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Item Effects of stimulus variability on speech perception in listeners with hearing impairment(ASHA, 1997) Kirk, Karen Iler; Pisoni, David B.; Miyamoto, R. Christopher; Otolaryngology -- Head and Neck Surgery, School of MedicineTraditional 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.Item Exceptional Speech Recognition Outcomes After Cochlear Implantation: Lessons From Two Case Studies(American Speech-Language-Hearing Association, 2022) Herbert, Carolyn J.; Pisoni, David B.; Kronenberger, William G.; Nelson, Rick F.; Otolaryngology -- Head and Neck Surgery, School of MedicinePurpose: Individual differences and variability in outcomes following cochlear implantation (CI) in patients with hearing loss remain significant unresolved clinical problems. Case reports of specific individuals allow for detailed examination of the information processing mechanisms underlying variability in outcomes. Two adults who displayed exceptionally good postoperative CI outcomes shortly after activation were administered a novel battery of auditory, speech recognition, and neurocognitive processing tests. Method: A case study of two adult CI recipients with postlingually acquired hearing loss who displayed excellent postoperative speech recognition scores within 3 months of initial activation. Preoperative City University of New York sentence testing and a postoperative battery of sensitive speech recognition tests were combined with auditory and visual neurocognitive information processing tests to uncover their strengths, weaknesses, and milestones. Results: Preactivation CUNY auditory-only (A) scores were < 5% correct while the auditory + visual (A + V) scores were > 74%. Acoustically with their CIs, both participants' scores on speech recognition, environmental sound identification and speech in noise tests exceeded average CI users scores by 1-2 standard deviations. On nonacoustic visual measures of language and neurocognitive functioning, both participants achieved above average scores compared with normal hearing adults in vocabulary knowledge, rapid phonological coding of visually presented words and nonwords, verbal working memory, and executive functioning. Conclusions: Measures of multisensory (A + V) speech recognition and visual neurocognitive functioning were associated with excellent speech recognition outcomes in two postlingual adult CI recipients. These neurocognitive information processing domains may underlie the exceptional speech recognition performance of these two patients and offer new directions for research explaining variability in postimplant outcomes. Results further suggest that current clinical outcome measures should be expanded beyond the conventional speech recognition measures to include more sensitive robust tests of speech recognition as well as neurocognitive measures of working memory, vocabulary, lexical access, and executive functioning.Item Extraordinary Speech and Language Outcomes After Auditory Brainstem Implantation: Guidance From a Case Study(American Speech-Language-Hearing Association, 2023) Herbert, Carolyn J.; Kronenberger, William G.; Wolfert, Kim; Nelson, Rick F.; Yates, Charles W.; Pisoni, David B.; Otolaryngology -- Head and Neck Surgery, School of MedicinePurpose: Large individual differences and poor speech recognition outcomes are routinely observed in most patients who have received auditory brainstem implants (ABIs). A case report of an ABI recipient with exceptionally good speech recognition outcomes presents an opportunity to better understand the core information processing mechanisms that underlie variability and individual differences in outcomes. Method: A case study is reported of an adult ABI recipient (ID-006) with postlingually acquired, Neurofibromatosis Type 2 (NF2)-related hearing loss who displayed exceptional postoperative speech recognition scores. A novel battery of assessment measures was used to evaluate ID-006's auditory, cognitive, and linguistic information processing skills. Results: Seventeen years following ABI activation, ID-006 scored 77.6% correct on the AzBio Sentences in quiet. On auditory processing tasks, ID-006 scored higher on tasks with meaningful sentences and much lower on tasks that relied exclusively on audibility. ID-006 also demonstrated exceptionally strong abilities on several cognitive and linguistic information processing tasks. Conclusions: Results from a novel battery of information processing tests suggest that ID-006 relies extensively on top-down predictive processing and cognitive control strategies to efficiently encode and process auditory information provided by his ABI. Results suggest that current measures of outcomes and benefits should be expanded beyond conventional speech recognition measures to include more sensitive and robust measures of speech recognition as well as neurocognitive measures such as executive function, working memory, and lexical access.Item Functional Hearing Quality in Prelingually Deaf School-Age Children and Adolescents with Cochlear Implants(Taylor & Francis, 2021) Kronenberger, William G.; Bozell, Hannah; Henning, Shirley C.; Montgomery, Caitlin J.; Ditmars, Allison M.; Pisoni, David B.; Psychiatry, School of MedicineObjective: This study investigated differences in functional hearing quality between youth with cochlear implants (CIs) and normal hearing (NH) peers, as well as associations between functional hearing quality and audiological measures, speech perception, language and executive functioning (EF). Design: Youth with CIs and NH peers completed measures of audiological functioning, speech perception, language and EF. Parents completed the Quality of Hearing Scale (QHS), a questionnaire measure of functional hearing quality. Study sample: Participants were 43 prelingually-deaf, early-implanted, long-term CI users and 43 NH peers aged 7-17 years. Results: Compared to NH peers, youth with CIs showed poorer functional hearing quality on the QHS Speech, Localization, and Sounds subscales and more hearing effort on the QHS Effort subscale. QHS scores did not correlate significantly with audiological/hearing history measures but were significantly correlated with most speech perception, language and EF scores in the CI sample. In the NH sample, QHS scores were uncorrelated with speech perception and language and were inconsistently correlated with EF. Conclusions: The QHS is a valid measure of functional hearing quality that is distinct from office-based audiometric or hearing history measures. Functional hearing outcomes are associated with speech-language and EF outcomes in CI users.Item Identification of Acoustically Similar and Dissimilar Vowels in Profoundly Deaf Adults Who Use Hearing Aids and/or Cochlear Implants: Some Preliminary Findings(ASHA, 2014) Hay-McCutcheon, Marcia J.; Peterson, Nathaniel R.; Rosado, Christian A.; Pisoni, David B.; Otolaryngology -- Head and Neck Surgery, School of MedicinePurpose: In this study, the authors examined the effects of aging and residual hearing on the identification of acoustically similar and dissimilar vowels in adults with postlingual deafness who use hearing aids (HAs) and/or cochlear implants (CIs). Method: The authors used two groups of acoustically similar and dissimilar vowels to assess vowel identification. Also, the Consonant-Nucleus-Consonant Word Recognition Test (Peterson & Lehiste, 1962) and sentences from the Hearing in Noise Test (Nilsson, Soli, & Sullivan, 1994) were administered. Forty CI recipients with postlingual deafness (ages 31-81 years) participated in the study. Results: Acoustically similar vowels were more difficult to identify than acoustically dissimilar vowels. With increasing age, performance deteriorated when identifying acoustically similar vowels. Vowel identification was also affected by the use of a contralateral HA and the degree of residual hearing prior to implantation. Moderate correlations were found between speech perception and vowel identification performance. Conclusions: Identification performance was affected by the acoustic similarity of the vowels. Older adults experienced more difficulty identifying acoustically similar confusable vowels than did younger adults. The findings might lend support to the ease of language understanding model (Ronnberg, Rudner, Foo, & Lunner, 2008), which proposes that the quality and perceptual robustness of acoustic input affects speech perception.Item Lexical Effects on Spoken Word Recognition by Pediatric Cochlear Implant Users(Wolters Kluwer, 1995) Kirk, Karen Iler; Pisoni, David B.; Osberger, Mary Joe; Otolaryngology -- Head and Neck Surgery, School of MedicineObjective: The purposes of this study were 1) to examine the effect of lexical characteristics on the spoken word recognition performance of children who use a multichannel cochlear implant (CI), and 2) to compare their performance on lexically controlled word lists with their performance on a traditional test of word recognition, the PB-K. Design: In two different experiments, 14 to 19 pediatric CI users who demonstrated at least some open-set speech recognition served as subjects. Based on computational analyses, word lists were constructed to allow systematic examination of the effects of word frequency, lexical density (i.e., the number of phonemically similar words, or neighbors), and word length. The subjects' performance on these new tests and the PB-K also was compared. Results: The percentage of words correctly identified was significantly higher for lexically "easy" words (high frequency words with few neighbors) than for "hard" words (low frequency words with many neighbors), but there was no lexical effect on phoneme recognition scores. Word recognition performance was consistently higher on the lexically controlled lists than on the PB-K. In addition, word recognition was better for multisyllabic than for momosyllabic stimuli. Conclusions: These results demonstrate that pediatric cochlear implant users are sensitive to the acoustic-phonetic similarities among words, that they organize words into similarity neighborhoods in long-term memory, and they use this structural information in recognizing isolated words. The results further suggest that the PB-K underestimates these subjects' spoken words recognition.Item List Equivalency of PRESTO for the Evaluation of Speech Recognition(American Academy of Audiology, 2015-06) Faulkner, Kathleen F.; Tamati, Terrin N.; Gilbert, Jaimie L.; Pisoni, David B.; Otolaryngology -- Head and Neck Surgery, School of MedicineBACKGROUND: There is a pressing clinical need for the development of ecologically valid and robust assessment measures of speech recognition. Perceptually Robust English Sentence Test Open-set (PRESTO) is a new high-variability sentence recognition test that is sensitive to individual differences and was designed for use with several different clinical populations. PRESTO differs from other sentence recognition tests because the target sentences differ in talker, gender, and regional dialect. Increasing interest in using PRESTO as a clinical test of spoken word recognition dictates the need to establish equivalence across test lists. PURPOSE: The purpose of this study was to establish list equivalency of PRESTO for clinical use. RESEARCH DESIGN: PRESTO sentence lists were presented to three groups of normal-hearing listeners in noise (multitalker babble [MTB] at 0 dB signal-to-noise ratio) or under eight-channel cochlear implant simulation (CI-Sim). STUDY SAMPLE: Ninety-one young native speakers of English who were undergraduate students from the Indiana University community participated in this study. DATA COLLECTION AND ANALYSIS: Participants completed a sentence recognition task using different PRESTO sentence lists. They listened to sentences presented over headphones and typed in the words they heard on a computer. Keyword scoring was completed offline. Equivalency for sentence lists was determined based on the list intelligibility (mean keyword accuracy for each list compared with all other lists) and listener consistency (the relation between mean keyword accuracy on each list for each listener). RESULTS: Based on measures of list equivalency and listener consistency, ten PRESTO lists were found to be equivalent in the MTB condition, nine lists were equivalent in the CI-Sim condition, and six PRESTO lists were equivalent in both conditions. CONCLUSIONS: PRESTO is a valuable addition to the clinical toolbox for assessing sentence recognition across different populations. Because the test condition influenced the overall intelligibility of lists, researchers and clinicians should take the presentation conditions into consideration when selecting the best PRESTO lists for their research or clinical protocols.Item Long-Term Speech and Language Outcomes in Prelingually Deaf Children, Adolescents and Young Adults Who Received Cochlear Implants in Childhood(Karger, 2013) Ruffin, Chad V.; Kronenberger, William G.; Colson, Bethany G.; Henning, Shirley C.; Pisoni, David B.; Otolaryngology -- Head and Neck Surgery, School of MedicineThis study investigated long-term speech and language outcomes in 51 prelingually deaf children, adolescents and young adults who received cochlear implants (CIs) prior to 7 years of age and had used their implants for at least 7 years. Average speech perception scores were similar to those found in prior research with other samples of experienced CI users. Mean language test scores were lower than norm-referenced scores from nationally representative normal-hearing, typically developing samples, although a majority of the CI users scored within 1 standard deviation of the normative mean or higher on the Peabody Picture Vocabulary Test, Fourth Edition (63%), and the Clinical Evaluation of Language Fundamentals, Fourth Edition (69%). Speech perception scores were negatively associated with a meningitic etiology of hearing loss, older age at implantation, poorer preimplant unaided pure-tone average thresholds, lower family income and the use of 'total communication'. Subjects who had used CIs for 15 years or more were more likely to have these characteristics and were more likely to score lower on measures of speech perception compared to those who had used CIs for 14 years or less. The aggregation of these risk factors in the >15 years of CI use subgroup accounts for their lower speech perception scores and may stem from more conservative CI candidacy criteria in use at the beginning of pediatric cochlear implantation.Item The Perception of Regional Dialects and Foreign Accents by Cochlear Implant Users(American Speech-Language-Hearing Association, 2021-02-17) Tamati, Terrin N.; Pisoni, David B.; Moberly, Aaron C.; Otolaryngology -- Head and Neck Surgery, School of MedicinePurpose: This preliminary research examined (a) the perception of two common sources of indexical variability in speech—regional dialects and foreign accents, and (b) the relation between indexical processing and sentence recognition among prelingually deaf, long-term cochlear implant (CI) users and normal-hearing (NH) peers. Method: Forty-three prelingually deaf adolescent and adult CI users and 44 NH peers completed a regional dialect categorization task, which consisted of identifying the region of origin of an unfamiliar talker from six dialect regions of the United States. They also completed an intelligibility rating task, which consisted of rating the intelligibility of short sentences produced by native and nonnative (foreign-accented) speakers of American English on a scale from 1 (not intelligible at all) to 7 (very intelligible). Individual performance was compared to demographic factors and sentence recognition scores. Results: Both CI and NH groups demonstrated difficulty with regional dialect categorization, but NH listeners significantly outperformed the CI users. In the intelligibility rating task, both CI and NH listeners rated foreign-accented sentences as less intelligible than native sentences; however, CI users perceived smaller differences in intelligibility between native and foreign-accented sentences. Sensitivity to accent differences was related to sentence recognition accuracy in CI users. Conclusions: Prelingually deaf, long-term CI users are sensitive to accent variability in speech, but less so than NH peers. Additionally, individual differences in CI users' sensitivity to indexical variability was related to sentence recognition abilities, suggesting a common source of difficulty in the perception and encoding of fine acoustic–phonetic details in speech.Item Preoperative Visual Measures of Verbal Learning and Memory and their Relations to Speech Recognition After Cochlear Implantation(Wolters Kluwer, 2022) Ray, Christin; Pisoni, David B.; Lu, Emily; Kronenberger, William G.; Moberly, Aaron C.; Psychiatry, School of MedicineObjectives: This study examined the performance of a group of adult cochlear implant (CI) candidates (CIC) on visual tasks of verbal learning and memory. Preoperative verbal learning and memory abilities of the CIC group were compared with a group of older normal-hearing (ONH) control participants. Relations between preoperative verbal learning and memory measures and speech recognition outcomes after 6 mo of CI use were also investigated for a subgroup of the CICs. Design: A group of 80 older adult participants completed a visually presented multitrial free recall task. Measures of word recall, repetition learning, and the use of self-generated organizational strategies were collected from a group of 49 CICs, before cochlear implantation, and a group of 31 ONH controls. Speech recognition outcomes were also collected from a subgroup of 32 of the CIC participants who returned for testing 6 mo after CI activation. Results: CICs demonstrated poorer verbal learning performance compared with the group of ONH control participants. Among the preoperative verbal learning and memory measures, repetition learning slope and measures of self-generated organizational clustering strategies were the strongest predictors of post-CI speech recognition outcomes. Conclusions: Older adult CI candidates present with verbal learning and memory deficits compared with older adults without hearing loss, even on visual tasks that are independent from the direct effects of audibility. Preoperative verbal learning and memory processes reflecting repetition learning and self-generated organizational strategies in free recall were associated with speech recognition outcomes 6 months after implantation. The pattern of results suggests that visual measures of verbal learning may be a useful predictor of outcomes in postlingual adult CICs.