Speech Discrimination Ability Research Articles

Audiological outcomes in sudden sensorineural hearing loss with presumed inner ear hemorrhage.

To explore the hearing outcomes and prognostic factors in patients with sudden sensorineural hearing loss resulting from inner ear hemorrhage. 42 patients (22 male and 20 female) were recruited from January 2016 to December 2017. Intravenous methylprednisolone and/or intratympanic corticosteroid were used as salvage therapy. The main measures included systemic risk factors and audiometric outcomes as proposed by American Academy of Otolaryngology-Head and Neck Surgery Hearing Loss Scale. All individuals were assessed at baseline, discharge (2 weeks post-treatment) and at 1, 3 and 6 months. The mean ages of patients were 39.3 ± 14.8 yrs. Cardiovascular disorders were seen in 19.0-33.3% of cases. Restoration of hearing and speech discrimination abilities were assessed at the first month post-treatment versus initial levels (95.5 ± 15.5 vs. 109.2 ± 9.6 dB, p = 0.000; and 17.6 ± 24.4 vs. 1.3 ± 4.0%, p = 0.003, respectively). Word recognition scores continued to recover at month 6 (38.7 ± 35.4%, p = 0.000), whereas puretone ceased to change (90.8 ± 16.2 dB, p = 0.139). The final percentages of complete, partial and no recovery were 0%, 57.1% and 42.9% respectively. The prognosis was independent of accompanying systemic risk factors as analyzed in this study. Intratympanic intervention was associated with improved word recognition scores, although intravenous corticosteroid was not. Profound sudden sensorineural hearing loss caused by inner ear hemorrhage often has an unsatisfactory prognosis. However, this cohort did experience partial audiological recovery with delayed onset. Immediate and effective intratympanic corticosteroid may have therapeutic potential for this intractable disease.

Delayed Recovery in Pediatric Sudden Sensorineural Hearing Loss Predicted via Magnetic Resonance Imaging.

To evaluate the potential origins via magnetic resonance imaging and the relevant hearing recovery course of pediatric sudden sensorineural hearing loss. We retrospectively analyzed data of 25 pediatric patients from our center with sudden sensorineural hearing loss from January 2011 to December 2016. All individuals were closely followed up at baseline and 1 and 6 months. Magnetic resonance imaging identified presumed causes in 9 cases, 5 of which showed intralabyrinthine hyperintensity, suggesting presumptive intralabyrinthine hemorrhage. The remaining 20 patients showed no hyperintensity. Restoration of hearing and speech discrimination abilities were noted in these 25 children at 6 months versus the initial levels (74.2 ± 22.6 vs 93.5 ± 20.5 dB, p = .000, and 45.8 ± 36.0 vs. 18.3 ± 22.1%, p = .004, respectively). The prognosis of the individuals with intralabyrinthine hemorrhage were superior in terms of frequency and hearing threshold at 6 months compared with that of the no-hemorrhage participants. Word recognition scores improved in either studied group. The potential recovery of hearing in children raises concerns about very early surgical intervention within the first 6 months. Rational imaging and sequential audiometric evaluation to monitor the progression of recovery may be beneficial.

Development of acoustic speech discrimination abilities in school-aged children

The acquisition of speech perception skills is challenging for children. Although some studies have shown that categorical perception boundaries become steeper during childhood and are sometimes shifted in children compared to adults, very few experiments on discrimination abilities in children have been conducted. To investigate this, we conducted a perceptual discrimination task in school-aged children. Sixty-seven 6- to 12-year-old native Quebec French-speaking children were asked to complete a speech perception task that used an AXB scheme. The children were asked to discriminate synthesized 5-formant vowels belonging to three continuums: /i-e/ and /e-ø/ (in which stimuli were equally stepped along F1) and /e-ø/ (in which stimuli were equally stepped along F2). There was a significant effect of age on peak discrimination scores, with older children having higher peak scores than younger children. There was no effect of age on the location of the categorical boundary on the three tested continuums. These findings support the hypothesis that speech development and learning experience play significant roles in the establishment of strong phonological targets.

Influence of temporal resolution skills in speech discrimination abilities of older subjects.

SUMMARYCompromised temporal resolving power of the auditory system can be one of the main factors contributing to poor speech perception skills in the elderly. Very few of the earlier studies have systematically examined this aspect. Hence, the current study was designed with the following objectives: 1) To establish normative database of Gaps in Noise (GIN) test in elderly population in an Indian context. 2) To determine the relationship between speech discrimination skills and temporal resolution abilities in elderly individuals with normal hearing sensitivity. Thirty normal hearing elderly individuals (age range: 55-75 years; mean age: 59.86 ± 4.11 years) participated in the study. The audiological evaluation comprised of tympanometry, puretone and speech audiometry (Speech Reception Threshold-SRT, Speech Discrimination Score-SDS) and GIN. The results of the present study revealed mean Gap Detection Threshold (GDT) of 8.7 msec (SD = 3.38) in the right ear and 8.83 msec (SD = 2.86) in the left ear for the older participants. The mean Total Percentage Score (TPS) in the right ear was 47% (SD = 11.92) and 45% (SD = 11.29) in the left ear. These results suggest that temporal resolution abilities are poor in the elderly compared to the young and middle-aged group. There was no significant ear based difference on either GDT or TPS. The GDT was inversely correlated with speech discrimination performance. The TPS was positively correlated with SDS. This study clearly demonstrated a positive relationship between temporal resolution abilities and speech discrimination. The current database might be useful when assessing temporal resolution abilities in hearing impaired elderly individuals. Furthermore, all elderly individuals should undergo temporal resolution evaluation, irrespective of their hearing status, during audiological assessment.

Study of pragmatic language ability in children with hearing loss

Abstract Pragmatic language refers to how language is used socially to achieve some purpose in communication. Pragmatic language impairment can be a disorder by itself, or as a sign of other accompanying disorders. Hearing-impaired children show less clear pragmatic communication functions. Knowledge of pragmatic abilities in children with hearing loss (HL) is lacking relative to that of children with normal hearing (NH). The aim of this study was to examine the pragmatic language ability in Arabic-speaking children with sensorineural hearing loss in order to apply a proper intervention program to guard against the effect of early pragmatic language skill disorders on later academic and social abilities. Twenty-seven children with HL were subjected to pragmatic language assessment using the Arabic version of the Test of Pragmatic Language, 2nd edition and both the Observational Rating Scale and the Pragmatic Profile subtests of the Clinical Evaluation of Language Fundamental, 4th edition. The results obtained were compared with the results of 27 age-matched and sex-matched NH children. The results of this study revealed significantly lower pragmatic abilities in children with HL compared with children with NH. Male children were significantly more impaired compared with female children. There were significant correlations between the pragmatic variables and the degree of HL, speech discrimination ability, and the duration of auditory deprivation. HL children had significantly lower pragmatic skills compared with NH children, with greater affection correlated with increasing severity of HL and the duration of auditory deprivation. The higher susceptibility to pragmatic impairment in this category of children as well as the importance of pragmatic skills for further social communicative and academic careers should be considered in their rehabilitative plan.

Speech discrimination is impaired in parkinsonian patients: Expanding the audiologic findings of Parkinson's disease

Background and objectivesHearing impairment (HI) has been previously demonstrated in patients with Parkinson's disease (PD). Pure Tone Audiometry (PTA) gives no information about patients' ability to hear and understand speech. To find out hearing ability and speech discrimination of PD patients, we expanded audiological evaluation by means of speech audiometry (SA). Patients and methodsWe screened a series of consecutive PD patients. Severity of motor symptoms and staging were measured by the UPDRS-III and the H&Y scales. Audiometric evaluation consisted of a standardized audiological examination, PTA and SA. Healthy age- and sex-matched subjects were selected as controls. Results45 PD patients and 45 healthy controls were enrolled. PTA confirmed our previous finding of high-frequency HI in PD patients. The mean values for the Speech Recognition Threshold were higher in PD patients as compared with controls. PD patients were more likely to have impaired speech discrimination profiles and higher disease stages. Neither the patients nor the controls showed a significant speech-tone dissociation and rollover phenomenon. ConclusionOur results confirmed sensorineural HI in PD patients. Moreover, SA showed impaired speech discrimination abilities in PD patients as compared with control group thus expanding the audiologic findings of PD.

Degraded neural and behavioral processing of speech sounds in a rat model of Rett syndrome

Individuals with Rett syndrome have greatly impaired speech and language abilities. Auditory brainstem responses to sounds are normal, but cortical responses are highly abnormal. In this study, we used the novel rat Mecp2 knockout model of Rett syndrome to document the neural and behavioral processing of speech sounds. We hypothesized that both speech discrimination ability and the neural response to speech sounds would be impaired in Mecp2 rats. We expected that extensive speech training would improve speech discrimination ability and the cortical response to speech sounds. Our results reveal that speech responses across all four auditory cortex fields of Mecp2 rats were hyperexcitable, responded slower, and were less able to follow rapidly presented sounds. While Mecp2 rats could accurately perform consonant and vowel discrimination tasks in quiet, they were significantly impaired at speech sound discrimination in background noise. Extensive speech training improved discrimination ability. Training shifted cortical responses in both Mecp2 and control rats to favor the onset of speech sounds. While training increased the response to low frequency sounds in control rats, the opposite occurred in Mecp2 rats. Although neural coding and plasticity are abnormal in the rat model of Rett syndrome, extensive therapy appears to be effective. These findings may help to explain some aspects of communication deficits in Rett syndrome and suggest that extensive rehabilitation therapy might prove beneficial.

Speech sound discrimination training improves auditory cortex responses in a rat model of autism.

Children with autism often have language impairments and degraded cortical responses to speech. Extensive behavioral interventions can improve language outcomes and cortical responses. Prenatal exposure to the antiepileptic drug valproic acid (VPA) increases the risk for autism and language impairment. Prenatal exposure to VPA also causes weaker and delayed auditory cortex responses in rats. In this study, we document speech sound discrimination ability in VPA exposed rats and document the effect of extensive speech training on auditory cortex responses. VPA exposed rats were significantly impaired at consonant, but not vowel, discrimination. Extensive speech training resulted in both stronger and faster anterior auditory field (AAF) responses compared to untrained VPA exposed rats, and restored responses to control levels. This neural response improvement generalized to non-trained sounds. The rodent VPA model of autism may be used to improve the understanding of speech processing in autism and contribute to improving language outcomes.

Auditory processing disorders in elderly people

Background and Aim: Aging is one of the most essential priorities of health system in all countries. With respect to increased life expectancy in recent years, we must serve special focus on their needs. Aging has apparent functional effects on speech and hearing processing, the most robust of them is decreased speech discrimination ability, especially at diffuse fields. This study has tried to introduce the different kinds of auditory processing disorders according to recent clinical researches. Material & Methods : Auditory processing deficit at elderly is representated as speech discrimination problem especially at noisy environments. 3 related factors are: peripheral hearing loss, cognitive declines and pure auditory processing disorders. Although these factors are intertwined but it is possible to study pure auditory processing deficits at elderly. Time processing & spatial processing deficits are two main causes. Results : Hydrogen molecule as an antioxidant potentially has numerous benefits including rapid diffusion into tissues and cells. Also it is mild enough neither to disturb metabolic redox reactions nor to affect reactive oxygen species that function in cell signaling and the action mechanism of hydrogen molecule is performed via decrease of the enzymes involved in apoptosis and inflammation. Keywords : Auditory Processing, Aging,Binaural Hearing, Temporal Resolution, Dichotic Hearing, Cognition

Decline of speech understanding in the hearing impaired elderly listeners who visited our hearing aid clinic

The aim of this study was to investigate distinctive change in the hearing impaired elderly listeners, especially about speech recognition. Subjects were 525 patients (235 males, 290 females), from 60 to 98 years of age who had visited the Hearing Aid Clinic of Otorhinolaryngology, National Center for Geriatrics and Gerontology Hospital, between June 2001 and December 2012. Pure-tone air conduction threshold determination was administered to each subject. The speech audiometry materials used to define speech discrimination ability were Japanese monosyllabic word lists, 67S word lists. Sex- and age-specific trends in maximum discrimination score (MDS) and rollover index (RI) were shown in this study. RI was computed by the formula (PBmax-PBmin)/PBmax. PBmax has almost the same meaning as MDS in Japan. PBmin represented the lowest PB score above the test intensity level of PBmax. Mean MDSs were 80.8% in their sixties, 75.3% in their seventies, 60.7% in their eighties, and 45.5% in their nineties. The rate of decrease in mean MDS per decade accelerated in the older generation. Mean RIs were 0.18 in patients in their sixties, 0.24 in their seventies, 0.30 in their eighties, and 0.30 in their nineties. It increased until the age of eighties. In the model 1, multiple logistic analyses were performed to examine the effect of age (in 10-year increments), sex and mean hearing levels in pure tone average of values at 500, 1000, 2000, 4000 Hz (in 10 dB increments) on the MDS < 60%. Significant associations were observed between MDS < 60% and age (odds ratio, 3.03; 95% confidence interval, 2.38 to 3.85), and mean hearing levels in pure tone average of values at 500, 1000, 2000, 4000 Hz (2.33; 2.03 to 2.68). Sex was not associated with MDS < 60%. In the model 2, multiple logistic analyses adjusted for age and sex were performed to examine the effect of hearing level at test frequencies of 125, 250, 500, 1000, 2000, 4000, and 8000 Hz (in 10 dB increments)on the MDS < 60%. Significant associations were observed between MDS < 60% and hearing level at 250 Hz (2.04; 1.44 to 2.89), and 2000 Hz (1.46; 1.16 to 1.83), and 4000 Hz(1.24; 1.02 to 1.50). These outcomes suggest that the important point in qualifying the fitting of hearing aid is to present the list words at an adequate sound pressure level for evaluation of speech understanding especially in the hearing impaired elderly listeners.

Cortical speech-evoked response patterns in multiple auditory fields are correlated with behavioral discrimination ability

Different speech sounds evoke unique patterns of activity in primary auditory cortex (A1). Behavioral discrimination by rats is well correlated with the distinctness of the A1 patterns evoked by individual consonants, but only when precise spike timing is preserved. In this study we recorded the speech-evoked responses in the primary, anterior, ventral, and posterior auditory fields of the rat and evaluated whether activity in these fields is better correlated with speech discrimination ability when spike timing information is included or eliminated. Spike timing information improved consonant discrimination in all four of the auditory fields examined. Behavioral discrimination was significantly correlated with neural discrimination in all four auditory fields. The diversity of speech responses across recordings sites was greater in posterior and ventral auditory fields compared with A1 and anterior auditor fields. These results suggest that, while the various auditory fields of the rat process speech sounds differently, neural activity in each field could be used to distinguish between consonant sounds with accuracy that closely parallels behavioral discrimination. Earlier observations in the visual and somatosensory systems that cortical neurons do not rely on spike timing should be reevaluated with more complex natural stimuli to determine whether spike timing contributes to sensory encoding.

Influence of an Intraoperative Perilymph Gusher on Cochlear Implant Performance in Children With Labyrinthine Malformations

To assess the effect of an intraoperative perilymph fluid gusher during cochlear implantation on speech perception abilities in pediatric patients with labyrinthine anomalies. Tertiary care academic referral center. Seventy subjects with labyrinthine malformations who received a cochlear implant were identified in our pediatric cochlear implant database. In 30 cases, an intraoperative perilymph fluid gusher was encountered during surgery. Fifteen children with GJB2 positive hereditary hearing loss served as controls. Multiple speech perception measures were obtained with the cochlear implant. The best score for each subject over time was determined as a speech reception index in quiet. This index was compared among groups and malformation types. The speech reception index in quiet demonstrated overall good performance scores of cochlear implantation in children with incomplete partitioning/enlarged vestibular aqueduct type malformations. Children with hypoplastic malformations, on the other hand, showed variable outcomes with many children demonstrating only limited long-term speech discrimination abilities. The presence or absence of a perilymph gusher did not significantly influence results after cochlear implantation. This report documents the variable outcomes of pediatric cochlear implantation in children with inner ear malformations. More importantly, anatomic parameters, such as the classification of the anomaly and the presence of a viable cochlear nerve, seem to influence performance measures substantially. The presence of a perilymph gusher did not influence outcomes in both hypoplastic and incomplete partitioning/enlarged vestibular aqueduct type malformations. 2b Individual retrospective cohort study.

Does the ACC Have Potential as an Index of Early Speech Discrimination Ability? A Preliminary Study in 4-Month-Old Infants With Normal Hearing

The acoustic change complex (ACC), an auditory evoked potential (AEP) comprises overlapping slow cortical responses, which reflects discrimination capacity in the absence of attention, has not yet been recorded in infants. Because the ACC is a large response, it may be useful as an index of discrimination for infants at both the individual and group level. This is an advantage compared with mismatch negativity, another AEP that reflects discrimination of a change in stimulus, because mismatch negativity is based on difference waves and is most sensitive to group effects. The two objectives of this study were to determine whether: (1) the ACC can be elicited to a change in the English consonants /da/ and /ba/ in young infants and adults whose native language is English, and (2) the ACC can also be elicited to changes in Hindi consonant contrasts reflecting the predicted patterns of discrimination for young infants reported in previous studies. Participants were six adults and twenty-five 4-month-old infants whose native language was English, and were at low risk for hearing loss. Stimuli were concatenated consonant pairs comprised from a dental /da/, plus either /ba/, Hindi retroflex /Da/, a second /da/ or a silent period (i.e., /dada/, /daba/, /daDa/ and /da_/). It was predicted that adults would show the largest ACC to /daba/, similar responses to /dada/ and /daDa/, and no ACC to /da_/, whereas, it was predicted that infants would show a similar ACC to /daba/ and /daDa/, a smaller ACC to /dada/ and no ACC to /da_/. The stimuli were a total of 564 msec in duration and were presented at 86 dB peak SPL with an interstimulus interval of 2200 msec. At least 100 accepted trials for each participant were required in the final waveform to be included in the study. Individual peak amplitudes and latencies were measured for the P1, N1, P2, and N2 components of the response to the initial /da/ and the ACC. Grand mean waveforms were averaged for each stimulus condition. ACCs were elicited in adults to /dada/, /daba/, and /daDa/ with a trend toward a larger grand mean ACC for /daba/ compared with the other stimulus conditions. For infants, cortical responses to /da_/ resembled the adult P1-N1-P2 complex in morphology but had much longer latencies; /daba/ was the only stimulus that consistently elicited ACCs in infants. The ACC to /daba/ had a more distinct and less variable morphology compared with both /dada/ and /daDa/, which might reflect that the infants detected a greater change from /da/ to /ba/ than from /da/ to either /da/ or /Da/. It may also be the case that the ACC could not be detected for these other stimuli because the stimulus duration and interstimulus intervals used in this study were not optimal for eliciting ACCs for a range of stimuli. The pattern of speech discrimination, as reflected by the ACC, only loosely parallels the behavioral discrimination patterns reported in previous studies. These preliminary findings show that it is possible to record an ACC in young infants and provide a starting point for further investigation of the infant ACC and its utility as an index of discrimination.

Neural Mechanisms Supporting Robust Discrimination of Spectrally and Temporally Degraded Speech

Cochlear implants provide good speech discrimination ability despite highly limited amount of information they transmit compared with normal cochlea. Noise vocoded speech, simulating cochlear implants in normal hearing listeners, have demonstrated that spectrally and temporally degraded speech contains sufficient cues to provide accurate speech discrimination. We hypothesized that neural activity patterns generated in the primary auditory cortex by spectrally and temporally degraded speech sounds will account for the robust behavioral discrimination of speech. We examined the behavioral discrimination of noise vocoded consonants and vowels by rats and recorded neural activity patterns from rat primary auditory cortex (A1) for the same sounds. We report the first evidence of behavioral discrimination of degraded speech sounds by an animal model. Our results show that rats are able to accurately discriminate both consonant and vowel sounds even after significant spectral and temporal degradation. The degree of degradation that rats can tolerate is comparable to human listeners. We observed that neural discrimination based on spatiotemporal patterns (spike timing) of A1 neurons is highly correlated with behavioral discrimination of consonants and that neural discrimination based on spatial activity patterns (spike count) of A1 neurons is highly correlated with behavioral discrimination of vowels. The results of the current study indicate that speech discrimination is resistant to degradation as long as the degraded sounds generate distinct patterns of neural activity.

Factors influencing the choice of prescribed hearing aid

In our paper we would like to emphasize the complexity of hearing aid prescription process. It is connected to a series of factors which impact the choice of hearing aid; type of hearing loss, degree of hearing loss according to the average hearing threshold expressed within the range from 500 Hz to 4000 Hz on a tonal audiogram, audiometric curve configuration, speech discrimination ability, patients' age at which the hearing impairment occurred, time elapsed between the occurrence of hearing impairment and prescription of a hearing aid, patients' age, physical and mental health and their cognitive function, anatomical characteristics of the auricle and external auditory canal, patient and parent motivation, cosmetic factors, financial abilities, cooperation with hearing aids manufacturers. This paper is important for everyday practice and can be used as a kind of guideline to the hearing aid prescription process.

Cortical activity patterns predict robust speech discrimination ability in noise

The neural mechanisms that support speech discrimination in noisy conditions are poorly understood. In quiet conditions, spike timing information appears to be used in the discrimination of speech sounds. In this study, we evaluated the hypothesis that spike timing is also used to distinguish between speech sounds in noisy conditions that significantly degrade neural responses to speech sounds. We tested speech sound discrimination in rats and recorded primary auditory cortex (A1) responses to speech sounds in background noise of different intensities and spectral compositions. Our behavioral results indicate that rats, like humans, are able to accurately discriminate consonant sounds even in the presence of background noise that is as loud as the speech signal. Our neural recordings confirm that speech sounds evoke degraded but detectable responses in noise. Finally, we developed a novel neural classifier that mimics behavioral discrimination. The classifier discriminates between speech sounds by comparing the A1 spatiotemporal activity patterns evoked on single trials with the average spatiotemporal patterns evoked by known sounds. Unlike classifiers in most previous studies, this classifier is not provided with the stimulus onset time. Neural activity analyzed with the use of relative spike timing was well correlated with behavioral speech discrimination in quiet and in noise. Spike timing information integrated over longer intervals was required to accurately predict rat behavioral speech discrimination in noisy conditions. The similarity of neural and behavioral discrimination of speech in noise suggests that humans and rats may employ similar brain mechanisms to solve this problem.

SIG 7 Perspectives Vol. 18, No. 1, October 2011

SIG 7 Perspectives Vol. 18, No. 1, October 2011

Bilingual language learning: An ERP study relating early brain responses to speech, language input, and later word production

Research on the development of speech processing in bilingual children has typically implemented a cross-sectional design and relied on behavioral measures. The present study is the first to explore brain measures within a longitudinal study of this population. We report results from the first phase of data analysis in a longitudinal study exploring Spanish-English bilingual children and the relationships among (a) early brain measures of phonetic discrimination in both languages, (b) degree of exposure to each language in the home, and (c) children's later bilingual word production abilities. Speech discrimination was assessed with event-related brain potentials (ERPs). A bilingual questionnaire was used to quantify the amount of language exposure from all adult speakers in the household, and subsequent word production was evaluated in both languages. Our results suggest that bilingual infants' brain responses to speech differ from the pattern shown by monolingual infants. Bilingual infants did not show neural discrimination of either the Spanish or English contrast at 6–9 months. By 10–12 months of age, neural discrimination was observed for both contrasts. Bilingual infants showed continuous improvement in neural discrimination of the phonetic units from both languages with increasing age. Group differences in bilingual infants' speech discrimination abilities are related to the amount of exposure to each of their native languages in the home. Finally, we show that infants' later word production measures are significantly related to both their early neural discrimination skills and the amount exposure to the two languages early in development.

Reversible cochlear disorders with normal vestibular functions in three cases with Wegener's granulomatosis

Patients with Wegener's granulomatosis (WG) often suffer from hearing loss, but its precise mechanisms have not been well understood. We experienced 3 WG cases whose initial symptoms were bilateral progressive mixed (both conductive and sensorineural) hearing loss, followed by systemic symptoms one year later. They were diagnosed as WG based on positive serology of anti-neutrophil cytoplasmic antibodies (ANCAs) and pathologic findings of affected lesions in addition to systemic symptoms. Although they were different in the type of ANCAs and systemic lesions, all showed considerably reversible cochlear disorders with normal vestibular functions. Moreover, their initial otologic manifestations shared same characteristic features, (1) thick ear drums with pulsatile serous intratympanic effusion, (2) poor speech discrimination ability, and (3) steroid-dependent changes of hearing levels (HLs). They exhibited no significant vestibular abnormalities in chair vestibule-ocular reflex (VOR) testing and cold air caloric tests even when they had severe hearing loss. On the basis of these results, we hypothesized that vasculitis of stria vascularis which generates endocochlear potential might cause these reversible cochlear-specific dysfunctions.

Listening in Color: An Audiologist’s CI Journey

Listening in Color: An Audiologist’s CI Journey