Abstract
Cochlear implants (CIs) are the state-of-the-art therapy for individuals with severe to profound hearing loss, providing them with good functional hearing. Nevertheless, speech understanding in background noise remains a significant challenge. The purposes of this study were to: (1) conduct a novel within-study comparison of speech-in-noise performance across ages in different populations of CI and normal hearing (NH) listeners using an adaptive sentence-in-noise test, and (2) examine the relative contribution of sensory information and cognitive–linguistic factors to performance. Forty CI users (mean age 20 years) were divided into “early-implanted” <4 years (n = 16) and “late-implanted” >6 years (n = 11), all prelingually deafened, and “progressively deafened” (n = 13). The control group comprised 136 NH subjects (80 children, 56 adults). Testing included the Hebrew Matrix test, word recognition in quiet, and linguistic and cognitive tests. Results show poorer performance in noise for CI users across populations and ages compared to NH peers, and age at implantation and word recognition in quiet were found to be contributing factors. For those recognizing 50% or more of the words in quiet (n = 27), non-verbal intelligence and receptive vocabulary explained 63% of the variance in noise. This information helps delineate the relative contribution of top-down and bottom-up skills for speech recognition in noise and can help set expectations in CI counseling.
Highlights
Cochlear implants (CIs) are currently the gold-standard therapy of choice for individuals with severe to profound hearing loss who do not benefit from hearing aids
A clear disadvantage was evident for most CI users, and especially for the late-implanted ones compared to the normal hearing (NH) listeners
The present study is the first of its kind to compare sentence-in-noise data from a wide range of cochlear implant users (n = 40; prelingual early-implanted and late-implanted and those with progressive hearing loss) to data from normal hearing individuals (n = 136), from children to young adults, using a sentence-in-noise test (Matrix test) that has been adapted to 17 languages [66] and will be helpful in setting expectations worldwide
Summary
Cochlear implants (CIs) are currently the gold-standard therapy of choice for individuals with severe to profound hearing loss who do not benefit from hearing aids. While hearing-impaired cochlear implant users can achieve excellent performance in quiet, speech recognition in background noise continues to be a significant challenge for them, especially under conditions in which the target stimuli are not spatially separated from the noise [3,4,5,6,7,8,9,10]. This leads to significant communication problems in many real-life listening situations [11], and can negatively affect linguistic and cognitive development [6,12]. This, together with the relatively wide spread of electrically evoked neuronal excitation in the cochlea [17], produces vague representations of the spectro-temporal information required for phonemic perception [16,17]
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