Publications by authors named "David B Pisoni"

206 Publications

Family Environmental Dynamics Differentially Influence Spoken Language Development in Children With and Without Hearing Loss.

J Speech Lang Hear Res 2022 Jan 24;65(1):361-377. Epub 2021 Nov 24.

DeVault Otologic Research Laboratory, Department of Otolaryngology, Indiana University School of Medicine, Indianapolis.

Purpose: The aim of this study was to evaluate whether families of children with sensorineural hearing loss (SNHL) are organized similarly to those of typically developing, typically hearing (TH) children and whether the dimensions of family dynamics and environment are related to spoken language development similarly in children with and without SNHL.

Method: Primary caregivers of children with SNHL ( = 63) or TH ( = 65) completed the Family Environment Scale-Fourth Edition (FES-4) to assess multiple dimensions of family environment. Children's receptive vocabulary was assessed with the Peabody Picture Vocabulary Test-Fourth Edition, and their receptive language was assessed by an age-appropriate version of the Concepts and Following Directions subtest of the Clinical Evaluation of Language Fundamentals and the Sentence Comprehension subscale of the Comprehensive Assessment of Spoken Language-Second Edition. Principal component analysis was used to examine the dimensional structure of the family environment.

Results: Three higher order components were derived from FES-4 subscales for both families of children with SNHL and with TH: Supportive, Controlling, and Conflicted. However, the composition of the factors themselves differed between the two groups. For the TH group, most family environment measures on the FES-4 were not associated with language outcomes. In contrast, for children with SNHL, families who were more supportive, less controlling, and less conflicted had children with better language skills.

Conclusions: Three well-accepted dimensions of family dynamics and functioning apply to families of children with SNHL, but their composition differs from those of families with TH children. Family environmental dynamics were much more strongly associated with language outcomes in children with SNHL than in their TH peers. The spoken language development of children with SNHL, in particular, is better in families that provide high levels of support for each other and, in particular, low levels of control, disorganization, and conflict, reflecting the fragile nature of their spoken language development.
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http://dx.doi.org/10.1044/2021_JSLHR-21-00220DOI Listing
January 2022

Verbal Working Memory Error Patterns and Speech-Language Outcomes in Youth With Cochlear Implants.

J Speech Lang Hear Res 2021 Dec 11;64(12):4949-4963. Epub 2021 Nov 11.

Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis.

Purpose: Verbal working memory (VWM) delays are commonly found in prelingually deaf youth with cochlear implants (CIs), albeit with considerable interindividual variability. However, little is known about the neurocognitive information-processing mechanisms underlying these delays and how these mechanisms relate to spoken language outcomes. The goal of this study was to use error analysis of the letter-number sequencing (LNS) task to test the hypothesis that VWM delays in CI users are due, in part, to fragile, underspecified phonological representations in short-term memory.

Method: Fifty-one CI users aged 7-22 years and 53 normal hearing (NH) peers completed a battery of speech, language, and neurocognitive tests. LNS raw scores and error profiles were compared between samples, and a hierarchical regression model was used to test for associations with measures of speech, language, and hearing.

Results: Youth with CIs scored lower on the LNS test than NH peers and committed a significantly higher number of errors involving phonological confusions (recalling an incorrect letter/digit in place of a phonologically similar one). More phonological errors were associated with poorer performance on measures of nonword repetition and following spoken directions but not with hearing quality.

Conclusions: Study findings support the hypothesis that poorer VWM in deaf children with CIs is due, in part, to fragile, underspecified phonological representations in short-term/working memory, which underlie spoken language delays. Programs aimed at strengthening phonological representations may improve VWM and spoken language outcomes in CI users.
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http://dx.doi.org/10.1044/2021_JSLHR-21-00114DOI Listing
December 2021

Differential At-Risk Pediatric Outcomes of Parental Sensitivity Based on Hearing Status.

J Speech Lang Hear Res 2021 09 31;64(9):3668-3684. Epub 2021 Aug 31.

DeVault Otologic Research Laboratory, Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis.

Purpose The aim of this study was to investigate the role of parental sensitivity in language and neurocognitive outcomes in children who are deaf and/or hard of hearing (DHH). Method Sixty-two parent-child dyads of children with normal hearing (NH) and 64 of children who are DHH (3-8 years) completed parent and child measures of inhibitory control/executive functioning and child measures of sentence comprehension and vocabulary. The dyads also participated in a video-recorded, free-play interaction that was coded for parental sensitivity. Results There was no evidence of associations between parental sensitivity and inhibitory control or receptive language in children with NH. In contrast, parental sensitivity was related to children's inhibitory control and all language measures in children who are DHH. Moreover, inhibitory control significantly mediated the association between parental sensitivity and child language on the Clinical Evaluation of Language Fundamentals-Fifth Edition Following Directions subscale (6-8 years)/Clinical Evaluation of Language Fundamentals Preschool-Second Edition Concepts and Following Directions subscale (3-5 years). Follow-up analyses comparing subgroups of children who used hearing aids ( = 29) or cochlear implants (CIs; = 35) revealed similar correlational trends, with the exception that parental sensitivity showed little relation to inhibitory control in the group of CI users. Conclusions Parental sensitivity is associated with at-risk language outcomes and disturbances in inhibitory control in young children who are DHH. Compared to children with NH, children who are DHH may be more sensitive to parental behaviors and their effects on emerging inhibitory control and spoken language. Specifically, inhibitory control, when scaffolded by positive parental behaviors, may be critically important for robust language development in children who are DHH.
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http://dx.doi.org/10.1044/2021_JSLHR-20-00491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8642085PMC
September 2021

Remote Assessment of Verbal Memory in Youth With Cochlear Implants During the COVID-19 Pandemic.

Am J Speech Lang Pathol 2021 03 18;30(2):740-747. Epub 2021 Mar 18.

Department of Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Indianapolis.

Purpose Youth with cochlear implants (CIs) are at risk for delays in verbal short-term memory (STM)/working memory (WM), which adversely affect language, neurocognitive, and behavioral outcomes. Assessment of verbal STM/WM is critical for identifying and addressing these delays, but standard assessment procedures require face-to-face (FTF) administration. The purpose of this study was to determine the feasibility and validity of remote testing methods (teleassessment) of verbal STM/WM in youth with CIs as a method of addressing COVID-19-related restrictions on FTF test administration. Method Tests of verbal STM/WM for nonwords, digit spans, letter-number sequences, sentences, and stories were individually administered by speech-language pathologists over a teleassessment platform to 28 youth (aged 9-22 years) with CIs and 36 same-aged normal-hearing peers. Examiners, parents, and participants completed quality and satisfaction ratings with the teleassessment procedure. Teleassessment scores were compared to results of tests obtained at FTF visits an average of 1.6 years earlier. Results Quality and satisfaction ratings for teleassessment were high and in almost all cases did not differ between the CI and normal-hearing samples. Youth with CIs scored lower than normal-hearing peers on measures of verbal STM/WM, and scores for digit span and letter-number sequencing did not differbetween teleassessment and FTF methods. Correlations across teleassessment and FTF visits were strong for digit span, letter-number sequencing, and sentence memory, but were more modest for nonword repetition. Conclusion With some caveats, teleassessment of verbal STM/WM was feasible and valid for youth with CIs.
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http://dx.doi.org/10.1044/2021_AJSLP-20-00276DOI Listing
March 2021

Recognizing spoken words in semantically-anomalous sentences: Effects of executive control in early-implanted deaf children with cochlear implants.

Cochlear Implants Int 2021 07 5;22(4):223-236. Epub 2021 Mar 5.

DeVault Otologic Research Laboratory, Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine.

Objectives: To investigate differences in speech, language, and neurocognitive functioning in normal hearing (NH) children and deaf children with cochlear implants (CIs) using anomalous sentences. Anomalous sentences block the use of downstream predictive coding during speech recognition, allowing for investigation of rapid phonological coding and executive functioning. Extreme groups were extracted from samples of children with CIs and NH peers (ages 9 to 17) based on the 7 highest and 7 lowest scores on the Harvard-Anomalous sentence test (Harvard-A). The four groups were compared on measures of speech, language, and neurocognitive functioning. The 7 highest-scoring CI users and the 7 lowest-scoring NH peers did not differ in Harvard-A scores but did differ significantly on measures of neurocognitive functioning. Compared to low-performing NH peers, highperforming children with CIs had significantly lower nonword repetition scores but higher nonverbal IQ scores, greater verbal WM capacity, and excellent EF skills related to inhibition, shifting attention/mental flexibility and working memory updating. High performing deaf children with CIs are able to compensate for their sensory deficits and weaknesses in automatic phonological coding of speech by engaging in a slow effortful mode of information processing involving inhibition, working memory and executive functioning.
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http://dx.doi.org/10.1080/14670100.2021.1884433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8392694PMC
July 2021

The Perception of Regional Dialects and Foreign Accents by Cochlear Implant Users.

J Speech Lang Hear Res 2021 02 25;64(2):683-690. Epub 2021 Jan 25.

Department of Otolaryngology, Wexner Medical Center, The Ohio State University, Columbus.

Purpose This preliminary research examined (a) the perception of two common sources of indexical variability in speech-regional dialects and foreign accents, and (b) the relation between indexical processing and sentence recognition among prelingually deaf, long-term cochlear implant (CI) users and normal-hearing (NH) peers. Method Forty-three prelingually deaf adolescent and adult CI users and 44 NH peers completed a regional dialect categorization task, which consisted of identifying the region of origin of an unfamiliar talker from six dialect regions of the United States. They also completed an intelligibility rating task, which consisted of rating the intelligibility of short sentences produced by native and nonnative (foreign-accented) speakers of American English on a scale from 1 () to 7 (). Individual performance was compared to demographic factors and sentence recognition scores. Results Both CI and NH groups demonstrated difficulty with regional dialect categorization, but NH listeners significantly outperformed the CI users. In the intelligibility rating task, both CI and NH listeners rated foreign-accented sentences as less intelligible than native sentences; however, CI users perceived smaller differences in intelligibility between native and foreign-accented sentences. Sensitivity to accent differences was related to sentence recognition accuracy in CI users. Conclusions Prelingually deaf, long-term CI users are sensitive to accent variability in speech, but less so than NH peers. Additionally, individual differences in CI users' sensitivity to indexical variability was related to sentence recognition abilities, suggesting a common source of difficulty in the perception and encoding of fine acoustic-phonetic details in speech.
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http://dx.doi.org/10.1044/2020_JSLHR-20-00496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8632473PMC
February 2021

Family-Level Executive Functioning and At-Risk Pediatric Hearing Loss Outcomes.

J Speech Lang Hear Res 2021 01 29;64(1):218-229. Epub 2020 Dec 29.

DeVault Otologic Research Laboratory, Department of Otolaryngology, Indiana University School of Medicine, Indianapolis.

Purpose Using a new measure of family-level executive functioning (EF; the Family Characteristics Scale [FCS]), we investigated associations between family-level EF, spoken language, and neurocognitive skills in children with hearing loss (HL), compared to children with normal hearing. Method Parents of children with HL ( = 61) or children with normal hearing ( = 65) completed the FCS-Parent, and clinicians evaluated families using the FCS-Examiner. Children completed an age-appropriate version of the Concepts and Following Directions subtest of the Clinical Evaluation of Language Fundamentals and the Peabody Picture Vocabulary Test-Fourth Edition. Child EF was assessed via the parent report Behavior Rating Inventory of Executive Function. Results Two higher order components were derived from FCS subscales: Family Inhibition and Family Organization. For both samples, Family Inhibition was positively associated with child inhibition, child shifting, and child language comprehension skills. Family Organization was differentially associated with child inhibition, working memory, and planning/organization skills across the samples. Additionally, Family Inhibition was associated with child planning and organization skills for children with HL. Conclusions Results support the FCS as a measure of family-level EF. Family-level inhibition related to better child inhibition, flexibility/shifting, and language comprehension across both samples and to better planning and organization skills in children with HL. As children with HL experienced greater difficulties in EF, families demonstrated greater organization, possibly as a compensatory measure. Results suggest that inhibition and organization at a family level may be important targets for the development of novel interventions to promote EF and language outcomes for children with HL.
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http://dx.doi.org/10.1044/2020_JSLHR-20-00342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8608142PMC
January 2021

Word and Nonword Reading Efficiency in Postlingually Deafened Adult Cochlear Implant Users.

Otol Neurotol 2021 03;42(3):e272-e278

Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

Hypothesis: This study tested the hypotheses that 1) experienced adult cochlear implants (CI) users demonstrate poorer reading efficiency relative to normal-hearing controls, 2) reading efficiency reflects basic, underlying neurocognitive skills, and 3) reading efficiency relates to speech recognition outcomes in CI users.

Background: Weak phonological processing skills have been associated with poor speech recognition outcomes in postlingually deaf adult CI users. Phonological processing can be captured in nonauditory measures of reading efficiency, which may have wide use in patients with hearing loss. This study examined reading efficiency in adults CI users, and its relation to speech recognition outcomes.

Methods: Forty-eight experienced, postlingually deaf adult CI users (ECIs) and 43 older age-matched peers with age-normal hearing (ONHs) completed the Test of Word Reading Efficiency (TOWRE-2), which measures word and nonword reading efficiency. Participants also completed a battery of nonauditory neurocognitive measures and auditory sentence recognition tasks.

Results: ECIs and ONHs did not differ in word (ECIs: M = 78.2, SD = 11.4; ONHs: M = 83.3, SD = 10.2) or nonword reading efficiency (ECIs: M = 42.0, SD = 11.2; ONHs: M = 43.7, SD = 10.3). For ECIs, both scores were related to untimed word reading with moderate to strong effect sizes (r = 0.43-0.69), but demonstrated differing relations with other nonauditory neurocognitive measures with weak to moderate effect sizes (word: r = 0.11-0.44; nonword: r = (-)0.15 to (-)0.42). Word reading efficiency was moderately related to sentence recognition outcomes in ECIs (r = 0.36-0.40).

Conclusion: Findings suggest that postlingually deaf adult CI users demonstrate neither impaired word nor nonword reading efficiency, and these measures reflect different underlying mechanisms involved in language processing. The relation between sentence recognition and word reading efficiency, a measure of lexical access speed, suggests that this measure may be useful for explaining outcome variability in adult CI users.
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http://dx.doi.org/10.1097/MAO.0000000000002925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874984PMC
March 2021

Functional hearing quality in prelingually deaf school-age children and adolescents with cochlear implants.

Int J Audiol 2021 04 1;60(4):282-292. Epub 2020 Oct 1.

Department of Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.

Objective: This study investigated differences in functional hearing quality between youth with cochlear implants (CIs) and normal hearing (NH) peers, as well as associations between functional hearing quality and audiological measures, speech perception, language and executive functioning (EF).

Design: Youth with CIs and NH peers completed measures of audiological functioning, speech perception, language and EF. Parents completed the Quality of Hearing Scale (QHS), a questionnaire measure of functional hearing quality.

Study Sample: Participants were 43 prelingually-deaf, early-implanted, long-term CI users and 43 NH peers aged 7-17 years.

Results: Compared to NH peers, youth with CIs showed poorer functional hearing quality on the QHS Speech, Localization, and Sounds subscales and more hearing effort on the QHS Effort subscale. QHS scores did not correlate significantly with audiological/hearing history measures but were significantly correlated with most speech perception, language and EF scores in the CI sample. In the NH sample, QHS scores were uncorrelated with speech perception and language and were inconsistently correlated with EF.

Conclusions: The QHS is a valid measure of functional hearing quality that is distinct from office-based audiometric or hearing history measures. Functional hearing outcomes are associated with speech-language and EF outcomes in CI users.
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http://dx.doi.org/10.1080/14992027.2020.1826586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012403PMC
April 2021

Letter to the Editor: Do Pediatric Cochlear Implant Recipients Display Domain-General Sequencing Difficulties? A Comment on.

Ear Hear 2020 Jul/Aug;41(4):1051-1054

Department of Otolaryngology - Head and Neck Surgery, DeVault Otologic Research Laboratory, Indiana University School of Medicine, Indianapolis, Indiana, USA.

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http://dx.doi.org/10.1097/AUD.0000000000000841DOI Listing
January 2021

Longitudinal Development of Executive Functioning and Spoken Language Skills in Preschool-Aged Children With Cochlear Implants.

J Speech Lang Hear Res 2020 04 23;63(4):1128-1147. Epub 2020 Mar 23.

DeVault Otologic Research Laboratory, Department of Otolaryngology, Indiana University School of Medicine, Indianapolis.

Purpose Auditory deprivation has downstream effects on the development of language and executive functioning (EF) in prelingually deaf children with cochlear implants (CIs), but little is known about the very early development of EF during preschool ages in children with CIs. This study investigated the longitudinal development of EF and spoken language skills in samples of children with normal hearing (NH; = 40) or CIs ( = 41) during preschool ages. Method Participants were enrolled in the study between ages 3 and 6 years and evaluated annually up to the age of 7 years. Mixed-effects models were used to evaluate and predict growth of spoken language and EF skills over time. Results Children with CIs scored lower than NH peers on language measures but improved significantly over time. On performance-based neurocognitive measures of controlled attention, inhibition, and working memory, children with CIs scored more poorly than the sample of NH peers but comparable to norms, whereas on a parent report behavior checklist, children with CIs scored more poorly than both NH peers and norms on inhibition and working memory. Children with CIs had poorer EF than the sample of NH peers in most domains even after accounting for language effects, and language predicted only the verbal working memory domain of EF. In contrast, EF skills consistently predicted language skills at subsequent visits. Conclusions Findings demonstrate that, despite significant improvement over time, some domains of EF (particularly parent-reported EF) and language skills in children with CIs lag behind those of children with NH during preschool ages. Language delays do not fully explain differences in EF development between children with CIs and NH peers during preschool ages, but EF skills predict subsequent language development in children with CIs.
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http://dx.doi.org/10.1044/2019_JSLHR-19-00247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7242982PMC
April 2020

Associations Between Parenting Stress, Language Comprehension, and Inhibitory Control in Children With Hearing Loss.

J Speech Lang Hear Res 2020 01 15;63(1):321-333. Epub 2020 Jan 15.

DeVault Otologic Research Laboratory, Department of Otolaryngology, Indiana University School of Medicine, Indianapolis.

Purpose Parenting stress has been studied as a potential predictor of developmental outcomes in children with normal hearing and children who are deaf and hard of hearing. However, it is unclear how parenting stress might underlie at-risk spoken language and neurocognitive outcomes in this clinical pediatric population. We investigated parenting stress levels and the shared relations between parenting stress, language comprehension, and inhibitory control skills in children with and without hearing loss (HL) using a cross-sectional design. Method Families of children with HL ( 39) and with normal hearing ( 41) were tested. Children completed an age-appropriate version of the Concepts & Following Directions subtest of the Clinical Evaluation of Language Fundamentals and the NIH Toolbox Flanker Test of Attention and Inhibitory control. Caregivers completed the Parenting Stress Index-Short Form 4. Results Parenting stress levels were not significantly different between parents of children with and without HL. A significant negative association was observed between parenting stress and our measure of language comprehension in children with HL. A negative association between parenting stress and inhibitory control skills was also found in families of children with HL, but not hearing children. The parenting stress-inhibitory control relationship was indirectly accounted for by delayed language comprehension skills in children with HL. Conclusion Even at moderate levels of parenting stress similar to parents of children with normal hearing, increases in parenting stress were associated with lower scores on our measures of language comprehension and inhibitory control in children with HL. Thus, parenting stress may underlie some of the variability in at-risk pediatric HL outcomes.
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http://dx.doi.org/10.1044/2019_JSLHR-19-00230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213483PMC
January 2020

Cognitive Functions in Adults Receiving Cochlear Implants: Predictors of Speech Recognition and Changes After Implantation.

Otol Neurotol 2020 03;41(3):e322-e329

Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.

Hypotheses: Significant variability in speech recognition outcomes is consistently observed in adults who receive cochlear implants (CIs), some of which may be attributable to cognitive functions. Two hypotheses were tested: 1) preoperative cognitive skills assessed visually would predict postoperative speech recognition at 6 months after CI; and 2) cochlear implantation would result in benefits to cognitive processes at 6 months.

Background: Several executive functioning tasks have been identified as contributors to speech recognition in adults with hearing loss. There is also mounting evidence that cochlear implantation can improve cognitive functioning. This study examined whether preoperative cognitive functions would predict speech recognition after implantation, and whether cognitive skills would improve as a result of CI intervention.

Methods: Nineteen post-lingually deafened adult CI candidates were tested preoperatively using a visual battery of tests to assess working memory (WM), processing speed, inhibition-concentration, and nonverbal reasoning. Six months post-implantation, participants were assessed with a battery of word and sentence recognition measures and cognitive tests were repeated.

Results: Multiple speech measures after 6 months of CI use were correlated with preoperative visual WM (symbol span task) and inhibition ability (stroop incongruent task) with moderate-to-large effect sizes. Small-to-large effect size improvements in visual WM, concentration, and inhibition tasks were found from pre- to post-CI. Patients with lower baseline cognitive abilities improved the most after implantation.

Conclusions: Findings provide evidence that preoperative cognitive factors contribute to speech recognition outcomes for adult CI users, and support the premise that implantation may lead to improvements in some cognitive domains.
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http://dx.doi.org/10.1097/MAO.0000000000002544DOI Listing
March 2020

Family Environment in Children With Hearing Aids and Cochlear Implants: Associations With Spoken Language, Psychosocial Functioning, and Cognitive Development.

Ear Hear 2020 Jul/Aug;41(4):762-774

Department of Speech and Hearing Sciences, Indiana University, Bloomington, Indiana, USA.

Objectives: To examine differences in family environment and associations between family environment and key speech, language, and cognitive outcomes in samples of children with normal hearing and deaf and hard-of-hearing (DHH) children who use hearing aids and cochlear implants.

Design: Thirty families of children with normal hearing (n = 10), hearing aids (n = 10), or cochlear implants (n = 10) completed questionnaires evaluating executive function, social skills, and problem behaviors. Children's language and receptive vocabulary were evaluated using standardized measures in the children's homes. In addition, families were administered a standardized in-home questionnaire and observational assessment regarding the home environment.

Results: Family environment overall was similar across hearing level and sensory aid, although some differences were found on parental responsivity and physical environment. The level of supportiveness and enrichment within family relationships accounted for much of the relations between family environment and the psychosocial and neurocognitive development of DHH children. In contrast, the availability of objects and experiences to stimulate learning in the home was related to the development of spoken language.

Conclusions: Whereas broad characteristics of the family environments of DHH children may not differ from those of hearing children, variability in family functioning is related to DHH children's at-risk speech, language, and cognitive outcomes. Results support the importance of further research to clarify and explain these relations, which might suggest novel methods and targets of family-based interventions to improve developmental outcomes.
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http://dx.doi.org/10.1097/AUD.0000000000000811DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190421PMC
July 2021

Assessing Higher Order Language Processing in Long-Term Cochlear Implant Users.

Am J Speech Lang Pathol 2019 11 16;28(4):1537-1553. Epub 2019 Oct 16.

Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis.

Purpose The purpose of this study was to describe and explain individual differences in complex/higher order language processing in long-term cochlear implant (CI) users relative to normal-hearing (NH) peers. Method Measures of complex/higher order language processing indexed by the Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4) Core Language subtests were obtained from 53 long-term (≥ 7 years) CI users aged 9-29 years and 60 NH controls who did not differ in age, gender, or nonverbal IQ. Vocabulary knowledge and fast, automatic language processing (rapid phonological coding, verbal rehearsal speed, and speech intelligibility) were also assessed. Results CI users showed weaker performance than NH controls on all CELF-4 Core Language subtests. These differences remained for Formulated Sentences and Recalling Sentences even when vocabulary knowledge was statistically controlled. About 50% of the CI sample scored within the range of the NH sample on Formulated Sentences and Recalling Sentences, while the remaining 50% scored well below the NH sample on these subtests. Vocabulary knowledge, rapid phonological coding, verbal rehearsal speed, and speech intelligibility were more strongly correlated with CELF-4 subtest scores in the CI sample than in the NH sample. Conclusions Weaknesses in complex, higher order language processing shown by a subgroup of CI users compared to NH peers may result from delays in fast, automatic processing of language. These at-risk domains of language functioning could serve as targets for novel interventions for deaf children who experience suboptimal spoken language outcomes following cochlear implantation.
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http://dx.doi.org/10.1044/2019_AJSLP-18-0138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251594PMC
November 2019

High- and Low-Performing Adult Cochlear Implant Users on High-Variability Sentence Recognition: Differences in Auditory Spectral Resolution and Neurocognitive Functioning.

J Am Acad Audiol 2020 05 9;31(5):324-335. Epub 2020 Jun 9.

Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.

Background: Postlingually deafened adult cochlear implant (CI) users routinely display large individual differences in the ability to recognize and understand speech, especially in adverse listening conditions. Although individual differences have been linked to several sensory (''bottom-up'') and cognitive (''top-down'') factors, little is currently known about the relative contributions of these factors in high- and low-performing CI users.

Purpose: The aim of the study was to investigate differences in sensory functioning and neurocognitive functioning between high- and low-performing CI users on the Perceptually Robust English Sentence Test Open-set (PRESTO), a high-variability sentence recognition test containing sentence materials produced by multiple male and female talkers with diverse regional accents.

Research Design: CI users with accuracy scores in the upper (HiPRESTO) or lower quartiles (LoPRESTO) on PRESTO in quiet completed a battery of behavioral tasks designed to assess spectral resolution and neurocognitive functioning.

Study Sample: Twenty-one postlingually deafened adult CI users, with 11 HiPRESTO and 10 LoPRESTO participants.

Data Collection And Analysis: A discriminant analysis was carried out to determine the extent to which measures of spectral resolution and neurocognitive functioning discriminate HiPRESTO and LoPRESTO CI users. Auditory spectral resolution was measured using the Spectral-Temporally Modulated Ripple Test (SMRT). Neurocognitive functioning was assessed with visual measures of working memory (digit span), inhibitory control (Stroop), speed of lexical/phonological access (Test of Word Reading Efficiency), and nonverbal reasoning (Raven's Progressive Matrices).

Results: HiPRESTO and LoPRESTO CI users were discriminated primarily by performance on the SMRT and secondarily by the Raven's test. No other neurocognitive measures contributed substantially to the discriminant function.

Conclusions: High- and low-performing CI users differed by spectral resolution and, to a lesser extent, nonverbal reasoning. These findings suggest that the extreme groups are determined by global factors of richness of sensory information and domain-general, nonverbal intelligence, rather than specific neurocognitive processing operations related to speech perception and spoken word recognition. Thus, although both bottom-up and top-down information contribute to speech recognition performance, low-performing CI users may not be sufficiently able to rely on neurocognitive skills specific to speech recognition to enhance processing of spectrally degraded input in adverse conditions involving high talker variability.
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http://dx.doi.org/10.3766/jaaa.18106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103548PMC
May 2020

L2 speech perception in noise: An fMRI study of advanced Spanish learners.

Brain Res 2019 10 3;1720:146316. Epub 2019 Jul 3.

Department of Psychological and Brain Sciences, Indiana University, 1101 E. 10th St., Bloomington, IN 47405, United States.

This experiment examined the neural correlates of second language (L2) speech perception in noise in advanced Spanish students. Participants completed a speech perception task in quiet and noise in their first language (L1 = English) and L2 during fMRI. Behavioral tests of L2 Spanish sentence recognition confirmed that advanced learners of Spanish can recognize sentences in quiet and in noise with an average of 85.45% and 74.43% accuracy, respectively. While listening to degraded sentences in the L2, both auditory and executive processing regions (specifically those of attention) were activated. While listening to L2 sentences in noise, learners focused on decoding the speech signal at the perceptual level, indicating a bottom-up processing strategy relying heavily on the signal's phonetic detail. During the processing of L1 in noise there was only significant activation in executive processing regions like the cingulate cortex and a region linked to lexical-semantic access (LIFG). In this case, participants appear to use a top-down strategy for sentence recognition, relying on lexical resources using a holistic strategy for perception. These findings suggest that L2 learners use fundamentally different perceptual strategies and neural circuits for understanding speech in noise in their L1 and L2.
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http://dx.doi.org/10.1016/j.brainres.2019.146316DOI Listing
October 2019

Verbal Learning and Memory in Early-Implanted, Prelingually Deaf Adolescent and Adult Cochlear Implant Users.

J Speech Lang Hear Res 2019 04;62(4):1033-1050

Speech Research Laboratory, Department of Psychological and Brain Sciences, Indiana University, Bloomington.

Purpose The purpose of this study was to investigate the information-processing strategies of early-implanted, prelingually deaf cochlear implant (CI) users with the California Verbal Learning Test-Second Edition (CVLT-II; Delis, Kramer, Kaplan, & Ober, 2000 ), a well-established normed measure of verbal learning and memory used in neuropsychological assessments of memory loss. Method Verbal learning and memory skills were compared in 20 older adolescent and young adult prelingually deaf long-term early-implanted CI users and their 24 normal hearing (NH) peers using the CVLT-II, a widely used multitrial free recall test of verbal learning and memory. Results On average, CI users recalled fewer words than their NH peers across the immediate, delayed, and cued recall trials of the CVLT-II but were comparable to their NH peers on yes/no recognition memory. CI users showed little evidence of semantic clustering of words during free recall but greater serial clustering compared to their NH peers, suggesting fundamental disturbances in automatic semantic activation of words from long-term memory. No differences were found in verbal memory between CI users and their NH peers on measures of retroactive interference and encoding/retrieval interactions. Performance on the 2nd word list of the CVLT-II (List B) and amount of semantic clustering of words during recall were correlated with sentence recognition in the CI group. Conclusion Study findings demonstrate significant differences in free recall performance and information-processing strategies that early-implanted, prelingually deaf CI users use to encode, organize, store, and retrieve spoken words in conventional verbal list learning paradigms, compared to their NH peers. Because verbal learning and memory are core foundational processes routinely used in daily functioning for a wide range of neurocognitive and language processing operations, these findings suggest potential domains for assessment and novel interventions to promote the development of optimal outcomes in prelingually deaf early-implanted long-term CI users.
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http://dx.doi.org/10.1044/2018_JSLHR-H-18-0125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802885PMC
April 2019

Evaluating Pediatric Cochlear Implant Users' Encoding, Storage, and Retrieval Strategies in Verbal Working Memory.

J Speech Lang Hear Res 2019 04;62(4):1016-1032

Indiana University School of Medicine, Indianapolis.

Purpose The current study adopts a systematic approach to the examination of working memory components in pediatric cochlear implant (CI) users by separately assessing contributions of encoding, storage, and retrieval. Method Forty-nine long-term CI users and 56 typically hearing controls completed forward and backward span tasks with 3 stimulus sets: visually presented digits, pictures of concrete nouns, and novel symbols. In addition, measures associated with each memory stage were collected: Rapid digit naming provided an estimate of phonological recoding speed, nonword repetition assessed the robustness of representations within phonological storage, and vocabulary knowledge (as measured by the Peabody Picture Vocabulary Test; Dunn & Dunn, 1997 ) estimated redintegration abilities during retrieval. Results Linear mixed modeling revealed that digit naming speed and vocabulary knowledge were consistently related to short-term and working memory span in both CI users and typically hearing controls. However, nonword repetition only contributed to the model for short-term memory. Conclusions Nonword repetition, an index of phonological storage, explained little of the individual variability inworking memory differences between CI users and typically hearing peers. On the other hand, individual differences in encoding and retrieval explained a significant amount of outcome variability in both short-term and working memory tasks. Differences between CI users and typically hearing peers in working memory therefore appear to reflect process components of encoding and retrieval and not simply differences in memory storage. Supplemental Material https://doi.org/10.23641/asha.7849394.
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http://dx.doi.org/10.1044/2018_JSLHR-H-18-0201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802891PMC
April 2019

High-Variability Sentence Recognition in Long-Term Cochlear Implant Users: Associations With Rapid Phonological Coding and Executive Functioning.

Ear Hear 2019 Sep/Oct;40(5):1149-1161

Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Objectives: The objective of the present study was to determine whether long-term cochlear implant (CI) users would show greater variability in rapid phonological coding skills and greater reliance on slow-effortful compensatory executive functioning (EF) skills than normal-hearing (NH) peers on perceptually challenging high-variability sentence recognition tasks. We tested the following three hypotheses: First, CI users would show lower scores on sentence recognition tests involving high speaker and dialect variability than NH controls, even after adjusting for poorer sentence recognition performance by CI users on a conventional low-variability sentence recognition test. Second, variability in fast-automatic rapid phonological coding skills would be more strongly associated with performance on high-variability sentence recognition tasks for CI users than NH peers. Third, compensatory EF strategies would be more strongly associated with performance on high-variability sentence recognition tasks for CI users than NH peers.

Design: Two groups of children, adolescents, and young adults aged 9 to 29 years participated in this cross-sectional study: 49 long-term CI users (≥7 years) and 56 NH controls. All participants were tested on measures of rapid phonological coding (Children's Test of Nonword Repetition), conventional sentence recognition (Harvard Sentence Recognition Test), and two novel high-variability sentence recognition tests that varied the indexical attributes of speech (Perceptually Robust English Sentence Test Open-set test and Perceptually Robust English Sentence Test Open-set test-Foreign Accented English test). Measures of EF included verbal working memory (WM), spatial WM, controlled cognitive fluency, and inhibition concentration.

Results: CI users scored lower than NH peers on both tests of high-variability sentence recognition even after conventional sentence recognition skills were statistically controlled. Correlations between rapid phonological coding and high-variability sentence recognition scores were stronger for the CI sample than for the NH sample even after basic sentence perception skills were statistically controlled. Scatterplots revealed different ranges and slopes for the relationship between rapid phonological coding skills and high-variability sentence recognition performance in CI users and NH peers. Although no statistically significant correlations between EF strategies and sentence recognition were found in the CI or NH sample after use of a conservative Bonferroni-type correction, medium to high effect sizes for correlations between verbal WM and sentence recognition in the CI sample suggest that further investigation of this relationship is needed.

Conclusions: These findings provide converging support for neurocognitive models that propose two channels for speech-language processing: a fast-automatic channel that predominates whenever possible and a compensatory slow-effortful processing channel that is activated during perceptually-challenging speech processing tasks that are not fully managed by the fast-automatic channel (ease of language understanding, framework for understanding effortful listening, and auditory neurocognitive model). CI users showed significantly poorer performance on measures of high-variability sentence recognition than NH peers, even after simple sentence recognition was controlled. Nonword repetition scores showed almost no overlap between CI and NH samples, and correlations between nonword repetition scores and high-variability sentence recognition were consistent with greater reliance on engagement of fast-automatic phonological coding for high-variability sentence recognition in the CI sample than in the NH sample. Further investigation of the verbal WM-sentence recognition relationship in CI users is recommended. Assessment of fast-automatic phonological processing and slow-effortful EF skills may provide a better understanding of speech perception outcomes in CI users in the clinical setting.
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http://dx.doi.org/10.1097/AUD.0000000000000691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7504907PMC
March 2020

How does aging affect recognition of spectrally degraded speech?

Laryngoscope 2018 11 16;128 Suppl 5. Epub 2018 Oct 16.

Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana.

Objectives/hypothesis: Cochlear implants (CIs) restore auditory sensation to patients with moderate-to-profound sensorineural hearing loss. However, the benefits to speech recognition vary considerably among patients. Advancing age contributes to this variability in postlingual adult CI users. Similarly, older individuals with normal hearing (NH) perform more poorly on tasks of recognition of spectrally degraded speech. The overarching hypothesis of this study was that the detrimental effects of advancing age on speech recognition can be attributed both to declines in auditory spectral resolution as well as declines in cognitive functions.

Study Design: Case-control study.

Methods: Speech recognition was assessed in CI users (in the clear) and NH controls (spectrally degraded using noise-vocoding), along with auditory spectral resolution using the Spectral-Temporally Modulated Ripple Test. Cognitive skills were assessed using nonauditory visual measures of working memory, inhibitory control, speed of lexical/phonological access, nonverbal reasoning, and perceptual closure. Linear regression models were tested for mediation to explain aging effects on speech recognition performance.

Results: For both groups, older age predicted poorer sentence and word recognition. The detrimental effects of advancing age on speech recognition were partially mediated by declines in spectral resolution and in some measures of cognitive function.

Conclusions: Advancing age contributes to poorer recognition of degraded speech for CI users and NH controls through declines in both auditory spectral resolution and cognitive functions. Findings suggest that improvements in spectral resolution as well as cognitive improvements may serve as therapeutic targets to optimize CI speech recognition outcomes.

Level Of Evidence: 3b Laryngoscope, 2018.
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http://dx.doi.org/10.1002/lary.27457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6572764PMC
November 2018

Cognitive Functions in Adult Cochlear Implant Users, Cochlear Implant Candidates, and Normal-Hearing Listeners.

Laryngoscope Investig Otolaryngol 2018 Aug 9;3(4):304-310. Epub 2018 Aug 9.

Department of Otolaryngology-Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio U.S.A.

Objectives: Increasing evidence suggests that hearing loss may be linked to cognitive decline, and that cochlear implantation may lead to improvements in cognition. The goal of this study was to examine the effects of severe-to-profound hearing loss and cochlear implantation in post-lingually deafened adults, compared with age-matched normal-hearing (NH) peers. Participants were tested on several non-auditory measures of cognition: working memory (WM) (digit span, object span, symbol span), non-verbal reasoning (Raven's progressive matrices), information-processing speed and inhibitory control (Stroop test), speed of phonological and lexical access (Test of Word Reading Efficiency), and verbal learning and memory (California Verbal Learning Test). Demographic measures were also collected.

Methods: Cohort study at tertiary neurotology center. Forty-three post-lingually deafened experienced CI users, 19 post-lingually deafened CI candidates, and 40 age-matched NH controls with no cognitive impairment were enrolled. Comparisons among the groups on the cognitive measures were performed.

Results: Adult CI users and CI candidates demonstrated worse (or a trend towards worse) performance as compared with NH peers on non-verbal reasoning, information-processing speed, speed of lexical access, and verbal learning and memory. However, after controlling for gender, socioeconomic status (SES), and vocabulary knowledge among groups, some of these differences were no longer significant. Similarly, large differences were not found in most cognitive abilities between experienced CI users and CI candidates.

Conclusions: Adult CI users, CI candidates, and NH peers generally demonstrated equivalent non-auditory cognitive abilities, after controlling for gender, SES, and vocabulary knowledge. These findings provide support for a link between cognitive decline and hearing loss, but this association may be partly attributable to group differences in SES and vocabulary knowledge.

Level Of Evidence: 2b.
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http://dx.doi.org/10.1002/lio2.172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119791PMC
August 2018

The Role of Statistical Learning in Understanding and Treating Spoken Language Outcomes in Deaf Children With Cochlear Implants.

Lang Speech Hear Serv Sch 2018 08;49(3S):723-739

Department of Psychology, Georgia State University, Atlanta.

Purpose: Statistical learning-the ability to learn patterns in environmental input-is increasingly recognized as a foundational mechanism necessary for the successful acquisition of spoken language. Spoken language is a complex, serially presented signal that contains embedded statistical relations among linguistic units, such as phonemes, morphemes, and words, which represent the phonotactic and syntactic rules of language. In this review article, we first review recent work that demonstrates that, in typical language development, individuals who display better nonlinguistic statistical learning abilities also show better performance on different measures of language. We next review research findings that suggest that children who are deaf and use cochlear implants may have difficulties learning sequential input patterns, possibly due to auditory and/or linguistic deprivation early in development, and that the children who show better sequence learning abilities also display improved spoken language outcomes. Finally, we present recent findings suggesting that it may be possible to improve core statistical learning abilities with specialized training and interventions and that such improvements can potentially impact and facilitate the acquisition and processing of spoken language.

Method: We conducted a literature search through various online databases including PsychINFO and PubMed, as well as including relevant review articles gleaned from the reference sections of other review articles used in this review. Search terms included various combinations of the following: sequential learning, sequence learning, statistical learning, sequence processing, procedural learning, procedural memory, implicit learning, language, computerized training, working memory training, statistical learning training, deaf, deafness, hearing impairment, hearing impaired, DHH, hard of hearing, cochlear implant(s), hearing aid(s), and auditory deprivation. To keep this review concise and clear, we limited inclusion to the foundational and most recent (2005-2018) relevant studies that explicitly included research or theoretical perspectives on statistical or sequential learning. We here summarize and synthesize the most recent and relevant literature to understanding and treating language delays in children using cochlear implants through the lens of statistical learning.

Conclusions: We suggest that understanding how statistical learning contributes to spoken language development is important for understanding some of the difficulties that children who are deaf and use cochlear implants might face and argue that it may be beneficial to develop novel language interventions that focus specifically on improving core foundational statistical learning skills.
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http://dx.doi.org/10.1044/2018_LSHSS-STLT1-17-0138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198910PMC
August 2018

Language processing fluency and verbal working memory in prelingually deaf long-term cochlear implant users: A pilot study.

Cochlear Implants Int 2018 11 5;19(6):312-323. Epub 2018 Jul 5.

b DeVault Otologic Research Laboratory, Department of Otolaryngology-Head and Neck Surgery , Indiana University School of Medicine , Indianapolis , IN , USA.

Objective: Verbal working memory (WM) is more strongly correlated with spoken language skills in prelingually deaf, early-implanted cochlear implant (CI) users than in normal-hearing (NH) peers, suggesting that CI users access WM in order to support and compensate for their slower, more effortful spoken language processing. This pilot study tested the feasibility and validity of a dual-task method for establishing the causal role of WM in basic language processing (lexical access speed) in samples of 9 CI users (ages 8-26 years) and 9 NH peers.

Methods: Participants completed tests of lexical access speed (rapid automatized picture naming test and lexical decision test) under two administration conditions: a standard condition and a dual-task WM condition requiring participants to hold numerals in WM during completion of the lexical access speed tests.

Results: CI users showed more dual-task interference (decline in speed during the WM condition compared to the standard condition) than NH peers, indicating that their lexical access speed was more dependent on engagement of WM resources. Furthermore, dual-task interference scores were significantly correlated with several measures of speed-based executive functioning (EF), consistent with the hypothesis that the dual-task method reflects the involvement of EF in language processing.

Conclusion: These pilot study results support the feasibility and validity of the dual-task WM method for investigating the influence of WM in the basic language processing of CI users. Preliminary findings indicate that CI users are more dependent on the use of WM as a compensatory strategy during slow-effortful basic language processing than NH peers.
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http://dx.doi.org/10.1080/14670100.2018.1493970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247421PMC
November 2018

Verbal learning and memory in prelingually deaf children with cochlear implants.

Int J Audiol 2018 10 22;57(10):746-754. Epub 2018 Jun 22.

b Department of Otolaryngology-Head and Neck Surgery , DeVault Otologic Research Laboratory , Indiana University School of Medicine , Indianapolis , IN , USA.

Objective: Deaf children with cochlear implants (CIs) show poorer verbal working memory compared to normal-hearing (NH) peers, but little is known about their verbal learning and memory (VLM) processes involving multi-trial free recall.

Design: Children with CIs were compared to NH peers using the California Verbal Learning Test for Children (CVLT-C).

Study Sample: Participants were 21 deaf (before age 6 months) children (6-16 years old) implanted prior to age 3 years, and 21 age-IQ matched NH peers.

Results: Results revealed no differences between groups in number of words recalled. However, CI users showed a pattern of increasing use of serial clustering strategies across learning trials, whereas NH peers decreased their use of serial clustering strategies. In the CI sample (but not in the NH sample), verbal working memory test scores were related to resistance to the build-up of proactive interference, and sentence recognition was associated with performance on the first exposure to the word list and to the use of recency recall strategies.

Conclusions: Children with CIs showed robust evidence of VLM comparable to NH peers. However, their VLM processing (especially recency and proactive interference) was related to speech perception outcomes and verbal WM in different ways from NH peers.
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http://dx.doi.org/10.1080/14992027.2018.1481538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215502PMC
October 2018

Three challenges for future research on cochlear implants.

World J Otorhinolaryngol Head Neck Surg 2017 Dec 2;3(4):240-254. Epub 2018 Jan 2.

Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43212, USA.

Cochlear implants (CIs) often work very well for many children and adults with profound sensorineural (SNHL) hearing loss. Unfortunately, while many CI patients display substantial benefits in recognizing speech and understanding spoken language following cochlear implantation, a large number of patients achieve poor outcomes. Understanding and explaining the reasons for poor outcomes following implantation is a very challenging research problem that has received little attention despite the pressing clinical significance. In this paper, we discuss three challenges for future research on CIs. First, we consider the issue of individual differences and variability in outcomes following implantation. At the present time, we still do not have a complete and satisfactory account of the causal underlying factors that are responsible for the enormous individual differences and variability in outcomes. Second, we discuss issues related to the lack of preimplant predictors of outcomes. Very little prospective research has been carried out on the development of preimplant predictors that can be used to reliably identify CI candidates who may be at high risk for a poor outcome following implantation. Other than conventional demographics and hearing history, there are no prognostic tools available to predict speech recognition outcomes after implantation. Finally, we discuss the third challenge - what to do with a CI-user who has a poor outcome. We suggest that new research efforts need to be devoted to studying this neglected clinical population in greater depth to find out why they are doing poorly with their CI and what novel interventions and treatments can be developed to improve their speech recognition outcomes. Using these three challenges as objectives for future research on CIs, we suggest that the field needs to adopt a new narrative grounded in theory and methods from Cognitive Hearing Science and information processing theory. Without knowing which specific biological and neurocognitive factors are responsible for individual differences or understanding the underlying sensory and neurocognitive basis for variability in performance, it is impossible to select a specific approach to habilitation after a deaf adult or child receives a CI. Deaf adults and children who are performing poorly with their CIs are not a homogeneous group and may differ in many different ways from each other, reflecting the dysfunction of multiple brain systems associated with both congenital and acquired deafness. Hearing loss is not only an ear issue, it is also a brain issue too reflecting close links between perception and action and brain, body and world working together as a functionally integrated information processing system to support robust speech recognition and spoken language processing after implantation.
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http://dx.doi.org/10.1016/j.wjorl.2017.12.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5956139PMC
December 2017

Visual working memory span in adults with cochlear implants: Some preliminary findings.

World J Otorhinolaryngol Head Neck Surg 2017 Dec 12;3(4):224-230. Epub 2018 Jan 12.

Department of Otorhinolaryngology, The Ohio State University Wexner Medical Center, OH 43212, USA.

Objective: Neurocognitive functions, specifically verbal working memory (WM), contribute to speech recognition in postlingual adults with cochlear implants (CIs) and normal-hearing (NH) listener shearing degraded speech. Three hypotheses were tested: (1) WM accuracy as assessed using three visual span measures - digits, objects, and symbols - would correlate with recognition scores for spectrally degraded speech (through a CI or when noise-vocoded); (2) WM accuracy would be best for digit span, intermediate for object span, and lowest for symbol span, due to the increasing cognitive demands across these tasks. Likewise, response times, relating to processing demands, would be shortest for digit span, intermediate for object span, and longest for symbol span; (3) CI users would demonstrate poorer and slower performance than NH peers on WM tasks, as a result of less efficient verbally mediated encoding strategies associated with a period of prolonged auditory deprivation.

Methods: Cross-sectional study of 30 postlingually deaf adults with CIs and 34 NH controls. Participants were tested for sentence recognition in quiet (CI users) or after noise-vocoding (NH peers), along with WM using visual measures of digit span, object span, and symbol span.

Results: Of the three measures of WM, digit span scores alone correlated with sentence recognition for CI users; no correlations were found using these three measures for NH peers. As predicted, WM accuracy (and response times) were best (and fastest) for digit span, intermediate for object span, and worst (and slowest) for symbol span. CI users and NH peers demonstrated equivalent WM accuracy and response time for digit span and object span, and similar response times for symbol span, but contrary to our original predictions, CI users demonstrated better accuracy on symbol span than NH peers.

Conclusions: Verbal WM assessed using visual tasks relates weakly to sentence recognition for degraded speech. CI users performed equivalently to NH peers on most visual tasks of WM, but they outperformed NH peers on symbol span accuracy. This finding deserves further exploration but may suggest that CI users develop alternative or compensatory strategies associated with rapid verbal coding, as a result of their prolonged experience of auditory deprivation.
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http://dx.doi.org/10.1016/j.wjorl.2017.12.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5956138PMC
December 2017

Performance variability on perceptual discrimination tasks in profoundly deaf adults with cochlear implants.

J Commun Disord 2018 Mar - Apr;72:122-135. Epub 2018 Jan 31.

The University of Alabama, Information Systems, Statistics, Management Sciences, United States.

Objectives: The purpose of this study was to evaluate performance on two challenging listening tasks, talker and regional accent discrimination, and to assess variables that could have affected the outcomes.

Study Design: A prospective study using 35 adults with one cochlear implant (CI) or a CI and a contralateral hearing aid (bimodal hearing) was conducted. Adults completed talker and regional accent discrimination tasks.

Methods: Two-alternative forced-choice tasks were used to assess talker and accent discrimination in a group of adults who ranged in age from 30 years old to 81 years old.

Results: A large amount of performance variability was observed across listeners for both discrimination tasks. Three listeners successfully discriminated between talkers for both listening tasks, 14 participants successfully completed one discrimination task and 18 participants were not able to discriminate between talkers for either listening task. Some adults who used bimodal hearing benefitted from the addition of acoustic cues provided through a HA but for others the HA did not help with discrimination abilities. Acoustic speech feature analysis of the test signals indicated that both the talker speaking rate and the fundamental frequency (F0) helped with talker discrimination. For accent discrimination, findings suggested that access to more salient spectral cues was important for better discrimination performance.

Conclusions: The ability to perform challenging discrimination tasks successfully likely involves a number of complex interactions between auditory and non-auditory pre- and post-implant factors. To understand why some adults with CIs perform similarly to adults with normal hearing and others experience difficulty discriminating between talkers, further research will be required with larger populations of adults who use unilateral CIs, bilateral CIs and bimodal hearing.
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http://dx.doi.org/10.1016/j.jcomdis.2018.01.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5860985PMC
April 2019

"Product" Versus "Process" Measures in Assessing Speech Recognition Outcomes in Adults With Cochlear Implants.

Otol Neurotol 2018 03;39(3):e195-e202

Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, DeVault Otologic Research Laboratory, Indianapolis.

Hypotheses: 1) When controlling for age in postlingual adult cochlear implant (CI) users, information-processing functions, as assessed using "process" measures of working memory capacity, inhibitory control, information-processing speed, and fluid reasoning, will predict traditional "product" outcome measures of speech recognition. 2) Demographic/audiologic factors, particularly duration of deafness, duration of CI use, degree of residual hearing, and socioeconomic status, will impact performance on underlying information-processing functions, as assessed using process measures.

Background: Clinicians and researchers rely heavily on endpoint product measures of accuracy in speech recognition to gauge patient outcomes postoperatively. However, these measures are primarily descriptive and were not designed to assess the underlying core information-processing operations that are used during speech recognition. In contrast, process measures reflect the integrity of elementary core subprocesses that are operative during behavioral tests using complex speech signals.

Methods: Forty-two experienced adult CI users were tested using three product measures of speech recognition, along with four process measures of working memory capacity, inhibitory control, speed of lexical/phonological access, and nonverbal fluid reasoning. Demographic and audiologic factors were also assessed.

Results: Scores on product measures were associated with core process measures of speed of lexical/phonological access and nonverbal fluid reasoning. After controlling for participant age, demographic and audiologic factors did not correlate with process measure scores.

Conclusion: Findings provide support for the important foundational roles of information processing operations in speech recognition outcomes of postlingually deaf patients who have received CIs.
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http://dx.doi.org/10.1097/MAO.0000000000001694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807136PMC
March 2018

Verbal Learning and Memory After Cochlear Implantation in Postlingually Deaf Adults: Some New Findings with the CVLT-II.

Ear Hear 2018 Jul/Aug;39(4):720-745

Department of Otolaryngology, The Ohio State University, Columbus, Ohio, USA.

Objectives: Despite the importance of verbal learning and memory in speech and language processing, this domain of cognitive functioning has been virtually ignored in clinical studies of hearing loss and cochlear implants in both adults and children. In this article, we report the results of two studies that used a newly developed visually based version of the California Verbal Learning Test-Second Edition (CVLT-II), a well-known normed neuropsychological measure of verbal learning and memory.

Design: The first study established the validity and feasibility of a computer-controlled visual version of the CVLT-II, which eliminates the effects of audibility of spoken stimuli, in groups of young normal-hearing and older normal-hearing (ONH) adults. A second study was then carried out using the visual CVLT-II format with a group of older postlingually deaf experienced cochlear implant (ECI) users (N = 25) and a group of ONH controls (N = 25) who were matched to ECI users for age, socioeconomic status, and nonverbal IQ. In addition to the visual CVLT-II, subjects provided data on demographics, hearing history, nonverbal IQ, reading fluency, vocabulary, and short-term memory span for visually presented digits. ECI participants were also tested for speech recognition in quiet.

Results: The ECI and ONH groups did not differ on most measures of verbal learning and memory obtained with the visual CVLT-II, but deficits were identified in ECI participants that were related to recency recall, the buildup of proactive interference, and retrieval-induced forgetting. Within the ECI group, nonverbal fluid IQ, reading fluency, and resistance to the buildup of proactive interference from the CVLT-II consistently predicted better speech recognition outcomes.

Conclusions: Results from this study suggest that several underlying foundational neurocognitive abilities are related to core speech perception outcomes after implantation in older adults. Implications of these findings for explaining individual differences and variability and predicting speech recognition outcomes after implantation are discussed.
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http://dx.doi.org/10.1097/AUD.0000000000000530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6013309PMC
March 2019
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