Effects of Presentation Level on Phoneme and Sentence Recognition in Quiet by Cochlear Implant Listeners

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Abstract
The objectives of this study were to characterize the effects of presentation level on speech recognition in quiet by cochlear implant users with the Nucleus 22 SPEAK and Clarion v1.2 CIS speech-processing strategies, and to relate speech recognition at low presentation levels to stimulus audibility as measured by sound field thresholds. It was hypothesized that speech recognition performance in both Nucleus SPEAK and Clarion CIS participants would decrease as presentation level was decreased below 50 to 60 dBA, due to audibility limitations. However, it was expected that such level effects would be less severe in CIS participants than in SPEAK participants because the Clarion v1.2 device encodes a wider acoustic dynamic range (up to 60 dB) than the Nucleus 22 device (30 dB). Performance-intensity (P-I) functions for vowels, consonants and sentences in quiet were obtained from each participant. P-I functions incorporated speech levels of 70, 60, 50, 40 and 30 dBA. Subjects used their clinical speech processor maps and adjusted the loudness (volume/sensitivity) controls on their processors so that speech presented at 60 dBA was comfortably loud. Maps were created using default clinical procedures and were not adjusted to optimize sound field thresholds. Sound field thresholds and dynamic ranges were measured for warbled pure tones with frequencies of 250 to 6000 Hz. Consonant and sentence recognition showed strong level effects for both SPEAK and CIS participants, with performance decreasing substantially at levels below 50 dBA in most individuals. Vowel recognition showed weaker level effects. For all three speech materials, SPEAK and CIS participants demonstrated similar mean performance at 70 dBA; however, SPEAK participants showed larger reductions in performance than CIS participants with decreasing level. Sound field thresholds were more sensitive for CIS participants than for SPEAK participants, supporting the hypothesis that performance differences were related to audibility. Cochlear implant listeners are unable to maintain good speech recognition at low presentation levels due to reduced stimulus audibility, and this may significantly limit their ability to communicate in daily life. It is likely that audibility differences between SPEAK and CIS participants in the present study can be attributed at least partly to differences in the acoustic dynamic range used by the respective processors. However, several additional factors may have contributed to differences in audibility and perception of soft speech among individual listeners with both devices. These include the minimum and maximum electrical stimulation levels specified in participants' maps and the speech processor sensitivity setting used for testing.