training may help some recipients to improve their music perception. This study developed and administered a questionnaire (The University of Canterbury Music Listening Questionnaire: UCMLQ), to collect information which could then be used to develop such a music training program (MTP). One hundred adult recipients completed the UCMLQ. Results showed that respondents generally found music to be less enjoyable post-implantation, and thought that music did not sound as they would expect it to sound to a person with normal hearing. However, it was reported that music listening could be enhanced by controlling the listening environment, being selective about the music chosen, and using a contralateral HA. The preferred logistics for a MTP were 30-minute sessions, 2-3 times per week, using a DVD format. The program should focus on improving recipients' ability to recognize tunes, and encompass a wide range of musical styles. The findings support the development of a MTP for CI users to better enable them to enjoy and appreciate music, and to maximize their potential with current technology.

Music Training for Children With Sensorineural Hearing Loss Improves Speech-in-Noise Perception.

Purpose A growing body of evidence suggests that long-term music training provides benefits to auditory abilities for typical-hearing adults and children. The purpose of this study was to evaluate how music training may provide perceptual benefits (such as speech-in-noise, spectral resolution, and prosody) for children with hearing loss. Method Fourteen children aged 6-9 years with prelingual sensorineural hearing loss using bilateral cochlear implants, bilateral hearing aids, or bimodal configuration participated in a 12-week music training program, with nine participants completing the full testing requirements of the music training. Activities included weekly group-based music therapy and take-home music apps three times a week. The design was a pseudorandomized, longitudinal study (half the cohort was wait-listed, initially serving as a passive control group prior to music training). The test battery consisted of tasks related to music perception, music appreciation, and speech perception. As a comparison, 16 age-matched children with typical hearing also completed this test battery, but without participation in the music training. Results There were no changes for any outcomes for the passive control group. After music training, perception of speech-in-noise, question/statement prosody, musical timbre, and spectral resolution improved significantly, as did measures of music appreciation. There were no benefits for emotional prosody or pitch perception. Conclusion The findings suggest even a modest amount of music training has benefits for music and speech outcomes. These preliminary results provide further evidence that music training is a suitable complementary means of habilitation to improve the outcomes for children with hearing loss.

The Role of Music in Families of Children With Hearing Loss and Normal Hearing in Australia, Finland, and the UK.

The primary aim of this current study was to compare the role, importance and value placed on music by families with normally hearing (NH) children, to those who had a child with a hearing loss (HL) who wore either hearing aids and/or cochlear implants. A secondary aim was to see whether this differed between the countries. Parents of children aged 2-6 years living in Australia, Finland, and the United Kingdom were invited to complete the Role of Music in Families Questionnaire (RMFQ). Two groups of participants were recruited from each country: (i) parents of NH children, and (ii) parents of children with a HL. The RMFQ had seven subsections covering topics such as music participation, attitudes to music, importance of music in the family, and future perspectives on music. Three hundred and twenty-two families of NH children, and 56 families of children with HL completed the questionnaire (Australia: 50 NH, 25 HL; Finland: 242 NH, 21 HL; United Kingdom: 30 NH, 10 HL). Analyses compared between NH and HL groups within each country, and between the three countries for the NH group, and the HL group, independently. Overall, there were few significant differences between the participation levels, role, or importance of music in families with NH children compared to those with a child who had a HL, regardless of whether the families lived in Australia, Finland or the United Kingdom. Children first started to respond to music at similar ages, and overall music participation frequency, and music enjoyment were relatively similar. The importance of music in the family was also similar between the NH and HL groups. In comparing between the countries, Finnish children had a tendency to have higher participation rates in musical activities, with few other differences noted. Overall, the results of this study indicate that children, regardless of hearing levels or country of residence, have similar levels of music engagement and enjoyment, and HL is not seen as a contraindication to music participation and involvement by the parents involved in this study.

The effect of cochlear implantation on music perception by adults with usable pre-operative acoustic hearing.

This study investigated the change in music perception of adults undergoing cochlear implantation. Nine adults scheduled for a cochlear implant (CI) were assessed on a music test battery both prior to implantation (whilst using hearing aids; HAs), and three months after activation of their CIs. The results were compared with data from a group of longer-term CI users and a group of HA-only users. The tests comprised assessments of rhythm, pitch, instrument, and melody perception. Pre-to-post surgery comparisons showed no significant difference in the rhythm, melody, and instrument identification scores. Subjects' scores were significantly lower post-implant for ranking pitch intervals of one octave and a quarter octave (p=0.007, and p<0.001, respectively), and were only at chance levels for the smaller interval. However, although pitch perception was generally poorer with a CI than with a HA, it is likely that the use of both devices simultaneously could have provided higher scores for these subjects. Analysis of the other tests' results provided insights into factors affecting music perception for adults with severe to profound hearing impairment.

Speech Recognition Outcomes After Cochlear Reimplantation Surgery.

This study compares speech recognition outcomes before and after cochlear reimplantation surgery, in relation to clinical factors known before and at time of surgery. Between 2006 and 2015, 2,055 adult cochlear implant surgeries were conducted at this center, of which 87 were reimplantation surgeries (4.2%). Speech recognition scores (SRS) assessed before and after reimplantation were available for 54 adults. Overall, SRS measured after reimplantation were similar to the best SRS obtained by the patient and greater than the last SRS measured before surgery. Additional complications were noted in the clinical files of all patients for which reimplantation was considered unsuccessful (16%).

Quality of life outcomes for children with hearing impairment in Singapore.

OBJECTIVES: This study aimed to investigate the hearing-related quality of life (hearing-QOL) of children with hearing loss in Singapore using hearing aids (HAs) and/or cochlear implants (CIs). Their health-related QOL (health-QOL) as well as their families' health-QOL were compared with normally hearing (NH) children and their families. METHODS: This cross-sectional study recruited families (i.e., children aged 2-18 years and their parents) of NH children (n=44), children wearing HAs (n=22) and children wearing CIs (n=14). Hearing-QOL was assessed using the parent-reported Children Using Hearing Devices QOL questionnaire. General health-QOL was assessed using parent and child-reported measures from the PedsQL inventory consisting of the Generic Core Scales, General Well-being Scale and Family Impact Module. The questionnaires were self-administered for children aged 8-18 years, and interviewer-administered for children aged 5-7 years. RESULTS: The NH children and their families had significantly higher general health-QOL scores compared to the children with hearing loss and their families. This indicates that hearing loss significantly impacts on the well-being of children and their families. Congruence between parent and child reports was only observed in the NH group. Parents of children wearing HAs rated their child's overall hearing-QOL significantly higher than parents of children wearing CIs. Family household income was the only significant predictor of child hearing-QOL scores with parents from the middle income families rating their child's hearing-QOL significantly poorer than parents from high income families. CONCLUSION: Overall, NH children and their families have higher self-rated general health-QOL than children with hearing loss and their families, with children using HAs providing higher hearing-QOL than those using CIs. Evaluating both general health and hearing specific QOL from both the child and their parent/caregiver is worthwhile, allowing a more holistic measure of real-life outcomes and better individualised clinical care.

A multicentre clinical evaluation of paediatric cochlear implant users upgrading to the Nucleus(®) 6 system.

OBJECTIVES: The aim of this study was to investigate whether experienced paediatric cochlear implant users could show benefits to speech perception outcomes from the introduction of noise reduction and automated scene classification technologies as implemented in the Nucleus(®) 6 sound processor. Previous research with adult cochlear implant users had shown significant improvements in speech intelligibility for listening in noisy conditions and good user acceptance for upgrading to the Nucleus 6 processor. In adults, these improvements for listening in noise were primarily attributed to the use of a range of new input processing technologies including noise reduction, as well as introduction of automatic scene classification technology. METHODS: Experienced paediatric cochlear implant users (n=25) were recruited from four clinics located in three countries. Research participants were evaluated on three occasions, an initial session using their Nucleus 5 sound processor; a second session in which participants used the Nucleus 6 processor programmed with the same technologies as were used in their Nucleus 5 sound processor; and a final session in which participants used the Nucleus 6 processor programmed with the default technologies including automatic scene classification (SCAN) which automatically selects the microphone directionality, noise reduction (SNR-NR), and wind noise reduction (WNR) technologies. Prior to both the second and third evaluations, research participants had approximately two weeks take-home experience with the new system. Speech perception performances on monosyllabic word tests presented in quiet and in noise, and a sentence test presented in noise, were compared across the three processor conditions. Acceptance of the Nucleus 6 default settings was assessed in a final session. RESULTS: No group mean difference in performance was found for monosyllabic words in quiet. A significant improvement in speech perception was found for both monosyllabic words and sentences in noise with the default Nucleus 6 program condition as compared with the Nucleus 5 condition. No acceptance issues were noted for any of the children. CONCLUSIONS: Experienced paediatric cochlear implant users showed a significant improvement in speech perception in listening in noise when upgraded to the Nucleus 6 sound processor primarily due to the introduction of a noise reduction technology, and all children accepted the default program. These findings suggest that school-aged children may benefit from upgrading to the Nucleus 6 sound processor using the default program.

Pitch and lexical tone perception of bilingual English-Mandarin-speaking cochlear implant recipients, hearing aid users, and normally hearing listeners.

OBJECTIVES: The purpose of this current study was to investigate whether pitch, lexical tone, and/or speech-in-noise perception were significantly correlated for Singaporean teenagers or adults who spoke both Mandarin and English. METHODS: Thirty-three normal hearing or near-normal hearing listeners who did not use a hearing device (NNH group), eight postlingually deafened cochlear implant (CI) recipients (CI group), and three postlingually deafened bilateral hearing aid (HA) users (HA group) were recruited. All participants were bilingual Mandarin-English-speaking Singaporean residents. Participants were assessed on tests of pitch-ranking, lexical tone perception, and speech-in-noise. RESULTS: The NNH group scored significantly better than the CI group for all tests and subtests. There were no significant differences for the pitch test between the HA group and either the CI or NNH group. However, HA users scored significantly better than the CI group, and more aligned with the NNH group's scores for both the lexical tone and Mandarin speech-in-noise test. There were highly significant moderate positive correlations between all three tests. Discussion Overall, the performance of the CI users in this study indicates that CI recipients still struggle on pitch-related auditory perception tasks. Additionally, although the test scores from the HA users were better than the CI recipients, they were not as good as the NNH listeners. The significant moderate correlations between all three tests indicate that there is at least some degree of overlap in the skills required to accurately perceive these stimuli. CONCLUSION: The overall results suggest that CI users, and to a lesser extent HA users, still struggle with complex auditory perceptual tasks, particularly when it requires the perception of pitch. However, it may be possible that training one of these skills (e.g. musical pitch) may then generalize to other tasks (e.g. lexical tone and/or speech-in-noise). This is important for counseling, as well as for planning effective rehabilitation programs.

Melodic Contour Training and Its Effect on Speech in Noise, Consonant Discrimination, and Prosody Perception for Cochlear Implant Recipients.

Cochlear implant (CI) recipients generally have good perception of speech in quiet environments but difficulty perceiving speech in noisy conditions, reduced sensitivity to speech prosody, and difficulty appreciating music. Auditory training has been proposed as a method of improving speech perception for CI recipients, and recent efforts have focussed on the potential benefits of music-based training. This study evaluated two melodic contour training programs and their relative efficacy as measured on a number of speech perception tasks. These melodic contours were simple 5-note sequences formed into 9 contour patterns, such as "rising" or "rising-falling." One training program controlled difficulty by manipulating interval sizes, the other by note durations. Sixteen adult CI recipients (aged 26-86 years) and twelve normal hearing (NH) adult listeners (aged 21-42 years) were tested on a speech perception battery at baseline and then after 6 weeks of melodic contour training. Results indicated that there were some benefits for speech perception tasks for CI recipients after melodic contour training. Specifically, consonant perception in quiet and question/statement prosody was improved. In comparison, NH listeners performed at ceiling for these tasks. There was no significant difference between the posttraining results for either training program, suggesting that both conferred benefits for training CI recipients to better perceive speech.

MUSIC APPRECIATION AND TRAINING FOR COCHLEAR IMPLANT RECIPIENTS: A REVIEW.

In recent years, there has been increasing interest in music perception of cochlear implant (CI) recipients, and a growing body of research conducted in this area. The majority of these studies have examined perceptual accuracy for pitch, rhythm, and timbre. Another important, but less commonly studied aspect of music listening is appreciation, or appraisal. Despite the ongoing research into potential technological improvements that may improve music perception for recipients, both perceptual accuracy and appreciation generally remain poor for most recipients. Whilst perceptual accuracy for music is important, appreciation and enjoyment also warrants research as it also contributes to clinical outcomes and perceived benefits. Music training is being shown to offer excellent potential for improving music perception and appreciation for recipients.Therefore, the primary topics of this review are music appreciation and training. However, a brief overview of the psychoacoustic, technical, and physiological factors associated with a recipient's perception of music is provided, as these are important factors in understanding the listening experience for CI recipients. The purpose of this review is to summarize key papers that have investigated these issues, in order to demonstrate that i) music enjoyment and appraisal is an important and valid consideration in evaluating music outcomes for recipients, and ii) that music training can improve music listening for many recipients, and is something that can be offered to persons using current technology.

A comparison of the speech recognition and pitch ranking abilities of children using a unilateral cochlear implant, bimodal stimulation or bilateral hearing aids.

OBJECTIVE: The present study compared the speech recognition and pitch ranking abilities of normally hearing children (n=15) to children using a cochlear implant (CI) alone (n=8), bilateral hearing aids (HAs) (n=6), or bimodal stimulation (BMS) (n=9). It was hypothesised that users of BMS would score higher on tasks of speech and pitch perception than children using a CI alone, but not children using HAs. METHODS: Participants were assessed on tasks of monosyllabic word recognition in quiet, sentence recognition in quiet and noise (10 dB signal-to-noise ratio), and a pitch ranking task using pairs of sung vowels one, half, and a quarter of an octave apart. RESULTS: There were no significant differences between the mean percentage-correct scores of the four participant groups for either words in quiet or sentences in quiet and noise. However, the proportion of bimodal users who scored >80% correct (80%) was significantly greater than the proportion of high-scoring unilateral CI (25%) or bilateral HA users (17%). Contrary to expectations, there was also no significant difference between the pitch ranking scores of users of BMS and users of a CI alone for all three interval sizes (p<0.05, RM-ANOVA). However participants using only acoustic hearing (i.e. the NH and HA groups) scored significantly higher than participants using electrical stimulation (i.e. the CI and BMS groups) on the pitch ranking task (p<0.05; RM-ANOVA). CONCLUSIONS: Contrary to findings in postlingually deafened adults, we found no significant bimodal advantage for pitch perception in prelingually deafened children. However, the performance of children using electrical stimulation was significantly poorer than children using only acoustic stimulation. Further research is required to investigate the contribution of the non-implanted ears of users of BMS to pitch perception, and the effect of hearing loss on the development of pitch perception in children.

Quality-of-life outcomes for adult cochlear implant recipients in New Zealand.

AIM: There were two aims to this study: to investigate the effect of a cochlear implant (CI) on quality-of-life (QOL) for adult recipients in New Zealand; and to determine which aspects of life that these changes are most noticed. METHOD: There were two groups of participants: CI Group - 94 postlingually deafened adult CI recipients; and WL group - 70 postlingually deafened adults on the waiting list (WL) for a CI. Two questionnaires were developed for this study. RESULTS: The results showed that cochlear implantation had a significant positive impact on QOL for recipients. The CI group had significantly higher ratings in all areas of QOL and satisfaction compared to the WL group. CONCLUSION: Overall, high QOL and satisfaction ratings were obtained from CI recipients. The significantly lower ratings from those on the WL for an implant highlight the difficulties experienced by those with a significant hearing impairment. Assessment of CI outcomes should include QOL measures in order to provide a more holistic picture.