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Use of Direct-Connect for Remote Speech-Perception Testing in Cochlear Implants

Sevier, Joshua D.; Choi, Sangsook; Hughes, Michelle L.

doi: 10.1097/AUD.0000000000000693
Research Articles

Objectives: Previous research has demonstrated the feasibility of programming cochlear implants (CIs) via telepractice. To effectively use telepractice in a comprehensive manner, all components of a clinical CI visit should be validated using remote technology. Speech-perception testing is important for monitoring outcomes with a CI, but it has yet to be validated for remote service delivery. The objective of this study, therefore, was to evaluate the feasibility of using direct audio input (DAI) as an alternative to traditional sound-booth speech-perception testing for serving people with CIs via telepractice. Specifically, our goal was to determine whether there was a significant difference in speech-perception scores between the remote DAI (telepractice) and the traditional (in-person) sound-booth conditions.

Design: This study used a prospective, split-half-design to test speech perception in the remote DAI and in-person sound-booth conditions. Thirty-two adults and older children with CIs participated; all had a minimum of 6 months of experience with their device. Speech-perception tests included the consonant–nucleus–consonant (CNC) words, Hearing-in-Noise test (HINT) sentences, and Arizona Biomedical Institute at Arizona State University (AzBio) sentences. All three tests were administered at levels of 50 and 60 dBA in quiet. Sentence stimuli were also presented in 4-talker babble at signal to noise ratios (SNRs) of +10 and +5 dB for both the 50- and 60-dBA presentation levels. A repeated-measures analysis of variance was used to assess the effects of location (remote, in person), stimulus level (50, 60 dBA), and SNR (if applicable; quiet, +10, +5 dB) on each outcome measure (CNC, HINT, AzBio).

Results: The results showed no significant effect of location for any of the tests administered (p > 0.1). There was no significant effect of presentation level for CNC words or phonemes (p > 0.2). There was, however, a significant effect of level (p < 0.001) for both HINT and AzBio sentences, but the direction of the effect was opposite of what was expected—scores were poorer for 60 dBA than for 50 dBA. For both sentence tests, there was a significant effect of SNR, with poorer performance for worsening SNRs, as expected.

Conclusions: The present study demonstrated that speech-perception testing via telepractice is feasible using DAI. There was no significant difference in scores between the remote and in-person conditions, which suggests that DAI testing can be used as a valid alternative to standard sound-booth testing. The primary limitation is that the calibration tools are presently not commercially available.

Boys Town National Research Hospital (Center for Hearing Research), Omaha, Nebraska, USA.

Received May 14, 2018; accepted November 14, 2018.

This study was supported by the National Institutes of Health (NIH), National Institute on Deafness and Other Communication Disorders (NIDCD) Grants R01 DC013281 (principal investigator: M. L. Hughes), and the National Institute on General Medicine and Surgery P20 GM109023. The content of this project is solely the authors’ responsibility and does not necessarily represent the official views of the NIDCD or the National Institutes of Health.

Michelle Hughes is a member of the Ear and Hearing editorial board.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (

Address for correspondence: Michelle L. Hughes, 4075 East Campus Loop, 276 Barkley Memorial Center, Lincoln, NE 68583, USA. E-mail:

Online date: January 11, 2019

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