Diagnosing impaired band access in patients with cochlear implants

The National Institute on Deafness and Other Communication Disorders, a division of the National Institutes of Health under the Department of Health and Human Services, awarded Father Flanagan's Boys' Home $350,000 on July 8, 2026, under the Biomedical Research and Research Training program (CFDA 93.859).

The award funds research to develop and validate an assessment tool for measuring variability in acoustic access to speech cues across frequency bands in cochlear implant users. The recipient will establish normative ranges and reliability measures for band access assessment using clinical and experimental data; identify mechanisms producing poor band access by examining relationships between band access and signal processing strategy, auditory nerve properties, and patient characteristics; and test whether band access measures generalize across varied speech stimuli and listening conditions. The work addresses the problem that speech recognition outcomes vary significantly among cochlear implant recipients despite the costly and invasive surgery, with individual differences in frequency-dependent access to speech information predicted to account for variable post-implant outcomes.

The period of performance runs from July 8, 2026, through May 31, 2031, with work performed in Omaha, Nebraska. The assistance type is a Project Grant.

Abstract

Speech recognition outcomes greatly vary across individuals who hear with cochlear implants. This variability is a major problem because many individuals undergo a costly and invasive surgery only to fall short of the potential benefits that their implant could provide. Many mechanisms have been hypothesized to impair transmission of speech information. These mechanisms vary across individuals and across stimulation sites within an ear, so they could account for variable outcomes. Determining how this variability within an ear affects speech recognition requires a tool to measure how access to speech cues varies across the speech spectrum. We have developed an assessment of access to speech cues by analyzing the acoustic structure of speech used in common clinical tests. Using this assessment reveals that individual variability in access to speech cues across frequencies predicts speech recognition outcomes in patients with cochlear implants. The proposed work builds on this finding to identify factors that affect access to speech cues in this frequency band. Across three specific aims, we will examine the relationships between band access and patient properties, properties of the processor and electrode-nerve interface, and listening conditions. Aim 1: establish an assessment of individual differences in band access in CI users. Aim 2: identify mechanisms that produce poor band access. Aim 3: identify effects of stimuli and listening condition on band access. In aim 1, we will establish normative ranges and reliability for band access measures by examining data collected in the clinic and experimentally by our lab. In aim 2, we will assess how band access depends on properties of the listener's signal processing strategy and auditory nerve to identify intervention strategies. In aim 3, we will test whether measures of band access generalize across a variety of speech stimuli and listening conditions, which would determine the need to tailor processing strategies to optimize access to speech cues in specific conditions. Completing these aims will provide a clinically feasible assessment for identifying regions of poor band access. This assessment will facilitate the development of a precision medicine approach to intervention for patients with cochlear implants, which is a high priority research area for nidcd. This work will form the basis for the design of clinical tools for personalized assessment and intervention to address suboptimal speech recognition outcomes in patients with cochlear implants.