Listening efficiency in adult cochlear-implant users compared with normally-hearing controls at ecologically relevant signal-to-noise ratios

Abstract

IntroductionDue to having to work with an impoverished auditory signal, cochlear-implant (CI) users may experience reduced speech intelligibility and/or increased listening effort in real-world listening situations, compared to their normally-hearing (NH) peers. These two challenges to perception may be usefully integrated in a measure of listening efficiency: conceptually, the amount of accuracy achieved for a certain amount of effort expended.MethodsWe describe a novel approach to quantifying listening efficiency based on the rate of evidence accumulation toward a correct response in a linear ballistic accumulator (LBA) model of choice decision-making. Estimation of this objective measure within a hierarchical Bayesian framework confers further benefits, including full quantification of uncertainty in parameter estimates. We applied this approach to examine the speech-in-noise performance of a group of 24 CI users (M age: 60.3, range: 20–84 years) and a group of 25 approximately age-matched NH controls (M age: 55.8, range: 20–79 years). In a laboratory experiment, participants listened to reverberant target sentences in cafeteria noise at ecologically relevant signal-to-noise ratios (SNRs) of +20, +10, and +4 dB SNR. Individual differences in cognition and self-reported listening experiences were also characterised by means of cognitive tests and hearing questionnaires.ResultsAt the group level, the CI group showed much lower listening efficiency than the NH group, even in favourable acoustic conditions. At the individual level, within the CI group (but not the NH group), higher listening efficiency was associated with better cognition (i.e., working-memory and linguistic-closure) and with more positive self-reported listening experiences, both in the laboratory and in daily life.DiscussionWe argue that listening efficiency, measured using the approach described here, is: (i) conceptually well-motivated, in that it is theoretically impervious to differences in how individuals approach the speed-accuracy trade-off that is inherent to all perceptual decision making; and (ii) of practical utility, in that it is sensitive to differences in task demand, and to differences between groups, even when speech intelligibility remains at or near ceiling level. Further research is needed to explore the sensitivity and practical utility of this metric across diverse listening situations.

Impact of SNR, peripheral auditory sensitivity, and central cognitive profile on the psychometric relation between pupillary response and speech performance in CI users

“…However, no study has yet validated this relation for CI users across a similarly wide range of listening conditions (i.e., 9 SNR steps with speech recognition score ranging from 0 to 100%). It is highly likely that CI users do not have similar hearing and physiological status as NH and HI listeners, thus CI users' psychometric relation between listening task and pupillary response might not be the same as in NH and HI listeners (Hughes and Galvin, 2013;Wang et al, 2016;Winn, 2016;Perreau et al, 2017;Perea Pérez et al, 2023). Therefore, without such validation with CI users on this piece of evidence, it is difficult to establish enough confidence to use pupillometry to interpret listening effort and assess efficacy of new CI interventions, such as new signal processing strategies, noise reduction and beamforming algorithms, among others.…”