Hearing devices such as hearables, personal sound amplification products, hearing aids, and active hearing protectors providing amplification in some settings are increasingly used by individuals with normal hearing. However, the benefits of providing amplification in this population remain unclear. This study investigated the effects of amplification on hearing thresholds, speech intelligibility in quiet, and experienced listening effort in normal-hearing listeners. Forty-four young adults with clinically normal hearing participated in two experiments comparing three conditions: open ear, aided with 0 dB insertion gain to approximate acoustic transparency, and aided with 15 dB flat insertion gain. Amplification was provided using a research hearing aid fitted with closed foam earplugs. Speech intelligibility was assessed with the Oldenburg Sentence Test, and experienced listening effort was measured using Adaptive CAtegorical Listening Effort Scaling (ACALES). Listening through the nominally transparent device introduced consistent disadvantages, including elevated hearing thresholds, reduced speech intelligibility, and increased listening effort. Providing 15 dB of amplification partially compensated hearing threshold elevation, fully restored speech intelligibility and reduced experienced listening effort beyond the unaided condition. Benefits of amplification at low input levels were primarily limited by the equivalent input noise of the hearing-aid microphones. These findings suggest that amplification can provide meaningful benefits for normal-hearing listeners at low speech levels, particularly when listening effort is considered alongside speech intelligibility. Future studies should examine these effects under more ecologically valid listening conditions, and potential benefits of increased amplification in hearing-impaired listeners.
Hearing aids have improved speech intelligibility but not speech emotion perception in older adults with hearing loss. Hearing loss has also been linked to altered brain responses to emotional non-speech sounds, potentially contributing to the speech emotion perception deficits even under aided listening. While fMRI requires hearing aid removal due to metal incompatibility, fNIRS is silent and hearing-aid compatible, creating a novel opportunity to identify neural processes during aided listening. We leveraged fNIRS to examine how hearing aids affect brain function in experienced hearing-aid users during speech emotion perception. Older adults (17 normal hearing, 14 hearing-aid users) judged vocal-emotion changes in speech while fNIRS recorded hemodynamic activity. Hearing-aid users completed the task under aided and unaided listening. Behaviorally, hearing aids did not improve speech emotion perception, replicating prior research. In cortical responses, individuals with hearing loss showed increased planum temporale activity, regardless of hearing-aid use. Unaided listening showed additional frontal recruitment, including increased medial superior frontal gyrus activity and stronger functional connectivity between inferior frontal and superior temporal gyri. Conversely, aided listening increased inferior parietal lobe activity, but reduced connectivity between inferior frontal gyrus and inferior parietal lobe. Together, findings indicate that hearing aids partially modify cortical processing of emotional speech. They reduced reliance on frontal compensatory control systems and increased engagement of a higher-order parietal region, consistent with partial restoration of bottom-up auditory information during aided listening. Persistent abnormalities in early auditory processing and incomplete sensorimotor integration may explain why hearing aids fail to normalize speech emotion perception.
Age-related hearing loss (ARHL) often leads to hearing difficulties, impacting communication and daily functioning even among hearing-aid users. While hearing loss and cognitive functions, such as cognitive shifting ability, have been proposed as predictors of hearing difficulties, their specific contributions remain unclear. This study investigated whether hearing loss and cognitive shifting ability predict self-reported hearing difficulties across the Speech, Spatial, and Qualities of Hearing Scale questionnaire (SSQ) subscales in adults with ARHL who use hearing aids, and whether sex moderates these associations, while controlling for age and level of education. A total of 215 adults underwent audiometry, completed a cognitive flexibility task, and answered the SSQ questionnaire, of which 203 (89 females) were included in our analysis. Hierarchical multiple regression analyses revealed that less hearing loss predicted lower levels of hearing difficulties in the three subscales of the SSQ, and higher education level was a significant predictor of less reported difficulties in the Speech and Spatial subscales. Contrary to our expectations, cognitive shifting ability was not associated with hearing difficulties in any subscale, nor did sex moderate the associations between cognitive shifting ability, degree of hearing loss and hearing difficulties. The findings highlight the influence of hearing loss and education on self-reported hearing difficulties and suggest that cognitive shifting ability does not play a significant role. Future studies should explore other cognitive and demographic factors that might contribute to hearing difficulties in hearing-aid users.
This study aimed to determine hearing benefits and challenges for children using cochlear implants (CIs) in one ear and acoustic hearing in the other (bimodal hearing) through hearing aids (HA-CI) or normal hearing (single-sided deafness/SSD-CI). Participants were 34 children with CIs [MAge (SD)=12.2 (3.2) years] and 6 peers with typical hearing/controls [MAge (SD)=13.8 (1.7) years]. Side of better hearing (aural preference) was measured by word recognition in quiet and noise, and spondee-word recognition thresholds in noise co-located/0° or separated (left/right 90°). Self-reported hearing was measured using the Speech, Spatial and Qualities of Hearing Scale (SSQ). Localization of stationary and moving sound (and unrestricted head movements) and sensitivity to interaural level and timing cues were measured (separate controls [n=5, MAge (SD)=14.0 (1.6) years]). Speech perception using the CI alone was similar in children with SSD-CI and HA-CI (p=0.84) but SSD-CI users had greater aural preference in their acoustic ear (p<0.01). CI users had high errors localizing stationary sound and poor moving sound detection (p<0.001) which was associated with earlier onset of hearing loss, and poor access to interaural cues (p<0.001) compared to controls. Head movements in children with CIs tended to favour their non-implanted ear (p<0.05). Results indicate that children with asymmetric hearing gain speech perception with their CI but have aural preference for the non-implanted ear, particularly in the presence of good residual hearing and later onset of hearing loss. Bimodal listeners had poor access to binaural cues, poor spatial hearing with slightly better results in children with later onset of hearing loss and ineffective gaze movements.
Digital interventions are increasingly used to support hearing aid users; however, evidence for first-time hearing aid users remains unclear. This systematic review and meta-analysis evaluated the efficacy and effectiveness of digital interventions to improve outcomes for first-time hearing aid users. The protocol was pre-registered (PROSPERO; CRD420251125785) and conducted in accordance with PRISMA 2020. PubMed, Scopus, and Web of Science were searched (January 2026). Eligible studies included randomized controlled trials, controlled clinical trials, and quasi-experimental studies evaluating internet-, app-, or web-based interventions. Outcomes were grouped into six domains: hearing aid use, benefit and satisfaction, hearing and communication, knowledge, skills and self-management, speech-in-noise performance, and psychosocial and emotional adjustment. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence using GRADE. Random-effects meta-analyses were conducted where ≥3 randomized trials reported comparable outcomes. Eleven publications (nine trials) were included. Most interventions focused on education, self-management, and counseling, with few targeting perceptual training. The most consistent improvements were observed in knowledge, skills and self-management (moderate-certainty). Evidence for hearing aid use, benefit and satisfaction, hearing and communication, and psychosocial and emotional adjustment was limited and inconsistent (low-certainty), while speech-in-noise evidence was of very low certainty. Meta-analyses of hearing aid use and IOI-HA outcomes showed no significant pooled effects. Digital interventions show the most consistent evidence for improving knowledge, skills, and self-management. Evidence for other outcomes remains limited and inconsistent. Clinicians may consider digital educational programs complementing standard care. Future research should prioritize larger, pre-registered trials with broader interventions and standardized outcomes.
Preferences for advanced hearing aid (HA) noise management features, such as directionality and noise reduction (DIR + NR), differ significantly among users. Due to the lack of standardized clinical guidelines for fine-tuning these features, audiologists often rely on individual user preferences. However, this approach doesn't always ensure optimal hearing outcomes. The goal of this study was to examine how users respond to these advanced features in everyday acoustic environments, with two main goals: to assess how sensitive users are to changes in DIR + NR settings compared to subtle gain adjustments, and to identify the factors influencing DIR + NR preferences in various situations. A total of 123 individuals using bilateral HAs participated in the study, conducted at two locations in Germany and Japan. Over six testing periods (half a year), participants were provided with two listening programs that differed either in the strength of their DIR + NR settings or in gain levels for high-frequency and soft sounds. Participants documented their preferences via self-initiated questionnaires, reporting experiences with the different settings in real-life listening scenarios. Most participants preferred modest adaptive DIR + NR settings and participants generally expressed higher preference strength for small gain changes than for variations in DIR + NR. Preferences could not be reliably predicted from audiologic or environmental factors, apart from a minor influence of subjective noisiness. These findings suggest that clinicians can guide the initial fitting of DIR + NR settings to optimize speech-in-noise performance, as adaptive DIR + NR configurations are broadly acceptable. User preferences remain important, particularly during gain fine-tuning, as small adjustments can be noticeable.
Assigning individuals with hearing impairment to auditory profiles can support a better understanding of the causes and consequences of hearing loss and facilitate profile-based hearing-aid fitting. However, the factors influencing auditory profile generation remain insufficiently understood, and existing profiling frameworks have rarely been compared systematically. This study therefore investigated the impact of two key factors-the clustering method and the number of profiles-on auditory profile generation. In addition, eight established auditory profiling frameworks were systematically reviewed and compared using intrinsic statistical measures and manifold learning techniques. Frameworks were evaluated with respect to internal consistency (i.e., grouping similar individuals) and cluster separation (i.e., clear differentiation between groups). To ensure comparability, all analyses were conducted on a common open-access dataset, the extended Oldenburg Hearing Health Record (OHHR), comprising 1,127 participants (mean age = 67.2 years, SD = 12.0). Results showed that both the clustering method and the chosen number of profiles substantially influenced the resulting auditory profiles. Among purely audiogram-based approaches, the Bisgaard auditory profiles demonstrated the strongest clustering performance, whereas audiometric phenotypes performed worst. Among frameworks incorporating supra-threshold information in addition to the audiogram, the Hearing4All auditory profiles achieved the lowest normalized Davies-Bouldin (DB) score, while the BEAR auditory profiles performed better on the other intrinsic measures. In conclusion, separability should be considered a primary criterion in auditory profile generation, as it directly determines how meaningfully different profiles can be distinguished in practice. Manifold learning and intrinsic measures enable systematic comparisons of auditory profiling frameworks and identify the Hearing4All auditory profile as a promising approach for future research.
Previous studies have shown that older adults can witness a decline in the integration of their spatial auditory cues even when they don't present pathological audiometric thresholds. Nonetheless, when spatial hearing in aging is discussed, most of the focus concerns elderly individuals with hearing impairments or presbycusis, rather than those with clinically normal hearing. In fact, auditory aging (even without presbycusis) may still result in a decline in spatial sensitivity, potentially contributing to the deterioration of key binaural functions crucial for speech understanding, such as binaural summation, squelch effect, and head shadow effect. The current study aims to determine whether Event-Related Potentials (ERPs) can reflect auditory spatial aging in populations without abnormal audiometric thresholds. Using a spatial oddball paradigm, we aim to explore the neural components associated with spatial sensitivity and examine whether these components correlate with changes in binaural integration with age. Our findings suggested a decrease in spatial auditory performance, speech in noise comprehension, and cognitive status across age even when audiometric thresholds were normal. Electroencephalograhy investigation revealed a strong correlation between N100 amplitudes and age, in addition to correlation between unmasking function and N100 amplitudes. These findings underscore the validity of ERP components as markers of spatial hearing performance and aging. This could orient the decision-making concerning the necessity for hearing rehabilitation in some cases to compensate for deficits and prevent auditory aging consequences on peripheral and central auditory processing.
Ecological Momentary Assessment (EMA) is a timely method for capturing differences between hearing aids (HAs) or HA features in real-world environments. Studies vary greatly in reporting periods, specifically how long ago an event can have occurred to still be reported and how events are selected when not summarizing over a period of time. The potential effects of different reporting periods on HA or HA feature contrast remain unexplored. In a 14-day EMA study, 22 hearing-aid users assessed both a basic and an advanced HA program, which were switched daily without participant control. Several times daily, participants used a smartphone app to report on satisfaction with the HA program, overall listening experience, sound quality, and listening effort. The app had participants focus on the current situation, denoting a momentary reporting period, and the worst listening experience within the previous 30 min, denoting a short-term retrospective period. Participants also completed an end-of-day questionnaire. Sound-pressure levels and HA classifier data were recorded continuously. Mixed modeling was used to examine the impact of reporting periods on ratings. Main findings showed no rating differences between the two HA programs in momentary or end-of-day assessments. However, differences emerged in short-term retrospective reporting, thus in the assessments of the worst experience within the preceding 30 min. Various time effects were also observed. Depending on the reporting period, the analysis of sound-pressure levels and HA classifier data revealed variations in real-world snapshots. In conclusion, this study underscores the need to diligently define reporting periods in hearing-related EMA research.
In birds, detection of sound source azimuth begins in the nucleus laminaris (NL), which computes interaural time differences (ITDs). Inhibition has been proposed to protect NL neurons from losing ITD sensitivity with increasing sound level, although the nature of this inhibition is incompletely understood. Anatomical studies show GABAergic synapses throughout NL and first order nuclei, while in vitro studies in chicken NL showed that GABAergic inhibitory postsynaptic potentials (IPSPs) shorten membrane time constants, perhaps to allow the membrane potential to follow rapid synaptic currents accurately over a range of sound levels. Given the importance of inhibition in regulating auditory brainstem activity, we examined the nature of inhibitory input to NL in vivo. The Superior Olivary Nucleus (SON) is the major source of descending GABAergic inhibition to the ipsilateral nucleus magnocellularis (NM), nucleus angularis (NA) and NL, and receives excitatory input from NA and NL. We used viral tracers to reveal projections from SON to NL, and characterized response types within SON. In NL, we isolated inhibitory synaptic contributions from extracellular field potentials through the iontophoretic application of blockers of GABA (gabazine) or glycine (strychnine). These blockers increase onset and offset responses evoked by tonal stimuli, but did not shift best ITD. The co-application of gabazine and strychnine revealed supra-linear summation of GABA and glycine. Profiles of synaptic activation revealed more prominent inhibition following stimulus offset, suggesting inputs to NL originate from both sustained and offset response types of the SON. These heterogeneous responses may represent separate SON neuronal populations. Together, our results support the role of SON inhibition in increasing the dynamic range of ITD tuning of NL neurons.
Previous research has highlighted challenges for individuals with hearing loss, including increased listening effort and fatigue. This study aimed to: (a) examine the relationship between auditory demand and listening effort, affect, and fatigue, focusing on the moderating role of hearing loss; and (b) assess whether listening effort and affect mediate the effect of auditory demand on fatigue. A total of 130 participants, with and without hearing loss, participated in EMA over 5.5 days, answering questions on listening effort, fatigue, and listening environment attributes. Auditory demand was defined by contextual and subjective components derived from EMA responses. LME models analyzed the effect of auditory demand on listening effort, affect, fatigue and the moderating role of hearing loss. Additional models tested mediation by listening effort and affect. Results: highlighted that both contextual and subjective auditory demand significantly increased listening effort with stronger effects in those with more hearing loss. No effects of contextual auditory demand on affective state were observed, nor was there a moderation effect of hearing loss. An effect of subjective auditory demand on affect was observed, but no moderation of hearing loss was present. Contextual and subjective auditory demand predicted fatigue (β = 0.07-0.14, p < .01-p < .001) with amplified effects present in those with more hearing loss (pinteraction < .01) for contextual demand. Mediation analyses highlighted that listening effort contributed to the demand-fatigue relationship, though patterns differed by demand type. The results indicate that increased listening effort, rather than negative affect, may underlie the association between auditory demand and fatigue.
Individuals with hearing loss, even when using hearing aids, often perceive pleasant environmental sounds as less pleasant than do those with normal hearing. This bias in emotional response may negatively impact well-being, leading to decreased social participation and increased loneliness. The present study examined whether the Positive Focus intervention-encouraging hearing aid users to focus on positive listening experiences-could influence emotional response to environmental sounds. Thirty participants were randomly assigned to either a Positive Focus or a Control group. At the initial laboratory visit, all participants were fitted with study hearing aids and performed affective ratings of 120 environmental sounds. Over 3 weeks, both groups wore the hearing aids; the Positive Focus group additionally reported daily positive listening experiences via a text message. At the end of the three-week period, participants completed questionnaires on hearing aid outcomes and repeated the affective ratings. The Positive Focus intervention did not alter emotional responses to environmental sounds in a laboratory setting. However, regression analyses revealed that valence ratings of typically pleasant sounds moderated the effectiveness of Positive Focus on hearing aid benefit; the intervention was more effective for individuals less naturally inclined to respond positively to such sounds. These findings suggest that valence screening may help identify individuals most likely to benefit from Positive Focus, supporting more personalized hearing care strategies.
Adult-onset hearing loss is associated with cognitive decline, although the mechanisms underlying this relationship remain unclear. Emerging evidence suggests that the early stages of hearing loss can alter brain network dynamics, which may be detectable before other neurocognitive markers. This systematic review aims to present evidence for altered brain connectivity in age-related hearing loss, and its subsequent relationship with cognitive performance. The review was preregistered in the Prospective Register of Systematic Reviews and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We screened 203 articles from 4 databases, of which 25 cohort and case-control studies published between 2019 and 2025 met the inclusion criteria. According to the Newcastle-Ottawa Scale, 76% of the included studies were classified as high methodological quality. The findings show that older adults with age-related hearing loss exhibit changes in brain connectivity. A novel finding is the disruption of higher-order networks, such as the Default Mode Network, and its association with reduced performance in cognitive control functions, particularly shifting. This may shed light on the association between hearing loss and cognitive decline, although causality has yet to be established. These findings suggest that brain connectivity may serve as an early neural correlate of cognitive vulnerability and inform future research into interventions targeting cognitive decline.
Measures of speech intelligibility in noise show limited correspondence with difficulties people with hearing loss report from daily life. This mismatch suggests that standard measurement conditions do not sufficiently capture aspects that are relevant for speech perception, such as dip listening and spatial release from masking. In the present study we developed and evaluated a test condition that incorporates these aspects and compared it with a standard condition. Speech intelligibility was measured in 100 participants with normal hearing (NH, N=17) and hearing loss (HL, N=83) ranging from mild to severe. Measurements were conducted using the German matrix sentence test (OLSA) in the standard condition with frontal presentation of stationary noise co-located with the target speech, and the proposed condition with fluctuating, speech-like maskers spatially separated (±60°) from the target. Stimuli were presented via headphones using virtual acoustics. Tests were performed unaided and with individualized amplification. The proposed condition revealed reduced speech intelligibility also for listeners with HL that showed close-to-normal speech intelligibility in the standard condition. With individualized amplification, more listeners with HL showed reduced speech intelligibility compared to NH listeners than in the standard condition. Benefit of amplification varied widely across individuals with similar hearing thresholds, with some listeners showing little or no benefit. The advantages of the proposed condition were driven by masker fluctuations rather than by spatial separation of sound sources. These findings demonstrate that speech intelligibility measurements incorporating fluctuating maskers provide potentially relevant information beyond standard assessments and can support a more individualized assessment of hearing loss.
The purpose of this study was to evaluate the effect of sound quality on ratings of mood (esteem-related affect, vigor, and fatigue), listening-related fatigue, and perceived hearing-related experiences (speech intelligibility, perceived disability, participation, concentration). Thirty adults (51-80 years old) with bilateral hearing loss and at least six months of hearing aid experience participated in this crossover study. They adjusted hearing aids based on sound quality in a laboratory setting, creating a preferred program (good sound quality) and a non-preferred program (tolerable sound quality). After a cooling-off period, they wore each hearing aid program (counterbalanced) home for approximately one week each. During the home trial, they provided ratings of hearing aid sound quality, mood, and hearing-related experiences daily. After each home trial, they rated their listening-related fatigue retrospectively. Sound quality ratings were significantly related to hearing-related experiences and mood ratings during the home trial. Nineteen of the participants preferred their "good" program during the home trial, while the remaining 11 preferred the "tolerable" program. For the participants whose program preference was consistent between the lab and home experiences, listening-related fatigue and mood were significantly better during the week with the "good" program. These results highlight the importance of sound quality for listening-related fatigue and mood for adult hearing aid users.
Deep neural network (DNN)-based noise reduction has emerged as a promising advancement in hearing aid signal processing as a means to improve speech intelligibility in noisy environments for hearing aid wearers. The aim of this study was to investigate the impact of the DNN on speech intelligibility in speech-shaped noise (SSN) and multitalker babble (MTB) when the target speech was coming from the front and from the side. Subjective ratings of clarity, total impression, listening effort, and background noise awareness were also collected. Twenty adult participants with mild to moderately severe sensorineural hearing loss were fitted with hearing aids from a single manufacturer, programmed with four different settings that varied across combinations of microphone directionality (omnidirectional and directional beamforming) and noise reduction (off, traditional, DNN). Results showed that DNN, when combined with beamforming, consistently outperformed the other programs across all metrics. Outcomes were influenced by both noise type and spatial configuration. DNN was more effective in SSN than MTB. Beamforming was especially beneficial when the target speech came from the front. Listening in programs that included both DNN and beamforming together resulted in additional benefits shown in the outcome measures, most likely due to the beamforming improving the signal-to-noise ratio and providing a cleaner signal for the DNN to work with.
Cochlear implants (CIs) effectively restore speech understanding in quiet for many recipients. However, bilateral CI listeners continue to perform poorer than acoustic-hearing listeners on spatial-hearing tasks such as sound localization. One explanation is that stimulation strategies and the lack of coordination across sound processors degrade the fidelity of binaural cues. To provide further insight on this issue, this study compared the binaural cues transmitted by two CI stimulation strategies: a spectral peak-picking stimulation strategy and a constantly stimulating strategy. Two clinical CI sound processors were placed on a binaural manikin centered in a horizontal ring of loudspeakers in an anechoic chamber. Speech and non-speech stimuli were presented from the loudspeakers and the resulting electrical pulse trains were recorded. Envelope interaural time differences and interaural level differences were extracted from the recordings. Binaural cues were compared between the two stimulation strategies and against acoustic cues measured using behind-the-ear microphones. Results showed that, compared to the constantly stimulating strategy, the spectral peak-picking strategy led to more variable and less monotonic binaural cues, which could constrain sound-localization abilities. These findings highlight the need for bilateral coordination of CIs in multiple domains, including electrode selection in peak-picking stimulation strategies and pulse timing. (198/250).
This study investigates the impact of uncalibrated consumer hardware on the outcomes of the German Matrix Sentence Test (GMST) in a remote setting. Speech-in-noise tests like the MST are relevant in audiology, as they better reflect everyday listening conditions compared to pure-tone audiometry. Due to their suprathreshold signal presentation and robustness against calibration offsets, they are particularly suitable for remote testing. It is unclear, however, if a sensitive and efficient test like the MST exhibits the same robustness against uncontrolled conditions in remote testing with uncalibrated consumer devices. This motivates the systematic assessment of the online MST's reliability and its agreement with laboratory administration, conducted in normal-hearing participants using the browser-based platform "Virtual Hearing Clinic" (VHC). Twenty normal hearing participants completed the test in a randomized sequence: once in a lab with calibrated equipment and twice remotely via the VHC using uncalibrated consumer devices (smartphones, laptops, headphones).Resultsrevealed no significant influence of headphone type, test environment, or pure-tone average. The remote condition demonstrated high test-retest reliability (r = 0.82) and strong correlation with lab-based measurements (r = 0.78). A mean bias of 0.29 dB in speech recognition thresholds was observed with slightly better performance in the lab, though not statistically significant (p = 0.15). Overall, results demonstrate that the MST, when implemented remotely and using uncalibrated consumer hardware, yields results of accuracy and reliability comparable to those obtained in the lab for normal hearing, supporting further applications of remote hearing assessments with optimized test materials.
Hearing-related quality of life is a crucial outcome for adults with cochlear implants. The Cochlear Implant Quality of Life (CIQOL)-35 Profile is a patient-reported outcome measure originally developed in English. In a previous study, this instrument was cross-culturally adapted into German to address the need for standardized assessment tools in German-speaking regions. To ensure the adapted instrument meets psychometric criteria, validation is required. The German adaptation of the CIQOL-35 Profile was validated through an online survey including questions on demographics, the German CIQOL-35 Profile, and the German Nijmegen Cochlear Implant Questionnaire (NCIQ). The collected data were analyzed for reliability and validity. A total of 204 adults (aged 19-87 years) with bilateral hearing loss completed the online survey. Cronbach's α between 0.84 and 0.91 demonstrates good internal consistency for all subscales of the CIQOL-35 Profile and the global outcome. Moderate to strong correlations (rs = 0.55-0.85) between the CIQOL and NCIQ indicate good convergent validity. Confirmatory factor analysis established construct validity for the German CIQOL instruments. These findings confirm that the adapted German version of the CIQOL instruments is a reliable and valid measure for assessing hearing-related quality of life in adults with cochlear implants and demonstrates higher validity than the NCIQ. The availability of the CIQOL in multiple languages facilitates international comparability of research results and increases clinical application. Implementing quality of life instruments in clinical practice enables a more comprehensive evaluation of patient outcomes and may help identify patient needs that may be addressed in therapy and rehabilitation.
Implicit learning is thought to play an important role in speech recognition under challenging conditions. However, auditory deprivation has been proposed to influence implicit learning, including in the visual modality, although evidence in adults with post-lingual deafness is limited. Therefore, we investigated implicit visual learning and its associations with speech recognition in adults with post-lingual deafness who use cochlear implants (CIs). Thus, this study focuses on the effects of late auditory deprivation rather than on the effects of early deprivation associated with congenital deafness. Adult CI users (n = 30) and a group of individuals with normal hearing (NH, n = 36) completed two implicit visual learning tasks (statistical and perceptual), a battery of challenging speech recognition tests and cognitive measures (vocabulary, working memory, attention, and verbal processing speed). NH listeners demonstrated significant visual statistical learning, whereas CI users showed a similar but nonsignificant pattern. In the visual perceptual learning task, both groups exhibited comparable learning effects. In CI users, visual statistical learning contributed to the recognition of speech in noise (words and sentences). Visual perceptual learning only contributed to the recognition of words in noise. The current findings are inconsistent with the idea that auditory deprivation beyond the sensitive period interferes with visual learning. Rather, in CI users, visual implicit learning contributes to the recognition of challenging speech. Therefore, future work might investigate whether visual learning in CI candidates is predictive of postimplantation milestones.