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Fehrmann MLA, Meijer FJA, Mylanus EAM, Pennings RJE, Lanting CP, Huinck WJ. Evaluating cochlear implant outcomes in DFNA9 subjects: a comprehensive study on cerebral white matter lesions and vestibular abnormalities. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08933-1. [PMID: 39271588 DOI: 10.1007/s00405-024-08933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/19/2024] [Indexed: 09/15/2024]
Abstract
PURPOSE This study assessed whether the Fazekas score could account for the variability in cochlear implantation (CI) outcomes among individuals with DFNA9 and evaluated signal loss in the semicircular canals (SCCs) on magnetic resonance imaging (MRI) among individuals with DFNA9. METHOD This retrospective cross-sectional study included CI recipients with DFNA9. Pre-implantation MRI-scans were reviewed to determine the Fazekas score, localizing and grading cerebral white matter lesions (WML), and identify abnormalities in the SCCs. CI performance was assessed by evaluating phoneme scores one year post-implantation. The function of the SCCs was evaluated using rotatory chair testing with electronystagmography (ENG) and the video Head Impulse Test (vHIT). RESULTS Forty-five subjects (49 ears) were enrolled. The phoneme scores significantly improved from 35% (IQR 11-50) pre-implantation to 84% (IQR 76-90) one year post-implantation. No correlation was observed between the Fazekas score and the one-year post-implantation phoneme score (rsp=0.003, p = 0.986). Signal loss in at least one SCCs was detected in 97.7% of subjects and 77.8% of ears. There was no correlation between vestibular test results and fluid signal loss in the SCCs on MRI. CONCLUSION Most individuals with DFNA9 show improved speech recognition with CI. The observed variability in CI outcomes was not linked to the Fazekas score. Additionally, our study confirms a high prevalence of focal sclerosis in DFNA9. Recognizing the limitations of this study, further research is needed to explore the predictive role of the Fazekas score on CI outcomes and its relationship with vestibular function.
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Affiliation(s)
- M L A Fehrmann
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - F J A Meijer
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E A M Mylanus
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - R J E Pennings
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - C P Lanting
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - W J Huinck
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands.
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
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McMurray B, Smith FX, Huffman M, Rooff K, Muegge JB, Jeppsen C, Kutlu E, Colby S. Underlying dimensions of real-time word recognition in cochlear implant users. Nat Commun 2024; 15:7382. [PMID: 39209837 PMCID: PMC11362525 DOI: 10.1038/s41467-024-51514-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/08/2024] [Indexed: 09/04/2024] Open
Abstract
Word recognition is a gateway to language, linking sound to meaning. Prior work has characterized its cognitive mechanisms as a form of competition between similar-sounding words. However, it has not identified dimensions along which this competition varies across people. We sought to identify these dimensions in a population of cochlear implant users with heterogenous backgrounds and audiological profiles, and in a lifespan sample of people without hearing loss. Our study characterizes the process of lexical competition using the Visual World Paradigm. A principal component analysis reveals that people's ability to resolve lexical competition varies along three dimensions that mirror prior small-scale studies. These dimensions capture the degree to which lexical access is delayed ("Wait-and-See"), the degree to which competition fully resolves ("Sustained-Activation"), and the overall rate of activation. Each dimension is predicted by a different auditory skills and demographic factors (onset of deafness, age, cochlear implant experience). Moreover, each dimension predicts outcomes (speech perception in quiet and noise, subjective listening success) over and above auditory fidelity. Higher degrees of Wait-and-See and Sustained-Activation predict poorer outcomes. These results suggest the mechanisms of word recognition vary along a few underlying dimensions which help explain variable performance among listeners encountering auditory challenge.
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Affiliation(s)
- Bob McMurray
- Dept. of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, USA.
- Dept. of Communication Sciences & Disorders, University of Iowa, Iowa City, IA, USA.
- Dept. of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA, USA.
- Dept. of Linguistics, University of Iowa, Iowa City, IA, USA.
| | - Francis X Smith
- Dept. of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, USA
- Dept. of Communication Sciences & Disorders, University of Iowa, Iowa City, IA, USA
| | - Marissa Huffman
- Dept. of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Kristin Rooff
- Dept. of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - John B Muegge
- Dept. of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Charlotte Jeppsen
- Dept. of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Ethan Kutlu
- Dept. of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, USA
- Dept. of Linguistics, University of Iowa, Iowa City, IA, USA
| | - Sarah Colby
- Dept. of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, USA
- Dept. of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
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Marx M, Laborde ML, Algans C, Tartayre M, James CJ. Barriers to Early Progress in Adult Cochlear Implant Outcomes. Ear Hear 2024:00003446-990000000-00329. [PMID: 39129126 DOI: 10.1097/aud.0000000000001559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
OBJECTIVES Adult cochlear implant (CI) recipients obtain varying levels of speech perception from their device. Adult CI users adapt quickly to their CI if they have no peripheral "bottom-up" or neurocognitive "top-down" limiting factors. Our objective here was to understand the influence of limiting factors on the progression of sentence understanding in quiet and in noise, initially and over time. We hypothesized that the presence of limiting factors, detected using a short test battery, would predictably influence sentence recognition with practical consequences. We aimed to validate the test battery by comparing the presence of limiting factors and the success criteria of >90% sentence understanding in quiet 1 month after activation. DESIGN The study was a single-clinic, cross-sectional, retrospective design incorporating 32 adult unilateral Nucleus CI users aged 27 to 90 years (mean = 70, SD = 13.5). Postoperative outcome was assessed through sentence recognition scores in quiet and in varying signal to noise ratios at 1 day, 1 to 2 months, and up to 2 years. Our clinic's standard test battery comprises physiological and neurocognitive measures. Physiological measures included electrically evoked compound action potentials for recovery function, spread of excitation, and polarity effect. To evaluate general cognitive function, inhibition, and phonological awareness, the Montreal Cognitive Assessment screening test, the Stroop Color-Word Test, and tests 3 and 4 of the French Assessment of Reading Skills in Adults over 16 years of age, respectively were performed. Physiological scores were considered abnormal, and therefore limiting, when total neural recovery periods and polarity effects, for both apical and basal electrode positions, were >1.65 SDs from the population mean. A spread of excitation of >6 electrode units was also considered limiting. For the neurocognitive tests, scores poorer than 1.65 SDs from published normal population means were considered limiting. RESULTS At 1 month, 13 out of 32 CI users scored ≥90% sentence recognition in quiet with no significant dependence on age. Subjects with no limiting peripheral or neurocognitive factors were 8.5 times more likely to achieve ≥90% score in quiet at 1 month after CI switch-on (p = 0.010). In our sample, we detected 4 out of 32 cases with peripheral limiting factors that related to neural health or poor electrode-neural interface at both apical and basal positions. In contrast, neurocognitive limiting factors were identified in 14 out of 32 subjects. Early sentence recognition scores were predictive of long-term sentence recognition thresholds in noise such that limiting factors appeared to be of continuous influence. CONCLUSIONS Both peripheral and neurocognitive processing factors affect early sentence recognition after CI activation. Peripheral limiting factors may have been detected less often than neurocognitive limiting factors because they were defined using sample-based criteria versus normal population-based criteria. Early performance was generally predictive of long-term performance. Understanding the measurable covariables that limit CI performance may inform follow-up and improve counseling. A score of ≥90% for sentence recognition in quiet at 1 month may be used to define successful progress; whereas, lower scores indicate the need for diagnostic testing and ongoing rehabilitation. Our findings suggest that sentence test scores as early as 1 day after activation can provide vital information for the new CI user and indicate the need for rehabilitation follow-up.
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Affiliation(s)
- Mathieu Marx
- Service Oto Rhino Laryngologie Hôpital Riquet, Toulouse, France
| | | | - Carol Algans
- Service Oto Rhino Laryngologie Hôpital Riquet, Toulouse, France
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Amini AE, Naples JG, Cortina L, Hwa T, Morcos M, Castellanos I, Moberly AC. A Scoping Review and Meta-Analysis of the Relations Between Cognition and Cochlear Implant Outcomes and the Effect of Quiet Versus Noise Testing Conditions. Ear Hear 2024:00003446-990000000-00304. [PMID: 38953851 DOI: 10.1097/aud.0000000000001527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
OBJECTIVES Evidence continues to emerge of associations between cochlear implant (CI) outcomes and cognitive functions in postlingually deafened adults. While there are multiple factors that appear to affect these associations, the impact of speech recognition background testing conditions (i.e., in quiet versus noise) has not been systematically explored. The two aims of this study were to (1) identify associations between speech recognition following cochlear implantation and performance on cognitive tasks, and to (2) investigate the impact of speech testing in quiet versus noise on these associations. Ultimately, we want to understand the conditions that impact this complex relationship between CI outcomes and cognition. DESIGN A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed on published literature evaluating the relation between outcomes of cochlear implantation and cognition. The current review evaluates 39 papers that reported associations between over 30 cognitive assessments and speech recognition tests in adult patients with CIs. Six cognitive domains were evaluated: Global Cognition, Inhibition-Concentration, Memory and Learning, Controlled Fluency, Verbal Fluency, and Visuospatial Organization. Meta-analysis was conducted on three cognitive assessments among 12 studies to evaluate relations with speech recognition outcomes. Subgroup analyses were performed to identify whether speech recognition testing in quiet versus in background noise impacted its association with cognitive performance. RESULTS Significant associations between cognition and speech recognition in a background of quiet or noise were found in 69% of studies. Tests of Global Cognition and Inhibition-Concentration skills resulted in the highest overall frequency of significant associations with speech recognition (45% and 57%, respectively). Despite the modest proportion of significant associations reported, pooling effect sizes across samples through meta-analysis revealed a moderate positive correlation between tests of Global Cognition (r = +0.37, p < 0.01) as well as Verbal Fluency (r = +0.44, p < 0.01) and postoperative speech recognition skills. Tests of Memory and Learning are most frequently utilized in the setting of CI (in 26 of 39 included studies), yet meta-analysis revealed nonsignificant associations with speech recognition performance in a background of quiet (r = +0.30, p = 0.18), and noise (r = -0.06, p = 0.78). CONCLUSIONS Background conditions of speech recognition testing may influence the relation between speech recognition outcomes and cognition. The magnitude of this effect of testing conditions on this relationship appears to vary depending on the cognitive construct being assessed. Overall, Global Cognition and Inhibition-Concentration skills are potentially useful in explaining speech recognition skills following cochlear implantation. Future work should continue to evaluate these relations to appropriately unify cognitive testing opportunities in the setting of cochlear implantation.
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Affiliation(s)
- Andrew E Amini
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- These authors contributed equally to this work
| | - James G Naples
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- These authors contributed equally to this work
| | - Luis Cortina
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Tiffany Hwa
- Division of Otology, Neurotology, & Lateral Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary Morcos
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Irina Castellanos
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Aaron C Moberly
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Khayr R, Khnifes R, Shpak T, Banai K. Task-Specific Rapid Auditory Perceptual Learning in Adult Cochlear Implant Recipients: What Could It Mean for Speech Recognition. Ear Hear 2024:00003446-990000000-00285. [PMID: 38829780 DOI: 10.1097/aud.0000000000001523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Speech recognition in cochlear implant (CI) recipients is quite variable, particularly in challenging listening conditions. Demographic, audiological, and cognitive factors explain some, but not all, of this variance. The literature suggests that rapid auditory perceptual learning explains unique variance in speech recognition in listeners with normal hearing and those with hearing loss. The present study focuses on the early adaptation phase of task-specific rapid auditory perceptual learning. It investigates whether adult CI recipients exhibit this learning and, if so, whether it accounts for portions of the variance in their recognition of fast speech and speech in noise. DESIGN Thirty-six adult CI recipients (ages = 35 to 77, M = 55) completed a battery of general speech recognition tests (sentences in speech-shaped noise, four-talker babble noise, and natural-fast speech), cognitive measures (vocabulary, working memory, attention, and verbal processing speed), and a rapid auditory perceptual learning task with time-compressed speech. Accuracy in the general speech recognition tasks was modeled with a series of generalized mixed models that accounted for demographic, audiological, and cognitive factors before accounting for the contribution of task-specific rapid auditory perceptual learning of time-compressed speech. RESULTS Most CI recipients exhibited early task-specific rapid auditory perceptual learning of time-compressed speech within the course of the first 20 sentences. This early task-specific rapid auditory perceptual learning had unique contribution to the recognition of natural-fast speech in quiet and speech in noise, although the contribution to natural-fast speech may reflect the rapid learning that occurred in this task. When accounting for demographic and cognitive characteristics, an increase of 1 SD in the early task-specific rapid auditory perceptual learning rate was associated with ~52% increase in the odds of correctly recognizing natural-fast speech in quiet, and ~19% to 28% in the odds of correctly recognizing the different types of speech in noise. Age, vocabulary, attention, and verbal processing speed also had unique contributions to general speech recognition. However, their contribution varied between the different general speech recognition tests. CONCLUSIONS Consistent with previous findings in other populations, in CI recipients, early task-specific rapid auditory perceptual, learning also accounts for some of the individual differences in the recognition of speech in noise and natural-fast speech in quiet. Thus, across populations, the early rapid adaptation phase of task-specific rapid auditory perceptual learning might serve as a skill that supports speech recognition in various adverse conditions. In CI users, the ability to rapidly adapt to ongoing acoustical challenges may be one of the factors associated with good CI outcomes. Overall, CI recipients with higher cognitive resources and faster rapid learning rates had better speech recognition.
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Affiliation(s)
- Ranin Khayr
- Department of Communication Sciences and Disorders, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Technion-Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Riyad Khnifes
- Department of Communication Sciences and Disorders, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Technion-Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Talma Shpak
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Technion-Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Karen Banai
- Department of Communication Sciences and Disorders, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
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Thompson NJ, Dillon MT, Nix EP, Overton AB, Selleck AM, Dedmon MM, Brown KD. Variables Affecting Cochlear Implant Performance After Loss of Residual Hearing. Laryngoscope 2024; 134:1868-1873. [PMID: 37767794 DOI: 10.1002/lary.31066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/15/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Determine variables that influence post-activation performance for cochlear implant (CI) recipients who lost low-frequency acoustic hearing. METHODS A retrospective review evaluated CNC word recognition for adults with normal to moderately severe low-frequency hearing (preoperative unaided thresholds of ≤70 dB HL at 250 Hz) who were implanted between 2012 and 2021 at a tertiary academic center, lost functional acoustic hearing, and were fit with a CI-alone device. Performance scores were queried from the 1, 3, 6, 12, and 24-month post-activation visits. A linear mixed model evaluated the effects of age at implantation, array length (long vs. mid/short), and preoperative low-frequency hearing (normal to mild, moderate, and moderately severe) on speech recognition with a CI alone. RESULTS 113 patients met the inclusion criteria. There was a significant main effect of interval (p < 0.001), indicating improved word recognition post-activation despite loss of residual hearing. There were significant main effects of age (p = 0.029) and array length (p = 0.038), with no effect of preoperative low-frequency hearing (p = 0.171). There was a significant 2-way interaction between age and array length (p = 0.018), indicating that older adults with mid/short arrays performed more poorly than younger adults with long lateral wall arrays when functional acoustic hearing was lost. CONCLUSION CI recipients with preoperative functional low-frequency hearing experience a significant improvement in speech recognition with a CI alone as compared to preoperative performance-despite the loss of low-frequency hearing. Age and electrode array length may play a role in post-activation performance. These data have implications for the preoperative counseling and device selection for hearing preservation candidates. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1868-1873, 2024.
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Affiliation(s)
- Nicholas J Thompson
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Margaret T Dillon
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Evan P Nix
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Andrea B Overton
- Audiology Department, UNC Health, Chapel Hill, North Carolina, U.S.A
| | - A Morgan Selleck
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Matthew M Dedmon
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Kevin D Brown
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
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Tamati TN, Jebens A, Başkent D. Lexical effects on talker discrimination in adult cochlear implant usersa). THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2024; 155:1631-1640. [PMID: 38426835 PMCID: PMC10908561 DOI: 10.1121/10.0025011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024]
Abstract
The lexical and phonological content of an utterance impacts the processing of talker-specific details in normal-hearing (NH) listeners. Adult cochlear implant (CI) users demonstrate difficulties in talker discrimination, particularly for same-gender talker pairs, which may alter the reliance on lexical information in talker discrimination. The current study examined the effect of lexical content on talker discrimination in 24 adult CI users. In a remote AX talker discrimination task, word pairs-produced either by the same talker (ST) or different talkers with the same (DT-SG) or mixed genders (DT-MG)-were either lexically easy (high frequency, low neighborhood density) or lexically hard (low frequency, high neighborhood density). The task was completed in quiet and multi-talker babble (MTB). Results showed an effect of lexical difficulty on talker discrimination, for same-gender talker pairs in both quiet and MTB. CI users showed greater sensitivity in quiet as well as less response bias in both quiet and MTB for lexically easy words compared to lexically hard words. These results suggest that CI users make use of lexical content in same-gender talker discrimination, providing evidence for the contribution of linguistic information to the processing of degraded talker information by adult CI users.
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Affiliation(s)
- Terrin N Tamati
- Department of Otolaryngology, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, Tennessee 37232, USA
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Almut Jebens
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Deniz Başkent
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Research School of Behavioral and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, The Netherlands
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MacIntyre AD, Carlyon RP, Goehring T. Neural Decoding of the Speech Envelope: Effects of Intelligibility and Spectral Degradation. Trends Hear 2024; 28:23312165241266316. [PMID: 39183533 PMCID: PMC11345737 DOI: 10.1177/23312165241266316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/23/2024] [Accepted: 06/16/2024] [Indexed: 08/27/2024] Open
Abstract
During continuous speech perception, endogenous neural activity becomes time-locked to acoustic stimulus features, such as the speech amplitude envelope. This speech-brain coupling can be decoded using non-invasive brain imaging techniques, including electroencephalography (EEG). Neural decoding may provide clinical use as an objective measure of stimulus encoding by the brain-for example during cochlear implant listening, wherein the speech signal is severely spectrally degraded. Yet, interplay between acoustic and linguistic factors may lead to top-down modulation of perception, thereby complicating audiological applications. To address this ambiguity, we assess neural decoding of the speech envelope under spectral degradation with EEG in acoustically hearing listeners (n = 38; 18-35 years old) using vocoded speech. We dissociate sensory encoding from higher-order processing by employing intelligible (English) and non-intelligible (Dutch) stimuli, with auditory attention sustained using a repeated-phrase detection task. Subject-specific and group decoders were trained to reconstruct the speech envelope from held-out EEG data, with decoder significance determined via random permutation testing. Whereas speech envelope reconstruction did not vary by spectral resolution, intelligible speech was associated with better decoding accuracy in general. Results were similar across subject-specific and group analyses, with less consistent effects of spectral degradation in group decoding. Permutation tests revealed possible differences in decoder statistical significance by experimental condition. In general, while robust neural decoding was observed at the individual and group level, variability within participants would most likely prevent the clinical use of such a measure to differentiate levels of spectral degradation and intelligibility on an individual basis.
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Affiliation(s)
| | - Robert P. Carlyon
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Tobias Goehring
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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Amini AE, Naples JG, Hwa T, Larrow DC, Campbell FM, Qiu M, Castellanos I, Moberly AC. Emerging Relations among Cognitive Constructs and Cochlear Implant Outcomes: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 169:792-810. [PMID: 37365967 DOI: 10.1002/ohn.344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/07/2023] [Accepted: 03/25/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Hearing loss has a detrimental impact on cognitive function. However, there is a lack of consensus on the impact of cochlear implants on cognition. This review systematically evaluates whether cochlear implants in adult patients lead to cognitive improvements and investigates the relations of cognition with speech recognition outcomes. DATA SOURCES A literature review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies evaluating cognition and cochlear implant outcomes in postlingual, adult patients from January 1996 to December 2021 were included. Of 2510 total references, 52 studies were included in qualitative analysis and 11 in meta-analyses. REVIEW METHODS Proportions were extracted from studies of (1) the significant impacts of cochlear implantation on 6 cognitive domains and (2) associations between cognition and speech recognition outcomes. Meta-analyses were performed using random effects models on mean differences between pre- and postoperative performance on 4 cognitive assessments. RESULTS Only half of the outcomes reported suggested cochlear implantation had a significant impact on cognition (50.8%), with the highest proportion in assessments of memory & learning and inhibition-concentration. Meta-analyses revealed significant improvements in global cognition and inhibition-concentration. Finally, 40.4% of associations between cognition and speech recognition outcomes were significant. CONCLUSION Findings relating to cochlear implantation and cognition vary depending on the cognitive domain assessed and the study goal. Nonetheless, assessments of memory & learning, global cognition, and inhibition-concentration may represent tools to assess cognitive benefit after implantation and help explain variability in speech recognition outcomes. Enhanced selectivity in assessments of cognition is needed for clinical applicability.
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Affiliation(s)
- Andrew E Amini
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - James G Naples
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tiffany Hwa
- Division of Otology, Neurotology, and Lateral Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Danielle C Larrow
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank M Campbell
- Biotech Commons, Johnson Pavilion, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maylene Qiu
- Biotech Commons, Johnson Pavilion, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Irina Castellanos
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Aaron C Moberly
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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10
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Patro C, Bennaim A, Shephard E. Effects of spectral degradation on gated word recognition. JASA EXPRESS LETTERS 2023; 3:084401. [PMID: 37561082 DOI: 10.1121/10.0020646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
Although much is known about how normal-hearing listeners process spoken words under ideal listening conditions, little is known about how a degraded signal, such as speech transmitted via cochlear implants, affects the word recognition process. In this study, gated word recognition performance was measured with the goal of describing the time course of word identification by using a noise-band vocoder simulation. The results of this study demonstrate that spectral degradations can impact the temporal aspects of speech processing. These results also provide insights into the potential advantages of enhancing spectral resolution in the processing of spoken words.
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Affiliation(s)
- Chhayakanta Patro
- Department of Speech-Language Pathology & Audiology, Towson University, Towson, Maryland 21252, , ,
| | - Ariana Bennaim
- Department of Speech-Language Pathology & Audiology, Towson University, Towson, Maryland 21252, , ,
| | - Ellen Shephard
- Department of Speech-Language Pathology & Audiology, Towson University, Towson, Maryland 21252, , ,
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Layfield E, Hwa TP, Quimby AE, Brant JA, Bigelow D, Ruckenstein MJ, Eliades SJ. Impact of Anticholinergic Medications on Speech Perception Performance after Cochlear Implantation. Otol Neurotol 2023; 44:e364-e368. [PMID: 37205865 DOI: 10.1097/mao.0000000000003896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To identify and characterize the impact of anticholinergic medications, which have known adverse effects on cognition in older adults, on speech perception after cochlear implantation. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. SUBJECT POPULATION Adult patients who underwent cochlear implantation between January 2010 and September 2020 with speech perception scores at 3, 6, and 12 months. INTERVENTIONS Anticholinergic burden of patients' prescribed medications. MAIN OUTCOME MEASURES AzBio speech perception scores after implantation. RESULTS One hundred twenty-six patients had documented AzBio in quiet speech perception score at all three postactivation time points. Patients were divided into three groups by anticholinergic burden (ACB) score, including ACB = 0 (90 patients), 1 (23 patients), and ≥2 (13 patients). There was no statistically significant difference between ACB groups in audiologic performance at candidacy testing ( p = 0.77) or at 3 months after implantation ( p = 0.13). Beginning at 6 months, a lower mean AzBio was seen in patients with higher ACB scores (68% ACB = 0; 62% ACB = 1; 48.1% ACB ≥ 2; p = 0.03). At 12 months, there were further differences between the groups (71.0% ACB = 0, 69.5% ACB = 1, 48.0% ACB ≥2, p < 0.01). Controlling for the effects of age using multivariate linear regression showed persistent effects of ACB score on learning-related AzBio improvements. Comparatively, the negative impact of a single ACB score point was equivalent to nearly 10 years of aging ( p = 0.03). CONCLUSIONS Increased ACB is associated with worse speech perception scores after cochlear implantation, an effect that persists even when accounting for patient age, suggesting that these medications may have cognitive and learning effects that reduce cochlear implant performance.
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Affiliation(s)
- Eleanor Layfield
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Tiffany Peng Hwa
- Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alexandra E Quimby
- Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jason A Brant
- Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Douglas Bigelow
- Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael J Ruckenstein
- Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Steven J Eliades
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
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Gundogdu O, Serbetcioglu MB, Kara E, Eser BN. Effects of Cognitive Functions on Speech Recognition in Noise in Cochlear Implant Recipients. ORL J Otorhinolaryngol Relat Spec 2023; 85:208-214. [PMID: 37331341 DOI: 10.1159/000530233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/08/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION There are substantial differences in speech recognition performance of adult cochlear implant (CI) recipients. This study investigated the effects of cognitive function on speech recognition in CI recipients. METHODS The verbal working memory of 36 adults with unilateral CIs was tested using digit span tests. Attention and inhibition abilities were assessed by using the Stroop test (both congruent and incongruent tasks). Speech recognition in noise was measured using the Turkish matrix test. RESULTS A moderate negative correlation was observed between the critical signal-to-noise ratio obtained via speech recognition in noise test and the digit span test scores (backward and digit span total scores). There was no correlation between Stroop test scores and speech recognition in noise in CI recipients. CONCLUSION The findings indicated that verbal working memory correlated well with speech recognition outcomes in adult CI recipients and that higher working memory capacity led to better speech recognition performance in noise.
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Affiliation(s)
- Oğulcan Gundogdu
- Department of Audiology, Graduate School of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | | | - Eyyup Kara
- Department of Audiology, Faculty Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Busra Nur Eser
- Department of Audiology, Graduate School of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
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Casazza JA, Yancey KL, Hunter JB. The Influence of Activities and Functional Social Support on Adult Cochlear Implant Outcomes. OTOLOGY & NEUROTOLOGY OPEN 2023; 3:e033. [PMID: 38516123 PMCID: PMC10950132 DOI: 10.1097/ono.0000000000000033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/18/2023] [Indexed: 03/23/2024]
Abstract
Objective The objective of this study is to assess whether patient participation in specific activities and perceived social support correlate with speech perception following cochlear implantation. Setting Tertiary referral hospital. Methods Adult cochlear implantation patients implanted in their poorer hearing ear between January 2019 and December 2020 completed the Functional Social Support Questionnaire (FSSQ) and a modified version of the Victoria Lifestyle Study-Activities Lifestyle Questionnaire (VLS-ALQ). Demographics, FSSQ score, and individual activities were correlated with implanted ear and binaural AzBio scores. Results Twenty-three patients completed the survey and had at least 6 months of follow-up with appropriate speech perception testing. The average age at survey completion was 71.7 (SD, 9.1). Average pure-tone average in the contralateral ear was 70.1 (SD: 20) dB. The majority (N = 21, 91.3%) wore a hearing aid in the contralateral ear following cochlear implantation. Mean AzBioQuiet score improvement was 60.6% (range: 20%-99%) in the implanted ear and 42.6% (range: -2% to 67%) binaurally. Work-related social support correlated positively with improvement in the implanted ear (Pearson's R = 0.473; 95% CI, 0.075-0.741; P = 0.023). Improvement in the implanted ear correlated positively with creative writing (R = 0.542; 95% CI, 0.167-0.780; P = 0.008), attending films (R = 0.448; 95% CI, 0.044-0.726; P = 0.032), going out with friends (R = 0.423; 95% CI, 0.013-0.711; P = 0.044) listening to audiobooks (R = 0.433; 95% CI, 0.025-0.717; P = 0.039), and public speaking (R = 0.468; 95% CI, 0.069-0.738; P = 0.024). Gains in binaural performance correlated positively with watching TV news (R = 0.819; 95% CI, 0.509-0.941; P < 0.001) and negatively with eating at restaurants (R = -0.532; 95% CI, -0.829 to -0.002; P = 0.05). Conclusions Activities that provide intellectual stimulation and engage auditory faculties correlate with greater speech perception testing improvements in adult cochlear implantation patients.
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Affiliation(s)
- Julia A Casazza
- Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kristen L Yancey
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jacob B Hunter
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Raymond MJ, Ma C, Schvartz-Leyzac KC, Camposeo EL, Nguyen SA, Meyer TA, McRackan TR. Association of Cognitive Impairment Screening Scores With Improvements in Speech Recognition and Quality of Life After Cochlear Implantation. JAMA Otolaryngol Head Neck Surg 2023; 149:344-351. [PMID: 36729460 PMCID: PMC9896371 DOI: 10.1001/jamaoto.2022.4825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/02/2022] [Indexed: 02/03/2023]
Abstract
Importance Many cochlear implant centers screen patients for cognitive impairment as part of the evaluation process, but the utility of these scores in predicting cochlear implant outcomes is unknown. Objective To determine whether there is an association between cognitive impairment screening scores and cochlear implant outcomes. Design, Setting, and Participants Retrospective case series of adult cochlear implant recipients who underwent preoperative cognitive impairment screening with the Montreal Cognitive Assessment (MoCA) from 2018 to 2020 with 1-year follow-up at a single tertiary cochlear implant center. Data analysis was performed on data from January 2018 through December 2021. Exposures Cochlear implantation. Main Outcomes and Measures Preoperative MoCA scores and mean (SD) improvement (aided preoperative to 12-month postoperative) in Consonant-Nucleus-Consonant phonemes (CNCp) and words (CNCw), AzBio sentences in quiet (AzBio Quiet), and Cochlear Implant Quality of Life-35 (CIQOL-35) Profile domain and global scores. Results A total of 52 patients were included, 27 (52%) of whom were male and 46 (88%) were White; mean (SD) age at implantation was 68.2 (13.3) years. Twenty-three (44%) had MoCA scores suggesting mild and 1 (2%) had scores suggesting moderate cognitive impairment. None had been previously diagnosed with cognitive impairment. There were small to medium effects of the association between 12-month postoperative improvement in speech recognition measures and screening positive or not for cognitive impairment (CNCw mean [SD]: 48.4 [21.9] vs 38.5 [26.6] [d = -0.43 (95% CI, -1.02 to 0.16)]; AzBio Quiet mean [SD]: 47.5 [34.3] vs 44.7 [33.1] [d = -0.08 (95% CI, -0.64 to 0.47)]). Similarly, small to large effects of the associations between 12-month postoperative change in CIQOL-35 scores and screening positive or not for cognitive impairment were found (global: d = 0.32 [95% CI, -0.59 to 1.23]; communication: d = 0.62 [95% CI, -0.31 to 1.54]; emotional: d = 0.26 [95% CI, -0.66 to 1.16]; entertainment: d = -0.005 [95% CI, -0.91 to 0.9]; environmental: d = -0.92 [95% CI, -1.86 to 0.46]; listening effort: d = -0.79 [95% CI, -1.65 to 0.22]; social: d = -0.51 [95% CI, -1.43 to 0.42]). Conclusions and Relevance In this case series, screening scores were not associated with the degree of improvement of speech recognition or patient-reported outcome measures after cochlear implantation. Given the prevalence of screening positive for cognitive impairment before cochlear implantation, preoperative screening can be useful for early identification of potential cognitive decline. These findings support that screening scores may have a limited role in preoperative counseling of outcomes and should not be used to limit candidacy.
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Affiliation(s)
- Mallory J. Raymond
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Cheng Ma
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Kara C. Schvartz-Leyzac
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Elizabeth L. Camposeo
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Shaun A. Nguyen
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Ted A. Meyer
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Theodore R. McRackan
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
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Fullerton AM, Vickers DA, Luke R, Billing AN, McAlpine D, Hernandez-Perez H, Peelle JE, Monaghan JJM, McMahon CM. Cross-modal functional connectivity supports speech understanding in cochlear implant users. Cereb Cortex 2023; 33:3350-3371. [PMID: 35989307 PMCID: PMC10068270 DOI: 10.1093/cercor/bhac277] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/12/2022] Open
Abstract
Sensory deprivation can lead to cross-modal cortical changes, whereby sensory brain regions deprived of input may be recruited to perform atypical function. Enhanced cross-modal responses to visual stimuli observed in auditory cortex of postlingually deaf cochlear implant (CI) users are hypothesized to reflect increased activation of cortical language regions, but it is unclear if this cross-modal activity is "adaptive" or "mal-adaptive" for speech understanding. To determine if increased activation of language regions is correlated with better speech understanding in CI users, we assessed task-related activation and functional connectivity of auditory and visual cortices to auditory and visual speech and non-speech stimuli in CI users (n = 14) and normal-hearing listeners (n = 17) and used functional near-infrared spectroscopy to measure hemodynamic responses. We used visually presented speech and non-speech to investigate neural processes related to linguistic content and observed that CI users show beneficial cross-modal effects. Specifically, an increase in connectivity between the left auditory and visual cortices-presumed primary sites of cortical language processing-was positively correlated with CI users' abilities to understand speech in background noise. Cross-modal activity in auditory cortex of postlingually deaf CI users may reflect adaptive activity of a distributed, multimodal speech network, recruited to enhance speech understanding.
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Affiliation(s)
- Amanda M Fullerton
- Department of Linguistics and Macquarie University Hearing, Australian Hearing Hub, Macquarie University, Sydney 2109, Australia
| | - Deborah A Vickers
- Cambridge Hearing Group, Sound Lab, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 OSZ, United Kingdom
- Speech, Hearing and Phonetic Sciences, University College London, London WC1N 1PF, United Kingdom
| | - Robert Luke
- Department of Linguistics and Macquarie University Hearing, Australian Hearing Hub, Macquarie University, Sydney 2109, Australia
| | - Addison N Billing
- Institute of Cognitive Neuroscience, University College London, London WCIN 3AZ, United Kingdom
- DOT-HUB, Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - David McAlpine
- Department of Linguistics and Macquarie University Hearing, Australian Hearing Hub, Macquarie University, Sydney 2109, Australia
| | - Heivet Hernandez-Perez
- Department of Linguistics and Macquarie University Hearing, Australian Hearing Hub, Macquarie University, Sydney 2109, Australia
| | - Jonathan E Peelle
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - Jessica J M Monaghan
- National Acoustic Laboratories, Australian Hearing Hub, Sydney 2109, Australia
- Department of Linguistics and Macquarie University Hearing, Australian Hearing Hub, Macquarie University, Sydney 2109, Australia
| | - Catherine M McMahon
- Department of Linguistics and Macquarie University Hearing, Australian Hearing Hub, Macquarie University, Sydney 2109, Australia
- HEAR Centre, Macquarie University, Sydney 2109, Australia
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Schvartz-Leyzac KC, Giordani B, Pfingst BE. Association of Aging and Cognition With Complex Speech Understanding in Cochlear-Implanted Adults: Use of a Modified National Institutes of Health (NIH) Toolbox Cognitive Assessment. JAMA Otolaryngol Head Neck Surg 2023; 149:239-246. [PMID: 36701145 PMCID: PMC9880868 DOI: 10.1001/jamaoto.2022.4806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/01/2022] [Indexed: 01/27/2023]
Abstract
Importance The association between cognitive function and outcomes in cochlear implant (CI) users is not completely understood, partly because some cognitive tests are confounded by auditory status. It is important to determine appropriate cognitive tests to use in a cohort of CI recipients. Objective To provide proof-of-concept for using an adapted version of the National Institutes of Health (NIH) Toolbox Cognition Battery in a cohort of patients with CIs and to explore how hearing in noise with a CI is affected by cognitive status using the adapted test. Design, Setting, and Participants In this prognostic study, participants listened to sentences presented in a speech-shaped background noise. Cognitive tests consisted of 7 subtests of the NIH Toolbox Cognition Battery that were adapted for hearing impaired individuals by including written instructions and visual stimuli. Participants were prospectively recruited from and evaluated at a tertiary medical center. All participants had at least 6 months' experience with their CI. Main Outcomes and Measures The main outcomes were performance on the adapted cognitive test and a speech recognition in noise task. Results Participants were 20 adult perilingually or postlingually deafened CI users (50% male participants; median [range] age, 66 [26-80] years old). Performance on a sentence recognition in noise task was negatively associated with the chronological age of the listener (R2 = 0.29; β = 0.16; standard error, SE = 0.06; t = 2.63; 95% confidence interval, 0.03-0.27). Testing using the adapted version of the NIH Toolbox Cognition Battery revealed that a test of processing speed was also associated with performance, using a standardized score that accounted for contributions of other demographic factors (R2 = 0.28; 95% confidence interval, -0.42 to -0.05). Conclusions and Relevance In this prognostic study, older CI users showed poorer performance on a sentence-in-noise test compared with younger users. This poorer performance was correlated with a cognitive deficit in processing speed when cognitive function was assessed using a test battery adapted for participants with hearing loss. These results provide initial proof-of-concept results for using a standardized and adapted cognitive test battery in CI recipients.
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Affiliation(s)
- Kara C. Schvartz-Leyzac
- Kresge Hearing Research Institute, Department of Otolaryngology, University of Michigan Health Systems, Ann Arbor
- Hearing Rehabilitation Center, Department of Otolaryngology, University of Michigan Health Systems, Ann Arbor
- Medical University of South Carolina, Charleston
| | - Bruno Giordani
- Department of Psychiatry & Michigan Alzheimer’s Disease Center, University of Michigan Health Systems, Ann Arbor
| | - Bryan E. Pfingst
- Kresge Hearing Research Institute, Department of Otolaryngology, University of Michigan Health Systems, Ann Arbor
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Harris MS, Hamel BL, Wichert K, Kozlowski K, Mleziva S, Ray C, Pisoni DB, Kronenberger WG, Moberly AC. Contribution of Verbal Learning & Memory and Spectro-Temporal Discrimination to Speech Recognition in Cochlear Implant Users. Laryngoscope 2023; 133:661-669. [PMID: 35567421 PMCID: PMC9659673 DOI: 10.1002/lary.30210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/01/2022] [Accepted: 05/03/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Existing cochlear implant (CI) outcomes research demonstrates a high degree of variability in device effectiveness among experienced CI users. Increasing evidence suggests that verbal learning and memory (VL&M) may have an influence on speech recognition with CIs. This study examined the relations in CI users between visual measures of VL&M and speech recognition in a series of models that also incorporated spectro-temporal discrimination. Predictions were that (1) speech recognition would be associated with VL&M abilities and (2) VL&M would contribute to speech recognition outcomes above and beyond spectro-temporal discrimination in multivariable models of speech recognition. METHODS This cross-sectional study included 30 adult postlingually deaf experienced CI users who completed a nonauditory visual version of the California Verbal Learning Test-Second Edition (v-CVLT-II) to assess VL&M, and the Spectral-Temporally Modulated Ripple Test (SMRT), an auditory measure of spectro-temporal processing. Participants also completed a battery of word and sentence recognition tasks. RESULTS CI users showed significant correlations between some v-CVLT-II measures (short-delay free- and cued-recall, retroactive interference, and "subjective" organizational recall strategies) and speech recognition measures. Performance on the SMRT was correlated with all speech recognition measures. Hierarchical multivariable linear regression analyses showed that SMRT performance accounted for a significant degree of speech recognition outcome variance. Moreover, for all speech recognition measures, VL&M scores contributed independently in addition to SMRT. CONCLUSION Measures of spectro-temporal discrimination and VL&M were associated with speech recognition in CI users. After accounting for spectro-temporal discrimination, VL&M contributed independently to performance on measures of speech recognition for words and sentences produced by single and multiple talkers. LEVEL OF EVIDENCE 3 Laryngoscope, 133:661-669, 2023.
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Affiliation(s)
- Michael S. Harris
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | | | - Kristin Wichert
- Department of Communication Sciences & Disorders, University of Wisconsin - Eau Claire, Eau Claire, WI
| | - Kristin Kozlowski
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Sarah Mleziva
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Christin Ray
- Department of Otolaryngology – Head & Neck Surgery, The Ohio State Wexner Medical Center, Columbus, OH
| | - David B. Pisoni
- Speech Research Laboratory, Department of Psychology, Indiana University, Bloomington, IN
| | | | - Aaron C. Moberly
- Department of Otolaryngology – Head & Neck Surgery, The Ohio State Wexner Medical Center, Columbus, OH
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Tamati TN, Janse E, Başkent D. The relation between speaking-style categorization and speech recognition in adult cochlear implant users. JASA EXPRESS LETTERS 2023; 3:035201. [PMID: 37003708 DOI: 10.1121/10.0017439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The current study examined the relation between speaking-style categorization and speech recognition in post-lingually deafened adult cochlear implant users and normal-hearing listeners tested under 4- and 8-channel acoustic noise-vocoder cochlear implant simulations. Across all listeners, better speaking-style categorization of careful read and casual conversation speech was associated with more accurate recognition of speech across those same two speaking styles. Findings suggest that some cochlear implant users and normal-hearing listeners under cochlear implant simulation may benefit from stronger encoding of indexical information in speech, enabling both better categorization and recognition of speech produced in different speaking styles.
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Affiliation(s)
- Terrin N Tamati
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
| | - Esther Janse
- Centre for Language Studies, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Deniz Başkent
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, The Netherlands , ,
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Lazard DS, Doelling KB, Arnal LH. Plasticity After Hearing Rehabilitation in the Aging Brain. Trends Hear 2023; 27:23312165231156412. [PMID: 36794429 PMCID: PMC9936397 DOI: 10.1177/23312165231156412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Age-related hearing loss, presbycusis, is an unavoidable sensory degradation, often associated with the progressive decline of cognitive and social functions, and dementia. It is generally considered a natural consequence of the inner-ear deterioration. However, presbycusis arguably conflates a wide array of peripheral and central impairments. Although hearing rehabilitation maintains the integrity and activity of auditory networks and can prevent or revert maladaptive plasticity, the extent of such neural plastic changes in the aging brain is poorly appreciated. By reanalyzing a large-scale dataset of more than 2200 cochlear implant users (CI) and assessing the improvement in speech perception from 6 to 24 months of use, we show that, although rehabilitation improves speech understanding on average, age at implantation only minimally affects speech scores at 6 months but has a pejorative effect at 24 months post implantation. Furthermore, older subjects (>67 years old) were significantly more likely to degrade their performances after 2 years of CI use than the younger patients for each year increase in age. Secondary analysis reveals three possible plasticity trajectories after auditory rehabilitation to account for these disparities: Awakening, reversal of deafness-specific changes; Counteracting, stabilization of additional cognitive impairments; or Decline, independent pejorative processes that hearing rehabilitation cannot prevent. The role of complementary behavioral interventions needs to be considered to potentiate the (re)activation of auditory brain networks.
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Affiliation(s)
- Diane S. Lazard
- Institut Pasteur, Université Paris Cité, INSERM AU06, Institut de l’Audition, Paris, France,ENT department, Institut Arthur Vernes, Paris, France,Diane Lazard, Institut de l’Audition, Institut Pasteur, 63 rue de Charenton, 75012 Paris, France.
| | - Keith B. Doelling
- Institut Pasteur, Université Paris Cité, INSERM AU06, Institut de l’Audition, Paris, France
| | - Luc H. Arnal
- Institut Pasteur, Université Paris Cité, INSERM AU06, Institut de l’Audition, Paris, France
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Beckers L, Tromp N, Philips B, Mylanus E, Huinck W. Exploring neurocognitive factors and brain activation in adult cochlear implant recipients associated with speech perception outcomes-A scoping review. Front Neurosci 2023; 17:1046669. [PMID: 36816114 PMCID: PMC9932917 DOI: 10.3389/fnins.2023.1046669] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023] Open
Abstract
Background Cochlear implants (CIs) are considered an effective treatment for severe-to-profound sensorineural hearing loss. However, speech perception outcomes are highly variable among adult CI recipients. Top-down neurocognitive factors have been hypothesized to contribute to this variation that is currently only partly explained by biological and audiological factors. Studies investigating this, use varying methods and observe varying outcomes, and their relevance has yet to be evaluated in a review. Gathering and structuring this evidence in this scoping review provides a clear overview of where this research line currently stands, with the aim of guiding future research. Objective To understand to which extent different neurocognitive factors influence speech perception in adult CI users with a postlingual onset of hearing loss, by systematically reviewing the literature. Methods A systematic scoping review was performed according to the PRISMA guidelines. Studies investigating the influence of one or more neurocognitive factors on speech perception post-implantation were included. Word and sentence perception in quiet and noise were included as speech perception outcome metrics and six key neurocognitive domains, as defined by the DSM-5, were covered during the literature search (Protocol in open science registries: 10.17605/OSF.IO/Z3G7W of searches in June 2020, April 2022). Results From 5,668 retrieved articles, 54 articles were included and grouped into three categories using different measures to relate to speech perception outcomes: (1) Nineteen studies investigating brain activation, (2) Thirty-one investigating performance on cognitive tests, and (3) Eighteen investigating linguistic skills. Conclusion The use of cognitive functions, recruiting the frontal cortex, the use of visual cues, recruiting the occipital cortex, and the temporal cortex still available for language processing, are beneficial for adult CI users. Cognitive assessments indicate that performance on non-verbal intelligence tasks positively correlated with speech perception outcomes. Performance on auditory or visual working memory, learning, memory and vocabulary tasks were unrelated to speech perception outcomes and performance on the Stroop task not to word perception in quiet. However, there are still many uncertainties regarding the explanation of inconsistent results between papers and more comprehensive studies are needed e.g., including different assessment times, or combining neuroimaging and behavioral measures. Systematic review registration https://doi.org/10.17605/OSF.IO/Z3G7W.
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Affiliation(s)
- Loes Beckers
- Cochlear Ltd., Mechelen, Belgium,Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands,*Correspondence: Loes Beckers,
| | - Nikki Tromp
- Cochlear Ltd., Mechelen, Belgium,Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Emmanuel Mylanus
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wendy Huinck
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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21
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Schvartz-Leyzac KC, Colesa DJ, Swiderski DL, Raphael Y, Pfingst BE. Cochlear Health and Cochlear-implant Function. J Assoc Res Otolaryngol 2023; 24:5-29. [PMID: 36600147 PMCID: PMC9971430 DOI: 10.1007/s10162-022-00882-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/24/2022] [Indexed: 01/06/2023] Open
Abstract
The cochlear implant (CI) is widely considered to be one of the most innovative and successful neuroprosthetic treatments developed to date. Although outcomes vary, CIs are able to effectively improve hearing in nearly all recipients and can substantially improve speech understanding and quality of life for patients with significant hearing loss. A wealth of research has focused on underlying factors that contribute to success with a CI, and recent evidence suggests that the overall health of the cochlea could potentially play a larger role than previously recognized. This article defines and reviews attributes of cochlear health and describes procedures to evaluate cochlear health in humans and animal models in order to examine the effects of cochlear health on performance with a CI. Lastly, we describe how future biologic approaches can be used to preserve and/or enhance cochlear health in order to maximize performance for individual CI recipients.
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Affiliation(s)
- Kara C Schvartz-Leyzac
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA
| | - Deborah J Colesa
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
| | - Donald L Swiderski
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
| | - Yehoash Raphael
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
| | - Bryan E Pfingst
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA.
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22
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Burkhardt P, Müller V, Meister H, Weglage A, Lang-Roth R, Walger M, Sandmann P. Age effects on cognitive functions and speech-in-noise processing: An event-related potential study with cochlear-implant users and normal-hearing listeners. Front Neurosci 2022; 16:1005859. [PMID: 36620447 PMCID: PMC9815545 DOI: 10.3389/fnins.2022.1005859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
A cochlear implant (CI) can partially restore hearing in individuals with profound sensorineural hearing loss. However, electrical hearing with a CI is limited and highly variable. The current study aimed to better understand the different factors contributing to this variability by examining how age affects cognitive functions and cortical speech processing in CI users. Electroencephalography (EEG) was applied while two groups of CI users (young and elderly; N = 13 each) and normal-hearing (NH) listeners (young and elderly; N = 13 each) performed an auditory sentence categorization task, including semantically correct and incorrect sentences presented either with or without background noise. Event-related potentials (ERPs) representing earlier, sensory-driven processes (N1-P2 complex to sentence onset) and later, cognitive-linguistic integration processes (N400 to semantically correct/incorrect sentence-final words) were compared between the different groups and speech conditions. The results revealed reduced amplitudes and prolonged latencies of auditory ERPs in CI users compared to NH listeners, both at earlier (N1, P2) and later processing stages (N400 effect). In addition to this hearing-group effect, CI users and NH listeners showed a comparable background-noise effect, as indicated by reduced hit rates and reduced (P2) and delayed (N1/P2) ERPs in conditions with background noise. Moreover, we observed an age effect in CI users and NH listeners, with young individuals showing improved specific cognitive functions (working memory capacity, cognitive flexibility and verbal learning/retrieval), reduced latencies (N1/P2), decreased N1 amplitudes and an increased N400 effect when compared to the elderly. In sum, our findings extend previous research by showing that the CI users' speech processing is impaired not only at earlier (sensory) but also at later (semantic integration) processing stages, both in conditions with and without background noise. Using objective ERP measures, our study provides further evidence of strong age effects on cortical speech processing, which can be observed in both the NH listeners and the CI users. We conclude that elderly individuals require more effortful processing at sensory stages of speech processing, which however seems to be at the cost of the limited resources available for the later semantic integration processes.
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Affiliation(s)
- Pauline Burkhardt
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology and Pediatric Audiology, Cochlear Implant Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,*Correspondence: Pauline Burkhardt, ; orcid.org/0000-0001-9850-9881
| | - Verena Müller
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology and Pediatric Audiology, Cochlear Implant Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hartmut Meister
- Jean-Uhrmacher-Institute for Clinical ENT-Research, University of Cologne, Cologne, Germany
| | - Anna Weglage
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology and Pediatric Audiology, Cochlear Implant Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ruth Lang-Roth
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology and Pediatric Audiology, Cochlear Implant Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Walger
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology and Pediatric Audiology, Cochlear Implant Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Jean-Uhrmacher-Institute for Clinical ENT-Research, University of Cologne, Cologne, Germany
| | - Pascale Sandmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology and Pediatric Audiology, Cochlear Implant Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Völter C, Oberländer K, Haubitz I, Carroll R, Dazert S, Thomas JP. Poor Performer: A Distinct Entity in Cochlear Implant Users? Audiol Neurootol 2022; 27:356-367. [PMID: 35533653 PMCID: PMC9533457 DOI: 10.1159/000524107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Several factors are known to influence speech perception in cochlear implant (CI) users. To date, the underlying mechanisms have not yet been fully clarified. Although many CI users achieve a high level of speech perception, a small percentage of patients does not or only slightly benefit from the CI (poor performer, PP). In a previous study, PP showed significantly poorer results on nonauditory-based cognitive and linguistic tests than CI users with a very high level of speech understanding (star performer, SP). We now investigate if PP also differs from the CI user with an average performance (average performer, AP) in cognitive and linguistic performance. METHODS Seventeen adult postlingually deafened CI users with speech perception scores in quiet of 55 (9.32) % (AP) on the German Freiburg monosyllabic speech test at 65 dB underwent neurocognitive (attention, working memory, short- and long-term memory, verbal fluency, inhibition) and linguistic testing (word retrieval, lexical decision, phonological input lexicon). The results were compared to the performance of 15 PP (speech perception score of 15 [11.80] %) and 19 SP (speech perception score of 80 [4.85] %). For statistical analysis, U-Test and discrimination analysis have been done. RESULTS Significant differences between PP and AP were observed on linguistic tests, in Rapid Automatized Naming (RAN: p = 0.0026), lexical decision (LexDec: p = 0.026), phonological input lexicon (LEMO: p = 0.0085), and understanding of incomplete words (TRT: p = 0.0024). AP also had significantly better neurocognitive results than PP in the domains of attention (M3: p = 0.009) and working memory (OSPAN: p = 0.041; RST: p = 0.015) but not in delayed recall (delayed recall: p = 0.22), verbal fluency (verbal fluency: p = 0.084), and inhibition (Flanker: p = 0.35). In contrast, no differences were found hereby between AP and SP. Based on the TRT and the RAN, AP and PP could be separated in 100%. DISCUSSION The results indicate that PP constitute a distinct entity of CI users that differs even in nonauditory abilities from CI users with an average speech perception, especially with regard to rapid word retrieval either due to reduced phonological abilities or limited storage. Further studies should investigate if improved word retrieval by increased phonological and semantic training results in better speech perception in these CI users.
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Affiliation(s)
- Christiane Völter
- Department of Otorhinolaryngology, Head and Neck Surgery, Cochlear Implant Center Ruhrgebiet, St Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Kirsten Oberländer
- Department of Otorhinolaryngology, Head and Neck Surgery, Cochlear Implant Center Ruhrgebiet, St Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany,
| | - Imme Haubitz
- Department of Otorhinolaryngology, Head and Neck Surgery, Cochlear Implant Center Ruhrgebiet, St Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Rebecca Carroll
- Institute of English and American Studies, Technical University Braunschweig, Braunschweig, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Cochlear Implant Center Ruhrgebiet, St Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Peter Thomas
- Department of Otorhinolaryngology, Head and Neck Surgery, St-Johannes-Hospital, Dortmund, Germany
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Ray C, Pisoni DB, Lu E, Kronenberger WG, Moberly AC. Preoperative Visual Measures of Verbal Learning and Memory and their Relations to Speech Recognition After Cochlear Implantation. Ear Hear 2022; 43:993-1002. [PMID: 35319518 PMCID: PMC9010345 DOI: 10.1097/aud.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study examined the performance of a group of adult cochlear implant (CI) candidates (CIC) on visual tasks of verbal learning and memory. Preoperative verbal learning and memory abilities of the CIC group were compared with a group of older normal-hearing (ONH) control participants. Relations between preoperative verbal learning and memory measures and speech recognition outcomes after 6 mo of CI use were also investigated for a subgroup of the CICs. DESIGN A group of 80 older adult participants completed a visually presented multitrial free recall task. Measures of word recall, repetition learning, and the use of self-generated organizational strategies were collected from a group of 49 CICs, before cochlear implantation, and a group of 31 ONH controls. Speech recognition outcomes were also collected from a subgroup of 32 of the CIC participants who returned for testing 6 mo after CI activation. RESULTS CICs demonstrated poorer verbal learning performance compared with the group of ONH control participants. Among the preoperative verbal learning and memory measures, repetition learning slope and measures of self-generated organizational clustering strategies were the strongest predictors of post-CI speech recognition outcomes. CONCLUSIONS Older adult CI candidates present with verbal learning and memory deficits compared with older adults without hearing loss, even on visual tasks that are independent from the direct effects of audibility. Preoperative verbal learning and memory processes reflecting repetition learning and self-generated organizational strategies in free recall were associated with speech recognition outcomes 6 months after implantation. The pattern of results suggests that visual measures of verbal learning may be a useful predictor of outcomes in postlingual adult CICs.
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Affiliation(s)
- Christin Ray
- Department of Otolaryngology, The Ohio State University, Columbus, OH
| | - David B. Pisoni
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN
| | - Emily Lu
- Department of Otolaryngology, The Ohio State University, Columbus, OH
| | - William G. Kronenberger
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Aaron C. Moberly
- Department of Otolaryngology, The Ohio State University, Columbus, OH
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25
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Radecke JO, Schierholz I, Kral A, Lenarz T, Murray MM, Sandmann P. Distinct multisensory perceptual processes guide enhanced auditory recognition memory in older cochlear implant users. Neuroimage Clin 2022; 33:102942. [PMID: 35033811 PMCID: PMC8762088 DOI: 10.1016/j.nicl.2022.102942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 11/15/2022]
Abstract
Congruent audio-visual encoding enhances later auditory processing in the elderly. CI users benefit from additional congruent visual information, similar to controls. CI users show distinct neurophysiological processes, compared to controls. CI users show an earlier modulation of event-related topographies, compared to controls.
In naturalistic situations, sounds are often perceived in conjunction with matching visual impressions. For example, we see and hear the neighbor’s dog barking in the garden. Still, there is a good chance that we recognize the neighbor’s dog even when we only hear it barking, but do not see it behind the fence. Previous studies with normal-hearing (NH) listeners have shown that the audio-visual presentation of a perceptual object (like an animal) increases the probability to recognize this object later on, even if the repeated presentation of this object occurs in a purely auditory condition. In patients with a cochlear implant (CI), however, the electrical hearing of sounds is impoverished, and the ability to recognize perceptual objects in auditory conditions is significantly limited. It is currently not well understood whether CI users – as NH listeners – show a multisensory facilitation for auditory recognition. The present study used event-related potentials (ERPs) and a continuous recognition paradigm with auditory and audio-visual stimuli to test the prediction that CI users show a benefit from audio-visual perception. Indeed, the congruent audio-visual context resulted in an improved recognition ability of objects in an auditory-only condition, both in the NH listeners and the CI users. The ERPs revealed a group-specific pattern of voltage topographies and correlations between these ERP maps and the auditory recognition ability, indicating a different processing of congruent audio-visual stimuli in CI users when compared to NH listeners. Taken together, our results point to distinct cortical processing of naturalistic audio-visual objects in CI users and NH listeners, which however allows both groups to improve the recognition ability of these objects in a purely auditory context. Our findings are of relevance for future clinical research since audio-visual perception might also improve the auditory rehabilitation after cochlear implantation.
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Affiliation(s)
- Jan-Ole Radecke
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Germany; Institute of Audioneurotechnology, Hannover Medical School, Hannover, Germany; Department of Experimental Otology, ENT Clinics, Hannover Medical School, Hannover, Germany.
| | - Irina Schierholz
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany; Department of Otorhinolaryngology, University of Cologne, Cologne, Germany
| | - Andrej Kral
- Institute of Audioneurotechnology, Hannover Medical School, Hannover, Germany; Department of Experimental Otology, ENT Clinics, Hannover Medical School, Hannover, Germany
| | - Thomas Lenarz
- Institute of Audioneurotechnology, Hannover Medical School, Hannover, Germany; Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Micah M Murray
- The LINE (The Laboratory for Investigative Neurophysiology), Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; CIBM Center for Biomedical Imaging of Lausanne and Geneva, Lausanne, Switzerland; Department of Ophthalmology, Fondation Asile des aveugles, Lausanne, Switzerland; Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA
| | - Pascale Sandmann
- Department of Otorhinolaryngology, University of Cologne, Cologne, Germany
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Zucca M, Albera A, Albera R, Montuschi C, Della Gatta B, Canale A, Rainero I. Cochlear Implant Results in Older Adults with Post-Lingual Deafness: The Role of "Top-Down" Neurocognitive Mechanisms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1343. [PMID: 35162365 PMCID: PMC8834693 DOI: 10.3390/ijerph19031343] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 12/04/2022]
Abstract
To date, no clear specific cognitive predictors of speech perception outcome in older adult cochlear implant (CI) users have yet emerged. The aim of this prospective study was to increase knowledge on cognitive and clinical predictors of the audiological outcome in adult cochlear implant users. A total of 21 patients with post-lingual deafness, who were candidates for cochlear implantation, were recruited at the Department of Ear, Nose and Throat, University of Torino (Italy) and subjected to a pre-operatory neuropsychological assessment (T0) and an audiological examination after 12 months of implantation (T12). Patients who, at T12, had a 60 dB verbal recognition above 80%, were younger (z = -2.131, p = 0.033) and performed better in the Verbal Semantic Fluency Test at T0 (z = -1.941, p = 0.052) than subjects who had a 60 dB verbal recognition at T12 below 80%. The most significant predictors of the CI audiological outcome at T12 were age (β = -0.492, p = 0.024) and patients' TMT-A performance at baseline (β = -0.486, p = 0.035). We conclude that cognitive processing speed might be a good predictor of the level of speech understanding in older adult patients with CI after one year of implantation.
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Affiliation(s)
- Milena Zucca
- Department of Neuroscience, Aging Brain and Memory Clinic, University of Torino, 10126 Turin, Italy;
| | - Andrea Albera
- Department of Surgical Sciences, ENT Division, University of Torino, 10126 Turin, Italy; (A.A.); (R.A.); (B.D.G.); (A.C.)
| | - Roberto Albera
- Department of Surgical Sciences, ENT Division, University of Torino, 10126 Turin, Italy; (A.A.); (R.A.); (B.D.G.); (A.C.)
| | - Carla Montuschi
- Section of Otorhinolaryngology, Department of Surgery, Ospedale degli Infermi, 13875 Biella, Italy;
| | - Beatrice Della Gatta
- Department of Surgical Sciences, ENT Division, University of Torino, 10126 Turin, Italy; (A.A.); (R.A.); (B.D.G.); (A.C.)
| | - Andrea Canale
- Department of Surgical Sciences, ENT Division, University of Torino, 10126 Turin, Italy; (A.A.); (R.A.); (B.D.G.); (A.C.)
| | - Innocenzo Rainero
- Department of Neuroscience, Aging Brain and Memory Clinic, University of Torino, 10126 Turin, Italy;
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Luo X, Azuma T, Kolberg C, Pulling KR. The effects of stimulus modality, task complexity, and cuing on working memory and the relationship with speech recognition in older cochlear implant users. JOURNAL OF COMMUNICATION DISORDERS 2022; 95:106170. [PMID: 34839068 DOI: 10.1016/j.jcomdis.2021.106170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The role of working memory (WM) in speech recognition of older cochlear implant (CI) users remains unclear. This study 1) examined the effects of aging and CI on WM performance across different modalities (auditory vs. visual) and cuing conditions, and 2) assessed how specific WM measures relate to sentence and word recognition in noise. METHOD Fourteen Older CI users, 12 Older acoustic-hearing (AH) listeners with age-appropriate hearing loss, and 15 Young normal-hearing (NH) listeners were tested. Participants completed two simple span tasks (auditory digit and visual letter span), two complex WM tasks (reading span and cued-modality WM with simultaneously presented auditory digits and visual letters), and two speech recognition tasks (sentence and word recognition in speech-babble noise). RESULTS The groups showed similar simple span performance, except that Older CI users had lower auditory digit span than Young NH listeners. Both older groups had similar reading span performance, but scored significantly lower than Young NH listeners, indicating age-related declines in attentional and phonological processing. A similar group effect was observed in the cued-modality WM task. All groups showed higher recall for auditory digits than for visual letters and the advantage was most evident without modality cuing. All groups displayed greater cuing benefits for visual recall than for auditory recall, suggesting that participants consistently allocated more attention to auditory stimuli regardless of cuing. For Older CI users, after controlling for the previously reported spectral resolution, auditory-uncued WM performance was significantly correlated with word recognition but not sentence recognition. CONCLUSIONS Complex WM was significantly affected by aging but not by CI. Neither aging nor CI significantly affected modality cuing benefits in the WM task. For Older CI users, complex auditory WM with attentional control may better reflect the cognitive load of speech recognition in noise than simple span or complex visual WM.
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Affiliation(s)
- Xin Luo
- Program of Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe, AZ, United States of America.
| | - Tamiko Azuma
- Program of Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe, AZ, United States of America
| | - Courtney Kolberg
- Program of Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe, AZ, United States of America
| | - Kathryn R Pulling
- Program of Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe, AZ, United States of America
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Tamati TN, Moberly AC. Talker Adaptation and Lexical Difficulty Impact Word Recognition in Adults with Cochlear Implants. Audiol Neurootol 2021; 27:260-270. [PMID: 34535583 DOI: 10.1159/000518643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Talker-specific adaptation facilitates speech recognition in normal-hearing listeners. This study examined talker adaptation in adult cochlear implant (CI) users. Three hypotheses were tested: (1) high-performing adult CI users show improved word recognition following exposure to a talker ("talker adaptation"), particularly for lexically hard words, (2) individual performance is determined by auditory sensitivity and neurocognitive skills, and (3) individual performance relates to real-world functioning. METHODS Fifteen high-performing, post-lingually deaf adult CI users completed a word recognition task consisting of 6 single-talker blocks (3 female/3 male native English speakers); words were lexically "easy" and "hard." Recognition accuracy was assessed "early" and "late" (first vs. last 10 trials); adaptation was assessed as the difference between late and early accuracy. Participants also completed measures of spectral-temporal processing and neurocognitive skills, as well as real-world measures of multiple-talker sentence recognition and quality of life (QoL). RESULTS CI users showed limited talker adaptation overall, but performance improved for lexically hard words. Stronger spectral-temporal processing and neurocognitive skills were weakly to moderately associated with more accurate word recognition and greater talker adaptation for hard words. Finally, word recognition accuracy for hard words was moderately related to multiple-talker sentence recognition and QoL. CONCLUSION Findings demonstrate a limited talker adaptation benefit for recognition of hard words in adult CI users. Both auditory sensitivity and neurocognitive skills contribute to performance, suggesting additional benefit from adaptation for individuals with stronger skills. Finally, processing differences related to talker adaptation and lexical difficulty may be relevant to real-world functioning.
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Affiliation(s)
- Terrin N Tamati
- Department of Otolaryngology, Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Aaron C Moberly
- Department of Otolaryngology, Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Relationship Between Electrocochleography, Angular Insertion Depth, and Cochlear Implant Speech Perception Outcomes. Ear Hear 2021; 42:941-948. [PMID: 33369942 PMCID: PMC8217403 DOI: 10.1097/aud.0000000000000985] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Electrocochleography (ECochG), obtained before the insertion of a cochlear implant (CI) array, provides a measure of residual cochlear function that accounts for a substantial portion of variability in postoperative speech perception outcomes in adults. It is postulated that subsequent surgical factors represent independent sources of variance in outcomes. Prior work has demonstrated a positive correlation between angular insertion depth (AID) of straight arrays and speech perception under the CI-alone condition, with an inverse relationship observed for precurved arrays. The purpose of the present study was to determine the combined effects of ECochG, AID, and array design on speech perception outcomes. DESIGN Participants were 50 postlingually deafened adult CI recipients who received one of three straight arrays (MED-EL Flex24, MED-EL Flex28, and MED-EL Standard) and two precurved arrays (Cochlear Contour Advance and Advanced Bionics HiFocus Mid-Scala). Residual cochlear function was determined by the intraoperative ECochG total response (TR) measured before array insertion, which is the sum of magnitudes of spectral components in response to tones of different stimulus frequencies across the speech spectrum. The AID was then determined with postoperative imaging. Multiple linear regression was used to predict consonant-nucleus-consonant (CNC) word recognition in the CI-alone condition at 6 months postactivation based on AID, TR, and array design. RESULTS Forty-one participants received a straight array and nine received a precurved array. The AID of the most apical electrode contact ranged from 341° to 696°. The TR measured by ECochG accounted for 43% of variance in speech perception outcomes (p < 0.001). A regression model predicting CNC word scores with the TR tended to underestimate the performance for precurved arrays and deeply inserted straight arrays, and to overestimate the performance for straight arrays with shallower insertions. When combined in a multivariate linear regression, the TR, AID, and array design accounted for 72% of variability in speech perception outcomes (p < 0.001). CONCLUSIONS A model of speech perception outcomes that incorporates TR, AID, and array design represents an improvement over a model based on TR alone. The success of this model shows that peripheral factors including cochlear health and electrode placement may play a predominant role in speech perception with CIs.
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Abstract
Supplemental Digital Content is available in the text. The primary objective of this study is to identify the biographic, audiologic, and electrode position factors that influence speech perception performance in adult cochlear implant (CI) recipients implanted with a device from a single manufacturer. The secondary objective is to investigate the independent association of the type of electrode (precurved or straight) with speech perception.
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Jahn KN, Arenberg JG. Electrophysiological Estimates of the Electrode-Neuron Interface Differ Between Younger and Older Listeners With Cochlear Implants. Ear Hear 2021; 41:948-960. [PMID: 32032228 PMCID: PMC10424265 DOI: 10.1097/aud.0000000000000827] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary objective of this study was to quantify differences in evoked potential correlates of spiral ganglion neuron (SGN) density between younger and older individuals with cochlear implants (CIs) using the electrically evoked compound action potential (ECAP). In human temporal bone studies and in animal models, SGN density is the lowest in older subjects and in those who experienced long durations of deafness during life. SGN density also varies as a function of age at implantation and hearing loss etiology. Taken together, it is likely that younger listeners who were deafened and implanted during childhood have denser populations of SGNs than older individuals who were deafened and implanted later in life. In animals, ECAP amplitudes, amplitude growth function (AGF) slopes, and their sensitivity to stimulus interphase gap (IPG) are predictive of SGN density. The authors hypothesized that younger listeners who were deafened and implanted as children would demonstrate larger ECAP amplitudes, steeper AGF slopes, and greater IPG sensitivity than older, adult-deafened and implanted listeners. DESIGN Data were obtained from 22 implanted ears (18 individuals). Thirteen ears (9 individuals) were deafened and implanted as children (child-implanted group), and nine ears (9 individuals) were deafened and implanted as adults (adult-implanted group). The groups differed significantly on a number of demographic variables that are implicitly related to SGN density: (1) chronological age; (2) age at implantation; and (3) duration of preimplantation hearing loss. ECAP amplitudes, AGF linear slopes, and thresholds were assessed on a subset of electrodes in each ear in response to two IPGs (7 and 30 µsec). Speech recognition was assessed using a medial vowel identification task. RESULTS Compared with the adult-implanted listeners, individuals in the child-implanted group demonstrated larger changes in ECAP amplitude when the IPG of the stimulus was increased from 7 to 30 µsec (i.e., greater IPG sensitivity). On average, child-implanted participants also had larger ECAP amplitudes and steeper AGF linear slopes than the adult-implanted participants, irrespective of IPG. IPG sensitivity for AGF linear slope and ECAP threshold did not differ between age groups. Vowel recognition performance was not correlated with any of the ECAP measures assessed in this study. CONCLUSIONS The results of this study support the theory that young CI listeners who were deafened and implanted during childhood may have denser neural populations than older listeners who were deafened and implanted as adults. Potential between-group differences in SGN integrity emphasize a need to investigate optimized CI programming parameters for younger and older listeners.
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Affiliation(s)
- Kelly N. Jahn
- Department of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, MA 02114, USA
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114, USA
| | - Julie G. Arenberg
- Department of Otolaryngology – Head and Neck Surgery, Harvard Medical School, Boston, MA 02114, USA
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA 02114, USA
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Schierholz I, Schönermark C, Ruigendijk E, Kral A, Kopp B, Büchner A. An event-related brain potential study of auditory attention in cochlear implant users. Clin Neurophysiol 2021; 132:2290-2305. [PMID: 34120838 DOI: 10.1016/j.clinph.2021.03.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/09/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Cochlear implants (CIs) provide access to the auditory world for deaf individuals. We investigated whether CIs enforce attentional alterations of auditory cortical processing in post-lingually deafened CI users compared to normal-hearing (NH) controls. METHODS Event-related potentials (ERPs) were recorded in 40 post-lingually deafened CI users and in a group of 40 NH controls using an auditory three-stimulus oddball task, which included frequent standard tones (Standards) and infrequent deviant tones (Targets), as well as infrequently occurring unique sounds (Novels). Participants were exposed twice to the three-stimulus oddball task, once under the instruction to ignore the stimuli (ignore condition), and once under the instruction to respond to infrequently occurring deviant tones (attend condition). RESULTS The allocation of attention to auditory oddball stimuli exerted stronger effects on N1 amplitudes at posterior electrodes in response to Standards and to Targets in CI users than in NH controls. Other ERP amplitudes showed similar attentional modulations in both groups (P2 in response to Standards, N2 in response to Targets and Novels, P3 in response to Targets). We also observed a statistical trend for an attenuated attentional modulation of Novelty P3 amplitudes in CI users compared to NH controls. CONCLUSIONS ERP correlates of enhanced CI-mediated auditory attention are confined to the latency range of the auditory N1, suggesting that enhanced attentional modulation during auditory stimulus discrimination occurs primarily in associative auditory cortices of CI users. SIGNIFICANCE The present ERP data support the hypothesis of attentional alterations of auditory cortical processing in CI users. These findings may be of clinical relevance for the CI rehabilitation.
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Affiliation(s)
- Irina Schierholz
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany; Cluster of Excellence "Hearing4all", Germany; Department of Otorhinolaryngology, University of Cologne, Cologne, Germany.
| | | | - Esther Ruigendijk
- Cluster of Excellence "Hearing4all", Germany; Department for Dutch Studies, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Andrej Kral
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany; Cluster of Excellence "Hearing4all", Germany; Department of Experimental Otology, Institute for AudioNeuroTechnology (VIANNA), Hannover Medical School, Hannover, Germany
| | - Bruno Kopp
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Andreas Büchner
- Department of Otorhinolaryngology, Hannover Medical School, Hannover, Germany; Cluster of Excellence "Hearing4all", Germany
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Schvartz-Leyzac KC, Zwolan TA, Pfingst BE. Using the electrically-evoked compound action potential (ECAP) interphase gap effect to select electrode stimulation sites in cochlear implant users. Hear Res 2021; 406:108257. [PMID: 34020316 DOI: 10.1016/j.heares.2021.108257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/25/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
Studies in cochlear implanted animals show that the IPG Effect for ECAP growth functions (i.e., the magnitude of the change in ECAP amplitude growth function (AGF) slope or peak amplitude when the interphase gap (IPG) is increased) can be used to estimate the densities of spiral ganglion neurons (SGNs) near the electrode stimulation and recording sites. In humans, the same ECAP IPG Effect measures correlate with speech recognition performance. The present study examined the efficacy of selecting electrode sites for stimulation based on the IPG Effect, in order to improve performance of CI users on speech recognition tasks. We measured the ECAP IPG Effect for peak amplitude in adult (>18 years old) CI users (N= 18 ears), and created experimental programs to stimulate electrodes with either the highest or lowest ECAP IPG Effect for peak amplitude. Subjects also listened to a program without any electrodes deactivated. In a subset of subject ears (11/18), we compared performance differences between the experimental programs to post-operative computerized tomography (CT) scans to examine underlying factors that might contribute to the efficacy of an electrode site-selection approach. For sentences-in-noise, average performance was better when subjects listened to the experimental program that stimulated electrodes with the highest rather than the lowest IPG Effect for ECAP peak amplitude. A similar pattern was noted for transmission and perception of consonant place cues in a consonant recognition task. However, on average, performance when listening to a program with higher IPG Effect values was equal to that when listening with all electrodes activated. Results also suggest that scalar location (scala tympani or vestibuli) should be considered when using an ECAP-based electrode site-selection procedure to optimize CI performance.
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Affiliation(s)
- Kara C Schvartz-Leyzac
- Kresge Hearing Research Institute, Department of Otolaryngology, Michigan Medicine, 1150 West Medical Center Drive, Ann Arbor, MI 48109-5616, United States; Hearing Rehabilitation Center, Department of Otolaryngology, Michigan Medicine, 475 W. Market Place, Building 1, Suite A, Ann Arbor, MI 48108, United States.
| | - Teresa A Zwolan
- Hearing Rehabilitation Center, Department of Otolaryngology, Michigan Medicine, 475 W. Market Place, Building 1, Suite A, Ann Arbor, MI 48108, United States
| | - Bryan E Pfingst
- Kresge Hearing Research Institute, Department of Otolaryngology, Michigan Medicine, 1150 West Medical Center Drive, Ann Arbor, MI 48109-5616, United States
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Abstract
OBJECTIVE Assess relationships between patient, hearing, and cochlear implant (CI)-related factors and second-side CI speech recognition outcomes in adults who are bilaterally implanted. STUDY DESIGN Retrospective review of a prospectively maintained CI database. SETTING Tertiary academic center. PATIENTS One hundred two adults receiving bilateral sequential or simultaneous CIs. OUTCOME MEASURES Postimplantation consonant-nucleus-consonant (CNC) word and AzBio sentence scores at ≥12 months. RESULTS Of patient, hearing and CI-specific, factors examined only postimplantation speech recognition scores of the first CI were independently associated with speech recognition performance of the second CI on multivariable regression analysis (CNC: ß = 0.471[0.298, 0.644]; AzBio: ß = 0.602[0.417, 0.769]). First-side postoperative CNC scores explained 24.3% of variation in second CI postoperative CNC scores, while change in first CI AzBio scores explained 40.3% of variation in second CI AzBio scores. Based on established 95% confidence intervals, 75.2% (CNC) and 65.9% (AzBio) of patients score equivalent or better with their second CI compared to first CI performance. Age at implantation, duration of hearing loss, receiving simultaneous versus sequential CIs, and preoperative residual hearing (measured by pure-tone average and aided speech recognition scores) were not associated with 12 month speech recognition scores at 12 months. CONCLUSIONS The degree of improvement in speech recognition from first CI may predict speech recognition with a second CI. This provides preliminary evidence-based expectations for patients considering a second CI. Counseling should be guarded given the remaining unexplained variability in outcomes. Nonetheless, these data may assist decision making when considering a second CI versus continued use of a hearing aid for an unimplanted ear. LEVEL OF EVIDENCE III.
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Cognitive Functions in Adults Receiving Cochlear Implants: Predictors of Speech Recognition and Changes After Implantation. Otol Neurotol 2021; 41:e322-e329. [PMID: 31868779 DOI: 10.1097/mao.0000000000002544] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HYPOTHESES Significant variability in speech recognition outcomes is consistently observed in adults who receive cochlear implants (CIs), some of which may be attributable to cognitive functions. Two hypotheses were tested: 1) preoperative cognitive skills assessed visually would predict postoperative speech recognition at 6 months after CI; and 2) cochlear implantation would result in benefits to cognitive processes at 6 months. BACKGROUND Several executive functioning tasks have been identified as contributors to speech recognition in adults with hearing loss. There is also mounting evidence that cochlear implantation can improve cognitive functioning. This study examined whether preoperative cognitive functions would predict speech recognition after implantation, and whether cognitive skills would improve as a result of CI intervention. METHODS Nineteen post-lingually deafened adult CI candidates were tested preoperatively using a visual battery of tests to assess working memory (WM), processing speed, inhibition-concentration, and nonverbal reasoning. Six months post-implantation, participants were assessed with a battery of word and sentence recognition measures and cognitive tests were repeated. RESULTS Multiple speech measures after 6 months of CI use were correlated with preoperative visual WM (symbol span task) and inhibition ability (stroop incongruent task) with moderate-to-large effect sizes. Small-to-large effect size improvements in visual WM, concentration, and inhibition tasks were found from pre- to post-CI. Patients with lower baseline cognitive abilities improved the most after implantation. CONCLUSIONS Findings provide evidence that preoperative cognitive factors contribute to speech recognition outcomes for adult CI users, and support the premise that implantation may lead to improvements in some cognitive domains.
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Zhao EE, Dornhoffer JR, Loftus C, Nguyen SA, Meyer TA, Dubno JR, McRackan TR. Association of Patient-Related Factors With Adult Cochlear Implant Speech Recognition Outcomes: A Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 146:613-620. [PMID: 32407461 DOI: 10.1001/jamaoto.2020.0662] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Multiple studies have evaluated associations between post-cochlear implant (CI) speech recognition outcomes and patient-related factors. Current literature often appears equivocal or contradictory, so little is known about the factors that contribute to successful speech recognition outcomes with CIs. Objective To use a meta-analysis to pool data from the extant literature and provide an objective summary of existing evidence on associations of patient-related factors and CI speech recognition outcomes. Data Sources A literature search was performed using PubMed, Scopus, and CINAHL databases in January 2019 using the following search terms: cochlear implant or cochlear implants or cochlear implantation and speech recognition or word recognition or sentence recognition. Studies of postlingually deafened adult CI recipients that reported word or sentence recognition scores were included. Study Selection Inclusion criteria were postlingual adult CI recipients 18 years or older with word or sentence recognition scores at minimum 6-month postimplantation. Studies that included patients undergoing revision or reimplantation surgery were excluded. Data Extraction and Synthesis Following the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines, 1809 unique articles underwent review by abstract, and 121 articles underwent full-text review, resulting in 13 articles of 1095 patients for a meta-analysis of correlations. Random-effects model was used when the heterogeneity test yielded a low P value (P < .05). Main Outcomes and Measures The planned primary outcome was the pooled correlation values between postimplant speech recognition scores and patient-related factors. Results Of the 1095 patients included from the 13 studies, the mean age at implantation ranged from 51.2 to 63.7 years and the mean duration of hearing loss ranged from 9.5 to 31.8 years; for the 825 patients for whom sex was reported, 421 (51.0%) were women. A weak negative correlation was observed between age at implantation and postimplant sentence recognition in quiet (r = -0.31 [95% CI, -0.41 to -0.20]). Other correlations between patient-related factors and postimplant word or sentence recognition were statistically significant, but all correlations were absent to negligible (r = 0.02-0.27). Conclusions and Relevance Given that most associations were weak, negligible, or absent, patient-related factors often thought to affect CI speech recognition ability offer limited assistance in clinical decision-making in cochlear implantation. Additional research is needed to identify patient-related and other factors that predict CI outcomes, including speech recognition and other important variables related to success with CIs.
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Affiliation(s)
- Elise E Zhao
- Medical University of South Carolina, Charleston
| | | | | | | | - Ted A Meyer
- Medical University of South Carolina, Charleston
| | - Judy R Dubno
- Medical University of South Carolina, Charleston
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Tamati TN, Vasil KJ, Kronenberger WG, Pisoni DB, Moberly AC, Ray C. Word and Nonword Reading Efficiency in Postlingually Deafened Adult Cochlear Implant Users. Otol Neurotol 2021; 42:e272-e278. [PMID: 33306660 PMCID: PMC7874984 DOI: 10.1097/mao.0000000000002925] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
HYPOTHESIS This study tested the hypotheses that 1) experienced adult cochlear implants (CI) users demonstrate poorer reading efficiency relative to normal-hearing controls, 2) reading efficiency reflects basic, underlying neurocognitive skills, and 3) reading efficiency relates to speech recognition outcomes in CI users. BACKGROUND Weak phonological processing skills have been associated with poor speech recognition outcomes in postlingually deaf adult CI users. Phonological processing can be captured in nonauditory measures of reading efficiency, which may have wide use in patients with hearing loss. This study examined reading efficiency in adults CI users, and its relation to speech recognition outcomes. METHODS Forty-eight experienced, postlingually deaf adult CI users (ECIs) and 43 older age-matched peers with age-normal hearing (ONHs) completed the Test of Word Reading Efficiency (TOWRE-2), which measures word and nonword reading efficiency. Participants also completed a battery of nonauditory neurocognitive measures and auditory sentence recognition tasks. RESULTS ECIs and ONHs did not differ in word (ECIs: M = 78.2, SD = 11.4; ONHs: M = 83.3, SD = 10.2) or nonword reading efficiency (ECIs: M = 42.0, SD = 11.2; ONHs: M = 43.7, SD = 10.3). For ECIs, both scores were related to untimed word reading with moderate to strong effect sizes (r = 0.43-0.69), but demonstrated differing relations with other nonauditory neurocognitive measures with weak to moderate effect sizes (word: r = 0.11-0.44; nonword: r = (-)0.15 to (-)0.42). Word reading efficiency was moderately related to sentence recognition outcomes in ECIs (r = 0.36-0.40). CONCLUSION Findings suggest that postlingually deaf adult CI users demonstrate neither impaired word nor nonword reading efficiency, and these measures reflect different underlying mechanisms involved in language processing. The relation between sentence recognition and word reading efficiency, a measure of lexical access speed, suggests that this measure may be useful for explaining outcome variability in adult CI users.
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Affiliation(s)
- Terrin N. Tamati
- Department of Otolaryngology—Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kara J. Vasil
- Department of Otolaryngology—Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - William G. Kronenberger
- Department of Otolaryngology—Head and Neck Surgery, DeVault Otologic Research Laboratory, Indianapolis
| | - David B. Pisoni
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, USA
| | - Aaron C. Moberly
- Department of Otolaryngology—Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christin Ray
- Department of Otolaryngology—Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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O'Neill ER, Parke MN, Kreft HA, Oxenham AJ. Role of semantic context and talker variability in speech perception of cochlear-implant users and normal-hearing listeners. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 149:1224. [PMID: 33639827 PMCID: PMC7895533 DOI: 10.1121/10.0003532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/01/2021] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
This study assessed the impact of semantic context and talker variability on speech perception by cochlear-implant (CI) users and compared their overall performance and between-subjects variance with that of normal-hearing (NH) listeners under vocoded conditions. Thirty post-lingually deafened adult CI users were tested, along with 30 age-matched and 30 younger NH listeners, on sentences with and without semantic context, presented in quiet and noise, spoken by four different talkers. Additional measures included working memory, non-verbal intelligence, and spectral-ripple detection and discrimination. Semantic context and between-talker differences influenced speech perception to similar degrees for both CI users and NH listeners. Between-subjects variance for speech perception was greatest in the CI group but remained substantial in both NH groups, despite the uniformly degraded stimuli in these two groups. Spectral-ripple detection and discrimination thresholds in CI users were significantly correlated with speech perception, but a single set of vocoder parameters for NH listeners was not able to capture average CI performance in both speech and spectral-ripple tasks. The lack of difference in the use of semantic context between CI users and NH listeners suggests no overall differences in listening strategy between the groups, when the stimuli are similarly degraded.
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Affiliation(s)
- Erin R O'Neill
- Department of Psychology, University of Minnesota, Elliott Hall, 75 East River Parkway, Minneapolis, Minnesota 55455, USA
| | - Morgan N Parke
- Department of Psychology, University of Minnesota, Elliott Hall, 75 East River Parkway, Minneapolis, Minnesota 55455, USA
| | - Heather A Kreft
- Department of Psychology, University of Minnesota, Elliott Hall, 75 East River Parkway, Minneapolis, Minnesota 55455, USA
| | - Andrew J Oxenham
- Department of Psychology, University of Minnesota, Elliott Hall, 75 East River Parkway, Minneapolis, Minnesota 55455, USA
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Prentiss S, Snapp H, Zwolan T. Audiology Practices in the Preoperative Evaluation and Management of Adult Cochlear Implant Candidates. JAMA Otolaryngol Head Neck Surg 2021; 146:136-142. [PMID: 31830215 DOI: 10.1001/jamaoto.2019.3760] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Currently, no clear guidelines exist regarding clinical testing methods for identifying adult cochlear implant (CI) candidates. Indications provided by the US Food and Drug Administration, Medicare, and private insurers are ambiguous concerning test materials and the level and mode of test presentation. This could lead to wide variability in clinical assessment and, potentially, unequal access to CIs for individuals with clinically significant hearing loss. Objective To examine the preoperative testing methods used by audiologists in evaluating adult CI candidates across the United States. Design, Setting, and Participants A survey assessing audiology practice patterns was created using a Research Electronic Data Capture system hosted at the University of Miami. A link to a survey (65 questions in multiple-choice or rank-order format was distributed electronically along with a request for completion to members of the American Cochlear Implant Alliance and to the Institute for Cochlear Implant Training forum. Responses were collected from January 17 to June 4, 2018. Participation was limited to audiologists who evaluate adult CI candidates, and respondents who do not provide adult CI care were excluded. Collected demographic information included work setting, years of experience, and highest level of education attained. Main Outcomes and Measures Percentages, medians, and interquartile ranges were from aggregated responses concerning hearing aid verification methods; testing methods, materials, and practices; nonauditory factors that might affect CI candidacy; audiology practice patterns; and expanded indications for CIs. Results Anonymized surveys were returned by 99 respondents; because surveys were available electronically, the number of audiologists who viewed the survey but did not respond was not available. Seven respondents identified themselves as pediatric specialists and were excluded, resulting in a total of 92 surveys available for analysis (denominators vary because respondents could complete the survey without answering all questions). Seventy percent of respondents (51 of 72) were doctors of audiology, and nearly 50% (33 of 74) were employed at universities and academic centers performing more than 50 CIs per year. When assessing adult candidacy for implant, most respondents reported using test materials from the Minimum Speech Test Battery: 96% (51 of 53), using AzBio sentences in quiet; 89% (47 of 53), AzBio sentences in noise; and 100% (53 of 53), the consonant-vowel nucleus-consonant, monosyllabic words test. However, these tests were applied inconsistently, with 39 of 53 respondents (74%) reporting use of a sound pressure level scale and the other 14 (26%) a hearing level scale at various decibel levels, and with some using a single signal-to-noise ratio and others using multiple ratios for sound-in-noise tests. Respondents' definitions of the best aided listening condition for assessing implant candidates also varied widely. Among the nonauditory factors ranked most important for assessing CI candidacy were patient's level of cognition and expectations of CI; yet, few respondents reported including cognitive or psychological tests in the assessment protocol. Conclusions and Relevance Findings of this study reveal considerable variability in preoperative testing methods and practices across health care professionals assessing adult candidates for CI. This lack of standardization in the delivery of care may increase the risk for health care inequities, specifically in access to care for adults with clinically significant hearing loss.
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Affiliation(s)
- Sandra Prentiss
- Department of Otolaryngology, University of Miami, Miami, Florida
| | - Hillary Snapp
- Department of Otolaryngology, University of Miami, Miami, Florida
| | - Teresa Zwolan
- Cochlear Implant Program, Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan
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Icht M, Mama Y, Taitelbaum-Swead R. Visual and Auditory Verbal Memory in Older Adults: Comparing Postlingually Deaf Cochlear Implant Users to Normal-Hearing Controls. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3865-3876. [PMID: 33049151 DOI: 10.1044/2020_jslhr-20-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The aim of this study was to test whether a group of older postlingually deafened cochlear implant users (OCIs) use similar verbal memory strategies to those used by older normal-hearing adults (ONHs). Verbal memory functioning was assessed in the visual and auditory modalities separately, enabling us to eliminate possible modality-based biases. Method Participants performed two separate visual and auditory verbal memory tasks. In each task, the visually or aurally presented study words were learned by vocal production (saying aloud) or by no production (reading silently or listening), followed by a free recall test. Twenty-seven older adults (> 60 years) participated (OCI = 13, ONH = 14), all of whom demonstrated intact cognitive abilities. All OCIs showed good open-set speech perception results in quiet. Results Both ONHs and OCIs showed production benefits (higher recall rates for vocalized than nonvocalized words) in the visual and auditory tasks. The ONHs showed similar production benefits in the visual and auditory tasks. The OCIs demonstrated a smaller production effect in the auditory task. Conclusions These results may indicate that different modality-specific memory strategies were used by the ONHs and the OCIs. The group differences in memory performance suggest that, even when deafness occurs after the completion of language acquisition, the reduced and distorted external auditory stimulation leads to a deterioration in the phonological representation of sounds. Possibly, this deterioration leads to a less efficient auditory long-term verbal memory.
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Affiliation(s)
- Michal Icht
- Department of Communication Disorders, Ariel University, Israel
| | - Yaniv Mama
- Department of Behavioral Sciences and Psychology, Ariel University, Israel
| | - Riki Taitelbaum-Swead
- Department of Communication Disorders, Ariel University, Israel
- Meuhedet Health Services, Tel Aviv, Israel
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Mancini P, Dincer D'Alessandro H, Portanova G, Atturo F, Russo FY, Greco A, de Vincentiis M, Giallini I, De Seta D. Bimodal cochlear implantation in elderly patients. Int J Audiol 2020; 60:469-478. [PMID: 33174776 DOI: 10.1080/14992027.2020.1843080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Bimodal stimulation is a standard option for asymmetric hearing loss in adults. Questions have been raised whether receiving two stimulations may conflict in elderly listeners where the central integration of an acoustic/electrical signal may be very important to obtain benefit in terms of speech perception. DESIGN Clinical retrospective study. STUDY SAMPLE The outcomes from 17 bimodal cochlear implant (CI) users were analysed. The test material consisted of speech audiometry in quiet and in noise (STARR and Matrix). RESULTS Bimodal PTA and speech perception both in quiet and in noise were significantly better than CI or HA alone. Age showed a significant effect on bimodal STARR outcomes. Similarly, bimodal STARR scores improved significantly in comparison to Better Ear. CONCLUSION Both Matrix and STARR tests were very difficult for many elderly CI listeners from the present study group, especially in unilateral listening condition. The performance improved significantly, emphasising a good integration of acoustic and electric hearing in this group of elderly bimodal listeners. Overall results highlighted how a specific study, based on speech perception in noise in the elderly listeners, might shed light on the effect of speech test modality on bimodal outcomes.
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Affiliation(s)
- Patrizia Mancini
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Hilal Dincer D'Alessandro
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy.,Department of Audiology, Hacettepe University, Ankara, Turkey
| | - Ginevra Portanova
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Francesca Atturo
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Ilaria Giallini
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Daniele De Seta
- Department of Surgical Sciences, Section of Otolaryngology, University of Cagliari, Cagliari, Italy
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Moberly AC, Vasil K, Baxter J, Klamer B, Kline D, Ray C. Comprehensive auditory rehabilitation in adults receiving cochlear implants: A pilot study. Laryngoscope Investig Otolaryngol 2020; 5:911-918. [PMID: 33134539 PMCID: PMC7585234 DOI: 10.1002/lio2.442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE In the United States, most adults who receive cochlear implants (CIs) do not undergo a comprehensive auditory rehabilitation (CAR) approach, which may result in suboptimal outcomes. The objectives of this pilot study were to demonstrate that a CAR approach incorporating auditory training (AT) by a speech-language pathologist (SLP) is feasible in adults receiving CIs and to explore whether this approach results in improved outcomes. METHODS Twenty-four postlingually deaf adult CI candidates were serially assigned to one of three groups: (a) a "CAR group" that received standard of care implantation, programming by an audiologist, an additional preoperative counseling session, and eight one-hour AT sessions; (b) a "passive control" standard-of-care group; and (c) an "active control" group that also received the extra preoperative counseling session. Participants were tested preoperatively and 1, 3, and 6 months after CI using measures of word and sentence recognition in quiet and in babble, as well as measures of quality of life (QOL). RESULTS The CAR approach was feasible, but this pilot study was underpowered to determine efficacy. Differential time courses of speech recognition improvement were seen for sentence and word recognition. All QOL measurements showed improvement from pre-CI to 1 month post-CI activation. Results revealed issues to consider for a larger-scale study of CAR revolving around participant selection, study measures, and sample size. CONCLUSION The CAR approach is feasible in new CI users. A larger trial is needed to investigate whether CAR leads to better outcomes or faster improvement in this clinical population. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Aaron C. Moberly
- Department of Otolaryngology – Head and Neck SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Kara Vasil
- Department of Otolaryngology – Head and Neck SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Jodi Baxter
- Department of Speech and Hearing ScienceThe Ohio State UniversityColumbusOhioUSA
| | - Brett Klamer
- Center for Biostatistics, Department of Biomedical InformaticsThe Ohio State UniversityColumbusOhioUSA
| | - David Kline
- Center for Biostatistics, Department of Biomedical InformaticsThe Ohio State UniversityColumbusOhioUSA
| | - Christin Ray
- Department of Otolaryngology – Head and Neck SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA
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Kessler M, Schierholz I, Mamach M, Wilke F, Hahne A, Büchner A, Geworski L, Bengel FM, Sandmann P, Berding G. Combined Brain-Perfusion SPECT and EEG Measurements Suggest Distinct Strategies for Speech Comprehension in CI Users With Higher and Lower Performance. Front Neurosci 2020; 14:787. [PMID: 32848560 PMCID: PMC7431776 DOI: 10.3389/fnins.2020.00787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022] Open
Abstract
Cochlear implantation constitutes a successful therapy of inner ear deafness, with the majority of patients showing good outcomes. There is, however, still some unexplained variability in outcomes with a number of cochlear-implant (CI) users, showing major limitations in speech comprehension. The current study used a multimodal diagnostic approach combining single-photon emission computed tomography (SPECT) and electroencephalography (EEG) to examine the mechanisms underlying speech processing in postlingually deafened CI users (N = 21). In one session, the participants performed a speech discrimination task, during which a 96-channel EEG was recorded and the perfusions marker 99mTc-HMPAO was injected intravenously. The SPECT scan was acquired 1.5 h after injection to measure the cortical activity during the speech task. The second session included a SPECT scan after injection without stimulation at rest. Analysis of EEG and SPECT data showed N400 and P600 event-related potentials (ERPs) particularly evoked by semantic violations in the sentences, and enhanced perfusion in a temporo-frontal network during task compared to rest, involving the auditory cortex bilaterally and Broca's area. Moreover, higher performance in testing for word recognition and verbal intelligence strongly correlated to the activation in this network during the speech task. However, comparing CI users with lower and higher speech intelligibility [median split with cutoff + 7.6 dB signal-to-noise ratio (SNR) in the Göttinger sentence test] revealed for CI users with higher performance additional activations of parietal and occipital regions and for those with lower performance stronger activation of superior frontal areas. Furthermore, SPECT activity was tightly coupled with EEG and cognitive abilities, as indicated by correlations between (1) cortical activation and the amplitudes in EEG, N400 (temporal and occipital areas)/P600 (parietal and occipital areas) and (2) between cortical activation in left-sided temporal and bilateral occipital/parietal areas and working memory capacity. These results suggest the recruitment of a temporo-frontal network in CI users during speech processing and a close connection between ERP effects and cortical activation in CI users. The observed differences in speech-evoked cortical activation patterns for CI users with higher and lower speech intelligibility suggest distinct processing strategies during speech rehabilitation with CI.
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Affiliation(s)
- Mariella Kessler
- Department of Nuclear Medicine, Hannover Medical School, Hanover, Germany
- Cluster of Excellence Hearing4all, Hannover Medical School, University of Oldenburg, Oldenburg, Germany
| | - Irina Schierholz
- Cluster of Excellence Hearing4all, Hannover Medical School, University of Oldenburg, Oldenburg, Germany
- Department of Otorhinolaryngology, Hannover Medical School, Hanover, Germany
- Department of Otorhinolaryngology, University of Cologne, Cologne, Germany
| | - Martin Mamach
- Cluster of Excellence Hearing4all, Hannover Medical School, University of Oldenburg, Oldenburg, Germany
- Department of Medical Physics and Radiation Protection, Hannover Medical School, Hanover, Germany
| | - Florian Wilke
- Department of Medical Physics and Radiation Protection, Hannover Medical School, Hanover, Germany
| | - Anja Hahne
- Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Saxonian Cochlear Implant Center, Technical University Dresden, Dresden, Germany
| | - Andreas Büchner
- Cluster of Excellence Hearing4all, Hannover Medical School, University of Oldenburg, Oldenburg, Germany
- Department of Otorhinolaryngology, Hannover Medical School, Hanover, Germany
| | - Lilli Geworski
- Department of Medical Physics and Radiation Protection, Hannover Medical School, Hanover, Germany
| | - Frank M. Bengel
- Department of Nuclear Medicine, Hannover Medical School, Hanover, Germany
| | - Pascale Sandmann
- Department of Otorhinolaryngology, University of Cologne, Cologne, Germany
| | - Georg Berding
- Department of Nuclear Medicine, Hannover Medical School, Hanover, Germany
- Cluster of Excellence Hearing4all, Hannover Medical School, University of Oldenburg, Oldenburg, Germany
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Swiderski DL, Colesa DJ, Hughes AP, Raphael Y, Pfingst BE. Relationships between Intrascalar Tissue, Neuron Survival, and Cochlear Implant Function. J Assoc Res Otolaryngol 2020; 21:337-352. [PMID: 32691251 PMCID: PMC7445211 DOI: 10.1007/s10162-020-00761-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 07/12/2020] [Indexed: 12/15/2022] Open
Abstract
Fibrous tissue and/or new bone are often found surrounding a cochlear implant in the cochlear scalae. This new intrascalar tissue could potentially limit cochlear implant function by increasing impedance and altering signaling pathways between the implant and the auditory nerve. In this study, we investigated the relationship between intrascalar tissue and 5 measures of implant function in guinea pigs. Variation in both spiral ganglion neuron (SGN) survival and intrascalar tissue was produced by implanting hearing ears, ears deafened with neomycin, and neomycin-deafened ears treated with a neurotrophin. We found significant effects of SGN density on 4 functional measures but adding intrascalar tissue level to the analysis did not explain more variation in any measure than was explained by SGN density alone. These results suggest that effects of intrascalar tissue on electrical hearing are relatively unimportant in comparison to degeneration of the auditory nerve, although additional studies in human implant recipients are still needed to assess the effects of this tissue on complex hearing tasks like speech perception. The results also suggest that efforts to minimize the trauma that aggravates both tissue development and SGN loss could be beneficial.
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Affiliation(s)
- Donald L Swiderski
- Kresge Hearing Research Institute, Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Deborah J Colesa
- Kresge Hearing Research Institute, Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Aaron P Hughes
- Kresge Hearing Research Institute, Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Yehoash Raphael
- Kresge Hearing Research Institute, Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Bryan E Pfingst
- Kresge Hearing Research Institute, Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
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Tamati TN, Ray C, Vasil KJ, Pisoni DB, Moberly AC. High- and Low-Performing Adult Cochlear Implant Users on High-Variability Sentence Recognition: Differences in Auditory Spectral Resolution and Neurocognitive Functioning. J Am Acad Audiol 2020; 31:324-335. [PMID: 31580802 DOI: 10.3766/jaaa.18106] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Postlingually deafened adult cochlear implant (CI) users routinely display large individual differences in the ability to recognize and understand speech, especially in adverse listening conditions. Although individual differences have been linked to several sensory (''bottom-up'') and cognitive (''top-down'') factors, little is currently known about the relative contributions of these factors in high- and low-performing CI users. PURPOSE The aim of the study was to investigate differences in sensory functioning and neurocognitive functioning between high- and low-performing CI users on the Perceptually Robust English Sentence Test Open-set (PRESTO), a high-variability sentence recognition test containing sentence materials produced by multiple male and female talkers with diverse regional accents. RESEARCH DESIGN CI users with accuracy scores in the upper (HiPRESTO) or lower quartiles (LoPRESTO) on PRESTO in quiet completed a battery of behavioral tasks designed to assess spectral resolution and neurocognitive functioning. STUDY SAMPLE Twenty-one postlingually deafened adult CI users, with 11 HiPRESTO and 10 LoPRESTO participants. DATA COLLECTION AND ANALYSIS A discriminant analysis was carried out to determine the extent to which measures of spectral resolution and neurocognitive functioning discriminate HiPRESTO and LoPRESTO CI users. Auditory spectral resolution was measured using the Spectral-Temporally Modulated Ripple Test (SMRT). Neurocognitive functioning was assessed with visual measures of working memory (digit span), inhibitory control (Stroop), speed of lexical/phonological access (Test of Word Reading Efficiency), and nonverbal reasoning (Raven's Progressive Matrices). RESULTS HiPRESTO and LoPRESTO CI users were discriminated primarily by performance on the SMRT and secondarily by the Raven's test. No other neurocognitive measures contributed substantially to the discriminant function. CONCLUSIONS High- and low-performing CI users differed by spectral resolution and, to a lesser extent, nonverbal reasoning. These findings suggest that the extreme groups are determined by global factors of richness of sensory information and domain-general, nonverbal intelligence, rather than specific neurocognitive processing operations related to speech perception and spoken word recognition. Thus, although both bottom-up and top-down information contribute to speech recognition performance, low-performing CI users may not be sufficiently able to rely on neurocognitive skills specific to speech recognition to enhance processing of spectrally degraded input in adverse conditions involving high talker variability.
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Affiliation(s)
- Terrin N Tamati
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Christin Ray
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kara J Vasil
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - David B Pisoni
- Department of Psychological and Brain Sciences, Indiana University - Bloomington, Bloomington, IN
| | - Aaron C Moberly
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
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Canfarotta MW, O'Connell BP, Buss E, Pillsbury HC, Brown KD, Dillon MT. Influence of Age at Cochlear Implantation and Frequency-to-Place Mismatch on Early Speech Recognition in Adults. Otolaryngol Head Neck Surg 2020; 162:926-932. [PMID: 32178574 PMCID: PMC8590812 DOI: 10.1177/0194599820911707] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Default frequency filters of cochlear implant (CI) devices assign frequency information irrespective of intracochlear position, resulting in varying degrees of frequency-to-place mismatch. Substantial mismatch negatively influences speech recognition in postlingually deafened CI recipients, and acclimatization may be particularly challenging for older adults due to effects of aging on the auditory pathway. The present report investigated the influence of mismatch and age at implantation on speech recognition within the initial 6 months of CI use. STUDY DESIGN Retrospective review. SETTING Tertiary referral center. SUBJECTS AND METHODS Forty-eight postlingually deafened adult CI recipients of lateral wall electrode arrays underwent postoperative computed tomography to determine angular insertion depth of each electrode contact. Frequency-to-place mismatch was determined by comparing spiral ganglion place frequencies to default frequency filters. Consonant-nucleus-consonant (CNC) scores in the CI-alone condition at 1, 3, and 6 months postactivation were compared to the degree of mismatch at 1500 Hz and age at implantation. RESULTS Younger adult CI recipients experienced more rapid growth in speech recognition during the initial 6 months postactivation. Greater degrees of frequency-to-place mismatch were associated with poorer performance, yet older listeners were not particularly susceptible to this effect. CONCLUSIONS While older adults are not necessarily more sensitive to detrimental effects of frequency-to-place mismatch, other factors appear to limit early benefit with a CI in this population. These results suggest that minimizing mismatch could optimize outcomes in adult CI recipients across the life span, which may be particularly beneficial in the elderly considering auditory processing deficits associated with advanced age.
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Affiliation(s)
- Michael W Canfarotta
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brendan P O'Connell
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily Buss
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Harold C Pillsbury
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kevin D Brown
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Margaret T Dillon
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Mussoi BSS, Brown CJ. Age-Related Changes in Temporal Resolution Revisited: Electrophysiological and Behavioral Findings From Cochlear Implant Users. Ear Hear 2020; 40:1328-1344. [PMID: 31033701 PMCID: PMC6814519 DOI: 10.1097/aud.0000000000000732] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The mechanisms underlying age-related changes in speech perception are still unclear, most likely multifactorial and often can be difficult to parse out from the effects of hearing loss. Age-related changes in temporal resolution (i.e., the ability to track rapid changes in sounds) have long been associated with speech perception declines exhibited by many older individuals. The goals of this study were as follows: (1) to assess age-related changes in temporal resolution in cochlear implant (CI) users, and (2) to examine the impact of changes in temporal resolution and cognition on the perception of speech in noise. In this population, it is possible to bypass the cochlea and stimulate the auditory nerve directly in a noninvasive way. Additionally, CI technology allows for manipulation of the temporal properties of a signal without changing its spectrum. DESIGN Twenty postlingually deafened Nucleus CI users took part in this study. They were divided into groups of younger (18 to 40 years) and older (68 to 82 years) participants. A cross-sectional study design was used. The speech processor was bypassed and a mid-array electrode was used for stimulation. We compared peripheral and central physiologic measures of temporal resolution with perceptual measures obtained using similar stimuli. Peripherally, temporal resolution was assessed with measures of the rate of recovery of the electrically evoked compound action potential (ECAP), evoked using a single pulse and a pulse train as maskers. The acoustic change complex (ACC) to gaps in pulse trains was used to assess temporal resolution more centrally. Psychophysical gap detection thresholds were also obtained. Cognitive assessment included two tests of processing speed (Symbol Search and Coding) and one test of working memory (Digit Span Test). Speech perception was tested in the presence of background noise (QuickSIN test). A correlational design was used to explore the relationship between temporal resolution, cognition, and speech perception. RESULTS The only metric that showed significant age effects in temporal processing was the ECAP recovery function recorded using pulse train maskers. Younger participants were found to have faster rates of neural recovery following presentation of pulse trains than older participants. Age was not found to have a significant effect on speech perception. When results from both groups were combined, digit span was the only measure significantly correlated with speech perception performance. CONCLUSIONS In this sample of CI users, few effects of advancing age on temporal resolution were evident. While this finding would be consistent with a general lack of aging effects on temporal resolution, it is also possible that aging effects are influenced by processing peripheral to the auditory nerve, which is bypassed by the CI. However, it is known that cross-fiber neural synchrony is improved with electrical (as opposed to acoustic) stimulation. This change in neural synchrony may, in turn, make temporal cues more robust/perceptible to all CI users. Future studies involving larger sample sizes should be conducted to confirm these findings. Results of this study also add to the growing body of literature that suggests that working memory is important for the perception of degraded speech.
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Affiliation(s)
- Bruna S. S. Mussoi
- Kent State University, Speech Pathology and Audiology Program, Kent, Ohio, USA
| | - Carolyn J. Brown
- University of Iowa, Department of Communication Sciences and Disorders / Department of Otolaryngology – Head and Neck Surgery, Iowa City, Iowa, USA
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Huber M, Roesch S, Pletzer B, Lukaschyk J, Lesinski-Schiedat A, Illg A. Cognition in older adults with severe to profound sensorineural hearing loss compared to peers with normal hearing for age. Int J Audiol 2019; 59:254-262. [DOI: 10.1080/14992027.2019.1687947] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Maria Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Sebastian Roesch
- Department of Otorhinolaryngology, Head and Neck Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Belinda Pletzer
- Department of Psychology, Center for Neurocognitive Research, University of Salzburg, Salzburg, Austria
| | - Julia Lukaschyk
- Department of Otorhinolaryngology, Hannover Medical University, Hannover, Germany
| | | | - Angelika Illg
- Department of Otorhinolaryngology, Hannover Medical University, Hannover, Germany
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Mattingly JK, Castellanos I, Moberly AC. Nonverbal Reasoning as a Contributor to Sentence Recognition Outcomes in Adults With Cochlear Implants. Otol Neurotol 2019; 39:e956-e963. [PMID: 30444843 DOI: 10.1097/mao.0000000000001998] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS Significant variability in speech recognition persists among postlingually deafened adults with cochlear implants (CIs). We hypothesize that scores of nonverbal reasoning predict sentence recognition in adult CI users. BACKGROUND Cognitive functions contribute to speech recognition outcomes in adults with hearing loss. These functions may be particularly important for CI users who must interpret highly degraded speech signals through their devices. This study used a visual measure of reasoning (the ability to solve novel problems), the Raven's Progressive Matrices (RPM), to predict sentence recognition in CI users. METHODS Participants were 39 postlingually deafened adults with CIs and 43 age-matched normal-hearing (NH) controls. CI users were assessed for recognition of words in sentences in quiet, and NH controls listened to eight-channel vocoded versions to simulate the degraded signal delivered by a CI. A computerized visual task of the RPM, requiring participants to identify the correct missing piece in a 3×3 matrix of geometric designs, was also performed. Particular items from the RPM were examined for their associations with sentence recognition abilities, and a subset of items on the RPM was tested for the ability to predict degraded sentence recognition in the NH controls. RESULTS The overall number of items answered correctly on the 48-item RPM significantly correlated with sentence recognition in CI users (r = 0.35-0.47) and NH controls (r = 0.36-0.57). An abbreviated 12-item version of the RPM was created and performance also correlated with sentence recognition in CI users (r = 0.40-0.48) and NH controls (r = 0.49-0.56). CONCLUSIONS Nonverbal reasoning skills correlated with sentence recognition in both CI and NH subjects. Our findings provide further converging evidence that cognitive factors contribute to speech processing by adult CI users and can help explain variability in outcomes. Our abbreviated version of the RPM may serve as a clinically meaningful assessment for predicting sentence recognition outcomes in CI users.
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Affiliation(s)
- Jameson K Mattingly
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio
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Dingemanse JG, Goedegebure A. The Important Role of Contextual Information in Speech Perception in Cochlear Implant Users and Its Consequences in Speech Tests. Trends Hear 2019; 23:2331216519838672. [PMID: 30991904 PMCID: PMC6472157 DOI: 10.1177/2331216519838672] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study investigated the role of contextual information in speech
intelligibility, the influence of verbal working memory on the use of contextual
information, and the suitability of an ecologically valid sentence test
containing contextual information, compared with a CNC
(Consonant-Nucleus-Consonant) word test, in cochlear implant (CI) users. Speech
intelligibility performance was assessed in 50 postlingual adult CI users on
sentence lists and on CNC word lists. Results were compared with a
normal-hearing (NH) group. The influence of contextual information was
calculated from three different context models. Working memory capacity was
measured with a Reading Span Test. CI recipients made significantly more use of
contextual information in recognition of CNC words and sentences than NH
listeners. Their use of contextual information in sentences was related to
verbal working memory capacity but not to age, indicating that the ability to
use context is dependent on cognitive abilities, regardless of age. The presence
of context in sentences enhanced the sensitivity to differences in sensory
bottom-up information but also increased the risk of a ceiling effect. A
sentence test appeared to be suitable in CI users if word scoring is used and
noise is added for the best performers.
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Affiliation(s)
- J. Gertjan Dingemanse
- 1 Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - André Goedegebure
- 1 Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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