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

• Published in: Frontiers in human neuroscience Vol. 17; p. 1214485
• Main Authors: Perea Pérez, Francisca, Hartley, Douglas E H, Kitterick, Pádraig T, Zekveld, Adriana A, Naylor, Graham, Wiggins, Ian M
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Research Foundation 14.07.2023; Frontiers Media S.A
• Subjects: Accuracy; Bayesian analysis; Cochlea; cochlear implants; Cognition; Cognitive psychology; Decision making; ecological relevance; Efficiency; linear ballistic accumulator; Listening; listening efficiency; listening effort; Neuroscience; Response time; Short term memory; Speech; speech intelligibility; Speech perception; Transplants & implants; ecological relevance; listening efficiency; listening effort; linear ballistic accumulator; evidence accumulation model; decision-making model; cochlear implants; speech intelligibility
• ISSN: 1662-5161; 1662-5161
• DOI: 10.3389/fnhum.2023.1214485

Due 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. We 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. At 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. We 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.