Objectives: Audiological rehabilitation includes sensory management, auditory training (AT), and counseling and can alleviate the negative consequences associated with (untreated) hearing impairment. AT aims at improving auditory skills through structured analytical (bottom-up) or synthetic (top-down) listening exercises. The evidence for AT to improve auditory outcomes of postlingually deafened adults with a cochlear implant (CI) remains a point of debate due to the relatively limited number of studies and methodological shortcomings. There is a general agreement that more rigorous scientific study designs are needed to determine the effectiveness, generalization, and consolidation of AT for CI users. The present study aimed to investigate the effectiveness of a personalized AT program compared to a nonpersonalized Active Control program with adult CI users in a stratified randomized controlled clinical trial. Design: Off-task outcomes were sentence understanding in noise, executive functioning, and health-related quality of life. Participants were tested before and after 16 weeks of training and after a further 8 months without training. Participant expectations of the training program were assessed before the start of training. Results:The personalized and nonpersonalized AT programs yielded similar results. Significant on-task improvements were observed. Moreover, AT generalized to improved speech understanding in noise for both programs. Half of the CI users reached a clinically relevant improvement in speech understanding in noise of at least 2 dB SNR post-training. These improvements were maintained 8 months after completion of the training. In addition, a significant improvement in quality of life was observed for participants in both treatment groups. Adherence to the training programs was high, and both programs were considered user-friendly. Conclusions:Training in both treatments yielded similar results. For half of the CI users, AT transferred to better performance with generalization of learning for speech understanding in noise and quality of life. Our study supports the previous findings that AT can be beneficial for some CI users.

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Speech-perception testing is essential for monitoring outcomes with a hearing aid or cochlear implant (CI). However, clinical care is time-consuming and often challenging with an increasing number of clients. A potential approach to alleviating some clinical care and possibly making room for other outcome measures is to employ technologies that assess performance in the home environment. In this study, we investigate 3 different speech perception indices in the same 40 CI users: phoneme identification (vowels and consonants), digits in noise (DiN) and sentence recognition in noise (SiN). The first two tasks were implemented on a tablet and performed multiple times by each client in their home environment, while the sentence task was administered at the clinic. Speech perception outcomes in the same forty CI users showed that DiN assessed at home can serve as an alternative to SiN assessed at the clinic. DiN scores are in line with the SiN ones by 3–4 dB improvement and are useful to monitor performance at regular intervals and to detect changes in auditory performance. Phoneme identification in quiet also explains a significant part of speech perception in noise, and provides additional information on the detectability and discriminability of speech cues. The added benefit of the phoneme identification task, which also proved to be easy to administer at home, is the information transmission analysis in addition to the summary score. Performance changes for the different indices can be interpreted by comparing against measurement error and help to target personalized rehabilitation. Altogether, home-based speech testing is reliable and proves powerful to complement care in the clinic for CI users.

The understanding of speech in noise relies (at least partially) on spectrotemporal modulation sensitivity. This sensitivity can be measured by spectral ripple tests, which can be administered at different presentation levels. However, it is not known how presentation level affects spectrotemporal modulation thresholds. In this work, we present behavioral data for normal-hearing adults which show that at higher ripple densities (2 and 4 ripples/oct), increasing presentation level led to worse discrimination thresholds. Results of a computational model suggested that the higher thresholds could be explained by a worsening of the spectrotemporal representation in the auditory nerve due to broadening of cochlear filters and neural activity saturation. Our results demonstrate the importance of taking presentation level into account when administering spectrotemporal modulation detection tests.

The understanding of speech in noise relies (at least partially) on spectrotemporal modulation sensitivity. This sensitivity can be measured by spectral ripple tests, which can be administered at different presentation levels. However, it is not known how presentation level affects spectrotemporal modulation thresholds. In this work, we present behavioral data for normal-hearing adults which show that at higher ripple densities (2 and 4 ripples/oct), increasing presentation level led to worse discrimination thresholds. Results of a computational model suggested that the higher thresholds could be explained by a worsening of the spectrotemporal representation in the auditory nerve due to broadening of cochlear filters and neural activity saturation.Our results demonstrate the importance of taking presentation level into account when administering spectrotemporal modulation detection tests.