Perceptual learning and auditory training in cochlear implant recipients

Barriers to Early Progress in Adult Cochlear Implant Outcomes

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.

Individual differences in visual pattern completion predict adaptation to degraded speech

Recognizing acoustically degraded speech relies on predictive processing whereby incomplete auditory cues are mapped to stored linguistic representations via pattern recognition processes. While listeners vary in their ability to recognize degraded speech, performance improves when a written transcription is presented, allowing completion of the partial sensory pattern to preexisting representations. Building on work characterizing predictive processing as pattern completion, we examined the relationship between domain-general pattern recognition and individual variation in degraded speech learning. Participants completed a visual pattern recognition task to measure individual-level tendency towards pattern completion. Participants were also trained to recognize noise-vocoded speech with written transcriptions and tested on speech recognition pre- and post-training using a retrieval-based transcription task. Listeners significantly improved in recognizing speech after training, and pattern completion on the visual task predicted improvement for novel items. The results implicate pattern completion as a domain-general learning mechanism that can facilitate speech adaptation in challenging contexts.

Evaluating Changes in Adult Cochlear Implant Users' Brain and Behavior Following Auditory Training

OBJECTIVES

To describe the effects of two types of auditory training on both behavioral and physiological measures of auditory function in cochlear implant (CI) users, and to examine whether a relationship exists between the behavioral and objective outcome measures.

DESIGN

This study involved two experiments, both of which used a within-subject design. Outcome measures included behavioral and cortical electrophysiological measures of auditory processing. In Experiment I, 8 CI users participated in a music-based auditory training. The training program included both short training sessions completed in the laboratory as well as a set of 12 training sessions that participants completed at home over the course of a month. As part of the training program, study participants listened to a range of different musical stimuli and were asked to discriminate stimuli that differed in pitch or timbre and to identify melodic changes. Performance was assessed before training and at three intervals during and after training was completed. In Experiment II, 20 CI users participated in a more focused auditory training task: the detection of spectral ripple modulation depth. Training consisted of a single 40-minute session that took place in the laboratory under the supervision of the investigators. Behavioral and physiologic measures of spectral ripple modulation depth detection were obtained immediately pre- and post-training. Data from both experiments were analyzed using mixed linear regressions, paired t tests, correlations, and descriptive statistics.

RESULTS

In Experiment I, there was a significant improvement in behavioral measures of pitch discrimination after the study participants completed the laboratory and home-based training sessions. There was no significant effect of training on electrophysiologic measures of the auditory N1-P2 onset response and acoustic change complex (ACC). There were no significant relationships between electrophysiologic measures and behavioral outcomes after the month-long training. In Experiment II, there was no significant effect of training on the ACC, although there was a small but significant improvement in behavioral spectral ripple modulation depth thresholds after the short-term training.

CONCLUSIONS

This study demonstrates that auditory training improves spectral cue perception in CI users, with significant perceptual gains observed despite cortical electrophysiological responses like the ACC not reliably predicting training benefits across short- and long-term interventions. Future research should further explore individual factors that may lead to greater benefit from auditory training, in addition to optimization of training protocols and outcome measures, as well as demonstrate the generalizability of these findings.

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

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

Task-Specific Rapid Auditory Perceptual Learning in Adult Cochlear Implant Recipients: What Could It Mean for Speech Recognition

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.

Neural correlates of flexible sound perception in the auditory midbrain and thalamus

Hearing is an active process in which listeners must detect and identify sounds, segregate and discriminate stimulus features, and extract their behavioral relevance. Adaptive changes in sound detection can emerge rapidly, during sudden shifts in acoustic or environmental context, or more slowly as a result of practice. Although we know that context- and learning-dependent changes in the spectral and temporal sensitivity of auditory cortical neurons support many aspects of flexible listening, the contribution of subcortical auditory regions to this process is less understood. Here, we recorded single- and multi-unit activity from the central nucleus of the inferior colliculus (ICC) and the ventral subdivision of the medial geniculate nucleus (MGV) of Mongolian gerbils under two different behavioral contexts: as animals performed an amplitude modulation (AM) detection task and as they were passively exposed to AM sounds. Using a signal detection framework to estimate neurometric sensitivity, we found that neural thresholds in both regions improved during task performance, and this improvement was driven by changes in firing rate rather than phase locking. We also found that ICC and MGV neurometric thresholds improved and correlated with behavioral performance as animals learn to detect small AM depths during a multi-day perceptual training paradigm. Finally, we reveal that in the MGV, but not the ICC, context-dependent enhancements in AM sensitivity grow stronger during perceptual training, mirroring prior observations in the auditory cortex. Together, our results suggest that the auditory midbrain and thalamus contribute to flexible sound processing and perception over rapid and slow timescales.

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

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

Effects of spectral smearing on speech understanding and masking release in simulated bilateral cochlear implants

Differences in spectro-temporal degradation may explain some variability in cochlear implant users' speech outcomes. The present study employs vocoder simulations on listeners with typical hearing to evaluate how differences in degree of channel interaction across ears affects spatial speech recognition. Speech recognition thresholds and spatial release from masking were measured in 16 normal-hearing subjects listening to simulated bilateral cochlear implants. 16-channel sine-vocoded speech simulated limited, broad, or mixed channel interaction, in dichotic and diotic target-masker conditions, across ears. Thresholds were highest with broad channel interaction in both ears but improved when interaction decreased in one ear and again in both ears. Masking release was apparent across conditions. Results from this simulation study on listeners with typical hearing show that channel interaction may impact speech recognition more than masking release, and may have implications for the effects of channel interaction on cochlear implant users' speech recognition outcomes.

Postoperative optimization of cochlear implantation for single sided deafness and asymmetric hearing loss: a systematic review

OBJECTIVE

Identify and evaluate the effectiveness of methods for improving postoperative cochlear implant (CI) hearing performance in subjects with single-sided deafness (SSD) and asymmetric hearing loss (AHL).

DATA SOURCES

Embase, PubMed, Scopus.

REVIEW METHODS

Systematic review and narrative synthesis. English language studies of adult CI recipients with SSD and AHL reporting a postoperative intervention and comparative audiometric data pertaining to speech in noise, speech in quiet and sound localization were included.

RESULTS

32 studies met criteria for full text review and 6 (n = 81) met final inclusion criteria. Interventions were categorized as: formal auditory training, programming techniques, or hardware optimization. Formal auditory training (n = 10) found no objective improvement in hearing outcomes. Experimental CI maps did not improve audiologic outcomes (n = 9). Programed CI signal delays to improve synchronization demonstrated improved sound localization (n = 12). Hardware optimization, including multidirectional (n = 29) and remote (n = 11) microphones, improved sound localization and speech in noise, respectively.

CONCLUSION

Few studies meeting inclusion criteria and small sample sizes highlight the need for further study. Formal auditory training did not appear to improve hearing outcomes. Programming techniques, such as CI signal delay, and hardware optimization, such as multidirectional and remote microphones, show promise to improve outcomes for SSD and AHL CI users.

Preliminary Evidence to Support a De-Escalated Cochlear Implant Programming Paradigm for New Adult Recipients: A Systematic Review

Background: No standard schedule for cochlear implant (CI) programming has been developed, and common practices may have CI recipients seen in excess of what is necessary. The objective of this study was to review evidence for a de-escalated, evidence-based schedule for adult CI programming. Methods: Systematic review was undertaken in March 2023 of PubMed, Scopus, and CINAHL databases using the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines. Studies were included if (1) they evaluated an evidence-based programming/follow-up schedule in new adult CI patients or (2) they evaluated programming or outcomes in a longitudinal fashion such that they could inform CI follow-up strategies. Level of evidence was evaluated using the LEGEND evidence assessment tool. Results: Our review identified 940 studies. After screening with a priori inclusion criteria, 18 studies were ultimately included in this review. Of these, 2 demonstrated feasibility of de-escalated approaches to new adult CI programming. The remainder presented longitudinal speech and programming parameter data that demonstrated relative stability of both categories by 3 to 6 months post-activation. Conclusions: Overall, there is a paucity of literature evaluating any form of evidence-based CI programming or follow-up. Most applicable data derive from longitudinal outcomes featured in studies of other CI features, with only a handful of studies directly evaluating CI programming strategies over time. However, stability in outcomes and programming detailed in the available data supports consideration of a de-escalated programming paradigm that could primarily limit programming to the very early post-activation period (before 3 to 6 months) to enhance patient care and reduce operational strains on cochlear implant programs.

Recognition of Sentences With Complex Syntax in Speech Babble by Adolescents With Normal Hearing or Cochlear Implants

PURPOSE

General language abilities of children with cochlear implants have been thoroughly investigated, especially at young ages, but far less is known about how well they process language in real-world settings, especially in higher grades. This study addressed this gap in knowledge by examining recognition of sentences with complex syntactic structures in backgrounds of speech babble by adolescents with cochlear implants, and peers with normal hearing.

DESIGN

Two experiments were conducted. First, new materials were developed using young adults with normal hearing as the normative sample, creating a corpus of sentences with controlled, but complex syntactic structures presented in three kinds of babble that varied in voice gender and number of talkers. Second, recognition by adolescents with normal hearing or cochlear implants was examined for these new materials and for sentence materials used with these adolescents at younger ages. Analyses addressed three objectives: (1) to assess the stability of speech recognition across a multiyear age range, (2) to evaluate speech recognition of sentences with complex syntax in babble, and (3) to explore how bottom-up and top-down mechanisms account for performance under these conditions.

RESULTS

Results showed: (1) Recognition was stable across the ages of 10-14 years for both groups. (2) Adolescents with normal hearing performed similarly to young adults with normal hearing, showing effects of syntactic complexity and background babble; adolescents with cochlear implants showed poorer recognition overall, and diminished effects of both factors. (3) Top-down language and working memory primarily explained recognition for adolescents with normal hearing, but the bottom-up process of perceptual organization primarily explained recognition for adolescents with cochlear implants.

CONCLUSIONS

Comprehension of language in real-world settings relies on different mechanisms for adolescents with cochlear implants than for adolescents with normal hearing. A novel finding was that perceptual organization is a critical factor.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21965228.

Sleep-Based Memory Consolidation Stabilizes Perceptual Learning of Noise-Vocoded Speech

PURPOSE

Sleep-based memory consolidation has been shown to facilitate perceptual learning of atypical speech input including nonnative speech sounds, accented speech, and synthetic speech. The current research examined the role of sleep-based memory consolidation on perceptual learning for noise-vocoded speech, including maintenance of learning over a 1-week time interval. Because comprehending noise-vocoded speech requires extensive restructuring of the mapping between the acoustic signal and prelexical representations, sleep consolidation may be critical for this type of adaptation. Thus, the purpose of this study was to investigate the role of sleep-based memory consolidation on adaptation to noise-vocoded speech in listeners without hearing loss as a foundational step toward identifying parameters that can be useful to consider for auditory training with clinical populations.

METHOD

Two groups of normal-hearing listeners completed a transcription training task with feedback for noise-vocoded sentences in either the morning or the evening. Learning was assessed through transcription accuracy before training, immediately after training, 12 hr after training, and 1 week after training for both trained and novel sentences.

RESULTS

Both the morning and evening groups showed improved comprehension of noise-vocoded sentences immediately following training. Twelve hours later, the evening group showed stable gains (following a period of sleep), whereas the morning group demonstrated a decline in gains (following a period of wakefulness). One week after training, the morning and evening groups showed equivalent performance for both trained and novel sentences.

CONCLUSION

Sleep-consolidated learning helps stabilize training gains for degraded speech input, which may hold clinical utility for optimizing rehabilitation recommendations.

Patient-Related Factors Do Not Predict Use of Computer-Based Auditory Training by New Adult Cochlear Implant Recipients

OBJECTIVE

The use of computer-based auditory training (CBAT) after cochlear implantation is associated with improved speech recognition and real-world functional abilities. However, patient-related factors associated with CBAT use remain unknown. This study seeks to identify such factors and recognize those at risk for not implementing CBAT.

STUDY DESIGN

Prospective natural experiment.

SETTING

Tertiary academic center.

PATIENTS

A total of 117 new adult cochlear implant (CI) recipients with bilateral moderate-to-profound hearing loss.

INTERVENTIONS/MAIN OUTCOME MEASURES

Patient demographic and lifestyle information, preimplantation aided speech recognition scores, Cochlear Implant Quality of Life (CIQOL) domain and global scores, CIQOL-Expectations scores, and CBAT use in the first 3 months after activation. Patient-related variables included age, sex, race, duration of hearing loss before implantation, hours of CI use per day, hearing-aid use before implantation, living arrangements/marital status, annual household income, employment, technology use, and education.

RESULTS

Overall, 33 new CI users (28.2%) used CBAT in the first 3 months after activation. On bivariate analysis of the pre-CI CIQOL scores, CIQOL-Expectations score, aided speech recognition scores, and demographic/lifestyle factors examined, regular use of smartphone, tablet, or computer technology was significantly associated with an increased likelihood of CBAT use (odds ratio, 9.354 [1.198-73.020]), whereas higher CIQOL-Expectations emotional domain scores were associated with a lower likelihood of CBAT use (d = -0.69 [-1.34 to -0.05]). However, using multivariable analysis to control for potential confounding factors revealed no significant associations between CBAT use in the first 3 months after cochlear implantation and any examined factor.

CONCLUSIONS

No associations between patient demographic, lifestyle, or pre-CI speech recognition and patient-reported outcome measures and CBAT use were identified. Therefore, discussions with all patients after implantation on the availability of CBAT and its potential benefits are warranted. In addition, given the limited overall use of CBAT and its association with improved CI outcomes, future studies are needed to investigate facilitators and barriers to CBAT use.

The experience of sensorimotor integration of a lower limb sensory neuroprosthesis: A qualitative case study

Introduction

Lower limb prosthesis users often struggle to navigate uneven terrain or ambulate in low light conditions where it can be challenging to rely on visual cues for balance and walking. Sensory feedback about foot-floor interactions may allow users to reduce reliance on secondary sensory cues and improve confidence and speed when navigating difficult terrain. Our group has developed a Sensory Neuroprosthesis (SNP) to restore sensation to people with lower limb amputation by pairing electrical stimulation of nerves in the residual limb applied via implanted neurotechnology with pressure sensors in the insole of a standard prosthesis. Stimulation applied to the nerves evoked sensations perceived as originating on the missing leg and foot.

Methods

This qualitative case study reports on the experiences of a 68-year-old with a unilateral trans-tibial amputation who autonomously used the SNP at home for 31 weeks. Interview data collected throughout the study period was analyzed using a grounded theory approach with constant comparative methods to understand his experience with this novel technology and its impacts on his daily life.

Results

A conceptual model was developed that explained the experience of integrating SNP-provided sensory feedback into his body and motor plans. The model described the requirements of integration, which were a combination of a low level of mental focus and low stimulation levels. While higher levels of stimulation and focus could result in distinct sensory percepts and various phantom limb experiences, optimal integration was associated with SNP-evoked sensation that was not readily perceivable. Successful sensorimotor integration of the SNP resulted in improvements to locomotion, a return to a more normal state, an enhancement of perceived prosthesis utility, and a positive outlook on the experience.

Discussion

These outcomes emerged over the course of the nearly 8 month study, suggesting that findings from long-term home studies of SNPs may differ from those of short-term in-laboratory tests. Our findings on the experience of sensorimotor integration of the SNP have implications for the optimal training of SNP users and the future deployment of clinical SNP systems for long-term home use.

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.

Many tasks, same outcome: Role of training task on learning and maintenance of noise-vocoded speech

Listeners who use cochlear implants show variability in speech recognition. Research suggests that structured auditory training can improve speech recognition outcomes in cochlear implant users, and a central goal in the rehabilitation literature is to identify factors that maximize training. Here, we examined factors that may influence perceptual learning for noise-vocoded speech in normal hearing listeners as a foundational step towards clinical recommendations. Three groups of listeners were exposed to anomalous noise-vocoded sentences and completed one of three training tasks: transcription with feedback, transcription without feedback, or talker identification. Listeners completed a word transcription test at three time points: immediately before training, immediately after training, and one week following training. Accuracy at test was indexed by keyword accuracy at the sentence-initial and sentence-final position for high and low predictability noise-vocoded sentences. Following training, listeners showed improved transcription for both sentence-initial and sentence-final items, and for both low and high predictability sentences. The training groups showed robust and equivalent learning of noise-vocoded sentences immediately after training. Critically, gains were largely maintained equivalently among training groups one week later. These results converge with evidence pointing towards the utility of non-traditional training tasks to maximize perceptual learning of noise-vocoded speech.

Effects of training and using an audio-tactile sensory substitution device on speech-in-noise understanding

Understanding speech in background noise is challenging. Wearing face-masks, imposed by the COVID19-pandemics, makes it even harder. We developed a multi-sensory setup, including a sensory substitution device (SSD) that can deliver speech simultaneously through audition and as vibrations on the fingertips. The vibrations correspond to low frequencies extracted from the speech input. We trained two groups of non-native English speakers in understanding distorted speech in noise. After a short session (30-45 min) of repeating sentences, with or without concurrent matching vibrations, we showed comparable mean group improvement of 14-16 dB in Speech Reception Threshold (SRT) in two test conditions, i.e., when the participants were asked to repeat sentences only from hearing and also when matching vibrations on fingertips were present. This is a very strong effect, if one considers that a 10 dB difference corresponds to doubling of the perceived loudness. The number of sentence repetitions needed for both types of training to complete the task was comparable. Meanwhile, the mean group SNR for the audio-tactile training (14.7 ± 8.7) was significantly lower (harder) than for the auditory training (23.9 ± 11.8), which indicates a potential facilitating effect of the added vibrations. In addition, both before and after training most of the participants (70-80%) showed better performance (by mean 4-6 dB) in speech-in-noise understanding when the audio sentences were accompanied with matching vibrations. This is the same magnitude of multisensory benefit that we reported, with no training at all, in our previous study using the same experimental procedures. After training, performance in this test condition was also best in both groups (SRT ~ 2 dB). The least significant effect of both training types was found in the third test condition, i.e. when participants were repeating sentences accompanied with non-matching tactile vibrations and the performance in this condition was also poorest after training. The results indicate that both types of training may remove some level of difficulty in sound perception, which might enable a more proper use of speech inputs delivered via vibrotactile stimulation. We discuss the implications of these novel findings with respect to basic science. In particular, we show that even in adulthood, i.e. long after the classical "critical periods" of development have passed, a new pairing between a certain computation (here, speech processing) and an atypical sensory modality (here, touch) can be established and trained, and that this process can be rapid and intuitive. We further present possible applications of our training program and the SSD for auditory rehabilitation in patients with hearing (and sight) deficits, as well as healthy individuals in suboptimal acoustic situations.

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

OBJECTIVE

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

STUDY DESIGN

Longitudinal, prospective cohort.

SETTING

Tertiary academic center.

PATIENTS

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

INTERVENTIONS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

Auditory training for adults with cochlear implants: a systematic review

OBJECTIVE

To systematically review the peer-reviewed literature on the efficacy of auditory training (AT) on auditory outcomes in post lingually deafened adults with cochlear implants (CIs).

DESIGN

A systematic review.

STUDY SAMPLE

Searches of five electronic databases yielded 10 studies published after 2010 that met the inclusion criteria.

RESULTS

For post lingually deafened adults with CIs, the evidence is suggestive that some AT can improve some auditory outcomes compared to no training. More specifically, the evidence suggests that phonemic training can improve identification of trained phonemes, and nonsense word training can improve sentence recognition in noise in this population.

CONCLUSIONS

While many AT interventions are currently being used with post lingually deafened adults with CIs, the evidence for AT improving auditory outcomes is suggestive with the best evidence being for nonsense word training improving sentence recognition in noise by an average of 10% with these improvements retained at 26 weeks post-training in this population. There remains a need for high quality studies that have the capacity to demonstrate, clearly and unequivocally, which AT is most effective for improving which auditory outcomes in this population.

Visuo-Acoustic Stimulation's Role in Synaptic Plasticity: A Review of the Literature

Brain plasticity is the capacity of cerebral neurons to change, structurally and functionally, in response to experiences. This is an essential property underlying the maturation of sensory functions, learning and memory processes, and brain repair in response to the occurrence of diseases and trauma. In this field, the visual system emerges as a paradigmatic research model, both for basic research studies and for translational investigations. The auditory system remains capable of reorganizing itself in response to different auditory stimulations or sensory organ modification. Acoustic biofeedback training can be an effective way to train patients with the central scotoma, who have poor fixation stability and poor visual acuity, in order to bring fixation on an eccentrical and healthy area of the retina: a pseudofovea. This review article is focused on the cellular and molecular mechanisms underlying retinal sensitivity changes and visual and auditory system plasticity.

Can Haptic Stimulation Enhance Music Perception in Hearing-Impaired Listeners?

Cochlear implants (CIs) have been remarkably successful at restoring hearing in severely-to-profoundly hearing-impaired individuals. However, users often struggle to deconstruct complex auditory scenes with multiple simultaneous sounds, which can result in reduced music enjoyment and impaired speech understanding in background noise. Hearing aid users often have similar issues, though these are typically less acute. Several recent studies have shown that haptic stimulation can enhance CI listening by giving access to sound features that are poorly transmitted through the electrical CI signal. This “electro-haptic stimulation” improves melody recognition and pitch discrimination, as well as speech-in-noise performance and sound localization. The success of this approach suggests it could also enhance auditory perception in hearing-aid users and other hearing-impaired listeners. This review focuses on the use of haptic stimulation to enhance music perception in hearing-impaired listeners. Music is prevalent throughout everyday life, being critical to media such as film and video games, and often being central to events such as weddings and funerals. It represents the biggest challenge for signal processing, as it is typically an extremely complex acoustic signal, containing multiple simultaneous harmonic and inharmonic sounds. Signal-processing approaches developed for enhancing music perception could therefore have significant utility for other key issues faced by hearing-impaired listeners, such as understanding speech in noisy environments. This review first discusses the limits of music perception in hearing-impaired listeners and the limits of the tactile system. It then discusses the evidence around integration of audio and haptic stimulation in the brain. Next, the features, suitability, and success of current haptic devices for enhancing music perception are reviewed, as well as the signal-processing approaches that could be deployed in future haptic devices. Finally, the cutting-edge technologies that could be exploited for enhancing music perception with haptics are discussed. These include the latest micro motor and driver technology, low-power wireless technology, machine learning, big data, and cloud computing. New approaches for enhancing music perception in hearing-impaired listeners could substantially improve quality of life. Furthermore, effective haptic techniques for providing complex sound information could offer a non-invasive, affordable means for enhancing listening more broadly in hearing-impaired individuals.

Auditory memory for random time patterns in cochlear implant listeners

Learning about new sounds is essential for cochlear-implant and normal-hearing listeners alike, with the additional challenge for implant listeners that spectral resolution is severely degraded. Here, a task measuring the rapid learning of slow or fast stochastic temporal sequences [Kang, Agus, and Pressnitzer (2017). J. Acoust. Soc. Am. 142, 2219-2232] was performed by cochlear-implant (N = 10) and normal-hearing (N = 9) listeners, using electric or acoustic pulse sequences, respectively. Rapid perceptual learning was observed for both groups, with highly similar characteristics. Moreover, for cochlear-implant listeners, an additional condition tested ultra-fast electric pulse sequences that would be impossible to represent temporally when presented acoustically. This condition also demonstrated learning. Overall, the results suggest that cochlear-implant listeners have access to the neural plasticity mechanisms needed for the rapid perceptual learning of complex temporal sequences.

Does Auditory Environment Predict Speech Perception Outcomes in Elderly Cochlear Implant Patients?

INTRODUCTION

Cochlear implantation (CI) is a reliable and safe means by which sensorineural hearing loss can be ameliorated in the elderly population. However, a high degree of variation exists in postimplantation hearing outcomes for which some modifiable factors of the daily natural auditory environment may be contributory. In this study, we analyze the relationship between cochlear implant patient age, natural auditory environment, and postimplantation speech perception among older adults.

METHODS

Data log from automatic environment classification enabled sound processors of postlingually deafened CI recipients ≥50 years old (n = 115) were obtained retrospectively and analyzed for time spent (hours per day) in listening environment and loudness (SPL dB). Speech perception testing was assessed in a subset of patients (n = 27) using open-set word recognition in quiet Consonant-Nucleus-Consonant in the short and intermediate postoperative period.

RESULTS

The mean subject age was 70 years (range, 53-99 years). Average daily implant use was 10.8 h and was not significantly correlated with age (p = 0.23, Spearman's rho). Age was positively correlated with the percentage of hours spent at <40 and 40-50 dB and negatively correlated to proportional CI use at higher volume (60-70, 70-80, and >80 dB; rs = 0.21, 0.20, -0.20, -0.35, -0.43; p = 0.021, 0.036, 0.033, <0.001, <0.001, respectively). Age was positively correlated with CI use in the quiet scene (rs = 0.26, p = 0.006) and negatively correlated with scenes containing speech and noise (rs = -0.19, -0.25; p = 0.046, 0.007). Total hours of device use and time spent at <40, 40-50 dB, and quiet environments were significantly correlated with improved CNC word scores (rs = 0.48, 0.48, 0.51; p = 0.01, 0.01, <0.01, Spearman's rho). While all speech (speech in noise + speech) was not significantly correlated to improvements in speech perception, a medium effect size was observed (rs = 0.37, p = 0.057).

DISCUSSION/CONCLUSION

This study supports a relationship between auditory environment and age, with older CI recipients spending a greater proportion of time in quiet. Older CI users demonstrated greater improvements in speech perception with longer daily device use. Additional examination of the relationship between auditory environment and speech perception is necessary to conclusively guide future auditory rehabilitation efforts.

Impact of Auditory-Motor Musical Training on Melodic Pattern Recognition in Cochlear Implant Users

OBJECTIVE

Cochlear implant (CI) users struggle with tasks of pitch-based prosody perception. Pitch pattern recognition is vital for both music comprehension and understanding the prosody of speech, which signals emotion and intent. Research in normal-hearing individuals shows that auditory-motor training, in which participants produce the auditory pattern they are learning, is more effective than passive auditory training. We investigated whether auditory-motor training of CI users improves complex sound perception, such as vocal emotion recognition and pitch pattern recognition, compared with purely auditory training.

STUDY DESIGN

Prospective cohort study.

SETTING

Tertiary academic center.

PATIENTS

Fifteen postlingually deafened adults with CIs.

INTERVENTION(S)

Participants were divided into 3 one-month training groups: auditory-motor (intervention), auditory-only (active control), and no training (control). Auditory-motor training was conducted with the "Contours" software program and auditory-only training was completed with the "AngelSound" software program.

MAIN OUTCOME MEASURE

Pre and posttest examinations included tests of speech perception (consonant-nucleus-consonant, hearing-in-noise test sentence recognition), speech prosody perception, pitch discrimination, and melodic contour identification.

RESULTS

Participants in the auditory-motor training group performed better than those in the auditory-only and no-training (p < 0.05) for the melodic contour identification task. No significant training effect was noted on tasks of speech perception, speech prosody perception, or pitch discrimination.

CONCLUSIONS

These data suggest that short-term auditory-motor music training of CI users impacts pitch pattern recognition. This study offers approaches for enriching the world of complex sound in the CI user.

An mHealth App (Speech Banana) for Auditory Training: App Design and Development Study

Background

With the growing adult population using electronic hearing devices such as cochlear implants or hearing aids, there is an increasing worldwide need for auditory training (AT) to promote optimal device use. However, financial resources and scheduling conflicts make clinical AT infeasible.

Objective

To address this gap between need and accessibility, we primarily aimed to develop a mobile health (mHealth) app called Speech Banana for AT. The app would be substantially more affordable and portable than clinical AT; would deliver a validated training model that is reflective of modern techniques; and would track users’ progress in speech comprehension, providing greater continuity between periodic in-person visits. To improve international availability, our secondary aim was to implement the English language training model into Korean as a proof of concept for worldwide usability.

Methods

A problem- and objective-centered Design Science Research Methodology approach was adopted to develop the Speech Banana app. A review of previous literature and computer-based learning programs outlined current AT gaps, whereas interviews with speech pathologists and users clarified the features that were addressed in the app. Past and present users were invited to evaluate the app via community forums and the System Usability Scale.

Results

Speech Banana has been implemented in English and Korean languages for iPad and web use. The app comprises 38 lessons, which include analytic exercises pairing visual and auditory stimuli, and synthetic quizzes presenting auditory stimuli only. During quizzes, users type the sentence heard, and the app provides visual feedback on performance. Users may select a male or female speaker and the volume of background noise, allowing for training with a range of frequencies and signal-to-noise ratios. There were more than 3200 downloads of the English iPad app and almost 100 downloads of the Korean app; more than 100 users registered for the web apps. The English app received a System Usability Scale rating of “good” from 6 users, and the Korean app received a rating of “OK” from 16 users.

Conclusions

Speech Banana offers AT accessibility with a validated curriculum, allowing users to develop speech comprehension skills with the aid of a mobile device. This mHealth app holds potential as a supplement to clinical AT, particularly in this era of global telemedicine.

Perceptual Learning of Vocoded Speech With and Without Contralateral Hearing: Implications for Cochlear Implant Rehabilitation

Purpose An increasing number of individuals with residual or even normal contralateral hearing are being considered for cochlear implantation. It remains unknown whether the presence of contralateral hearing is beneficial or detrimental to their perceptual learning of cochlear implant (CI)-processed speech. The aim of this experiment was to provide a first insight into this question using acoustic simulations of CI processing. Method Sixty normal-hearing listeners took part in an auditory perceptual learning experiment. Each subject was randomly assigned to one of three groups of 20 referred to as NORMAL, LOWPASS, and NOTHING. The experiment consisted of two test phases separated by a training phase. In the test phases, all subjects were tested on recognition of monosyllabic words passed through a six-channel "PSHC" vocoder presented to a single ear. In the training phase, which consisted of listening to a 25-min audio book, all subjects were also presented with the same vocoded speech in one ear but the signal they received in their other ear differed across groups. The NORMAL group was presented with the unprocessed speech signal, the LOWPASS group with a low-pass filtered version of the speech signal, and the NOTHING group with no sound at all. Results The improvement in speech scores following training was significantly smaller for the NORMAL than for the LOWPASS and NOTHING groups. Conclusions This study suggests that the presentation of normal speech in the contralateral ear reduces or slows down perceptual learning of vocoded speech but that an unintelligible low-pass filtered contralateral signal does not have this effect. Potential implications for the rehabilitation of CI patients with partial or full contralateral hearing are discussed.

Perceptual learning of pitch provided by cochlear implant stimulation rate

Cochlear implant users hear pitch evoked by stimulation rate, but discrimination diminishes for rates above 300 Hz. This upper limit on rate pitch is surprising given the remarkable and specialized ability of the auditory nerve to respond synchronously to stimulation rates at least as high as 3 kHz and arguably as high as 10 kHz. Sensitivity to stimulation rate as a pitch cue varies widely across cochlear implant users and can be improved with training. The present study examines individual differences and perceptual learning of stimulation rate as a cue for pitch ranking. Adult cochlear implant users participated in electrode psychophysics that involved testing once per week for three weeks. Stimulation pulse rate discrimination was measured in bipolar and monopolar configurations for apical and basal electrodes. Base stimulation rates between 100 and 800 Hz were examined. Individual differences were quantified using psychophysically derived metrics of spatial tuning and temporal integration. This study examined distribution of measures across subjects, predictive power of psychophysically derived metrics of spatial tuning and temporal integration, and the effect of training on rate discrimination thresholds. Psychophysical metrics of spatial tuning and temporal integration were not predictive of stimulation rate discrimination, but discrimination thresholds improved at lower frequencies with training. Since most clinical devices do not use variable stimulation rates, it is unknown to what extent recipients may learn to use stimulation rate cues if provided in a clear and consistent manner.

Music perception and training for pediatric cochlear implant users

INTRODUCTION

Cochlear implants (CIs) are biomedical devices that restore sound perception for people with severe-to-profound sensorineural hearing loss. Most postlingually deafened CI users are able to achieve excellent speech recognition in quiet environments. However, current CI sound processors remain limited in their ability to deliver fine spectrotemporal information, making it difficult for CI users to perceive complex sounds. Limited access to complex acoustic cues such as music, environmental sounds, lexical tones, and voice emotion may have significant ramifications on quality of life, social development, and community interactions.

AREAS COVERED

The purpose of this review article is to summarize the literature on CIs and music perception, with an emphasis on music training in pediatric CI recipients. The findings have implications on our understanding of noninvasive, accessible methods for improving auditory processing and may help advance our ability to improve sound quality and performance for implantees.

EXPERT OPINION

Music training, particularly in the pediatric population, may be able to continue to enhance auditory processing even after performance plateaus. The effects of these training programs appear generalizable to non-trained musical tasks, speech prosody and, emotion perception. Future studies should employ rigorous control groups involving a non-musical acoustic intervention, standardized auditory stimuli, and the provision of feedback.

Effects of auditory training on low-pass filtered speech perception and listening-related cognitive load

Studies supporting learning-induced reductions in listening-related cognitive load have lacked procedural learning controls, making it difficult to determine the extent to which effects arise from perceptual or procedural learning. Here, listeners were trained in the coordinate response measure (CRM) task under unfiltered (UT) or degraded low-pass filtered (FT) conditions. Improvements in low-pass filtered CRM performance were larger for FT. Both conditions showed training-related reductions in cognitive load as indexed by a secondary working memory task. However, only the FT condition showed a correlation between CRM improvement and secondary task performance, suggesting that effects can be driven by perceptual and procedural learning.

Bimodal Benefits for Lexical Tone Recognition: An Investigation on Mandarin-speaking Preschoolers with a Cochlear Implant and a Contralateral Hearing Aid

Pitch perception is known to be difficult for individuals with cochlear implant (CI), and adding a hearing aid (HA) in the non-implanted ear is potentially beneficial. The current study aimed to investigate the bimodal benefit for lexical tone recognition in Mandarin-speaking preschoolers using a CI and an HA in opposite ears. The child participants were required to complete tone identification in quiet and in noise with CI + HA in comparison with CI alone. While the bimodal listeners showed confusion between Tone 2 and Tone 3 in recognition, the additional acoustic information from the contralateral HA alleviated confusion between these two tones in quiet. Moreover, significant improvement was demonstrated in the CI + HA condition over the CI alone condition in noise. The bimodal benefit for individual subjects could be predicted by the low-frequency hearing threshold of the non-implanted ear and the duration of bimodal use. The findings support the clinical practice to fit a contralateral HA in the non-implanted ear for the potential benefit in Mandarin tone recognition in CI children. The limitations call for further studies on auditory plasticity on an individual basis to gain insights on the contributing factors to the bimodal benefit or its absence.

A Preliminary Study of the Effects of Attentive Music Listening on Cochlear Implant Users' Speech Perception, Quality of Life, and Behavioral and Objective Measures of Frequency Change Detection

Introduction

Most cochlear implant (CI) users have difficulty in listening tasks that rely strongly on perception of frequency changes (e.g., speech perception in noise, musical melody perception, etc.). Some previous studies using behavioral or subjective assessments have shown that short-term music training can benefit CI users’ perception of music and speech. Electroencephalographic (EEG) recordings may reveal the neural basis for music training benefits in CI users.

Objective

To examine the effects of short-term music training on CI hearing outcomes using a comprehensive test battery of subjective evaluation, behavioral tests, and EEG measures.

Design

Twelve adult CI users were recruited for a home-based music training program that focused on attentive listening to music genres and materials that have an emphasis on melody. The participants used a music streaming program (i.e., Pandora) downloaded onto personal electronic devices for training. The participants attentively listened to music through a direct audio cable or through Bluetooth streaming. The training schedule was 40 min/session/day, 5 days/week, for either 4 or 8 weeks. The pre-training and post-training tests included: hearing thresholds, Speech, Spatial and Qualities of Hearing Scale (SSQ12) questionnaire, psychoacoustic tests of frequency change detection threshold (FCDT), speech recognition tests (CNC words, AzBio sentences, and QuickSIN), and EEG responses to tones that contained different magnitudes of frequency changes.

Results

All participants except one finished the 4- or 8-week training, resulting in a dropout rate of 8.33%. Eleven participants performed all tests except for two who did not participate in EEG tests. Results showed a significant improvement in the FCDTs as well as performance on CNC and QuickSIN after training (p < 0.05), but no significant improvement in SSQ scores (p > 0.05). Results of the EEG tests showed larger post-training cortical auditory evoked potentials (CAEPs) in seven of the nine participants, suggesting a better cortical processing of both stimulus onset and within-stimulus frequency changes.

Conclusion

These preliminary data suggest that extensive, focused music listening can improve frequency perception and speech perception in CI users. Further studies that include a larger sample size and control groups are warranted to determine the efficacy of short-term music training in CI users.

The effect of dopamine on the comprehension of spectrally-shifted noise-vocoded speech: a pilot study

Objectives: Cochlear implantation has proven beneficial in restoring hearing. However, success is variable, and there is a need for a simple post-implantation therapy that could significantly increase implantation success. Dopamine has a general role in learning and in assigning value to environmental stimuli. We tested the effect of dopamine in the comprehension of spectrally-shifted noise-vocoded (SSNV) speech, which simulates, in hearing individuals, the signal delivered by a cochlear implant (CI).Design and study sample: Thirty-five participants (age = 38.0 ± 10.1 SD) recruited from the general population were divided into three groups. We tested SSNV speech comprehension in two experimental sessions. In one session, a metabolic precursor of dopamine (L-DOPA) was administered to participants in two of the groups; a placebo was administered in the other session.Results: A single dose of L-DOPA interacted with training to improve perception of SSNV speech, but did not significantly accelerate learning.Conclusions: These findings are a first step in exploring the use of dopamine to enhance speech understanding in CI patients. Replications of these results using SSNV in individuals with normal hearing, and also in CI users, are needed to determine whether these effects can translate into benefits in everyday language comprehension.

Spectral-Temporal Trade-Off in Vocoded Sentence Recognition: Effects of Age, Hearing Thresholds, and Working Memory

OBJECTIVES

Cochlear implant (CI) signal processing degrades the spectral components of speech. This requires CI users to rely primarily on temporal cues, specifically, amplitude modulations within the temporal envelope, to recognize speech. Auditory temporal processing ability for envelope modulations worsens with advancing age, which may put older CI users at a disadvantage compared with younger users. To evaluate how potential age-related limitations for processing temporal envelope modulations impact spectrally degraded sentence recognition, noise-vocoded sentences were presented to younger and older normal-hearing listeners in quiet. Envelope modulation rates were varied from 10 to 500 Hz by adjusting the low-pass filter cutoff frequency (LPF). The goal of this study was to evaluate if age impacts recognition of noise-vocoded speech and if this age-related limitation existed for a specific range of envelope modulation rates.

DESIGN

Noise-vocoded sentence recognition in quiet was measured as a function of number of spectral channels (4, 6, 8, and 12 channels) and LPF (10, 20, 50, 75, 150, 375, and 500 Hz) in 15 younger normal-hearing listeners and 15 older near-normal-hearing listeners. Hearing thresholds and working memory were assessed to determine the extent to which these factors were related to recognition of noise-vocoded sentences.

RESULTS

Younger listeners achieved significantly higher sentence recognition scores than older listeners overall. Performance improved in both groups as the number of spectral channels and LPF increased. As the number of spectral channels increased, the differences in sentence recognition scores between groups decreased. A spectral-temporal trade-off was observed in both groups in which performance in the 8- and 12-channel conditions plateaued with lower-frequency amplitude modulations compared with the 4- and 6-channel conditions. There was no interaction between age group and LPF, suggesting that both groups obtained similar improvements in performance with increasing LPF. The lack of an interaction between age and LPF may be due to the nature of the task of recognizing sentences in quiet. Audiometric thresholds were the only significant predictor of vocoded sentence recognition. Although performance on the working memory task declined with advancing age, working memory scores did not predict sentence recognition.

CONCLUSIONS

Younger listeners outperformed older listeners for recognizing noise-vocoded sentences in quiet. The negative impact of age was reduced when ample spectral information was available. Age-related limitations for recognizing vocoded sentences were not affected by the temporal envelope modulation rate of the signal, but instead, appear to be related to a generalized task limitation or to reduced audibility of the signal.

Practices and Attitudes That Enhance Music Engagement of Adult Cochlear Implant Users

BACKGROUND

Cochlear implants (CIs) are auditory prostheses designed to support spoken communication in persons with severe to profound hearing loss. Many post-lingually deaf adult CI users achieve good speech recognition in quiet; unfortunately, CI technology conveys a degraded representation of pitch and timbre, essential components of music. Not surprisingly, most CI users achieve significantly poorer perception and enjoyment of music compared with normal hearing listeners. Anecdotal evidence indicates that this impacts music engagement, particularly singing and playing instruments requiring ongoing tuning to external pitches or producing intervallic ratios. Interestingly, a small cohort of adult CI users has shown remarkable success in recovering or developing musical skills, but their success is poorly understood. Greater understanding of their efforts and attitudes may suggest potential rehabilitative approaches for other CI users.

PURPOSE

This article documented personal characteristics and experiences perceived to contribute to high level musicianship. Research questions included: (1) What forms of practice/experience have most contributed to (re)establishing satisfying music making? (2) What situations or musical tasks are most frustrating or challenging? (3) What attitudes, motivational factors, or forms of support help CI users persist in working toward improved music engagement?

METHODS

Qualitative and patient-engaged research methodologies were used. Our study involved a unique collaboration of six CI users engaged in high levels of musicianship and a researcher whose scholarship focuses on music and CIs. The CI recipients conveyed their experiences and attitudes regarding music and CIs through open-ended narratives. These narratives were analyzed using an integrative approach of inductive and deductive coding methods. The codes and themes that emerged through inductive methods were then organized within the Dynamic Problem Solving Model for Management of Music Listening Environments (Gfeller et al., 2019a).

OUTCOMES

This paper provides reflections of six CI users who successfully engage in active music making, including on-going tuning to external pitches and ensemble participation. Their perspectives emphasize the importance of pre-CI music instruction, extensive practice and immersion in music listening and playing, persistence and self-efficacy, and problem solving skills that optimize music engagement, and suggest possible strategies useful to other CI users interested in improving music experiences.

Practices and Attitudes That Enhance Music Engagement of Adult Cochlear Implant Users

BACKGROUND

Cochlear implants (CIs) are auditory prostheses designed to support spoken communication in persons with severe to profound hearing loss. Many post-lingually deaf adult CI users achieve good speech recognition in quiet; unfortunately, CI technology conveys a degraded representation of pitch and timbre, essential components of music. Not surprisingly, most CI users achieve significantly poorer perception and enjoyment of music compared with normal hearing listeners. Anecdotal evidence indicates that this impacts music engagement, particularly singing and playing instruments requiring ongoing tuning to external pitches or producing intervallic ratios. Interestingly, a small cohort of adult CI users has shown remarkable success in recovering or developing musical skills, but their success is poorly understood. Greater understanding of their efforts and attitudes may suggest potential rehabilitative approaches for other CI users.

PURPOSE

This article documented personal characteristics and experiences perceived to contribute to high level musicianship. Research questions included: (1) What forms of practice/experience have most contributed to (re)establishing satisfying music making? (2) What situations or musical tasks are most frustrating or challenging? (3) What attitudes, motivational factors, or forms of support help CI users persist in working toward improved music engagement?

METHODS

Qualitative and patient-engaged research methodologies were used. Our study involved a unique collaboration of six CI users engaged in high levels of musicianship and a researcher whose scholarship focuses on music and CIs. The CI recipients conveyed their experiences and attitudes regarding music and CIs through open-ended narratives. These narratives were analyzed using an integrative approach of inductive and deductive coding methods. The codes and themes that emerged through inductive methods were then organized within the Dynamic Problem Solving Model for Management of Music Listening Environments (Gfeller et al., 2019a).

OUTCOMES

This paper provides reflections of six CI users who successfully engage in active music making, including on-going tuning to external pitches and ensemble participation. Their perspectives emphasize the importance of pre-CI music instruction, extensive practice and immersion in music listening and playing, persistence and self-efficacy, and problem solving skills that optimize music engagement, and suggest possible strategies useful to other CI users interested in improving music experiences.

Auditory cortical plasticity in cochlear implant users

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

Implicit Processing of Pitch in Postlingually Deafened Cochlear Implant Users

Cochlear implant (CI) users can only access limited pitch information through their device, which hinders music appreciation. Poor music perception may not only be due to CI technical limitations; lack of training or negative attitudes toward the electric sound might also contribute to it. Our study investigated with an implicit (indirect) investigation method whether poorly transmitted pitch information, presented as musical chords, can activate listeners’ knowledge about musical structures acquired prior to deafness. Seven postlingually deafened adult CI users participated in a musical priming paradigm investigating pitch processing without explicit judgments. Sequences made of eight sung-chords that ended on either a musically related (expected) target chord or a less-related (less-expected) target chord were presented. The use of a priming task based on linguistic features allowed CI patients to perform fast judgments on target chords in the sung music. If listeners’ musical knowledge is activated and allows for tonal expectations (as in normal-hearing listeners), faster response times were expected for related targets than less-related targets. However, if the pitch percept is too different and does not activate musical knowledge acquired prior to deafness, storing pitch information in a short-term memory buffer predicts the opposite pattern. If transmitted pitch information is too poor, no difference in response times should be observed. Results showed that CI patients were able to perform the linguistic task on the sung chords, but correct response times indicated sensory priming, with faster response times observed for the less-related targets: CI patients processed at least some of the pitch information of the musical sequences, which was stored in an auditory short-term memory and influenced chord processing. This finding suggests that the signal transmitted via electric hearing led to a pitch percept that was too different from that based on acoustic hearing, so that it did not automatically activate listeners’ previously acquired musical structure knowledge. However, the transmitted signal seems sufficiently informative to lead to sensory priming. These findings are encouraging for the development of pitch-related training programs for CI patients, despite the current technological limitations of the CI coding.

Learning of Artificial Sensation Through Long-Term Home Use of a Sensory-Enabled Prosthesis

Upper limb prostheses are specialized tools, and skilled operation is learned by amputees over time. Recently, neural prostheses using implanted peripheral nerve interfaces have enabled advances in artificial somatosensory feedback that can improve prosthesis outcomes. However, the effect of sensory learning on artificial somatosensation has not been studied, despite its known influence on intact somatosensation and analogous neuroprostheses. Sensory learning involves changes in the perception and interpretation of sensory feedback and may further influence functional and psychosocial outcomes. In this mixed methods case study, we examined how passive learning over 115 days of home use of a neural-connected, sensory-enabled prosthetic hand influenced perception of artificial sensory feedback in a participant with transradial amputation. We examined perceptual changes both within individual days of use and across the duration of the study. At both time scales, the reported percept locations became significantly more aligned with prosthesis sensor locations, and the phantom limb became significantly more extended toward the prosthesis position. Similarly, the participant’s ratings of intensity, naturalness, and contact touch significantly increased, while his ratings of vibration and movement significantly decreased across-days for tactile channels. These sensory changes likely resulted from engagement of cortical plasticity mechanisms as the participant learned to use the artificial sensory feedback. We also assessed psychosocial and functional outcomes through surveys and interviews, and found that self-efficacy, perceived function, prosthesis embodiment, social touch, body image, and prosthesis efficiency improved significantly. These outcomes typically improved within the first month of home use, demonstrating rapid benefits of artificial sensation. Participant interviews indicated that the naturalness of the experience and engagement with the prosthesis increased throughout the study, suggesting that artificial somatosensation may decrease prosthesis abandonment. Our data showed that prosthesis embodiment was intricately related to naturalness and phantom limb perception, and that learning the artificial sensation may have modified the body schema. As another indicator of successfully learning to use artificial sensation, the participant reported the emergence of stereognosis later in the study. This study provides the first evidence that artificial somatosensation can undergo similar learning processes as intact sensation and highlights the importance of sensory restoration in prostheses.

A Dynamically Focusing Cochlear Implant Strategy Can Improve Vowel Identification in Noise

Supplemental Digital Content is available in the text.

Objectives:

The standard, monopolar (MP) electrode configuration used in commercially available cochlear implants (CI) creates a broad electrical field, which can lead to unwanted channel interactions. Use of more focused configurations, such as tripolar and phased array, has led to mixed results for improving speech understanding. The purpose of the present study was to assess the efficacy of a physiologically inspired configuration called dynamic focusing, using focused tripolar stimulation at low levels and less focused stimulation at high levels. Dynamic focusing may better mimic cochlear excitation patterns in normal acoustic hearing, while reducing the current levels necessary to achieve sufficient loudness at high levels.

Design:

Twenty postlingually deafened adult CI users participated in the study. Speech perception was assessed in quiet and in a four-talker babble background noise. Speech stimuli were closed-set spondees in noise, and medial vowels at 50 and 60 dB SPL in quiet and in noise. The signal to noise ratio was adjusted individually such that performance was between 40 and 60% correct with the MP strategy. Subjects were fitted with three experimental strategies matched for pulse duration, pulse rate, filter settings, and loudness on a channel-by-channel basis. The strategies included 14 channels programmed in MP, fixed partial tripolar (σ = 0.8), and dynamic partial tripolar (σ at 0.8 at threshold and 0.5 at the most comfortable level). Fifteen minutes of listening experience was provided with each strategy before testing. Sound quality ratings were also obtained.

Results:

Speech perception performance for vowel identification in quiet at 50 and 60 dB SPL and for spondees in noise was similar for the three tested strategies. However, performance on vowel identification in noise was significantly better for listeners using the dynamic focusing strategy. Sound quality ratings were similar for the three strategies. Some subjects obtained more benefit than others, with some individual differences explained by the relation between loudness growth and the rate of change from focused to broader stimulation.

Conclusions:

These initial results suggest that further exploration of dynamic focusing is warranted. Specifically, optimizing such strategies on an individual basis may lead to improvements in speech perception for more adult listeners and improve how CIs are tailored. Some listeners may also need a longer period of time to acclimate to a new program.

Sonority's Effect as a Surface Cue on Lexical Speech Perception of Children With Cochlear Implants

OBJECTIVES

Sonority is the relative perceptual prominence/loudness of speech sounds of the same length, stress, and pitch. Children with cochlear implants (CIs), with restored audibility and relatively intact temporal processing, are expected to benefit from the perceptual prominence cues of highly sonorous sounds. Sonority also influences lexical access through the sonority-sequencing principle (SSP), a grammatical phonotactic rule, which facilitates the recognition and segmentation of syllables within speech. The more nonsonorous the onset of a syllable is, the larger is the degree of sonority rise to the nucleus, and the more optimal the SSP. Children with CIs may experience hindered or delayed development of the language-learning rule SSP, as a result of their deprived/degraded auditory experience. The purpose of the study was to explore sonority's role in speech perception and lexical access of prelingually deafened children with CIs.

DESIGN

A case-control study with 15 children with CIs, 25 normal-hearing children (NHC), and 50 normal-hearing adults was conducted, using a lexical identification task of novel, nonreal CV-CV words taught via fast mapping. The CV-CV words were constructed according to four sonority conditions, entailing syllables with sonorous onsets/less optimal SSP (SS) and nonsonorous onsets/optimal SSP (NS) in all combinations, that is, SS-SS, SS-NS, NS-SS, and NS-NS. Outcome measures were accuracy and reaction times (RTs). A subgroup analysis of 12 children with CIs pair matched to 12 NHC on hearing age aimed to study the effect of oral-language exposure period on the sonority-related performance.

RESULTS

The children groups showed similar accuracy performance, overall and across all the sonority conditions. However, within-group comparisons showed that the children with CIs scored more accurately on the SS-SS condition relative to the NS-NS and NS-SS conditions, while the NHC performed equally well across all conditions. Additionally, adult-comparable accuracy performance was achieved by the children with CIs only on the SS-SS condition, as opposed to NS-SS, SS-NS, and SS-SS conditions for NHC. Accuracy analysis of the subgroups of children matched in hearing age showed similar results. Overall longer RTs were recorded by the children with CIs on the sonority-treated lexical task, specifically on the SS-SS condition compared with age-matched controls. However, the subgroup analysis showed that both groups of children did not differ on RTs.

CONCLUSIONS

Children with CIs performed better in lexical tasks relying on the sonority perceptual prominence cues, as in SS-SS condition, than on SSP initial relying conditions as NS-NS and NS-SS. Template-driven word learning, an early word-learning strategy, appears to play a role in the lexical access of children with CIs whether matched in hearing age or not. The SS-SS condition acts as a preferred word template. The longer RTs brought about by the highly accurate SS-SS condition in children with CIs is possibly because listening becomes more effortful. The lack of RTs difference between the children groups when matched on hearing age points out the importance of oral-language exposure period as a key factor in developing the auditory processing skills.

Brain Plasticity Can Predict the Cochlear Implant Outcome in Adult-Onset Deafness

Sensory plasticity, which is associated with deafness, has not been as thoroughly investigated in the adult brain as it has in the developing brain. In this study, we examined the brain reorganization induced by auditory deprivation in people with adult-onset deafness and its clinical relevance by measuring glucose metabolism before cochlear implant (CI) surgery. F-18 fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET) scans were performed in 37 postlingually deafened patients during the preoperative workup period, and in 39 normal-hearing (NH) controls. Behavioral CI outcomes were measured at 1 year after implantation using a phoneme identification test with auditory cueing only. In the deaf individuals, areas involved in the auditory pathway such as the inferior colliculus and bilateral superior temporal gyri were hypometabolic compared to the NH controls. The hypometabolism observed in the deaf auditory cortices gradually returned to levels similar to the controls as the duration of deafness increased. However, contrary to our previous findings in congenitally deaf children, this metabolic recovery failed to have a significant prognostic value for the recovery of the speech perception ability in adult CI patients. In a broad occipital area centered on the primary visual cortices, glucose metabolism was higher in the deaf patients than the controls, suggesting that the area had become visually hyperactive for sensory compensation immediately after the onset of deafness. In addition, a negative correlation between the metabolic activity and behavioral speech perception outcomes was observed in the visual association areas. In the medial frontal cortices, cortical metabolism in most patients decreased, but patients who had preserved metabolic activities showed better speech performance. These results suggest that the auditory cortex in people with adult-onset deafness is relatively resistant to cross-modal plasticity, and instead, individual traits in late-stage visual processing and cognitive control seem to be more reliable prognostic markers for adult-onset deafness.

Comparing Auditory-Only and Audiovisual Word Learning for Children With Hearing Loss

Although reducing visual input to emphasize auditory cues is a common practice in pediatric auditory (re)habilitation, the extant literature offers minimal empirical evidence for whether unisensory auditory-only (AO) or multisensory audiovisual (AV) input is more beneficial to children with hearing loss for developing spoken language skills. Using an adapted alternating treatments single case research design, we evaluated the effectiveness and efficiency of a receptive word learning intervention with and without access to visual speechreading cues. Four preschool children with prelingual hearing loss participated. Based on probes without visual cues, three participants demonstrated strong evidence for learning in the AO and AV conditions relative to a control (no-teaching) condition. No participants demonstrated a differential rate of learning between AO and AV conditions. Neither an inhibitory effect predicted by a unisensory theory nor a beneficial effect predicted by a multisensory theory for providing visual cues was identified. Clinical implications are discussed.

Effects of Training on Lateralization for Simulations of Cochlear Implants and Single-Sided Deafness

While cochlear implantation has benefitted many patients with single-sided deafness (SSD), there is great variability in cochlear implant (CI) outcomes and binaural performance remains poorer than that of normal-hearing (NH) listeners. Differences in sound quality across ears-temporal fine structure (TFS) information with acoustic hearing vs. coarse spectro-temporal envelope information with electric hearing-may limit integration of acoustic and electric patterns. Binaural performance may also be limited by inter-aural mismatch between the acoustic input frequency and the place of stimulation in the cochlea. SSD CI patients must learn to accommodate these differences between acoustic and electric stimulation to maximize binaural performance. It is possible that training may increase and/or accelerate accommodation and further improve binaural performance. In this study, we evaluated lateralization training in NH subjects listening to broad simulations of SSD CI signal processing. A 16-channel vocoder was used to simulate the coarse spectro-temporal cues available with electric hearing; the degree of inter-aural mismatch was varied by adjusting the simulated insertion depth (SID) to be 25 mm (SID25), 22 mm (SID22) and 19 mm (SID19) from the base of the cochlea. Lateralization was measured using headphones and head-related transfer functions (HRTFs). Baseline lateralization was measured for unprocessed speech (UN) delivered to the left ear to simulate SSD and for binaural performance with the acoustic ear combined with the 16-channel vocoders (UN+SID25, UN+SID22 and UN+SID19). After completing baseline measurements, subjects completed six lateralization training exercises with the UN+SID22 condition, after which performance was re-measured for all baseline conditions. Post-training performance was significantly better than baseline for all conditions (p < 0.05 in all cases), with no significant difference in training benefits among conditions. Given that there was no significant difference between the SSD and the SSD CI conditions before or after training, the results suggest that NH listeners were unable to integrate TFS and coarse spectro-temporal cues across ears for lateralization, and that inter-aural mismatch played a secondary role at best. While lateralization training may benefit SSD CI patients, the training may largely improve spectral analysis with the acoustic ear alone, rather than improve integration of acoustic and electric hearing.

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.

Auditory perceptual learning and changes in the conceptualization of auditory cortex

Perceptual learning, improvement in discriminative ability as a consequence of training, is one of the forms of sensory system plasticity that has driven profound changes in our conceptualization of sensory cortical function. Psychophysical and neurophysiological studies of auditory perceptual learning have indicated that the characteristics of the learning, and by implication the nature of the underlying neural changes, are highly task specific. Some studies in animals have indicated that recruitment of neurons to the population responding to the training stimuli, and hence an increase in the so-called cortical "area of representation" of those stimuli, is the substrate of improved performance, but such changes have not been observed in other studies. A possible reconciliation of these conflicting results is provided by evidence that changes in area of representation constitute a transient stage in the processes underlying perceptual learning. This expansion - renormalization hypothesis is supported by evidence from studies of the learning of motor skills, another form of procedural learning, but leaves open the nature of the permanent neural substrate of improved performance. Other studies have suggested that the substrate might be reduced response variability - a decrease in internal noise. Neuroimaging studies in humans have also provided compelling evidence that training results in long-term changes in auditory cortical function and in the auditory brainstem frequency-following response. Musical training provides a valuable model, but the evidence it provides is qualified by the fact that most such training is multimodal and sensorimotor, and that few of the studies are experimental and allow control over confounding variables. More generally, the overwhelming majority of experimental studies of the various forms of auditory perceptual learning have established the co-occurrence of neural and perceptual changes, but have not established that the former are causally related to the latter. Important forms of perceptual learning in humans are those involved in language acquisition and in the improvement in speech perception performance of post-lingually deaf cochlear implantees over the months following implantation. The development of a range of auditory training programs has focused interest on the factors determining the extent to which perceptual learning is specific or generalises to tasks other than those used in training. The context specificity demonstrated in a number of studies of perceptual learning suggests a multiplexing model, in which learning relating to a particular stimulus attribute depends on a subset of the diverse inputs to a given cortical neuron being strengthened, and different subsets being gated by top-down influences. This hypothesis avoids the difficulty of balancing system stability with plasticity, which is a problem for recruitment hypotheses. The characteristics of auditory perceptual learning reflect the fact that auditory cortex forms part of distributed networks that integrate the representation of auditory stimuli with attention, decision, and reward processes.

Effects of Long-Term Musical Training on Cortical Auditory Evoked Potentials

OBJECTIVE

Evidence suggests that musicians, as a group, have superior frequency resolution abilities when compared with nonmusicians. It is possible to assess auditory discrimination using either behavioral or electrophysiologic methods. The purpose of this study was to determine if the acoustic change complex (ACC) is sensitive enough to reflect the differences in spectral processing exhibited by musicians and nonmusicians.

DESIGN

Twenty individuals (10 musicians and 10 nonmusicians) participated in this study. Pitch and spectral ripple discrimination were assessed using both behavioral and electrophysiologic methods. Behavioral measures were obtained using a standard three interval, forced choice procedure. The ACC was recorded and used as an objective (i.e., nonbehavioral) measure of discrimination between two auditory signals. The same stimuli were used for both psychophysical and electrophysiologic testing.

RESULTS

As a group, musicians were able to detect smaller changes in pitch than nonmusician. They also were able to detect a shift in the position of the peaks and valleys in a ripple noise stimulus at higher ripple densities than non-musicians. ACC responses recorded from musicians were larger than those recorded from non-musicians when the amplitude of the ACC response was normalized to the amplitude of the onset response in each stimulus pair. Visual detection thresholds derived from the evoked potential data were better for musicians than non-musicians regardless of whether the task was discrimination of musical pitch or detection of a change in the frequency spectrum of the ripple noise stimuli. Behavioral measures of discrimination were generally more sensitive than the electrophysiologic measures; however, the two metrics were correlated.

CONCLUSIONS

Perhaps as a result of extensive training, musicians are better able to discriminate spectrally complex acoustic signals than nonmusicians. Those differences are evident not only in perceptual/behavioral tests but also in electrophysiologic measures of neural response at the level of the auditory cortex. While these results are based on observations made from normal-hearing listeners, they suggest that the ACC may provide a non-behavioral method of assessing auditory discrimination and as a result might prove useful in future studies that explore the efficacy of participation in a musically based, auditory training program perhaps geared toward pediatric or hearing-impaired listeners.

Neural Correlates of Selective Attention With Hearing Aid Use Followed by ReadMyQuips Auditory Training Program

OBJECTIVES

The objectives of this study were to investigate the effects of hearing aid use and the effectiveness of ReadMyQuips (RMQ), an auditory training program, on speech perception performance and auditory selective attention using electrophysiological measures. RMQ is an audiovisual training program designed to improve speech perception in everyday noisy listening environments.

DESIGN

Participants were adults with mild to moderate hearing loss who were first-time hearing aid users. After 4 weeks of hearing aid use, the experimental group completed RMQ training in 4 weeks, and the control group received listening practice on audiobooks during the same period. Cortical late event-related potentials (ERPs) and the Hearing in Noise Test (HINT) were administered at prefitting, pretraining, and post-training to assess effects of hearing aid use and RMQ training. An oddball paradigm allowed tracking of changes in P3a and P3b ERPs to distractors and targets, respectively. Behavioral measures were also obtained while ERPs were recorded from participants.

RESULTS

After 4 weeks of hearing aid use but before auditory training, HINT results did not show a statistically significant change, but there was a significant P3a reduction. This reduction in P3a was correlated with improvement in d prime (d') in the selective attention task. Increased P3b amplitudes were also correlated with improvement in d' in the selective attention task. After training, this correlation between P3b and d' remained in the experimental group, but not in the control group. Similarly, HINT testing showed improved speech perception post training only in the experimental group. The criterion calculated in the auditory selective attention task showed a reduction only in the experimental group after training. ERP measures in the auditory selective attention task did not show any changes related to training.

CONCLUSIONS

Hearing aid use was associated with a decrement in involuntary attention switch to distractors in the auditory selective attention task. RMQ training led to gains in speech perception in noise and improved listener confidence in the auditory selective attention task.