Understanding Speech In Background Noise Research Articles

Assistive Technology for Adults with Hearing Aids.

Although there is a strong trend of satisfaction with hearing aids, recent consumer surveys indicate that there are still challenges with understanding speech in background noise and low penetration of wireless technologies using many modern-day communication and audio devices, such as smartphones, tablets, and computers. For some listening and communication settings, many patients could benefit from assistive technology that exceeds the capabilities of their hearing aids. When patients are not wearing their hearing aids, such as during sleep, concerns about environmental awareness and safety begin to arise. This article describes some current assistive technologies and accessories that facilitate accessibility to other devices and to satisfy the patient's listening and communication needs.

The Effect of Aging on the Electrically Evoked Compound Action Potential.

To examine the effect of aging on electrically evoked compound action potential (eCAP) growth functions and their relationship with speech recognition in noise in cochlear implant (CI) users. Aging typically leads to difficulty understanding speech in background noise. Previous research has explored cognitive and central auditory mechanisms contributing to these age-related changes. However, it is likely that the peripheral auditory system may also play a role. One challenge is separating the effects of aging on cochlear structures from the effects of aging on the auditory nerve in humans. CI users provide a unique way to address this issue, as intracochlear electrical stimulation bypasses surviving hair cells and activates the auditory nerve directly. Studies in animal models suggest that age-related loss of spiral ganglion cells could lead to shallower eCAP growth functions and/or increased eCAP thresholds and potentially negatively impact speech recognition. Ten younger and 10 older postlingually deafened, adult CI recipients participated in this study. eCAP amplitude-intensity functions were recorded from a mid-array electrode and fit using linear functions. Speech recognition in noise was assessed using the Quick Speech-in-Noise (QuickSIN) test. Older CI users had significantly shallower eCAP growth functions and higher eCAP thresholds than younger CI users. eCAP growth functions were not correlated with speech recognition in noise. Results of this study suggest that older adults may have poorer neural survival, resulting in higher eCAP thresholds and shallower eCAP growth functions. These findings expand our understanding of mechanisms underlying age-related changes in the peripheral auditory system.

Evoked Potentials Reveal Noise Exposure-Related Central Auditory Changes Despite Normal Audiograms.

Purpose Complaints of auditory perceptual deficits, such as tinnitus and difficulty understanding speech in background noise, among individuals with clinically normal audiograms present a perplexing problem for audiologists. One potential explanation for these "hidden" auditory deficits is loss of the synaptic connections between the inner hair cells and their afferent auditory nerve fiber targets, a condition that has been termed cochlear synaptopathy. In animal models, cochlear synaptopathy can occur due to aging or exposure to noise or ototoxic drugs and is associated with reduced auditory brainstem response (ABR) wave I amplitudes. Decreased ABR wave I amplitudes have been demonstrated among young military Veterans and non-Veterans with a history of firearm use, suggesting that humans may also experience noise-induced synaptopathy. However, the downstream consequences of synaptopathy are unclear. Method To investigate how noise-induced reductions in wave I amplitude impact the central auditory system, the ABR, the middle latency response (MLR), and the late latency response (LLR) were measured in 65 young Veterans and non-Veterans with normal audiograms. Results In response to a click stimulus, the MLR was weaker for Veterans compared to non-Veterans, but the LLR was not reduced. In addition, low ABR wave I amplitudes were associated with a reduced MLR, but with an increased LLR. Notably, Veterans reporting tinnitus showed the largest mean LLRs. Conclusions These findings indicate that decreased peripheral auditory input leads to compensatory gain in the central auditory system, even among individuals with normal audiograms, and may impact auditory perception. This pattern of reduced MLR, but not LLR, was observed among Veterans even after statistical adjustment for sex and distortion product otoacoustic emission differences, suggesting that synaptic loss plays a role in the observed central gain. Supplemental Material https://doi.org/10.23641/asha.11977854.

Core Rehabilitation Outcome Set for Single Sided Deafness (CROSSSD) study: protocol for an international consensus on outcome measures for single sided deafness interventions using a modified Delphi survey

BackgroundSingle-sided deafness (SSD) describes the presence of a unilateral severe to profound sensorineural hearing loss. SSD disrupts spatial hearing and understanding speech in background noise. It has functional, psychological and social consequences. Potential options for rehabilitation include hearing aids and auditory implants. Benefits and harms of these interventions are documented inconsistently in the literature, using a variety of outcomes ranging from tests of speech perception to quality of life questionnaires. It is therefore difficult to compare interventions when rehabilitating SSD. The Core Rehabilitation Outcome Set for Single Sided Deafness (CROSSSD) study is an international initiative that aims to develop a minimum set of core outcomes for use in future trials of SSD interventions.Methods/designThe CROSSSD study adopts an international two-round online modified Delphi survey followed by a stakeholder consensus meeting to identify a patient-centred core outcome domain set for SSD based on what is considered critical and important for assessing whether an intervention for SSD has worked.DiscussionThe resulting core outcome domain set will act as a minimum standard for reporting in future clinical trials and could have further applications in guiding the use of outcome measures in clinical practice. Standardisation will facilitate comparison of research findings.

Speech perception is similar for musicians and non-musicians across a\xa0wide range of conditions

It remains unclear whether musical training is associated with improved speech understanding in a noisy environment, with different studies reaching differing conclusions. Even in those studies that have reported an advantage for highly trained musicians, it is not known whether the benefits measured in laboratory tests extend to more ecologically valid situations. This study aimed to establish whether musicians are better than non-musicians at understanding speech in a background of competing speakers or speech-shaped noise under more realistic conditions, involving sounds presented in space via a spherical array of 64 loudspeakers, rather than over headphones, with and without simulated room reverberation. The study also included experiments testing fundamental frequency discrimination limens (F0DLs), interaural time differences limens (ITDLs), and attentive tracking. Sixty-four participants (32 non-musicians and 32 musicians) were tested, with the two groups matched in age, sex, and IQ as assessed with Raven’s Advanced Progressive matrices. There was a significant benefit of musicianship for F0DLs, ITDLs, and attentive tracking. However, speech scores were not significantly different between the two groups. The results suggest no musician advantage for understanding speech in background noise or talkers under a variety of conditions.

Characterizing noise-induced hidden hearing loss in veterans

Cochlear synaptopathy, the partial loss of auditory nerve synapses onto inner hair cells, has been proposed as a possible source of hyperacusis, some forms of tinnitus, and difficulty understanding speech in background noise. In animal models, cochlear synaptopathy is associated with a reduction in the amplitude of wave I of the auditory brainstem response (ABR) and can occur even when auditory thresholds are normal. This presentation will discuss noise exposure-related changes to several auditory physiological measures, including the ABR, in young military Veterans with clinically normal pure tone thresholds. Veterans show differences from non-Veteran controls even after statistically adjusting for group differences in sex and otoacoustic emissions, suggestive of synaptic or neuronal loss. While these physiological changes do not appear to be associated with decreased performance on standard speech-in-noise tests, they are associated with the report of frequent or constant tinnitus. Although post-mortem histological analysis would be necessary for confirmation, these data are consistent with animal models of cochlear synaptopathy and suggest that synaptopathy or “hidden hearing loss” may occur in response to high intensity noise exposure in humans and be correlated with tinnitus.

Difficulty with understanding speech in background noise is predicted by broad binaural pitch fusion in bimodal cochlear implant users

Combined use of a cochlear implant (CI) and a contralateral hearing aid has been shown to improve CI users’ speech perception performance in multi-talker environments, presumably due to the use of acoustic temporal fine structure cues for separating one talker from several other talkers. However, there is large variability in this bimodal benefit. In this study, we show that differences in width of binaural pitch fusion, the fusion of dichotically presented tones that evoke different pitches across ears, explain a large part of this variability. Specifically, broad binaural pitch fusion could lead to fusion of multiple voices as one voice, and reduce the ability to use voice pitch differences to separate voices and understand speech in a multi-talker environment. Speech reception thresholds measured using male and female target talkers were compared with binaural pitch fusion results. Overall performance improved with different genders for target and maskers. A strong negative correlation was observed between voice gender benefit and breadth of binaural pitch fusion. These results suggest that sharp binaural pitch fusion is necessary for maximal speech perception in noise when acoustic hearing is available to transmit voice pitch cues. [Work supported by NIH-NIDCD Grant Nos. R01 DC01337 and F32 DC016193.]

Outer Hair Cell Damage: A Completely Different Listening Experience

Outer Hair Cell Damage: A Completely Different Listening Experience

Auditory rehabilitation after stroke: treatment of auditory processing disorders in stroke patients with personal frequency-modulated (FM) systems

Purpose: Auditory disability due to impaired auditory processing (AP) despite normal pure-tone thresholds is common after stroke, and it leads to isolation, reduced quality of life and physical decline. There are currently no proven remedial interventions for AP deficits in stroke patients. This is the first study to investigate the benefits of personal frequency-modulated (FM) systems in stroke patients with disordered AP. Methods: Fifty stroke patients had baseline audiological assessments, AP tests and completed the (modified) Amsterdam Inventory for Auditory Disability and Hearing Handicap Inventory for Elderly questionnaires. Nine out of these 50 patients were diagnosed with disordered AP based on severe deficits in understanding speech in background noise but with normal pure-tone thresholds. These nine patients underwent spatial speech-in-noise testing in a sound-attenuating chamber (the “crescent of sound”) with and without FM systems. Results: The signal-to-noise ratio (SNR) for 50% correct speech recognition performance was measured with speech presented from 0° azimuth and competing babble from ±90° azimuth. Spatial release from masking (SRM) was defined as the difference between SNRs measured with co-located speech and babble and SNRs measured with spatially separated speech and babble. The SRM significantly improved when babble was spatially separated from target speech, while the patients had the FM systems in their ears compared to without the FM systems. Conclusions: Personal FM systems may substantially improve speech-in-noise deficits in stroke patients who are not eligible for conventional hearing aids. FMs are feasible in stroke patients and show promise to address impaired AP after stroke.Implications for RehabilitationThis is the first study to investigate the benefits of personal frequency-modulated (FM) systems in stroke patients with disordered AP.All cases significantly improved speech perception in noise with the FM systems, when noise was spatially separated from the speech signal by 90° compared with unaided listening.Personal FM systems are feasible in stroke patients, and may be of benefit in just under 20% of this population, who are not eligible for conventional hearing aids.

Heritability of non-speech auditory processing skills.

Recent insight into the genetic bases for autism spectrum disorder, dyslexia, stuttering, and language disorders suggest that neurogenetic approaches may also reveal at least one etiology of auditory processing disorder (APD). A person with an APD typically has difficulty understanding speech in background noise despite having normal pure-tone hearing sensitivity. The estimated prevalence of APD may be as high as 10% in the pediatric population, yet the causes are unknown and have not been explored by molecular or genetic approaches. The aim of our study was to determine the heritability of frequency and temporal resolution for auditory signals and speech recognition in noise in 96 identical or fraternal twin pairs, aged 6-11 years. Measures of auditory processing (AP) of non-speech sounds included backward masking (temporal resolution), notched noise masking (spectral resolution), pure-tone frequency discrimination (temporal fine structure sensitivity), and nonsense syllable recognition in noise. We provide evidence of significant heritability, ranging from 0.32 to 0.74, for individual measures of these non-speech-based AP skills that are crucial for understanding spoken language. Identification of specific heritable AP traits such as these serve as a basis to pursue the genetic underpinnings of APD by identifying genetic variants associated with common AP disorders in children and adults.

Speech Perception Ability in Noise is Correlated with Auditory Brainstem Response Wave I Amplitude.

Difficulty understanding speech in background noise is a common complaint of individuals with sensorineural hearing loss. Recent animal studies suggest this difficulty may be due, in part, to spiral ganglion cell degeneration related to aging or noise exposure. Although auditory brainstem response (ABR) thresholds and standard clinical audiometric tests are minimally affected by neuronal degeneration, the amplitude of wave I of the ABR is correlated to spiral ganglion cell density. This study hypothesized that wave I amplitude was correlated to speech-in-noise performance. To test this, the relationships between wave I amplitude, age, and speech perception ability were analyzed in human participants. This is a correlational study. A total of 101 ears from 57 adults ranging in age from 19 to 90 yr with a pure-tone average of 45 dB HL or better were examined in this study. Only individuals with no history of neurological disease and ears without any evidence of conductive involvement were included. Speech perception was measured in quiet using NU-6 word lists and in background noise using the QuickSIN. Ear canal electrodes were used to obtain ABR waveforms from each ear and the amplitude of wave I was measured as the absolute difference in voltage between the peak of the wave and the following trough. Speech perception performance in quiet and in background noise were both modeled using a linear mixed model with the covariates age, four-frequency pure-tone average (4fPTA), wave I amplitude, and the interaction between 4fPTA and wave I amplitude. ABR wave I amplitudes were modeled using a linear mixed model with age and 4fPTA as the covariates. The correlation between the right and left ears of the same participant were modeled using random effects. The results indicate that reduced ABR wave I amplitudes are (1) related to increased age, (2) associated with decreased speech-in-noise performance, with the greatest effects in individuals with poorer pure-tone thresholds, and (3) not correlated to speech perception in quiet. Reduced ABR wave I amplitude, an indicator of cochlear neuronal degeneration, is associated with decreased speech perception ability in noise, with a more pronounced effect in ears with poorer pure-tone thresholds, but does not appear to contribute to decreased speech perception in quiet.

Hearing aid and hearing assistance technology use in Aotearoa/New Zealand

Objective: The purpose of this study was to describe factors that are related to hearing aid and hearing assistance technology ownership and use in Aotearoa/New Zealand. Design: Adults with hearing impairment living in New Zealand were surveyed regarding health-related quality of life and device usage. Audiometric data (hearing sensitivity and speech in noise) were collected. Study sample: Data were obtained from 123 adults with hearing impairment: 73 reported current hearing-aid use, 81 reported current hearing assistance technology use. Results: In both analyses, device users had more difficulty understanding speech in background noise, had poor hearing in both their better and worse hearing ears, and perceived more consequences of hearing impairment in their everyday lives (both emotionally and socially) than non-hearing-aid users. Discriminant analyses showed that the social consequences of hearing impairment and the better ear hearing best classified hearing aid users from non-users but social consequences and worse ear hearing best classified hearing assistance technology users from non-users. Conclusions: Quality of life measurements and speech-in-noise assessments provide useful clinical information. Hearing-impaired adults in New Zealand who use hearing aids also tend to use hearing assistance technology, which has important clinical implications.

Bigger is Not Better

Figure: A: For the envelope-dominated lower frequencies, older adults with hearing loss have larger amplitudes than older adults with normal hearing. B: These differences are not seen in the temporal fine structure (TFS)-dominated high frequencies. C: There is a greater ratio of envelope to temporal fine structure in older adults with hearing loss. (Adapted from J Acoust Soc Am 2013;133[5]:3030-3038 http://scitation.aip.org/content/asa/journal/jasa/133/5/10.1121/1.4799804.)Older adults who wear hearing aids frequently report that speech is too loud, yet they have difficulty with the clarity of the message.Figure: Nina Kraus, PhDWith new hearing aid wearers, we often use the analogy of coming out of a theater in the middle of the day and being momentarily blinded by the brightness of the sun. As we know, however, the retinal adjustment to increased light occurs quickly, while adjustment to amplified sound is a longer process.Figure: Samira Anderson, AuD, PhDPart of this difficulty is rooted in the well-known phenomenon of recruitment. However, changes in speech representation in the central auditory system also play a role. SWAMPING OUT THE TFS Recruitment effects can be seen in the auditory brainstem response (ABR) to clicks. In an individual with sensorineural hearing loss, brainstem latencies are delayed at low intensities but drop to normal latencies at higher intensities. The effects of hearing loss on auditory processing of a speech syllable were recently evaluated using the cABR—the ABR to complex sounds (J Acoust Soc Am 2013;133[5]:3030-3038http://scitation.aip.org/content/asa/journal/jasa/133/5/10.1121/1.4799804). Brainstem responses were recorded to a 40-ms speech syllable /da/ in quiet and in noise in two groups of older adults. One group had clinically normal hearing and the other had mild to moderate sensorineural hearing loss and had never worn hearing aids. The group with hearing loss had higher representation of the low frequencies that comprise the speech envelope. In response to the temporal fine structure (TFS), there was no difference in frequency representation between the groups. Overall, in the group with hearing loss, there was a greater ratio of envelope to temporal fine structure than there was in the group with normal hearing, suggesting that the augmented response to the speech envelope swamps out the temporal fine structure, leading to a deficit in fine structure coding. ROLE OF TRAINING AND AMPLIFICATION These results are in line with the work of Sushrut Kale and Michael G. Heinz, who found greater coding of the envelope in auditory nerve fibers of chinchillas who had noise-induced hearing loss (J Assoc Res Otolaryngol 2010;11[4]:657-673http://link.springer.com/article/10.1007/s10162-010-0223-6). When the stimuli were presented in quiet, Kale and Heinz did not find any differences in temporal fine structure coding. However, when the stimuli were presented in noise during a later study, chinchillas with hearing loss had a deficit in temporal coding compared with normal-hearing chinchillas (Nat Neurosci 2012;15[10]:1362-1364http://www.nature.com/neuro/journal/v15/n10/full/nn.3216.html). Work with cochlear implants has taught us that access to the speech envelope is adequate for hearing in quiet situations, but temporal fine structure cues may be important for hearing in background noise (Science 1995;270[5234]:303-304http://www.sciencemag.org/content/270/5234/303). Therefore, a relative deficit in fine structure coding in individuals who wear hearing aids may account for difficulty understanding speech in background noise. Work is under way to examine the effects of training and amplification on the balance of envelope and temporal fine structure representation of the speech signal. This work was supported by the National Institutes of Health (grants T32 DC009399-01A10 and RO1 DC10016) and the Knowles Hearing Center. HJ Return to www.thehearingjournal.com

Psychophysiological indices of effortful listening in younger and older adults

Older adults often have difficulty understanding speech in background noise, and this difficulty may be associated with cognitive processing demand. According to the effortfulness hypothesis, even sub-clinical age-related changes in hearing may increase cognitive demand for speech understanding, making listening in noise more effortful for older adults even when recognition performance is comparable to that of younger listeners. Separating speech from background noise requires both segregating target from masking signals and selectively attending to the target while ignoring maskers. While both segregation and selection may demand cognitive resources, it is not known whether both mechanisms interact with age to the same degree. To address this question, younger and older adults listened to and repeated sentences presented in quiet and under conditions that put relatively more emphasis on segregation (energetic masking using speech-shaped broad-band noise) or selection (informational masking using two-talker babble) or are cognitively demanding without masking (synthetic speech). Masked stimuli were equally intelligible based on prior research, so differences in listening effort may be attributed to age and/or masker type. Listening effort was measured behaviorally via traditional rating scales (NASA TLX), and psychophysiologically in terms of autonomic nervous system responses (heart rate, pulse period, and amplitude, and skin conductance).

The Effects of Hearing Impairment and Aging on Spatial Processing

Difficulty in understanding speech in background noise is frequently reported by hearing-impaired people despite well-fitted amplification. Understanding speech in the presence of background noise involves segregating the various auditory stimuli into distinct streams using cues such as pitch characteristics, spatial location of speakers, and contextual information. One possible cause of listening difficulties in noise is reduced spatial-processing ability. Previous attempts to investigate spatial processing in hearing-impaired people have often been confounded by inadequate stimulus audibility. The present research aimed to investigate the effects of hearing impairment and aging on spatial-processing ability. The effect of cognitive ability on spatial processing was also explored. In addition, the relationship between spatial-processing ability and self-report measures of listening difficulty was examined to investigate how much effect spatial-processing ability has in real-world situations. Eighty participants aged between 7 and 89 years took part in the study. Participants' hearing thresholds ranged from within normal limits to a moderately severe sensorineural hearing loss. All participants had English as their first language and no reported learning disabilities. The study sample included both hearing aid users and non-hearing aid users. Spatial-processing ability was assessed with a modified version of the Listening in Spatialized Noise-Sentences test (LiSN-S). The LiSN-S was modified to incorporate a prescribed gain amplifier that amplified the target and distracting stimulus according to the National Acoustic Laboratories-Revised Profound (NAL-RP) prescription. In addition, participants aged 18 years and above completed the Neurobehavioral Cognitive Status examination and the Speech, Spatial and Qualities questionnaire. Participants aged under 18 years completed the Listening Inventory for Education questionnaire. Spatial-processing ability, as measured by the spatial advantage measure of the LiSN-S, was negatively affected by hearing impairment. Aging was not significantly correlated with spatial-processing ability. No significant relationship was found between cognitive ability and spatial processing. Self-reported listening difficulty in children, as measured with the Listening Inventory for Education, and spatial-processing ability were not correlated. Self-reported listening difficulty in adults, as measured by the Speech, Spatial and Qualities questionnaire, was significantly correlated with spatial-processing ability. All hearing-impaired people will have a spatial processing deficit of some degree. This should be given due consideration when counseling patients in regard to realistic expectations of how they will perform in background noise. Further research is required into potential remediation for spatial-processing deficits and the cause of these deficits.

Noise reduction for auditory prostheses based on harmonic detection

Difficulty in understanding speech in background noise is one of the most common complaints of hearing-aid and cochlear-implant users. Various noise-reduction and spectral-enhancement algorithms have been designed and tested over the years, often with limited success in terms of improving speech intelligibility. A commonly used method involves spectral subtraction, which is based on the assumption that the noise spectrum can be estimated and the clean speech signal can be extracted by subtracting the noise spectrum from the noisy speech signal. However, recent studies have shown that such methods often result in poorer signal-to-noise ratios in the modulation-spectrum domain, which may explain why little benefit in speech intelligibility has been found. Also, identifying noise in terms of its stationarity runs the risk of misidentification in more stationary signals, such as music. Here a noise reduction algorithm based on harmonic detection and enhancement was explored. Simulation results showed that this algorithm could help suppress noise in both speech and music. Results from perceptual tests will be reported. [Supported in part by Advanced Bionics.]

A neural basis of speech-in-noise perception in older adults.

We investigated a neural basis of speech-in-noise perception in older adults. Hearing loss, the third most common chronic condition in older adults, is most often manifested by difficulty understanding speech in background noise. This trouble with understanding speech in noise, which occurs even in individuals who have normal-hearing thresholds, may arise, in part, from age-related declines in central auditory processing of the temporal and spectral components of speech. We hypothesized that older adults with poorer speech-in-noise (SIN) perception demonstrate impairments in the subcortical representation of speech. In all participants (28 adults, age 60-73 yr), average hearing thresholds calculated from 500 to 4000 Hz were ≤ 25 dB HL. The participants were evaluated behaviorally with the Hearing in Noise Test (HINT) and neurophysiologically using speech-evoked auditory brainstem responses recorded in quiet and in background noise. The participants were divided based on their HINT scores into top and bottom performing groups that were matched for audiometric thresholds and intelligent quotient. We compared brainstem responses in the two groups, specifically, the average spectral magnitudes of the neural response and the degree to which background noise affected response morphology. In the quiet condition, the bottom SIN group had reduced neural representation of the fundamental frequency of the speech stimulus and an overall reduction in response magnitude. In the noise condition, the bottom SIN group demonstrated greater disruption in noise, reflecting reduction in neural synchrony. The role of brainstem timing is particularly evident in the strong relationship between SIN perception and quiet-to-noise response correlations. All physiologic measures correlated with SIN perception. Adults in the bottom SIN group differed from the audiometrically matched top SIN group in how speech was neurally encoded. The strength of subcortical encoding of the fundamental frequency appears to be a factor in successful speech-in-noise perception in older adults. Given the limitations of amplification, our results suggest the need for inclusion of auditory training to strengthen central auditory processing in older adults with SIN perception difficulties.

Problems Hearing in Noise in Older Adults

Difficulty understanding speech in background noise, even with amplification to restore audibility, is a common problem for hearing-impaired individuals and is especially frequent in older adults. Despite the debilitating nature of the problem the cause is not yet completely clear. This review considers the role of spatial processing ability in understanding speech in noise, highlights the potential impact of disordered spatial processing, and attempts to establish if aging leads to reduced spatial processing ability. Evidence supporting and opposing the hypothesis that spatial processing is disordered among the aging population is presented. With a few notable exceptions, spatial processing ability was shown to be reduced in an older population in comparison to young adults, leading to poorer speech understanding in noise. However, it is argued that to conclude aging negatively effects spatial processing ability may be oversimplified or even premature given potentially confounding factors such as cognitive ability and hearing impairment. Further research is required to determine the effect of aging and hearing impairment on spatial processing and to investigate possible remediation options for spatial processing disorder.

Reflections on 40 Years of Amplification

Reflections on 40 Years of Amplification

Maximizing cochlear implant patients’ performance with advanced speech training procedures

Advances in implant technology and speech processing have provided great benefit to many cochlear implant patients. However, some patients receive little benefit from the latest technology, even after many years’ experience with the device. Moreover, even the best cochlear implant performers have great difficulty understanding speech in background noise, and music perception and appreciation remain major challenges. Recent studies have shown that targeted auditory training can significantly improve cochlear implant patients’ speech recognition performance. Such benefits are not only observed in poorly performing patients, but also in good performers under difficult listening conditions (e.g., speech noise, telephone speech, music, etc.). Targeted auditory training has also been shown to enhance performance gains provided by new implant devices and/or speech processing strategies. These studies suggest that cochlear implantation alone may not fully meet the needs of many patients, and that additional auditory rehabilitation may be needed to maximize the benefits of the implant device. Continuing research will aid in the development of efficient and effective training protocols and materials, thereby minimizing the costs (in terms of time, effort and resources) associated with auditory rehabilitation while maximizing the benefits of cochlear implantation for all recipients.