Valeriy Shafiro

Access to environmental sounds in everyday settings is essential for situational awareness, safety, and well-being but can be compromised by hearing loss. Cochlear implants (CI) improve speech recognition, yet their benefits for environmental sound perception remain unclear. Prior research, centered on sound identification, suggests persistent deficits, but may not adequately represent CI users' abilities because identification alone offers limited insight into everyday listening. To provide a broader assessment, we examined environmental sound perception and comprehension in 25 CI users, 21 hard of hearing (HoH), and 22 normal-hearing controls using three tasks: semantic discrimination, single sound identification, and auditory scene comprehension. Normal hearing and HoH performed similarly and significantly better than CI users across tasks. Mean performance across the groups was highest for semantic discrimination (93.4%–82.9%), followed by identification (86.7%–67.0%) and scene comprehension (88.1%–66.9%). CI users showed difficulty with comprehension tasks requiring semantic integration and inference in complex scenes. Scene comprehension scores correlated with perceived hearing handicap in HoH and CI participants. These findings suggest that environmental sound perception deficits in CI users extend beyond sound identification and include semantic discrimination and scene comprehension. They highlight the need for ecologically valid assessment and rehabilitation approaches that address real-world listening demands.

From the pioneering days of cochlear implants (CIs) more than half a century ago until the present time, speech perception outcomes remain a broadly recognized benchmark of CI success. However, speech test scores alone do not directly map onto individual patients’ aural communication needs. Rather, speech tests provide a relatively time-efficient way to assess specific aspects of everyday speech processing abilities. We review how speech perception testing has evolved in the United States of America since the early days of CIs and critically examine its current clinical roles: (1) establishing CI candidacy, (2) measuring benefit post-CI, and (3) pinpointing specific perceptual deficits to guide counseling, rehabilitation, or programming changes. We further consider: (a) factors that have driven changes in how speech perception has been evaluated over time, (b) approaches to selecting outcome measures of speech perception and interpretation of outcomes, (c) the role that speech perception plays in the assessment of overall CI benefit and individualized rehabilitation, and (d) how test selection and conditions can influence CI care. We argue that conventional speech perception tests provide only a partial view of CI outcomes and call for more comprehensive, ecologically meaningful assessment approaches. We conclude with recommendations for selecting outcome measures that better reflect real-world communication demands and guide patient-centered care for adult CI users.

Background: Cochlear implantation (CI) in pediatric patients with cochlear nerve deficiencies (CND) remains controversial due to a highly variable clinical population, lack of evidence-based guidelines, and mixed research findings. This study assessed current clinical perspectives and practices regarding CI candidacy in children with CND among hearing healthcare professionals in the USA. Methods: An anonymous 19-question online survey was distributed to CI clinicians nationwide. The survey assessed professional background, experience with aplasia and hypoplasia, and perspectives on CI versus auditory brainstem implant (ABI) candidacy, including imaging practices and outcome expectations. Both multiple-choice and open-ended responses were analyzed to identify trends and reasoning. Results: Seventy-two responses were analyzed. Most clinicians supported CI for hypoplasia (60.2%) and, to a lesser extent, for aplasia (41.7%), with audiologists more likely than neurotologists to favor CI. Respondents cited lower risk, accessibility, and the potential for benefit as reasons to attempt CI before ABI. However, many emphasized a case-by-case approach, incorporating imaging, electrophysiological testing, and family counseling. Only 22.2% considered structural factors the best predictors of CI success. Conclusions: Overall, hearing health professionals in the USA tend to favor CI as a first-line option, while acknowledging the limitations of current diagnostic tools and the importance of individualized, multidisciplinary decision-making in CI candidacy for children with CND. Findings reveal a high variability in clinical perspectives on CI implantation for pediatric aplasia and hypoplasia and a lack of clinical consensus, highlighting the need for more standardized assessment and imaging protocols to provide greater consistency across centers and enable the development of evidence-based guidelines.

An improvement in speech perception is a major well-documented benefit of cochlear implantation (CI), which is commonly discussed with CI candidates to set expectations. However, a large variability exists in speech perception outcomes. We evaluated the accuracy of clinical predictions of post-CI speech perception scores. In an online survey, clinicians involved in CI care were asked to predict 6-month performance on AzBio sentences and CNC words for 15 anonymised CI patients based on demographic, medical, and audiological data, and preoperative speech recognition scores. Sixty-five participants (72% audiologists, 14% neurotologists, 14% speech-language pathologists, and CI researchers) provided predictions for two or more cases, and 43 provided predictions for all 15 CI cases. Clinical predictions had low accuracy and high variability (i.e. median interclass correlation coefficients [ICC] 0.11-0.13). No relationship was observed between clinicians' confidence and prediction accuracy. The present findings are consistent with previous research and indicate a concerning discrepancy between clinical predictions and actual speech perception outcomes for adult post-lingual CI users. Future research may explore incorporating predictions based on statistical models into speech outcome prognostication to reduce variance and improve counselling and expectations setting for individual CI candidates.

Sounds in everyday environments typically precede and follow one another in systematic ways determined by the properties and interactions of corresponding sound sources. Familiar and predictable contextual relationships between consecutive sounds are known to provide perceptual benefit under adverse listening conditions. Previous work has demonstrated implicit learning of arbitrary rule-based sound patterns by young normal hearing adults. However, the role of such rule-based learning on identification of individual sounds within a sound pattern and the effect of listener age has not been investigated. Here younger and older adults with age-appropriate hearing were first familiarized with a set of rule-based nonspeech sound sequences produced by a finite-state machine. Subsequently, they identified individual target sounds within sequences under a range of signal-to-noise ratios (0 to -15 dB). The test sequences were (a) familiar, rule-based; (b) novel, rule-based; or (c) novel, non rule-based. The results for both younger and older listeners revealed superior sound identification in sequences versus in isolation, and a greater overall accuracy of rule-based versus non rule-based sequences. Younger listeners significantly outperformed older listeners. Implicit learning benefit did not correlate with measures of working memory processing. Current findings have implications for audiologic rehabilitation and auditory display design.

Sounds in everyday environments often follow one another in systematic ways determined by the properties and interactions of of corresponding sound sources. Pre Sounds in everyday environments often follow one another in systematic ways determined by the properties and interactions of of corresponding sound sources. Pre

Sounds of everyday environments are rarely heard in isolation. Usually, they occur in the context of complex auditory scenes, where they are preceded and followed by other sounds or overlap with other sounds in time. In contrast, behavioral tests of auditory function are typically focused on isolated and often artificially constructed sounds which do not represent real world objects and events or the context in which they occur. Thus, results of such tests may have limited generalizability to important aspects of everyday listening. This presentation will review alternative approaches that focus on comprehension of auditory scenes and require integration of semantic information across multiple sounds. For listeners with hearing loss, our results suggest that comprehension of auditory scenes constitutes an important aspect of auditory assessment which, combined with findings from more traditional auditory tests, can provide a basis for auditory rehabilitation.

Environmental sounds, defined as semantically rich acoustic signals different from speech or music, are ubiquitous in daily living. Environmental sound research in various forms has been long embedded into many areas of acoustics including noise control, bioacoustics, music, signal processing, speech communication, and psychoacoustics. However, environmental sounds have been typically investigated in the limited context of specific lines of inquiry unique to each of these areas. In this fractured research landscape, there is also a growing body of work which focuses on ecological aspects and elucidates the neurobiological bases of environmental sound perception and cognition. We will review main questions addressed in recent work, including existing theoretical and methodological challenges and opportunities, and suggest directions for developing a more comprehensive framework for future environmental sound research and applications. A better understanding of environmental sound perception and cognition can in turn have practical implications for many diverse areas of acoustics and related fields.

Purpose: Studies of speech and text interruption indicate that the interruption rate influences the perceptual information available, from whole words at slow rates to subphonemic cues at faster interruptions rates. In young adults, the benefit obtained from text supplementation of speech may depend on the type of perceptual information available in either modality. Age commonly reduces temporal aspects of information processing, which may influence the benefit older adults obtain from text-supplemented speech across interruption rates. Method: Older adults were tested unimodally and multimodally with spoken and printed sentences that were interrupted by silence or white space at various rates. Results: Results demonstrate U-shaped performance-rate functions for all modality conditions, with minimal performance around interruption rates of 2–4 Hz. Comparison to previous studies with younger adults indicates overall poorer recognition for interrupted materials by the older adults. However, as a group, older adults can integrate information between the two modalities to a similar degree as younger adults. Individual differences in multimodal integration were noted. Conclusion: Overall, these results indicate that older adults, while demonstrating poorer overall performance in comparison to younger adults, successfully combine distributed partial information across speech and text modalities to facilitate sentence recognition.