Mandarin speech perception in combined electric and acoustic stimulation

Meta-analysis on lexical tone recognition in cochlear implant users

OBJECTIVE

Lexical tone plays a vital role in speech communication in tonal languages. This study investigated lexical tone recognition in cochlear implant (CI) users, and identified potential factors that influence lexical tone recognition in the CI population.

DESIGN

We conducted a systematic search across eleven major databases, evaluated the risk of bias in the included studies, and conducted five meta-analyses.

STUDY SAMPLE

Forty studies that utilised a multi-item alternative forced-choice paradigm were included to evaluate the performance of lexical tone recognition in CI users.

RESULTS

CI users performed worse at recognising lexical tones than normal hearing (NH) controls. Furthermore, bimodal stimulation could benefit lexical tone recognition for CI users in both quiet and noisy conditions. Besides, the pooled results showed a negative correlation between tone recognition accuracy and age at implantation, as well as a positive correlation between tone recognition performance and the duration of CI experience.

CONCLUSIONS

This study indicates that CI users could not recognise lexical tones at the same level as the NH population. The bimodal intervention does have a more positive effect than unimodal implantation regardless of the listening environment. Moreover, earlier implantation and longer experience with the CI could facilitate lexical tone recognition.

Importance of ipsilateral residual hearing for spatial hearing by bimodal cochlear implant users

Bimodal cochlear implant (CI) listeners have difficulty utilizing spatial cues to segregate competing speech, possibly due to tonotopic mismatch between the acoustic input frequency and electrode place of stimulation. The present study investigated the effects of tonotopic mismatch in the context of residual acoustic hearing in the non-CI ear or residual hearing in both ears. Speech recognition thresholds (SRTs) were measured with two co-located or spatially separated speech maskers in normal-hearing adults listening to acoustic simulations of CIs; low frequency acoustic information was available in the non-CI ear (bimodal listening) or in both ears. Bimodal SRTs were significantly better with tonotopically matched than mismatched electric hearing for both co-located and spatially separated speech maskers. When there was no tonotopic mismatch, residual acoustic hearing in both ears provided a significant benefit when maskers were spatially separated, but not when co-located. The simulation data suggest that hearing preservation in the implanted ear for bimodal CI listeners may significantly benefit utilization of spatial cues to segregate competing speech, especially when the residual acoustic hearing is comparable across two ears. Also, the benefits of bilateral residual acoustic hearing may be best ascertained for spatially separated maskers.

Differential weighting of temporal envelope cues from the low-frequency region for Mandarin sentence recognition in noise

BACKGROUND

Temporal envelope cues are conveyed by cochlear implants (CIs) to hearing loss patients to restore hearing. Although CIs could enable users to communicate in clear listening environments, noisy environments still pose a problem. To improve speech-processing strategies used in Chinese CIs, we explored the relative contributions made by the temporal envelope in various frequency regions, as relevant to Mandarin sentence recognition in noise.

METHODS

Original speech material from the Mandarin version of the Hearing in Noise Test (MHINT) was mixed with speech-shaped noise (SSN), sinusoidally amplitude-modulated speech-shaped noise (SAM SSN), and sinusoidally amplitude-modulated (SAM) white noise (4 Hz) at a + 5 dB signal-to-noise ratio, respectively. Envelope information of the noise-corrupted speech material was extracted from 30 contiguous bands that were allocated to five frequency regions. The intelligibility of the noise-corrupted speech material (temporal cues from one or two regions were removed) was measured to estimate the relative weights of temporal envelope cues from the five frequency regions.

RESULTS

In SSN, the mean weights of Regions 1-5 were 0.34, 0.19, 0.20, 0.16, and 0.11, respectively; in SAM SSN, the mean weights of Regions 1-5 were 0.34, 0.17, 0.24, 0.14, and 0.11, respectively; and in SAM white noise, the mean weights of Regions 1-5 were 0.46, 0.24, 0.22, 0.06, and 0.02, respectively.

CONCLUSIONS

The results suggest that the temporal envelope in the low-frequency region transmits the greatest amount of information in terms of Mandarin sentence recognition for three types of noise, which differed from the perception strategy employed in clear listening environments.

Acoustic analysis of tone production in Mandarin-speaking bimodal cochlear implant users

The benefit of using a hearing aid with a cochlear implant (bimodal hearing) has been demonstrated for tone perception under certain conditions. The present study evaluated bimodal effects for tone production by comparing performance between a bimodal and a unimodal implant group. Results showed that acoustic differentiation of tones produced by the bimodal group was better than the unimodal implant group, and performance was dependent on the subject's acoustic thresholds but not related to implant experience or age at implantation. The findings support the use of amplified acoustic hearing in conjunction with the implant for better development of pitch production.

Pitch Accuracy of Vocal Singing in Deaf Children With Bimodal Hearing and Bilateral Cochlear Implants

OBJECTIVES

The purpose of the present study was to investigate the pitch accuracy of vocal singing in children with severe to profound hearing loss who use bilateral cochlear implants (CIs) or bimodal devices [CI at one ear and hearing aid (HA) at the other] in comparison to similarly-aged children with normal-hearing (NH).

DESIGN

The participants included four groups: (1) 26 children with NH, (2) 13 children with bimodal devices, (3) 31 children with bilateral CIs that were implanted sequentially, and (4) 10 children with bilateral CIs that were implanted simultaneously. All participants were aged between 7 and 11 years old. Each participant was recorded singing a self-chosen song that was familiar to him or her. The fundamental frequencies (F0) of individual sung notes were extracted and normalized to facilitate cross-subject comparisons. Pitch accuracy was quantified using four pitch-based metrics calculated with reference to the target music notes: mean note deviation, contour direction, mean interval deviation, and F0 variance ratio. A one-way ANOVA was used to compare listener-group difference on each pitch metric. A principal component analysis showed that the mean note deviation best accounted for pitch accuracy in vocal singing. A regression analysis examined potential predictors of CI children's singing proficiency using mean note deviation as the dependent variable and demographic and audiological factors as independent variables.

RESULTS

The results revealed significantly poorer performance on all four pitch-based metrics in the three groups of children with CIs in comparison to children with NH. No significant differences were found among the three CI groups. Among the children with CIs, variability in the vocal singing proficiency was large. Within the group of 13 bimodal users, the mean note deviation was significantly correlated with their unaided pure-tone average thresholds (r = 0.582, p = 0.037). The regression analysis for all children with CIs, however, revealed no significant demographic or audiological predictor for their vocal singing performance.

CONCLUSION

Vocal singing performance in children with bilateral CIs or bimodal devices is not significantly different from each other on a group level. Compared to children with NH, the pediatric bimodal and bilateral CI users, in general, demonstrated significant deficits in vocal singing ability. Demographic and audiological factors, known from previous studies to be associated with good speech and language development in prelingually-deafened children with CIs, were not associated with singing accuracy for these children.

Categorical perception of lexical tones based on acoustic-electric stimulation

The effect of low-frequency acoustic input on the categorical perception of lexical tones was investigated with simulated electric-acoustic hearing. A synthesized T1-T2 (flat-rising) tone continuum of Mandarin monosyllables /i/ was used, and they were manipulated as five conditions: unprocessed, low-frequency acoustic-only, electric-only, electric-acoustic stimulation, and bimodal stimulation. Results showed the performance under electric-only condition was the significantly lowest, and the difference of other pairwise comparisons between conditions was quite small. These findings suggest that the low-frequency acoustic input can shape the categorical perception, and the combinations of acoustic and electric hearing within or across ears have no significant effect.

Bimodal benefits in Mandarin-speaking cochlear implant users for music perception and tone recognition

BACKGROUND

Cochlear implant (CI) users have difficulty appreciating music and perceiving lexical tones in Mandarin Chinese. Wearing a hearing aid (HA) in the contralateral ear for bimodal hearing may provide additional benefits.

OBJECTIVES

To measure the bimodal benefits of music perception and tone recognition and to investigate the relationship between the two in Mandarin-speaking bimodal CI subjects.

MATERIALS AND METHODS

Sixteen Mandarin-speaking bimodal CI subjects (aged between 16 and 49 years) participated in the study. Music perception (pitch discrimination, melody discrimination and instrument identification) and lexical tone recognition were tested with electric stimulation (CI alone) or bimodal stimulation (CI + HA).

RESULTS

Subjects showed a significant bimodal benefit in tone recognition in quiet and noise, and in all music perception tests. The bimodal benefit for tone recognition in noise was significantly correlated with that of pitch discrimination thresholds and instrument identification scores.

CONCLUSION

Mandarin-speaking bimodal CI users achieved better music perception and tone recognition ability with CI + HA than with CI alone. The bimodal benefit of tone recognition was significantly correlated with that of music perception.

Bimodal Benefits Revealed by Categorical Perception of Lexical Tones in Mandarin-Speaking Kindergarteners With a Cochlear Implant and a Contralateral Hearing Aid

Purpose Pitch reception poses challenges for individuals with cochlear implants (CIs), and adding a hearing aid (HA) in the nonimplanted ear is potentially beneficial. The current study used fine-scale synthetic speech stimuli to investigate the bimodal benefit for lexical tone categorization in Mandarin-speaking kindergarteners using a CI and an HA in opposite ears. Method The data were collected from 16 participants who were required to complete two classical tasks for speech categorical perception (CP) with CI + HA device condition and CI alone condition. Linear mixed-effects models were constructed to evaluate the identification and discrimination scores across different device conditions. Results The bimodal kindergarteners showed CP for the continuum varying from Mandarin Tone 1 and Tone 2. Moreover, the additional acoustic information from the contralateral HA contributes to improved lexical tone categorization, with a steeper slope, a higher discrimination score of between-category stimuli pair, and an improved peakedness score (i.e., an increased benefit magnitude for discriminations of between-category over within-category pairs) for the CI + HA condition than the CI alone condition. The bimodal kindergarteners with better residual hearing thresholds at 250 Hz level in the nonimplanted ear could perceive lexical tones more categorically. Conclusion The enhanced CP results with bimodal listening provide clear evidence for the clinical practice to fit a contralateral HA in the nonimplanted ear in kindergarteners with unilateral CIs with direct benefits from the low-frequency acoustic hearing.

Effects of nonlinear frequency compression on Mandarin speech and sound-quality perception in hearing-aid users

Objective: The purpose of the present study was to examine the effects of NLFC fitting in hearing aids and auditory acclimatisation on speech perception and sound-quality rating in hearing-impaired, native Mandarin-speaking adult listeners.Design: Mandarin consonant, vowel and tone recognition were tested in quiet and sentence recognition in noise (speech-shaped noise at a +5 dB signal-to-noise ratio) with NLFC-on and NLFC-off. Sound-quality ratings were collected on a 0-10 scale at each test session. A generalised linear model and correlational analyses were performed.Study sample: Thirty native Mandarin-speaking adults with moderate-to-severe sensorineural hearing loss were recruited.Results: The hearing-impaired listeners showed significantly higher accuracy with NLFC-on than with NLFC-off for consonant and sentence recognition and the recognition performance improved with both NLFC-on and off as a function of increased length of use. The satisfaction score of sound-quality ratings for different types of sounds significantly increased with NLFC-on than with NLFC-off. The speech recognition results showed moderate to strong correlation with the unaided hearing thresholds.Conclusion: For native Mandarin-speaking listeners with hearing loss, the NLFC technology provided modest but significant improvement in Mandarin fricative and sentence recognition. Subjectively, the naturalness and overall preference of sound-quality satisfaction judgement also improved with NLFC.

Factors Affecting Bimodal Benefit in Pediatric Mandarin-Speaking Chinese Cochlear Implant Users

OBJECTIVES

While fundamental frequency (F0) cues are important to both lexical tone perception and multitalker segregation, F0 cues are poorly perceived by cochlear implant (CI) users. Adding low-frequency acoustic hearing via a hearing aid in the contralateral ear may improve CI users' F0 perception. For English-speaking CI users, contralateral acoustic hearing has been shown to improve perception of target speech in noise and in competing talkers. For tonal languages such as Mandarin Chinese, F0 information is lexically meaningful. Given competing F0 information from multiple talkers and lexical tones, contralateral acoustic hearing may be especially beneficial for Mandarin-speaking CI users' perception of competing speech.

DESIGN

Bimodal benefit (CI+hearing aid - CI-only) was evaluated in 11 pediatric Mandarin-speaking Chinese CI users. In experiment 1, speech recognition thresholds (SRTs) were adaptively measured using a modified coordinated response measure test; subjects were required to correctly identify 2 keywords from among 10 choices in each category. SRTs were measured with CI-only or bimodal listening in the presence of steady state noise (SSN) or competing speech with the same (M+M) or different voice gender (M+F). Unaided thresholds in the non-CI ear and demographic factors were compared with speech performance. In experiment 2, SRTs were adaptively measured in SSN for recognition of 5 keywords, a more difficult listening task than the 2-keyword recognition task in experiment 1.

RESULTS

In experiment 1, SRTs were significantly lower for SSN than for competing speech in both the CI-only and bimodal listening conditions. There was no significant difference between CI-only and bimodal listening for SSN and M+F (p > 0.05); SRTs were significantly lower for CI-only than for bimodal listening for M+M (p < 0.05), suggesting bimodal interference. Subjects were able to make use of voice gender differences for bimodal listening (p < 0.05) but not for CI-only listening (p > 0.05). Unaided thresholds in the non-CI ear were positively correlated with bimodal SRTs for M+M (p < 0.006) but not for SSN or M+F. No significant correlations were observed between any demographic variables and SRTs (p > 0.05 in all cases). In experiment 2, SRTs were significantly lower with two than with five keywords (p < 0.05). A significant bimodal benefit was observed only for the 5-keyword condition (p < 0.05).

CONCLUSIONS

With the CI alone, subjects experienced greater interference with competing speech than with SSN and were unable to use voice gender difference to segregate talkers. For the coordinated response measure task, subjects experienced no bimodal benefit and even bimodal interference when competing talkers were the same voice gender. A bimodal benefit in SSN was observed for the five-keyword condition but not for the two-keyword condition, suggesting that bimodal listening may be more beneficial as the difficulty of the listening task increased. The present data suggest that bimodal benefit may depend on the type of masker and/or the difficulty of the listening task.

Mandarin lexical tone recognition in bimodal cochlear implant users

Objective: To assess the recognition of lexical tones in Mandarin-speaking bimodal cochlear implant (CI) subjects.Design: Lexical tone recognition in quiet and noise (SNR= +5 dB) was measured with electric stimulation (CI alone) or bimodal stimulation (CI + hearing aid (HA)). The recognition and confusion rates of the four tones (T1, T2, T3 and T4) were analysed. Spearman correlation analysis was performed to examine the relationship between hearing levels in the contralateral ear and bimodal benefits.Study sample: Twenty native Mandarin-speaking bimodal CI users, with ages ranging from 16-49 years.Results: Relative to the CI alone, mean tone recognition with the CI + HA improved significantly from 84.1-92.1% correct in quiet (+8 points) and from 57.9-73.1% correct in noise (+15.2 points). Tone confusions between T2 and T3 were the most prominent in all test conditions, and T4 tended to be labelled as T3 in noise. There was no significant correlation between the bimodal benefits for tone recognition and the unaided or HA-aided pure-tone thresholds at 0.25 kHz.Conclusion: Listeners with CI + HA exhibited significantly better tone recognition than with CI alone. The bimodal advantage for tone recognition was greater in noise than in quiet, perhaps due to a ceiling effect in quiet.

Bimodal Benefits for Lexical Tone Recognition: An Investigation on Mandarin-speaking Preschoolers with a Cochlear Implant and a Contralateral Hearing Aid

Pitch perception is known to be difficult for individuals with cochlear implant (CI), and adding a hearing aid (HA) in the non-implanted ear is potentially beneficial. The current study aimed to investigate the bimodal benefit for lexical tone recognition in Mandarin-speaking preschoolers using a CI and an HA in opposite ears. The child participants were required to complete tone identification in quiet and in noise with CI + HA in comparison with CI alone. While the bimodal listeners showed confusion between Tone 2 and Tone 3 in recognition, the additional acoustic information from the contralateral HA alleviated confusion between these two tones in quiet. Moreover, significant improvement was demonstrated in the CI + HA condition over the CI alone condition in noise. The bimodal benefit for individual subjects could be predicted by the low-frequency hearing threshold of the non-implanted ear and the duration of bimodal use. The findings support the clinical practice to fit a contralateral HA in the non-implanted ear for the potential benefit in Mandarin tone recognition in CI children. The limitations call for further studies on auditory plasticity on an individual basis to gain insights on the contributing factors to the bimodal benefit or its absence.

Singing Proficiency of Members of a Choir Formed by Prelingually Deafened Children With Cochlear Implants

Purpose A group of 10 prelingually deafened children with cochlear implants (CIs) formed a choir and received 21 months of formal music training. The purpose of this study was to evaluate the singing proficiency of these children. Method The participants included all choir members (7 girls and 3 boys, mean age of 9.5 years old) who were unilateral CI users. Meanwhile, 8 age-matched children with normal hearing were recruited as controls and were trained on 1 song for 2 weeks. Individual singing samples without instrument accompaniment were recorded from all participants. The singing samples were subject to acoustic analysis in which the fundamental frequency (F0) of each note was extracted and the duration was measured. Five metrics were developed and computed to quantify the accuracy of their pitch and rhythm performance. The 5 metrics included (a) percent correct of F0 contour direction of adjacent notes, (b) mean deviation of the normalized F0 across the notes, (c) mean deviation of the pitch intervals, (d) mean deviation of adjacent note duration ratio, and (e) mean absolute deviation of note duration. Results The choir members with CIs demonstrated high accuracy in both pitch and tempo measures and performed on par with the children with normal hearing. Early start of music training after implantation and use of bimodal hearing contributed to the development of better music ability in these children with CIs. Conclusion These findings indicated that rigorous music training could facilitate high singing proficiency in prelingually deafened children with CIs.

Bilaterally Combined Electric and Acoustic Hearing in Mandarin-Speaking Listeners: The Population With Poor Residual Hearing

The hearing loss criterion for cochlear implant candidacy in mainland China is extremely stringent (bilateral severe to profound hearing loss), resulting in few patients with substantial residual hearing in the nonimplanted ear. The main objective of the current study was to examine the benefit of bimodal hearing in typical Mandarin-speaking implant users who have poorer residual hearing in the nonimplanted ear relative to those used in the English-speaking studies. Seventeen Mandarin-speaking bimodal users with pure-tone averages of ∼80 dB HL participated in the study. Sentence recognition in quiet and in noise as well as tone and word recognition in quiet were measured in monaural and bilateral conditions. There was no significant bimodal effect for word and sentence recognition in quiet. Small bimodal effects were observed for sentence recognition in noise (6%) and tone recognition (4%). The magnitude of both effects was correlated with unaided thresholds at frequencies near voice fundamental frequencies (F0s). A weak correlation between the bimodal effect for word recognition and unaided thresholds at frequencies higher than F0s was identified. These results were consistent with previous findings that showed more robust bimodal benefits for speech recognition tasks that require higher spectral resolution than speech recognition in quiet. The significant but small F0-related bimodal benefit was also consistent with the limited acoustic hearing in the nonimplanted ear of the current subject sample, who are representative of the bimodal users in mainland China. These results advocate for a more relaxed implant candidacy criterion to be used in mainland China.

An ERP Study on the Combined-stimulation Advantage in Vocoder Simulations

Electric hearing is presently the only treatment solution for patients with profound-to-severe hearing loss. For those patients also preserving low-frequency residual hearing on the ipsilateral ear, combined electric-and-acoustic stimulation (EAS) could notably improve their speech understanding abilities relative to those aided with electric-only (E-only) hearing. Early behavioral studies have consistently shown the advantage of combined stimulation. The aim of this work was to objectively examine the advantage of combined stimulation over electric-only hearing using an oddballparadigm based event-related potential (ERP) experiment. The vowel stimulus was processed by vocoding processes simulating the E-only and EAS conditions, and the generated stimuli were presented to normal-hearing listeners in the ERP experiment. Experiment results showed that the mismatch negativity (MMN) response elicited in the combined-stimulation condition featured a smaller peak amplitude and a more delayed peak latency than that in the E-only condition. The MMN results in this work demonstrated that compared with the ERP response elicited in the E-only condition, the response in the combinedstimulation condition was much closer to that elicited by the full-spectrum stimulus, yielding neurophysiological evidence on the combined-stimulation advantage.

Effects of fundamental frequency contour on understanding Mandarin sentences in bimodal hearing simulations

Fundamental frequency (F0) contour carries important information for understanding a tonal language. The present work assessed the effects of F0 contour on understanding Mandarin sentences in bimodal hearing simulations, including three conditions of acoustic-only, electric-only, and combined stimulations. Test stimuli were synthesized Mandarin sentences, each word with a normal, flat, or randomly assigned lexical tone, and presented to normal-hearing Mandarin-speaking listeners to recognize. Experimental results showed that changing F0 contour significantly affected the perception of Mandarin sentences under all conditions of acoustic-only, electric-only, and combined stimulations. The combined-stimulation advantage was only observed for test stimuli with the normal F0 contour.

The Benefits of Residual Hair Cell Function for Speech and Music Perception in Pediatric Bimodal Cochlear Implant Listeners

Objective

The aim of this study was to investigate the benefits of residual hair cell function for speech and music perception in bimodal pediatric Mandarin-speaking cochlear implant (CI) listeners.

Design

Speech and music performance was measured in 35 Mandarin-speaking pediatric CI users for unilateral (CI-only) and bimodal listening. Mandarin speech perception was measured for vowels, consonants, lexical tones, and sentences in quiet. Music perception was measured for melodic contour identification (MCI).

Results

Combined electric and acoustic hearing significantly improved MCI and Mandarin tone recognition performance, relative to CI-only performance. For MCI, performance was significantly better with bimodal listening for all semitone spacing conditions (p < 0.05 in all cases). For tone recognition, bimodal performance was significantly better only for tone 2 (rising; p < 0.05). There were no significant differences between CI-only and CI + HA for vowel, consonant, or sentence recognition.

Conclusions

The results suggest that combined electric and acoustic hearing can significantly improve perception of music and Mandarin tones in pediatric Mandarin-speaking CI patients. Music and lexical tone perception depends strongly on pitch perception, and the contralateral acoustic hearing coming from residual hair cell function provided pitch cues that are generally not well preserved in electric hearing.

Electro-tactile stimulation (ETS) enhances cochlear-implant Mandarin tone recognition

Objective

Electro-acoustic stimulation (EAS) is an effective method to enhance cochlear-implant performance in individuals who have residual low-frequency acoustic hearing. To help the majority of cochlear implant users who do not have any functional residual acoustic hearing, electro-tactile stimulation (ETS) may be used because tactile sensation has a frequency range and perceptual capabilities similar to that produced by acoustic stimulation in the EAS users.

Methods

Following up the first ETS study showing enhanced English sentence recognition in noise,¹ the present study evaluated the effect of ETS on Mandarin tone recognition in noise in two groups of adult Mandarin-speaking individuals. The first group included 11 normal-hearing individuals who listened to a 4-channel, noise-vocoded, cochlear-implant simulation. The second group included 1 unilateral cochlear-implant user and 2 bilateral users with each of their devices being tested independently. Both groups participated in a 4-alternative, forced-choice task, in which they had to identify a tone that was presented in noise at a 0-dB signal-to-noise ratio via electric stimulation (actual or simulated cochlear implants), tactile stimulation or the combined ETS.

Results

While electric or tactile stimulation alone produced similar tone recognition (∼40% correct), the ETS enhanced the cochlear-implant tone recognition by 17–18 percentage points. The size of the present ETS enhancement effect was similar to that of the previously reported EAS effect on Mandarin tone recognition. Psychophysical analysis on tactile sensation showed an important role of frequency discrimination in the ETS enhancement.

Conclusion

Tactile stimulation can potentially enhance Mandarin tone recognition in cochlear-implant users who do not have usable residual acoustic hearing. To optimize this potential, high fundamental frequencies need to be transposed to a 100–200 Hz range.

Integration of acoustic and electric hearing is better in the same ear than across ears

Advances in cochlear implant (CI) technology allow for acoustic and electric hearing to be combined within the same ear (electric-acoustic stimulation, or EAS) and/or across ears (bimodal listening). Integration efficiency (IE; the ratio between observed and predicted performance for acoustic-electric hearing) can be used to estimate how well acoustic and electric hearing are combined. The goal of this study was to evaluate factors that affect IE in EAS and bimodal listening. Vowel recognition was measured in normal-hearing subjects listening to simulations of unimodal, EAS, and bimodal listening. The input/output frequency range for acoustic hearing was 0.1–0.6 kHz. For CI simulations, the output frequency range was 1.2–8.0 kHz to simulate a shallow insertion depth and the input frequency range was varied to provide increasing amounts of speech information and tonotopic mismatch. Performance was best when acoustic and electric hearing was combined in the same ear. IE was significantly better for EAS than for bimodal listening; IE was sensitive to tonotopic mismatch for EAS, but not for bimodal listening. These simulation results suggest acoustic and electric hearing may be more effectively and efficiently combined within rather than across ears, and that tonotopic mismatch should be minimized to maximize the benefit of acoustic-electric hearing, especially for EAS.

Cantonese Tone Perception for Children Who Use a Hearing Aid and a Cochlear Implant in Opposite Ears

OBJECTIVES

The ability to recognize tones is vital for speech perception in tonal languages. Cantonese has six tones, which are differentiated almost exclusively by pitch cues (tones 1 to 6). The differences in pitch contours among the tones are subtle, making Cantonese a challenging language for cochlear implant users. The addition of a hearing aid has been shown to improve speech perception in nontonal languages and in Mandarin Chinese. This study (1) investigates the Cantonese tone perception ability of children who use a cochlear implant and a hearing aid in opposite ears; (2) evaluates the effect of varying pitch height and pitch contour cues on Cantonese tone perception for these children; and (3) compares the Cantonese tone perception ability for using a hearing aid and a cochlear implant together versus an implant alone.

DESIGN

Eight native Cantonese speaking children using a cochlear implant and a hearing aid in opposite ears were assessed for tone perception and word identification. The tone perception test involved discriminating and ranking tone pairs from natural and artificially manipulated Cantonese tones with various pitch heights and/or pitch contours. The word identification test involved identifying Cantonese words in a four-alternative forced-choice task. All tests were performed in two device conditions: (1) cochlear implant and hearing aid together and (2) implant alone.

RESULTS

Seven of the 8 subjects performed significantly above chance in both tests using the cochlear implant alone. Results showed that both pitch height and/or pitch direction were important perceptual cues for implant users. Perception for some tones was improved by increasing the pitch height differences between the tones. The ability to discriminate and rank the tone 2/tone 5 contrast and the tone 4/tone 6 contrast was poor, as the tones in these contrasts are similar in pitch contours and onset frequencies. No significant improvement was observed after artificially increasing the pitch offset differences between the tones in the tone 2/tone 5 and the tone 4/tone 6 contrasts. Tone perception results were significantly better with the addition of the hearing aid in the nonimplanted ear compared with using the implant alone; however, word identification results were not significantly different between using the implant alone and using both the hearing aid and the implant together. None of the subjects performed worse in tone perception or in word identification when the hearing aid was added.

CONCLUSIONS

Reduced ability to perceive pitch contour cues, even when artificially exaggerated, may explain some of the difficulties in Cantonese word recognition for implant users. The addition of a contralateral hearing aid could be beneficial for Cantonese tone perception for some individuals with a unilateral implant. The results encouraged Cantonese speakers to trial a hearing aid in the nonimplanted ear when using a cochlear implant.

Low-frequency fine-structure cues allow for the online use of lexical stress during spoken-word recognition in spectrally degraded speech

English listeners use suprasegmental cues to lexical stress during spoken-word recognition. Prosodic cues are, however, less salient in spectrally degraded speech, as provided by cochlear implants. The present study examined how spectral degradation with and without low-frequency fine-structure information affects normal-hearing listeners' ability to benefit from suprasegmental cues to lexical stress in online spoken-word recognition. To simulate electric hearing, an eight-channel vocoder spectrally degraded the stimuli while preserving temporal envelope information. Additional lowpass-filtered speech was presented to the opposite ear to simulate bimodal hearing. Using a visual world paradigm, listeners' eye fixations to four printed words (target, competitor, two distractors) were tracked, while hearing a word. The target and competitor overlapped segmentally in their first two syllables but mismatched suprasegmentally in their first syllables, as the initial syllable received primary stress in one word and secondary stress in the other (e.g., "'admiral," "'admi'ration"). In the vocoder-only condition, listeners were unable to use lexical stress to recognize targets before segmental information disambiguated them from competitors. With additional lowpass-filtered speech, however, listeners efficiently processed prosodic information to speed up online word recognition. Low-frequency fine-structure cues in simulated bimodal hearing allowed listeners to benefit from suprasegmental cues to lexical stress during word recognition.

Discriminability and Perceptual Saliency of Temporal and Spectral Cues for Final Fricative Consonant Voicing in Simulated Cochlear-Implant and Bimodal Hearing

Multiple redundant acoustic cues can contribute to the perception of a single phonemic contrast. This study investigated the effect of spectral degradation on the discriminability and perceptual saliency of acoustic cues for identification of word-final fricative voicing in "loss" versus "laws", and possible changes that occurred when low-frequency acoustic cues were restored. Three acoustic cues that contribute to the word-final /s/-/z/ contrast (first formant frequency [F1] offset, vowel-consonant duration ratio, and consonant voicing duration) were systematically varied in synthesized words. A discrimination task measured listeners' ability to discriminate differences among stimuli within a single cue dimension. A categorization task examined the extent to which listeners make use of a given cue to label a syllable as "loss" versus "laws" when multiple cues are available. Normal-hearing listeners were presented with stimuli that were either unprocessed, processed with an eight-channel noise-band vocoder to approximate spectral degradation in cochlear implants, or low-pass filtered. Listeners were tested in four listening conditions: unprocessed, vocoder, low-pass, and a combined vocoder + low-pass condition that simulated bimodal hearing. Results showed a negative impact of spectral degradation on F1 cue discrimination and a trading relation between spectral and temporal cues in which listeners relied more heavily on the temporal cues for "loss-laws" identification when spectral cues were degraded. Furthermore, the addition of low-frequency fine-structure cues in simulated bimodal hearing increased the perceptual saliency of the F1 cue for "loss-laws" identification compared with vocoded speech. Findings suggest an interplay between the quality of sensory input and cue importance.