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Multisensory Integration in Cochlear Implant Recipients

Stevenson, Ryan A.1,2; Sheffield, Sterling W.3; Butera, Iliza M.4; Gifford, René H.4–5,8; Wallace, Mark T.4–7

doi: 10.1097/AUD.0000000000000435
Review Article
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Speech perception is inherently a multisensory process involving integration of auditory and visual cues. Multisensory integration in cochlear implant (CI) recipients is a unique circumstance in that the integration occurs after auditory deprivation and the provision of hearing via the CI. Despite the clear importance of multisensory cues for perception, in general, and for speech intelligibility, specifically, the topic of multisensory perceptual benefits in CI users has only recently begun to emerge as an area of inquiry. We review the research that has been conducted on multisensory integration in CI users to date and suggest a number of areas needing further research. The overall pattern of results indicates that many CI recipients show at least some perceptual gain that can be attributable to multisensory integration. The extent of this gain, however, varies based on a number of factors, including age of implantation and specific task being assessed (e.g., stimulus detection, phoneme perception, word recognition). Although both children and adults with CIs obtain audiovisual benefits for phoneme, word, and sentence stimuli, neither group shows demonstrable gain for suprasegmental feature perception. Additionally, only early-implanted children and the highest performing adults obtain audiovisual integration benefits similar to individuals with normal hearing. Increasing age of implantation in children is associated with poorer gains resultant from audiovisual integration, suggesting a sensitive period in development for the brain networks that subserve these integrative functions, as well as length of auditory experience. This finding highlights the need for early detection of and intervention for hearing loss, not only in terms of auditory perception, but also in terms of the behavioral and perceptual benefits of audiovisual processing. Importantly, patterns of auditory, visual, and audiovisual responses suggest that underlying integrative processes may be fundamentally different between CI users and typical-hearing listeners. Future research, particularly in low-level processing tasks such as signal detection will help to further assess mechanisms of multisensory integration for individuals with hearing loss, both with and without CIs.

1Department of Psychology, University of Western Ontario, London, Ontario, Canada; 2Brain and Mind Institute, University of Western Ontario, London, Ontario, Canada; 3Walter Reed National Military Medical Center, Audiology and Speech Pathology Center, London, Ontario, Canada; 4Vanderbilt Brain Institute, Nashville, Tennesse; 5Vanderbilt Kennedy Center, Nashville, Tennesse; 6Department of Psychology, Vanderbilt University, Nashville, Tennesse; 7Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennesse; and 8Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennesse.

Received May 2, 2016; accepted January 30, 2017.

R.G. was a member of the Audiology Advisory Board for Advanced Bionics and Cochlear Americas at the time of publication. No conflicts of interest or sources of funding are declared for any of the other authors.

Address for correspondence: Ryan A. Stevenson, Department of Psychology, University of Western Ontario, Ontario, Canada. E-mail: rsteve28@uwo.ca

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