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Word Recognition Variability With Cochlear Implants: “Perceptual Attention” Versus “Auditory Sensitivity”

Moberly, Aaron C.1; Lowenstein, Joanna H.2; Nittrouer, Susan2

doi: 10.1097/AUD.0000000000000204
Research Articles

Objectives: Cochlear implantation does not automatically result in robust spoken language understanding for postlingually deafened adults. Enormous outcome variability exists, related to the complexity of understanding spoken language through cochlear implants (CIs), which deliver degraded speech representations. This investigation examined variability in word recognition as explained by “perceptual attention” and “auditory sensitivity” to acoustic cues underlying speech perception.

Design: Thirty postlingually deafened adults with CIs and 20 age-matched controls with normal hearing (NH) were tested. Participants underwent assessment of word recognition in quiet and perceptual attention (cue-weighting strategies) based on labeling tasks for two phonemic contrasts: (1) “cop”–“cob,” based on a duration cue (easily accessible through CIs) or a dynamic spectral cue (less accessible through CIs), and (2) “sa”–“sha,” based on static or dynamic spectral cues (both potentially poorly accessible through CIs). Participants were also assessed for auditory sensitivity to the speech cues underlying those labeling decisions.

Results: Word recognition varied widely among CI users (20 to 96%), but it was generally poorer than for NH participants. Implant users and NH controls showed similar perceptual attention and auditory sensitivity to the duration cue, while CI users showed poorer attention and sensitivity to all spectral cues. Both attention and sensitivity to spectral cues predicted variability in word recognition.

Conclusions: For CI users, both perceptual attention and auditory sensitivity are important in word recognition. Efforts should be made to better represent spectral cues through implants, while also facilitating attention to these cues through auditory training.

Enormous outcome variability exists for adults with cochlear implants (CIs). This study examined “perceptual attention” and “auditory sensitivity” to acoustic cues as sources of variability. Adults with CIs and controls with normal hearing (NH) performed three tasks: (1) Word recognition in quiet; (2) Labeling for stimuli varying along temporal or spectral dimensions; and (3) Discrimination of nonspeech analogs. Attention to spectral cues, beyond sensitivity, predicted variability in word recognition for CI listeners; neither attention nor sensitivity to temporal cues did. Thus, efforts are needed to improve spectral representations through implants and to facilitate attention to these cues through auditory training.

1Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA; and 2Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, USA.

This study was supported by the Triological Society Career Development Award (to A.C.M.). In addition, this research was supported by grants R01 DC000633 and R01 DC006237 from the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health (NIH) (to S.N.). ResearchMatch, used to recruit control participants, is supported by grants UL1TR000445 and 1U54RR032646-01 from the NIH Clinical and Translational Science Award program.

The authors declare no other conflict of interest.

Received December 31, 2014; accepted June 23, 2015.

Address for correspondence: Aaron C. Moberly, Department of Otolaryngology, Ohio State University College of Medicine, 915 Olentangy River Road, Suite 4000, Columbus, OH 43212, USA. E-mail:

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