Sunday, May 11, 2025
5/11/2025
Binaural processing and hearing in children with cochlear implants - Abstract There is strong clinical impetus to provide bilateral hearing early in life, not only for safety in navigating the environment, but also to maximize learning and socializing in mainstreamed settings. Although this topic is an active area of research, we lack critically important information on how to assess and interpret the impact of age at onset of deafness and auditory experience in children with bilateral cochlear Implants (CIs). Four groups of bilateral CI users and normal hearing (NH) participants in the same age ranges will be recruited to test hypotheses about the role of auditory experience and inter-implant delay in emergence of binaural hearing, functional listening and cognition. Here we propose novel studies aimed at gaining fresh insight into the role of auditory experience and inter-implant delay on outcomes. We will integrate perceptual and electroencephalographical (EEG) measures of binaural integrity (Aim 1), and functional listening with binaural cues (Aim 2). Further, cognitive measures of executive function (EF) are introduced to promote novel discovery of the association between binaural listening measures and EF (Aim 3). By synergistically combining these approaches, this project will be the first to provide urgently needed answers to timely and clinically critical questions regarding pediatric cochlear implantation. An important barrier to maximizing outcomes stems from engineering limitations whereby CIs are lacking binaural coordination. In addition, while speech envelope (ENV) cues are preserved in speech signals, cues that are significant for binaural hearing, namely temporal fine structure (TFS) cues, are not preserved in CI processing. We will systematically manipulate the control of ENV and TFS cues by using either research processors that allow exquisite control of timing of stimuli reaching each electrode or presenting stimuli to clinical processors and in free field, where stimulation is more akin to today’s CI processing. comprehensive investigation into outcomes in children with bilateral CIs, using perceptual, eye tracking and EEG measures at multiple levels of auditory processing. The stepwise assessment along the neural axis, from brainstem to auditory cortex, to cortical connectivity and whole brain coherence analyses, will enable us to understand which perceptual deficits are associated with abnormal neural processing. Cognitive measures are introduced to promote novel discovery of how abnormal neural development is related to EF, and if these effects show pervasive effects beyond auditory-based EF tasks. This information is important for understanding how the timing of bilateral CIs is related to a set of cognitive processes– regulating attention, memory, and controlling cognitive behaviors – necessary for success across academic, social, and daily living domains. We will harness the tests used in our studies to develop a clinical assessment toolbox that can be used by clinicians to assess binaural hearing abilities, and our findings will further identify which cognitive EF measures should be use along with auditory measures to clinically assess outcomes in children. Results will inform selection of design features in engineering CIs, with an emphasis on binaural processors, thus aiming to reduce the gap in performance relative to NH listeners.
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