Introducing music as a means of habilitation for children with cochlear implants

The Impact of Musical Rehabilitation on Complex Sound Perception in Cochlear Implant Users: A Systematic Review

OBJECTIVE

Musical rehabilitation has been used in clinical and nonclinical contexts to improve postimplantation auditory processing in implanted individuals. This systematic review aimed to evaluate the efficacy of music rehabilitation in controlled experimental and quasi-experimental studies on cochlear implant (CI) user speech and music perception.

DATABASES REVIEWED

PubMed/MEDLINE, EMBASE, Web of Science, PsycARTICLES, and PsycINFO databases through July 2022.

METHODS

Controlled experimental trials and prospective studies were included if they compared pretest and posttest data and excluded hearing aid-only users. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were then used to extract data from 11 included studies with a total of 206 pediatric and adult participants. Interventions included group music therapy, melodic contour identification training, auditory-motor instruction, or structured digital music training. Studies used heterogeneous outcome measures evaluating speech and music perception. Risk of bias was assessed using the National Heart, Lung, and Blood Institute Quality Assessment Tool.

RESULTS

A total of 735 studies were screened, and 11 met the inclusion criteria. Six trials reported both speech and music outcomes, whereas five reported only music perception outcomes after the intervention relative to control. For music perception outcomes, significant findings included improvements in melodic contour identification (five studies, p < 0.05), timbre recognition (three studies, p < 0.05), and song appraisal (three studies, p < 0.05) in their respective trials. For speech prosody outcomes, only vocal emotion identification demonstrated significant improvements (two studies, p < 0.05).

CONCLUSION

Music rehabilitation improves performance on multiple measures of music perception, as well as tone-based characteristics of speech (i.e., emotional prosody). This suggests that rehabilitation may facilitate improvements in the discrimination of spectrally complex signals.

Improved Music Perception after Music Therapy following Cochlear Implantation in the Elderly Population

Background: Cochlear implantation (CI) and the accompanying rehabilitation has become a routine procedure in hearing restoration. Literature is sparse on elderly CI recipients focusing on the issue of age and their inclined auditory resolution, taking their diminished cognitive function into account, which requires adaptation of rehabilitation programs to overcome habituation. Objective: This study aims to show that a few adjustments in the therapy program towards age, mental, physical and auditory condition significantly improve music perception and overall auditory benefit, hence normal communication and social interactions can be found. Methods: Subjects implanted with a CI 65 years or older were compared to age-matched normal hearing subjects. Questionnaires were administered before and after ten music therapy sessions, to evaluate the participant’s music habits, the perception of sound quality and self-awareness and hearing implant satisfaction. Results: The greatest benefit was seen in participants’ gain in self-confidence and enjoyable music perception. Not only did the amount of listening to music increase, but also the impression of sound quality changed from poor up to good/very good sound quality. Conclusions: The music therapy was well accepted and resulted in beneficial subjective as well as objective outcomes towards hearing and music impression, hence improved quality of life.

Rehabilitation of children with cochlear implant in Iran: A scoping review

Background: Recovery of children does not appear on its own after cochlear implantation. Coherent, thoughtful, and comprehensive rehabilitation is needed to achieve complete success. The purpose of this study was to identify the types of rehabilitation interventions for children with cochlear implants that have been performed in Iran.

Methods: A scoping review study was conducted. An electronic search was carried out both in English and Persian. In English, the following keywords were used: cochlear implantation, child, cochlear implants, auditory rehabilitation, deaf, hearing loss, comprehensive, interventions, rehabilitation, and telerehabilitation and a combination of them in ProQuest, PubMed, Science Direct, and Scopus databases, Web of Sciences, Medline and Embase. Persian electronic search was conducted in the Scientific Information Database (SID) of Jihad Daneshgahi, Iran Journals Database (MagIran), and Islamic World Science Citation Database (ISC). Searches were done using articles published until September 25, 2020, and a total of 902 articles were found, of which 14 were directly related to the purpose of the study. Interventional studies were included in the study, and the quality of studies was measured using the Structured Effectiveness Quality Evaluation Scale.

Results: The results showed that using music and rehabilitation equipment, different methods of speech therapy and auditory training, story-based instruction, creative play, family-centered instruction, and occupational therapy are interventions in cochlear implant rehabilitation. Speech therapy accounts for 54% of the rehabilitation share. The mean number of rehabilitation sessions was 26. These interventions were all somehow effective in children with cochlear implantation; the longer the training duration, the better the results.

Conclusion: The process of cochlear implant rehabilitation in children is multi-professional; auditory training and speech therapy possesses the highest share of rehabilitation. Therefore, it is recommended to develop speech therapy centers in Iran.

Crucial Music Components Needed for Speech Perception Enhancement of Pediatric Cochlear Implant Users: A Systematic Review and Meta-Analysis

BACKGROUND

Although many clinicians have attempted music training for the hearing-impaired children, no specific effects have yet been reported for individual music components. This paper seeks to discover specific music components that help in improving speech perception of children with cochlear implants (CI) and to identify the effective training periods and methods needed for each component.

METHOD

While assessing 5 electronic databases, that is, ScienceDirect, Scopus, PubMed, CINAHL, and Web of Science, 1,638 articles were found initially. After the screening and eligibility assessment stage based on the Participants, Intervention, Comparisons, Outcome, and Study Design (PICOS) inclusion criteria, 18 of 1,449 articles were chosen.

RESULTS

A total of 18 studies and 14 studies (209 participants) were analyzed using a systematic review and meta-analysis, respectively. No publication bias was detected based on an Egger's regression result even though the funnel plot was asymmetrical. The results of the meta-analysis revealed that the largest improvement was seen for rhythm perception, followed by the perception of pitch and harmony and smallest for timbre perception after the music training. The duration of training affected the rhythm, pitch, and harmony perception but not the timbre. Interestingly, musical activities, such as singing, produced the biggest effect size, implying that children with CI obtained the greatest benefits of music training by singing, followed by playing an instrument and achieved the smallest effect by only listening to musical stimuli. Significant improvement in pitch perception helped with the enhancement of prosody perception.

CONCLUSION

Music training can improve the music perception of children with CI and enhance their speech prosody. Long training duration was shown to provide the largest training effect of the children's perception improvement. The children with CI learned rhythm and pitch better than they did with harmony and timbre. These results support the finding of past studies that with music training, both rhythm and pitch perception can be improved, and it also helps in the development of prosody perception.

Musical stimulation proposal for hearing impaired children: case reports

PURPOSE

To develop and to apply a musical stimulation program for children using Cochlear Implant.

METHOD

The research was conducted at the Educational Audiology Outpatient Clinic, UNIFESP, and was carried out in two stages - conception of the musical stimulation activities and its application in five children using Cochlear Implant, aged between 2 and 5 years, who had been under speech therapy for at least 12 months. The study group was submitted to six sessions of musical stimulation. We used three instruments to quantify the evolution of the child: Children's Musical Identification, Musical Skills Development and Musical Aptitude Test - all of them were designed by one of the authors.

RESULTS

Musical stimulation had a positive effect, thereby improving the rhythm and the melody skills of the participants. The children showed a performance over 50% in the tasks undertaken. Musical stimulation had a positive effect, thereby improving the rhythm (p=0.0267) and the melody (p=0.0445) skills of the participants.

CONCLUSION

We conclude that it is possible to develop a musical stimulation program that can be applied to children using Cochlear Implant inserted in aurioral rehabilitation, who benefit from the activities.

Music Training for Children With Sensorineural Hearing Loss Improves Speech-in-Noise Perception

Purpose A growing body of evidence suggests that long-term music training provides benefits to auditory abilities for typical-hearing adults and children. The purpose of this study was to evaluate how music training may provide perceptual benefits (such as speech-in-noise, spectral resolution, and prosody) for children with hearing loss. Method Fourteen children aged 6-9 years with prelingual sensorineural hearing loss using bilateral cochlear implants, bilateral hearing aids, or bimodal configuration participated in a 12-week music training program, with nine participants completing the full testing requirements of the music training. Activities included weekly group-based music therapy and take-home music apps three times a week. The design was a pseudorandomized, longitudinal study (half the cohort was wait-listed, initially serving as a passive control group prior to music training). The test battery consisted of tasks related to music perception, music appreciation, and speech perception. As a comparison, 16 age-matched children with typical hearing also completed this test battery, but without participation in the music training. Results There were no changes for any outcomes for the passive control group. After music training, perception of speech-in-noise, question/statement prosody, musical timbre, and spectral resolution improved significantly, as did measures of music appreciation. There were no benefits for emotional prosody or pitch perception. Conclusion The findings suggest even a modest amount of music training has benefits for music and speech outcomes. These preliminary results provide further evidence that music training is a suitable complementary means of habilitation to improve the outcomes for children with hearing loss.

Musical Training for Auditory Rehabilitation in Hearing Loss

Despite the overall success of cochlear implantation, language outcomes remain suboptimal and subject to large inter-individual variability. Early auditory rehabilitation techniques have mostly focused on low-level sensory abilities. However, a new body of literature suggests that cognitive operations are critical for auditory perception remediation. We argue in this paper that musical training is a particularly appealing candidate for such therapies, as it involves highly relevant cognitive abilities, such as temporal predictions, hierarchical processing, and auditory-motor interactions. We review recent studies demonstrating that music can enhance both language perception and production at multiple levels, from syllable processing to turn-taking in natural conversation.

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.

Teaching language components to deaf/hard-of-hearing and cochlear implant users: a literature review

ABSTRACT Cochlear implants are one of the possible ways for Deaf or Hard-of-Hearing (DHH) individuals to detect sounds and as a mean of insertion in the social, academic and work environments. Nevertheless, in many cases, the cochlear implant alone is not sufficient, demanding hearing and expressive language skills rehabilitation to optimize the device used. This study aimed at reviewing scientific articles that described empirical research with interventions and/or teaching methods of various language repertoires to deaf and hard-of-hearing cochlear implant users. The review was carried out in five scientific databases considering all periods. On the first phase, 156 articles were identified and from these, 24 publications were selected. After being read, these articles were categorized and analyzed as to the participants, teaching targets and procedures adopted. On the last stage of the research, 10 experimental studies were selected and analyzed regarding procedures and results, indicating important factors in teaching this population. The results point to the necessity of an increase of scientific production in the construction and evaluation of effective verbal repertoires teaching programs for cochlear implant users.

Music-based training for pediatric CI recipients: A systematic analysis of published studies

In recent years, there has been growing interest in the use of music-based training to enhance speech and language development in children with normal hearing and some forms of communication disorders, including pediatric CI users. The use of music training for CI users may initially seem incongruous given that signal processing for CIs presents a degraded version of pitch and timbre, both key elements in music. Furthermore, empirical data of systematic studies of music training, particularly in relation to transfer to speech skills are limited. This study describes the rationale for music training of CI users, describes key features of published studies of music training with CI users, and highlights some developmental and logistical issues that should be taken into account when interpreting or planning studies of music training and speech outcomes with pediatric CI recipients.

Cochlear implants in children implanted in Jordan: A parental overview

OBJECTIVE

Exploring the perspective of parents on the cochlear implant process in Jordan.

METHODS

Sixty parents of deaf children were surveyed on the information gathering process prior to cochlear implant surgery, and their implant outcome expectations post-surgery. Whether child or parent characteristics may impact parents' post-surgical expectations was explored.

RESULTS

Although parents used a variety of information sources when considering a cochlear implant, the ear, nose and throat doctor comprised their major source of information (60%). Parents received a range of information prior to cochlear implant but agreed (93.3%) on the need for a multidisciplinary team approach. Post-surgically, parents' expected major developments in the areas of spoken language (97%), and auditory skills (100%). Receiving education in mainstream schools (92%) was expected too. Parents perceived the cochlear implant decision as the best decision they can make for their child (98.3%). A significant correlation was found between parents contentment with the cochlear implant decision and expecting developments in the area of reading and writing (r=0.7). Child's age at implantation and age at hearing loss diagnosis significantly affected parents' post-implant outcome expectations (p<0.05).

CONCLUSION

Despite the general satisfaction from the information quantity and quality prior to cochlear implant, parents agree on the need for a comprehensive multidisciplinary team approach during the different stages of the cochlear implant process. Parents' education about cochlear implants prior to the surgery can affect their post-surgical outcome expectations. The parental perspective presented in this study can help professionals develop better understanding of parents' needs and expectations and henceforth improve their services and support during the different stages of the cochlear implant process.

Recognition of music and melody in patients with cochlear implants, using a new programming approach for frequency assignment

INTRODUCTION AND OBJECTIVE

Music is a universal, cross-cultural phenomenon. Perception and enjoyment of music are still not solved with current technological objectives of cochlear implants. The objective of this article was to advance the development and validation of a method of programming of cochlear implants that implements a frequency allocation strategy. We compared standard programming vs frequency programming in every subject.

METHODS

We studied a total of 40 patients with cochlear implants. Each patient was programmed with a optimal version of the standard program, using the Custom Sound Suite 3.2 cochlear platform. Speech tests in quiet were performed using syllable word lists from the protocol for the assessment of hearing in the Spanish language. Patients implanted bilaterally were tested in both ears at the same time. For assessing music listening habits we used the Munich Music Questionnaire and «MACarena»(minimum auditory capability) software.

RESULTS

All patients achieved better results in recognition, instrument tests and tonal scales with frequency programming (P<.005). Likewise, there were better results with frequency programming in recognising harmonics and pitch test (P<.005).

CONCLUSIONS

Frequency programming achieves better perception and recognition results in patients in comparison with standard programming. Bilateral stimulation patients have better perception of musical patterns and better performance in recognition of tonal scales, harmonics and musical instruments compared with patients with unilateral stimulation. Modification and frequency allocation during programming allows decreased levels of current intensity and increase the dynamic range, which allows mapping of each audio band less obtrusively and improves the quality of representation of the signal.

Biological impact of auditory expertise across the life span: musicians as a model of auditory learning

Experience-dependent characteristics of auditory function, especially with regard to speech-evoked auditory neurophysiology, have garnered increasing attention in recent years. This interest stems from both pragmatic and theoretical concerns as it bears implications for the prevention and remediation of language-based learning impairment in addition to providing insight into mechanisms engendering experience-dependent changes in human sensory function. Musicians provide an attractive model for studying the experience-dependency of auditory processing in humans due to their distinctive neural enhancements compared to nonmusicians. We have only recently begun to address whether these enhancements are observable early in life, during the initial years of music training when the auditory system is under rapid development, as well as later in life, after the onset of the aging process. Here we review neural enhancements in musically trained individuals across the life span in the context of cellular mechanisms that underlie learning, identified in animal models. Musicians' subcortical physiologic enhancements are interpreted according to a cognitive framework for auditory learning, providing a model in which to study mechanisms of experience-dependent changes in human auditory function.

MUSIC APPRECIATION AND TRAINING FOR COCHLEAR IMPLANT RECIPIENTS: A REVIEW

In recent years, there has been increasing interest in music perception of cochlear implant (CI) recipients, and a growing body of research conducted in this area. The majority of these studies have examined perceptual accuracy for pitch, rhythm, and timbre. Another important, but less commonly studied aspect of music listening is appreciation, or appraisal. Despite the ongoing research into potential technological improvements that may improve music perception for recipients, both perceptual accuracy and appreciation generally remain poor for most recipients. Whilst perceptual accuracy for music is important, appreciation and enjoyment also warrants research as it also contributes to clinical outcomes and perceived benefits. Music training is being shown to offer excellent potential for improving music perception and appreciation for recipients.Therefore, the primary topics of this review are music appreciation and training. However, a brief overview of the psychoacoustic, technical, and physiological factors associated with a recipient's perception of music is provided, as these are important factors in understanding the listening experience for CI recipients. The purpose of this review is to summarize key papers that have investigated these issues, in order to demonstrate that i) music enjoyment and appraisal is an important and valid consideration in evaluating music outcomes for recipients, and ii) that music training can improve music listening for many recipients, and is something that can be offered to persons using current technology.

Developing a music programme for preschool children with cochlear implants

Although music perception is especially challenging for cochlear implant (CI) users, young CI users' musical perception abilities are improved by participation in structured musical activities.

OBJECTIVES

To design, implement, evaluate, and publish a music training programme with a monitoring tool for preschool CI users, for use in family-centred habilitation programmes.

METHODS

We devised a programme of musical activities, Musical EARS®, and a curriculum-related hierarchical Evaluation Form to represent performance. The programme included sections on singing; recognizing songs, tunes, and timbre; and responding appropriately to music and rhythm. It was implemented over 18 months at Ilkses Rehabilitation Centre, with 25 paediatric MED-EL CI users split into three groups of varying age, duration of CI use, and ability.

RESULTS

Mean total scores increased significantly for all groups. Scores increased unevenly across subscales. Participation in and enjoyment of musical activities increased for both children and parents. Significant correlations were found between scores and length of CI use.

DISCUSSION

The training programme effectively enriches child CI users' musical experience. To varying degrees, children learned to perform the Musical EARS® activities. The study allowed us to validate the lesson content and the hierarchical nature of the Evaluation Form. We conclude that prelingually deafened CI users should be systematically involved in musical activities to help them acquire skills acquired more easily by hearing peers.

Music Therapy for Preschool Cochlear Implant Recipients

This paper provides research and clinical information relevant to music therapy for preschool children who use cochlear implants (CI). It consolidates information from various disciplinary sources regarding (a) cochlear implantation of young prelingually-deaf children (~age 2-5), (b) patterns of auditory and speech-language development, and (c) research regarding music perception of children with CIs. This information serves as a foundation for the final portion of the article, which describes typical music therapy goals and examples of interventions suitable for preschool children.

Music Perception in Children With Cochlear Implants

As a result of the widespread use of cochlear implants, individuals with profound hearing loss now are able to hear sounds ranging from a syllable to a symphony. This form of “electric hearing” has been remarkably successful in providing sound to the deaf population and at least 100,000 implantation procedures have been performed worldwide in more than 80 countries (Clark, 2008). Today, it is routine for post-lingual deafened individuals (one who lost their hearing after normal childhood language acquisition) to achieve high performance on language tests following implantation (Lalwani, Larky, Wareing, Kwast, & Schindler, 1998). Deaf children implanted at an early age with a CI usually develop excellent spoken language skills, with placement into mainstream educational schooling (Francis, Koch, Wyatt, & Niparko, 1999). The overwhelming emphasis on language perception in CI users has led to relative neglect of non-linguistic sound perception. Yet, the auditory world consists of many other sounds besides those of spoken language. Of all non-linguistic sounds, perception of music—particularly pitch and timbre—represents the greatest challenge for implant-mediated listening (Limb, 2006). High-level perception of music rarely is attained through conventional speech processing technology in adults or children. Recent technological advances, however, have increased the processing capabilities of modern CIs and hold great promise for music perception and quality of life for children with cochlear implants (Lassaletta et al., 2007).

Effects of training on recognition of musical instruments presented through cochlear implant simulations

BACKGROUND

The simulation of the CI (cochlear implant) signal presents a degraded representation of each musical instrument, which makes recognition difficult.

PURPOSE

To examine the efficiency and effectiveness of three types of training on recognition of musical instruments as presented through simulations of the sounds transmitted through a CI.

RESEARCH DESIGN

Participants were randomly assigned to one of three training conditions: repeated exposure, feedback, and direct instruction.

STUDY SAMPLE

Sixty-six adults with normal hearing.

INTERVENTION

Each participant completed three training sessions per week, over a five-week time period, in which they listened to the CI simulations of eight different musical instruments.

DATA COLLECTION AND ANALYSIS

Analyses on percent of instruments identified correctly showed statistically significant differences between recognition accuracy of the three training conditions (p < .01).

RESULTS

those assigned to the direct instruction group showed the greatest improvement over the five-week training period as well as sustained improvement after training. The feedback group achieved the next highest level of recognition accuracy. The repeated exposure group showed modest improvement during the first three-week time period, but no subsequent improvements.

CONCLUSIONS

These results indicate that different types of training are differentially effective with regard to improving recognition of musical instruments presented through a degraded signal, which has practical implications for the auditory rehabilitation of persons who use cochlear implants.

Changes in listening habits and quality of musical sound after cochlear implantation

OBJECTIVE

To evaluate listening habits and quality of musical sound after cochlear implantation.

STUDY DESIGN

A total of 89 consecutive, adult, postlingually deafened, cochlear implant recipients entered the study. Music questionnaire included questions about musical background, listening habits, and quality of musical sound through cochlear implants. Music perception was evaluated with the Primary Measures of Music Audiation (PMMA). The questionnaire and the PMMA were administered to 67 and 65 patients, respectively.

RESULTS

Listening habits significantly decreased postimplantation. The mean score (0-100) for the adjective pairs "like-dislike," "sounds like music-doesn't sound like music," "natural-mechanical," and "easy to follow-difficult to follow" was 60, 59, 50, and 40, respectively. The adjective pairs were associated with music enjoyment. Mean PMMA scores were 71 and 78 percent for tone and rhythm, respectively, with no association with music enjoyment.

CONCLUSION

Music perception through a cochlear implant is a complex phenomenon that depends on audiological and non-audiological factors.

Unique technological voice method (The YUBA Method) shows clear improvement in patients with cochlear implants in singing

It is known that children with cochlear implants tend to sing off-key, monotonously, and flat. There are a few reports that it is possible to improve off-key singing mainly through instruction using the falsetto voice for people with normal hearing. We examined whether their singing skills could be improved through instruction. Eight subjects (five boys and three girls aged 10.4+/-2.4 years) with cochlear implants were selected. Speech perception scores of short sentences were on average 66.5%+/-26.5%. We diagnosed their singing acuity by letting them sing a nursery song, well known to all of them, before and after the instruction. The mean fundamental frequencies of their singing approached the mean Musical Instrument Digital Interface (MIDI)-specified frequencies as references and the deviation between fundamental frequencies of their singing and reference MIDI sounds became smaller. This study shows a clear improvement in the singing ability of children with cochlear implants through a unique technological voice method, mainly focused on the falsetto voice in this experiment.

Does music perception have an impact on quality of life following cochlear implantation?

CONCLUSION

Despite the decrease in listening habits, about half of the patients still enjoy music post implantation. Better quality of sound through the implant improves music enjoyment and contributes to achievement of better postoperative quality of life (QOL).

OBJECTIVES

To evaluate music perception and enjoyment in cochlear implant (CI) users, and to assess their influence on QOL.

MATERIALS AND METHODS

Sixty-five post-lingually deaf CI recipients were enrolled in this study. A musical questionnaire evaluated musical background, listening habits, and quality of musical sound through the CI. The validated Glasgow Benefit Inventory (GBI) was used to quantify changes in QOL.

RESULTS

Fifty-two patients answered the questionnaires. Listening habits (music enjoyment and hours spent listening to music per week) significantly decreased following implantation when compared with the same parameters before deafness. Nevertheless, 52% of the patients enjoyed music post implantation. The quality of musical sound was rated >50 (0-100 scale) for the adjective pairs 'like-dislike', 'sounds like music-doesn't sound like music' and 'natural-mechanical' by most users. Med-el device users obtained better scores in the adjective pair 'sounds like music-doesn't sound like music' than Cochlear device users. Recipients rating higher scores for quality of sound enjoyed music post implantation and had higher total GBI scores than those rating lower scores.

Music perception with cochlear implants: a review

The acceptance of cochlear implantation as an effective and safe treatment for deafness has increased steadily over the past quarter century. The earliest devices were the first implanted prostheses found to be successful in compensating partially for lost sensory function by direct electrical stimulation of nerves. Initially, the main intention was to provide limited auditory sensations to people with profound or total sensorineural hearing impairment in both ears. Although the first cochlear implants aimed to provide patients with little more than awareness of environmental sounds and some cues to assist visual speech-reading, the technology has advanced rapidly. Currently, most people with modern cochlear implant systems can understand speech using the device alone, at least in favorable listening conditions. In recent years, an increasing research effort has been directed towards implant users' perception of nonspeech sounds, especially music. This paper reviews that research, discusses the published experimental results in terms of both psychophysical observations and device function, and concludes with some practical suggestions about how perception of music might be enhanced for implant recipients in the future. The most significant findings of past research are: (1) On average, implant users perceive rhythm about as well as listeners with normal hearing; (2) Even with technically sophisticated multiple-channel sound processors, recognition of melodies, especially without rhythmic or verbal cues, is poor, with performance at little better than chance levels for many implant users; (3) Perception of timbre, which is usually evaluated by experimental procedures that require subjects to identify musical instrument sounds, is generally unsatisfactory; (4) Implant users tend to rate the quality of musical sounds as less pleasant than listeners with normal hearing; (5) Auditory training programs that have been devised specifically to provide implant users with structured musical listening experience may improve the subjective acceptability of music that is heard through a prosthesis; (6) Pitch perception might be improved by designing innovative sound processors that use both temporal and spatial patterns of electric stimulation more effectively and precisely to overcome the inherent limitations of signal coding in existing implant systems; (7) For the growing population of implant recipients who have usable acoustic hearing, at least for low-frequency sounds, perception of music is likely to be much better with combined acoustic and electric stimulation than is typical for deaf people who rely solely on the hearing provided by their prostheses.