Analysis of Ceiling Effects Occurring with Speech Recognition Tests in Adult Cochlear-Implanted Patients

Abstract

This article presents a simple method of analysing speech test scores which are biased through ceiling effects. Eighty postlingually deafened adults implanted with a MED-EL COMBI 40/40+ cochlear implant (CI) were administered a numbers test and a sentence test at initial device activation and at 1, 3, 6, 12 and 24 months thereafter. As a measure for speech recognition performance, the number of patients who scored at the ‘ceiling level’ (i.e. at least 95% correct answers) was counted at each test interval. Results showed a quick increase in this number soon after device activation as well as a continuous improvement over time (numbers test: 1 month: 51%; 6 months: 73%; 24 months: 88%; sentence test: 1 month: 33%; 6 months: 49%; 24 months: 64%). The new method allows for the detection of speech recognition progress in CI patient samples even at late test intervals, where improvement curves based on averaged scores are usually assuming a flat shape.

Speech perception scores in cochlear implant recipients: An analysis of ceiling effects in the CUNY sentence test (Quiet) in post-lingually deafened cochlear implant recipients

“…This finding is similar to the findings in other studies (Gifford et al, 2008, Helms et al, 2004. There was, however, an association between the bilateral users reaching ceiling scores more than unilateral users at 12 months.…”

“…Counting the number of users reaching ceiling scores over time has been proposed to monitor the progress of a group of recipients (Helms et al, 2004). However, this will not show the degree of improvement over time once recipients reach ceiling scores.…”

“…In some of the studies on CI recipients, ceiling was considered the highest score on a test, that is 100% (Gifford et al, 2008, Lenarz et al, 2012, whilst others used a cut-off of 95% (Helms et al, 2004).…”

“…Today's post-lingually deafened adult implant recipients, however, demonstrate high levels of speech perception scores-inquiet with current sentence tests such as Hearing in Noise (HINT) sentence test in the first few months post implantation (Gifford et al, 2008, Gifford et al, 2010, Fabry et al, 2009, Lenarz et al, 2012, Helms et al, 2004. Gifford et al (2008) reported that 71% of cochlear-implanted adults scored above 85% on a common test of sentence perception in quiet, of whom 28% reached the maximum possible score.…”

Vineland Screener 0–12 years research version (NL). Constructing a screening instrument to assess adaptive behaviour

“…The variance of items is expected to be somewhat limited. Ceiling effects on a scale occur when a considerable number of subjects are scoring at, or close to, the 100% performance level of a test (Helms et al, 2004). Similarly fl oor effects can occur close to the 0% performance.…”