Effects of auditory training on adult cochlear implant patients: a preliminary report

Computer-based Auditory Training by New Adult Cochlear Implant Recipients Is Associated With Durable Improvements in Cochlear Implant Quality of Life

OBJECTIVE

The process of adapting to communicate with a cochlear implant (CI) is complex. The use of auditory training after cochlear implantation may help to facilitate improvements in postoperative speech recognition and quality-of-life outcomes in new adult CI recipients. However, the effectiveness of auditory training remains uncertain and long-term effects have not been examined in a large sample of new adult CI users. As such, the objective of this study was to examine the influence of common forms of auditory training on speech recognition and CI-related quality-of-life (CI-related QOL) outcomes at 1 year after cochlear implantation. We hypothesized that patients who reported use of computer-based auditory training (CBAT) would show improved speech and CIQOL-35 Profile scores at 1 year after activation of their implant, compared with their peers.

DESIGN

This study was designed as a prospective study and was undertaken at a tertiary academic CI center. Participants included 114 adults undergoing cochlear implantation for bilateral hearing loss. Patients serially self-reported use of the following types of post-CI auditory training over their first-year postactivation: (1) face-to-face training (e.g., speech-language pathologist), (2) passive home-based training (e.g., listening to audiobooks), and (3) CBAT (e.g., self-directed software). Outcomes measures for this study included change in Consonant-Nucleus-Consonant phoneme (CNCp), CNC word (CNCw), AzBio sentences in quiet, and CIQOL-35 Profile global and domain scores from pre-CI to 12-mo post-CI.

RESULTS

Of 114 patients, 94 (82.5%) used one or more auditory training resources. Of these, 19.3% used face-to-face training, 67.5% passive home-based training, and 46.5% CBAT. Of 114 patients, 73 had complete CIQOL data. At 12 mo, only CBAT use was associated with significantly greater improvements in global and all domain-specific CIQOL scores ( d -range  =  0.72-0.87), compared with those not using CBAT. Controlling for demographics and use of multiple training resources, CBAT remained the strongest positive predictor of CIQOL improvement, with significant associations with global score (ß  =  12.019[4.127,19.9]) and all domain scores at 12-mo post-CI: communication (ß  =  11.937[2.456,21.318), emotional (ß  =  12.293[1.827,22.759), entertainment (ß  =  17.014[5.434,28.774), environment (ß  =  13.771[1.814,25.727]), listening effort (ß  =  12.523[2.798,22.248]), and social (ß  =  18.114[7.403,28.826]). No significant benefits were noted with use of CBAT or any other form of auditory training and speech recognition scores at 12-mo post-CI ( d -range  =  -0.12-0.22).

CONCLUSIONS

Auditory training with CBAT was associated with improved CI-related QOL outcomes at 12-mo post-CI. Given its availability and low cost, this study provides evidence to support using CBAT to improve real-world functional abilities in new adult CI recipients.

Effects of training length on adaptation to noise-vocoded speech

Listeners show rapid perceptual learning of acoustically degraded speech, though the amount of exposure required to maximize speech adaptation is unspecified. The current work used a single-session design to examine the length of auditory training on perceptual learning for normal hearing listeners exposed to eight-channel noise-vocoded speech. Participants completed short, medium, or long training using a two-alternative forced choice sentence identification task with feedback. To assess learning and generalization, a 40-trial pre-test and post-test transcription task was administered using trained and novel sentences. Training results showed all groups performed near ceiling with no reliable differences. For test data, we evaluated changes in transcription accuracy using separate linear mixed models for trained or novel sentences. In both models, we observed a significant improvement in transcription at post-test relative to pre-test. Critically, the three training groups did not differ in the magnitude of improvement following training. Subsequent Bayes factors analysis evaluating the test by group interaction provided strong evidence in support of the null hypothesis. For these stimuli and procedure, results suggest increased training does not necessarily maximize learning outcomes; both passive and trained experience likely supported adaptation. Findings may contribute to rehabilitation recommendations for listeners adapting to degraded speech signals.

Systematic Review of Auditory Training Outcomes in Adult Cochlear Implant Recipients and Meta-Analysis of Outcomes

Objective: to review evidence on the efficacy of auditory training in adult cochlear implant recipients. Data Sources: PRISMA guidelines for a systematic review of the literature were followed. PubMed, Scopus, and CINAHL databases were queried on 29 June 2023 for terms involving cochlear implantation and auditory training. Studies were limited to the English language and adult patient populations. Study Selection: Three authors independently reviewed publications for inclusion in the review based on a priori inclusion and exclusion criteria. Inclusion criteria encompassed adult cochlear implant populations, an analysis of clinician- or patient-directed auditory training, and an analysis of one or more measures of speech recognition and/or patient-reported outcome. Exclusion criteria included studies with only pediatric implant populations, music or localization training in isolation, and single-sample case studies. Data Extraction: The data were collected regarding study design, patient population, auditory training modality, auditory training timing, speech outcomes, and data on the durability of outcomes. A quality assessment of the literature was performed using a quality metric adapted from the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group guidelines. Data Synthesis and Meta-Analysis: Data were qualitatively summarized for 23 studies. All but four studies demonstrated significant improvement in at least one measured or patient-reported outcome measure with training. For 11 studies with sufficient data reporting, pre-intervention and post-intervention pooled means of different outcome measures were compared for 132 patients using meta-analysis. Patient-direct training was associated with significant improvement in vowel-phoneme recognition and speech recognition in noise (p < 0.05 and p < 0.001, respectively), and clinician-directed training showed significant improvement in sentence recognition in noise (p < 0.001). Conclusions: The literature on auditory training for adult cochlear implant recipients is limited and heterogeneous, including a small number of studies with limited levels of evidence and external validity. However, the current evidence suggests that auditory training can improve speech recognition in adult cochlear implant recipients.

Individual Differences in Auditory Training Benefits for Hearing Aid Users

The present study aimed to examine whether individual differences in baseline speech perception could serve as predictors for the effectiveness and generalization of auditory training (AT) to non-trained tasks. Twelve adults, aged 60-75 years with bilateral hearing loss, completed a two-month, home-based, computerized AT program, involving sessions four times per week. Training tasks included the identification of vowel frontal, height, manner of articulation, point of articulation, voicing, and open-set consonant-vowel-consonant (CVC) words. Non-trained speech perception tests were conducted one month before AT, prior to training, after one and two months of training, and during a two-month follow-up. The results showed that one month of AT improved performance in most trained tasks, with generalization observed in the CVC words test and HeBio sentences with speech-shaped noise (SSN). No evidence of spontaneous learning or added benefit from an extra month of training was found. Most importantly, baseline speech perception predicted improvements in both training and post-training generalization tasks. This emphasizes the significance of adopting an individualized approach when determining the potential effectiveness of AT, applicable in both clinical and research contexts.

Use of Auditory Training and Its Influence on Early Cochlear Implant Outcomes in Adults

OBJECTIVE

Assess associations between postcochlear implant (CI) auditory training and early outcomes related to speech recognition and CI quality of life (CIQOL).

STUDY DESIGN

Longitudinal, prospective cohort.

SETTING

Tertiary academic center.

PATIENTS

Seventy-two adults undergoing cochlear implantation for bilateral severe-to-profound hearing loss.

INTERVENTIONS

Self-reported use of three categories of auditory training post-CI activation: (1) face-to-face training (e.g., speech pathologist), (2) passive home-based training (e.g., listening to audiobooks), and (3) computer-based training (e.g., interactive software).

MAIN OUTCOME MEASURES

Change in Consonant-Nucleus-Consonant phoneme (CNCp), CNC word (CNCw), AzBio sentences in quiet, and CIQOL-35 Profile global and domain scores from pre-CI to 3-month post-CI.

RESULTS

Of 72 patients, 52 (72.2%) used an auditory training resource. Of all patients, 18.4% used face-to-face training, 58.3% passive home-based training, and 33.3% computer-based training. At 3 months post-CI, use of any training was associated with greater improvement in speech recognition (d-range = 0.57-0.85) and global and domain-specific CIQOL scores, except entertainment (d-range = -0.33 to 0.77). Use of computer-based training demonstrated the greatest effect, with larger improvements in speech recognition (CNCp: d = 0.69[0.03,1.35]; CNCw: d = 0.80[0.14,1.46]; AzBio: d = 1.11[0.44,1.77]) and global and all domain-specific CIQOL scores (d-range = 0.05-1.35). Controlling for age, sex, household income, and use of multiple training resources, computer-based training remained the strongest positive predictor of speech recognition and CIQOL improvement, with significant associations with CNCp (ß = 33.07[1,43,64.719]), AzBio (ß = 33.03[5.71,60.35]), and CIQOL-global (ß = 10.92[1.15,20.70]) score improvement.

CONCLUSIONS

Our findings provide preliminary evidence-based recommendations for use of specific auditory training resources for new adult CI recipients. Auditory training, especially self-directed computer software, resulted in improved speech recognition and CIQOL outcomes after 3 months and are widely available for CI users.

Benefits of auditory-verbal intervention for adult cochlear implant users: perspectives of users and their coaches

OBJECTIVE

Post-implant rehabilitation is limited for adult cochlear implant (CI) recipients. The objective of this research was to capture the perspectives of CI users and their coaches regarding their experiences with auditory-verbal intervention as an example of post-implant rehabilitation and their views on perceived benefits and challenges related to the intervention.

DESIGN

This qualitative study involved semi-structured focus group interviews with adult CI users and their coaches who accompanied them in a 24-week auditory-verbal intervention program.

STUDY SAMPLE

A total of 17 participants (eight CI users and nine coaches) contributed to the interviews.

RESULTS

Three key topic areas emerged from the interviews capturing CI users' and coaches' experiences related to the intervention program: (1) benefits of the intervention, (2) factors affecting experiences, and (3) challenges and barriers. Benefits included increased confidence in hearing, communication, social participation, and new knowledge about technology and hearing. Factors affecting the experience were participants' motivation and the therapist's skills. The primary challenge was the time commitment for weekly therapy.

CONCLUSIONS

Both CI users and coaches perceived a focussed auditory-verbal intervention to be beneficial in improving speech understanding, confidence in using hearing, social interaction, and knowledge about technology. Participants recommended reducing the intensity of intervention to facilitate participation.

Effectiveness of Computer-Based Auditory Training for Adult Cochlear Implant Users: A Randomized Crossover Study

The aim of this study was to assess whether a computer-based speech-in-noise auditory training (AT) program would lead to short- and long-term changes in trained and untrained measures of listening, cognition, and quality of life. A secondary aim was to assess whether directly training the underlying cognitive abilities required for speech perception in noise, using a computer-based visual training (VT) program without the auditory component, would elicit comparable outcomes as the AT program. A randomized crossover study with repeated measures was conducted with 26 adult cochlear implant users. Participants completed either 6 weeks of speech perception in noise training followed by 6 weeks of masked text recognition training, or vice versa. Outcome measures were administered twice before each training program, as well as twice after the completion of each program. The test battery was designed to evaluate whether training led to improvements in listening abilities, cognitive abilities, or quality of life. Mixed-effects models were conducted to analyze whether changes occurred on the trained tasks and on untrained outcome measures after training. Statistically significant improvements were shown for verbal recognition performance during both training programs, in particular for consonants in words, and during the first 2 weeks of training. This on-task learning, however, did not lead to clear improvements in outcomes measured beyond the training programs. This suggests that experienced cochlear implant users may not show transfer of on-task learning to untrained tasks after computer-based auditory and visual training programs such as the ones used in this study.

Auditory Training to Improve Speech Perception and Self-Efficacy in Aging Adults

Purpose Difficulty in understanding spoken speech is a common complaint among aging adults, even when hearing impairment is absent. Correlational studies point to a relationship between age, auditory temporal processing (ATP), and speech perception but cannot demonstrate causality unlike training studies. In the current study, we test (a) the causal relationship between a spatial-temporal ATP task (temporal order judgment [TOJ]) and speech perception among aging adults using a training design and (b) whether improvement in aging adult speech perception is accompanied by improved self-efficacy. Method Eighty-two participants aged 60-83 years were randomly assigned to a group receiving (a) ATP training (TOJ) over 14 days, (b) non-ATP training (intensity discrimination) over 14 days, or (c) no training. Results The data showed that TOJ training elicited improvement in all speech perception tests, which was accompanied by increased self-efficacy. Neither improvement in speech perception nor self-efficacy was evident following non-ATP training or no training. Conclusions There was no generalization of the improvement resulting from TOJ training to intensity discrimination or generalization of improvement resulting from intensity discrimination training to speech perception. These findings imply that the effect of TOJ training on speech perception is specific and such improvement is not simply the product of generally improved auditory perception. It provides support for the idea that temporal properties of speech are indeed crucial for speech perception. Clinically, the findings suggest that aging adults can be trained to improve their speech perception, specifically through computer-based auditory training, and this may improve perceived self-efficacy.

Semantic influences on the perception of degraded speech by individuals with cochlear implants

This study investigated whether speech intelligibility in cochlear implant (CI) users is affected by semantic context. Three groups participated in two experiments: Two groups of listeners with normal hearing (NH) listened to either full spectrum speech or vocoded speech, and one CI group listened to full spectrum speech. Experiment 1 measured participants' sentence recognition as a function of target-to-masker ratio (four-talker babble masker), and experiment 2 measured perception of interrupted speech as a function of duty cycles (long/short uninterrupted speech). Listeners were presented with both semantic congruent/incongruent targets. Results from the two experiments suggested that NH listeners benefitted more from the semantic cues as the listening conditions became more challenging (lower signal-to-noise ratios and interrupted speech with longer silent intervals). However, the CI group received minimal benefit from context, and therefore performed poorly in such conditions. On the contrary, in the conditions that were less challenging, CI users benefitted greatly from the semantic context, and NH listeners did not rely on such cues. The results also confirmed that such differential use of semantic cues appears to originate from the spectro-temporal degradations experienced by CI users, which could be a contributing factor for their poor performance in suboptimal environments.

Auditory cortical plasticity in cochlear implant users

Cochlear implants are one of the most successful neuroprosthetic devices that have been developed to date. Profoundly deaf patients can achieve speech perception after complete loss of sensory input. Despite the improvements many patients experience, there is still a large degree of outcome variability. It has been proposed that central plasticity may be a major factor in the different levels of benefit that patients experience. However, the neural mechanisms of how plasticity impacts cochlear implant learning and the degree of plasticity's influence remain unknown. Here, we review the human and animal research on three of the main ways that central plasticity affects cochlear implant outcomes.

DEVELOPMENT AND VALIDATION OF A METHOD TO ENHANCE AUDITORY ATTENTION DURING CONTINUOUS SPEECH-SHAPED NOISE ENVIRONMENT

Auditory training (AT) may strengthen auditory skills that help human not only in on-task auditory perception performance but in continuous speech-shaped noise (SSN) environment. AT based on musical material has provided some evidence for an “auditory advantage” in understanding speech-in-noise (SIN), but with a long period training and complex procedure. Experimental research is essential to develop a simplified method named auditory target tracking training (ATT) which refined from musical material is necessary to determine the benefits of training. We developed two kinds of refined AT method: basic auditory target tracking (BAT) training and enhanced auditory target tracking (EAT) training to adult participants ([Formula: see text]) separately for 20 units, assessing performance to perceive speech in noise environment after training. The EAT group presented better speech perception performance than the other groups and no significant differences between BAT group and control group. The training effect of EAT is the most significant when uni-gender SSN and [Formula: see text] dB. Outcomes suggest that efficacy of trained EAT can improve speech perception performance and selective attention during SSN environment. These findings provide an important link between musical-based training and auditory selective attention in real-world, and extended to special vocational training.

Systematic Review of Auditory Training in Pediatric Cochlear Implant Recipients

Objective The purpose of this systematic review is to evaluate the published research in auditory training (AT) for pediatric cochlear implant (CI) recipients. This review investigates whether AT in children with CIs leads to improvements in speech and language development, cognition, and/or quality of life and whether improvements, if any, remain over time post AT intervention. Method A systematic search of 7 databases identified 96 review articles published up until January 2017, 9 of which met the inclusion criteria. Data were extracted and independently assessed for risk of bias and quality of study against a PICOS (participants, intervention, control, outcomes, and study) framework. Results All studies reported improvements in trained AT tasks, including speech discrimination/identification and working memory. Retention of improvements over time was found whenever it was assessed. Transfer of learning was measured in 4 of 6 studies, which assessed generalization. Quality of life was not assessed. Overall, evidence for the included studies was deemed to be of low quality. Conclusion Benefits of AT were illustrated through the improvement in trained tasks, and this was observed in all reviewed studies. Transfer of improvement to other domains and also retention of benefits post AT were evident when assessed, although rarely done. However, higher quality evidence to further examine outcomes of AT in pediatric CI recipients is needed.

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.

Auditory Training for Adults Who Have Hearing Loss: A Comparison of Spaced Versus Massed Practice Schedules

Purpose

The spacing effect in human memory research refers to situations in which people learn items better when they study items in spaced intervals rather than massed intervals. This investigation was conducted to compare the efficacy of meaning-oriented auditory training when administered with a spaced versus massed practice schedule.

Method

Forty-seven adult hearing aid users received 16 hr of auditory training. Participants in a spaced group (mean age = 64.6 years, SD = 14.7) trained twice per week, and participants in a massed group (mean age = 69.6 years, SD = 17.5) trained for 5 consecutive days each week. Participants completed speech perception tests before training, immediately following training, and then 3 months later. In line with transfer appropriate processing theory, tests assessed both trained tasks and an untrained task.

Results

Auditory training improved the speech recognition performance of participants in both groups. Benefits were maintained for 3 months. No effect of practice schedule was found on overall benefits achieved, on retention of benefits, nor on generalizability of benefits to nontrained tasks.

Conclusion

The lack of spacing effect in otherwise effective auditory training suggests that perceptual learning may be subject to different influences than are other types of learning, such as vocabulary learning. Hence, clinicians might have latitude in recommending training schedules to accommodate patients' schedules.

Voice gender and the segregation of competing talkers: Perceptual learning in cochlear implant simulations

Two experiments explored the role of differences in voice gender in the recognition of speech masked by a competing talker in cochlear implant simulations. Experiment 1 confirmed that listeners with normal hearing receive little benefit from differences in voice gender between a target and masker sentence in four- and eight-channel simulations, consistent with previous findings that cochlear implants deliver an impoverished representation of the cues for voice gender. However, gender differences led to small but significant improvements in word recognition with 16 and 32 channels. Experiment 2 assessed the benefits of perceptual training on the use of voice gender cues in an eight-channel simulation. Listeners were assigned to one of four groups: (1) word recognition training with target and masker differing in gender; (2) word recognition training with same-gender target and masker; (3) gender recognition training; or (4) control with no training. Significant improvements in word recognition were observed from pre- to post-test sessions for all three training groups compared to the control group. These improvements were maintained at the late session (one week following the last training session) for all three groups. There was an overall improvement in masked word recognition performance provided by gender mismatch following training, but the amount of benefit did not differ as a function of the type of training. The training effects observed here are consistent with a form of rapid perceptual learning that contributes to the segregation of competing voices but does not specifically enhance the benefits provided by voice gender cues.

Musicians Are Better than Non-musicians in Frequency Change Detection: Behavioral and Electrophysiological Evidence

Objective: The objectives of this study were: (1) to determine if musicians have a better ability to detect frequency changes under quiet and noisy conditions; (2) to use the acoustic change complex (ACC), a type of electroencephalographic (EEG) response, to understand the neural substrates of musician vs. non-musician difference in frequency change detection abilities.

Methods: Twenty-four young normal hearing listeners (12 musicians and 12 non-musicians) participated. All participants underwent psychoacoustic frequency detection tests with three types of stimuli: tones (base frequency at 160 Hz) containing frequency changes (Stim 1), tones containing frequency changes masked by low-level noise (Stim 2), and tones containing frequency changes masked by high-level noise (Stim 3). The EEG data were recorded using tones (base frequency at 160 and 1200 Hz, respectively) containing different magnitudes of frequency changes (0, 5, and 50% changes, respectively). The late-latency evoked potential evoked by the onset of the tones (onset LAEP or N1-P2 complex) and that evoked by the frequency change contained in the tone (the acoustic change complex or ACC or N1′-P2′ complex) were analyzed.

Results: Musicians significantly outperformed non-musicians in all stimulus conditions. The ACC and onset LAEP showed similarities and differences. Increasing the magnitude of frequency change resulted in increased ACC amplitudes. ACC measures were found to be significantly different between musicians (larger P2′ amplitude) and non-musicians for the base frequency of 160 Hz but not 1200 Hz. Although the peak amplitude in the onset LAEP appeared to be larger and latency shorter in musicians than in non-musicians, the difference did not reach statistical significance. The amplitude of the onset LAEP is significantly correlated with that of the ACC for the base frequency of 160 Hz.

Conclusion: The present study demonstrated that musicians do perform better than non-musicians in detecting frequency changes in quiet and noisy conditions. The ACC and onset LAEP may involve different but overlapping neural mechanisms.

Significance: This is the first study using the ACC to examine music-training effects. The ACC measures provide an objective tool for documenting musical training effects on frequency detection.

Personalised long-term follow-up of cochlear implant patients using remote care, compared with those on the standard care pathway: study protocol for a feasibility randomised controlled trial

INTRODUCTION

Many resources are required to provide postoperative care to patients who receive a cochlear implant. The implant service commits to lifetime follow-up. The patient commits to regular adjustment and rehabilitation appointments in the first year and annual follow-up appointments thereafter. Offering remote follow-up may result in more stable hearing, reduced patient travel expense, time and disruption, more empowered patients, greater equality in service delivery and more freedom to optimise the allocation of clinic resources.

METHODS AND ANALYSIS

This will be a two-arm feasibility randomised controlled trial (RCT) involving 60 adults using cochlear implants with at least 6 months device experience in a 6-month clinical trial of remote care. This project will design, implement and evaluate a person-centred long-term follow-up pathway for people using cochlear implants offering a triple approach of remote and self-monitoring, self-adjustment of device and a personalised online support tool for home speech recognition testing, information, self-rehabilitation, advice, equipment training and troubleshooting. The main outcome measure is patient activation. Secondary outcomes are stability and quality of hearing, stability of quality of life, clinic resources, patient and clinician experience, and any adverse events associated with remote care. We will examine the acceptability of remote care to service users and clinicians, the willingness of participants to be randomised, and attrition rates. We will estimate numbers required to plan a fully powered RCT.

ETHICS AND DISSEMINATION

Ethical approval was received from North West-Greater Manchester South Research Ethics Committee (15/NW/0860) and the University of Southampton Research Governance Office (ERGO 15329).

RESULTS

Results will be disseminated in the clinical and scientific communities and also to the patient population via peer-reviewed research publications both online and in print, conference and meeting presentations, posters, newsletter articles, website reports and social media.

TRIAL REGISTRATION NUMBER

ISRCTN14644286; Pre-results.

The impact of cochlear implantation on speech understanding, subjective hearing performance, and tinnitus perception in patients with unilateral severe to profound hearing loss

OBJECTIVES

This study aimed to determine the impact of cochlear implantation on speech understanding in noise, subjective perception of hearing, and tinnitus perception of adult patients with unilateral severe to profound hearing loss and to investigate whether duration of deafness and age at implantation would influence the outcomes. In addition, this article describes the auditory training protocol used for unilaterally deaf patients.

DESIGN

This is a prospective study of subjects undergoing cochlear implantation for unilateral deafness with or without associated tinnitus.

METHODS

Speech perception in noise was tested using the Bamford-Kowal-Bench speech-in-noise test presented at 65 dB SPL. The Speech, Spatial, and Qualities of Hearing Scale and the Abbreviated Profile of Hearing Aid Benefit were used to evaluate the subjective perception of hearing with a cochlear implant and quality of life. Tinnitus disturbance was measured using the Tinnitus Reaction Questionnaire. Data were collected before cochlear implantation and 3, 6, 12, and 24 months after implantation.

RESULTS

Twenty-eight postlingual unilaterally deaf adults with or without tinnitus were implanted. There was a significant improvement in speech perception in noise across time in all spatial configurations. There was an overall significant improvement on the subjective perception of hearing and quality of life. Tinnitus disturbance reduced significantly across time. Age at implantation and duration of deafness did not influence the outcomes significantly.

CONCLUSION

Cochlear implantation provided significant improvement in speech understanding in challenging situations, subjective perception of hearing performance, and quality of life. Cochlear implantation also resulted in reduced tinnitus disturbance. Age at implantation and duration of deafness did not seem to influence the outcomes.

Auditory Learning in Children With Cochlear Implants

PURPOSE

The purpose of this study was to examine and characterize the training-induced changes in speech-in-noise perception in children with congenital deafness who have cochlear implants (CIs).

METHOD

Twenty-seven children with congenital deafness who have CIs were studied. Eleven children with CIs were trained on a speech-in-noise task, number recognition in white noise, at home for 5 weeks (total 40 hr). Speech recognition thresholds (SRTs) in the trained, partially trained (numbers in speech-shaped noise), and untrained (digit triplets in speech-shaped noise) conditions were measured before, immediately after, and 3 weeks after training completion. Data were also collected from children (n = 13) and adults (n = 5) with normal hearing for comparison.

RESULTS

Analyses indicated that following training, the performance of children with CIs improved for all speech-in-noise tasks (∆SRT was approximately 3 dB). Training-induced improvements in speech-in-noise performance were retained for 3 weeks following cessation of training. Untrained children with CIs showed no such improvements. The performance of children with CIs, even after intensive training, was significantly lower than children and adults with normal hearing.

CONCLUSIONS

Training enhances speech-in-noise performance for children with congenital deafness who have CIs. Learning effects were stable and generalized to similar but untrained conditions. Current findings are encouraging for the consideration of home-based auditory training to be included in the pediatric CI habilitation programs.

Cortical encoding of pitch contour changes in cochlear implant users: a mismatch negativity study

A better understanding of melodic pitch perception in cochlear implants (CIs) may guide signal processing and/or rehabilitation techniques to improve music perception and appreciation in CI patients. In this study, the mismatch negativity (MMN) in response to infrequent changes in 5-tone pitch contours was obtained in CI users and normal-hearing (NH) listeners. Melodic contour identification (MCI) was also measured. Results showed that MCI performance was poorer in CI than in NH subjects; the MMNs were missing in all CI subjects for the 1-semitone contours. The MMNs with the 5-semitone contours were observed in a smaller proportion of CI than NH subjects. Results suggest that encoding of pitch contour changes in CI users appears to be degraded, most likely due to the limited pitch cues provided by the CI and deafness-related compromise of brain substrates.

Efficacy of individual computer-based auditory training for people with hearing loss: a systematic review of the evidence

Background

Auditory training involves active listening to auditory stimuli and aims to improve performance in auditory tasks. As such, auditory training is a potential intervention for the management of people with hearing loss.

Objective

This systematic review (PROSPERO 2011: CRD42011001406) evaluated the published evidence-base for the efficacy of individual computer-based auditory training to improve speech intelligibility, cognition and communication abilities in adults with hearing loss, with or without hearing aids or cochlear implants.

Methods

A systematic search of eight databases and key journals identified 229 articles published since 1996, 13 of which met the inclusion criteria. Data were independently extracted and reviewed by the two authors. Study quality was assessed using ten pre-defined scientific and intervention-specific measures.

Results

Auditory training resulted in improved performance for trained tasks in 9/10 articles that reported on-task outcomes. Although significant generalisation of learning was shown to untrained measures of speech intelligibility (11/13 articles), cognition (1/1 articles) and self-reported hearing abilities (1/2 articles), improvements were small and not robust. Where reported, compliance with computer-based auditory training was high, and retention of learning was shown at post-training follow-ups. Published evidence was of very-low to moderate study quality.

Conclusions

Our findings demonstrate that published evidence for the efficacy of individual computer-based auditory training for adults with hearing loss is not robust and therefore cannot be reliably used to guide intervention at this time. We identify a need for high-quality evidence to further examine the efficacy of computer-based auditory training for people with hearing loss.

The listening cube: a three dimensional auditory training program

OBJECTIVES

Here we present the Listening Cube, an auditory training program for children and adults receiving cochlear implants, developed during the clinical practice at the KIDS Royal Institute for the Deaf in Belgium. We provide information on the content of the program as well as guidance as to how to use it.

METHODS

The Listening Cube is a three-dimensional auditory training model that takes the following into consideration: the sequence of auditory listening skills to be trained, the variety of materials to be used, and the range of listening environments to be considered. During auditory therapy, it is important to develop training protocols and materials to provide rapid improvement over a relatively short time period. Moreover, effectiveness and the general real-life applicability of these protocols to various users should be determined.

RESULTS

Because this publication is not a research article, but comes out of good daily practice, we cannot state the main results of this study. We can only say that this auditory training model is very successful. Since the first report was published in the Dutch language in 2003, more than 200 therapists in Belgium and the Netherlands followed a training course elected to implement the Listening Cube in their daily practice with children and adults with a hearing loss, especially in those wearing cochlear implants.

CONCLUSION

The Listening Cube is a tool to aid in planning therapeutic sessions created to meet individual needs, which is often challenging. The three dimensions of the cube are levels of perception, practice material, and practice conditions. These dimensions can serve as a visual reminder of the task analysis and of other considerations that play a role in structuring therapy sessions.

Digit training in noise can improve cochlear implant users' speech understanding in noise

OBJECTIVE

While auditory training in quiet has been shown to improve cochlear implant (CI) users' speech understanding in quiet, it is unclear whether training in noise will benefit speech understanding in noise. The present study investigated whether auditory training could improve CI users' speech recognition in noise and whether training with familiar stimuli in an easy listening task (closed-set digit recognition) would improve recognition of unfamiliar stimuli in a more difficult task (open-set sentence recognition).

DESIGN

CI users' speech understanding in noise was assessed before, during, and after auditory training with a closed-set recognition task (digits identification) in speech babble. Before training was begun, recognition of digits, Hearing in Noise Test (HINT) sentences, and IEEE sentences presented in steady speech-shaped noise or multitalker speech babble was repeatedly measured to establish a stable estimate of baseline performance. After completing baseline measures, participants trained at home on their personal computers using custom software for approximately 30 mins/day, 5 days/wk, for 4 wks, for a total of 10 hrs of training. Participants were trained only to identify random sequences of three digits presented in speech babble, using a closed-set task. During training, the signal-to-noise ratio was adjusted according to subject performance; auditory and visual feedback was provided. Recognition of digits, HINT sentences, and IEEE sentences in steady noise and speech babble was remeasured after the second and fourth week of training. Training was stopped after the fourth week, and subjects returned to the laboratory 1 mo later for follow-up testing to see whether any training benefits had been retained.

RESULTS

Mean results showed that the digit training in babble significantly improved digit recognition in babble (which was trained) and in steady noise (which was not trained). The training benefit generalized to improved HINT and IEEE sentence recognition in both types of noise. Training benefits were largely retained in follow-up measures made 1 mo after training was stopped.

CONCLUSIONS

The results demonstrated that auditory training in noise significantly improved CI users' speech performance in noise, and that training with simple stimuli using an easy closed-set listening task improved performance with difficult stimuli and a difficult open-set listening task.

Comparison of word-, sentence-, and phoneme-based training strategies in improving the perception of spectrally distorted speech

PURPOSE

To compare the effectiveness of 3 self-administered strategies for auditory training that might improve speech perception by adult users of cochlear implants. The strategies are based, respectively, on discriminating isolated words, words in sentences, and phonemes in nonsense syllables.

METHOD

Participants were 18 normal-hearing adults who listened to speech processed by a noise-excited vocoder to simulate the information provided by a cochlear implant. They were assigned randomly to word-, sentence-, or phoneme-based training and underwent 9 training sessions (20 min each) on separate days over a 2- to 3-week period. The effectiveness of training was assessed as the improvement in accuracy of discriminating vowels and consonants, as well as identifying words in sentences, relative to participants' best performance in repeated tests prior to training.

RESULTS

Word- and sentence-based training led to significant improvements in the ability to identify words in sentences that were significantly larger than the improvements produced by phoneme-based training. There were no significant differences between the effectiveness of word- and sentence-based training. No significant improvements in consonant or vowel discrimination were found for the sentence- or phoneme-based training groups, but some improvements were found for the word-based training group.

CONCLUSION

The word- and sentence-based training strategies were more effective than the phoneme-based strategy at improving the perception of spectrally distorted speech.