Effect of Test Realism on Speech-in-noise Outcomes in Bilateral Cochlear Implant Users

Ear Hear. 2021 Nov-Dec;42(6):1687-1698. doi: 10.1097/AUD.0000000000001061.


Objectives: First, to evaluate the effect of laboratory-based test realism on speech intelligibility outcomes of cochlear implant users. Second, to conduct an exploratory investigation of speech intelligibility of cochlear implant users, including bilateral benefit, under realistic laboratory conditions.

Design: For the first goal, the authors measured speech intelligibility scores of 15 bilateral cochlear implant recipients under three different test realism levels at two different signal-to-noise ratios (SNRs). The levels included (1) standard Bamford-Kowal-Bench-like sentences with spatially separated standard babble noise; (2) standard Bamford-Kowal-Bench-like sentences with three-dimensional recordings of actual situations; and (3) a variation of the second realism level where the sentences were obtained from natural effortful conversations. For the second goal, speech intelligibility of the realistic speech material was measured in six different acoustic scenes with realistic signal-to-noise ratios ranging from -5.8 dB to 3.2 dB.

Results: Speech intelligibility was consistently highest in the most artificial (standard) test and lowest in the most realistic test. The effect of the realistic noise and that of the realistic speech material resulted in distinct SNR-dependent performance shifts with respect to their baselines. Speech intelligibility in realistic laboratory conditions was in general low, with mean scores around 60% at the highest SNR. Bilateral benefit provided on average a 7% benefit over unilateral speech understanding in the better-performing ear.

Conclusions: The results obtained here suggest that standard speech-in-noise tests overestimate the performance of cochlear implant recipients in the real world. To address this limitation, future assessments need to improve the realism over current tests by considering the realism of both, the speech and the noise materials. Likewise, speech intelligibility data under realistic conditions suggest that, insofar as these results can be considered representative of real-life performance, conversational speech and noise levels common to cochlear implant recipients are challenging in terms of speech intelligibility, with average scores around 60%. The findings and limitations are discussed alongside the factors affecting speech intelligibility.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cochlear Implantation* / methods
  • Cochlear Implants*
  • Humans
  • Noise
  • Speech Intelligibility
  • Speech Perception*