Speech Perception Performance Research Articles

Revision Cochlear Implantation With Device Manufacturer Conversion: Surgical Outcomes and Speech Perception Performance.

Describe the clinical profile of revision cochlear implantation (RCI) cases involving device manufacturer conversion (RCImc+), compare them to cases without manufacturer conversion (RCImc-), and classify the reasons for manufacturer conversion (MC). Retrospective case review. Tertiary academic center. Data on demographics, RCI indications, medical background, surgical details, and the reasons for MC were collected for all RCIs from 1989 to 2020. Post-RCI speech perception performance was categorized as unchanged, improved, or declined, according to clinically based criteria. Of 185 RCIs, 39 (21%) involved MC, mostly in pediatric patients (67%). The leading RCImc+ indications were device-related (59%) and medical (31%) failures. Initial implant manufacturers were Advanced Bionics (49%), Cochlear (25.5%), or Medel (25.5%). Most MC reasons were patient-driven (64%) versus CI team recommendations (36%). The RCImc+ group demonstrated a 3-fold higher rate of medical indications than RCImc- (31% vs11.5%, P = .007). The time interval from symptom onset to RCI was longer in RCImc+ (43 vs20.3 months, P = .001), and the rate of multiple revisions in the same ear was higher (25.6% vs8.2%, P = .009). Complete reinsertion rates were high in both RCImc+ and RCImc- (94.8% vs94.5%, P = 1) without any complications. Speech perception improved or remained unchanged in most (84%) cases, with no significant difference between the groups (P = .183). This retrospective study showed that RCI involving MC is safe and beneficial. Although RCImc+ patients exhibited distinct clinical characteristics, MC did not impact surgical or speech perception outcomes. This provides evidence-based data to support informed decision-making by CI teams and patients.

Can Videoconferencing Be a Viable Method to Measure Speech Perception?

Telehealth has proven effective for service delivery to remote and rural locations and was helpful during lockdowns when patients were unable to see clinicians in person. To assure the reliability of clinical services, the aim of the present study was to evaluate a telehealth protocol to measure speech perception skills through virtual meeting applications such as Zoom. A total of 20 participants with normal hearing and cognition participated in the study. Participants' speech perception performance was measured in two sessions: one over a Zoom call and one in person in the laboratory. Speech perception was measured using Quick Speech-in-Noise Test, Bamford-Kowal-Bench Speech-in-Noise Test, and Words-in-Noise Test. Statistical analysis revealed no significant differences between speech perception scores obtained over the Zoom and in-person methodologies for any of the tests. Additionally, our study found no significant difference in the scores obtained between wired and wireless headphones during Zoom calls. These results suggest that Zoom can be used as a reliable method to measure speech perception in young individuals with normal hearing using these three tests in situations where conventional methods cannot be utilized.

Clinical experience of an adhesive bone conduction hearing system in children with congenital single-sided deafness

ObjectivesThis study aimed to investigate the effects of an adhesive bone conduction device (aBCD) in children with congenital single-sided deafness (SSD). Specifically, we examined whether the aBCD elicits improvement in the speech perception ability of children with congenital SSD and whether using this device would adversely affect the horizontal localisation abilities of these children. MethodsThirteen school-aged children with SSD and seven children with Normal Hearing (NH) were included in this study. Speech perception in noise was measured using the Mandarin Speech Test Materials and sound localisation performance was evaluated using broadband noise stimuli (0.5–20 kHz), randomly played from seven loudspeakers at different stimulus levels (65-, 70-, and 75-dB SPL). ResultsAll children with SSD showed inferior speech perception and sound localisation performance compared with children with NH. The aBCD use remarkably improved the speech perception abilities of these children under quiet and noise conditions; however, their sound localisation abilities neither improved nor deteriorated. ConclusionThis study reveals the effectiveness and safety of a non-surgical aBCD in paediatric patients with SSD. Our results provide a theoretical basis for early hearing intervention with an aBCD in children with congenital SSD who are temporarily unable to undergo ear surgery. Level of evidenceLevel 3.

Peripheral Neural Synchrony in Postlingually Deafened Adult Cochlear Implant Users.

This paper reports a noninvasive method for quantifying neural synchrony in the cochlear nerve (i.e., peripheral neural synchrony) in cochlear implant (CI) users, which allows for evaluating this physiological phenomenon in human CI users for the first time in the literature. In addition, this study assessed how peripheral neural synchrony was correlated with temporal resolution acuity and speech perception outcomes measured in quiet and in noise in postlingually deafened adult CI users. It tested the hypothesis that peripheral neural synchrony was an important factor for temporal resolution acuity and speech perception outcomes in noise in postlingually deafened adult CI users. Study participants included 24 postlingually deafened adult CI users with a Cochlear™ Nucleus® device. Three study participants were implanted bilaterally, and each ear was tested separately. For each of the 27 implanted ears tested in this study, 400 sweeps of the electrically evoked compound action potential (eCAP) were measured at four electrode locations across the electrode array. Peripheral neural synchrony was quantified at each electrode location using the phase-locking value (PLV), which is a measure of trial-by-trial phase coherence among eCAP sweeps/trials. Temporal resolution acuity was evaluated by measuring the within-channel gap detection threshold (GDT) using a three-alternative, forced-choice procedure in a subgroup of 20 participants (23 implanted ears). For each ear tested in these participants, GDTs were measured at two electrode locations with a large difference in PLVs. For 26 implanted ears tested in 23 participants, speech perception performance was evaluated using consonant-nucleus-consonant (CNC) word lists presented in quiet and in noise at signal to noise ratios (SNRs) of +10 and +5 dB. Linear Mixed effect Models were used to evaluate the effect of electrode location on the PLV and the effect of the PLV on GDT after controlling for the stimulation level effects. Pearson product-moment correlation tests were used to assess the correlations between PLVs, CNC word scores measured in different conditions, and the degree of noise effect on CNC word scores. There was a significant effect of electrode location on the PLV after controlling for the effect of stimulation level. There was a significant effect of the PLV on GDT after controlling for the effects of stimulation level, where higher PLVs (greater synchrony) led to lower GDTs (better temporal resolution acuity). PLVs were not significantly correlated with CNC word scores measured in any listening condition or the effect of competing background noise presented at an SNR of +10 dB on CNC word scores. In contrast, there was a significant negative correlation between the PLV and the degree of noise effect on CNC word scores for a competing background noise presented at an SNR of +5 dB, where higher PLVs (greater synchrony) correlated with smaller noise effects on CNC word scores. This newly developed method can be used to assess peripheral neural synchrony in CI users, a physiological phenomenon that has not been systematically evaluated in electrical hearing. Poorer peripheral neural synchrony leads to lower temporal resolution acuity and is correlated with a larger detrimental effect of competing background noise presented at an SNR of 5 dB on speech perception performance in postlingually deafened adult CI users.

Preserved Gray Matter Volume in the Left Superior Temporal Gyrus Underpins Speech-in-Noise Processing in Middle-Aged Adults.

Neuroanatomical evidence suggests that behavioral speech-in-noise (SiN) perception and the underlying cortical structural network are altered by aging, and these aging-induced changes could be initiated during middle age. However, the mechanism behind the relationship between auditory performance and neural substrates of speech perception in middle-aged individuals remains unclear. In this study, we measured the structural volumes of selected neuroanatomical regions involved in speech and hearing processing to establish their association with speech perception ability in middle-aged adults. Sentence perception in quiet and noisy conditions was behaviorally measured in 2 different age groups: young (20-39 years old) and middle-aged (40-59-year-old) adults. Anatomical magnetic resonance images were taken to assess the gray matter volume of specific parcellated brain areas associated with speech perception. The relationships between these and behavioral auditory performance with age were determined. The middle-aged adults showed poorer speech perception in both quiet and noisy conditions than the young adults. Neuroanatomical data revealed that the normalized gray matter volume in the left superior temporal gyrus, which is closely related to acoustic and phonological processing, is associated with behavioral SiN perception in the middle-aged group. In addition, the normalized gray matter volumes in multiple cortical areas seem to decrease with age. The results indicate that SiN perception in middle-aged adults is closely related to the brain region responsible for lower-level speech processing, which involves the detection and phonemic representation of speech. Nonetheless, the higher-order cortex may also contribute to age-induced changes in auditory performance.

Autistic traits and speech perception in social and non-social noises

Individuals with the autism spectrum disorder (ASD) experience difficulties in perceiving speech in background noises with temporal dips; they also lack social orienting. We tested two hypotheses: (1) the higher the autistic traits, the lower the performance in the speech-in-noise test, and (2) individuals with high autistic traits experience greater difficulty in perceiving speech, especially in the non-vocal noise, because of their attentional bias toward non-vocal sounds. Thirty-eight female Japanese university students participated in an experiment measuring their ability to perceive speech in the presence of noise. Participants were asked to detect Japanese words embedded in vocal and non-vocal background noises with temporal dips. We found a marginally significant effect of autistic traits on speech perception performance, suggesting a trend that favors the first hypothesis. However, caution is needed in this interpretation because the null hypothesis is not rejected. No significant interaction was found between the types of background noise and autistic traits, indicating that the second hypothesis was not supported. This might be because individuals with high autistic traits in the general population have a weaker attentional bias toward non-vocal sounds than those with ASD or to the explicit instruction given to attend to the target speech.

Comparison of Speech Perception Performance According to Prosody Change Between People With Normal Hearing and Cochlear Implant Users.

Cochlear implants (CIs) are well known to improve audibility and speech recognition in individuals with hearing loss, but some individuals still struggle with many aspects in communication, such as prosody. This study explores how prosodic elements are perceived by those with normal hearing (NH) and CIs. Thirteen individuals with NH and thirteen CI users participated in this study and completed speech perception, speech prosody perception, speech prosody production, pitch difference discrimination, and melodic contour perception testing. NH listeners performed significantly better than CI users on speech perception, speech prosody perception (except for words with neutral meaning and a negative prosody change and when words were repeated twice), pitch difference discrimination, and melodic contour perception testing. No statistical significance was observed for speech prosody production for both groups. Compared to NH listeners, CI users had limited ability to recognize prosodic elements. The study findings highlight the necessity of an assessment tool and signal processing algorithm for CIs, specifically targeting prosodic elements in clinical settings.

Preliminary Speech Perception Performance Profiles of School-Age Children With Childhood Apraxia of Speech, Speech Sound Disorder, and Typical Development.

Limited research exists assessing speech perception in school-age children with speech sound disorder (SSD) and childhood apraxia of speech (CAS); despite early evidence that speech perception may lead to error-prone motor planning/programming. In this study, we examine speech perception performance in school-age children with and without speech production deficits. Speech perception was assessed using the Wide Range Acoustic Accuracy Scale to determine the just-noticeable difference in discrimination for three consonant-vowel syllable contrasts (/bɑ/-/wɑ/, /dɑ/-/gɑ/, /ɹɑ/-/wɑ/), each varying along a single acoustic parameter for seven children with CAS with rhotic errors, seven children with SSD with rhotic errors, and seven typically developing (TD) children. Findings revealed statistically significant mean differences between perceptual performance of children with CAS when compared to TD children for discrimination of /ɹɑ/-/wɑ/ contrasts. Large effect sizes were also observed for comparisons of /ɹɑ/-/wɑ/ contrasts between children with CAS, SSD, and TD peers. Additionally, large effect sizes were observed for /dɑ/-/gɑ/ contrasts between children with CAS and SSD and TD children despite nonsignificant mean differences in group performance. Overall, mean outcome scores suggest that school-age children with CAS and persistent rhotic errors demonstrated less accurate speech perception skills relative to TD children for the /ɹɑ/-/wɑ/ contrasts. However, the relatively small sample sizes per group limit the extent to which these findings may be generalized to the broader population.

Indoor acoustic quality of educational buildings in South West Europe: Influence of current ventilation strategies

The quality of the classroom environment has a great impact on the physical and mental health of students and teachers. The COVID-19 pandemic has highlighted the need for new measures and ventilation strategies to be implemented in educational buildings, to ensure indoor air quality in classrooms and to minimise the risk of airborne virus transmission. However, these ventilation protocols can influence the acoustic quality of classrooms and negatively affect students’ speech perception and learning performance. This study presents the results obtained from a field measurement campaign carried out to assess the acoustic characteristics of classrooms of the Fuentenueva Campus (University of Granada) and Azurém Campus (University of Minho). Different ventilation operating scenarios (active and inactive) were assessed to evaluate their impact on the indoor acoustic conditions. The reverberation time (RT), the only parameter used in both countries' regulations to assess acoustic conditions, was found to be higher on both campuses than the RT limits values. Comparison of the measured Speech Transmission Index (STI) and background noise values in the active and inactive ventilation scenario showed a clear variation of the indoor acoustic conditions. The background noise was higher in the active ventilation scenarios (40–57 dBA) than in the inactive ventilation scenarios (34–48 dBA). The average STI values obtained on both campuses for the inactive and active scenarios were 0.54 and 0.51, respectively. In some classrooms an STI difference of 0.1 was found between scenarios. The results obtained in this study provide a broader understanding of the acoustic conditions in university classrooms in Spain and Portugal. The results evidence the need of consider the synergies between the indoor acoustic and air quality conditions to ensure both: the spaces are safe and the acoustic conditions do not interfere with students' learning. The findings show that compliance with the current RT requirements does not ensure that classroom acoustic conditions do not interfere with student performance, and therefore, regulations need to be revised to include additional factors to ensure proper acoustic performance.

Are there good days and bad days for hearing? Quantifying day-to-day intraindividual speech perception variability in older and younger adults.

Moment-to-moment variations in hearing and speech perception have long been observed. Depending on the researcher's theoretical position, the observed fluctuations have been attributed to measurement error or to internal, nonsensory factors such as fluctuations in attention. While cognitive performance has been shown to fluctuate from day to day over longer time, such fluctuations have not been quantified for speech perception, despite being well-recognized by clinical audiologists and hearing-impaired patients. In three studies, we aimed to explore and quantify the magnitude of daily variability in speech perception and to investigate whether such variability goes beyond test unreliability. We also asked whether intraindividual variability depends on overall speech perception performance as observed in different groups of individuals. Older adults with objective hearing impairment and mostly hearing aids (N₁ = 45), with subjective hearing problems but no hearing aids (N₂ = 113), and younger adults without hearing problems (N₃ = 20) participated in three ecological momentary assessment studies. They performed a digit-in-noise test two to three times a day for several weeks. Variance heterogeneous linear mixed-effects models indicated reliable intraindividual variability in speech perception and substantial individual differences in daily variability. A protective factor against daily fluctuations is a higher average speech perception. These studies show that day-to-day variations in speech perception cannot simply be attributed to test unreliability and pave the way for investigating how psychological states that do not vary from moment-to-moment, but rather from day to day, predict variations in speech perception. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Improved Cochlear Implant Performance Estimation Using Tonotopic-Based Electrocochleography

Cochlear implantation produces remarkable results in postlingual deafness, although auditory outcomes vary. Electrocochleography (ECochG) has emerged as a valuable tool for assessing the cochlear-neural substrate and evaluating patient prognosis. To assess whether ECochG-total response (ECochG-TR) recorded at the best-frequency electrode (BF-ECochG-TR) correlates more strongly with speech perception performance than ECochG-TR measured at the round window (RW-ECochG-TR). This single-center cross-sectional study recruited 142 patients from July 1, 2021, to April 30, 2022, with 1-year follow-up. Exclusions included perilymph suctioning, crimped sound delivery tubes, non-native English speakers, inner ear malformations, nonpatent external auditory canals, or cochlear implantation revision surgery. Cochlear implantation. Speech perception testing, including the consonant-nucleus-consonant (CNC) words test, AzBio sentences in quiet, and AzBio sentences in noise plus 10-dB signal to noise ratio (with low scores indicating poor performance and high scores indicating excellent performance on all tests), at 6 months postoperatively; and RW-ECochG-TR and BF-ECochG-TR (measured for 250, 500, 1000, and 2000 Hz). A total of 109 of the 142 eligible postlingual adults (mean [SD] age, 68.7 [15.8] years; 67 [61.5%] male) were included in the study. Both BF-ECochG-TR and RW-ECochG-TR were correlated with 6-month CNC scores (BF-ECochG-TR: r = 0.74; 95% CI, 0.62-0.82; RW-ECochG-TR: r = 0.67; 95% CI, 0.54-0.76). A multivariate model incorporating age, duration of hearing loss, and angular insertion depth did not outperform BF-ECochG-TR or RW-ECochG-TR alone. The BF-ECochG-TR correlation with CNC scores was significantly stronger than the RW-ECochG-TR correlation (r difference = -0.18; 95% CI, -0.31 to -0.01; z = -2.02). More moderate correlations existed between 6-month AzBio scores in noise, Montreal Cognitive Assessment (MoCA) scores (r = 0.46; 95% CI, 0.29-0.60), and BF-ECochG-TR (r = 0.42; 95% CI, 0.22-0.58). MoCA and the interaction between BF-ECochG-TR and MoCA accounted for a substantial proportion of variability in AzBio scores in noise at 6 months (R2 = 0.50; 95% CI, 0.36-0.61). In this case series, BF-ECochG-TR was identified as having a stronger correlation with cochlear implantation performance than RW-ECochG-TR, although both measures highlight the critical role of the cochlear-neural substrate on outcomes. Demographic, audiologic, and surgical factors demonstrated weak correlations with cochlear implantation performance, and performance in noise was found to require a robust cochlear-neural substrate (BF-ECochG-TR) as well as sufficient cognitive capacity (MoCA). Future cochlear implantation studies should consider these variables when assessing performance and related interventions.

Dynamic Range and Neural Response Threshold in Cochlear Implant Mapping Can Be Useful in Predicting Prognosis Related to Postoperative Speech Perception.

To analyze mapping changes in dynamic range (DR) and neural response threshold (NRT) as prognostic factors for cochlear implant (CI). To analyze whether postoperative speech perception performance could be predicted using DR change and initial NRT. The speech comprehension data of 33 patients with CI were retrospectively analyzed after 1, 3, 6, and 12 months of device use. All subjects were adult, postlingually hearing-impaired, and Cochlear Nucleus CI users. Speech perception performance was evaluated using aided pure tone audiometry, consonant, vowel, one-word, two-word, and sentence tests. The averages of initial NRT and DR changes were 197.8±25.9 CU (104-236) and 22.2±18.4 CU (-15-79), respectively. The initial DR was 40.8±16.6 CU. The postoperative DR was 50.3±16.4 CU at 3 months, 58±12.3 CU at 6 months, and 62.9±10.4 CU at 12 months. A gradual increase of DR was observed during the first year of CI. Compared with the initial DR, significant increases in DR were observed at 3 (p<0.05), 6 (p<0.001), and 12 (p<0.001) months. Compared with initial speech performance outcomes, a significant gain in all performance outcomes was achieved at 12 months (p<0.001). Patients with low NRT after CI surgery could initially set DR to a wider range and had better final speech perception outcomes. Conversely, patients with high NRT after CI surgery had to set up a gradual increase in DR while adjusting the T-C level, and the final speech perception outcomes were worse. DR and NRT, the main CI mapping variables, can help predict prognosis related to speech perception outcomes after CI surgery. In conclusion, the post-CI speech perception is better with a lower initial NRT, wider final DR, or younger age.

Factors Affecting Performance in Adults With Cochlear Implants: A Role for Cognition and Residual Cochlear Function.

To evaluate the impact of preoperative and perioperative factors on postlinguistic adult cochlear implant (CI) performance and design a multivariate prediction model. Prospective cohort study. Tertiary referral center. Two hundred thirty-nine postlinguistic adult CI recipients. Speech-perception testing (consonant-nucleus-consonant [CNC], AzBio in noise +10-dB signal-to-noise ratio) at 3, 6, and 12 months postoperatively; electrocochleography-total response (ECochG-TR) at the round window before electrode insertion. ECochG-TR strongly correlated with CNC word score at 6 months ( r = 0.71, p < 0.0001). A multivariable linear regression model including age, duration of hearing loss, angular insertion depth, and ECochG-TR did not perform significantly better than ECochG-TR alone in explaining the variability in CNC. AzBio in noise at 6 months had moderate linear correlations with Montreal Cognitive Assessment (MoCA; r = 0.38, p < 0.0001) and ECochG-TR ( r = 0.42, p < 0.0001). ECochG-TR and MoCA and their interaction explained 45.1% of the variability in AzBio in noise scores. This study uses the most comprehensive data set to date to validate ECochG-TR as a measure of cochlear health as it relates to suitability for CI stimulation, and it further underlies the importance of the cochlear neural substrate as the main driver in speech perception performance. Performance in noise is more complex and requires both good residual cochlear function (ECochG-TR) and cognition (MoCA). Other demographic, audiologic, and surgical variables are poorly correlated with CI performance suggesting that these are poor surrogates for the integrity of the auditory substrate.

Gene mutations as a non-invasive measure of adult cochlear implant performance: Variable outcomes in patients with select TMPRSS3 mutations.

The cochlear implant (CI) has proven to be a successful treatment for patients with severe-to-profound sensorineural hearing loss, however outcome variance exists. We sought to evaluate particular mutations discovered in previously established sensory and neural partition genes and compare post-operative CI outcomes. Utilizing a prospective cohort study design, blood samples collected from adult patients with non-syndromic hearing loss undergoing CI were tested for 54 genes of interest with high-throughput sequencing. Patients were categorized as having a pathogenic variant in the sensory partition, pathogenic variant in the neural partition, pathogenic variant in both sensory and neural partition, or with no variant identified. Speech perception performance was assessed pre- and 12 months post-operatively. Performance measures were compared to genetic mutation and variant status utilizing a Wilcoxon rank sum test, with P<0.05 considered statistically significant. Thirty-six cochlear implant patients underwent genetic testing and speech understanding measurements. Of the 54 genes that were interrogated, three patients (8.3%) demonstrated a pathogenic mutation in the neural partition (within TMPRSS3 genes), one patient (2.8%) demonstrated a pathogenic mutation in the sensory partition (within the POU4F3 genes). In addition, 3 patients (8.3%) had an isolated neural partition variance of unknown significance (VUS), 5 patients (13.9%) had an isolated sensory partition VUS, 1 patient (2.8%) had a variant in both neural and sensory partition, and 23 patients (63.9%) had no mutation or variant identified. There was no statistically significant difference in speech perception scores between patients with sensory or neural partition pathogenic mutations or VUS. Variable performance was found within patients with TMPRSS3 gene mutations. The impact of genetic mutations on post-operative outcomes in CI patients was heterogenous. Future research and dissemination of mutations and subsequent CI performance is warranted to elucidate exact mutations within target genes providing the best non-invasive prognostic capability.

The Impact of Patient Factors on Objective Cochlear Implant Verification Using Acoustic Cortical Auditory-Evoked Potentials

Introduction: Hearing loss is a major global public health issue that negatively impacts quality of life, communication, cognition, social participation, and mental health. The cochlear implant (CI) is the most efficacious treatment for severe-to-profound sensorineural hearing loss. However, variability in outcomes remains high among CI users. Our previous research demonstrated that the existing subjective methodology of CI programming does not consistently produce optimal stimulation for speech perception, thereby limiting the potential for CI users to derive the maximum device benefit to achieve their peak potential. We demonstrated the benefit of utilising the objective method of measuring auditory-evoked cortical responses to speech stimuli as a reliable tool to guide and verify CI programming and, in turn, significantly improve speech perception performance. The present study was designed to investigate the impact of patient- and device-specific factors on the application of acoustically-evoked cortical auditory-evoked potential (aCAEP) measures as an objective clinical tool to verify CI mapping in adult CI users with bilateral deafness (BD). Methods: aCAEP responses were elicited using binaural peripheral auditory stimulation for four speech tokens (/m/, /g/, /t/, and /s/) and recorded by HEARLab™ software in adult BD CI users. Participants were classified into groups according to subjective or objective CI mapping procedures to elicit present aCAEP responses to all four speech tokens. The impact of patient- and device-specific factors on the presence of aCAEP responses and speech perception was investigated between participant groups. Results: Participants were categorised based on the presence or absence of the P1-N1-P2 aCAEP response to speech tokens. Out of the total cohort of adult CI users (n = 132), 63 participants demonstrated present responses pre-optimisation, 37 participants exhibited present responses post-optimisation, and the remaining 32 participants either showed an absent response for at least one speech token post-optimisation or did not accept the optimised CI map adjustments. Overall, no significant correlation was shown between patient and device-specific factors and the presence of aCAEP responses or speech perception scores. Conclusion: This study reinforces that aCAEP measures offer an objective, non-invasive approach to verify CI mapping, irrespective of patient or device factors. These findings further our understanding of the importance of personalised CI rehabilitation through CI mapping to minimise the degree of speech perception variation post-CI and allow all CI users to achieve maximum device benefit.

The relation between cochlear implant programming levels and speech perception performance in post-lingually deafened adults: a data-driven approach

PurposeProgramming a cochlear implant (fitting) is an essential part of a user’s post-implantation journey, defining how sound will be translated into electrical stimulation and aiming to provide optimal speech perception outcomes. Currently, there are no established, evidence-based guidelines for fitting cochlear implant users, leading to a high degree of variability in fitting practices, users’ parameters, and probably outcomes. In this study a data-driven approach is used to retrospectively investigate the relation between cochlear implant fitting parameters and speech perception outcomes in post-lingually deafened adults.Methods298 data points corresponding to fitting parameters and speech audiometry test results for the same number of adult, post-lingually deafened, experienced CI users were analyzed. Correlation analysis was performed, after which parameters from the top-scoring and bottom-scoring tertiles were compared via the Mann–Whitney–Wilcoxon u test.ResultsWeak correlations between dynamic range and speech audiometry outcomes were identified, having p values lower than (albeit close to) 0.05. A significant (p < 0.05) difference in electrical dynamic range (the difference between the minimum and maximum amount of current which may be delivered by each electrode) was found, with top-scoring subjects having on average a wider dynamic range.ConclusionThe association between dynamic range and speech perception outcomes shown in this retrospective study highlights the need for deeper investigation into evidence-driven fitting. It might be a first step in the direction of evidence-based fitting, minimizing variability in outcomes for cochlear implant users and helping mitigate the issue of unexplained low performance.

An Umbrella Review of Cochlear Implant Outcomes in Children With Auditory Neuropathy.

The objective of this overview of systematic reviews (SRs; umbrella review) was to systematically summarize and critically appraise current evidence of cochlear implant (CI) outcomes in children with auditory neuropathy spectrum disorder (ANSD). This study was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. The methodological quality and the risk of bias in the included SRs were assessed using A MeaSurement Tool to Assess systematic Reviews 2 checklist and the Risk of Bias in Systematic Reviews tool, respectively. According to eight included SRs, children with ANSD achieve CI outcomes (speech perception performance) similar to their peers with sensorineural hearing loss. In children with postsynaptic ANSD (cochlear nerve deficiency), cochlear nerve hypoplasia is associated with better speech recognition outcomes compared with cochlear nerve aplasia, especially in the absence of additional disabilities. Except for one study, the overall quality of the included SRs was critically low, and except for three studies, evidence of a high risk of bias was identified in other included SRs. Current evidence supports CI benefits for children with ANSD. To improve the quality of evidence, well-designed, prospective studies with appropriate sample sizes, using valid outcome measures, clarifying matching criteria, and taking into account the role of confounding factors are essential.

Long-term speech perception performance in prelingually deafened adult cochlear implant recipients

Objective To investigate the postoperative long-term outcomes after an average of 9.2 years following cochlear implantation (CI) in prelingually deafened adults, along with preimplantation factors predicting postoperative outcomes. Methods Twenty-six prelingually deafened adults who underwent CI at >18 years were compared with those who had undergone CI in childhood (<9 years) and were >10 years old. Outcome measures includedhearing thresholds, preoperative and postoperative aided hearing level (HL), speech discrimination score (SDS), and Categories of Auditory Performance (CAP) scores. Correlation analyses were performed on the following: SDS results, aided HL, school attendant status, implant manufacturers, and speech processor models. Results Improvement was achieved in the aided HL and SDS results, although these results were not better than those of the child group. CAP score was also statistically significantly improved after CI. Statistically significant correlation between the preoperative SDS and postoperative HL with CI results was observed. In other words, the better the preoperative SDS results, the better the postoperative SDS results. Conclusion Prelingually deafened adults achieved considerable improvement through CI. It is important to understand that patients achieving better hearing with a well-fitted hearing aid and good SDS performance before surgery may be good candidates for CI.

Children with developmental dyslexia have equivalent audiovisual speech perception performance but their perceptual weights differ.

As reading is inherently a multisensory, audiovisual (AV) process where visual symbols (i.e., letters) are connected to speech sounds, the question has been raised whether individuals with reading difficulties, like children with developmental dyslexia (DD), have broader impairments in multisensory processing. This question has been posed before, yet it remains unanswered due to (a) the complexity and contentious etiology of DD along with (b) lack of consensus on developmentally appropriate AV processing tasks. We created an ecologically valid task for measuring multisensory AV processing by leveraging the natural phenomenon that speech perception improves when listeners are provided visual information from mouth movements (particularly when the auditory signal is degraded). We designed this AV processing task with low cognitive and linguistic demands such that children with and without DD would have equal unimodal (auditory and visual) performance. We then collected data in a group of 135 children (age 6.5-15) with an AV speech perception task to answer the following questions: (1) How do AV speech perception benefits manifest in children, with and without DD? (2) Do children all use the same perceptual weights to create AV speech perception benefits, and (3) what is the role of phonological processing in AV speech perception? We show that children with and without DD have equal AV speech perception benefits on this task, but that children with DD rely less on auditory processing in more difficult listening situations to create these benefits and weigh both incoming information streams differently. Lastly, any reported differences in speech perception in children with DD might be better explained by differences in phonological processing than differences in reading skills. RESEARCH HIGHLIGHTS: Children with versus without developmental dyslexia have equal audiovisual speech perception benefits, regardless of their phonological awareness or reading skills. Children with developmental dyslexia rely less on auditory performance to create audiovisual speech perception benefits. Individual differences in speech perception in children might be better explained by differences in phonological processing than differences in reading skills.

Neural and Behavioral Differences in Speech Perception for Children With Autism Spectrum Disorders Within an Audiovisual Context.

Reduced use of visible articulatory information on a speaker's face has been implicated as a possible contributor to language deficits in autism spectrum disorders (ASD). We employ an audiovisual (AV) phonemic restoration paradigm to measure behavioral performance (button press) and event-related potentials (ERPs) of visual speech perception in children with ASD and their neurotypical peers to assess potential neural substrates that contribute to group differences. Two sets of speech stimuli, /ba/-"/a/" ("/a/" was created from the /ba/ token by a reducing the initial consonant) and /ba/-/pa/, were presented within an auditory oddball paradigm to children aged 6-13 years with ASD (n = 17) and typical development (TD; n = 33) within two conditions. The AV condition contained a fully visible speaking face; the pixelated (PX) condition included a face, but the mouth and jaw were PX, removing all articulatory information. When articulatory features were present for the /ba/-"/a/" contrast, it was expected that the influence of the visual articulators would facilitate a phonemic restoration effect in which "/a/" would be perceived as /ba/. ERPs were recorded during the experiment while children were required to press a button for the deviant sound for both sets of speech contrasts within both conditions. Button press data revealed that TD children were more accurate in discriminating between /ba/-"/a/" and /ba/-/pa/ contrasts in the PX condition relative to the ASD group. ERPs in response to the /ba/-/pa/ contrast within both AV and PX conditions differed between children with ASD and TD children (earlier P300 responses for children with ASD). Children with ASD differ in the underlying neural mechanisms responsible for speech processing compared with TD peers within an AV context.