Effects of computer-assisted speech training on Mandarin-speaking hearing-impaired children

Investigating Perception to Production Transfer in Children With Cochlear Implants: A High Variability Phonetic Training Study

PURPOSE

This study builds upon an established effective training method to investigate the advantages of high variability phonetic identification training for enhancing lexical tone perception and production in Mandarin-speaking pediatric cochlear implant (CI) recipients, who typically face ongoing challenges in these areas.

METHOD

Thirty-two Mandarin-speaking children with CIs were quasirandomly assigned into the training group (TG) and the control group (CG). The 16 TG participants received five sessions of high variability phonetic training (HVPT) within a period of 3 weeks. The CG participants did not receive the training. Perception and production of Mandarin tones were administered before (pretest) and immediately after (posttest) the completion of HVPT via lexical tone recognition task and picture naming task. Both groups participated in the identical pretest and posttest with the same time frame between the two test sessions.

RESULTS

TG showed significant improvement from pretest to posttest in identifying Mandarin tones for both trained and untrained speech stimuli. Moreover, perceptual learning of HVPT significantly facilitated trainees' production of T1 and T2 as rated by a cohort of 10 Mandarin-speaking adults with normal hearing, which was corroborated by acoustic analyses revealing improved fundamental frequency (F0) median for T1 and T2 production and enlarged F0 movement for T2 production. In contrast, TG children's production of T3 and T4 showed nonsignificant changes across two test sessions. Meanwhile, CG did not exhibit significant changes in either perception or production.

CONCLUSIONS

The results suggest a limited and inconsistent transfer of perceptual learning to lexical tone production in children with CIs, which challenges the notion of a robust transfer and highlights the complexity of the interaction between perceptual training and production outcomes. Further research on individual differences with a longitudinal design is needed to optimize the training protocol or tailor interventions to better meet the diverse needs of learners.

World of sounds (Seslerin Dünyası): A mobile auditory training game for children with cochlear implants

OBJECTIVES

The aim of this study is to develop a mobile auditory training application based on gaming for children aged 3-5 years using cochlear implants and to evaluate its usability.

METHODS

4 games were developed in the scope of the application World of Sounds; the crucible sound for auditory awareness, mole hunting for auditory discrimination, find the sound for auditory recognition, and choo-choo for auditory comprehension. The prototype was applied to 20 children with normal hearing and 20 children with cochlear implants, all of whom were aged 3-5. The participants were asked to fill out the Game Evaluation Form for Children. Moreover, 40 parents were included in the study, and the Evaluation Form for the Application was applied.

RESULTS

According to the form, at least 80% of children using cochlear implants, and all children in the healthy group, responded well to the usability factors. All factors were obtained as highly useable by parents of the children using cochlear implants. The results indicated that in the healthy group, the usefulness and motivation factors were above moderate, and the other factors were highly useable. In the mole-hunting game, there was no significant difference between the groups in the easy level of the first sub-section (p > 0.05). There was a significant difference between the groups in terms of the other sub-sections of the mole-hunting game and all sub-sections of the crucible sound, find the sound, and the choo-choo games (p < 0.05). While there was no correlation between duration of cochlear implant use and ADSI scores and the third sub-section of the crucible sound game (p > 0.05); a correlation was found in the other sub-sections of crucible sound and all sub-sections of the mole hunting, find the sound, and Choo-Choo games (p < 0.05).

CONCLUSION

It is thought that the application World of Sounds can serve as an accessible option to support traditional auditory rehabilitation for children with cochlear implants.

Effects of training length on adaptation to noise-vocoded speech

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

Speech Perception Training in Children: The Retention of Benefits and Booster Training

OBJECTIVES

Speech perception training can be a highly effective intervention to improve perception and language abilities in children who are deaf or hard of hearing. Most studies of speech perception training, however, only measure gains immediately following training. Only a minority of cases include a follow-up assessment after a period without training. A critical unanswered question was whether training-related benefits are retained for a period of time after training has stopped. A primary goal of this investigation was to determine whether children retained training-related benefits 4 to 6 weeks after they completed 16 hours of formal speech perception training. Training was comprised of either auditory or speechreading training, or a combination of both. Also important is to determine if "booster" training can help increase gains made during the initial intensive training period. Another goal of the study was to investigate the benefits of providing home-based booster training during the 4- to 6-week interval after the formal training ceased. The original investigation ( Tye-Murray et al. 2022 ) compared the effects of talker familiarity and the relative benefits of the different types of training. We predicted that the children who received no additional training would retain the gains after the completing the formal training. We also predicted that those children who completed the booster training would realize additional gains.

DESIGN

Children, 6 to 12 years old, with hearing loss who had previously participated in the original randomized control study returned 4 to 6 weeks after the conclusion to take a follow-up speech perception assessment. The first group (n = 44) returned after receiving no formal intervention from the research team before the follow-up assessment. A second group of 40 children completed an additional 16 hours of speech perception training at home during a 4- to 6-week interval before the follow-up speech perception assessment. The home-based speech perception training was a continuation of the same training that was received in the laboratory formatted to work on a PC tablet with a portable speaker. The follow-up speech perception assessment included measures of listening and speechreading, with test items spoken by both familiar (trained) and unfamiliar (untrained) talkers.

RESULTS

In the group that did not receive the booster training, follow-up testing showed retention for all gains that were obtained immediately following the laboratory-based training. The group that received booster training during the same interval also maintained the benefits from the formal training, with some indication of minor improvement.

CONCLUSIONS

Clinically, the present findings are extremely encouraging; the group that did not receive home-based booster training retained the benefits obtained during the laboratory-based training regimen. Moreover, the results suggest that self-paced booster training maintained the relative training gains associated with talker familiarity and training type seen immediately following laboratory-based training. Future aural rehabilitation programs should include maintenance training at home to supplement the speech perception training conducted under more formal conditions at school or in the clinic.

Effects of Auditory Training on Speech Recognition in Children with Single-Sided Deafness and Cochlea Implants Using a Direct Streaming Device: A Pilot Study

Treating individuals with single-sided deafness (SSD) with a cochlear implant (CI) offers significant benefits for speech perception in complex spatial listening environments. After implantation, training without involvement of the normal-hearing ear is essential. Therefore, the AudioLink streaming device (MED-EL GmbH, Austria) can be used to connect the externally worn audio processor to media devices; thus, the auditory stimuli are directly streamed to the implanted ear. The aim was to test whether children with SSD, aged 5-12 years, accept this training method and whether auditory training, streamed directly via AudioLink using the Tiptoi device (Ravensburger GmbH., Ravensburg, Germany), improves speech recognition. A total of 12 children with SSD and implanted with a CI received Tiptoi training via AudioLink and were asked to practice daily for 10 min over a period of one month. All participants completed the training. The measurements employed to assess improvement included speech audiometry, speech, spatial, and quality of hearing scale for parents (SSQ P), and specially designed tasks crafted for this study. Daily training of 9.93 min was reported. The word recognition score (WRS) at 65 dB and 80 dB in aided condition significantly improved and the WRS streamed via AudioLink was significantly better after training. The speech, spatial, and qualities of hearing scale for parents (SSQ P questionnaire) showed significant improvement in the dimension of quality of hearing and overall gain. The outcomes of the Tiptoi tasks resulted in a significant benefit in both categories of the "recognition of sounds" and "understanding of sentences". The results are very encouraging and do not only show the positive uptake of daily training at home but also how this resulted in a significant improvement in subjective and objective measures for this rather short training period of one month only.

Effectiveness of Computerized Auditory Training on Speech Perception in Children With Hearing Loss: A Systematic Review

PURPOSE

The purpose of this study was to investigate the effectiveness of using computerized auditory training in the auditory perception of speech in children who use electronic devices through a systematic review of the literature.

METHOD

This is a systematic review based on the elaboration of the following guiding question: In hearing-impaired children who use electronic devices, how effective is the use of computerized auditory training in the auditory perception of speech? The Cochrane Library, Embase, LILACS, PubMed, Web of Science, and Scopus databases and gray literature (Google Scholar and ProQuest) were consulted.

RESULTS

Nine hundred and eighteen records were identified, with additional two studies in the citation search, totaling 920 studies. After excluding the 184 duplicate references, using the Rayyan platform, the titles and abstracts were screened (n = 736), with 20 studies selected and considered for full reading. Six of the 20 studies were included in the systematic review of the literature.

CONCLUSIONS

Positive and beneficial results regarding computerized auditory training are evidenced, which describe and discuss the proof of the effectiveness of the positive effects on the auditory perception of speech in children using hearing aids and cochlear implants with regard to auditory detection skills, discrimination, recognition, and auditory memory. The positive results are inspiring for the continuity and expansion of studies that further investigate the use of computerized auditory training with contemporary technologies and have an impact on the improvement of access to specialized intervention.

Sustainable Benefits of High Variability Phonetic Training in Mandarin-speaking Kindergarteners With Cochlear Implants: Evidence From Categorical Perception of Lexical Tones

OBJECTIVES

Although pitch reception poses a great challenge for individuals with cochlear implants (CIs), formal auditory training (e.g., high variability phonetic training [HVPT]) has been shown to provide direct benefits in pitch-related perceptual performances such as lexical tone recognition for CI users. As lexical tones in spoken language are expressed with a multitude of distinct spectral, temporal, and intensity cues, it is important to determine the sources of training benefits for CI users. The purpose of the present study was to conduct a rigorous fine-scale evaluation with the categorical perception (CP) paradigm to control the acoustic parameters and test the efficacy and sustainability of HVPT for Mandarin-speaking pediatric CI recipients. The main hypothesis was that HVPT-induced perceptual learning would greatly enhance CI users' ability to extract the primary pitch contours from spoken words for lexical tone identification and discrimination. Furthermore, individual differences in immediate and long-term gains from training would likely be attributable to baseline performance and duration of CI use.

DESIGN

Twenty-eight prelingually deaf Mandarin-speaking kindergarteners with CIs were tested. Half of them received five sessions of HVPT within a period of 3 weeks. The other half served as control who did not receive the formal training. Two classical CP tasks on a tonal continuum from Mandarin tone 1 (high-flat in pitch) to tone 2 (mid-rising in pitch) with fixed acoustic features of duration and intensity were administered before (pretest), immediately after (posttest), and 10 weeks posttraining termination (follow-up test). Participants were instructed to either label a speech stimulus along the continuum (i.e., identification task) or determine whether a pair of stimuli separated by zero or two steps from the continuum was the same or different (i.e., discrimination task). Identification function measures (i.e., boundary position and boundary width) and discrimination function scores (i.e., between-category score, within-category score, and peakedness score) were assessed for each child participant across the three test sessions.

RESULTS

Linear mixed-effects (LME) models showed significant training-induced enhancement in lexical tone categorization with significantly narrower boundary width and better between-category discrimination in the immediate posttest over pretest for the trainees. Furthermore, training-induced gains were reliably retained in the follow-up test 10 weeks after training. By contrast, no significant changes were found in the control group across sessions. Regression analysis confirmed that baseline performance (i.e., boundary width in the pretest session) and duration of CI use were significant predictors for the magnitude of training-induced benefits.

CONCLUSIONS

The stringent CP tests with synthesized stimuli that excluded acoustic cues other than the pitch contour and were never used in training showed strong evidence for the efficacy of HVPT in yielding immediate and sustained improvement in lexical tone categorization for Mandarin-speaking children with CIs. The training results and individual differences have remarkable implications for developing personalized computer-based short-term HVPT protocols that may have sustainable long-term benefits for aural rehabilitation in this clinical population.

Tone perception development in Mandarin-speaking children with cochlear implants

OBJECTIVE

The purpose of this study was to examine the longer-term effects of cochlear implant (CI) use on tone perception by evaluating improvement in Mandarin tone recognition in children with CIs 2 and 3 years post CI activation, and to explore the effects of implant age, chronological age and duration of CI use on the development of tone perception.

METHODS

Tone perception was assessed in 29 bilateral profound hearing impaired children (mean chronological age = 4.6 years, SD = 0.7 years) with unilateral CIs at 24 and 36 months after CI activation using the tone perception subtest in the Mandarin Early Speech Perception (MESP-T) test.

RESULTS

Children's tone recognition for tone pairs and individual tones improved significantly between 2 and 3 years post CI use, showing an increase in average tone recognition score from 73.2% to 81.8%, which was significantly higher than chance level (i.e. 50%). There was no significant correlation between tone recognition ability and either implant age or chronological age at two evaluation points. Further analysis revealed that the tone recognition score for tone pair 2-3 was significantly lower than that for other tone pairs except for tone pair 2-4.

CONCLUSIONS

Longer CI experience can significantly improve tone recognition ability in CI children between 2 and 3 years post CI activation.

Preliminary evaluation of computer-assisted home training for French cochlear implant recipients

For French cochlear implant (CI) recipients, in-person clinical auditory rehabilitation is typically provided during the first few years post-implantation. However, this is often inconvenient, it requires substantial time resources and can be problematic when appointments are unavailable. In response, we developed a computer-based home training software ("French AngelSound™") for French CI recipients. We recently conducted a pilot study to evaluate the newly developed French AngelSound™ in 15 CI recipients (5 unilateral, 5 bilateral, 5 bimodal). Outcome measures included phoneme recognition in quiet and sentence recognition in noise. Unilateral CI users were tested with the CI alone. Bilateral CI users were tested with each CI ear alone to determine the poorer ear to be trained, as well as with both ears (binaural performance). Bimodal CI users were tested with the CI ear alone, and with the contralateral hearing aid (binaural performance). Participants trained at home over a one-month period (10 hours total). Phonemic contrast training was used; the level of difficulty ranged from phoneme discrimination in quiet to phoneme identification in multi-talker babble. Unilateral and bimodal CI users trained with the CI alone; bilateral CI users trained with the poorer ear alone. Outcomes were measured before training (pre-training), immediately after training was completed (post-training), and one month after training was stopped (follow-up). For all participants, post-training CI-only vowel and consonant recognition scores significantly improved after phoneme training with the CI ear alone. For bilateral and bimodal CI users, binaural vowel and consonant recognition scores also significantly improved after training with a single CI ear. Follow-up measures showed that training benefits were largely retained. These preliminary data suggest that the phonemic contrast training in French AngelSound™ may significantly benefit French CI recipients and may complement clinical auditory rehabilitation, especially when in-person visits are not possible.

Teaching Children With Hearing Loss to Recognize Speech: Gains Made With Computer-Based Auditory and/or Speechreading Training

OBJECTIVES

Transfer appropriate processing (TAP) refers to a general finding that training gains are maximized when training and testing are conducted under the same conditions. The present study tested the extent to which TAP applies to speech perception training in children with hearing loss. Specifically, we assessed the benefits of computer-based speech perception training games for enhancing children's speech recognition by comparing three training groups: auditory training (AT), audiovisual training (AVT), and a combination of these two (AT/AVT). We also determined whether talker-specific training, as might occur when children train with the speech of a next year's classroom teacher, leads to better recognition of that talker's speech and if so, the extent to which training benefits generalize to untrained talkers. Consistent with TAP theory, we predicted that children would improve their ability to recognize the speech of the trained talker more than that of three untrained talkers and, depending on their training group, would improve more on an auditory-only (listening) or audiovisual (speechreading) speech perception assessment, that matched the type of training they received. We also hypothesized that benefit would generalize to untrained talkers and to test modalities in which they did not train, albeit to a lesser extent.

DESIGN

Ninety-nine elementary school aged children with hearing loss were enrolled into a randomized control trial with a repeated measures A-A-B experimental mixed design in which children served as their own control for the assessment of overall benefit of a particular training type and three different groups of children yielded data for comparing the three types of training. We also assessed talker-specific learning and transfer of learning by including speech perception tests with stimuli spoken by the talker with whom a child trained and stimuli spoken by three talkers with whom the child did not train and by including speech perception tests that presented both auditory (listening) and audiovisual (speechreading) stimuli. Children received 16 hr of gamified training. The games provided word identification and connected speech comprehension training activities.

RESULTS

Overall, children showed significant improvement in both their listening and speechreading performance. Consistent with TAP theory, children improved more on their trained talker than on the untrained talkers. Also consistent with TAP theory, the children who received AT improved more on the listening than the speechreading. However, children who received AVT improved on both types of assessment equally, which is not consistent with our predictions derived from a TAP perspective. Age, language level, and phonological awareness were either not predictive of training benefits or only negligibly so.

CONCLUSIONS

The findings provide support for the practice of providing children who have hearing loss with structured speech perception training and suggest that future aural rehabilitation programs might include teacher-specific speech perception training to prepare children for an upcoming school year, especially since training will generalize to other talkers. The results also suggest that benefits of speech perception training were not significantly related to age, language level, or degree of phonological awareness. The findings are largely consistent with TAP theory, suggesting that the more aligned a training task is with the desired outcome, the more likely benefit will accrue.

Relative Weights of Temporal Envelope Cues in Different Frequency Regions for Mandarin Vowel, Consonant, and Lexical Tone Recognition

Objectives: Mandarin-speaking users of cochlear implants (CI) perform poorer than their English counterpart. This may be because present CI speech coding schemes are largely based on English. This study aims to evaluate the relative contributions of temporal envelope (E) cues to Mandarin phoneme (including vowel, and consonant) and lexical tone recognition to provide information for speech coding schemes specific to Mandarin.

Design: Eleven normal hearing subjects were studied using acoustic temporal E cues that were extracted from 30 continuous frequency bands between 80 and 7,562 Hz using the Hilbert transform and divided into five frequency regions. Percent-correct recognition scores were obtained with acoustic E cues presented in three, four, and five frequency regions and their relative weights calculated using the least-square approach.

Results: For stimuli with three, four, and five frequency regions, percent-correct scores for vowel recognition using E cues were 50.43–84.82%, 76.27–95.24%, and 96.58%, respectively; for consonant recognition 35.49–63.77%, 67.75–78.87%, and 87.87%; for lexical tone recognition 60.80–97.15%, 73.16–96.87%, and 96.73%. For frequency region 1 to frequency region 5, the mean weights in vowel recognition were 0.17, 0.31, 0.22, 0.18, and 0.12, respectively; in consonant recognition 0.10, 0.16, 0.18, 0.23, and 0.33; in lexical tone recognition 0.38, 0.18, 0.14, 0.16, and 0.14.

Conclusion: Regions that contributed most for vowel recognition was Region 2 (502–1,022 Hz) that contains first formant (F1) information; Region 5 (3,856–7,562 Hz) contributed most to consonant recognition; Region 1 (80–502 Hz) that contains fundamental frequency (F0) information contributed most to lexical tone recognition.

Development of Mandarin Chinese Vowel Perception in Young Children With Normal Hearing and Cochlear Implants

Purpose Depicting the development pattern of vowel perception for children with normal hearing (NH) and cochlear implants (CIs) would be useful for clinicians and school teachers to monitor children's auditory rehabilitation. The study was to investigate the development of Mandarin Chinese vowel perception for Mandarin Chinese native-speaking children with the ages of 4-6 years. Method Vowel identification of children with NH and CIs were tested. All children with CIs received CIs before the age of 4 years. In a picture identification task with Mandarin Chinese speech stimuli, listeners identified the target consonant-vowel word among two to four contrastive words that differed only in vowels. Each target word represented a concrete object and was spoken by a young female native Mandarin Chinese talker. The target words included 16 monophthongs, 22 diphthongs, and nine triphthongs. Results Children with NH showed significantly better identification of monophthongs and diphthongs than children with CIs at the age of 6 years, whereas the two groups had comparable performance at age of 4 and 5 years. Children with NH significantly outperformed children with CIs for triphthong identification across all three age groups. For children with NH, a rapid development of perception of all three types of vowels occurred between age 4 and 5 years with a rapid development only for monophthong perception between age 5 and 6 years. For children with CIs, a rapid development of both diphthong and triphthong perception occurred between 4 and 5 years old, but not monophthong, with no significant development between 5 and 6 years old for all three types of vowels. Overall, Mandarin-speaking children with NH achieved their ceiling performance in vowel perception before or at the age of 6 years, whereas children with CIs may need more time to reach the typical level of their peers with NH. Conclusions The development of Mandarin vowel perception for Mandarin-native children differed between preschool-age children with NH and CIs, likely due to the deficits of spectral processing for children with CIs. The results would be a supplement to the development of speech recognition in Mandarin-native children with NH and CIs.

Mandarin tone recognition training with cochlear implant simulation: Amplitude envelope enhancement and cue weighting

With limited fundamental frequency (F0) cues, cochlear implant (CI) users recognize Mandarin tones using amplitude envelope. This study investigated whether tone recognition training with amplitude envelope enhancement may improve tone recognition and cue weighting with CIs. Three groups of CI-simulation listeners received training using vowels with amplitude envelope modified to resemble F0 contour (enhanced-amplitude-envelope training), training using natural vowels (natural-amplitude-envelope training), and exposure to natural vowels without training, respectively. Tone recognition with natural and enhanced amplitude envelope cues and cue weighting of amplitude envelope and F0 contour were measured in pre-, post-, and retention-tests. It was found that with similar pre-test performance, both training groups had better tone recognition than the no-training group after training. Only enhanced-amplitude-envelope training increased the benefits of amplitude envelope enhancement in the post- and retention-tests than in the pre-test. Neither training paradigm increased the cue weighting of amplitude envelope and F0 contour more than stimulus exposure. Listeners attending more to amplitude envelope in the pre-test tended to have better tone recognition with enhanced amplitude envelope cues before training and improve more in tone recognition after enhanced-amplitude-envelope training. The results suggest that auditory training and speech enhancement may bring maximum benefits to CI users when combined.

The Effects of GJB2 or SLC26A4 Gene Mutations on Neural Response of the Electrically Stimulated Auditory Nerve in Children

OBJECTIVES

This study aimed to (1) investigate the effect of GJB2 and SLC26A4 gene mutations on auditory nerve function in pediatric cochlear implant users and (2) compare their results with those measured in implanted children with idiopathic hearing loss.

DESIGN

Participants included 20 children with biallelic GJB2 mutations, 16 children with biallelic SLC26A4 mutations, and 19 children with idiopathic hearing loss. All subjects except for two in the SLC26A4 group had concurrent Mondini malformation and enlarged vestibular aqueduct. All subjects used Cochlear Nucleus devices in their test ears. For each subject, electrophysiological measures of the electrically evoked compound action potential (eCAP) were recorded using both anodic- and cathodic-leading biphasic pulses. Dependent variables (DVs) of interest included slope of eCAP input/output (I/O) function, the eCAP threshold, and eCAP amplitude measured at the maximum comfortable level (C level) of the anodic-leading stimulus (i.e., the anodic C level). Slopes of eCAP I/O functions were estimated using statistical modeling with a linear regression function. These DVs were measured at three electrode locations across the electrode array. Generalized linear mixed effect models were used to evaluate the effects of study group, stimulus polarity, and electrode location on each DV.

RESULTS

Steeper slopes of eCAP I/O function, lower eCAP thresholds, and larger eCAP amplitude at the anodic C level were measured for the anodic-leading stimulus compared with the cathodic-leading stimulus in all subject groups. Children with GJB2 mutations showed steeper slopes of eCAP I/O function and larger eCAP amplitudes at the anodic C level than children with SLC26A4 mutations and children with idiopathic hearing loss for both the anodic- and cathodic-leading stimuli. In addition, children with GJB2 mutations showed a smaller increase in eCAP amplitude when the stimulus changed from the cathodic-leading pulse to the anodic-leading pulse (i.e., smaller polarity effect) than children with idiopathic hearing loss. There was no statistically significant difference in slope of eCAP I/O function, eCAP amplitude at the anodic C level, or the size of polarity effect on all three DVs between children with SLC26A4 mutations and children with idiopathic hearing loss. These results suggested that better auditory nerve function was associated with GJB2 but not with SLC26A4 mutations when compared with idiopathic hearing loss. In addition, significant effects of electrode location were observed for slope of eCAP I/O function and the eCAP threshold.

CONCLUSIONS

GJB2 and SLC26A4 gene mutations did not alter polarity sensitivity of auditory nerve fibers to electrical stimulation. The anodic-leading stimulus was generally more effective in activating auditory nerve fibers than the cathodic-leading stimulus, despite the presence of GJB2 or SLC26A4 mutations. Patients with GJB2 mutations appeared to have better functional status of the auditory nerve than patients with SLC26A4 mutations who had concurrent Mondini malformation and enlarged vestibular aqueduct and patients with idiopathic hearing loss.

High-Variability Phonetic Training Benefits Lexical Tone Perception: An Investigation on Mandarin-Speaking Pediatric Cochlear Implant Users

Purpose Lexical tone perception is known to be persistently difficult for individuals with cochlear implants (CIs). The purpose of this study was to evaluate the efficacy of high-variability phonetic training (HVPT) in improving Mandarin tone perception for native-speaking children with CIs. Method A total of 28 Mandarin-speaking pediatric CI recipients participated in the study. Half of the children with CIs received a five-session HVPT within a period of 3 weeks. Identification and discrimination of lexical tones produced by familiar talkers (used during training) and novel talkers (not used during training) were measured before, immediately after, and 10 weeks after training termination. The other half untrained children served as control for the identical pre- and posttests. Results Lexical tone perception significantly improved in both trained identification task and untrained discrimination task for the trainees. There was also a significant effect in transfer of learning to perceiving tones produced by novel talkers. Moreover, training-induced gains were retained for up to 10 weeks after training. By comparison, no significant pre-post changes were observed in the control group. Conclusion The results provide the first systematical assessment for the efficacy of the HVPT protocol for Mandarin-speaking pediatric CI users with congenital hearing loss, which supports the clinical utility of intensive short-term HVPT in these children's rehabilitative regimens.

Computer-Based Connected-Text Training of Speech-in-Noise Perception for Cochlear Implant Users

An interactive method for training speech perception in noise was assessed with adult cochlear implant users. The method employed recordings of connected narratives divided into phrases of 4 to 10 words, presented in babble. After each phrase, the listener identified key words from the phrase from among similar sounding foil words. Nine postlingually deafened adult cochlear implant users carried out 12 hr of training over a 4-week period. Training was carried out at home on tablet computers. The primary outcome measure was sentence recognition in babble. Vowel and consonant identification in speech-shaped noise were also assessed, along with digit span in noise, intended as a measure of some important underlying cognitive abilities. Talkers for speech tests were different from those used in training. To control for procedural learning, the test battery was administered repeatedly prior to training. Performance was assessed immediately after training and again after a further 4 weeks during which no training occurred. Sentence recognition in babble improved significantly after training, with an improvement in speech reception threshold of approximately 2 dB, which was maintained at the 4-week follow-up. There was little evidence of improvement in the other measures. It appears that the method has potential as a clinical intervention. However, the underlying sources of improvement and the extent to which benefits generalize to real-world situations remain to be determined.

Systematic Review of Auditory Training in Pediatric Cochlear Implant Recipients

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

Elaboration of an instrument to evaluate the recognition of Brazilian melodies in children

INTRODUCTION

There is evidence pointing to the importance of the evaluation of musical perception through objective and subjective instruments. In Brazil, there is a shortage of instruments that evaluates musical perception.

OBJECTIVE

To develop an instrument to evaluate the recognition of traditional Brazilian melodies and investigate the performance of children with typical hearing.

METHODS

The study was carried out after approval of the research ethics committee (1.198.607). The instrument was developed in software format with website access, using the languages PHP 5.5.12, Javascript, Cascade style sheets and "HTML5"; database "MYSQL 5.6.17" on the "Apache 2.4.9" server. Fifteen melodies of Brazilian folk songs were recorded in piano synthesized timbre, with 12 seconds per melody reproduction and four second intervals between them. A total of 155 schooled children, aged eight to 11 years, of both sexes, with typical hearing participated in the study. The test was performed in a silent room with sound stimuli amplified by a sound box at 65dBNA, positioned at 0 azimuth, and at one meter from the participant, the notebook was used for children to play with on the screen on the title and illustration of the melody they recognized they were listening to. The responses were recorded on their own database.

RESULTS

The instrument titled "Evaluation of recognition of traditional melodies in children" can be run on various devices (computers, notebooks, tablets, mobile phones) and operating systems (Windows, Macintosh, Android, Linux). Access: http://192.185.216.17/ivan/home/login.php by login and password. The most easily recognized melody was "Cai, cai balão" (89%) and the least recognized was "Capelinha de melão" (25.2%). The average time to perform the test was 3'15″.

CONCLUSION

The development and application of the software proved effective for the studied population. This instrument may contribute to the improvement of protocols for the evaluation of musical perception in children with hearing aid and/or cochlear implants users.

Benefits of Music Training for Perception of Emotional Speech Prosody in Deaf Children With Cochlear Implants

Objectives:

Children who use cochlear implants (CIs) have characteristic pitch processing deficits leading to impairments in music perception and in understanding emotional intention in spoken language. Music training for normal-hearing children has previously been shown to benefit perception of emotional prosody. The purpose of the present study was to assess whether deaf children who use CIs obtain similar benefits from music training. We hypothesized that music training would lead to gains in auditory processing and that these gains would transfer to emotional speech prosody perception.

Design:

Study participants were 18 child CI users (ages 6 to 15). Participants received either 6 months of music training (i.e., individualized piano lessons) or 6 months of visual art training (i.e., individualized painting lessons). Measures of music perception and emotional speech prosody perception were obtained pre-, mid-, and post-training. The Montreal Battery for Evaluation of Musical Abilities was used to measure five different aspects of music perception (scale, contour, interval, rhythm, and incidental memory). The emotional speech prosody task required participants to identify the emotional intention of a semantically neutral sentence under audio-only and audiovisual conditions.

Results:

Music training led to improved performance on tasks requiring the discrimination of melodic contour and rhythm, as well as incidental memory for melodies. These improvements were predominantly found from mid- to post-training. Critically, music training also improved emotional speech prosody perception. Music training was most advantageous in audio-only conditions. Art training did not lead to the same improvements.

Conclusions:

Music training can lead to improvements in perception of music and emotional speech prosody, and thus may be an effective supplementary technique for supporting auditory rehabilitation following cochlear implantation.

What Can Lexical Tone Training Studies in Adults Tell Us about Tone Processing in Children?

A growing number of studies on the acquisition of lexical tone by adult learners have revealed that factors such as language background, musical experience, cognitive abilities, and neuroanatomy all play a role in determining tone learning success. On the basis of these findings, it has been argued that the effectiveness of tone learning in adulthood depends on individual differences in these factors. However, it is not clear whether similar individual differences play an analogous role in tone learning in childhood. Indeed, relatively few studies have made comparisons between how adults and children learn lexical tones. Here, we review recent developments for tone learning in both adults and children. The review covers tone training in a range of contexts, including in naive listeners, in native speakers of other tone languages, in listeners with varying levels of musical experience, and in individuals with speech and hearing disorders. Finally, we discuss the parallels between adult and child tone learning, and provide recommendations concerning how findings in adult tone training can provide insights into tone learning for children by accommodating the needs of individual learners.

Impact of socioeconomic factors on paediatric cochlear implant outcomes

OBJECTIVES

The study was aimed at evaluating the impact of certain socioeconomic factors such as family income, level of parents' education, distance between the child's home and auditory verbal therapy clinic, and age of the child at implantation on postoperative cochlear implant outcomes.

METHODS

Children suffering from congenital bilateral profound sensorineural hearing loss and a chronologic age of 4 years or younger at the time of implantation were included in the study. Children who were able to complete a prescribed period of a 1-year follow-up were included in the study. These children underwent cochlear implantation surgery, and their postoperative outcomes were measured and documented using categories of auditory perception (CAP), meaningful auditory integration (MAIS), and speech intelligibility rating (SIR) scores. Children were divided into three groups based on the level of parental education, family income, and distance of their home from the rehabilitation-- auditory verbal therapy clinic.

RESULTS

A total of 180 children were studied. The age at implantation had a significant impact on the postoperative outcomes, with an inverse correlation. The younger the child's age at the time of implantation, the better were the postoperative outcomes. However, there were no significant differences among the CAP, MAIS, and SIR scores and each of the three subgroups. Children from families with an annual income of less than $7,500, between $7,500 and $15,000, and more than $15,000 performed equally well, except for significantly higher SIR scores in children with family incomes more than $15,000. Children with of parents who had attended high school or possessed a bachelor's or Master's master's degree had similar scores, with no significant difference. Also, distance from the auditory verbal therapy clinic failed to have any significantimpact on a child's performance.

DISCUSSION

These results have been variable, similar to those of previously published studies. A few of the earlier studies concurred with our results, but most of the studies had suggested that children in families of higher socioeconomic status had have better speech and language acquisition.

CONCLUSIONS

Cochlear implantation significantly improves auditory perception and speech intelligibility of children suffering from profound sensorineural hearing loss. Younger The younger the age at implantation, the better are the results. Hence, early implantation should be promoted and encouraged. Our study suggests that children who followed the designated program of postoperative mapping and auditory verbal therapy for a minimum period of 1 year seemed to do equally well in terms of hearing perception and speech intelligibility, irrespective of the socioeconomic status of the family. Further studies are essential to assess the impact of these factors on long-term speech acquisition andlanguage development.

Speech perception enhancement in elderly hearing aid users using an auditory training program for mobile devices

AIMS

The goal of the present study was to develop an auditory training program using a mobile device and to test its efficacy by applying it to older adults suffering from moderate-to-severe sensorineural hearing loss.

METHODS

Among the 20 elderly hearing-impaired listeners who participated, 10 were randomly assigned to a training group (TG) and 10 were assigned to a non-training group (NTG) as a control. As a baseline, all participants were measured by vowel, consonant and sentence tests. In the experiment, the TG had been trained for 4 weeks using a mobile program, which had four levels and consisted of 10 Korean nonsense syllables, with each level completed in 1 week. In contrast, traditional auditory training had been provided for the NTG during the same period. To evaluate whether a training effect was achieved, the two groups also carried out the same tests as the baseline after completing the experiment.

RESULTS

The results showed that performance on the consonant and sentence tests in the TG was significantly increased compared with that of the NTG. Also, improved scores of speech perception were retained at 2 weeks after the training was completed. However, vowel scores were not changed after the 4-week training in both the TG and the NTG.

CONCLUSIONS

This result pattern suggests that a moderate amount of auditory training using the mobile device with cost-effective and minimal supervision is useful when it is used to improve the speech understanding of older adults with hearing loss. Geriatr Gerontol Int 2017; 17: 61-68.

Environmental sound training in cochlear implant users

PURPOSE

The study investigated the effect of a short computer-based environmental sound training regimen on the perception of environmental sounds and speech in experienced cochlear implant (CI) patients.

METHOD

Fourteen CI patients with the average of 5 years of CI experience participated. The protocol consisted of 2 pretests, 1 week apart, followed by 4 environmental sound training sessions conducted on separate days in 1 week, and concluded with 2 posttest sessions, separated by another week without training. Each testing session included an environmental sound test, which consisted of 40 familiar everyday sounds, each represented by 4 different tokens, as well as the Consonant Nucleus Consonant (CNC) word test, and Revised Speech Perception in Noise (SPIN-R) sentence test.

RESULTS

Environmental sounds scores were lower than for either of the speech tests. Following training, there was a significant average improvement of 15.8 points in environmental sound perception, which persisted 1 week later after training was discontinued. No significant improvements were observed for either speech test.

CONCLUSIONS

The findings demonstrate that environmental sound perception, which remains problematic even for experienced CI patients, can be improved with a home-based computer training regimen. Such computer-based training may thus provide an effective low-cost approach to rehabilitation for CI users, and potentially, other hearing impaired populations.

Hear here: children with hearing loss learn words by listening

OBJECTIVES

Early use of hearing devices and family participation in auditory-verbal therapy has been associated with age-appropriate verbal communication outcomes for children with hearing loss. However, there continues to be great variability in outcomes across different oral intervention programmes and little consensus on how therapists should prioritise goals at each therapy session for positive clinical outcomes. This pilot intervention study aimed to determine whether therapy goals that concentrate on teaching preschool children with hearing loss how to distinguish between words in a structured listening programme is effective, and whether gains in speech perception skills impact on vocabulary and speech development without them having to be worked on directly in therapy.

METHOD

A multiple baseline across subjects design was used in this within-subject controlled study. 3 children aged between 2:6 and 3:1 with moderate-severe to severe-profound hearing loss were recruited for a 6-week intervention programme. Each participant commenced at different stages of the 10-staged listening programme depending on their individual listening skills at recruitment. Speech development and vocabulary assessments were conducted before and after the training programme in addition to speech perception assessments and probes conducted throughout the intervention programme.

RESULTS

All participants made gains in speech perception skills as well as vocabulary and speech development. Speech perception skills acquired were noted to be maintained a week after intervention. In addition, all participants were able to generalise speech perception skills learnt to words that had not been used in the intervention programme.

CONCLUSIONS

This pilot study found that therapy directed at listening alone is promising and that it may have positive impact on speech and vocabulary development without these goals having to be incorporated into a therapy programme. Although a larger study is necessary for more conclusive findings, the results from this preliminary study are promising in support of emphasise on listening skills within auditory-verbal therapy programmes.

Music lessons improve auditory perceptual and cognitive performance in deaf children

Despite advanced technologies in auditory rehabilitation of profound deafness, deaf children often exhibit delayed cognitive and linguistic development and auditory training remains a crucial element of their education. In the present cross-sectional study, we assess whether music would be a relevant tool for deaf children rehabilitation. In normal-hearing children, music lessons have been shown to improve cognitive and linguistic-related abilities, such as phonetic discrimination and reading. We compared auditory perception, auditory cognition, and phonetic discrimination between 14 profoundly deaf children who completed weekly music lessons for a period of 1.5-4 years and 14 deaf children who did not receive musical instruction. Children were assessed on perceptual and cognitive auditory tasks using environmental sounds: discrimination, identification, auditory scene analysis, auditory working memory. Transfer to the linguistic domain was tested with a phonetic discrimination task. Musically trained children showed better performance in auditory scene analysis, auditory working memory and phonetic discrimination tasks, and multiple regressions showed that success on these tasks was at least partly driven by music lessons. We propose that musical education contributes to development of general processes such as auditory attention and perception, which, in turn, facilitate auditory-related cognitive and linguistic processes.

Categories of auditory performance and speech intelligibility ratings of early-implanted children without speech training

OBJECTIVE

To assess whether speech therapy can lead to better results for early cochlear implantation (CI) children.

PATIENTS

A cohort of thirty-four congenitally profoundly deaf children who underwent CI before the age of 18 months at the Sixth Hospital affiliated with Shanghai Jiaotong University from January 2005 to July 2008 were included. Nineteen children received speech therapy in rehabilitation centers (ST), whereas the remaining fifteen cases did not (NST), but were exposed to the real world, as are normal hearing children.

METHODS

All children were assessed before surgery and at 6, 12, and 24 months after surgery with the Categories of Auditory Performance test (CAP) and the Speech Intelligibility Rating (SIR). Each assessment was given by the same therapist who was blind to the situation of the child at each observation interval. CAP and SIR scores of the groups were compared at each time point.

RESULTS

Our study showed that the auditory performance and speech intelligibility of trained children were almost the same as to those of untrained children with early implantation. The CAP and SIR scores of both groups increased with increased time of implant use during the follow-up period, and at each time point, the median scores of the two groups were about equal.

CONCLUSIONS

These results indicate that great communication benefits are achieved by early implantation (<18 months) without routine speech therapy. The results exemplify the importance of enhanced social environments provided by everyday life experience for human brain development and reassure parents considering cochlear implants where speech training is unavailable.

O uso de um software na (re)habilitação de crianças com deficiência auditiva

OBJETIVO: Verificar a aplicabilidade de um software na (re)habilitação de crianças com deficiência auditiva. MÉTODOS: A amostra foi composta por 17 crianças com deficiência auditiva, sendo dez usuárias de Implante Coclear (IC) e sete usuárias de Aparelho de Amplificação Sonora Individual (AASI). Foi utilizado o "Software Auxiliar na Reabilitação de Distúrbios Auditivos (SARDA)". Aplicou-se o protocolo de treinamento durante 30 minutos, duas vezes por semana, pelo tempo necessário para a finalização das estratégias que compõe software. Para mensurar a aplicabilidade do software no treinamento da habilidade de percepção da fala no silêncio e no ruído, foram realizadas avaliações com o Hearing in Noise Test (HINT) pré e pós o treinamento auditivo. Os dados foram analisados estatisticamente. RESULTADOS: O grupo de usuários de IC necessitou em média 12,2 dias para finalizar as estratégias e o grupo de usuários de AASI em média 10,14 dias. Os dois grupos apresentaram diferença entre as avaliações pré e pós no silêncio e no ruído. As crianças mais novas apresentaram maior dificuldade durante a execução das estratégias, porém não houve correlação entre a idade e o desempenho. Não houve influência do tipo do dispositivo eletrônico durante o treinamento. As crianças apresentaram maior dificuldade na estratégia que envolvia estímulos não verbais e na estratégia com estímulos verbais que treina a habilidade de atenção sustentada. A atenção e a motivação da criança durante a estimulação foram fundamentais para o bom rendimento do treinamento auditivo. CONCLUSÃO: O treinamento auditivo com o SARDA foi eficaz, pois propiciou melhora na habilidade de percepção da fala, no silêncio e no ruído, das crianças com deficiência auditiva.

Maximizing cochlear implant patients' performance with advanced speech training procedures

Advances in implant technology and speech processing have provided great benefit to many cochlear implant patients. However, some patients receive little benefit from the latest technology, even after many years' experience with the device. Moreover, even the best cochlear implant performers have great difficulty understanding speech in background noise, and music perception and appreciation remain major challenges. Recent studies have shown that targeted auditory training can significantly improve cochlear implant patients' speech recognition performance. Such benefits are not only observed in poorly performing patients, but also in good performers under difficult listening conditions (e.g., speech noise, telephone speech, music, etc.). Targeted auditory training has also been shown to enhance performance gains provided by new implant devices and/or speech processing strategies. These studies suggest that cochlear implantation alone may not fully meet the needs of many patients, and that additional auditory rehabilitation may be needed to maximize the benefits of the implant device. Continuing research will aid in the development of efficient and effective training protocols and materials, thereby minimizing the costs (in terms of time, effort and resources) associated with auditory rehabilitation while maximizing the benefits of cochlear implantation for all recipients.

Perceptual learning and auditory training in cochlear implant recipients

Learning electrically stimulated speech patterns can be a new and difficult experience for cochlear implant (CI) recipients. Recent studies have shown that most implant recipients at least partially adapt to these new patterns via passive, daily-listening experiences. Gradually introducing a speech processor parameter (eg, the degree of spectral mismatch) may provide for more complete and less stressful adaptation. Although the implant device restores hearing sensation and the continued use of the implant provides some degree of adaptation, active auditory rehabilitation may be necessary to maximize the benefit of implantation for CI recipients. Currently, there are scant resources for auditory rehabilitation for adult, postlingually deafened CI recipients. We recently developed a computer-assisted speech-training program to provide the means to conduct auditory rehabilitation at home. The training software targets important acoustic contrasts among speech stimuli, provides auditory and visual feedback, and incorporates progressive training techniques, thereby maintaining recipients' interest during the auditory training exercises. Our recent studies demonstrate the effectiveness of targeted auditory training in improving CI recipients' speech and music perception. Provided with an inexpensive and effective auditory training program, CI recipients may find the motivation and momentum to get the most from the implant device.

Computer-Assisted Speech Training for Cochlear Implant Patients: Feasibility, Outcomes, and Future Directions

Learning electrically stimulated speech patterns can be a new and difficult experience for cochlear implant patients. Cochlear implantation alone may not fully meet the needs of many patients, and additional auditory rehabilitation may be necessary to maximize the benefits of the implant device. A recently developed computer-assisted speech-training program provides cochlear implant patients with the means to conduct auditory rehabilitation at home. The training software targets important acoustic contrasts between speech stimuli and provides auditory and visual feedback as well as progressive training, thereby maintaining patients' interest in the auditory training exercises. Recent scientific studies have demonstrated the effectiveness of such specialized auditory training programs in improving cochlear implant patients' speech recognition performance. Provided with an inexpensive and accessible auditory training program, cochlear implant patients may find the motivation and momentum to get the most from the implant device.