Auditory cross-modal reorganization in cochlear implant users indicates audio-visual integration.

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Cochlear implantation is the primary treatment for severe-to-profound hearing loss, yet outcomes vary significantly among recipients. While visual-auditory cross-modal reorganization has been identified as a contributing factor to this variability, its impact in early-implanted children remains unclear. To address this knowledge gap, we investigated visual processing and its relationship with auditory outcomes in children who received early bilateral cochlear implants. To examine potential cross-modal reorganization, we recorded visual evoked potentials (VEPs) in response to pattern-reversal stimuli in 25 children with cochlear implants (CIs) (mean implantation age: 1.44 years) and 28 age-matched normal-hearing (NH) controls. Analysis focused on both the occipital region of interest (ROI: O1, OZ, and O2 electrode sites) and right temporal ROI, examining VEP components and their correlation with speech perception outcomes. Unlike previous studies in later-implanted children, the overall occipital ROI showed no significant differences between groups. However, the left occipital electrode (O1) revealed reduced P1 amplitudes and delayed N1 latencies in CI users. Importantly, O1 N1 latency negatively correlated with speech-in-noise performance (r = -0.318; p = 0.02). The right temporal region showed no significant differences in VEP N1 between groups and no correlation with speech performance in CI users. Early bilateral cochlear implantation appears to preserve global visual processing, suggesting minimal maladaptive reorganization. However, subtle alterations in left occipital visual processing may influence auditory outcomes, highlighting the importance of early intervention and the complex nature of sensory integration in this population.

ABSTRACTNormal auditory feedback contributes to moment-to-moment control of speech production. Effects of auditory feedback’s absence on hearing-impaired individuals are widely documented, but auditory perturbation has not been investigated. Our objective was to evaluate the effect of delayed auditory feedback (DAF) and frequency altered feedback (FAF) on speech production among prelingual cochlear implant (CI) users and normal hearing (NH) individuals, to evaluate CI users’ reliance on auditory feedback. Twenty young adults (10 CI, 10 NH), without developmental and cognitive impairments, participated in the study. Under variable auditory feedback conditions, speech production (spontaneous or reading aloud) was measured using speech rate, percentage of interruptions, fundamental frequency (F0), and relative intensity. Results showed that (1) both DAF and FAF caused slower speech rates and more interruptions while reading aloud, with DAF having larger effect; (2) altered feedback produced no differences between groups, except an increase in F0 for CI users during DAF; and (3) CI users’ ability to understand speech via phone and without lip-reading was positively correlated with performance under DAF. These findings suggest that auditory perturbation similarly affects speech production among prelingual CI users and NH individuals, indicating CI users depend on auditory feedback to the same degree as normal hearing individuals.

An intact auditory system is essential for the development and maintenance of voice quality and speech prosody. On the contrary hearing loss affects the adjustments and appropriate use of organs involved in speech and voice production. Spectro-acoustic voice parameters have been evaluated in Cochlear Implant (CI) users, and the authors of previous systematic reviews on the topic concluded that fundamental frequency (F0) seemed preliminarily the most reliable parameter to evaluate voice alterations in adult CI users. The main aim of this systematic review and meta-analysis was to clarify the vocal parameters and prosodic alterations of speech in pediatric CI users. The protocol of the systematic review was registered on the PROSPERO database, International prospective register of systematic reviews. We conducted a search of the English literature published in the period between January 1, 2005 and April 1, 2022 on the Pubmed and Scopus databases. A meta-analysis was conducted to compare the values of voice acoustic parameters in CI users and non-hearing-impaired controls. The analysis was conducted using the standardized mean difference as the outcome measure. A random-effects model was fitted to the data. A total of 1334 articles were initially evaluated using title and abstract screening. After applying inclusion/exclusion criteria, 20 articles were considered suitable for this review. The age of the cases ranged between 25 and 132 months at examination. The most studied parameters were F0, Jitter, Shimmer and Harmonics-to-Noise Ratio (HNR); other parameters were seldom reported. A total of 11 studies were included in the meta-analysis of F0, with the majority of estimates being positive (75%); the estimated average standardized mean difference based on the random-effects model was 0.3033 (95% CI: 0.0605 to 0.5462; P = 0.0144). For Jitter (0.2229; 95% CI: -0.1862 to 0.7986; P = 0.2229) and shimmer (0.2540; 95% CI: -0.1404 to 0.6485; P = 0.2068) there was a trend toward positive values without reaching statistical significance. This meta-analysis confirmed that higher F0 values have been observed in the pediatric population of CI users compared to age-matched normal hearing volunteers, whereas the parameters of voice noise were not significantly different between cases and controls. Prosodic aspects of language need further investigations. In longitudinal contexts, prolonged auditory experience with CI has brought voice parameters closer to the norm. Following the available evidence, we stress the utility of inclusion of vocal acoustic analysis in the clinical evaluation and follow-up of CI patients to optimize the rehabilitation process of pediatric patients with hearing loss.

On the relationship between auditory cognition and speech intelligibility in cochlear implant users: An ERP study

Cross-modal reorganization in cochlear implant users: Auditory cortex contributes to visual face processing

Speech perception in noise is an important aspect of the rehabilitation of children with hearing loss. We aimed to evaluate the feasibility and reliability of the Dutch digits-in-noise (DIN) test in the clinical follow-up of children with hearing aids (HAs) and/or cochlear implants (CIs). A second aim of the study was to gain insight in the speech perception in noise performance of children with different degrees of hearing loss. We retrospectively analyzed DIN test data of Dutch-speaking children with hearing loss (N = 188; 5 to 18 years old). A free-field version of the DIN-test was used. Children with open-set phoneme recognition in quiet of >70% at 65 dB SPL (best aided condition) were included. Ages ranged from 5 to 18 years old. All were experienced HA or CI users and had used their device(s) for at least 1 year before the measurement in the study. The DIN-test was performed in the framework of a clinical rehabilitation program. During testing, children wore their own devices with normal daily programs. The average speech reception threshold (SRT) was -3.6 dB (SD 3.6) for the first list and significantly improved to -4.0 dB (SD 3.1) for the second list. HA users had a 4-dB better SRT compared with CI users. The larger the child's hearing loss, the worse the SRT is. However, 15% of the children who completed a first list of 24 trials were unable to complete a second list. Mean adaptive staircase trajectories across trials suggested that learning occurred throughout the first list, and that loss of sustained attention contributed to response variability during the second list. The DIN test can be used to assess speech perception in noise abilities for children with different degrees of hearing loss and using HAs or CIs. The children with hearing loss required a higher signal-to-noise ratio (SNR) than did normal-hearing children and the required SNR is larger as the hearing loss increases. However, the current measurement procedure should be optimized for use in standard pediatric audiological care, as 15% of the children were unable to conduct a second list after the first list to reach a more stable SNR.

Objective To investigate electrically evoked auditory cortical responses (eACR) elicited from the stimulation of intracochlear electrodes based on individually fitted stimulation parameters in cochlear implant (CI) users. Design An eACR setup based on individual fitting parameters is proposed. A 50-ms alternating biphasic pulse train was used to stimulate apical, medial, and basal electrodes and to evoke auditory cortical potentials (N1-P2 complex). Study sample The eACR setup proposed was validated with 14 adult CI users. Results Individual and grand-average eACR waveforms were obtained. The eACR amplitudes were lower in the basal than in the apical and medial regions. Earlier N1 latencies were found in CI users with lower maximum comfortable loudness levels and shorter phase duration in response to apical stimulation, while medial and basal stimulation resulted in earlier N1 latencies and larger N1-P2 amplitudes in users with longer CI experience. Conclusions eACR could be elicited by direct intracochlear stimulation using individual fitting parameters with a success rate of 71%. The highest cortical peak-to-peak amplitudes were obtained in response to apical stimulation. Unlike the P2, the N1 component appeared to be a consistent cortical potential to determine eACR and gain knowledge of the auditory processing beyond the cochlea in CI users. Highlights eACR can be elicited through direct stimulation of intracochlear electrodes. Stimulation of apical and medial regions yielded the highest N1-P2 amplitudes. CI users with lower maximum comfortable loudness levels had shorter N1 latencies during apical stimulation. The present dataset of mainly well-performing CI users suggests better cortical processing, that is, higher amplitudes and shorter latencies of N1. The N1 potential appears a more consistent and reliable potential than the P2 to determine eACR responses in CI users.

Cochlear implantation constitutes a successful therapy of inner ear deafness, with the majority of patients showing good outcomes. There is, however, still some unexplained variability in outcomes with a number of cochlear-implant (CI) users, showing major limitations in speech comprehension. The current study used a multimodal diagnostic approach combining single-photon emission computed tomography (SPECT) and electroencephalography (EEG) to examine the mechanisms underlying speech processing in postlingually deafened CI users (N = 21). In one session, the participants performed a speech discrimination task, during which a 96-channel EEG was recorded and the perfusions marker 99mTc-HMPAO was injected intravenously. The SPECT scan was acquired 1.5 h after injection to measure the cortical activity during the speech task. The second session included a SPECT scan after injection without stimulation at rest. Analysis of EEG and SPECT data showed N400 and P600 event-related potentials (ERPs) particularly evoked by semantic violations in the sentences, and enhanced perfusion in a temporo-frontal network during task compared to rest, involving the auditory cortex bilaterally and Broca’s area. Moreover, higher performance in testing for word recognition and verbal intelligence strongly correlated to the activation in this network during the speech task. However, comparing CI users with lower and higher speech intelligibility [median split with cutoff + 7.6 dB signal-to-noise ratio (SNR) in the Göttinger sentence test] revealed for CI users with higher performance additional activations of parietal and occipital regions and for those with lower performance stronger activation of superior frontal areas. Furthermore, SPECT activity was tightly coupled with EEG and cognitive abilities, as indicated by correlations between (1) cortical activation and the amplitudes in EEG, N400 (temporal and occipital areas)/P600 (parietal and occipital areas) and (2) between cortical activation in left-sided temporal and bilateral occipital/parietal areas and working memory capacity. These results suggest the recruitment of a temporo-frontal network in CI users during speech processing and a close connection between ERP effects and cortical activation in CI users. The observed differences in speech-evoked cortical activation patterns for CI users with higher and lower speech intelligibility suggest distinct processing strategies during speech rehabilitation with CI.

For the perception of timbre of a musical instrument, the attack time is known to hold crucial information. The first 50 to 150 ms of sound onset reflect the excitation mechanism, which generates the sound. Since auditory processing and music perception in particular are known to be hampered in cochlear implant (CI) users, we conducted an electroencephalography (EEG) study with an oddball paradigm to evaluate the processing of small differences in musical sound onset. The first 60 ms of a cornet sound were manipulated in order to examine whether these differences are detected by CI users and normal-hearing controls (NH controls), as revealed by auditory evoked potentials (AEPs). Our analysis focused on the N1 as an exogenous component known to reflect physical stimuli properties as well as on the P2 and the Mismatch Negativity (MMN). Our results revealed different N1 latencies as well as P2 amplitudes and latencies for the onset manipulations in both groups. An MMN could be elicited only in the NH control group. Together with additional findings that suggest an impact of musical training on CI users’ AEPs, our findings support the view that impaired timbre perception in CI users is at partly due to altered sound onset feature detection.

The current study examined the neural mechanisms underlying auditory outcomes in pediatric cochlear implant (CI) users using event-related potentials, focusing on the frontocentral Novelty P3 (indexing automatic attention) and the parietal Target P3 (reflecting controlled attention). By comparing CI children with normal-hearing peers, we aimed to elucidate how these attention mechanisms contribute to post-implantation auditory performance variability. Prelingually deaf children with early bilateral CIs (n = 25) and normal-hearing (NH) controls (n = 28), matched for gender and age (7–13 years), completed an oddball paradigm during ERP recording and performed speech-in-noise and memory tasks. CI users showed reduced Novelty P3 amplitudes compared to NH peers, suggesting impaired automatic attention mechanisms, while Target P3 amplitudes were comparable between groups, indicating preserved controlled attention. CI users demonstrated poorer performance on speech-in-noise recognition and forward digit span tasks. Larger Novelty P3 and Target P3 amplitudes both correlated positively with speech-in-noise performance across all participants. In contrast, in CI users specifically, Target P3 amplitudes showed positive associations with short-term memory performance. This study provides novel evidence that pediatric CI users exhibit reduced automatic attention shifting in response to acoustic changes while maintaining intact controlled attention processes that may serve as a compensatory mechanism. The neural markers’ associations with behavioral performance suggest potential intervention targets: rehabilitation efforts might focus on strengthening automatic attention shifting while leveraging preserved controlled attention pathways.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-24476-9.

Event Abstract Back to Event Altered hemispheric asymmetries of auditory evoked potentials after cochlear implantation Pascale Sandmann1*, T. Eichele2, S. Debener3, 4, M. Buechler5, L. Jancke1, N. Dillier5, Kenneth Hugdahl2, 6 and M. Meyer1 1 University of Zurich, Switzerland 2 University of Bergen, Norway 3 MRC Institute of Hearing Research of Southampton, United Kingdom 4 University of Southampton, United Kingdom 5 University Hospital Zurich, Switzerland 6 Haukeland University Hospital, Norway Hearing can be restored in individuals suffering from severe and profound hearing loss using a cochlear implant (CI). A CI bypasses the outer and middle ear and directly stimulates the (residual) fibres of the auditory nerve. To assess auditory cortex functions, late auditory evoked potentials (AEPs) are widely used in clinical context. However, in CI users electrophysiological measures are of limited utility due to the generation of electrical artefacts in the electroencephalogram (EEG). In order to evaluate the functional outcome after cochlear implantation, the present study examined hemispheric asymmetries of AEPs to complex sound processing in CI users. Two dyadic tonal intervals were presented in an active oddball design as well as in a passive listening condition. Using independent component analysis (ICA), CI-related artefacts could be successfully reduced in EEGs of CI users (n=12). BESA dipole source analysis of recovered AEPs allowed for the evaluation of hemispheric differences in the primary auditory cortex. The results are remarkable for two reasons. First, they indicate altered hemispheric asymmetries for complex sound processing in CI users compared to normal-hearing listeners. Second, the results demonstrate that ICA can solve the problem of CI-related artefacts, thereby enabling a detailed investigation of auditory cortex activity in CI users. This is of utmost clinical relevance to make AEP applicable in investigating auditory cortical reorganization after cochlear implantation. Conference: 10th International Conference on Cognitive Neuroscience, Bodrum, Turkey, 1 Sep - 5 Sep, 2008. Presentation Type: Poster Presentation Topic: Cerebral Asymmetry Citation: Sandmann P, Eichele T, Debener S, Buechler M, Jancke L, Dillier N, Hugdahl K and Meyer M (2008). Altered hemispheric asymmetries of auditory evoked potentials after cochlear implantation. Conference Abstract: 10th International Conference on Cognitive Neuroscience. doi: 10.3389/conf.neuro.09.2009.01.149 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 05 Dec 2008; Published Online: 05 Dec 2008. * Correspondence: Pascale Sandmann, University of Zurich, Zurich, Switzerland, p.sandmann@psychologie.uzh.ch Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Pascale Sandmann T. Eichele S. Debener M. Buechler L. Jancke N. Dillier Kenneth Hugdahl M. Meyer Google Pascale Sandmann T. Eichele S. Debener M. Buechler L. Jancke N. Dillier Kenneth Hugdahl M. Meyer Google Scholar Pascale Sandmann T. Eichele S. Debener M. Buechler L. Jancke N. Dillier Kenneth Hugdahl M. Meyer PubMed Pascale Sandmann T. Eichele S. Debener M. Buechler L. Jancke N. Dillier Kenneth Hugdahl M. Meyer Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Musical and vocal emotion perception for cochlear implants users

Some cochlear implant (CI) users report having difficulty accessing indexical information in the speech signal, presumably due to limitations in the transmission of fine spectrotemporal cues. The purpose of this review article was to systematically review and evaluate the existing research on talker processing in CI users. Specifically, we reviewed the performance of CI users in three types of talker- and voice-related tasks. We also examined the different factors (such as participant, hearing, and device characteristics) that might influence performance in these specific tasks. We completed a systematic search of the literature with select key words using citation aggregation software to search Google Scholar. We included primary reports that tested (a) talker discrimination, (b) voice perception, and (c) talker identification. Each report must have had at least one group of participants with CIs. Each included study was also evaluated for quality of evidence. The searches resulted in 1,561 references, which were first screened for inclusion and then evaluated in full. Forty-three studies examining talker discrimination, voice perception, and talker identification were included in the final review. Most studies were focused on postlingually deafened and implanted adult CI users, with fewer studies focused on prelingual implant users. In general, CI users performed above chance in these tasks. When there was a difference between groups, CI users performed less accurately than their normal-hearing (NH) peers. A subset of CI users reached the same level of performance as NH participants exposed to noise-vocoded stimuli. Some studies found that CI users and NH participants relied on different cues for talker perception. Within groups of CI users, there is moderate evidence for a bimodal benefit for talker processing, and there are mixed findings about the effects of hearing experience. The current review highlights the challenges faced by CI users in tracking and recognizing voices and how they adapt to it. Although large variability exists, there is evidence that CI users can process indexical information from speech, though with less accuracy than their NH peers. Recent work has described some of the factors that might ease the challenges of talker processing in CI users. We conclude by suggesting some future avenues of research to optimize real-world speech outcomes.

Recent studies have questioned past conclusions regarding the mechanisms of the McGurk illusion, especially how McGurk susceptibility might inform our understanding of audiovisual (AV) integration. We previously proposed that the McGurk illusion is likely attributable to a default mechanism, whereby either the visual system, auditory system, or both default to specific phonemes—those implicated in the McGurk illusion. We hypothesized that the default mechanism occurs because visual stimuli with an indiscernible place of articulation (like those traditionally used in the McGurk illusion) lead to an ambiguous perceptual environment and thus a failure in AV integration. In the current study, we tested the default hypothesis as it pertains to the auditory system. Participants performed two tasks. One task was a typical McGurk illusion task, in which individuals listened to auditory-/ba/ paired with visual-/ga/ and judged what they heard. The second task was an auditory-only task, in which individuals transcribed trisyllabic words with a phoneme replaced by silence. We found that individuals’ transcription of missing phonemes often defaulted to ‘/d/t/th/’, the same phonemes often experienced during the McGurk illusion. Importantly, individuals’ default rate was positively correlated with their McGurk rate. We conclude that the McGurk illusion arises when people fail to integrate visual percepts with auditory percepts, due to visual ambiguity, thus leading the auditory system to default to phonemes often implicated in the McGurk illusion.