Roles of Speed vs. Inhibition-Concentration in Speech Recognition of Mandarin Cochlear Implant Users.

Evaluation of noise reduction technologies in a contemporary cochlear implant system

A coordinated fitting of a cochlear implant (CI) and contralateral hearing aid (HA) for bimodal device use should emphasize balanced audibility and loudness across devices. However, guidelines for allocating frequency information to the CI and HA are not well established for the growing population of bimodal recipients. The study aim was to compare the effects of three different HA frequency responses, when fitting a CI and an HA for bimodal use, on speech recognition and localization in children/young adults. Specifically, the three frequency responses were wideband, restricted high frequency, and nonlinear frequency compression (NLFC), which were compared with measures of word recognition in quiet, sentence recognition in noise, talker discrimination, and sound localization. The HA frequency responses were evaluated using an A B₁ A B₂ test design: wideband frequency response (baseline-A), restricted high-frequency response (experimental-B₁), and NLFC-activated (experimental-B2). All participants were allowed 3-4 weeks between each test session for acclimatization to each new HA setting. Bimodal benefit was determined by comparing the bimodal score to the CI-alone score. Participants were 14 children and young adults (ages 7-21 yr) who were experienced users of bimodal devices. All had been unilaterally implanted with a Nucleus CI24 internal system and used either a Freedom or CP810 speech processor. All received a Phonak Naida IX UP behind-the-ear HA at the beginning of the study. Group results for the three bimodal conditions (HA frequency response with wideband, restricted high frequency, and NLFC) on each outcome measure were analyzed using a repeated measures analysis of variance. Group results using the individual "best bimodal" score were analyzed and confirmed using a resampling procedure. Correlation analyses examined the effects of audibility (aided and unaided hearing) in each bimodal condition for each outcome measure. Individual data were analyzed for word recognition in quiet, sentence recognition in noise, and localization. Individual preference for the three bimodal conditions was also assessed. Group data revealed no significant difference between the three bimodal conditions for word recognition in quiet, sentence recognition in noise, and talker discrimination. However, group data for the localization measure revealed that both wideband and NLFC resulted in significantly improved bimodal performance. The condition that yielded the "best bimodal" score varied across participants. Because of this individual variability, the "best bimodal" score was chosen for each participant to reassess group data within word recognition in quiet, sentence recognition in noise, and talker discrimination. This method revealed a bimodal benefit for word recognition in quiet after a randomization test was used to confirm significance. The majority of the participants preferred NLFC at the conclusion of the study, although a few preferred a restricted high-frequency response or reported no preference. These results support consideration of restricted high-frequency and NLFC HA responses in addition to traditional wideband response for bimodal device users.

To study postoperative hearing outcomes in older adult cochlear implant recipients who did not meet Medicare candidacy criteria by sentence testing in quiet. Case Control Series. University Based Tertiary Referral Cochlear Implant Center. Fifty-four patients age 60 or greater with bilateral moderate to profound sensorineural hearing loss who underwent cochlear implantation. Patients were divided into three groups by preoperative testing scores: 1) sentence recognition in quiet and monosyllabic word recognition scores ≤40%, 2) sentence recognition in quiet scores >40% and sentence recognition in noise scores ≤40%, and 3) sentence recognition in quiet scores >40% and monosyllabic word recognition scores ≤40% in the ear to be implanted. Cochlear implantation. Pre- versus postoperative sentence and word recognition scores. All three groups received a statistically significant benefit from their cochlear implant as measured by both postoperative sentence and word recognition. When comparing postoperative sentence recognition scores between groups, there were no statistically significant differences (Group 1: mean 83.1%, SD ± 17.4%; Group 2: mean 90.1%, SD ± 8.0%; Group 3: mean 90.6%, SD ± 6.9%). When comparing postoperative monosyllabic word recognition scores, there were no statistically significant differences between groups (Group 1: mean 60.3%, SD ± 19.6%; Group 2: mean 66.8%, SD ± 20.0%; Group 3: mean 70.0%, SD ± 18.8%). Results of this study demonstrate that older patients who do not meet current Medicare candidacy criteria derive significant long-term benefit from cochlear implantation when either sentence in noise or monosyllabic word recognition in quiet ≤40% is used to determine candidacy. Further research and greater numbers are needed to better characterize the role of monosyllabic word recognition in cochlear implant candidacy.

Determine the impact of cochlear implantation on quality of life (QOL) and determine the correlation between QOL and speech recognition ability. Two authors independently searched PubMed, Medline, Scopus, and the Cumulative Index to Nursing and Allied Health Literature to identify studies reporting hearing-specific or cochlear implant (CI)-specific QOL outcomes before and after cochlear implantation, and studies reporting correlations between QOL and speech recognition after cochlear implantation. Data from the included articles were obtained independently by two authors. Standardized mean difference (SMD) for each measure and pooled effects were determined to assess improvement in QOL before and after cochlear implantation. From 14 articles with 679 CI patients who met the inclusion criteria, pooled analyses of all hearing-specific QOL measures revealed a very strong improvement in QOL after cochlear implantation (SMD = 1.77). Subset analysis of CI-specific QOL measures also showed very strong improvement (SMD = 1.69). Thirteen articles with 715 patients met the criteria to evaluate associations between QOL and speech recognition. Pooled analyses showed a low positive correlation between hearing-specific QOL and word recognition in quiet (r = 0.213), sentence recognition in quiet (r = 0.241), and sentence recognition in noise (r = 0.238). Subset analysis of CI-specific QOL showed similarly low positive correlations with word recognition in quiet (r = 0.213), word recognition in noise (r = 0.241), and sentence recognition in noise (r = 0.255). Using hearing-specific and CI-specific measures of QOL, patients report significantly improved QOL after cochlear implantation. However, widely used clinical measures of speech recognition are poor predictors of patient-reported QOL with CIs. Laryngoscope, 128:982-990, 2018.

Previous research shows that cochlear implant users experience significant difficulty with speech perception in noisy listening situations. There is a paucity of research evaluating the potential improvement in speech recognition in noise provided by a dual-microphone directional system in a commercial implant sound processor. The primary objective of this study was to compare speech recognition in quiet and in noise for the Nucleus Freedom and Nucleus 5 CP810 sound processors set to the manufacturer's default user programs for quiet and noisy environments. Crossover with repeated-measures design. This multi-center study was conducted across four cochlear implant clinics in the United States. Thirty-five adults with unilateral Nucleus Freedom cochlear implants. All subjects had used their cochlear implant for at least 6 months and had substantial open-set word recognition as evidenced by a score of at least 40% correct on the Consonant-Nucleus-Consonant (CNC) monosyllabic word recognition test in quiet. All subjects (previous users of the Nucleus Freedom sound processor) were fitted with the Nucleus 5 sound processor. Performance was assessed while these subjects used each sound processor in the default user program the manufacturer recommends for quiet and noisy conditions. Speech recognition was assessed with CNC monosyllabic words in quiet and sentences in noise from the BKB-SIN (Bamford-Kowal-Bench Sentences in Noise) test. The data were analyzed with descriptive statistics and performance with each processor in each listening condition was compared using a repeated-measures analysis of variance. Word recognition in quiet was significantly better with the Nucleus 5 sound processor when compared to performance with the Nucleus Freedom processor. In noise, the Nucleus 5 sound processor also provided a significant improvement in speech recognition relative to the performance with the Nucleus Freedom. The results of the study suggest that the Nucleus 5 sound processor provides significantly better speech recognition in quiet and in noise when compared with performance with the Nucleus Freedom processor.

Figure: iStockphoto.comThe majority of cochlear implant (CIs) recipients have been postlingually deaf adults, so it is not surprising that most research has focused them. The number of pediatric CI recipients is close to exceeding the number of implanted adults, however, and it is increasingly important for audiologists, speech therapists, and scientists to better understand performance outcomes in children.Figure: Jong Ho Won, PhDFigure: Jay T. Rubinstein, PhDWhat are some of the differences between prelingually and postlingually deaf CI users? Previous research has shown that the auditory nerve degenerates slowly following deafness. The degree of degeneration is proportional to the duration of deafness: the longer the deafness period, the greater the auditory nerve loss. The Food and Drug Administration in 2000 approved CI implantation in children 12 months and older with severe to profound hearing loss, meaning that a 12-month-old infants who receive CIs have been without sound since birth. The period of deafness, however, for postlingually deaf CI users can be anywhere from zero to 10 years or more, depending on patients' etiology. This means that the duration of deafness for pediatric CI users may be significantly shorter because they receive CIs when they are young. This is important because it suggests that prelingually deaf children may have greater neural survival than postlingually deaf adults. Prelingually deaf children with CIs might benefit more from CIs than postlingually deaf adults if speech understanding with a CI depends on the degree of nerve survival. Acoustic vs. Electric Hearing The story is not so simple, however, because another important factor influences CI outcomes. Postlingually deaf adults with CIs have been able to hear sound acoustically for a period of time. Depending on a patient's etiology and the onset of hearing loss, it could be 10 years or longer in cases of gradual, progressive hearing loss. These people have fully developed their auditory and spoken-language skills with their ears and brains during this time. This is not the case for prelingually deaf children who have had limited access to spoken language prior to receiving a CI. We need to be aware of a potentially huge difference between development of the auditory system with acoustic hearing via an intact ear and electric hearing via a CI. We need to remember when evaluating auditory performance in children that a normal auditory system does not fully develop until about age 11, sometimes older. Prelingually deaf children with CIs are still developing their basic auditory function with electric hearing, suggesting that the auditory development pattern in this group of children may proceed quite differently from the development pattern seen in normal hearing children. Music and Speech Perception We recently studied performance and music and speech perception in prelingually deaf children with CIs using adult CI tests from our research program at the Virginia Merrill Bloedel Hearing Research Center at the University of Washington in Seattle. (Audiol Neurootol 2012;17[3]:189.) We used five different tests: a monosyllabic word recognition test, or consonant-nucleus-consonant (CNC) word test; spondee word recognition in noise; a music perception test; spectral-ripple discrimination; and Schroeder-phase discrimination. The CNC word test is used in almost all adult CI centers across the country. The spondee word recognition in noise test is designed to evaluate CI users' speech perception abilities without rhythmic or syllabic cues in the presence of background noise. The test includes 12 spondees, such as the words birthday and stairway. We also employed the University of Washington Clinical Assessment of Music Perception (UW-CAMP) test, which has been widely used in many CI programs in the United States and Canada since 2007. This test evaluates three basic music perception abilities: pitch discrimination, melody recognition, and musical instrument identification. It is important to understand how prelingually deaf children using CIs perform on the speech-in-noise and music perception tests because these are the most common difficulties that typical CI users face. The spectral-ripple and Schroeder-phase tests do not use speech or music signals but artificially created sounds carefully designed to evaluate fundamental aspects of hearing abilities. The spectral-ripple discrimination test, for example, is useful to evaluate CI users' ability to distinguish two different spectral patterns. This skill is important for perceiving differences between certain speech sounds, especially vowels. The spectral-ripple discrimination performance by CI users has been shown to correlate with various types of speech perception abilities, including vowel perception, word and sentence recognition in quiet, and word recognition in babble or steady noise. The Schroeder-phase discrimination is designed to evaluate how well CI users can discriminate a rapid change in time and frequency domains. The stimuli used in this test sound like birds chirping. Spectral Cues We compared two groups of participants: prelingually deaf children with CIs and postlingually deaf adults with CIs. We tested 11 prelingually deaf children, ranging in age from 8 to 16 (mean age=12.1). The participant recruitment criteria included implantation before age 5 (mean age=2.4) with more than five years of CI use (range=5–16). All participants were native English speakers, bilaterally deaf, and had no residual hearing in either ear. They were all normally developing children except for their hearing loss. No differences were found between child and adult groups for spectral-ripple discrimination, CNC word recognition, and spondee word recognition in noise. This result confirmed early findings that prelingually implanted children and postlingually implanted adults show similar speech perception performance. Adult-like spectral-ripple discrimination performance in CI children suggested that, at the ages tested, children and adults have similar sensitivity to changes in the frequency spectrum. We speculated that adult-like spectral sensitivity might have greatly contributed to this speech outcome in prelingually deaf children. Schroeder-phase discrimination and music perception performance, except pitch discrimination, was generally poorer in children than in adults. It is perhaps discouraging to know that prelingually deaf children did not show similar performance in music perception to adults, but we need to understand that music involves more dynamic acoustic cues. Temporal cues, for instance, are critical for timbre perception. Timbre makes one particular musical sound different from another, such as sounds produced by different instruments, and this attribute cannot be explained in terms of pitch or loudness. That prelingually deaf children showed worse performance in Schroeder-phase discrimination might be related to their poorer performance in music perception. It is possible that the poorer Schroeder-phase discrimination scores seen in the children might be partly accounted for by incomplete maturation of their temporal processing ability. These findings suggest that it is not entirely clear how prelingually deaf children with CIs use their spectral and temporal sensitivities for speech understanding or music perception, although speech perception scores of children and adults with CIs are equivalent. Adult-like spectral-ripple discrimination and immature Schroeder-phase discrimination performance might suggest that children with CIs may place greater weight on spectral cues than on temporal cues for complex listening tasks. Compared with speech perception tasks, melody and timbre recognition tasks may require more fine temporal sensitivity, leading children to perform worse than adults. These data, however, do not have to be interpreted negatively; we might expect that prelingually deaf implanted children's performance of musical tasks may improve over time as their temporal sensitivity matures. It may be important to provide this population with a proper sound encoding strategy, clinical map, and training program that can maximize their development in temporal sensitivity, or take maximal advantage of their reliance on spectral cues. We would like to thank Liz Anderson and David Horn for their assistance with this article. Work supported by the NIH grants R01-DC007525, P30-DC04661, and F31-DC009755, and an educational fellowship from Advanced Bionics Corporation. FastLinks Visit HJ's Student Blog at http://bit.ly/HJStudentBlog. Check out HJ's R&D Blog at http://bit.ly/RDBlog. Click and Connect! Access the links in The Hearing Journal by reading this issue on our website or in our new iPad app, both available at thehearingjournal.com. Comments about this article? Write to HJ at [email protected]. Follow us on Twitter at twitter.com/hearingjournal and like us on Facebook at www.facebook.com/HearingJournal.

This study aimed to investigate open-set sentence recognition in quiet and amidst single-talker babble among Mandarin-speaking children with cochlear implants (CIs) to elucidate key contributing cognitive and linguistic factors influencing performance. Open-set sentence recognition was assessed in both conditions, alongside measurement of cognitive skills (operational efficiency and auditory short-term memory) and linguistic skills (oral vocabulary and syntactic competence) in kindergarten-aged children with CIs (n = 22; age = 59.8 ± 10.6 months; age at implantation = 31.9 ± 15.1 months; primary communication mode: auditory-oral) compared to peers with typical hearing (TH) (n = 21; age = 67.9 ± 7.9 months). Results showed that children with CIs exhibited poorer performance than TH peers across measures (p < 0.001) except for operational efficiency. Notably, in children with CIs, oral vocabulary significantly contributed to sentence recognition in quiet (β = 0.39, p = 0.029), while auditory short-term memory significantly influenced sentence recognition in both quiet (β = 0.51, p = 0.006) and noise conditions (β = 0.44, p = 0.04). These findings suggest that kindergarten-aged children with CIs face significant challenges in sentence recognition, particularly in the interference condition despite relatively early implantation. Auditory short-term memory emerges as a crucial factor affecting sentence recognition in children with CIs, underscoring its importance for clinical and educational consideration.

The objective of this study was to identify parameters which are related to speech recognition in quiet and in noise of cochlear implant (CI) users. These parameters may be important to improve current fitting practices. Adult CI users who visited the Amsterdam UMC, location VUmc, for their annual follow-up between January 2015 and December 2017 were retrospectively identified. After applying inclusion criteria, the final study population consisted of 138 postlingually deaf adult Cochlear CI users. Prediction models were built with speech recognition in quiet and in noise as the outcome measures, and aided sound field thresholds, and parameters related to fitting (i.e., T and C levels, dynamic range [DR]), evoked compound action potential thresholds and impedances as the independent variables. A total of 33 parameters were considered. Separate analyses were performed for postlingually deafened CI users with late onset (LO) and CI users with early onset (EO) of severe hearing impairment. Speech recognition in quiet was not significantly different between the LO and EO groups. Speech recognition in noise was better for the LO group compared with the EO group. For CI users in the LO group, mean aided thresholds, mean electrical DR, and measures to express the impedance profile across the electrode array were identified as predictors of speech recognition in quiet and in noise. For CI users in the EO group, the mean T level appeared to be a significant predictor in the models for speech recognition in quiet and in noise, such that CI users with elevated T levels had worse speech recognition in quiet and in noise. Significant parameters related to speech recognition in quiet and in noise were identified: aided thresholds, electrical DR, T levels, and impedance profiles. The results of this study are consistent with previous study findings and may guide audiologists in their fitting practices to improve the performance of CI users. The best performance was found for CI users with aided thresholds around the target level of 25 dB HL, and an electrical DR between 40 and 60 CL. However, adjustments of T and/or C levels to obtain aided thresholds around the target level and the preferred DR may not always be acceptable for individual CI users. Finally, clinicians should pay attention to profiles of impedances other than a flat profile with mild variations.

It is difficult for professionals to feel confident when referring patients for cochlear implant (CI) candidacy evaluations, as eligibility is largely determined by speech recognition measures that are typically unavailable before formal assessment. The Spectral-Temporally Modulated Ripple Test (SMRT) is an automated psychoacoustic measure that could be administered in audiology clinics before CI referral and may aid in identifying likely CI candidates. This study evaluated the relationship between aided SMRT performance and aided speech recognition in adult CI candidates. Retrospective analysis of prospectively collected data. Tertiary academic medical center. Twenty-five adult, native English-speaking CI candidates. Diagnostic and research testing before cochlear implantation. Aided SMRT scores obtained in a research setting using participants' own device(s) (everyday listening configuration) were correlated (Spearman) with bilateral and unilateral aided speech recognition scores collected during the clinical CI evaluation, including Consonant-Nucleus-Consonant (CNC) word recognition and AzBio sentence recognition in quiet and noise. Significant correlations were observed between laboratory SMRT scores and all clinical unilateral (ear to be implanted) best-aided speech recognition measures (CNC: n=25, ρ=0.54, P =0.006; AzBio quiet: n=25, ρ=0.59, P =0.002; AzBio noise: n=11, ρ=0.72, P =0.012). Significant correlations were also observed between laboratory SMRT and clinical bilateral best-aided speech recognition in quiet (CNC: n=25, ρ=0.50, P =0.01; AzBio: n=25, ρ=0.53, P =0.007), but not with bilateral AzBio speech recognition in noise (n=18, ρ=0.28, P =0.26). SMRT performance in everyday listening configuration correlates with unilateral best-aided speech recognition in quiet and noise in the ear to be implanted in adult CI candidates. These findings set the stage for future work to investigate if SMRT, alone or in combination with other metrics, can be used to predict CI candidacy versus noncandidacy.

Speech understanding in noise is comparatively more problematic for older listeners with and without hearing loss, and age-related changes in temporal resolution might be associated with reduced speech recognition in complex noise. The purpose of this study was to investigate the effects of aging on temporal processing and speech perception in noise for normal-hearing (NH) and cochlear-implant (CI) listeners. All participants completed three experimental procedures: (1) amplitude modulation (AM) detection thresholds, (2) sentence recognition in quiet, and (3) speech recognition in steady or modulating noise. Four listener groups participated in the study: 11 younger (≤ 30 yr old, YNH) listeners and 12 older (> 60 yr old, ONH) listeners with NH and 7 younger (< 55 yr old, YCI) and 6 older (> 60 yr old, OCI) CI users. CI listeners have been wearing their device either monaurally or binaurally at least 1 yr. For speech recognition testing, there were eight listening conditions in noise (4 modulation frequencies × 2 signal-to-noise ratios) and one in quiet for each listener. For modulation detection testing, a broadband noise with a duration of 500 msec served as the stimuli at three temporal modulation frequencies of 2, 4, and 8 Hz, which were used to modulate the noise in the speech recognition experiment. We measured AM detection thresholds using a two-interval, two-alternative, forced-choice adaptive procedure. We conducted a series of analysis of variance tests to examine the effect of aging on each test result and measured the correlation coefficient between speech recognition in noise and modulation detection thresholds. Although older NH and CI listeners performed similar to the younger listeners with the same hearing status for sentence recognition in quiet, there was a significant aging effect on speech recognition in noise. Regardless of modulation frequency and signal-to-noise ratio, speech recognition scores of the older listeners were poorer than those of the younger listeners when hearing status was matched. We also found a significant effect of aging on AM detection at each modulating frequency and a strong correlation between speech recognition in modulating noise and AM detection thresholds at 2 and 4 Hz. Regardless of differences in hearing status, the degree and pattern of aging effect on auditory processing of the NH listener groups were similar to those of the CI listener groups. This result suggests that age-related declines in speech understanding are likely multifactorial, including peripheral and central factors. Although the age cutoff of the current older age group was 10 yr less than in previous studies (Dubno et al, 2002; Lin et al, 2011), we still found the age-related differences on two auditory tasks. This study extends the knowledge of age-related auditory perception difficulties to CI listeners.

This pilot study examined speech recognition, localization, temporal and spectral discrimination, and subjective reports of cochlear implant (CI) recipients with unilateral deafness. Three adult male participants with short-term unilateral deafness (<5 yr) participated. All had sudden onset of severe-to-profound hearing loss in 1 ear, which then received a CI, and normal or near normal hearing in the other ear. Speech recognition in quiet and noise, localization, discrimination of temporal and spectral cues, and a subjective questionnaire were obtained over several days. Listening conditions were CI, normal hearing (NH) ear, and bilaterally (CI and NH). All participants had open-set speech recognition and excellent audibility (250-6,000 Hz) with the CI. Localization improved bilaterally compared with the NH ear alone. Word recognition in noise was significantly better bilaterally than with the NH ear for 2 participants. Sentence recognition in various noise conditions did not show significant bilateral improvement; however, the CI did not hinder performance in noise even when noise was toward the CI side. The addition of the CI improved temporal difference discrimination for 2 participants and spectral difference discrimination for all participants. Participants wore the CI full time, and subjective reports were positive. Overall, the CI recipients with unilateral deafness obtained open-set speech recognition, improved localization, improved word recognition in noise, and improved perception of their ability to hear in everyday life. A larger study is warranted to further quantify the benefits and limitations of cochlear implantation in individuals with unilateral deafness.

Taking advantage of the flexibility in the number of stimulating electrodes and the stimulation rate in a modern cochlear implant, the present study evaluated relative contributions of spectral and temporal cues to cochlear implant speech perception. Four experiments were conducted by using a Research Interface Box in five MED-EL COMBI 40+ cochlear implant users. Experiment 1 varied the number of electrodes from four to twelve or the maximal number of available active electrodes while keeping a constant stimulation rate at 1000 Hz per electrode. Experiment 2 varied the stimulation rate from 1000 to 4000 Hz per electrode on four pairs of fixed electrodes. Experiment 3 covaried the number of stimulating electrodes and the stimulation rate to study the trade-off between spectral and temporal cues. Experiment 4 studied the effects of envelope extraction on speech perception and listening preference, including half-wave rectification, full-wave rectification, and the Hilbert transform. Vowels, consonants, and HINT sentences in quiet, as well as with a competing female voice served as test materials. Experiment 1 found significant improvement in all speech tests with a higher number of stimulating electrodes. Experiment 2 found a significant advantage of the high stimulation rate only on consonant recognition and sentence recognition in noise. Experiment 3 found an almost linear trade-off between the number of stimulation electrodes and the stimulation rate for consonant and sentence recognition in quiet, but not for vowel and sentence recognition in noise. Experiment 4 found significantly better performance with the Hilbert transform and the full-wave rectification than the half-wave rectification. In addition, envelope extraction with the Hilbert transform produced the highest rating on subjective judgment of sound quality. Consistent with previous studies, the present result from the five MED-EL subjects showed that (1) the temporal envelope cues from a limited number of channels are sufficient to support high levels of phoneme and sentence recognition in quiet but not for speech recognition in a competing voice, (2) consonant recognition relies more on temporal cues while vowel recognition relies more on spectral cues, (3) spectral and temporal cues can be traded to some degree to produce similar performance in cochlear implant speech recognition, and (4) the Hilbert envelope improves both speech intelligibility and quality in cochlear implants.

Current clinical outcome measures for adults receiving cochlear implants (CIs) consist of word and sentence recognition, primarily under quiet conditions. However, these measures may not adequately reflect patients' CI-specific quality of life (QOL). This study first examined traditional auditory-only speech recognition measures and other potentially relevant auditory measures as correlates of QOL in CI users. Second, scores on nonauditory tasks of language and cognition were examined as potential predictors of QOL. Twenty-five postlingually deafened adults with CIs were assessed. Participants completed a validated CI-specific QOL measure (the Nijmegen Cochlear Implant Questionnaire) and were tested for word and sentence recognition in quiet, as well as sentence recognition in speech-shaped noise. Participants also completed assessments of audiovisual speech recognition, environmental sound identification, and a task of complex auditory verbal processing. Several nonauditory language and cognitive tasks were examined as potential predictors of QOL. Quality-of-life scores significantly correlated with scores for audiovisual speech recognition and recognition of complex sentences in quiet but not sentences in noise or isolated words. No significant correlations were obtained between QOL and environmental sound identification or complex auditory verbal processing. Quality-of-life subdomain scores were predicted by several nonauditory language and cognitive tasks as well as some patient characteristics. Postoperative measures of recognition of sentences in quiet and audiovisual sentence recognition correlate with CI-related QOL. Findings suggest that sentence recognition tasks are QOL-relevant outcomes but only explain a small fraction of the variability in QOL outcomes for this patient population. 4. Laryngoscope, 128:959-966, 2018.

Considerable variability exists in the speech recognition abilities achieved by children with cochlear implants (CIs) due to varying demographic and performance variables including language abilities. This article examines the factors associated with speech recognition performance of school-aged children with CIs who were grouped by language ability. This is a single-center cross-sectional study with repeated measures for subjects across two language groups. Participants included two groups of school-aged children, ages 7 to 17 years, who received unilateral or bilateral CIs by 4 years of age. The High Language group (N = 26) had age-appropriate spoken-language abilities, and the Low Language group (N = 24) had delays in their spoken-language abilities. Group comparisons were conducted to examine the impact of demographic characteristics on word recognition in quiet and sentence recognition in quiet and noise. Speech recognition in quiet and noise was significantly poorer in the Low Language compared with the High Language group. Greater hours of implant use and better adherence to auditory-verbal (AV) therapy appointments were associated with higher speech recognition in quiet and noise. To ensure maximal speech recognition in children with low-language outcomes, professionals should develop strategies to ensure that families support full-time CI use and have the means to consistently attend AV appointments.

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