Open-set Word Research Articles

Auditory Brainstem Implant Outcomes in Tumor andNontumor Patients: A Systematic Review.

To elucidate the differences in auditory performance between auditory brainstem implant (ABI) patients with tumor or nontumor etiologies. PubMed, Embase, and Web of Science Core Collection from 1990 to 2021. We included published studies with 5or more pediatric or adult ABI users. Auditory outcomes and side effects were analyzed with weighted means for closed-set, open-set speech, and categories of auditory performance (CAP) scores. Overall performance was compared using an Adult Pediatric Ranked Order Speech Perception (APROSPER) scale created for this study. Thirty-six studies were included and underwent full-text review. Data were extracted for 662 tumor and 267 nontumor patients. 83% were postlingually deafened and 17% were prelingually deafened. Studies that included tumor ABI patients had a weighted mean speech recognition of 39.2% (range: 19.6%-83.3%) for closed-set words, 23.4% (range: 17.2%-37.5%) for open-set words, 21.5% (range: 2.7%-48.4%) for open-set sentences, and 3.1 (range: 1.0-3.2) for CAP scores. Studies including nontumor ABI patients had a weighted mean speech recognition of 79.8% (range: 31.7%-84.4%) for closed-set words, 53.0% (range: 14.6%-72.5%) for open-set sentences, and 2.30 (range: 2.0-4.7) for CAP scores. Mean APROSPER results indicate better auditory performance among nontumor versus tumor patients (3.5 vs 3.0, P = .04). Differences in most common side effects were also observed between tumor and nontumor ABI patients. Auditory performance is similar for tumor and nontumor patients for standardized auditory test scores. However, the APROSPER scale demonstrates better ABI performance for nontumor compared to tumor patients.

Processing of linguistic and indexical information in adult cochlear implant users

Normal-hearing (NH) listeners simultaneously make use of both linguistic (speech content) and indexical (talker-specific) information in speech perception. For adult cochlear implant (CI) users, limitations in the talker-specific details conveyed by their devices may impact processing dependences between linguistic and indexical information. The current study examined the extent to which linguistic and indexical information are processed interdependently in adult CI users, using speeded phoneme and talker gender classification tasks. Higher-performing adult CI users (open-set word recognition >65% correct) reported the target vowel (phoneme classification) or target talker gender (gender classification). The non-target dimension varied by the number of talkers (phoneme classification) and the number of words (gender classification). Largely consistent with NH findings, adult CI users displayed asymmetric interference between linguistic and indexical dimensions. Phoneme classification was less accurate and slower with high talker variability. In contrast, gender classification was not affected by word variability. Processing dependencies also varied across individual CI users and related to auditory and cognitive-linguistic abilities. These preliminary findings suggest that adult CI users may make use of degraded linguistic and indexical information during speech processing. However, the extent to which they do so may depend on individual auditory and cognitive-linguistic factors.

Lilliput: speech perception in speech-weighted noise and in quiet in young children

Objective The aim of this study was to develop an open-set word recognition task in speech-weighted noise and in quiet for young children and examine age effects for open versus closed response formats. Design Dutch monosyllabic words were presented in quiet and in stationary speech-weighted noise to 4- and 5-year-old children as well as to young adults in an open-set response format. Additionally, performance in open and closed context was assessed, as well as in a picture-pointing paradigm Study sample: More than 200 children and 50 adults with normal hearing participated in the various validation phases. Results Average fitted speech reception thresholds (50%) yielded an age effect between 4-year and 5-year olds (and adults), both in speech-weighted noise and in quiet. The closed-set format yielded lower (better) SNRs than the open-set format, and children benefitted to the same extent as adults from phonetically similar words in speech-weighted noise. Additionally, the 4 AFC picture-pointing paradigm can be used to assess word recognition in quiet from 3 years of age. Conclusions The same materials reveal performance differences between 4 and 5 years of age (and adults), both in quiet and speech-weighted noise using an open-set response format. This relatively small yet significant difference in SRT for a gap of only 1 year shows a developmental change for word recognition in speech-weighted noise and in quiet in the first decade of life. The study is part of the protocol registered on ClinicalTrials.gov (ID = NCT04063748).

Magnetic stimulation allows focal activation of the mouse cochlea.

Cochlear implants (CIs) provide sound and speech sensations for patients with severe to profound hearing loss by electrically stimulating the auditory nerve. While most CI users achieve some degree of open set word recognition under quiet conditions, hearing that utilizes complex neural coding (e.g., appreciating music) has proved elusive, probably because of the inability of CIs to create narrow regions of spectral activation. Several novel approaches have recently shown promise for improving spatial selectivity, but substantial design differences from conventional CIs will necessitate much additional safety and efficacy testing before clinical viability is established. Outside the cochlea, magnetic stimulation from small coils (micro-coils) has been shown to confine activation more narrowly than that from conventional microelectrodes, raising the possibility that coil-based stimulation of the cochlea could improve the spectral resolution of CIs. To explore this, we delivered magnetic stimulation from micro-coils to multiple locations of the cochlea and measured the spread of activation utilizing a multielectrode array inserted into the inferior colliculus; responses to magnetic stimulation were compared to analogous experiments with conventional microelectrodes as well as to responses when presenting auditory monotones. Encouragingly, the extent of activation with micro-coils was ~60% narrower compared to electric stimulation and largely similar to the spread arising from acoustic stimulation. The dynamic range of coils was more than three times larger than that of electrodes, further supporting a smaller spread of activation. While much additional testing is required, these results support the notion that magnetic micro-coil CIs can produce a larger number of independent spectral channels and may therefore improve auditory outcomes. Further, because coil-based devices are structurally similar to existing CIs, fewer impediments to clinical translational are likely to arise.

Speech discrimination and word identification with a consumer-level bone-conduction headset and remote microphone for children with normal hearing

Objective This study investigated the use of bone-conduction headsets paired to a wireless, remote microphone on speech discrimination and word identification for children with normal hearing. Design Children were tested with and without the headset, using the McCormick speech discrimination test in quiet and in speech-shaped noise to measure word-discrimination thresholds. Additionally, open-set word identification in noise was assessed while children were simultaneously engaged in a visual-monitoring task. Study sample Twenty normal-hearing children, aged 4–11 years. Results Median word-discrimination threshold in quiet (n = 20) was 20.5 dB(A) without a headset and 11.5 dB(A) with a headset (Z = –3.826, p = 0.0001). In noise, the median word-discrimination threshold (n = 20) was 52 dB(A) without a headset and 40.5 dB(A) with a headset (Z = –3.926, p< 0.0001). For open-set word identification (n = 11), children performed significantly better with a headset than without it, with an average improvement of 23 percentage points (t(10) = −5.227, p = 0.0004, two tailed). Conclusions A bone-conduction headset paired to a Bluetooth microphone improved discrimination of distant speech in quiet and in noise and open-set word identification in noise.

Auditory Brainstem Implants in Children with Inner Ear Anomalies: An Indian Perspective.

Auditory brainstem implantation (ABI) is a viable option for individuals with inner ear anomalies, or other retro-cochlear pathologies, where cochlear implantation is not a suitable option. Although ABI has its advantages in those populations, most often, ABI is not recommended or accepted by the patients because of its limitations and shortcoming such as open-set word recognition in auditory mode, limited infrastructures for carrying out ABI surgery, and the high cost of implantation. This review highlights the benefits in non-tumor patients with ABI surgery and possible reasons for the limited acceptance of the ABI device from an Indian perspective.

Adult Auditory Brainstem Implant Outcomes and Three-Dimensional Electrode Array Position on Computed Tomography.

Factors contributing to auditory brainstem implant (ABI) outcomes are poorly understood. The aims of this study are to (1) characterize ABI electrode array position on postoperative imaging and (2) determine if variability in position is related to perceptual outcomes. Retrospective cohort study. Subjects were selected from the adult ABI recipient population at Massachusetts Eye and Ear. Postoperative three-dimensional (3D) computed tomography (CT) reconstruction of the head was used to measure ABI array position in 20 adult ABI recipients (17 with Neurofibromatosis Type 2 (NF2) and three non-NF2 recipients). Three-dimensional electrode array position was determined based on angles from the horizontal using posterior and lateral views and on distances between the proximal array tip superiorly from the basion (D1), laterally (D2P) and posteriorly (D2L) from the midline. Array position was correlated with perceptual data (in 15 of the 20 recipients who used their ABI). Perceptual data included the number of electrodes that provided auditory sensation, location and type of side effects, level of speech perception (from no sound to open-set word recognition of monosyllables) and the amount of charge required for auditory perception. Although the 3D orientation of the ABI array exhibited a variety of angles, all arrays were posteriorly tilted from the lateral view and most were medially tilted from the posterior view. ABI position relative to the basion from posterior showed mean distances of 1.71 ± 0.42 and 1.1 ± 0.29 cm for D1 and D2, respectively, and a mean D2 of 1.30 ± 0.45 cm from the lateral view. A strong linear negative correlation was found between the number of active electrodes and the distance of the proximal array tip laterally from the basion (D2P; rs = -0.73, p = 0.006) when measured in the posterior view. Although side effects were experienced in all recipients and varied in type and location across the array, electrodes in the middle part of the array tended to elicit auditory sensations while the proximal and distal tips of the array tended to elicit nonauditory side effects. Arrays with and without low charge thresholds appeared to generally overlap in position. However, the two recipients with the best (open-set) speech perception had low charge thresholds and had arrays that were tilted superiorly in the posterior view. ABI recipients with better speech perception appear to share a profile of arrays that are tilted superiorly as compared to recipients with lower speech perception levels. These ABI recipients have a high number of active electrodes (10 or more) and require less electrical charge on individual electrodes to achieve optimal stimulation.

Does Auditory Environment Predict Speech Perception Outcomes in Elderly Cochlear Implant Patients?

Introduction: Cochlear implantation (CI) is a reliable and safe means by which sensorineural hearing loss can be ameliorated in the elderly population. However, a high degree of variation exists in postimplantation hearing outcomes for which some modifiable factors of the daily natural auditory environment may be contributory. In this study, we analyze the relationship between cochlear implant patient age, natural auditory environment, and postimplantation speech perception among older adults. Methods: Data log from automatic environment classification enabled sound processors of postlingually deafened CI recipients ≥50 years old (n = 115) were obtained retrospectively and analyzed for time spent (hours per day) in listening environment and loudness (SPL dB). Speech perception testing was assessed in a subset of patients (n = 27) using open-set word recognition in quiet Consonant-Nucleus-Consonant in the short and intermediate postoperative period. Results: The mean subject age was 70 years (range, 53–99 years). Average daily implant use was 10.8 h and was not significantly correlated with age (p = 0.23, Spearman’s rho). Age was positively correlated with the percentage of hours spent at <40 and 40–50 dB and negatively correlated to proportional CI use at higher volume (60–70, 70–80, and >80 dB; r_s = 0.21, 0.20, −0.20, −0.35, −0.43; p = 0.021, 0.036, 0.033, <0.001, <0.001, respectively). Age was positively correlated with CI use in the quiet scene (r_s = 0.26, p = 0.006) and negatively correlated with scenes containing speech and noise (r_s = −0.19, −0.25; p = 0.046, 0.007). Total hours of device use and time spent at <40, 40–50 dB, and quiet environments were significantly correlated with improved CNC word scores (r_s = 0.48, 0.48, 0.51; p = 0.01, 0.01, <0.01, Spearman’s rho). While all speech (speech in noise + speech) was not significantly correlated to improvements in speech perception, a medium effect size was observed (r_s = 0.37, p = 0.057). Discussion/Conclusion: This study supports a relationship between auditory environment and age, with older CI recipients spending a greater proportion of time in quiet. Older CI users demonstrated greater improvements in speech perception with longer daily device use. Additional examination of the relationship between auditory environment and speech perception is necessary to conclusively guide future auditory rehabilitation efforts.

Audiologic Outcomes of Cochlear Implantation in Cochlear Malformations: A Comparative Analysis of Lateral Wall and Perimodiolar Electrode Arrays.

Cochlear implantation in children with inner ear malformations has been shown to be beneficial. The aims of this study are to evaluate open set word recognition outcomes among children with cochlear implants who have cochlear malformations, and to further assess if either the lateral wall (LW) or perimodiolar (PM) electrode arrays confer any performance outcome advantages. Retrospective case series. Tertiary referral center. Pediatric cochlear implant recipients with cochlear malformations who were implanted at our institution within the last 10 years and had speech perception scores were eligible for inclusion in the study. Potential participants were excluded if they had less than 1 year of listening experience with the cochlear implant or suspected cochlear nerve deficiency. None. Most recent consonant-nucleus-consonant word score. ANOVA analysis demonstrated that the type of cochlear malformation was significantly associated with speech perception outcome (p = 0.006). Those with IP2 malformations had significantly better word recognition outcomes than the remaining cochlear malformations. Array type (LW or PM) was not associated with better word recognition outcomes in long-term follow-up of patients with IP2 malformations (p = 0.13). In children who have cochlear malformations, cochlear implantation results in varying word recognition outcomes based on the type of malformation. While the participants in this study demonstrated postoperative open set word recognition skills, those with IP2 malformations demonstrated the most benefit. Electrode type was not found to significantly impact outcomes in this cohort.

The French Cochlear Implant Registry (EPIIC): Perception and language results in infants with cochlear implantation under the age of 24 months

ObjectiveMulti-centre study of the National French Registry (EPIIC) of patients with cochlear implants, focusing on infants who were operated-on under the age of 24 months between 2012 and 2016. Patients and methodsA total of 615 profoundly deaf infants, who received cochlear implants (CIs) before their second birthday, were included in the registry by different CI centers. Epidemiological, surgical, speech therapy and school, follow-up data were included in the registry, 12, 24, 36 and 48 months thereafter. The following parameters were studied: type of implantation (uni- or bilateral), complications, cause of deafness, category of auditory perception (CAP), Open-set word recognition score (OSW), speech intelligibility rating, lexical comprehension with EVIP (Peabody), communication mode and type of schooling. Bilateral simultaneous CI (BiCI) and unilateral CI (UniCI) groups were compared. ResultsThere were 744 implantations. The explantation-reimplantation rate, within the four-year follow-up, was just 3.6%. Mean implantation age was 16.0 months, and similar in the two groups (BiCI/UniCI). A total of 51% of children had their first implant between 12 and 18 months, and 15% before 12 months. Implantation was unilateral in 52% of cases. Fifty-six percent of the bilateral procedures were sequential, with a mean delay of 16.8 months for the second implantation. The cause of deafness was unknown in 52% of cases. Of the 48% (297/615) of attributed cases, 32% had clear genetic causes. The remaining deafness was due to cytomegalovirus (CMV, 8%), inner-ear malformation (5%) and meningitis (3%). The main complications were from infections (47%) and internal device failure (25%). Four years post-operation, 84% of the UniCI and 75% of BiCl groups had a CAP≥5, and 83% of UniCl and 100% BiCI had OSW≥80%. Furthermore 74% of UniCI and 77% of BiCI communicated orally and 85% of UniCI and 90% of BiCI integrated into mainstream schooling. ConclusionThe French Registry of cochlear implants (EPIIC) is the only such national registry in the world. Our analysis illustrates the immediate benefits of, either single or double, cochlear implantation for language, perception skills and schooling.

Options and strategies for hearing restoration in pediatric neurofibromatosis type 2.

In this article, we will review the mechanisms and natural history of hearing loss in neurofibromatosis type 2 (NF2) and discuss the hearing outcomes with different rehabilitation options. Review of the published literature. NF2 is a rare autosomal dominant syndrome characterized by vestibular schwannomas and other intracranial and spinal tumors. Bilateral vestibular schwannomas are the hallmark of the disease which occur in 90 to 95% of the patients. As a result, hearing loss will eventually occur in almost all NF2 patients. Deafness can occur from tumor progression or from treatment of vestibular schwannomas and is among the most debilitating aspects of NF2. A number of surgical and non-surgical rehabilitation options are available for these patients including cochlear and auditory brainstem implants. The audiologic outcomes with surgical rehabilitation options have been variable but most patients are able to achieve sound awareness and benefit from auditory cues in lip reading. Early identification and treatment of NF2 patients can help in achieving better hearing outcomes in the pediatric population. An increasing number of NF2 patients are receiving open set word understanding with refinement in surgical techniques.

Evaluation of the Optimized Pitch and Language Strategy in Cochlear Implant Recipients.

The Optimized Pitch and Language (OPAL) strategy enhances pitch perception through coding of fundamental frequency (F0) amplitude modulation information in the stimulus envelope delivered to a cochlear implant. Previous research using a prototype of the strategy demonstrated significant benefits in musical pitch and lexical tone discrimination tasks with no degradation in speech recognition when compared with the clinical Advanced Combination Encoder (ACE) strategy in a small group of subjects. Based on those studies, a modified version of the strategy was implemented in the commercial Nucleus CP900 series processor. The aims of the present study were to establish whether the CP900 OPAL implementation continued to provide improved F0 pitch perception in a speech intonation task with no degradation to speech perception in quiet and noise, when compared with the clinical ACE strategy in a larger cohort of subjects. Further aims were to evaluate fitting procedures and subject acclimatization to the strategy after take-home experience. Twenty experienced adult cochlear implant recipients were enrolled in the study. Two subjects withdrew during the study leaving 18 sets of data for analysis. A repeated-measures single-subject design with take-home experience was used to test for improved speech intonation perception using OPAL compared with ACE and for comparable performance between strategies for open-set word recognition in quiet at two presentation levels, sentence recognition in adaptive 4-talker babble noise, and speech intelligibility ratings. The stimulation rate employed for OPAL was 1200 pulses per second/channel which was higher than the default clinical rate of 900 pulses per second/channel used for ACE by all subjects in the present study. Two variations of the OPAL "F0 restore gain" (the gain applied to restore the loudness of modulated channels) were investigated: "custom" measured per subject and "default" which was the average of all subject custom gains. A significant group mean benefit on the intonation test of 8.5% points was shown for OPAL compared with ACE. There was a significant period of adaptation to OPAL with significantly poorer sentence in noise scores acutely and after only 2 weeks of take-home experience. After 4 weeks of take-home experience, comparable word perception in quiet and sentence perception in noise for OPAL were obtained. Furthermore, there was good subject acceptability in the field with comparable speech intelligibility ratings between strategies. Results of the fitting procedure showed that OPAL did not require any additional steps compared with fitting of ACE. A default F0 restore gain provided comparable outcomes to a custom gain setting. The CP900 OPAL implementation provided a significant benefit to perception of speech intonation when compared with ACE. Comparable speech perception (in quiet and noise) and subjective ratings of speech intelligibility between strategies were also achieved after a period of acclimatization. These outcomes are consistent with results of earlier studies using prototype versions of the strategy and reaffirm its potential for improvement of F0 pitch perception in speech while preserving coding of segmental speech information. Furthermore, the OPAL strategy can be programmed into subject's processors using the same fitting procedures used for ACE thereby simplifying its adoption in clinical settings.

Effects of Adaptive Hearing Aid Directionality and Noise Reduction on Masked Speech Recognition for Children Who Are Hard of Hearing.

Purpose The purpose of this study was to evaluate speech-in-noise and speech-in-speech recognition associated with activation of a fully adaptive directional hearing aid algorithm in children with mild to severe bilateral sensory/neural hearing loss. Method Fourteen children (5-14 years old) who are hard of hearing participated in this study. Participants wore laboratory hearing aids. Open-set word recognition thresholds were measured adaptively for 2 hearing aid settings: (a) omnidirectional (OMNI) and (b) fully adaptive directionality. Each hearing aid setting was evaluated in 3 listening conditions. Fourteen children with normal hearing served as age-matched controls. Results Children who are hard of hearing required a more advantageous signal-to-noise ratio than children with normal hearing to achieve comparable performance in all 3 conditions. For children who are hard of hearing, the average improvement in signal-to-noise ratio when comparing fully adaptive directionality to OMNI was 4.0 dB in noise, regardless of target location. Children performed similarly with fully adaptive directionality and OMNI settings in the presence of the speech maskers. Conclusions Compared to OMNI, fully adaptive directionality improved speech recognition in steady noise for children who are hard of hearing, even when they were not facing the target source. This algorithm did not affect speech recognition when the background noise was speech. Although the use of hearing aids with fully adaptive directionality is not proposed as a substitute for remote microphone systems, it appears to offer several advantages over fixed directionality, because it does not depend on children facing the target talker and provides access to multiple talkers within the environment. Additional experiments are required to further evaluate children's performance under a variety of spatial configurations in the presence of both noise and speech maskers.

Diagnostic precision of open- versus closed-set word recognition

The precision of forced-choice (closed-set) and open-ended (open-set) word recognition (WR) tasks for identifying a change in hearing was examined. WR performance for closed-set (4 and 6 choices) and open-set tasks was obtained from 70 listeners with normal hearing. Speech recognition was degraded by presenting words from the Modified Rhyme Test in speech-shaped noise (-8, -4, 0, and 4 signal-to-noise ratios) or by processing words using a sinewave vocoder (2, 4, 6, and 8 channels). The results for the two degraded listening conditions yielded similarly shaped, monotonically increasing psychometric functions. The closed-set tasks had shallower slopes and higher scores than the open-set task for the same condition. Fitted, average psychometric functions were the input to a computer simulation conducted to assess the ability of each task to identify a change in hearing. Individual data were also analyzed using 95% confidence intervals for significant changes in scores for words and phonemes. These analyses found the following for the most to least efficient condition: open-set (phoneme), open-set (word), 6-choice closed-set, and 4-choice closed-set. Greater than an order of magnitude more trials were needed for the 4-choice condition to equal the precision of the open-set word condition scored by the percentage of correct phonemes.

Late Cochlear Implantation in Early-Deafened Adults: A Detailed Analysis of Auditory and Self-Perceived Benefits

Objectives: It is known that early-deafened cochlear implant (CI) users are a very heterogeneously performing group. To gain more insight into this population, this study investigated (1) postoperative changes in auditory performance over time based on various outcome measures, focusing on poor performers, (2) self-perceived outcomes, (3) relations between auditory and self-perceived outcomes, and (4) preimplantation factors predicting postoperative outcomes. Methods: Outcomes were assessed prospectively in a group of 27 early-deafened, late-implanted CI users, up to 3 years after implantation. Outcome measures included open-set word and sentence recognition, closed-set word recognition, speech tracking and a questionnaire on self-perceived outcomes. Additionally, the relative influence of 8 preimplantation factors on CI outcome was assessed with linear regression analyses. Results: Significant improvements were found for auditory performance measures and most of the questionnaire domains. Significant changes of the closed-set word test, speech tracking and questionnaire were also found for a subgroup of poor performers. Correlations between auditory and self-perceived outcomes were weak and nonsignificant. Preoperative word recognition and preoperative hearing thresholds, both for the implanted ear, were significant predictors of postoperative outcome in the multivariable regression model, explaining 63.5% of the variation. Conclusions: Outcome measurement in this population should be adjusted to the patients’ individual performance level and include self-perceived benefit. There is still a need for more knowledge regarding predictors of CI outcomes in this group, but the current study suggests the importance of the preoperative performance of the ear to be implanted.

The similarities and differences of mandarin open-set word recognition between cochlear implant children and normal hearing children

Objective:To evaluate the ability of open-set word recognition in cochlear implant (CI) children,and compare the similarities and difference of open-set word recognition between CI children and normal hearing(NH) children.Method:This study included 485 children with CI and 162 children with NH, who completed the Mandarin lexical neighborhood test. The results for children at 1-8 years after receiving their CI were compared to those from the children with NH using analysis of variance.Result:There were significant differences in open-set word recognition between the CI and NH groups(P<0.05).For implantation before 2 years, there was no significant difference in recognition at the ages of 6-7 years,compared to 3-year-old children with NH, or at the age of 10 years, compared to 6-year-old children with NH(P>0.05).For implantation before 3 years, there was no significant difference in recognition at the ages of 8-9 years, compared to 3-year-old children with NH,or at the age of 10 years, compared to 6-year-old children with NH(P>0.05).For implantation after 3 years, there was a significant difference in recognition at the age of 13 years,compared to 3-year-old children with NH(P<0.05).Conclusion:Mandarin open-set word recognition increased with time after CI.Chinese children with CI had delayed but similar development of recognition, compared to normal children. Early CI can shorten the gap between children with CI and normal children.

Characteristics of Mandarin Open-set Word Recognition Development among Chinese Children with Cochlear Implants.

Background:Cochlear implants (CIs) can improve speech recognition for children with severe congenital hearing loss, and open-set word recognition is an important efficacy measure. This study examined Mandarin open-set word recognition development among Chinese children with CIs and normal hearing (NH).Methods:This study included 457 children with CIs and 131 children with NH, who completed the Mandarin lexical neighborhood test. The results for children at 1–8 years after receiving their CIs were compared to those from the children with NH using linear regression analysis and analysis of variance.Results:Recognition of disyllabic easy words, disyllabic hard words, monosyllabic easy words, and monosyllabic hard words increased with time after CI implantation. Scores for cases with implantation before 3 years old were significantly better than those for implantation after 3 years old. There were significant differences in open-set word recognition between the CI and NH groups. For implantation before 2 years, there was no significant difference in recognition at the ages of 6–7 years, compared to 3-year-old children with NH, or at the age of 10 years, compared to 6-year-old children with NH. For implantation before 3 years, there was no significant difference in recognition at the ages of 8–9 years, compared to 3-year-old children with NH, or at the age of 10 years, compared to 6-year-old children with NH. For implantation after 3 years, there was a significant difference in recognition at the age of 13 years, compared to 3-year-old children with NH.Conclusions:Mandarin open-set word recognition increased with time after CI implantation, and the age at implantation had a significant effect on long-term speech recognition. Chinese children with CIs had delayed but similar development of recognition, compared to normal children. Early CI implantation can shorten the gap between children with CIs and normal children.

Auditory object formation from background noise improves speech perception

Auditory object formation allows listeners to isolate a speech stream from a complex acoustic environment. While most studies focus on foregrounded speech, here we focus on whether listeners can form auditory objects from background noise to aid in speech perception. We use an open-set word recognition task with fluctuating speech-shaped-noise maskers, created by randomly interrupting the noise in each 125 ms window with a long (100 ms) or short (25 ms) silence. On each trial, three maskers were played, with the word occurring during the third. We previously showed that participants perform significantly better when the patterns repeat, compared to when the first two maskers differed from the third. Only the ordering of long or short within preceding patterns differs. To examine whether this advantage is due to auditory object formation, we leverage previous studies showing that inserted silences interfere with object formation. We insert 433 ms silences between patterns and observe defeat of the advantage we previously observed. We therefore attribute the advantage in the repeated masker condition to formation of an auditory object from background noise. Moving forward, we will manipulate other parameters affecting object formation and observe their affect on speech perception in noise.

Early Postimplant Speech Perception and Language Skills Predict Long-Term Language and Neurocognitive Outcomes Following Pediatric Cochlear Implantation.

We sought to determine whether speech perception and language skills measured early after cochlear implantation in children who are deaf, and early postimplant growth in speech perception and language skills, predict long-term speech perception, language, and neurocognitive outcomes. Thirty-six long-term users of cochlear implants, implanted at an average age of 3.4 years, completed measures of speech perception, language, and executive functioning an average of 14.4 years postimplantation. Speech perception and language skills measured in the 1st and 2nd years postimplantation and open-set word recognition measured in the 3rd and 4th years postimplantation were obtained from a research database in order to assess predictive relations with long-term outcomes. Speech perception and language skills at 6 and 18 months postimplantation were correlated with long-term outcomes for language, verbal working memory, and parent-reported executive functioning. Open-set word recognition was correlated with early speech perception and language skills and long-term speech perception and language outcomes. Hierarchical regressions showed that early speech perception and language skills at 6 months postimplantation and growth in these skills from 6 to 18 months both accounted for substantial variance in long-term outcomes for language and verbal working memory that was not explained by conventional demographic and hearing factors. Speech perception and language skills measured very early postimplantation, and early postimplant growth in speech perception and language, may be clinically relevant markers of long-term language and neurocognitive outcomes in users of cochlear implants. https://doi.org/10.23641/asha.5216200.

Cochlear Implantation in Inner Ear Malformations: Systematic Review of Speech Perception Outcomes and Intraoperative Findings.

Objective (1) To analyze reported speech perception outcomes in patients with inner ear malformations who undergo cochlear implantation, (2) to review the surgical complications and findings, and (3) to compare the 2 classification systems of Jackler and Sennaroglu. Data Sources PubMed, Scopus (including Embase), Medline, and CINAHL Plus. Review Methods Fifty-nine articles were included that contained speech perception and/or intraoperative data. Cases were differentiated depending on whether the Jackler or Sennaroglu malformation classification was used. A meta-analysis of proportions examined incidences of complete insertion, gusher, and facial nerve aberrancy. For speech perception data, weighted means and standard deviations were calculated for all malformations for short-, medium-, and long-term follow-up. Speech tests were grouped into 3 categories-closed-set words, open-set words, and open-set sentences-and then compared through a comparison-of-means t test. Results Complete insertion was seen in 81.8% of all inner ear malformations (95% CI: 72.6-89.5); gusher was reported in 39.1% of cases (95% CI: 30.3-48.2); and facial nerve anomalies were encountered in 34.4% (95% CI: 20.1-50.3). Significant improvements in average performance were seen for closed- and open-set tests across all malformation types at 12 months postoperatively. Conclusions Cochlear implantation outcomes are favorable for those with inner ear malformations from a surgical and speech outcome standpoint. Accurate classification of anatomic malformations, as well as standardization of postimplantation speech outcomes, is necessary to improve understanding of the impact of implantation in this difficult patient population.