Individual Differences in Lexical Access Among Cochlear Implant Users.

Purpose The current study investigates how individual differences in cochlear implant (CI) users' sensitivity to word-nonword differences, reflecting lexical uncertainty, relate to their reliance on sentential context for lexical access in processing continuous speech. Method Fifteen CI users and 14 normal-hearing (NH) controls participated in an auditory lexical decision task (Experiment 1) and a visual-world paradigm task (Experiment 2). Experiment 1 tested participants' reliance on lexical statistics, and Experiment 2 studied how sentential context affects the time course and patterns of lexical competition leading to lexical access. Results In Experiment 1, CI users had lower accuracy scores and longer reaction times than NH listeners, particularly for nonwords. In Experiment 2, CI users' lexical competition patterns were, on average, similar to those of NH listeners, but the patterns of individual CI users varied greatly. Individual CI users' word-nonword sensitivity (Experiment 1) explained differences in the reliance on sentential context to resolve lexical competition, whereas clinical speech perception scores explained competition with phonologically related words. Conclusions The general analysis of CI users' lexical competition patterns showed merely quantitative differences with NH listeners in the time course of lexical competition, but our additional analysis revealed more qualitative differences in CI users' strategies to process speech. Individuals' word-nonword sensitivity explained different parts of individual variability than clinical speech perception scores. These results stress, particularly for heterogeneous clinical populations such as CI users, the importance of investigating individual differences in addition to group averages, as they can be informative for clinical rehabilitation. Supplemental Material https://doi.org/10.23641/asha.11368106.

Low-Frequency Pitch Perception in Cochlear Implant Recipients With Normal Hearing in the Contralateral Ear.

Purpose Three experiments were carried out to evaluate the low-frequency pitch perception of adults with unilateral hearing loss who received a cochlear implant (CI). Method Participants were recruited from a cohort of CI users with unilateral hearing loss and normal hearing in the contralateral ear. First, low-frequency pitch perception was assessed for the 5 most apical electrodes at 1, 3, 6, and 12 months after CI activation using an adaptive pitch-matching task. Participants listened with a coding strategy that presents low-frequency temporal fine structure (TFS) and compared the pitch to that of an acoustic target presented to the normal hearing ear. Next, participants listened with an envelope-only, continuous interleaved sampling strategy. Pitch perception was compared between coding strategies to assess the influence of TFS cues on low-frequency pitch perception. Finally, participants completed a vocal pitch-matching task to corroborate the results obtained with the adaptive pitch-matching task. Results Pitch matches roughly corresponded to electrode center frequencies (CFs) in the CI map. Adaptive pitch matches exceeded the CF for the most apical electrode, an effect that was larger for continuous interleaved sampling than TFS. Vocal pitch matches were variable but correlated with the CF of the 3 most apical electrodes. There was no evidence that pitch matches changed between the 1- and 12-month intervals. Conclusions Relatively accurate and asymptotic pitch perception was observed at the 1-month interval, indicating either very rapid acclimatization or the provision of familiar place and rate cues. Early availability of appropriate pitch cues could have played a role in the early improvements in localization and masked speech recognition previously observed in this cohort. Supplemental Material https://doi.org/10.23641/asha.8862389.

Frequency change detection and speech perception in cochlear implant users.

Dynamic frequency changes in sound provide critical cues for speech perception. Most previous studies examining frequency discrimination in cochlear implant (CI) users have employed behavioral tasks in which target and reference tones (differing in frequency) are presented statically in separate time intervals. Participants are required to identify the target frequency by comparing stimuli across these time intervals. However, perceiving dynamic frequency changes in speech requires detection of within-interval frequency change. This study explored the relationship between detection of within-interval frequency changes and speech perception performance of CI users. Frequency change detection thresholds (FCDTs) were measured in 20 adult CI users using a 3-alternative forced-choice (3AFC) procedure. Stimuli were 1-sec pure tones (base frequencies at 0.25, 1, 4 kHz) with frequency changes occurring 0.5 s after the tone onset. Speech tests were 1) Consonant-Nucleus-Consonant (CNC) monosyllabic word recognition, 2) Arizona Biomedical Sentence Recognition (AzBio) in Quiet, 3) AzBio in Noise (AzBio-N, +10 dB signal-to-noise/SNR ratio), and 4) Digits-in-noise (DIN). Participants' subjective satisfaction with the CI was obtained. Results showed that correlations between FCDTs and speech perception were all statistically significant. The satisfaction level of CI use was not related to FCDTs, after controlling for major demographic factors. DIN speech reception thresholds were significantly correlated to AzBio-N scores. The current findings suggest that the ability to detect within-interval frequency changes may play an important role in speech perception performance of CI users. FCDT and DIN can serve as simple and rapid tests that require no or minimal linguistic background for the prediction of CI speech outcomes.

Semantic processing in children with cochlear implants: Evidence from event-related potentials.

Introduction: Existing research has shown that children with significant hearing loss who use cochlear implants (CIs) perform worse than their hearing peers on behavioral measures of spoken language. The present study sought to examine how children with CIs process lexical-semantic incongruence, as indexed by electrophysiological evidence of the N400 effect. Method: Twelve children with CIs, aged between 6 and 9 years, participated in a spoken word-picture matching task while event-related potentials (ERPs) were recorded. To determine whether the N400 effect elicited in this group deviated from normal, independent samples t tests and analysis of variance (ANOVA) analyses were used to compare the results of children with CIs against those of a similarly aged typically hearing (TH) group (n = 30). Correlational analyses were also conducted within each group to gauge the degree to which the N400 effect related to behavioral measures of spoken language. Results: An N400 effect was elicited in both groups of CI and TH children. The amplitude and latency of the N400 effect did not differ significantly between groups. Despite the similarity in ERP responses, children with CIs scored significantly lower on behavioral measures of spoken word- and sentence-level comprehension. No significant correlations between ERP and behavioral measures were found, although there was a trending relationship between sentence-level spoken language comprehension and the TH group's N400 effect mean amplitude (p = .060). Conclusions: The results suggest that, at a neural level, children with CIs can process lexical-semantic incongruence, and that other underlying processes not measured by the N400 effect contribute to this population's spoken language difficulties.

Don't look at it as a miracle cure: Contested notions of success and failure in family narratives of pediatric cochlear implantation.

Cochlear implants (CIs) are a routine treatment for children identified with a qualifying hearing loss. The CI, however, must be accompanied by a long-term and intense auditory training regimen in order to possibly acquire spoken language with the device. This research investigates families' experiences when they opted for the CI and undertook the task of auditory training, but the child failed to achieve what might be clinically considered "success" - the ability to function solely using spoken language. Using a science and technology studies informed approach that places the CI within a complex sociotechnical system, this research shows the uncertain trajectory of the CI, as well as the contingency of the very notions of success and failure. To do so, data from in-depth interviews with a diverse sample of parents (n = 11) were collected. Results show the shifting definitions of failure and success within families, as well as suggest areas for further exploration regarding clinical practice and pediatric CIs. First, professionals' messaging often conveyed to parents a belief in the infallibility of the CI, this potentially caused "soft failure" to go undetected and unmitigated. Second, speech assessments used in clinical measurements of outcomes did not capture a holistic understanding of a child's identity and social integration, leaving out an important component for consideration of what a 'good outcome' is. Third, minority parents experience structural racism and clinical attitudes that may render "failure" more likely to be identified and expected in these children, an individualizing process that allows structural failures to go uncritiqued.

Patterns of recognition of Arabic consonants by non-native children with cochlear implants and normal hearing.

OBJECTIVE: This study examined the patterns of recognition of Arabic consonants, via information transmission analysis for phonological features, in a group of Malay children with normal hearing (NH) and cochlear implants (CI). METHOD: A total of 336 and 616 acoustic tokens were collected from six CI and 11 NH Malay children, respectively. The groups were matched for hearing age and duration of exposure to Arabic sounds. All the 28 Arabic consonants in the form of consonant-vowel /a/ were presented randomly twice via a loudspeaker at approximately 65 dB SPL. The participants were asked to repeat verbally the stimulus heard in each presentation. RESULTS: Within the native Malay perceptual space, the two groups responded differently to the Arabic consonants. The dispersed uncategorized assimilation in the CI group was distinct in the confusion matrix (CM), as compared to the NH children. Consonants /h/, /tˁ/, /sˁ/ and /ʁ/ were difficult for the CI children, while the most accurate item was /k/ (84%). The CI group transmitted significantly reduced information, especially for place feature transmission, then the NH group (p < 0.001). Significant interactions between place-hearing status and manner-hearing status were also obtained, suggesting there were information transmission differences in the pattern of consonants recognition between the study groups. CONCLUSION: CI and NH Malay children may be using different acoustic cues to recognize Arabic sounds, which contribute to the different assimilation categories' patterns within the Malay perceptual space.

Prior exposure to a reverberant listening environment improves speech intelligibility in adult cochlear implant listeners.

OBJECTIVES: The goal of this study is to investigate whether prior exposure to reverberant listening environment improves speech intelligibility of adult cochlear implant (CI) users. METHODS: Six adult CI users participated in this study. Speech intelligibility was measured in five different simulated reverberant listening environments with two different speech corpuses. Within each listening environment, prior exposure was varied by either having the same environment across all trials (blocked presentation) or having different environment from trial to trial (unblocked). RESULTS: Speech intelligibility decreased as reverberation time increased. Although substantial individual variability was observed, all CI listeners showed an increase in the blocked presentation condition as compared to the unblocked presentation condition for both speech corpuses. CONCLUSION: Prior listening exposure to a reverberant listening environment improves speech intelligibility in adult CI listeners. Further research is required to understand the underlying mechanism of adaptation to listening environment.

The effect of fluctuating maskers on speech understanding of high-performing cochlear implant users.

OBJECTIVE: The present study evaluated whether the poorer baseline performance of cochlear implant (CI) users or the technical and/or physiological properties of CI stimulation are responsible for the absence of masking release. DESIGN: This study measured speech reception thresholds (SRTs) in continuous and modulated noise as a function of signal to noise ratio (SNR). STUDY SAMPLE: A total of 24 subjects participated: 12 normal-hearing (NH) listeners and 12 subjects provided with recent MED-EL CI systems. RESULTS: The mean SRT of CI users in continuous noise was -3.0 ± 1.5 dB SNR (mean ± SEM), while the normal-hearing group reached -5.9 ± 0.8 dB SNR. In modulated noise, the difference across groups increased considerably. For CI users, the mean SRT worsened to -1.4 ± 2.3 dB SNR, while it improved for normal-hearing listeners to -18.9 ± 3.8 dB SNR. CONCLUSIONS: The detrimental effect of fluctuating maskers on SRTs in CI users shown by prior studies was confirmed by the current study. Concluding, the absence of masking release is mainly caused by the technical and/or physiological properties of CI stimulation, not just the poorer baseline performance of many CI users compared to normal-hearing subjects. Speech understanding in modulated noise was more robust in CI users who had a relatively large electrical dynamic range.

Reverberation negatively impacts musical sound quality for cochlear implant users.

OBJECTIVE: Satisfactory musical sound quality remains a challenge for many cochlear implant (CI) users. In particular, questionnaires completed by CI users suggest that reverberation due to room acoustics can negatively impact their music listening experience. The objective of this study was to more specifically characterize of the effect of reverberation on musical sound quality in CI users, normal hearing (NH) non-musicians, and NH musicians using a previously designed assessment method, called Cochlear Implant-MUltiple Stimulus with Hidden Reference and Anchor (CI-MUSHRA). METHODS: In this method, listeners were randomly presented with an anechoic musical segment and five-versions of this segment in which increasing amounts of reverberation were artificially added. Participants listened to the six reverberation versions and provided sound quality ratings between 0 (very poor) and 100 (excellent). RESULTS: Results demonstrated that on average CI users and NH non-musicians preferred the sound quality of anechoic versions to more reverberant versions. In comparison, NH musicians could be delineated into those who preferred the sound quality of anechoic pieces and those who preferred pieces with some reverberation. DISCUSSION/CONCLUSION: This is the first study, to our knowledge, to objectively compare the effects of reverberation on musical sound quality ratings in CI users. These results suggest that musical sound quality for CI users can be improved by non-reverberant listening conditions and musical stimuli in which reverberation is removed.

Binaural fusion and listening effort in children who use bilateral cochlear implants: a psychoacoustic and pupillometric study.

Bilateral cochlear implants aim to provide hearing to both ears for children who are deaf and promote binaural/spatial hearing. Benefits are limited by mismatched devices and unilaterally-driven development which could compromise the normal integration of left and right ear input. We thus asked whether children hear a fused image (ie. 1 vs 2 sounds) from their bilateral implants and if this "binaural fusion" reduces listening effort. Binaural fusion was assessed by asking 25 deaf children with cochlear implants and 24 peers with normal hearing whether they heard one or two sounds when listening to bilaterally presented acoustic click-trains/electric pulses (250 Hz trains of 36 ms presented at 1 Hz). Reaction times and pupillary changes were recorded simultaneously to measure listening effort. Bilaterally implanted children heard one image of bilateral input less frequently than normal hearing peers, particularly when intensity levels on each side were balanced. Binaural fusion declined as brainstem asymmetries increased and age at implantation decreased. Children implanted later had access to acoustic input prior to implantation due to progressive deterioration of hearing. Increases in both pupil diameter and reaction time occurred as perception of binaural fusion decreased. Results indicate that, without binaural level cues, children have difficulty fusing input from their bilateral implants to perceive one sound which costs them increased listening effort. Brainstem asymmetries exacerbate this issue. By contrast, later implantation, reflecting longer access to bilateral acoustic hearing, may have supported development of auditory pathways underlying binaural fusion. Improved integration of bilateral cochlear implant signals for children is required to improve their binaural hearing.

Can young adolescents with cochlear implants perceive different timbral cues?

OBJECTIVE: This study aimed to compare the timbre recognition and preferences of young adolescents with cochlear implants (CIs) to that of adolescents with normal hearing (NH). METHODS: Nine Korean adolescents with CIs and 25 adolescents with NH participated in this study. After listening to each of four Western instruments and five traditional Korean instruments, participants were asked to identify presented instruments and rate how much they liked the timbres. RESULTS: The results showed that the CI group recognized instruments significantly less often than the NH group. They also tended to show a relatively higher recognition of the instruments bearing a rapid and strong attack time. With regard to timbre preferences, no significant differences were found between the groups. DISCUSSION: Young adolescents with CIs show potential for detecting salient features in sound information, especially instrumental timbre. This study indicates what can be considered to incorporate more sounds with varying origins and tone qualities into music perception and education for this population.

Perceptual weighting strategies of children with cochlear implants and normal hearing.

PURPOSE: This study compared perceptual weighting strategies of children with cochlear implants (CIs) and children with normal hearing (NH), and asked if strategies are explained solely by degraded spectral representations, or if diminished language experience accounts for some of the effect. Relationships between weighting strategies and other language skills were examined. METHOD: One hundred 8-year-olds (49 with NH and 51 with CIs) were tested on four measures: (1) labeling of cop-cob and sa-sha stimuli; (2) discrimination of the acoustic cues to the cop-cob decision; (3) phonemic awareness; and (4) word recognition. RESULTS: No differences in weighting of cues to the cop-cob decision were observed between children with CIs and NH, suggesting that language experience was sufficient for the children with CIs. Differences in weighting of cues to the sa-sha decision were found, but were not entirely explained by auditory sensitivity. Weighting strategies were related to phonemic awareness and word recognition. CONCLUSIONS: More salient cues facilitate stronger weighting of those cues. Nonetheless, individuals differ in how salient cues need to be to capture perceptual attention. Familiarity with stimuli also affects how reliably children attend to acoustic cues. Training should help children with CIs learn to categorize speech sounds with less-salient cues. LEARNING OUTCOMES: After reading this article, the learner should be able to: (1) recognize methods and motivations for studying perceptual weighting strategies in speech perception; (2) explain how signal quality and language experience affect the development of weighting strategies for children with cochlear implants and children with normal hearing; and (3) summarize the importance of perceptual weighting strategies for other aspects of language functioning.

Different perception of musical stimuli in patients with monolateral and bilateral cochlear implants.

The aim of the present study is to measure the perceived pleasantness during the observation of a musical video clip in a group of cochlear implanted adult patients when compared to a group of normal hearing subjects. This comparison was performed by using the imbalance of the EEG power spectra in alpha band over frontal areas as a metric for the perceived pleasantness. Subjects were asked to watch a musical video clip in three different experimental conditions: with the original audio included (Norm), with a distorted version of the audio (Dist), and without the audio (Mute). The frontal EEG imbalance between the estimated power spectra for the left and right prefrontal areas has been calculated to investigate the differences among the two populations. Results suggested that the perceived pleasantness of the musical video clip in the normal hearing population and in the bilateral cochlear implanted populations has similar range of variation across the different stimulations (Norm, Dist, and Mute), when compared to the range of variation of video clip's pleasantness for the monolateral cochlear implanted population. A similarity exists in the trends of the perceived pleasantness across the different experimental conditions in the mono- and bilaterally cochlear implanted patients.

Music mixing preferences of cochlear implant recipients: a pilot study.

OBJECTIVE: Music perception and appraisal are generally poor in cochlear implant recipients. Simple musical structures, lyrics that are easy to follow, and clear rhythm/beat have been reported among the top factors to enhance music enjoyment. The present study investigated the preference for modified relative instrument levels in music with normal-hearing and cochlear implant subjects. DESIGN: In experiment 1, test subjects were given a mixing console and multi-track recordings to determine their most enjoyable audio mix. In experiment 2, a preference rating experiment based on the preferred relative level settings in experiment 1 was performed. STUDY SAMPLE: Experiment 1 was performed with four postlingually deafened cochlear implant subjects, experiment 2 with ten normal-hearing and ten cochlear implant subjects. RESULTS: A significant difference in preference rating was found between normal-hearing and cochlear implant subjects. The latter preferred an audio mix with larger vocals-to-instruments ratio. In addition, given an audio mix with clear vocals and attenuated instruments, cochlear implant subjects preferred the bass/drum track to be louder than the other instrument tracks. CONCLUSIONS: The original audio mix in real-world music might not be suitable for cochlear implant recipients. Modifying the relative instrument level settings potentially improves music enjoyment.

Cochlear implants: clinical and societal outcomes.

Over the past 30 years, hearing care clinicians have increasingly relied on cochlear implants to restore auditory sensitivity in selected patients with advanced sensorineural hearing loss. This article examines the impact of intervention with cochlear implantation in children and adults. The authors report a range of clinic-based results and patient-based outcomes reflected in the reported literature on cochlear implants. The authors describe the basic assessment of the physiologic response to auditory nerve stimulation; measures of receptive and productive benefit; and surveys of life effects as reflected measures of quality of life, educational attainment, and economic impact.

Comparison of loudness adjustments by MCL and maplaw in users of the MED-EL COMBI 40/40+ cochlear implant system.

The programming of a CI speech processor involves measurement of electrical threshold and 'most comfortable loudness' (MCL) levels on each electrode. However, when the derived 'map' is activated the resultant percept is often too loud or too soft. In this situation, adjustments of MCL settings are usually made in order to achieve a comfortable percept.The present study examined the range of volume control adjustments in 24 users of the MED-EL C40/40+ device. Volume control settings varied from 36% to 126% with a mean of 84.3% (SD = 20.4%). Additionally, the output compression function ('maplaw') was adjusted to test whether this alternative manipulation could result in a comfortable percept. It was found that this could be achieved satisfactorily, with maplaw values ranging from 10 to 2000. Clinical implications of these findings are discussed.

Localization cues with bilateral cochlear implants.

Selected subjects with bilateral cochlear implants (CIs) showed excellent horizontal localization of wide-band sounds in previous studies. The current study investigated localization cues used by two bilateral CI subjects with outstanding localization ability. The first experiment studied localization for sounds of different spectral and temporal composition in the free field. Localization of wide-band noise was unaffected by envelope pulsation, suggesting that envelope-interaural time difference (ITD) cues contributed little. Low-pass noise was not localizable for one subject and localization depended on the cutoff frequency for the other which suggests that ITDs played only a limited role. High-pass noise with slow envelope changes could be localized, in line with contribution of interaural level differences (ILDs). In experiment 2, processors of one subject were raised above the head to void the head shadow. If they were spaced at ear distance, ITDs allowed discrimination of left from right for a pulsed wide-band noise. Good localization was observed with a head-sized cardboard inserted between processors, showing the reliance on ILDs. Experiment 3 investigated localization in virtual space with manipulated ILDs and ITDs. Localization shifted predominantly for offsets in ILDs, even for pulsed high-pass noise. This confirms that envelope ITDs contributed little and that localization with bilateral CIs was dominated by ILDs.

Assessing the pitch structure associated with multiple rates and places for cochlear implant users.

Cochlear implant subjects continue to experience difficulty understanding speech in noise and performing pitch-based musical tasks. Acoustic model studies have suggested that transmitting additional fine structure via multiple stimulation rates is a potential mechanism for addressing these issues [Nie et al., IEEE Trans. Biomed. Eng. 52, 64-73 (2005); Throckmorton et al., Hear. Res. 218, 30-42 (2006)]; however, results from preliminary cochlear implant studies have been less compelling. Multirate speech processing algorithms previously assumed a place-dependent pitch structure in that a basal electrode would always elicit a higher pitch percept than an apical electrode, independent of stimulation rate. Some subjective evidence contradicts this assumption [H. J. McDermott and C. M. McKay, J. Acoust. Soc. Am. 101, 1622-1630 (1997); R. V. Shannon, Hear. Res. 11, 157-189 (1983)]. The purpose of this study is to test the hypothesis that the introduction of multiple rates may invalidate the tonotopic pitch structure resulting from place-pitch alone. The SPEAR3 developmental speech processor was used to collect psychophysical data from five cochlear implant users to assess the tonotopic structure for stimuli presented at two rates on all active electrodes. Pitch ranking data indicated many cases where pitch percepts overlapped across electrodes and rates. Thus, the results from this study suggest that pitch-based tuning across rate and electrode may be necessary to optimize performance of a multirate sound processing strategy in cochlear implant subjects.

Across-site patterns of modulation detection in listeners with cochlear implants.

In modern cochlear implants, much of the information required for recognition of important sounds is conveyed by temporal modulation of the charge per phase in interleaved trains of electrical pulses. In this study, modulation detection thresholds (MDTs) were used to assess listeners' abilities to detect sinusoidal modulation of charge per phase at each available stimulation site in their 22-electrode implants. Fourteen subjects were tested. MDTs were found to be highly variable across stimulation sites in most listeners. The across-site patterns of MDTs differed considerably from subject to subject. The subject-specific patterns of across-site variability of MDTs suggest that peripheral site-specific characteristics, such as electrode placement and the number and condition of surviving neurons, play a primary role in determining modulation sensitivity. Across-site patterns of detection thresholds (T levels), maximum comfortable loudness levels (C levels) and dynamic ranges (DRs) were not consistently correlated with across-site patterns of MDTs within subjects, indicating that the mechanisms underlying across-site variation in these measures differed from those underlying across-site variation in MDTs. MDTs sampled from multiple sites in a listener's electrode array might be useful for diagnosing across-subject differences in speech recognition with cochlear implants and for guiding strategies to improve the individual's perception.

Auditory cortical activation and speech perception in cochlear implant users: effects of implant experience and duration of deafness.

This study aimed to investigate the relationship between outcome following cochlear implantation and auditory cortical activation. It also studied the effects of length of implant use and duration of deafness on the auditory cortical activations. Cortical activity resulting from auditory stimulation was measured using [(18)F]FDG positron emission tomography. In a group of 18 experienced adult cochlear implant users, we found a positive correlation between speech perception and activations in both the primary and association auditory cortices. This correlation was present in a subgroup of experienced implant users but absent in a group of new implant users with similar speech perception abilities. There was a significant negative correlation between duration of deafness and auditory cortical activation. This study gives insights into the relationship between implant speech perception and auditory cortical activation and the influence of duration of preceding deafness and implant experience.