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Speech recognition in cochlear implant users

Kaandorp, M.W.

2018

document version

Publisher's PDF, also known as Version of record

Link to publication in VU Research Portal

citation for published version (APA)

Kaandorp, M. W. (2018). Speech recognition in cochlear implant users: Outcome measures and the role of

linguistic skills.

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516088-L-bw-Kaandorp 516088-L-bw-Kaandorp 516088-L-bw-Kaandorp 516088-L-bw-Kaandorp Processed on: 2-1-2018 Processed on: 2-1-2018 Processed on: 2-1-2018

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Processed on: 2-1-2018 PDF page: 23PDF page: 23PDF page: 23PDF page: 23

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ABSTRACT

2EMHFWLYH7KHSULPDU\REMHFWLYHRIWKHVWXG\ZDVWRLQYHVWLJDWHWKHIHDVLELOLW\UHOLDELOLW\ DQGYDOLGLW\RIWKH'XWFK'LJLWV,Q1RLVH',1WHVWIRUPHDVXULQJVSHHFKUHFRJQLWLRQLQ hearing-aid and cochlear-implant users and compare results to the standard sentences-LQQRLVH6,1WHVW 'HVLJQ7KHUHODWLRQEHWZHHQVSHHFKUHFHSWLRQWKUHVKROGVIRU',1WHVWDQG6,1WHVWZDV DQDO\VHGWRGHWHUPLQHWKHYDOLGLW\RIWKH',1WHVW$VOLQJXLVWLFVNLOOVZHUHH[SHFWHGWR PDNHGLරHUHQWFRQWULEXWLRQVLQWKHVHWHVWVWKHLULQÁXHQFHZDVDQDO\]HG 6WXG\VDPSOH3DUWLFLSDQWVZHUHQRUPDOKHDULQJOLVWHQHUVKHDULQJDLGXVHUVDQG cochlear-implant users. 5HVXOWV7KH',1WHVWZDVIHDVLEOHIRUPRUHSDUWLFLSDQWVWKDQWKH6,1WHVW,QWUDFODVV FRUUHODWLRQFRH඼FLHQWVVKRZHGKLJKUHOLDELOLW\7KHVWDQGDUGHUURURIPHDVXUHPHQWZDV VPDOOHUIRUWKH',1WHVWWKDQIRUWKH6,1WHVW',1WHVWDQG6,1WHVWZHUHKLJKO\FRUUHODWHG U DQGU IRU1++$DQG&,XVHUVUHVSHFWLYHO\,QWKHUHJUHVVLRQDQDO\VLVQR VLJQLÀFDQWFRQWULEXWLRQRIEDVLFOLQJXLVWLFVNLOOVRUSHUVRQDOIDFWRUVZDVIRXQG &RQFOXVLRQ,QWKHDVVHVVPHQWRIVSHHFKUHFRJQLWLRQLQQRLVHRIDLGHGKHDULQJLPSDLUHG OLVWHQHUVZLWKKHDULQJDLGVRUFRFKOHDULPSODQWVWKH',1WHVWLVDIHDVLEOHUHOLDEOHDQG valid test. 0DUUH:.DDQGRUS Cas Smits Paul Merkus 67KHR*RYHUWV -RRVW0)HVWHQ

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INTRODUCTION

Assessment of speech-recognition abilities in noise is important to determine the LPSDFWRIKHDULQJORVVLQGDLO\OLIHVLWXDWLRQV,GHDOO\DVSHHFKLQQRLVHWHVWVKRXOGEH applicable over a wide range of hearing losses to enable comparison of results between OLVWHQHUVZLWKGLරHUHQWFDSDELOLWLHV:LWKLQOLVWHQHUVVXFKDWHVWLVXVHIXOLQGLDJQRVWLFV and in rehabilitation, e.g. over the course of rehabilitative training, for the evaluation of UHKDELOLWDWLRQDQGIRURSWLPL]LQJÀWWLQJSDUDPHWHUVRIKHDULQJDLGVRUFRFKOHDULPSODQWV 6PLWV*RYHUWVDQG)HVWHQUHFHQWO\GHYHORSHGDGLJLWWULSOHWVSHHFKLQQRLVHWHVW WKH'LJLWV,Q1RLVH',1WHVW7KH',1WHVWZDVGHYHORSHGWRVHUYHDVDQDOWHUQDWLYHWR the standard Dutch speech-in-noise test that uses short meaningful sentences (sentence-LQQRLVHWHVW6,1WHVW3ORPSDQG0LPSHQ6LPLODUVHQWHQFHLQQRLVHWHVWVH[LVWLQ RWKHUODQJXDJHVHJ+DUYDUG,(((VHQWHQFHVWKH+,17WHVW1LOVVRQ6ROLDQG6XOOLYDQ 9DLOODQFRXUWHWDO.ROOPHLHUDQG:HVVHONDPSIRUDUHYLHZVHH7KHXQLVVHQ 6ZDQHSRHOGHDQG+DQHNRP$OWKRXJKWKH6,1WHVWKDVEHHQZLGHO\XVHGLQUHVHDUFK and clinic, severe hearing impairment or limited linguistic skills (as in children or second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recognition abilities, because the use of a closed-set paradigm with easy familiar words OLPLWVWKHHරHFWRIWRSGRZQSURFHVVHVOLNHOLQJXLVWLFVNLOOV6PLWV*RYHUWVDQG)HVWHQ 7KH',1WHVWVKRXOGEHIHDVLEOHIRUDZLGHUDQJHRIOLVWHQHUVZLWKPLOGWRVHYHUH KHDULQJORVVFRFKOHDULPSODQW&,XVHUVDQGFKLOGUHQ6PLWV*RYHUWVDQG)HVWHQ HYDOXDWHGWKHWHVWIRU1+OLVWHQHUV5HSHWLWLYHWHVWLQJZLWKWKH',1WHVWVKRZHGDOHDUQLQJ HරHFWRQO\EHWZHHQWKHYHU\ÀUVWWHVWUXQDQGWKHVHFRQGUXQHYHQZLWKZHHNVEHWZHHQ separate sessions of repetitive runs. Additionally the test was validated for university students with normal hearing and a wide range of simulated hearing losses to evaluate its RXWFRPHZKLOHPLQLPL]LQJWKHHරHFWRIGLරHUHQFHVLQWRSGRZQSURFHVVLQJ7KHYDOLGLW\RI WKH',1WHVWZDVGHWHUPLQHGE\FRPSDULQJWKH',1WHVW657VZLWKWKRVHIRUWKH6,1WHVW \LHOGLQJDKLJKFRUUHODWLRQFRH඼FLHQWRI'LJLWVGRQRWFRYHUWKHFRPSOHWHSKRQHPH

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GLVWULEXWLRQRIGDLO\OLIHVSHHFKEXW6PLWV*RYHUWVDQG)HVWHQVKRZHGWKDWIRUWKH overall recognition of digits vowel, consonant, and word length recognition is needed. All LQDOOWKHUHLVVXEVWDQWLDOHYLGHQFHWKDWWKH',1WHVWLVDYDOLGWHVWIRUPHDVXULQJVSHHFK recognition abilities in noise. Currently similar tests are being developed in other countries HJ)HHQH\HWDO7KHVWXG\RI6PLWV*RYHUWVDQG)HVWHQKRZHYHUGRHVQRW VKRZZKHWKHUWKHVHSURPLVLQJUHVXOWVDOVRDSSO\WRWKHLQWHQGHGOLVWHQHUVSDWLHQWVZLWK a wide range of hearing losses and varying cognitive and linguistic abilities.

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UHFRJQLWLRQLQQRLVHDELOLW\IRU'XWFKWKH6,1WHVW3ORPSDQG0LPSHQ9HUVIHOGHW DO$GGLWLRQDOO\ZHLQYHVWLJDWHGKRZOLQJXLVWLFDELOLWLHVDQGSHUVRQDOFKDUDFWHULVWLFV IRULQVWDQFHDJHDQGHGXFDWLRQDOOHYHOLQÁXHQFHWKHUHVXOWVRI6,1DQG',1WHVWLQWKHVH listeners.

MATERIALS AND METHODS

PARTICIPANTS

7KUHHJURXSVRIOLVWHQHUVSDUWLFLSDWHG\RXQJ1+OLVWHQHUVQ +$XVHUVQ DQG &,XVHUVQ $OOSDUWLFLSDQWVZHUHRYHU\HDUVRIDJHDQGKDGQRUHOHYDQWDGGLWLRQDO PHGLFDOSUREOHPV7DEOHOLVWVWKHFKDUDFWHULVWLFVRIWKHWKUHHSDUWLFLSDQWJURXSV

TABLE 1.&KDUDFWHULVWLFVRIWKHWKUHHSDUWLFLSDQWJURXSV*URXSPHDQV6'VDQGUDQJHDUHVKRZQ

NH listeners HA users CI users

0HDQ6' 5DQJH 0HDQ6' 5DQJH 0HDQ6' 5DQJH Age [years] Age at onset of hearing loss

[years] - - Age at onset of severe

hearing loss [years] - - - - Duration of hearing loss*

[years] - - Duration of severe hearing

loss* [years] - - - - Pre-operative aided word

VFRUHDWG%63/>@ - - - - Average pure-tone threshold

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NH participants, all university students, were primarily included to serve as control group RIWKHVHWXSRIWKHVSHHFKLQQRLVHWHVWVVX඼FLHQWGDWDRQ1+VXEMHFWVDUHDYDLODEOHIRU DOORWKHUWHVWV1RUPDOKHDULQJZDVGHÀQHGDVSXUHWRQHWKUHVKROGVHTXDOWRRUEHWWHU WKDQG%+/DWRFWDYHIUHTXHQFLHVN+]LQERWKHDUV$OO1+SDUWLFLSDQWVZHUH native Dutch speakers.

HA users were patients of the ENT & Audiology department at VU University Medical &HQWHU980&LQ$PVWHUGDP7KH\UHVSRQGHGWRDQLQYLWDWLRQWRSDUWLFLSDWHLQWKHVWXG\ GXULQJDYLVLWWRWKHDXGLRORJ\FOLQLFDIWHUKDYLQJEHHQVXFFHVVIXOO\ÀWWHGZLWKWKHLUÀUVW KHDULQJDLGVRUQHZKHDULQJDLGVYDULRXVEUDQGVEHLQJXVHGIRUWKLVSXUSRVH+$XVHUV with additional medical problems or prelingually deaf patients were not invited. All had DWOHDVWWZRPRQWKVH[SHULHQFHZLWKWKHLUKHDULQJDLGVEXWWKHPDMRULW\KDGPRUHWKDQ ÀYH\HDUVH[SHULHQFH'XULQJWKHWHVWVWKH\XVHGWKHLUKHDULQJDLGZLWKWKHSURJUDPDQG volume setting they preferred for everyday use. All HA users were native Dutch speakers. &,XVHUVZHUHSRVWOLQJXDOO\GHDIZLWKRQVHWRIVHYHUHKHDULQJLPSDLUPHQWDIWHUWKHDJH RIVL[\HDUV7KH\ZHUHSDWLHQWVRIWKH(17 $XGLRORJ\GHSDUWPHQWDW980&ZKR UHVSRQGHGWRDQHPDLOLQYLWDWLRQWRSDUWLFLSDWHLQWKHVWXG\&,XVHUVZLWKDGGLWLRQDO medical problems or prelingually deaf patients were not invited. All had at least one year H[SHULHQFHZLWKWKHLU&,HLWKHU&RFKOHDU6\GQH\$XVWUDOLDQ RU$GYDQFHG%LRQLFV 9DOHQFLD86$Q 'XULQJWKHWHVWVWKH\XVHGWKHLUGHYLFHZLWKWKHSURJUDPDQGYROXPH VHWWLQJWKH\SUHIHUUHGIRUHYHU\GD\XVH$OO&,XVHUVZHUHQDWLYH'XWFKVSHDNHUVZLWKWKH H[FHSWLRQRIRQHELOLQJXDO&,XVHUZKRZDVERUQLQWKH1HWKHUODQGVEXWKDG(QJOLVK speaking parents.

Participants provided informed consent before participating, they were reimbursed for WUDYHOFRVWVDQGUHFHLYHGDIHHRIHXURVSHUKRXUIRUWKHLUFRQWULEXWLRQWRWKHVWXG\ The study was approved by the Medical Ethics Committee of VUMC.

SPEECH RECOGNITION MEASURES

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phonemes that are correctly reproduced. This test is commonly used in Dutch clinical practice. 6HQWHQFHOLVWV989HUVIHOGHWDOFRQVLVWLQJRIVKRUWPHDQLQJIXOVHQWHQFHV RUV\OODEOHVLQOHQJWKSURQRXQFHGE\DIHPDOHVSHDNHUZHUHXVHGWRWHVWVHQWHQFH UHFRJQLWLRQ7KHOLVWVZHUHSUHVHQWHGLQTXLHWDQGLQVWHDG\VWDWHORQJWHUPDYHUDJH VSHHFKVSHFWUXP/7$66PDVNLQJQRLVH9HUVIHOGHWDO7KHVFRUHLQTXLHWZDVWKH SHUFHQWDJHRIVHQWHQFHVWKDWZDVFRUUHFWO\UHSURGXFHG7KH657LQQRLVHGHÀQHGDVWKH 615ZKHUHRQDYHUDJHRIWKHVHQWHQFHVZDVUHSHDWHGFRUUHFWO\ZDVPHDVXUHGE\ WKHDGDSWLYHSURFHGXUHGHVFULEHGE\3ORPSDQG0LPSHQ7KHRYHUDOOLQWHQVLW\ OHYHOVSHHFKDQGQRLVHFRPELQHGZDVNHSWFRQVWDQWDWG%$DQGWKH615ZDVYDULHG LQDQDGDSWLYHSURFHGXUHGXULQJWKHWHVW(DFKVHQWHQFHVWDUWHGPVDIWHUWKHQRLVH ZDVVWDUWHG(DFKQRLVHWUDFNZDVPV7KHIROORZLQJSUHVHQWDWLRQVWDUWHGDIWHUWKH UHVSRQVHZDVHQWHUHG7KHÀUVWVHQWHQFHRIHDFKWULDOZDVSUHVHQWHGDWG%615DQG ZDVUHSHDWHGO\SUHVHQWHGZLWKDG%LQFUHDVHRI615XQWLOWKHSDUWLFLSDQWUHVSRQGHG FRUUHFWO\RUWRDPD[LPXPLQWHQVLW\RIG%615WRDYRLGYHU\KLJK615VDWWKHVWDUWRI WKHDGDSWLYHSURFHGXUH$OOVXEVHTXHQWVHQWHQFHVZHUHSUHVHQWHGRQO\RQFHZLWK615V GHSHQGLQJRQWKHUHVSRQVHWRWKHSUHYLRXVVHQWHQFH$IWHUDFRUUHFWUHVSRQVHWKH615ZDV ORZHUHGE\G%DQGDIWHUDQLQFRUUHFWUHVSRQVHWKH615ZDVUDLVHGE\G%$UHVSRQVH ZDVFRQVLGHUHGFRUUHFWRQO\LIWKHHQWLUHVHQWHQFHZDVUHSHDWHGZLWKRXWHUURU7KH657ZDV FDOFXODWHGE\WDNLQJWKHDYHUDJH615IRUVHQWHQFHVWRZKHUHVHQWHQFHGRHVQRW H[LVWEXWLWV615FDQEHFDOFXODWHGIURPWKHUHVSRQVHWRVHQWHQFH7KHVHQWHQFHLQ noise test with adaptive procedure is considered as the gold standard for speech-in-noise testing in Dutch clinical practice.

'LJLWWULSOHWOLVWV6PLWV*RYHUWVDQG)HVWHQFRQWDLQLQJEURDGEDQGKRPRJHQHRXV digit-triplets were used to test digit recognition. The digits are pronounced by a male VSHDNHUDQGZHUHSUHVHQWHGERWKLQTXLHWDQGLQ/7$66PDVNLQJQRLVH',1WHVW6PLWV *RYHUWVDQG)HVWHQ7KHWHVWVFRUHLQTXLHWZDVWKHSHUFHQWDJHRIGLJLWWULSOHWV UHSURGXFHGZLWKRXWHUURUDVDIXQFWLRQRILQWHQVLW\OHYHO,QQRLVHWKHVDPHDGDSWLYH SURFHGXUHZDVXVHGIRUWKH',1WHVWDVIRUWKH6,1WHVW$JDLQWKHRYHUDOOLQWHQVLW\OHYHO ZDVNHSWFRQVWDQWDWG%$DQGWKHÀUVWGLJLWWULSOHWZDVSUHVHQWHGDWG%6157KH WULSOHWVWDUWHGPVDIWHUWKHQRLVHZDVVWDUWHG1RLVHRරVHWZDVPVDIWHUWKHHQG of the triplet. Both noise intervals were enlarged or reduced by a randomly chosen interval EHWZHHQRUPV7KH657ZDVFDOFXODWHGE\WDNLQJWKHDYHUDJH615VRIWULSOHWV WR$OOWKUHHGLJLWVKDGWREHUHSHDWHGFRUUHFWO\IRUWKHWULSOHWWREHTXDOLÀHGDVFRUUHFW

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VOCABULARY SIZE

7ZRGLරHUHQWWHVWVWRPHDVXUHUHFHSWLYHYRFDEXODU\VL]HZHUHXVHG,QWKH3HDERG\ 3LFWXUH9RFDEXODU\7HVW,,,1/33976FKOLFKWLQJHDFKWHVWLWHPZDVSUHVHQWHGERWK written and spoken by the experimenter. Participants were instructed to choose one out RIIRXUSLFWXUHVWKDWEHVWPDWFKHVWKHPHDQLQJRIWKHZRUGSUHVHQWHG:HXVHGWKHODVW OLVWVRIWKH3397ZLWKLWHPVLQWRWDO7KHVHFRQGWHVWZDVWKHYRFDEXODU\VL]HVXEWHVW RIWKH*URQLQJHQ,QWHOOLJHQFH7HVW,,*,7YV/XWHLMQDQG%DUHOGVZKLFKXVHVDOLVW RILWHPV7KHSDUWLFLSDQWZDVDVNHGWRFKRRVHWKHFRUUHFWV\QRQ\PRXWRIZRUGV IRUHDFKYLVXDOO\SUHVHQWHGWHVWZRUG,QERWKWHVWVZHXVHGUDZVFRUHVWRSHUPLWGLUHFW comparison of participants.

GENERAL PROCEDURES

Tests were performed in a sound-treated booth by a trained experimenter. Speech tests ZHUH DGPLQLVWHUHG ZLWK D FOLQLFDO DXGLRPHWHU 'HFRV $XGLRORJ\ :RUNVWDWLRQ 'HFRV 6\VWHPV1RRUGZLMNWKH1HWKHUODQGV6SHHFKDQGQRLVHZHUHSUHVHQWHGWKURXJKDVLQJOH ORXGVSHDNHU<DPDKD0636WXGLR3DUWLFLSDQWVZHUHVHDWHGIDFLQJWKHORXGVSHDNHUDW DGLVWDQFHRIDSSUR[LPDWHO\FP7KHPHDVXUHPHQWSURWRFROLVVKRZQLQ7DEOH7HVWV were presented in three blocks, in the same order for every participant, in one two-hour VHVVLRQ1+SDUWLFLSDQWVRQO\SHUIRUPHGWKHVSHHFKLQQRLVHWHVWV%ORFNEHFDXVH VSHHFKUHFRJQLWLRQVFRUHVLQTXLHWFLWHGLQWKHOLWHUDWXUHIRU\RXQJOLVWHQHUVZLWKQRUPDO KHDULQJDUHRUQHDUDWDOOLQWHQVLWLHVXVHG%RVPDQDQG6PRRUHQEXUJ 9HUVIHOGHWDO6PLWV*RYHUWVDQG)HVWHQ

TABLE 2. Measurement protocol. Each participant received the three test blocks in the same order,

with material being presented in a balanced order within the blocks.

Block Test order Test Practice

list Test list intensities

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7KHÀUVWEORFNFRQVLVWHGRIWKHVSHHFKWHVWVLQTXLHW6SHHFKWHVWPDWHULDOVZHUHSUHVHQWHG LQDFRXQWHUEDODQFHGRUGHUXVLQJD[/DWLQVTXDUH:LWKLQHDFKWHVWVL[OLVWVZHUH SUHVHQWHGDWGLරHUHQWOHYHOVSUHFHGHGE\DSUDFWLFHOLVW&9&OLVWVZHUHSUHVHQWHGDW WRG%63/_{LQG%VWHSVZLWKG%63/RFFXUULQJWZLFH6HQWHQFHVDQGGLJLWVZHUH} SUHVHQWHGDWWRG%$LQG%VWHSVZLWKG%$RFFXUULQJWZLFH/LVWVZHUHSUHVHQWHG LQDÀ[HGRUGHUDQGSUHVHQWDWLRQOHYHOVZHUHFRXQWHUEDODQFHGLQDFFRUGDQFHZLWKD[ GLJUDPEDODQFHG/DWLQVTXDUH:DJHQDDUWRDYRLGOLVWHරHFWVDQGRUGHUHරHFWVLQ the average data. Per participant the same order of presentation levels was used for each speech test in this block. The second block consisted of the tests for vocabulary size, PPVT DQG*,7YVLQDÀ[HGRUGHU,QWKHWKLUGEORFNWKHVHQWHQFHVDQGGLJLWVZHUHSUHVHQWHGLQ QRLVH+DOIRIWKHSDUWLFLSDQWVZHUHJLYHQWKH',1WHVWÀUVWZKHUHDVWKHRWKHUKDOIZHUH JLYHQWKH6,1WHVWÀUVW%RWKVSHHFKLQQRLVHWHVWVZHUHFRQGXFWHGWZLFHSUHFHGHGE\D practice list.

,Q EORFNV DQG RQO\ RQH HDU ZDV WHVWHG )RXU &, XVHUV ZKR QRUPDOO\ XVHG D +$ contralaterally were asked not to use the HA on the test day. The contralateral ear was QRWRFFOXGHGLQ&,XVHUV+$XVHUVDQG1+SDUWLFLSDQWVZHUHWHVWHGRQWKHLUSUHIHUUHG ear, the contralateral ear being occluded with a hearing protector foam earplug and a FLUFXPDXUDOHDUPXර3HOWRU2SWLPH,,,

RESULTS

SPEECH RECOGNITION IN QUIET

)LJXUHVKRZVER[SORWVRIVSHHFKUHFRJQLWLRQVFRUHVLQTXLHWIRU&9&VVHQWHQFHVDQG digit-triplets for the hearing-impaired participants.

(DFKER[UHSUHVHQWVDVLQJOHPHDVXUHPHQWDWDJLYHQOHYHOH[FHSWDWG%$RUG%63/ ZKHUHWKHWHVWUHWHVWDYHUDJHZDVXVHG5HVXOWVVKRZDODUJHYDULDWLRQLQSHUIRUPDQFH DQGEHWWHUSHUIRUPDQFHIRUWKH+$JURXSWKDQIRUWKH&,XVHUVIRUDOOVSHHFKPDWHULDOV +RZHYHUIRUGLJLWWULSOHWUHFRJQLWLRQDWG%$DOOKHDULQJLPSDLUHGSDUWLFLSDQWV+$ DQG &, KDG VFRUHV QHDU UDQJH WR 7KH UDQJH ZDV PXFK ZLGHU IRU UHFRJQLWLRQRI&9&VDQGVHQWHQFHVDWWKLVLQWHQVLW\0RVW&,XVHUVKDGDUHODWLYHO\SRRU performance on sentence recognition compared to recognition of CVCs in contrast to the 6WDQGDUGFOLQLFDOFDOLEUDWLRQSURWRFROVZHUHXVHGIRUDOOVSHHFKPDWHULDO,QWKH1HWKHUODQGV&9& speech material is calibrated in dB SPL, whereas sentences and digit triplets are calibrated in dBA.

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+$XVHUV,QVSHFWLRQRILQGLYLGXDOSV\FKRPHWULFFXUYHVQRWVKRZQGHPRQVWUDWHGWKDW PRVWSDUWLFLSDQWVERWK&,DQG+$UHDFKHGWKHLUPD[LPDOVSHHFKGLVFULPLQDWLRQVFRUHV DWG%$)RUWKHVHQWHQFHWHVWWKHFXUYHVVKRZHGDGURSLQSHUIRUPDQFHDWG%$IRU WKH&,XVHUVSUHVXPDEO\FDXVHGE\WKHOLPLWHGLQSXWG\QDPLFUDQJHRIWKH&,SURFHVVRU

SPEECH RECOGNITION IN NOISE

SRTs and feasibility. )LJXUHVKRZV657VWHVWYHUVXVUHWHVWIRUWKH',1DQG6,1WHVW,W

VKRZVDODUJHYDULDQFHLQ657VIRU+$DQG&,XVHUVZKLFKLVDOVRLOOXVWUDWHGE\WKHPHDQV DQG6'VLQWDEOH,WDOVRVKRZVWKDWDOOKHDULQJLPSDLUHGSDUWLFLSDQWVKDGZRUVH657VWKDQ WKHQRUPDOKHDULQJOLVWHQHUV6L[&,XVHUVDQGRQH+$XVHUGLGQRWFRPSOHWHDWKHWHVWUXQ RIWKH6,1WHVWEHFDXVHWKH\ZHUHXQDEOHWRUHSHDWDQ\VHQWHQFHFRUUHFWO\ ,QVSHFWLRQRIWKHUDZGDWDVKRZHGWKDWWKHVHVHYHQSDUWLFLSDQWVKDGWKHORZHVWVFRUHVRQ VHQWHQFHVLQTXLHWDWG%$7KXVDJURXSRISDUWLFLSDQWVKDGUHVXOWVRQDOOVSHHFK LQQRLVHWHVWV1+OLVWHQHUV+$XVHUVDQG&,XVHUV7HVWUHWHVWGLරHUHQFHVZHUH GHWHUPLQHGDQGZHUHSDUWLFXODUO\PDUNHGIRUWKH6,1WHVWDWKLJKHU657YDOXHV)RUPDQ\ KHDULQJLPSDLUHG OLVWHQHUV WKH ORZHU PD[LPXP SHUIRUPDQFH LQ TXLHW DQG VKDOORZHU SV\FKRPHWULFFXUYHUHVXOWLQDOHVVVWHHSVORSHDWWKHSRLQW7KXVSRRUSHUIRUPDQFH LQTXLHWVHH)LJXUHZLOOOHDGWRLQFUHDVLQJXQFHUWDLQW\LQ657RXWFRPHZKLFKFDQUHVXOW LQKLJKWHVWUHWHVWGLරHUHQFHV)RUWKHVHOLVWHQHUVWKHVWDQGDUGDGDSWLYHSURFHGXUH3ORPS TABLE 3. 0HDQ657VLQG%615EHWZHHQVXEMHFWVWDQGDUGGHYLDWLRQV6'VLQWUDFODVVFRUUHODWLRQ FRH඼FLHQW,&&DQGVWDQGDUGHUURURIPHDVXUHPHQW6(0IRUVHQWHQFHV6,1WHVWDQGGLJLWWULSOHWV ',1WHVWLQQRLVHIRUSDUWLFLSDQWVZLWKQRUPDOKHDULQJ1+KHDULQJDLG+$DQGFRFKOHDULPSODQW &,XVHUV$OOWHVWVZHUHSHUIRUPHGDWDÀ[HGRYHUDOOVRXQGOHYHORIG%$

Test Participants Mean (SD) [dB SNR] ICC SEM [dB]

All data

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Learning effect. 7RLQYHVWLJDWHDSRVVLEOHOHDUQLQJHරHFWGDWDQ ZHUHDWÀUVWDQDO\VHG

ZLWKDPL[HGUHSHDWHGPHDVXUHVDQDO\VLVRIYDULDQFHZLWK7HVW1XPEHUWHVWUHWHVWDQG 6SHHFK0DWHULDO',16,1DVZLWKLQVXEMHFWYDULDEOHVDQG3DUWLFLSDQW*URXS1++$&, DVEHWZHHQVXEMHFWVIDFWRU6LQFHWKHÀUVWOLVWZDVDSUDFWLFHOLVWLWZDVQRWLQFOXGHGLQ WKHDQDO\VLV$VH[SHFWHGDPDMRUHරHFWZDVIRXQGIRU6SHHFK0DWHULDOF  pDVZHOODVDQLQWHUDFWLRQEHWZHHQ6SHHFK0DWHULDODQG3DUWLFLSDQW*URXSF  p7KHUHZDVDOVRDPDMRUHරHFWRI7HVW1XPEHUF p = EXWQRLQWHUDFWLRQEHWZHHQ7HVW1XPEHUDQG6SHHFK0DWHULDOF p = RUEHWZHHQ7HVW1XPEHUDQG3DUWLFLSDQW*URXSF p +HQFH ZHFRQFOXGHWKDWGHVSLWHWKHSUDFWLFHOLVWWKHUHZDVIRUERWK',1DQG6,1WHVWVWLOODVPDOO OHDUQLQJHරHFWEHWZHHQWHVWDQGUHWHVW7KLVHරHFWRIG%ZDVQRWVWDWLVWLFDOO\GLරHUHQW EHWZHHQ',1DQG6,1WHVWRUEHWZHHQSDUWLFLSDQWJURXSV7KHVL]HRIWKHOHDUQLQJHරHFW ZDVVPDOOFRPSDUHGWRWKH657LQFUHPHQWDQGPD\EHFRQVLGHUHGLUUHOHYDQWLQPDQ\ VLWXDWLRQV:LWKRXWSULRUSUDFWLFHZLWKWKHVSHHFKPDWHULDOLQTXLHWWKHOHDUQLQJHරHFWDQG measurement error could be somewhat higher.

Validity: relation between DIN test and SIN test. 7KHYDOLGLW\RIWKH',1WHVWZDVDVVHVVHGE\

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(16)

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(17)

0DQQ:KLWQH\ 8 WHVWV ZHUH FDUULHG RXW RQ LQGHSHQGHQW VDPSOHV VKRZQ LQ 7DEOH WRHYDOXDWHSRVVLEOHGLරHUHQFHVLQSHUVRQDOFKDUDFWHULVWLFVWKDWFDQSUHGLFWWKHDELOLW\ WRSHUIRUPWKH6,1WHVW1H[WWRDJHWKHVHZHUHVHOIUHSRUWHGYDULDEOHVGXUDWLRQRI KHDULQJLPSDLUPHQWDJHDWRQVHWRIKHDULQJLPSDLUPHQW\HDUVRI&,RU+$H[SHULHQFH DQGHGXFDWLRQOHYHO$OOZHUHQRWVLJQLÀFDQWO\GLරHUHQWEHWZHHQWKHJURXSZKHUHWKH6,1 test was feasible and that where it was not.

1H[WZHORRNHGDWGLරHUHQFHVLQSHUIRUPDQFHRQWKHOLQJXLVWLFWHVWVDQGWKH&9&WHVW between the groups, since these are aspects that should be taken into account in clinical SUDFWLFH3397UDZVFRUHVVKRZHGDQRUPDOGLVWULEXWLRQDQGUDQJHGIURPWRHUURUV PHDQ HUURUV6' HUURUVIRUWKH+$XVHUVDQGWRHUURUVPHDQ HUURUV6' HUURUVIRUWKH&,XVHUV*,7YVUDZVFRUHVVKRZHGDQRUPDOGLVWULEXWLRQDQG UDQJHGIURPWRHUURUVPHDQ HUURUV6' HUURUVIRUWKH+$XVHUVDQGWR HUURUVPHDQ HUURUV6'HUURUVIRUWKH&,XVHUV$FRPSRVLWHPHDVXUH´9RFDEXODU\ Size” was created for the purposes of further analysis by converting both test results to

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DOSKD 9RFDEXODU\6L]HZDVQRWVWDWLVWLFDOO\GLරHUHQWp EHWZHHQWKHJURXS WKDWZDVDEOHWRSHUIRUPWKH6,1WHVWDQGWKHJURXSWKDWZDVQRW$LGHGUHFRJQLWLRQRI &9&VLQTXLHWDWG%63/ZDVVLJQLÀFDQWO\ORZHUpIRUWKHJURXSXQDEOHWR SHUIRUPWKH6,1WHVW TABLE 4. &RPSDULVRQRIKHDULQJLPSDLUHGSDUWLFLSDQWVZKRZHUHDEOHWRSHUIRUPWKH6,1WHVWDQGWKRVH ZKRZHUHXQDEOHWRSHUIRUPWKLVWHVW*URXSPHDQV6'VDQG0DQQ:KLWQH\8WHVWRIWKHSHUVRQDO FKDUDFWHULVWLFVDQGWHVWRXWFRPHVDUHVKRZQ*URXSGLරHUHQFHVDUHFRQVLGHUHGVLJQLÀFDQWLIp Personal characteristics

and test scores SIN feasible(n = 36) SIN not feasible(n = 12)

0HDQ6' 0HDQ6' z p

Personal

characteristics Age [years] &,RU+$H[SHULHQFH>\HDUV@ Duration of

hearing-impairment [years] Age at onset

hearing-impairment [years] Education Test scores &9&DWG%63/>

phonemes]  <0.001 Vocabulary size [z-score] 0.07

(18)

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DISCUSSION

7KHSULPDU\REMHFWLYHRIWKLVVWXG\ZDVWRLQYHVWLJDWHWKHIHDVLELOLW\UHOLDELOLW\DQGYDOLGLW\ RIWKH',1WHVWIRUKHDULQJLPSDLUHGSDUWLFLSDQWVZLWKHLWKHUFRFKOHDULPSODQWVRUKHDULQJ DLGVDQGFRPSDUHWKHUHVXOWVZLWKUHVXOWVRIWKHVWDQGDUG6,1WHVW

(19)

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(20)

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EVALUATION OF EXTREME SRT VALUES

0DQ\VWXGLHVKDYHXVHGWKHDGDSWLYH657SURFHGXUHWRPHDVXUHWKHDELOLW\WRUHFRJQL]H VSHHFKLQQRLVHEXWLWLVQRWDOZD\VFOHDUZKHQ657UHVXOWVDUHFRQVLGHUHGXQUHOLDEOH:H IRXQGODUJHWHVWUHWHVWGLර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ÁXHQFHRIWKH657VWKDWZHFRQVLGHUHGXQUHOLDEOHZDV HVSHFLDOO\YLVLEOHLQWKHGLරHUHQFHG%RUPRUHLQ6(0YDOXHVIRUKHDULQJLPSDLUHG OLVWHQHUV7DEOH+HQFHWKHUHLVODFNRIDJUHHPHQWRQWKHFULWHULRQWRMXGJHZKHWKHUDQ individual result for a speech-in-noise test with an adaptive procedure is reliable. Such a ZHOOGHÀQHGFULWHULRQLVQHHGHGWRDYRLGDVHOHFWLRQELDVLQWKHUHVXOWV7KLVSUREOHPLV PXFKOHVVSUHVHQWLQWKH',1WHVW

INFLUENCE OF LINGUISTIC AND PERSONAL FACTORS

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FU\VWDOOL]HGNQRZOHGJHZDVQRWDSUHGLFWRURIZRUGUHFRJQLWLRQLQQRLVHXQGHUFRQGLWLRQV LQYROYLQJ GLරHUHQW OHYHOV RI FRQWH[WXDO SUREDELOLW\ EXW KHDULQJ DFXLW\ DQG FRJQLWLYH IXQFWLRQÁXLGDELOLWLHVZHUHVLJQLÀFDQWFRQWULEXWRUVWRWKHYDULDQFHREWDLQHG,QIXWXUH studies we will also explore other, more process-related, measures of linguistic abilities and WKHLUUROHLQVSHHFKUHFRJQLWLRQ:HFRQFOXGHWKDWWKH',1WHVWPHDVXUHVDSSUR[LPDWHO\ DVLPLODUDELOLW\DVWKH6,1WHVW 7KHORJLVWLFUHJUHVVLRQGLGVKRZWKDW&9&VFRUHDWG%63/ZKLFKLVLQWKHFOLQLFXVXDOO\ NQRZQIRUKHDULQJLPSDLUHGOLVWHQHUVZDVDJRRGSUHGLFWRURIWKHDELOLW\WRSHUIRUPWKH 6,1WHVW6PLWV*RYHUWVDQG)HVWHQIRXQGQHDUSHUIHFWUHFRJQLWLRQRIVSHFWUDOO\ VPHDUHGDQGORZSDVVÀOWHUHGGLJLWWULSOHWVLQTXLHWDWG%$ZKHUHDVUHFRJQLWLRQVFRUHV IRU&9&VDWG%$LQWKLVFRQGLWLRQZHUHRQO\DSSUR[LPDWHO\)RUWKHPRUHGL඼FXOW ÀOWHUHGVLJQDOFRQGLWLRQVWKHSHUIRUPDQFHRIGLJLWWULSOHWVLQTXLHWDOVRGURSSHG+HDULQJ LPSDLUHGOLVWHQHUVLQWKHFXUUHQWVWXG\DOOKDG&9&VFRUHVRIRUKLJKHULQTXLHWDW G%63/7KHVHUHVXOWVFRQÀUPWKDWWKH',1WHVWLVDWOHDVWDSSOLFDEOHIRUSHUVRQVZLWK&9& VFRUHVLQTXLHWRIRUPRUHDWG%63/

COMPARISON TO OTHER TESTS

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WRHYHQDEURDGHUJURXSRIOLVWHQHUVZRUVHKHDULQJORVVHVDQG\RXQJFKLOGUHQ$OWKRXJK GLJLWVGRQRWFRYHUWKHFRPSOHWHUDQJHRISKRQHPHVLQGDLO\OLIHVSHHFK6PLWV*RYHUWV DQG)HVWHQVKRZHGWKDWQRWRQO\YRZHOEXWDOVRFRQVRQDQWUHFRJQLWLRQLVLPSRUWDQW in this test. The use of digits makes it easy to translate the test to other languages, and therefore might enable comparison of large groups of listeners.

CONCLUSIONS

7KHUHVXOWVRIWKLVVWXG\GHPRQVWUDWHWKDWWKH',1WHVWLVDIHDVLEOHUHOLDEOHDQGYDOLG WHVWIRUPHDVXULQJVSHHFKUHFRJQLWLRQLQQRLVHLQ+$DQG&,XVHUVZLWKDZLGHUDQJHRI KHDULQJORVVHV7KHYDOLGLW\RIWKH',1WHVWLVGHPRQVWUDWHGE\WKHKLJKFRUUHODWLRQZLWK WKH6,1WHVWWKRXJKWKHUHODWLRQEHWZHHQ',1DQG6,1VFRUHVLVVOLJKWO\GLරHUHQWIRU&, XVHUVWKDQIRU+$XVHUVDQG1+OLVWHQHUV9RFDEXODU\VL]HZDVQRWVLJQLÀFDQWO\UHODWHG WRWKHGLරHUHQFHEHWZHHQ6,1RU',1UHVXOWV7KH',1WHVWFDQEHUHSHDWHGPDQ\WLPHV DQGLVQRWWLPHFRQVXPLQJZKLFKPDNHVLWVXLWDEOHIRUWKHIROORZXSRI+$DQG&,XVHUV

Declaration of Interest: The authors would like to thank Cochlear Europe LTD for their

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