The Role of Early Intact Auditory Experience on the Perception of Spoken Emotions, Comparing Prelingual to Postlingual Cochlear Implant Users.

OBJECTIVES: Cochlear implants (CI) are remarkably effective, but have limitations regarding the transformation of the spectro-temporal fine structures of speech. This may impair processing of spoken emotions, which involves the identification and integration of semantic and prosodic cues. Our previous study found spoken-emotions-processing differences between CI users with postlingual deafness (postlingual CI) and normal hearing (NH) matched controls (age range, 19 to 65 years). Postlingual CI users over-relied on semantic information in incongruent trials (prosody and semantics present different emotions), but rated congruent trials (same emotion) similarly to controls. Postlingual CI's intact early auditory experience may explain this pattern of results. The present study examined whether CI users without intact early auditory experience (prelingual CI) would generally perform worse on spoken emotion processing than NH and postlingual CI users, and whether CI use would affect prosodic processing in both CI groups. First, we compared prelingual CI users with their NH controls. Second, we compared the results of the present study to our previous study (Taitlebaum-Swead et al. 2022; postlingual CI). DESIGN: Fifteen prelingual CI users and 15 NH controls (age range, 18 to 31 years) listened to spoken sentences composed of different combinations (congruent and incongruent) of three discrete emotions (anger, happiness, sadness) and neutrality (performance baseline), presented in prosodic and semantic channels (Test for Rating of Emotions in Speech paradigm). Listeners were asked to rate (six-point scale) the extent to which each of the predefined emotions was conveyed by the sentence as a whole (integration of prosody and semantics), or to focus only on one channel (rating the target emotion [RTE]) and ignore the other (selective attention). In addition, all participants performed standard tests of speech perception. Performance on the Test for Rating of Emotions in Speech was compared with the previous study (postlingual CI). RESULTS: When asked to focus on one channel, semantics or prosody, both CI groups showed a decrease in prosodic RTE (compared with controls), but only the prelingual CI group showed a decrease in semantic RTE. When the task called for channel integration, both groups of CI users used semantic emotional information to a greater extent than their NH controls. Both groups of CI users rated sentences that did not present the target emotion higher than their NH controls, indicating some degree of confusion. However, only the prelingual CI group rated congruent sentences lower than their NH controls, suggesting reduced accumulation of information across channels. For prelingual CI users, individual differences in identification of monosyllabic words were significantly related to semantic identification and semantic-prosodic integration. CONCLUSIONS: Taken together with our previous study, we found that the degradation of acoustic information by the CI impairs the processing of prosodic emotions, in both CI user groups. This distortion appears to lead CI users to over-rely on the semantic information when asked to integrate across channels. Early intact auditory exposure among CI users was found to be necessary for the effective identification of semantic emotions, as well as the accumulation of emotional information across the two channels. Results suggest that interventions for spoken-emotion processing should not ignore the onset of hearing loss.

Speech perception following transcranial direct current stimulation (tDCS) over left superior temporal gyrus (STG) (including Wernicke's area) versus inferior frontal gyrus (IFG) (including Broca's area).

Imaging and neurocognitive studies have searched for the brain areas involved in speech perception, specifically when speech is accompanied by noise, attempting to identify the underlying neural mechanism(s). Transcranial direct current stimulation (tDCS), a noninvasive, painless cortical neuromodulation technique, has been used to either excite or inhibit brain activity in order to better understand the neural mechanism underlying speech perception in noise. In the present study, anodal (excitatory) and cathodal (inhibitory) stimulations were performed on 48 participants, either over the left Inferior Frontal Gyrus (IFG), which includes Broca's area (n = 10 anodal, and n = 10 cathodal) or over the left Superior Temporal Gyrus (STG), which includes Wernicke's area (n = 13 anodal, n = 15 cathodal). Speech perception was measured using a sentence recognition task accompanied by white noise with a signal-to-noise ratio of -10 dB. Speech perception performance was measured four times: at baseline, after each of the two sessions of stimulation (one active and one sham session, the order of which was randomized between participants), and at a two-week follow-up session. Groups receiving anodal and cathodal stimulation over the left IFG did not show an effect of stimulation type. For groups receiving left STG stimulation, anodal stimulation resulted in higher scores, regardless of whether it was given before or after sham stimulation. However, cathodal stimulation showed an effect only when active stimulation was applied following sham stimulation. These results showed that tDCS had a direct effect on improving speech perception only over left STG. Furthermore, while anodal stimulation was effective in whatever order it was given, cathodal stimulation was effective only following sham stimulation, thereby allowing some amount of training. These findings carry both theoretical and clinical implications for the relationship between the DMN's left IFG and left STG areas during speech perception accompanied by background noise.

Hebrew Digits in Noise (DIN) Test in Cochlear Implant Users and Normal Hearing Listeners.

This study aimed to compare the Hebrew version of the digits-in-noise (DIN) thresholds among cochlear implant (CI) users and their normal-hearing (NH) counterparts, explore the influence of age on these thresholds, examine the effects of early auditory exposure versus its absence on DIN threshold, and assess the correlation between DIN thresholds and other speech perception tests. A total of 13 children with CI (aged 5.5-11 years), 15 pre-lingual CI users (aged 14-30 years), and 15 post-lingual CI users (aged 22-77 years), and their age-matched NH controls (n = 45) participated in the study. Speech perception tasks, including the DIN test, one-syllable word test, and sentence identification tasks in various auditory conditions, served as the main outcome measures. The results indicated that CI users exhibited higher speech reception thresholds in noise across all age groups compared to NH peers, with no significant difference between pre-lingual and post-lingual CI users. Significant differences were also observed in monosyllabic word and sentence accuracy in both quiet and noise conditions between CI and NH groups. Furthermore, correlations were observed between the DIN and other speech perception tests. The study concludes that CI users require a notably higher signal-to-noise ratio to discern digits in noise, underscoring the DIN test's utility in assessing speech recognition capabilities in CI users while emphasizing the need for a comprehensive test battery to fully gauge their speech perception abilities.

Assessment of Interaural Attenuation in Infants and Young Children Using Bone-Conducted Auditory Brainstem Response.

OBJECTIVES: In hearing assessment, the term interaural attenuation (IAA) is used to quantify the reduction in test signal intensity as it crosses from the side of the test ear to the nontest ear. In the auditory brainstem response (ABR) testing of infants and young children, the size of the IAA of bone-conducted (BC) stimuli is essential for the appropriate use of masking, which is needed for the accurate measurement of BC ABR thresholds. This study aimed to assess the IAA for BC ABR testing using 0.5 to 4 kHz narrowband (NB) CE-chirp LS stimuli in infants and toddlers with normal hearing from birth to three years of age and to examine the effects of age and frequency on IAA. DESIGN: A total of 55 infants and toddlers with normal hearing participated in the study. They were categorized into three age groups: the young group (n = 31, infants from birth to 3 mo), middle-aged group (n = 13, infants aged 3-12 mo), and older group (n = 11, toddlers aged 12-36 mo). The participants underwent BC ABR threshold measurements for NB CE-chirp LS stimuli at 0.5 to 4 kHz. For each participant, one ear was randomly defined as the "test ear" and the other as the "nontest ear." BC ABR thresholds were measured under two conditions. In both conditions, traces were recorded from the channel ipsilateral to the test ear, whereas masking was delivered to the nontest ear. In condition A, the bone oscillator was placed on the mastoid of the test ear, whereas in condition B, the bone oscillator was placed on the mastoid contralateral to the test ear. The difference between the thresholds obtained under conditions A and B was calculated to assess IAA. RESULTS: The means of IAA (and range) in the young age group for the frequencies 0.5, 1, 2, and 4 kHz were 5.38 (0-15) dB, 11.67 (0-30) dB, 21.15 (10-40) dB, and 23.53 (15-35) dB, respectively. Significant effects were observed for both age and frequency on BC IAA. BC IAA levels decreased with age from birth to 36 mo. In all age groups, smaller values were observed at lower frequencies and increased values were observed at higher frequencies. CONCLUSIONS: BC IAA levels were both age and frequency dependent. The study found that the BC IAA values for lower stimulus frequencies were smaller than previously assumed, even in infants younger than 3 mo. These results suggest that masking should be applied in BC ABR threshold assessments for NB CE-chirp LS stimuli at 0.5, 1, and 2 kHz, even in young infants. Masking may not be necessary for testing at 4 kHz if a clear response is obtained at 15 dB normal-hearing level (nHL) in infants younger than 3 mo.

Speech recognition in noise task among children and young-adults: a pupillometry study.

Introduction: Children experience unique challenges when listening to speech in noisy environments. The present study used pupillometry, an established method for quantifying listening and cognitive effort, to detect temporal changes in pupil dilation during a speech-recognition-in-noise task among school-aged children and young adults. Methods: Thirty school-aged children and 31 young adults listened to sentences amidst four-talker babble noise in two signal-to-noise ratios (SNR) conditions: high accuracy condition (+10 dB and + 6 dB, for children and adults, respectively) and low accuracy condition (+5 dB and + 2 dB, for children and adults, respectively). They were asked to repeat the sentences while pupil size was measured continuously during the task. Results: During the auditory processing phase, both groups displayed pupil dilation; however, adults exhibited greater dilation than children, particularly in the low accuracy condition. In the second phase (retention), only children demonstrated increased pupil dilation, whereas adults consistently exhibited a decrease in pupil size. Additionally, the children's group showed increased pupil dilation during the response phase. Discussion: Although adults and school-aged children produce similar behavioural scores, group differences in dilation patterns point that their underlying auditory processing differs. A second peak of pupil dilation among the children suggests that their cognitive effort during speech recognition in noise lasts longer than in adults, continuing past the first auditory processing peak dilation. These findings support effortful listening among children and highlight the need to identify and alleviate listening difficulties in school-aged children, to provide proper intervention strategies.

Is COVID-19 to Blame for Sensorineural Hearing Deterioration? A Pre/Post COVID-19 Hearing Evaluation Study.

OBJECTIVES: Here, we aimed to (a) determine whether a clinically significant sensorineural hearing loss (SNHL) change could be detected in post-coronavirus disease (COVID-19) hearing levels on comparing them with pre-infection hearing levels after controlling for the effect of age and (b) to identify risk factors, such as hypertension, diabetes, and smoking, which increase the likelihood of hearing loss in COVID-19 patients. METHODS: We retrospectively analyzed hearing thresholds in unvaccinated patient's pre- and post-COVID-19 infection. Thresholds were controlled for age and the duration between the pre- and post-COVID-19 hearing evaluations. Correlations between additional COVID-19-related symptoms, hypertension, diabetes, and smoking and hearing threshold changes were analyzed. RESULTS: A significant (but not clinical) threshold elevation was found post-COVID-19 infection. However, on controlling for age and the duration between the pre- and post-COVID-19 hearing evaluations, no significant threshold elevation was found. No significant correlation was found between hearing threshold changes and additional COVID-19-related symptoms, hypertension, diabetes, or smoking. CONCLUSION: COVID-19 did not lead to a significant hearing threshold elevation in our cohort, even among patients with additional COVID-19 symptoms, hypertension, or diabetes mellitus or among those who smoked. LEVEL OF EVIDENCE: 3: nonrandomized controlled cohort, follow-up study Laryngoscope, 133:1976-1981, 2023.

The Effect of Age, Type of Noise, and Cochlear Implants on Adaptive Sentence-in-Noise Task.

Adaptive tests of sentences in noise mimic the challenge of daily listening situations. The aims of the present study were to validate an adaptive version of the HeBio sentence test on normal hearing (NH) adults; to evaluate the effect of age and type of noise on speech reception threshold in noise (SRTn); and to test it on prelingual adults with cochlear implants (CI). In Experiment 1, 45 NH young adults listened to two lists accompanied by four-talker babble noise (4TBN). Experiment 2 presented the sentences amidst 4TBN or speech-shaped noise (SSN) to 80 participants in four age groups. In Experiment 3, 18 CI adult users with prelingual bilateral profound hearing loss performed the test amidst SSN, along with HeBio sentences and monosyllabic words in quiet and forward digits span. The main findings were as follows: SRTn for NH participants was normally distributed and had high test-retest reliability; SRTn was lower among adolescents and young adults than middle-aged and older adults, and were better for SSN than 4TBN; SRTn for CI users was higher and more variant than for NH and correlated with speech perception tests in quiet, digits span, and age at first CI. This suggests that the adaptive HeBio can be implemented in clinical and research settings with various populations.

Music Therapy Intervention in an Open Bay Neonatal Intensive Care Unit Room Is Associated with Less Noise and Higher Signal to Noise Ratios: A Case-Control Study.

BACKGROUND: Noise reduction in the Neonatal Intensive Care Unit (NICU) is important for neurodevelopment, but the impact of music therapy on noise is not yet known. OBJECTIVE: To investigate the effect of music therapy (MT) on noise levels, and whether individual MT (IMT) or environmental MT (EMT) increases meaningful signal-to-noise ratios (SNR). STUDY DESIGN: This case-control study was conducted in a level III NICU. Noise levels were recorded simultaneously from two open bay rooms, with a maximum of 10 infants in each room: one with MT and the other without. MT sessions were carried out for approximately 45 min with either IMT or EMT, implemented according to the Rhythm Breath and Lullaby principles. Noise production data were recorded for 4 h on 26 occasions of EMT and IMT, and analyzed using R version 4.0.2 software. RESULTS: Overall average equivalent continuous noise levels (Leq) were lower in the room with MT as compared to the room without MT (53.1 (3.6) vs. 61.4 (4.7) dBA, p = 0.02, d = 2.1 (CI, 0.82, 3.42). IMT was associated with lower overall Leq levels as compared to EMT (51.2 vs. 56.5 dBA, p = 0.04, d = 1.6 (CI, 0.53, 1.97). The lowest sound levels with MT occurred approximately 60 min after the MT started (46 ± 3.9 dBA), with a gradual increase during the remaining recording time, but still significantly lower compared to the room without MT. The SNR was higher (18.1 vs. 10.3 dBA, p = 0.01, d = 2.8 (CI, 1.3, 3.86)) in the room with MT than in the room without MT. CONCLUSION: Integrating MT modalities such as IMT and EMT in an open bay NICU room helps reduce noise. Both MT modalities resulted in higher SNR compared to the control room, which may indicate that they are meaningful for the neurodevelopment of preterm infants.

AzBio Sentence test in Hebrew (HeBio): development, preliminary validation, and the effect of noise.

The AzBio sentence test is widely used to assess speech perception pre- and post-cochlear implantation. This study created and validated a Hebrew version of AzBio (HeBio) and tested its intelligibility amidst background noise.In Experiment 1, 1,000 recorded Hebrew sentences were presented via five-channel vocoder to 10 normal hearing (NH) listeners for intelligibility testing. In Experiment 2, HeBio lists were presented to 25 post-lingual cochlear implant (CI) users amidst four-talker babble noise (4TBN) or in quiet, along with one-syllable word test. In Experiment 3, 20 NH listeners were presented with eight HeBio lists in two noise conditions [4TBN, speech shaped noise (SSN)] and four SNRs (+3, 0 dB, -3 dB, -6 dB).HeBio lists (33) produced 82% average understanding, no inter-list intelligibility differences among NH, and equal intelligibility for CI users. One-syllable words predicted 67% of the variance in HeBio among CI users. Higher intelligibility was found for SSN than for 4TBN, and the mean speech receptive threshold (SRT) was more negative for SSN than for 4TBN.HeBio results were similar to AzBio. Results obtained with two noise types were as expected. HeBio is recommended for evaluation of different populations in quiet and noise.

More Than Words: the Relative Roles of Prosody and Semantics in the Perception of Emotions in Spoken Language by Postlingual Cochlear Implant Users.

OBJECTIVES: The processing of emotional speech calls for the perception and integration of semantic and prosodic cues. Although cochlear implants allow for significant auditory improvements, they are limited in the transmission of spectro-temporal fine-structure information that may not support the processing of voice pitch cues. The goal of the current study is to compare the performance of postlingual cochlear implant (CI) users and a matched control group on perception, selective attention, and integration of emotional semantics and prosody. DESIGN: Fifteen CI users and 15 normal hearing (NH) peers (age range, 18-65 years) 1istened to spoken sentences composed of different combinations of four discrete emotions (anger, happiness, sadness, and neutrality) presented in prosodic and semantic channels-T-RES: Test for Rating Emotions in Speech. In three separate tasks, listeners were asked to attend to the sentence as a whole, thus integrating both speech channels (integration), or to focus on one channel only (rating of target emotion) and ignore the other (selective attention). Their task was to rate how much they agreed that the sentence conveyed each of the predefined emotions. In addition, all participants performed standard tests of speech perception. RESULTS: When asked to focus on one channel, semantics or prosody, both groups rated emotions similarly with comparable levels of selective attention. When the task was called for channel integration, group differences were found. CI users appeared to use semantic emotional information more than did their NH peers. CI users assigned higher ratings than did their NH peers to sentences that did not present the target emotion, indicating some degree of confusion. In addition, for CI users, individual differences in speech comprehension over the phone and identification of intonation were significantly related to emotional semantic and prosodic ratings, respectively. CONCLUSIONS: CI users and NH controls did not differ in perception of prosodic and semantic emotions and in auditory selective attention. However, when the task called for integration of prosody and semantics, CI users overused the semantic information (as compared with NH). We suggest that as CI users adopt diverse cue weighting strategies with device experience, their weighting of prosody and semantics differs from those used by NH. Finally, CI users may benefit from rehabilitation strategies that strengthen perception of prosodic information to better understand emotional speech.

Production Improves Visual and Auditory Text Memory in Younger and Older Adults.

INTRODUCTION: The production effect refers to memory benefits for materials that were produced (e.g., read aloud) relative to not produced (e.g., read silently) at study. Previous works have found a production benefit for younger and older adults studying written words and for young adults studying written text. The present study aimed to extend these findings by examining the effect of production on text memory in younger and older adults, in the visual, and in the auditory modalities. METHODS: A group of young adults (n = 30) and a group of older adults (n = 30) learned informational texts, presented either visually or aurally. In each text, half of the sentences were learned by production (reading aloud or writing) and half by no production (reading silently or listening), followed by fill-in-the-blank tests. RESULTS: An overall memory performance was found to be similar for both groups, with an advantage for the auditory modality. For both groups, more test items were filled in correctly when the relevant information appeared in the produced than in nonproduced sentences, showing the learners' ability to use distinctiveness information. The production effects were larger for older than younger adults, in both modalities. DISCUSSION: Since older adults are increasingly engage in learning, it is important to develop high-quality structured learning programs for this population. The current results demonstrate the preserved ability of older adults to successfully memorize texts and may guide planning of such programs. Specifically, since learning via the auditory modality yields superior performance for learners across age-groups, it may be recommended for text learning. Because older adults showed larger benefits from active production of the study material, it may be used to better remember educationally relevant material.

Visual and Auditory Verbal Memory in Older Adults: Comparing Postlingually Deaf Cochlear Implant Users to Normal-Hearing Controls.

Purpose The aim of this study was to test whether a group of older postlingually deafened cochlear implant users (OCIs) use similar verbal memory strategies to those used by older normal-hearing adults (ONHs). Verbal memory functioning was assessed in the visual and auditory modalities separately, enabling us to eliminate possible modality-based biases. Method Participants performed two separate visual and auditory verbal memory tasks. In each task, the visually or aurally presented study words were learned by vocal production (saying aloud) or by no production (reading silently or listening), followed by a free recall test. Twenty-seven older adults (> 60 years) participated (OCI = 13, ONH = 14), all of whom demonstrated intact cognitive abilities. All OCIs showed good open-set speech perception results in quiet. Results Both ONHs and OCIs showed production benefits (higher recall rates for vocalized than nonvocalized words) in the visual and auditory tasks. The ONHs showed similar production benefits in the visual and auditory tasks. The OCIs demonstrated a smaller production effect in the auditory task. Conclusions These results may indicate that different modality-specific memory strategies were used by the ONHs and the OCIs. The group differences in memory performance suggest that, even when deafness occurs after the completion of language acquisition, the reduced and distorted external auditory stimulation leads to a deterioration in the phonological representation of sounds. Possibly, this deterioration leads to a less efficient auditory long-term verbal memory.

Auditory Training to Improve Speech Perception and Self-Efficacy in Aging Adults.

Purpose Difficulty in understanding spoken speech is a common complaint among aging adults, even when hearing impairment is absent. Correlational studies point to a relationship between age, auditory temporal processing (ATP), and speech perception but cannot demonstrate causality unlike training studies. In the current study, we test (a) the causal relationship between a spatial-temporal ATP task (temporal order judgment [TOJ]) and speech perception among aging adults using a training design and (b) whether improvement in aging adult speech perception is accompanied by improved self-efficacy. Method Eighty-two participants aged 60-83 years were randomly assigned to a group receiving (a) ATP training (TOJ) over 14 days, (b) non-ATP training (intensity discrimination) over 14 days, or (c) no training. Results The data showed that TOJ training elicited improvement in all speech perception tests, which was accompanied by increased self-efficacy. Neither improvement in speech perception nor self-efficacy was evident following non-ATP training or no training. Conclusions There was no generalization of the improvement resulting from TOJ training to intensity discrimination or generalization of improvement resulting from intensity discrimination training to speech perception. These findings imply that the effect of TOJ training on speech perception is specific and such improvement is not simply the product of generally improved auditory perception. It provides support for the idea that temporal properties of speech are indeed crucial for speech perception. Clinically, the findings suggest that aging adults can be trained to improve their speech perception, specifically through computer-based auditory training, and this may improve perceived self-efficacy.

Listening Effort Among Adults With and Without Attention-Deficit/Hyperactivity Disorder.

Purpose Few studies have assessed listening effort (LE)-the cognitive resources required to perceive speech-among populations with intact hearing but reduced availability of cognitive resources. Attention/deficit/hyperactivity disorder (ADHD) is theorized to restrict attention span, possibly making speech perception in adverse conditions more challenging. This study examined the effect of ADHD on LE among adults using a behavioral dual-task paradigm (DTP). Method Thirty-nine normal-hearing adults (aged 21-27 years) participated: 19 with ADHD (ADHD group) and 20 without ADHD (control group). Baseline group differences were measured in visual and auditory attention as well as speech perception. LE using DTP was assessed as the performance difference on a visual-motor task versus a simultaneous auditory and visual-motor task. Results Group differences in attention were confirmed by differences in visual attention (larger reaction times between congruent and incongruent conditions) and auditory attention (lower accuracy in the presence of distractors) among the ADHD group, compared to the controls. LE was greater among the ADHD group than the control group. Nevertheless, no group differences were found in speech perception. Conclusions LE is increased among those with ADHD. As a DTP assumes limited cognitive capacity to allocate attentional resources, LE among those with ADHD may be increased because higher level cognitive processes are more taxed in this population. Studies on LE using a DTP should take into consideration mechanisms of selective and divided attention. Among young adults who need to continuously process great volumes of auditory and visual information, much more effort may be expended by those with ADHD than those without it. As a result, those with ADHD may be more prone to fatigue and irritability, similar to those who are engaged in more outwardly demanding tasks.

The effect of delayed auditory feedback (DAF) and frequency altered feedback (FAF) on speech production: cochlear implanted versus normal hearing individuals.

Normal auditory feedback contributes to moment-to-moment control of speech production. Effects of auditory feedback's absence on hearing-impaired individuals are widely documented, but auditory perturbation has not been investigated. Our objective was to evaluate the effect of delayed auditory feedback (DAF) and frequency altered feedback (FAF) on speech production among prelingual cochlear implant (CI) users and normal hearing (NH) individuals, to evaluate CI users' reliance on auditory feedback. Twenty young adults (10 CI, 10 NH), without developmental and cognitive impairments, participated in the study. Under variable auditory feedback conditions, speech production (spontaneous or reading aloud) was measured using speech rate, percentage of interruptions, fundamental frequency (F0), and relative intensity. Results showed that (1) both DAF and FAF caused slower speech rates and more interruptions while reading aloud, with DAF having larger effect; (2) altered feedback produced no differences between groups, except an increase in F0 for CI users during DAF; and (3) CI users' ability to understand speech via phone and without lip-reading was positively correlated with performance under DAF. These findings suggest that auditory perturbation similarly affects speech production among prelingual CI users and NH individuals, indicating CI users depend on auditory feedback to the same degree as normal hearing individuals.

Auditory temporal processing, reading, and phonological awareness among aging adults.

Auditory temporal processing (ATP) has been related in the literature to both speech perception as well as reading and phonological awareness. In aging adults, it is known to be related to difficulties in speech perception. In the present study, we aimed to test whether an age-related deficit in ATP would also be accompanied by poor reading and phonological awareness. Thirty-eight aging adults were compared to 55 readers with dyslexia and 42 young normal readers on temporal order judgment (TOJ), speech perception, reading, and phonological awareness tests. Aging adults had longer TOJ thresholds than young normal readers, but shorter than readers with dyslexia; however, they had lower speech perception accuracy than both groups. Phonological awareness of the aging adults was better than readers with dyslexia, but poorer than young normal readers, although their reading accuracy was similar to that of the young controls. This is the first report on poor phonological awareness among aging adults. Suprisingly, it was not accompanied by difficulties in reading ability, and might instead be related to aging adults' difficulties in speech perception. This newly discovered relationship between ATP and phonological awareness among aging adults appears to extend the existing understanding of this relationship, and suggests it should be explored in other groups with ATP deficits.

The Effect of Learning Modality and Auditory Feedback on Word Memory: Cochlear-Implanted versus Normal-Hearing Adults.

BACKGROUND: In recent years, the effect of cognitive abilities on the achievements of cochlear implant (CI) users has been evaluated. Some studies have suggested that gaps between CI users and normal-hearing (NH) peers in cognitive tasks are modality specific, and occur only in auditory tasks. PURPOSE: The present study focused on the effect of learning modality (auditory, visual) and auditory feedback on word memory in young adults who were prelingually deafened and received CIs before the age of 5 yr, and their NH peers. RESEARCH DESIGN: A production effect (PE) paradigm was used, in which participants learned familiar study words by vocal production (saying aloud) or by no-production (silent reading or listening). Words were presented (1) in the visual modality (written) and (2) in the auditory modality (heard). CI users performed the visual condition twice-once with the implant ON and once with it OFF. All conditions were followed by free recall tests. STUDY SAMPLE: Twelve young adults, long-term CI users, implanted between ages 1.7 and 4.5 yr, and who showed ≥50% in monosyllabic consonant-vowel-consonant open-set test with their implants were enrolled. A group of 14 age-matched NH young adults served as the comparison group. DATA COLLECTION AND ANALYSIS: For each condition, we calculated the proportion of study words recalled. Mixed-measures analysis of variances were carried out with group (NH, CI) as a between-subjects variable, and learning condition (aloud or silent reading) as a within-subject variable. Following this, paired sample t tests were used to evaluate the PE size (differences between aloud and silent words) and overall recall ratios (aloud and silent words combined) in each of the learning conditions. RESULTS: With visual word presentation, young adults with CIs (regardless of implant status CI-ON or CI-OFF), showed comparable memory performance (and a similar PE) to NH peers. However, with auditory presentation, young adults with CIs showed poorer memory for nonproduced words (hence a larger PE) relative to their NH peers. CONCLUSIONS: The results support the construct that young adults with CIs will benefit more from learning via the visual modality (reading), rather than the auditory modality (listening). Importantly, vocal production can largely improve auditory word memory, especially for the CI group.

Audio-visual speech perception in noise: Implanted children and young adults versus normal hearing peers.

OBJECTIVE: The purpose of the current study was to evaluate auditory, visual and audiovisual speech perception abilities among two groups of cochlear implant (CI) users: prelingual children and long-term young adults, as compared to their normal hearing (NH) peers. METHODS: Prospective cohort study that included 50 participants, divided into two groups of CI (10 children and 10 adults), and two groups of normal hearing peers (15 participants each). Speech stimuli included monosyllabic meaningful and nonsense words in a signal to noise ratio of 0 dB. Speech stimuli were introduced via auditory, visual and audiovisual modalities. RESULTS: (1) CI children and adults show lower speech perception accuracy with background noise in audiovisual and auditory modalities, as compared to NH peers, but significantly higher visual speech perception scores. (2) CI children are superior to CI adults in speech perception in noise via auditory modality, but inferior in the visual one. Both CI children and CI adults had similar audiovisual integration. CONCLUSIONS: The findings of the current study show that in spite of the fact that the CI children were implanted bilaterally, at a very young age, and using advanced technology, they still have difficulties in perceiving speech in adverse listening conditions even when adding the visual modality. This suggests that adding audiovisual training might be beneficial for this group by improving their audiovisual integration in difficult listening situations.

The Effect of Age and Type of Noise on Speech Perception under Conditions of Changing Context and Noise Levels.

OBJECTIVE: Everyday life includes fluctuating noise levels, resulting in continuously changing speech intelligibility. The study aims were: (1) to quantify the amount of decrease in age-related speech perception, as a result of increasing noise level, and (2) to test the effect of age on context usage at the word level (smaller amount of contextual cues). PATIENTS AND METHODS: A total of 24 young adults (age 20-30 years) and 20 older adults (age 60-75 years) were tested. Meaningful and nonsense one-syllable consonant-vowel-consonant words were presented with the background noise types of speech noise (SpN), babble noise (BN), and white noise (WN), with a signal-to-noise ratio (SNR) of 0 and -5 dB. RESULTS: Older adults had lower accuracy in SNR = 0, with WN being the most difficult condition for all participants. Measuring the change in speech perception when SNR decreased showed a reduction of 18.6-61.5% in intelligibility, with age effect only for BN. Both young and older adults used less phonemic context with WN, as compared to other conditions. CONCLUSION: Older adults are more affected by an increasing noise level of fluctuating informational noise as compared to steady-state noise. They also use less contextual cues when perceiving monosyllabic words. Further studies should take into consideration that when presenting the stimulus differently (change in noise level, less contextual cues), other perceptual and cognitive processes are involved.

Auditory and visual information in speech perception: A developmental perspective.

This study investigates the development of audiovisual speech perception from age 4 to 80, analysing the contribution of modality, context and special features of specific language being tested. Data of 77 participants in five age groups is presented in the study. Speech stimuli were introduced via auditory, visual and audiovisual modalities. Monosyllabic meaningful and nonsense words were included in a signal-to-noise ratio of 0 dB. Speech perception accuracy in audiovisual and auditory modalities by age resulted in an inverse U-shape, with lowest performance at ages 4-5 and 65-80. In the visual modality, a clear difference was shown between performance of children (ages 4-5 and 8-9) and adults (age 20 and above). The findings of the current study have important implications for strategic planning in rehabilitation programmes for child and adult speakers of different languages with hearing difficulties.