High- and Low-Performing Adult Cochlear Implant Users on High-Variability Sentence Recognition: Differences in Auditory Spectral Resolution and Neurocognitive Functioning

Abstract

Background: Postlingually deafened adult cochlear implant (CI) users routinely display large individual differences in the ability to recognize and understand speech, especially in adverse listening conditions. Although individual differences have been linked to several sensory (''bottom-up'') and cognitive (''top-down'') factors, little is currently known about the relative contributions of these factors in high- and low-performing CI users.

Purpose: The aim of the study was to investigate differences in sensory functioning and neurocognitive functioning between high- and low-performing CI users on the Perceptually Robust English Sentence Test Open-set (PRESTO), a high-variability sentence recognition test containing sentence materials produced by multiple male and female talkers with diverse regional accents.

Research design: CI users with accuracy scores in the upper (HiPRESTO) or lower quartiles (LoPRESTO) on PRESTO in quiet completed a battery of behavioral tasks designed to assess spectral resolution and neurocognitive functioning.

Study sample: Twenty-one postlingually deafened adult CI users, with 11 HiPRESTO and 10 LoPRESTO participants.

Data collection and analysis: A discriminant analysis was carried out to determine the extent to which measures of spectral resolution and neurocognitive functioning discriminate HiPRESTO and LoPRESTO CI users. Auditory spectral resolution was measured using the Spectral-Temporally Modulated Ripple Test (SMRT). Neurocognitive functioning was assessed with visual measures of working memory (digit span), inhibitory control (Stroop), speed of lexical/phonological access (Test of Word Reading Efficiency), and nonverbal reasoning (Raven's Progressive Matrices).

Results: HiPRESTO and LoPRESTO CI users were discriminated primarily by performance on the SMRT and secondarily by the Raven's test. No other neurocognitive measures contributed substantially to the discriminant function.

Conclusions: High- and low-performing CI users differed by spectral resolution and, to a lesser extent, nonverbal reasoning. These findings suggest that the extreme groups are determined by global factors of richness of sensory information and domain-general, nonverbal intelligence, rather than specific neurocognitive processing operations related to speech perception and spoken word recognition. Thus, although both bottom-up and top-down information contribute to speech recognition performance, low-performing CI users may not be sufficiently able to rely on neurocognitive skills specific to speech recognition to enhance processing of spectrally degraded input in adverse conditions involving high talker variability.

Figure 1.

Average SMRT scores for HiPRESTO and LoPRESTO groups. The boxes extend from the lower to the upper quartile (the interquartile range, IQ), and the midline indicates the median. The whiskers indicate the highest and lowest values not >1.5 times the IQ. Light gray circles represent individual scores. Circles containing an “x” indicate outliers, that is, data points >1.5 times the IQ.

Figure 2.

Same as Figure 1, except average Raven’s scores are shown for HiPRESTO and LoPRESTO groups.