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Effects of three amplification strategies on speech perception by children with severe and profound hearing loss.

OBJECTIVE: Traditionally in the United Kingdom, children with severe and profound hearing loss have been fitted with linear, analog hearing aids. Fast-acting, wide-dynamic-range compression (WDRC) has been shown to give better discrimination of speech than linear amplification for moderately hearing-impaired young adults. For severe and profound hearing losses, higher compression ratios are needed. The resultant distortion of the temporal envelope and reduced modulation depth may offset improvements in audibility offered by WDRC. In this study, speech recognition and discrimination were assessed for severely and profoundly hearing-impaired children, using three different amplification strategies, including WDRC. DESIGN: Fifteen children (ages 7 to 15 yr) with severe and profound hearing loss were fitted bilaterally with high-power, multichannel compression hearing aids, incorporating one of three different amplification strategies: linear with peak clipping, linear with compression limiting, or WDRC. Output responses were matched to Desired Sensation Level (DSL i/o) targets. The children wore hearing aids programmed with each of the amplification strategies in turn, for at least 1 wk, in a counterbalanced order across children. After using a particular amplification strategy for at least 1 wk, speech perception tests were carried out. RESULTS: Speech scores on closed-set testing for the profound group showed significant benefit for WDRC over the other two algorithms. None of the other results showed a statistically significant effect of algorithm on speech performance. CONCLUSIONS: WDRC amplification sometimes led to better performance than linear amplification with peak clipping or output limiting, and it never led to poorer performance. Therefore, it appears to be safe to use well-designed WDRC for hearing-impaired children with severe or profound hearing loss.

Adolescent↗

The effects of phonological and morphological training on speech perception scores and grammatical judgments in deaf and hard-of-hearing children.

Seventeen primary school deaf and hard-of-hearing children were given two types of training for 9 weeks each. Phonological training involved practice of /s, z, t, d/ in word final position in monomorphemic words. Morphological training involved learning and practicing the rules for forming third-person singular, present tense, past tense, and plurals. The words used in the two training types were different (monomorphemic or polymorphemic) but both involved word final /s, z, t, d/. Grammatical judgments were tested before and after training using short sentences that were read aloud by the child (or by the presenter if the child was unable to read them). Perception was tested with 150 key words in sentences using the trained morphemes and phonemes in word final position. Grammatical judgments for sentences involving the trained morphemes improved significantly after each type of training. Both types of training needed to be completed before a significant improvement was found for speech perception scores. The results suggest that both phonological and morphological training are beneficial in improving speech perception and grammatical performance of deaf and hard-of-hearing children and that both types of training were required to obtain the maximum benefit.

Child↗

Effects of stimulus variability on speech perception in listeners with hearing impairment.

Traditional word-recognition tests typically use phonetically balanced (PB) word lists produced by one talker at one speaking rate. Intelligibility measures based on these tests may not adequately evaluate the perceptual processes used to perceive speech under more natural listening conditions involving many sources of stimulus variability. The purpose of this study was to examine the influence of stimulus variability and lexical difficulty on the speech-perception abilities of 17 adults with mild-to-moderate hearing loss. The effects of stimulus variability were studied by comparing word-identification performance in single-talker versus multiple-talker conditions and at different speaking rates. Lexical difficulty was assessed by comparing recognition of "easy" words (i.e., words that occur frequently and have few phonemically similar neighbors) with "hard" words (i.e., words that occur infrequently and have many similar neighbors). Subjects also completed a 20-item questionnaire to rate their speech understanding abilities in daily listening situations. Both sources of stimulus variability produced significant effects on speech intelligibility. Identification scores were poorer in the multiple-talker condition than in the single-talker condition, and word-recognition performance decreased as speaking rate increased. Lexical effects on speech intelligibility were also observed. Word-recognition performance was significantly higher for lexically easy words than lexically hard words. Finally, word-recognition performance was correlated with scores on the self-report questionnaire rating speech understanding under natural listening conditions. The pattern of results suggest that perceptually robust speech-discrimination tests are able to assess several underlying aspects of speech perception in the laboratory and clinic that appear to generalize to conditions encountered in natural listening situations where the listener is faced with many different sources of stimulus variability. That is, word-recognition performance measured under conditions where the talker varied from trial to trial was better correlated with self-reports of listening ability than was performance in a single-talker condition where variability was constrained.

Adult↗

Right rolandic activation during speech perception in stutterers: a MEG study.

The focus of our magnetoencephalographic (MEG) study was to obtain further insight into the neuronal organization of language processing in stutterers. We recorded neuronal activity of 10 male developmental stutterers and 10 male controls, while they listened to pure tones, to words in order to repeat them, and to sentences in order to either repeat or transform them into passive form. Stimulation with pure tones resulted in similar activation patterns in the two groups, but differences emerged in the more complex auditory language tasks. In the stutterers, the left inferior frontal cortex was activated for a short while from 95 to 145 ms after sentence onset, which was not evident in the controls nor in either group during the word task. In both subject groups, the left rolandic area was activated when listening to the speech stimuli, but in the stutterers, there was an additional activation of the right rolandic area from 315 ms onwards, which was more pronounced in the sentence than word task. Activation of areas typically associated with language production was thus observed also during speech perception both in controls and in stutterers. Previous research on speech production in stutterers has found abnormalities in both the amount and timing of activation in these areas. The present data suggest that activation in the left inferior frontal and right rolandic areas in stutterers differs from that in controls also during speech perception.

Adolescent↗

Effectiveness of an intensive speech perception training program for adult cochlear implant recipients.

A staggered multiple baseline single-subject experimental design was used to assess the effectiveness of a postimplant intensive aural rehabilitation program. Four adults with an acquired profound hearing loss were provided with a Nucleus 22-channel cochlear implant. The subjects completed a speech perception test protocol once before their cochlear implant operation and at 3-month intervals for a period of 12 months postimplantation. Each subject participated in a 12-week postimplant intensive aural rehabilitation program. A comparison of the prerehabilitation and postrehabilitation results failed to reveal any systematic improvements in performance on the speech perception tests that could be attributed unequivocally to the aural rehabilitation program.

Adult↗

Deep electrode insertion in cochlear implants: apical morphology, electrodes and speech perception results.

Morphological examination of the human temporal bone in the apical region supports the benefits of deep electrode insertion. Initiation of spikes on peripheral processes close to the basilar membrane would provide improved channel selectivity during electrical stimulation but recruiting of nerve fibres requires a higher current. A clinical study was performed on 10 users of the MED-EL COMBI 40 + implant to evaluate the effect of the insertion depth of the cochlear implant electrode on speech perception. All subjects were implanted with the standard COMBI 40 + electrode with an insertion depth of > 30 mm. Acute speech tests were carried out in which stimulation was restricted to the apical, middle and basal regions of the cochlea in turn, and using electrode arrangements in which contacts were either distributed over the whole length of the cochlea or concentrated at the basal end, thus mimicking an insertion depth of approximately 20 mm only. The results showed that stimulation of the apical region of the cochlea supports a significant degree of speech understanding, and that distributing the contacts over the whole length of the cochlea improves speech perception in quiet and in noise.

Adult↗

Evaluation of the speech perception in noise (SPIN) test.

Several investigations were perfomed with normal hearing subjects to determine the effects of presentation level and signal-to-babble ratio on the speech perception in noise (SPIN) test. The SPIN test contains sentences that simulate a range of contextual situations encountered in everyday speech communication. Findings from several representative patients with sensorineural hearing loss demonstrate the possible clinical utility of the test to measure the effects of context on speech discrimination.

Acoustic Stimulation↗

Pure-tone auditory stream segregation and speech perception in noise in cochlear implant recipients.

This study examined the ability of cochlear implant users and normal-hearing subjects to perform auditory stream segregation of pure tones. An adaptive, rhythmic discrimination task was used to assess stream segregation as a function of frequency separation of the tones. The results for normal-hearing subjects were consistent with previously published observations (L.P.A.S van Noorden, Ph.D. dissertation, Eindhoven University of Technology, Eindhoven, The Netherlands 1975), suggesting that auditory stream segregation increases with increasing frequency separation. For cochlear implant users, there appeared to be a range of pure-tone streaming abilities, with some subjects demonstrating streaming comparable to that of normal-hearing individuals, and others possessing much poorer streaming abilities. The variability in pure-tone streaming of cochlear implant users was correlated with speech perception in both steady-state noise and multi-talker babble. Moderate, statistically significant correlations between streaming and both measures of speech perception in noise were observed, with better stream segregation associated with better understanding of speech in noise. These results suggest that auditory stream segregation is a contributing factor in the ability to understand speech in background noise. The inability of some cochlear implant users to perform stream segregation may therefore contribute to their difficulties in noise backgrounds.

Adult↗

Improvements in speech perception with use of the AVR TranSonic frequency-transposing hearing aid.

Five adults with sensorineural hearing impairment participated in a trial comparing the performance of the AVR TranSonic frequency-transposing hearing aid with that of their own conventional aids. They used the TranSonic for approximately 12 weeks, during which time systematic changes were made to the transposition parameters. Speech perception was assessed with each setting of those parameters and with the participants' own hearing aids. Four participants obtained significantly higher scores with the TranSonic than with their own aids on at least one of the tests. However, analysis of the consonant confusions suggested that the improvement resulted mostly from the TranSonic's low-frequency electro-acoustic characteristics. There was only limited evidence for 2 of the participants that the frequency-lowering function was effective at improving speech perception.

Adult↗

Practical evaluation procedure to assess and remediate speech perception skills.

The University of Miami/Dade County Public Schools Model Program for the Deaf and Hard of Hearing is a research and training effort dedicated to the utilization of sensory aids including hearing aids, tactual vocoders, and cochlear implants. The program's teachers and clinicians follow the Miami Cochlear Implant, Auditory, and Tactile Skills (CHATS) Curriculum for the development of individualized speech perception and production goals. A series of peech perception tests has been used for the past five years to evaluate the children's progress. The test battery, administered at six month intervals, is extensive and impractical for school clinicians and teachers to administer to their students. To assist teachers and clinicians in the process of selecting appropriate goals and objectives for sensory aid training, a speech perception test has been developed to accompany the curriculum. This paper includes a discussion of the test design as it correlates with the curriculum.

Child↗

Comparison of speech perception benefits with SPEAK and ACE coding strategies in pediatric Nucleus CI24M cochlear implant recipients.

Nine congenitally deaf children who received a Nucleus CI24M cochlear implant and who were fitted with the SPrint speech processor participated in this study. All subjects were initially programmed with the SPEAK coding strategy and then converted to the ACE strategy. Speech perception was evaluated before and after conversion to the new coding strategy using word and Common Phrase speech recognition tests in both the presence and absence of noise. In quiet conditions, the mean percent correct scores for words were 68.8% with SPEAK and 91% with ACE; for phrases the percentage was 66.6% with SPEAK and 85.5% with ACE. In the presence of noise (at +10 dB signal-to-noise ratio), the mean percent correct scores for words were 43.3% with SPEAK compared to 84.4% with ACE; for phrases the percentage was 41.1% with SPEAK and 82.2% with ACE. Statistical analysis revealed significant improvement in open-set speech recognition with ACE compared to SPEAK. Preliminary data suggest that converting children from SPEAK to the ACE strategy improves their performance. Subjects showed significant improvements for open-set word and sentence recognition in quiet as well as in noise when ACE was used in comparison with SPEAK. The greatest improvements were obtained when tests were presented in the presence of noise.

Acoustic Stimulation↗

The motor theory of speech perception reviewed.

More than 50 years after the appearance of the motor theory of speech perception, it is timely to evaluate its three main claims that (1) speech processing is special, (2) perceiving speech is perceiving gestures, and (3) the motor system is recruited for perceiving speech. We argue that to the extent that it can be evaluated, the first claim is likely false. As for the second claim, we review findings that support it and argue that although each of these findings may be explained by alternative accounts, the claim provides a single coherent account. As for the third claim, we review findings in the literature that support it at different levels of generality and argue that the claim anticipated a theme that has become widespread in cognitive science.

Association Learning↗

Age-related changes on a children's test of sensory-level speech perception capacity.

Normative data, as a function of age, were obtained on a test designed to assess sensory-level speech perception capacity, the Three-Interval Forced-Choice Test of Speech Pattern Contrast Perception, otherwise known as THRIFTSPAC (or THRIFT for short). Performance under the input modalities of hearing alone, speech-reading alone, and the two combined was measured in 44 normally developing children between the ages of 5 years 7 months and 10 years 9 months. Results revealed that within each condition there were significant influences of age on performance for children below age 7 years. These changes appeared to be related to cognitive and, possibly, to phonological development. Implications for the clinical implementation of THRIFT are discussed.

Age Factors↗

Effect of deep insertion of the cochlear implant electrode array on pitch estimation and speech perception.

CONCLUSION: Deeply inserted electrodes offer the possibility that apical stimulation may improve speech performances. Therefore, deep insertion is reasonable and should be performed in patients with profound or total hearing loss. OBJECTIVES: To evaluate the importance of insertion depth beyond 25 mm in a group of cochlear implant patients with deeply inserted electrodes up to 32 mm. PATIENTS AND METHODS: In the first part of the study patients were asked to perform a pitch estimation for channels across the whole length of the electrode array. We evaluated whether pitch discrimination was possible along the whole cochlea and especially in its apical part. Then, the audiological performances of 10 patients were tested in 5 conditions, in which we artificially varied the insertion depth in each patient by activating and deactivating channels. The patients were tested immediately in the new condition to avoid adaptation. RESULTS: The results showed that activating the electrodes in the uppermost region of the cochlea improves speech perception significantly. Furthermore it could be demonstrated that the pitch perceived in the cochlea with electrical stimulation decreases with increasing insertion depth along the whole length of deeply inserted electrode arrays.

Adult↗

Cerebellum and speech perception: a functional magnetic resonance imaging study.

A variety of data indicate that the cerebellum participates in perceptual tasks requiring the precise representation of temporal information. Access to the word form of a lexical item requires, among other functions, the processing of durational parameters of verbal utterances. Therefore, cerebellar dysfunctions must be expected to impair word recognition. In order to specify the topography of the assumed cerebellar speech perception mechanism, a functional magnetic resonance imaging study was performed using the German lexical items "Boden" ([bodn], Engl. "floor") and "Boten" ([botn], "messengers") as test materials. The contrast in sound structure of these two lexical items can be signaled either by the length of the wordmedial pause (closure time, CLT; an exclusively temporal measure) or by the aspiration noise of wordmedial "d" or "t" (voice onset time, VOT; an intrasegmental cue). A previous study found bilateral cerebellar disorders to compromise word recognition based on CLT whereas the encoding of VOT remained unimpaired. In the present study, two series of "Boden - Boten" utterances were resynthesized, systematically varying either in CLT or VOT. Subjects had to identify both words "Boden" and "Boten" by analysis of either the durational parameter CLT or the VOT aspiration segment. In a subtraction design, CLT categorization as compared to VOT identification (CLT - VOT) yielded a significant hemodynamic response of the right cerebellar hemisphere (neocerebellum Crus I) and the frontal lobe (anterior to Broca's area). The reversed contrast ( VOT - CLT) resulted in a single activation cluster located at the level of the supratemporal plane of the dominant hemisphere. These findings provide first evidence for a distinct contribution of the right cerebellar hemisphere to speech perception in terms of encoding of durational parameters of verbal utterances. Verbal working memory tasks, lexical response selection, and auditory imagery of word strings have been reported to elicit activation clusters of a similar location. Conceivably, representation of the temporal structure of speech sound sequences represents the common denominator of cerebellar participation in cognitive tasks acting on a phonetic code.

Acoustic Stimulation↗

Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear.

The aim of this study was to determine the improvement in speech recognition provided by a cochlear implant (CI) in conjunction with a hearing aid (HA) in the opposite ear. The study was a retrospective cohort study in the context of a university teaching hospital CI programme. Seven CI patients who still use their HA in the opposite ear were tested. The scores with the CI alone and the CI in conjunction with an HA were evaluated by using three speech perception tests in quiet (Freiburger Numbers. Freiburger Monosyllables, and Innsbrucker Sentence Test). In the majority of tests and subjects. the CI alone performed better than the HA alone, and the bimodal (CI + HA) condition was superior to the CI alone. On the sentence test, the patients as a group improved from 47 96% (mean: 79%; CI alone) to 50-100% (mean: 88.1%; CI + HA, pv < 0.05). With the more difficult monosyllable test, the scores improved from 15-52% (mean: 37.2%; CI alone) to 15 82% (mean: 48.7%; CI + HA, p < 0.05). On the numbers test. scores increased from 65-98% (mean: 83%; CI alone) to 75-98% (mean: 88.7%; CI + HA, p < 0.05). All patients in this study were implanted in the poorer ear. The results of the present study suggest the advantage of CI usage in conjunction with an HA in the opposite ear.

Acoustic Stimulation↗

Dynamic visual speech perception in a patient with visual form agnosia.

To examine the role of dynamic cues in visual speech perception, a patient with visual form agnosia (DF) was tested with a set of static and dynamic visual displays of three vowels. Five conditions were tested: (1) auditory only which provided only vocal pitch information, (2) dynamic visual only, (3) dynamic audiovisual with vocal pitch information, (4) dynamic audiovisual with full voice information and (5) static visual only images of postures during vowel production. DF showed normal performance in all conditions except the static visual only condition in which she scored at chance. Control subjects scored close to ceiling in this condition. The results suggest that spatiotemporal signatures for objects and events are processed separately from static form cues.

Adult↗

Speech perception results--the first 10 years of a cochlear implant program.

Long-term speech perception test results for prelingually deaf children were compared with those of postlingually deafened adults, both groups having undergone cochlear implant at our Center. Average open-set score results of adults were similar to those of the children. However, some qualitative differences were demonstrated on the perception of phonological contrasts between the groups.

Adolescent↗