Effectiveness of Computer-Based Auditory Training for Adult Cochlear Implant Users: A Randomized Crossover Study

Abstract

The aim of this study was to assess whether a computer-based speech-in-noise auditory training (AT) program would lead to short- and long-term changes in trained and untrained measures of listening, cognition, and quality of life. A secondary aim was to assess whether directly training the underlying cognitive abilities required for speech perception in noise, using a computer-based visual training (VT) program without the auditory component, would elicit comparable outcomes as the AT program. A randomized crossover study with repeated measures was conducted with 26 adult cochlear implant users. Participants completed either 6 weeks of speech perception in noise training followed by 6 weeks of masked text recognition training, or vice versa. Outcome measures were administered twice before each training program, as well as twice after the completion of each program. The test battery was designed to evaluate whether training led to improvements in listening abilities, cognitive abilities, or quality of life. Mixed-effects models were conducted to analyze whether changes occurred on the trained tasks and on untrained outcome measures after training. Statistically significant improvements were shown for verbal recognition performance during both training programs, in particular for consonants in words, and during the first 2 weeks of training. This on-task learning, however, did not lead to clear improvements in outcomes measured beyond the training programs. This suggests that experienced cochlear implant users may not show transfer of on-task learning to untrained tasks after computer-based auditory and visual training programs such as the ones used in this study.

Comparing the Outcomes of a Personalized Versus Nonpersonalized Home-Based Auditory Training Program for Cochlear Implant Users

“…With hearing aid users, the RCT of Ferguson et al (2014) showed generalized far transfer improvements for complex measures of cognition that indexed executive processes, such as divided attention and updating working memory (following a phoneme discrimination performance). However, the only other training study for CI that included cognitive measures (Reis et al 2021) also failed to show improvements in cognitive abilities post-training. Failure to observe changes in performance may be related to significant variability in performance or to the sensitivity of the materials used to assess cognition (Heinrich et al 2016).…”

“…Despite insufficient evidence of CI studies, training results are encouraging. On-task learning improvements following AT have been reported by Fu et al (2005), Oba et al (2011), Zhang et al (2012, Lo et al (2015), Schumann et al (2015), Miller et al (2016), Green et al (2019), andReis et al (2021). An important issue in AT concerns the generalization of improvement to untrained materials and real-world listening environments.…”

“…Regarding nonauditory outcomes in the CI studies, only Reis et al (2021) took cognition into account, and only Baungaard et al (2019) and Reis et al (2021) considered aspects related to quality of life. None of the CI studies captured the expectations of the users, although this is also important, as they can influence the outcomes (Boot et al 2013; Grenness et al 2017; World Health Organization 2021).…”

Poor Performer: A Distinct Entity in Cochlear Implant Users?

“…In most studies dealing with auditory training, the impact on trained items has been described, but long-term or transfer effects have rarely been reported [Sweetow and Palmer, 2005;Bernstein et al, 2012;Ingvalson and Wong, 2013;Shafiro et al, 2015;Schumann et al, 2016;Green et al, 2019]. These mixed findings may be due to a limited overlap between the training and the untrained tasks, or due to an insufficient duration of the training used [Reis et al, 2021]. However, a combined auditory-cognitive program might have the potential to improve auditory and cognitive skills in CI users as shown in unaided hard-of-hearing adults [Anderson et al, 2013] and in hearing aid users [Sweetow and Sabes, 2006;Ferguson and Henshaw, 2015].…”

Editorial: Changes in the auditory brain following deafness, cochlear implantation, and auditory training, volume II

“…While CI users' brain can learn new modality of hearing after implantation via passive exposure to sound environment, active auditory training has been suggested to maximize CI benefits (Fu et al, 2008 ; Roman et al, 2016 ; Reis et al, 2021 ). Zhao et al provided valuable direction of possibly using music training in CI users, who typically complain difficulty in music perception.…”