Categorization of everyday sounds by cochlear implanted children

Language and executive function in Mandarin-speaking deaf and hard-of-hearing children aged 3-5

The study aimed to explore spoken language and executive function (EF) characteristics in 3-5-year-old prelingually deaf and hard-of-hearing (DHH) children, and evaluate the impact of demographic variables and EF on spoken language skills. 48 DHH children and 48 typically developing children who use auditory-oral communication were recruited. All participants underwent EF tests, including auditory working memory (WM), inhibitory control, cognitive flexibility, and the EF performance reported by parents. Using Mandarin Clinical Evaluation of Language for Preschoolers (MCELP), vocabulary comprehension, sentence comprehension, vocabulary naming, sentence structure imitation, and story narration were evaluated only in the DHH group, and their results were compared with the typical developmental level provided by MCELP. Results showed that DHH children exhibit deficiencies in different spoken language domains and EF components. While the spoken language skills of DHH children tend to improve as they age, a growing proportion of individuals fail to reach the typical developmental level. The spoken language ability in DHH children was positively correlated with age and EFs, and negatively correlated with aided hearing threshold, while auditory WM could positively predict their spoken language performance.

Auditory sequence learning with degraded input: children with cochlear implants ('nature effect') compared to children from low and high socio-economic backgrounds ('nurture effect')

Implicit sequence learning (SL) is crucial for language acquisition and has been studied in children with organic language deficits (e.g., specific language impairment). However, language delays are also seen in children with non-organic deficits, such as those with hearing loss or from low socioeconomic status (SES). While some children with cochlear implants (CI) develop strong language skills, variability in performance suggests that degraded auditory input (nature) may affect SL. Low SES children typically experience language delays due to environmental deprivation (nurture). The purpose of this study was to investigate nature versus nurture effects on auditory SL. A total of 100 participants were divided into normal hearing (NH) children, young adults, CI children from high-moderate SES, and NH children from low SES who were tested with two Serial Reaction Time (SRT) tasks with speech and environmental sounds, and with cognitive tests. Results showed SL for speech and nonspeech stimuli for all participants, suggesting that SL is resilient to degradation of auditory and language input and that SL is not specific to speech. Absolute reaction time (RT) (reflecting a combination of complex processes including SL) was found to be a sensitive measure for differentiating between groups and between types of stimuli. Specifically, normal hearing groups showed longer RT for speech compared to environmental stimuli, a prolongation that was not evident for the CI group, suggesting similar perceptual strategies applying for both sound types; and RT of Low SES children was the longest for speech stimuli compared to other groups of children, evidence of the negative impact of language deprivation on speech processing. Age was the largest contributing factor to the results (~ 50%) followed by cognitive abilities (~ 10%). Implications for intervention include speech-processing targeted programs, provided early in the critical periods of development for low SES children.

Identification Accuracy of Safety-Relevant Environmental Sounds in Adult Cochlear Implant Users

OBJECTIVE

Examine cochlear implant (CI) users' ability to identify safety-relevant environmental sounds, imperative for safety, independence, and personal well-being.

METHODS

Twenty-one experienced adult CI users completed an Environmental Sound Identification (ESI) test consisting of 42 common environmental sounds, 28 of which were relevant to personal safety, along with 14 control sounds. Prior to sound identification, participants were shown sound names and asked to rate the familiarity and, separately, relevance to safety of each corresponding sound on a 1-5 scale.

RESULTS

Overall ESI accuracy was 57% correct for the safety-relevant sounds and 55% correct for control sounds. Participants rated safety-relevant sounds as more important to safety and more familiar than the non-safety sounds. ESI accuracy significantly correlated with familiarity ratings.

CONCLUSION

The present findings suggest mediocre ESI accuracy in postlingual adult CI users for safety-relevant and other environmental sounds. Deficits in the identification of these sounds may put CI listeners at increased risk of accidents or injuries and may require a specific rehabilitation program to improve CI outcomes.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:2388-2393, 2023.

Recognizing Voices Through a Cochlear Implant: A Systematic Review of Voice Perception, Talker Discrimination, and Talker Identification

OBJECTIVE

Some cochlear implant (CI) users report having difficulty accessing indexical information in the speech signal, presumably due to limitations in the transmission of fine spectrotemporal cues. The purpose of this review article was to systematically review and evaluate the existing research on talker processing in CI users. Specifically, we reviewed the performance of CI users in three types of talker- and voice-related tasks. We also examined the different factors (such as participant, hearing, and device characteristics) that might influence performance in these specific tasks.

DESIGN

We completed a systematic search of the literature with select key words using citation aggregation software to search Google Scholar. We included primary reports that tested (a) talker discrimination, (b) voice perception, and (c) talker identification. Each report must have had at least one group of participants with CIs. Each included study was also evaluated for quality of evidence.

RESULTS

The searches resulted in 1,561 references, which were first screened for inclusion and then evaluated in full. Forty-three studies examining talker discrimination, voice perception, and talker identification were included in the final review. Most studies were focused on postlingually deafened and implanted adult CI users, with fewer studies focused on prelingual implant users. In general, CI users performed above chance in these tasks. When there was a difference between groups, CI users performed less accurately than their normal-hearing (NH) peers. A subset of CI users reached the same level of performance as NH participants exposed to noise-vocoded stimuli. Some studies found that CI users and NH participants relied on different cues for talker perception. Within groups of CI users, there is moderate evidence for a bimodal benefit for talker processing, and there are mixed findings about the effects of hearing experience.

CONCLUSIONS

The current review highlights the challenges faced by CI users in tracking and recognizing voices and how they adapt to it. Although large variability exists, there is evidence that CI users can process indexical information from speech, though with less accuracy than their NH peers. Recent work has described some of the factors that might ease the challenges of talker processing in CI users. We conclude by suggesting some future avenues of research to optimize real-world speech outcomes.

Perception of Environmental Sounds in Cochlear Implant Users: A Systematic Review

Objectives: Improved perception of environmental sounds (PES) is one of the primary benefits of cochlear implantation (CI). However, past research contains mixed findings on PES ability in contemporary CI users, which at times contrast with anecdotal clinical reports. The present review examined extant PES research to provide an evidence basis for clinical counseling, identify knowledge gaps, and suggest directions for future work in this area of CI outcome assessment.

Methods: Six electronic databases were searched using medical subject headings (MeSH) and keywords broadly identified to reference CI and environmental sounds. Records published between 2000 and 2021 were screened by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement to identify studies that met the inclusion criteria. Data were subsequently extracted and evaluated according to synthesis without-meta-analysis (SWiM) guidelines.

Results: Nineteen studies met the inclusion criteria. Most examined PES in post-lingually implanted adults, with one study focused on pre/perilingual adults. Environmental sound identification (ESI) in quiet using open- or closed-set response format was most commonly used in PES assessment, included in all selected studies. ESI accuracy in CI children (3 studies) and adults (16 studies), was highly variable but generally mediocre (means range: 31–87%). Only two studies evaluated ESI performance prospectively before and after CI, while most studies were cross-sectional. Overall, CI performance was consistently lower than that of normal-hearing peers. No significant differences in identification accuracy were reported between CI candidates and CI users. Environmental sound identification correlated in CI users with measures of speech perception, music and spectro-temporal processing.

Conclusion: The findings of this systematic review indicate considerable limitations in the current knowledge of PES in contemporary CI users, especially in pre/perilingual late-implanted adults and children. Although no overall improvement in PES following implantation was found, large individual variability and existing methodological limitations in PES assessment may potentially obscure potential CI benefits for PES. Further research in this ecologically relevant area of assessment is needed to establish a stronger evidence basis, identify CI users with significant deficits, and improve CI users' safety and satisfaction through targeted PES rehabilitation.