Speech Perception Tests Research Articles

The relationship between speech recognition in noise and non-speech recognition in noise test performances: Implications for central auditory processing disorders testing

BackgroundAccording to the American Academy of Audiology, a recommendation for frequency-modulation systems may be based upon performances on speech perception tests that do not include background noise. PurposeThe primary purpose of this study was to evaluate the presumption that non-speech recognition in noise test results are related to speech recognition in noise ability for a group of young adults. Research designPerformances on the non-speech recognition in noise tests included in the SCAN-3:A test battery were compared to speech recognition in noise performances as measured with the auditory figure ground subtest of the SCAN-3:A and the Hearing in Noise Test. Study sampleFifty-four young, native speakers of American English with normal pure-tone thresholds participated in the study. Data collection and analysisFor the purposes of this study, the SCAN-3:A raw scores were used. The Hearing in Noise Test was administered in a simulated soundfield environment under headphones. The Spearman rho statistic was used to determine the relationships between non-speech recognition in noise vs. speech recognition in noise test results. ResultsNo significant relationships were found between the auditory figure-ground results and any of the non-speech recognition in noise subtest performances. Modest but statistically significant relationships were found between the Hearing in Noise Test Composite scores vs. the competing words-directed ear and the time compressed sentences subtests of the SCAN-3:A. ConclusionOf the four non-speech recognition in noise subtests that were evaluated, only the competing words-directed ear and the time-compressed sentences performances were significantly correlated to the Composite scores of the Hearing in Noise Test. The results demonstrated a limited external validity for two of the four non-SRN tests for the determination of SRN ability.

Wireless binaural hearing aid technology for telephone use and listening in wind noise

Objective: To assess the speech perception benefits of binaural streaming technology for bilateral hearing aid users in two difficult listening conditions.Design: Two studies were conducted to compare hearing aid processing features relating to telephone use and wind noise. Speech perception testing was conducted in four different experimental conditions in each study.Study sample: Ten bilaterally-aided children in each study.Results: Significant improvements in speech perception were obtained with a wireless feature for telephone use. Significant speech perception benefits were also obtained with wireless hearing aid features when listening to speech in simulated wind noise.Conclusions: Binaural signal processing algorithms can significantly improve speech perception for bilateral hearing aid users in challenging listening situations.

Working Memory Function in Children with Single Side Deafness Using a Bone-Anchored Hearing Implant: A Case-Control Study

The importance of a good hearing function to preserve memory and cognitive abilities has been shown in the adult population, but studies on the pediatric population are currently lacking. This study aims at evaluating the effects of a bone-anchored hearing implant (BAHI) on speech perception, speech processing, and memory abilities in children with single side deafness (SSD). We enrolled n = 25 children with SSD and assessed them prior to BAHI implantation, and at 1-month and 3-month follow-ups after BAHI implantation using tests of perception in silence and perception in phonemic confusion, dictation in silence and noise, and working memory and short-term memory function in conditions of silence and noise. We also enrolled and evaluated n = 15 children with normal hearing. We found a statistically significant difference in performance between healthy children and children with SSD before BAHI implantation in the scores of all tests. After 3 months from BAHI implantation, the per­formance of children with SSD was comparable to that of healthy subjects as assessed by tests of speech perception, working memory, and short-term memory function in silence condition, while differences persisted in the scores of the dictation test (both in silence and noise conditions) and of the working memory function test in noise condition. Our data suggest that in children with SSD BAHI improves speech perception and memory. Speech rehabilitation may be necessary to further improve speech processing.

Hearing Rehabilitation through Bone-Conducted Sound Stimulation: Preliminary Results.

Introduction The bone-anchored hearing aid (BAHA) is a bone conduction system that transmits the sound directly to the inner ear by surpassing the skin impedance and the subcutaneous tissue. It is indicated for patients with mixed, conductive and unilateral sensorineural hearing loss who did not benefit from conventional hearing aids (HAs). Although the benefits from BAHA are well demonstrated internationally, this field still lacks studies in Brazil. Objective To assess the auditory rehabilitation process in BAHA users through audiological, speech perception and tinnitus aspects. Methods Individuals with hearing loss were assessed before and after the implantation. The participants were subjected to pure tone audiometry in free field, functional gain audiometry, speech perception tests, tinnitus handicap inventory (THI) in open format, and to the visual analog scale (VAS). Results It was found that the participants benefited from the use of BAHA. The difference in the performance of the participants before and after the BAHA surgery was significant in terms of hearing acuity. There was no statistically significant difference in the speech perception tests. The tinnitus assessment showed that 80% of the participants scored slight tinnitus severity in THI after using a BAHA. Eighty percent of the participants classified their tinnitus as absent to mild in the VAS after the surgery. Conclusion Based on the results of the current study, we can conclude that the participants improved both the auditory perception and the tinnitus handicap.

Sequential bilateral cochlear implants in children and adolescents: Outcomes and prognostic factors

ObjectivesCochlear implants (CI) have enabled an increasing proportion of deaf children to develop oral communication. Despite the well-known benefits of bilateral implantation, many of these children and teenagers have only a unilateral implant. The aim of this study was to evaluate the benefits of sequential bilateral CI and the influence of relevant factors on outcome. Material and methodsA single-center retrospective study included 109 children and adolescents who received a second sequential CI between 2008 and 2016. Subjects were evaluated before sequential implantation and subsequently at 3, 12 and 24 months, on Speech Intelligibility Rating and speech perception tests: Categories of Auditory Performance, word and sentence recognition in silence and in noise. The influence of inter-implant interval and performance with the first CI were analyzed. ResultsIn the majority of patients, sequential CI provided significant improvement in speech and intelligibility perception. These benefits were seen not only for short but also for long inter-implant intervals. Some subjects with poor performance with their first implant showed significant progression after sequential bilateral implantation. ConclusionIn view of the benefits of sequential bilateral CI, we suggest that a second CI should be proposed to all unilaterally implanted children and adolescents, regardless of inter-implant interval and initial performance with the first CI. Further studies need to be conducted to identify prognostic factors for success in sequential contralateral implantation.

Speech auditory evoked potentials in cochlear implant recipients in relation to rehabilitation outcomes

Background: Speech perception abilities showed great variability among different cochlear implants (CIs) recipients. Assessment of such perceptual abilities through behavioural speech perception tests is very limited, especially in young recipients. Hence, objective auditory evoked potentials (AEPs) can be very important in the assessment of such a young age group.Objectives: To study the ability to use different types of speech evoked AEPs clinically for the assessment of auditory pathway at different levels in children fitted with CIs.Methods: Two groups of children fitted with CIs participated in this study. They were divided into two groups according to their language improvement quotient (LIQ): Group I: included 20 children with LIQ >0.7 and Group II: included 20 children with LIQ <0.7. Children were evaluated through an auditory skills assessment, aided sound field, aided speech evoked AEPs.Results: Children of group I showed better aided-AEPs results in response to speech stimuli compared with group II with the significant positive effect of early age of implantation on the results.Conclusions: Objective aided-AEPs recording in response to complex sounds (such as speech) can be used efficiently for evaluation of speech perception at different levels along the auditory pathway in children fitted with CIs. In addition, they constitute a promising tool for following up and designing the appropriate rehabilitation programs.

Upgrade to Nucleus® 6 in Previous Generation Cochlear™ Sound Processor Recipients.

The Nucleus® 6 sound processor is now compatible with the Nucleus® 22 (CI22M)-Cochlear's first generation cochlear implant. The Nucleus 6 offers three new signal processing algorithms that purportedly facilitate improved hearing in background noise. These studies were designed to evaluate listening performance and user satisfaction with the Nucleus 6 sound processor. The research design was a prospective, single-participant, repeated measures design. A group of 80 participants implanted with various Nucleus internal implant devices (CI22M, CI24M, Freedom® CI24RE, CI422, and CI512) were recruited from a total of six North American sites. Participants had their external sound processor upgraded to the Nucleus 6 sound processor. Final speech perception testing in noise and subjective questionnaires were completed after four or 12 weeks of take-home use with the Nucleus 6. Speech perception testing in noise showed significant improvement and participants reported increased satisfaction with the Nucleus 6. These studies demonstrated the benefit of the new algorithms in the Nucleus 6 over previous generations of sound processors.

Impact of Consistency in Daily Device Use on Speech Perception Abilities in Children with Cochlear Implants: Datalogging Evidence.

Cochlear implants (CIs) give children with severe to profound hearing loss access to sound. There appears to be a dose effect of sound exposure on speech perception abilities as shown by the positive influence of early implantation and CI experience. The consistency in device use per day could also affect sound dose, potentially affecting perceptual abilities in children with CIs. The objectives of the present study were to identify the impact of consistency in device use on: (1) speech perception abilities and (2) asymmetry in speech perception abilities between bilateral CIs. Retrospective analysis. To achieve the first objective, data from 65 children (age range at speech test: 1.91-18.05 yrs) with one (unilaterally implanted or bimodal) or two CIs (sequentially or simultaneously implanted) were included. A subset of data from 40 children with bilateral CIs was included to achieve the second objective. Of the 40 children with two CIs, 15 received their CIs sequentially. Device use information was extracted from datalogs stored in personal speech processors using custom software. Speech perception scores per CI collected in quiet were also evaluated. Multiple regression was used to assess the impact of daily CI use, while controlling for factors previously identified to affect speech perception: age at speech test, length of pre-CI (acoustic) hearing experience, length of CI hearing experience, and order of CI for the first objective, and CI category (simultaneous/sequential implantation), interimplant delay, and length of CI experience for the second objective. On average, children wore their CIs for 11.59 ± 2.86 hours/day and, with one CI, exhibited 65.07 ± 22.64% accuracy on speech perception tests. Higher monaural speech perception scores were associated with longer everyday CI use and CI experience (p < 0.05). Among children with bilateral CIs, those with simultaneously implanted CIs and similar bilateral hearing experience demonstrated a small but significant right ear advantage with higher speech perception scores when using the right rather than left CI (mean difference = 4.55 ± 9.83%). The asymmetry in speech perception between CIs was larger and more variable in children who received their CIs sequentially (mean difference CI1-CI2 = 27.48 ± 24.87%). These asymmetries decreased with longer/consistent everyday use of the newer CI (p < 0.05). Yet, despite consistent everyday device use of the second CI (>12 hours/day), only a small proportion of children implanted sequentially (one out of seven children) achieved symmetrical function similar to children with simultaneously received bilateral CIs. Consistent everyday CI use contributes to higher speech perception scores. Although consistent CI use can help reduce the asymmetry in speech perception abilities of children with sequentially implanted CIs subsequent to interimplant delay, residual asymmetry often persists.

Relationships Between Reasoning, Verbal Working Memory, and Language in Children with Early Cochlear Implantation: A Mediation Effect

The aim of this study was to examine the relationships between reasoning, working memory, and language in children with cochlear implants. A battery of tests of language, working memory, reasoning tasks, and speech perception tests was administered to each child. The participants were twenty-five children with deaf who had cochlear implant surgery before the age of 3. Parallel mediation analysis was conducted. The cause of reasoning is the working memory, however this effect is shown with the indirect effects of receptive and expressive language skills. As a result, activities to improve verbal working memory and receptive and expressive language skills might improve reasoning skills of children with cochlear implants.

Sequential bilateral cochlear implant: results in children and adolescents

IntroductionThe use of the bilateral cochlear implants can promote the symmetrical development of the central auditory pathways, thus benefiting the development of auditory abilities and improving sound localization and the ability of auditory speech perception in situations of competitive noise. ObjectiveTo evaluate the ability of speech perception in children and adolescents using sequential bilateral cochlear implants, considering the association of these variables: age at surgery, time of device use and interval between surgeries. MethodsA total of 14 individuals between 10 and 16 years of age, who demonstrated surgical indication for the use of sequential bilateral cochlear implants as intervention in the auditory habilitation process, were assessed. The speech perception ability was assessed through sentence lists constructed in the Portuguese language, presented in two situations: in silence, with fixed intensity of 60dB SPL, and in competitive noise, with a signal-to-noise ratio of +15dB. The evaluation was performed under the following conditions: unilateral with the first activated cochlear implant, unilateral with the second activated cochlear implant and bilateral with both devices activated. ResultsThe results of the speech perception tests showed better performance in both silence and in noise for the bilateral cochlear implant condition when compared to the 1st cochlear implant and the 2nd cochlear implant alone. A worse result of speech perception was found using the 2nd cochlear implant alone. No statistically significant correlation was found between age at the surgical procedure, interval between surgeries and the time of use of the 2nd cochlear implant, and the auditory speech perception performance for all assessed conditions. The use of a hearing aid prior to the 2nd cochlear implant resulted in benefits for auditory speech perception with the 2nd cochlear implant, both in silence and in noise. ConclusionThe bilateral cochlear implant provided better speech perception in silence and in noise situations when compared to the unilateral cochlear implant, regardless of the interval between surgeries, age at the surgical procedure and the time of use of the 2nd cochlear implant. Speech perception with the 1st cochlear implant was significantly better than with the 2nd cochlear implant, both in silence and in noise. The use of the hearing aid prior to the 2nd cochlear implant influenced speech perception performance with the 2nd cochlear implant, both in silence and in noise.

CI Programming in Patients with Neurologic Impairment

CI Programming in Patients with Neurologic Impairment

Development of Hindi Early Speech Perception Test

Development of Hindi Early Speech Perception Test

Auditory temporal processing, reading, and phonological awareness among aging adults

Auditory temporal processing (ATP) has been related in the literature to both speech perception as well as reading and phonological awareness. In aging adults, it is known to be related to difficulties in speech perception. In the present study, we aimed to test whether an age-related deficit in ATP would also be accompanied by poor reading and phonological awareness. Thirty-eight aging adults were compared to 55 readers with dyslexia and 42 young normal readers on temporal order judgment (TOJ), speech perception, reading, and phonological awareness tests. Aging adults had longer TOJ thresholds than young normal readers, but shorter than readers with dyslexia; however, they had lower speech perception accuracy than both groups. Phonological awareness of the aging adults was better than readers with dyslexia, but poorer than young normal readers, although their reading accuracy was similar to that of the young controls. This is the first report on poor phonological awareness among aging adults. Suprisingly, it was not accompanied by difficulties in reading ability, and might instead be related to aging adults' difficulties in speech perception. This newly discovered relationship between ATP and phonological awareness among aging adults appears to extend the existing understanding of this relationship, and suggests it should be explored in other groups with ATP deficits.

Early Speech Perception Test Outcome in Children with Severe Sensorineural Hearing Loss with Unilateral Cochlear Implants Alone versus Bimodal Stimulation.

Bilateral stimulation of the auditory system has clear advantages over unilateral hearing. Hearing-impaired children are, therefore, generally fitted with hearing aids in both ears so that they can have the benefits of binaural hearing. Children who use acochlear implant in one ear and no acoustic stimulation in the opposite ear are at a definite disadvantage. This study was undertaken to determine the advantages of bimodal stimulation in pediatric population especially in terms of speech recognition. This study comprised of 30 children between 3 and 6years of age with profound bilateral sensorineural hearing loss with cochlear implant in one ear and fitted with digital hearing aid in non-implanted ear. Speech recognition performance was compared in unilateral cochlear implant only and with bimodal hearing stimulation in the same set of children. A statistically significant difference was found between speech reception scores in children with a unilateral cochlear implant only and those with a cochlear implant in one ear and a hearing aid in the non implanted ear in quiet surroundings. It is suggested that the use of bimodal fitting be considered as an effective management method to obtain the advantage of binaural hearing in children who undergo unilateral cochlear implantation.

Auditory brainstem implant in postmeningitis totally ossified cochleae

Introduction: An auditory brainstem implant (ABI) is an option for auditory rehabilitation in patients with totally ossified cochleae who cannot receive a conventional cochlear implant.Objective: To evaluate the outcomes in audiometry and speech perception tests after the implantation of an ABI via the extended retrolabyrinthine approach in patients with postmeningitis hearing loss.Materials and methods: Ten patients, including children and adults, with postmeningitis hearing loss and bilateral totally ossified cochleae received an ABI in a tertiary center from 2009 to 2015. The extended retrolabyrinthine approach was performed in all the patients by the same surgeons. A statistical analysis compared pure tonal averages and speech perception tests before and at least 12 months after the ABI activation.Results: Eight patients (80%) showed improvements in tonal audiometry and the word and vowel perception tests after an average follow-up of 3.3 years. Two patients recognized up to 40% of the closed-set sentences without lip-reading. Two patients had no auditory response.Conclusions: The ABI improved hearing performance in audiometry and speech perception tests in cases of postmeningitis hearing loss. The extended retrolabyrinthine approach is a safe surgical option for patients with postmeningitis hearing loss and bilateral totally ossified cochleae.

Facial nerve stimulation after cochlear implantation: Our experience in 448 adult patients

Facial nerve stimulation (FNS) after cochlear implant activation is a well-known side effect, with an incidence rate raging between 1% and 14.9%. Some causes of deafness have been associated with a higher incidence of this entity, however, there is still no consensus regarding its pathophysiological mechanisms. Although FNS can be solved with changes in speech processor programming, in some cases this can lead to a decrease in performance. The aim of this work was to review the epidemiologic, clinical aspects, and performance results in a group of FNS after cochlear implantation. It was conducted a retrospective chart review of 448 adult patients, all implanted between 1985 and 2016. Speech perception tests results were statistically analysed, using non-parametric tests. We registered a group of 13 patients with FNS, contributing to a prevalence of 2.9%. The causes of hearing loss in this group varied between otosclerosis, Menière’s disease, head trauma, and idiopathic cause. Six cases were managed by changing the programming strategy and the other seven required the deactivation of the affected electrodes. Statistical evaluation showed no statistically significant difference between the performance results of the groups with and without FNS. In this series, the overall incidence of FNS was consistent with the literature. Our study supports the current idea that FNS can frequently be eliminated by changing programming strategies or deactivating the involved electrodes, without affecting the implant’s performance.

Evaluating the effectiveness and reliability of the Vibrant Soundbridge and Bonebridge auditory implants in clinical practice: Study design and methods for a multi-centre longitudinal observational study.

BackgroundThe Vibrant Soundbridge middle ear implant and the Bonebridge bone conducting hearing device are hearing implants that use radio frequency transmission to send information from the sound processor to the internal transducer. This reduces the risk of skin problems and infection but requires a more involved surgical procedure than competitor skin penetrating devices. It is not known whether more complex surgery will lead to additional complications. There is little information available on the reliability of these systems and adverse medical or surgical events. The primary research question is to determine the reliability and complication rate for the Vibrant Soundbridge and Bonebridge. The secondary research question explores changes in quality of life following implantation of the devices. The tertiary research question looks at effectiveness via changes in auditory performance.MethodThe study was designed based on a combination of a literature search, two clinician focus groups and expert review.A multi-centre longitudinal observational study was designed. There are three study groups, two will have been implanted prior to the start of the study and one group, the prospective group, will be implanted after initiation of the study. Outcomes are surgical questionnaires, measures of quality of life, user satisfaction and speech perception tests in quiet and in noise.ConclusionThis is the first multi-centre study to look at these interventions and includes follow up over time to understand effectiveness, reliability, quality of life and complications.

Speech Perception Skills of Hindi Speaking Children with Pre-lingual Hearing Loss Using Hearing Aids and Cochlear Implants.

Very few published studies have reported auditory speech perception in Hindi children with pre-lingual hearing loss. The study is aimed at comparing the speech perception skills of Hindi speaking children with pre-lingual severe to profound hearing loss using hearing aids and cochlear implants. Forty-three 6 to 8-year old children were included as participants, of which 22 were bilateral behind-the-ear hearing aid (HA) users and 21 were unilateral cochlear implant (CI) users. Speech perception was assessed through a forced-choice, picture-pointing task using recorded stimuli presented at 70dBHL in the sound field. The skills assessed include: (a) pattern perception, (b) bisyllabic word identification, (c) monosyllabic word identification, (d) sentence identification and (e) minimal pair identification. Children using CI consistently performed significantly better than those with HA on all tasks. For the skills assessed, best performance was seen in pattern perception and poorest performance was seen in monosyllabic word identification. One participant from the CI group obtained ceiling scores for pattern perception and bisyllabic word identification. There was no statistically significant difference in the performance of 6 to 7 and 7 to 8-year-old children for any of the tasks. Children fitted with CI have better access to the cues important for perception of speech and hence perform consistently better than those using hearing aids. Recorded speech perception test can be used with children using cochlear implants and hearing aids.

Retrospective analysis of auditory neuropathy patients after cochlear implantation

Objectives: To study an effects on hearing ability and speech performance of the patients with auditory neuropathy (AN) after cochlear implantation (CI). Methods: Thirty-five AN patients (26 males and 9 females) after CI in our center since 2007 were chosen, including 5 postlingual patients (implanted age from 14.3 to 38.6 years old) and 30 prelingual patients (implanted age from 1.1 to 13.7 years old). Hearing sensitivity and speech performance were estimated via following methods: (1) implanted hearing thresholds by sound field audiometry; (2) speech audiometry, including monosyllable, disyllable and sentences recognition test by computer-controlled software and sentence recognition test under noise condition (signal to noise ratio=+ 10dB); (3) Mandarin Early Speech Perception test (MESP), Mandarin Pediatric Speech Intelligibility test (MPSI), MAIS, or IT-MAIS for prelingual AN implantees. Results: The average implanted hearing threshold (250-4 000 Hz) was (41.1±11.7) dBHL in 22 AN implantees, while those prelingual implantees was (39.1±10.9) dBHL, and (44.9±12.3) dBHL in postlingual implantees. Speech audiometry were implemented in four of 5 postlingual AN implantees, the results showed increasing tendency in monosyllable recognition scores, dramatic individual variation in computer-controlled disyllable and sentences recognition test, and poor scores (<30%) in speech recognition test in noise condition. Four of 30 prelingual implantees reconstruct their speech recognition ability within 1-3 years after switch-on, characterized as recognition scores (>60%) in monosyllable, disyllable and sentences. The one of prelingual implantee gained recognition scores of speech in noise within 1 year after switch-on. MAIS or IT-MAIS were implemented in twenty-five prelingual implantees, the average score in these patients was 28.6±11.7. Conclusion: Cochlear implant can improve the hearing thresholds of AN patients, however, the improvement in speech performance presented significant variations among the implanted individuals.

Quality of Life and Speech Perception in Two Late Deafened Adults with Cochlear Implants

The aim was to demonstrate the need for a quality of life assessment in biopsychosocial aural rehabilitation (AR) practices with late deafened adults (LDAs) with cochlear implants (CIs).We present a case report of a medical records review of two LDAs enrolled in a biopsychosocial group AR program. A speech perception test Contrasts for Auditory and Speech Training (CAST) and a quality of life (QoL) assessment the Nijmegen Cochlear Implant Questionnaire (NCIQ) were given prior to AR therapy. CAST scores indicated both patients had excellent basic speech perception. However, NCIQ results revealed patients’ difficulties in basic and advanced listening settings. NCIQ highlighted patients’ self-perceived poor self-esteem and ongoing challenges to their QoL. Speech perception testing results alone are not enough to document the daily challenges of QoL needs of LDAs with CIs. The inclusion of a QoL measure such as the NCIQ is vital in evaluating outcomes of cochlear implantation in LDAs.