Music perception and training for pediatric cochlear implant users

Low-frequency pitch coding: relationships with speech-in-noise and music perception by pediatric populations with typical hearing and cochlear implants

PURPOSE

This study aimed to investigate the effects of low frequency (LF) pitch perception on speech-in-noise and music perception performance by children with cochlear implants (CIC) and typical hearing (THC). Moreover, the relationships between speech-in-noise and music perception as well as the effects of demographic and audiological factors on present research outcomes were studied.

METHODS

The sample consisted of 22 CIC and 20 THC (7-10 years). Harmonic intonation (HI) and disharmonic intonation (DI) tests were used to assess LF pitch perception. Speech perception in quiet (WRSq)/noise (WRSn + 10) were tested with the Italian bisyllabic words for pediatric populations. The Gordon test was used to evaluate music perception (rhythm, melody, harmony, and overall).

RESULTS

CIC/THC performance comparisons for LF pitch, speech-in-noise, and all music measures except harmony revealed statistically significant differences with large effect sizes. For the CI group, HI showed statistically significant correlations with melody discrimination. Melody/total Gordon scores were significantly correlated with WRSn + 10. For the overall group, HI/DI showed significant correlations with all music perception measures and WRSn + 10. Hearing thresholds showed significant effects on HI/DI scores. Hearing thresholds and WRSn + 10 scores were significantly correlated; both revealed significant effects on all music perception scores. CI age had significant effects on WRSn + 10, harmony, and total Gordon scores (p < 0.05).

CONCLUSION

Such findings confirmed the significant effects of LF pitch perception on complex listening performance. Significant speech-in-noise and music perception correlations were as promising as results from recent studies indicating significant positive effects of music training on speech-in-noise recognition in CIC.

Motor Processing in Children With Cochlear Implants as Assessed by Functional Near-Infrared Spectroscopy

Auditory-motor and visual-motor networks are often coupled in daily activities, such as when listening to music and dancing; but these networks are known to be highly malleable as a function of sensory input. Thus, congenital deafness may modify neural activities within the connections between the motor, auditory, and visual cortices. Here, we investigated whether the cortical responses of children with cochlear implants (CI) to a simple and repetitive motor task would differ from that of children with typical hearing (TH) and we sought to understand whether this response related to their language development. Participants were 75 school-aged children, including 50 with CI (with varying language abilities) and 25 controls with TH. We used functional near-infrared spectroscopy (fNIRS) to record cortical responses over the whole brain, as children squeezed the back triggers of a joystick that vibrated or not with the squeeze. Motor cortex activity was reflected by an increase in oxygenated hemoglobin concentration (HbO) and a decrease in deoxygenated hemoglobin concentration (HbR) in all children, irrespective of their hearing status. Unexpectedly, the visual cortex (supposedly an irrelevant region) was deactivated in this task, particularly for children with CI who had good language skills when compared to those with CI who had language delays. Presence or absence of vibrotactile feedback made no difference in cortical activation. These findings support the potential of fNIRS to examine cognitive functions related to language in children with CI.

Psychosocial and auditory factors that influence successful music-based auditory training in pediatric cochlear implant recipients

Introduction

Cochlear implants (CIs), which are designed to support spoken communication of persons with severe to profound hearing loss, can provide improved hearing capability through passive exposure. However, auditory training may optimize perception of spectrally complex sounds such as music or speech. Reviews of music-based training for pediatric CI users have reported modest though variable benefits, as well as problems with attrition. It is presumed that more substantial changes may result from longer, more intensive training; however, the development of protocols sufficiently motivating for sustained intensity is challenging. This article examined the experiences of star pediatric CI users, whose years of music training have yielded exceptional auditory benefits. Greater understanding of their experiences and attitudes may suggest best practices for music-based training. Research aims included: (a) characterizing the musical behaviors and perceptual learning processes of music-centric (Music-centric, for purposes of this paper, refers to CI users who engage in sustained and successful music making such as music lessons and ensembles and focused music listening over a period of years, and who derive deep satisfaction from those experiences.) pediatric CI users, and (b) identifying psychosocial and auditory factors that motivated persistence in auditory training.

Methods

We used qualitative and patient-engaged research methodologies, gathering data through questionnaires with open-ended questions. The participants, six music-centric CI users and five parents, described their experiences and attitudes regarding music training, and factors that supported or undermined those experiences. Data were analyzed using reflexive thematic analysis.

Results

The codes were consolidated into five themes and organized into a Model of Music-Based Learning for Pediatric Cochlear Implant Recipients. Sustained participation in music training was perceived as a dynamic process including varied musical stimuli, and moderated by intrinsic (attitude, perceived behavioral control) and extrinsic (parents, teachers, peers) influences, hearing status, sound access and background factors.

Discussion

These themes highlighted motivational factors that pediatric CI users and parents considered important to sustained, intensive and successful music learning throughout childhood and adolescence. These factors should be considered in the development of music-based training for pediatric CI recipients.

Evaluation of musical emotion perception and language development in children with cochlear implants

OBJECTIVES

While the primary purpose of cochlear implant (CI) fitting is to improve individuals' receptive and expressive skills, musical emotion perception (MEP) is generally ignored. This study assesses the MEP and language skills (LS) of children using CI.

METHODS

26 CI users and 26 matched healthy controls between the ages of 6 and 9 were included in the study. The Test of Language Development (TOLD) was applied to evaluate the LS of the participants, and the Montreal Emotion Identification Test (MEI) was applied to evaluate the MEP.

RESULTS

MEI test scores and all subtests of TOLD were statistically significantly lower in the CI group. Also, there was a statistically significant and moderate correlation between the listening subtest of TOLD and the MEI test.

CONCLUSIONS

MEP and language skills are poor in children with CI. Although language skills are primarily targeted in CI performance, improving MEP should also be included in rehabilitation programs. The relationship between music and the TOLD's listening subtest may provide evidence that listening skills can be improved by paying attention to the MEP, which is frequently ignored in rehabilitation programs.

Emotions and Psychological Mechanisms of Listening to Music in Cochlear Implant Recipients

OBJECTIVES

Music is a multidimensional phenomenon and is classified by its arousal properties, emotional quality, and structural characteristics. Although structural features of music (i.e., pitch, timbre, and tempo) and music emotion recognition in cochlear implant (CI) recipients are popular research topics, music-evoked emotions, and related psychological mechanisms that reflect both the individual and social context of music are largely ignored. Understanding the music-evoked emotions (the "what") and related mechanisms (the "why") can help professionals and CI recipients better comprehend the impact of music on CI recipients' daily lives. Therefore, the purpose of this study is to evaluate these aspects in CI recipients and compare their findings to those of normal hearing (NH) controls.

DESIGN

This study included 50 CI recipients with diverse auditory experiences who were prelingually deafened (deafened at or before 6 years of age)-early implanted (N = 21), prelingually deafened-late implanted (implanted at or after 12 years of age-N = 13), and postlingually deafened (N = 16) as well as 50 age-matched NH controls. All participants completed the same survey, which included 28 emotions and 10 mechanisms (Brainstem reflex, Rhythmic entrainment, Evaluative Conditioning, Contagion, Visual imagery, Episodic memory, Musical expectancy, Aesthetic judgment, Cognitive appraisal, and Lyrics). Data were presented in detail for CI groups and compared between CI groups and between CI and NH groups.

RESULTS

The principal component analysis showed five emotion factors that are explained by 63.4% of the total variance, including anxiety and anger, happiness and pride, sadness and pain, sympathy and tenderness, and serenity and satisfaction in the CI group. Positive emotions such as happiness, tranquility, love, joy, and trust ranked as most often experienced in all groups, whereas negative and complex emotions such as guilt, fear, anger, and anxiety ranked lowest. The CI group ranked lyrics and rhythmic entrainment highest in the emotion mechanism, and there was a statistically significant group difference in the episodic memory mechanism, in which the prelingually deafened, early implanted group scored the lowest.

CONCLUSION

Our findings indicate that music can evoke similar emotions in CI recipients with diverse auditory experiences as it does in NH individuals. However, prelingually deafened and early implanted individuals lack autobiographical memories associated with music, which affects the feelings evoked by music. In addition, the preference for rhythmic entrainment and lyrics as mechanisms of music-elicited emotions suggests that rehabilitation programs should pay particular attention to these cues.

Vocal singing skills by cochlear implanted children without formal musical training: Familiar versus unfamiliar songs

OBJECTIVES

Vocal singing skills in pediatric CI users are not much known due to the limited number of studies. The principal aim of the present study was to evaluate vocal singing skills in Italian pediatric CI users. A further aim was to investigate factors that may significantly influence their performance.

METHODS

The participants were twenty-two implanted children and twenty-two hearing peers. Their vocal singing skills for familiar ("Happy Birthday to You") and unfamiliar songs ("Baton Twirler" from Pam Pam 2- Tribute to Gordon) were evaluated in relation to their music perception (the Gordon test). Acoustic analysis was performed using Praat and MATLAB software. Nonparametric statistical tests and principal component analysis (PCA) were used to analyze the data.

RESULTS

Hearing children outperformed implanted peers in both music perception and vocal singing tasks (all measures regarding intonation, vocal range, melody, and memory for the familiar song versus measures regarding intonation and overall melody production for the unfamiliar song). Music perception and vocal singing performances revealed strong correlations. For the familiar and unfamiliar songs, age-appropriate vocal singing was observed in 27.3% versus 45.4% of children, all implanted within 24 months of age. Age at implantation and duration of CI experience were moderately correlated with the total score obtained from the Gordon test.

CONCLUSION

Implanted children show limited vocal singing skills in comparison to their hearing peers. However, some children implanted within 24 months of age seem to achieve vocal singing skills as good as their hearing peers. Future research could be useful to better understand the role of brain plasticity to implement specific training programs for both music perception and vocal singing.

Mismatch negativity as a marker of music perception in individual cochlear implant users: A spike density component analysis study

OBJECTIVE

Ninety percent of cochlear implant (CI) users are interested in improving their music perception. However, only few objective behavioral and neurophysiological tests have been developed for tracing the development of music discrimination skills in CI users. In this study, we aimed to obtain an accurate individual mismatch negativity (MMN) marker that could predict behavioral auditory discrimination thresholds.

METHODS

We measured the individual MMN response to four magnitudes of deviations in four different musical features (intensity, pitch, timbre, and rhythm) in a rare sample of experienced CI users and a control sample of normally hearing participants. We applied a recently developed spike density component analysis (SCA), which can suppress confounding alpha waves, and contrasted it with previously proposed methods.

RESULTS

Statistically detected individual MMN predicted attentive sound discrimination ability with high accuracy: for CI users 89.2% (278/312 cases) and for controls 90.5% (384/424 cases). As expected, MMN was detected for fewer CI users when the sound deviants were of smaller magnitude.

CONCLUSIONS

The findings support the use of MMN responses in individual CI users as a diagnostic tool for testing music perception.

SIGNIFICANCE

For CI users, the new SCA method provided more accurate and replicable diagnostic detections than preceding state-of-the-art.

Musical Training Enhances Categorical Perception of Speech in Preschoolers: Training Duration and Musical Program Matter

PURPOSE

Previous research has indicated the beneficial effects of musical training on speech perception in children. However, little has been known about whether musical training exerts transfer effects on fine-grained perception of linguistic pitch and time information. This study aimed to investigate the effects of different musical training programs and training duration on preschoolers' categorical perception (CP) of lexical tones and voice onset time (VOT) in Mandarin Chinese, which utilize pitch and time changes, respectively, to convey phonemic contrasts.

METHOD

Sixty-one Mandarin-speaking children aged 4 years were randomly assigned to pitch-based musical training (carillon group), rhythm-based musical training (drum group), or handcraft learning (control group). Children completed the tests designed to assess their musical abilities, CP of lexical tones and VOT, IQ, and working memory at three time-points. Repeated-measures analyses of variance were conducted to evaluate the training-related effects in various tasks. Correlation analyses were used to infer the relationships between musical abilities and CP performance of speech.

RESULTS

The carillon group demonstrated advantages over the drum and control groups in music pitch processing and CP of lexical tones; besides, the drum group performed better in the music time processing and CP of VOT than the control group. Moreover, positive correlations were found between musical gains and improvements on CP of speech.

CONCLUSIONS

These results provide evidence that transfer effects occur in CP of lexical tones and VOT in preschoolers. Our findings highlight the selectivity of musical advantages driven by different components of training programs and suggest that long-term musical training could be a means of early speech rehabilitation in children with communication disorders.

Conversations in Cochlear Implantation: The Inner Ear Therapy of Today

As biomolecular approaches for hearing restoration in profound sensorineural hearing loss evolve, they will be applied in conjunction with or instead of cochlear implants. An understanding of the current state-of-the-art of this technology, including its advantages, disadvantages, and its potential for delivering and interacting with biomolecular hearing restoration approaches, is helpful for designing modern hearing-restoration strategies. Cochlear implants (CI) have evolved over the last four decades to restore hearing more effectively, in more people, with diverse indications. This evolution has been driven by advances in technology, surgery, and healthcare delivery. Here, we offer a practical treatise on the state of cochlear implantation directed towards developing the next generation of inner ear therapeutics. We aim to capture and distill conversations ongoing in CI research, development, and clinical management. In this review, we discuss successes and physiological constraints of hearing with an implant, common surgical approaches and electrode arrays, new indications and outcome measures for implantation, and barriers to CI utilization. Additionally, we compare cochlear implantation with biomolecular and pharmacological approaches, consider strategies to combine these approaches, and identify unmet medical needs with cochlear implants. The strengths and weaknesses of modern implantation highlighted here can mark opportunities for continued progress or improvement in the design and delivery of the next generation of inner ear therapeutics.

The Neural Processing of Vocal Emotion After Hearing Reconstruction in Prelingual Deaf Children: A Functional Near-Infrared Spectroscopy Brain Imaging Study

As elucidated by prior research, children with hearing loss have impaired vocal emotion recognition compared with their normal-hearing peers. Cochlear implants (CIs) have achieved significant success in facilitating hearing and speech abilities for people with severe-to-profound sensorineural hearing loss. However, due to the current limitations in neuroimaging tools, existing research has been unable to detail the neural processing for perception and the recognition of vocal emotions during early stage CI use in infant and toddler CI users (ITCI). In the present study, functional near-infrared spectroscopy (fNIRS) imaging was employed during preoperative and postoperative tests to describe the early neural processing of perception in prelingual deaf ITCIs and their recognition of four vocal emotions (fear, anger, happiness, and neutral). The results revealed that the cortical response elicited by vocal emotional stimulation on the left pre-motor and supplementary motor area (pre-SMA), right middle temporal gyrus (MTG), and right superior temporal gyrus (STG) were significantly different between preoperative and postoperative tests. These findings indicate differences between the preoperative and postoperative neural processing associated with vocal emotional stimulation. Further results revealed that the recognition of vocal emotional stimuli appeared in the right supramarginal gyrus (SMG) after CI implantation, and the response elicited by fear was significantly greater than the response elicited by anger, indicating a negative bias. These findings indicate that the development of emotional bias and the development of emotional perception and recognition capabilities in ITCIs occur on a different timeline and involve different neural processing from those in normal-hearing peers. To assess the speech perception and production abilities, the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and Speech Intelligibility Rating (SIR) were used. The results revealed no significant differences between preoperative and postoperative tests. Finally, the correlates of the neurobehavioral results were investigated, and the results demonstrated that the preoperative response of the right SMG to anger stimuli was significantly and positively correlated with the evaluation of postoperative behavioral outcomes. And the postoperative response of the right SMG to anger stimuli was significantly and negatively correlated with the evaluation of postoperative behavioral outcomes.