Common wisdom suggests that listening in noise poses disproportionately greater difficulty for listeners with cochlear implants (CIs) than for peers with normal hearing (NH). The purpose of this study was to examine phonological, language, and cognitive skills that might help explain speech-in-noise abilities for children with CIs.


Three groups of kindergartners (NH, hearing aid wearers, and CI users) were tested on speech recognition in quiet and noise and on tasks thought to underlie the abilities that fit into the domains of phonological awareness, general language, and cognitive skills. These last measures were used as predictor variables in regression analyses with speech-in-noise scores as dependent variables.


Compared to children with NH, children with CIs did not perform as well on speech recognition in noise or on most other measures, including recognition in quiet. Two surprising results were that (a) noise effects were consistent across groups and (b) scores on other measures did not explain any group differences in speech recognition.


Limitations of implant processing take their primary toll on recognition in quiet and account for poor speech recognition and language/phonological deficits in children with CIs. Implications are that teachers/clinicians need to teach language/phonology directly and maximize signal-to-noise levels in the classroom.


  • Ahissar, M. (2007). Dyslexia and the anchoring-deficit hypothesis.Trends in Cognitive Sciences, 11, 458–465.
  • Ahissar, M., Lubin, Y., Putter-Katz, H., & Banai, K. (2006). Dyslexia and the failure to form a perceptual anchor.Nature Neuroscience, 9, 1558–1564.
  • Baer, T., Moore, B. C., & Gatehouse, S. (1993). Spectral contrast enhancement of speech in noise for listeners with sensorineural hearing impairment: Effects on intelligibility, quality, and response times.Journal of Rehabilitation Research & Development, 30, 49–72.
  • Bernstein, J. G., & Brungart, D. S. (2011). Effects of spectral smearing and temporal fine-structure distortion on the fluctuating-masker benefit for speech at a fixed signal-to-noise ratio.The Journal of the Acoustical Society of America, 130, 473–488.
  • Boothroyd, A. (1968). Statistical theory of the speech discrimination score.The Journal of the Acoustical Society of America, 43, 362–367.
  • Boothroyd, A. (1984). Auditory perception of speech contrasts by subjects with sensorineural hearing loss.Journal of Speech and Hearing Research, 27, 134–144.
  • Boothroyd, A., Mulhearn, B., Gong, J., & Ostroff, J. (1996). Effects of spectral smearing on phoneme and word recognition.The Journal of the Acoustical Society of America, 100, 1807–1818.
  • Boothroyd, A., & Nittrouer, S. (1988). Mathematical treatment of context effects in phoneme and word recognition.The Journal of the Acoustical Society of America, 84, 101–114.
  • Bradlow, A. R., & Pisoni, D. B. (1999). Recognition of spoken words by native and non-native listeners: Talker-, listener-, and item-related factors.The Journal of the Acoustical Society of America, 106, 2074–2085.
  • Brady, S., Shankweiler, D., & Mann, V. (1983). Speech perception and memory coding in relation to reading ability.Journal of Experimental Child Psychology, 35, 345–367.
  • Breier, J. I., Gray, L., Fletcher, J. M., Diehl, R. L., Klaas, P., Foorman, B. R., & Molis, M. R. (2001). Perception of voice and tone onset time continua in children with dyslexia with and without attention deficit/hyperactivity disorder.Journal of Experimental Child Psychology, 80, 245–270.
  • Brownell, R. (2000). Expressive One-Word Picture Vocabulary Test (3rd ed.). Novato, CA: Academic Therapy.
  • Burkholder, R. A., & Pisoni, D. B. (2003). Speech timing and working memory in profoundly deaf children after cochlear implantation.Journal of Experimental Child Psychology, 85, 63–88.
  • Carroll, J., Tiaden, S., & Zeng, F. G. (2011). Fundamental frequency is critical to speech perception in noise in combined acoustic and electric hearing.The Journal of the Acoustical Society of America, 130, 2054–2062.
  • Cleary, M., Pisoni, D. B., & Geers, A. E. (2001). Some measures of verbal and spatial working memory in eight- and nine-year-old hearing-impaired children with cochlear implants.Ear and Hearing, 22, 395–411.
  • Cutler, A., Garcia Lecumberri, M. L., & Cooke, M. (2008). Consonant identification in noise by native and non-native listeners: Effects of local context.The Journal of the Acoustical Society of America, 124, 1264–1268.
  • Davidson, L. S., Geers, A. E., Blamey, P. J., Tobey, E. A., & Brenner, C. A. (2011). Factors contributing to speech perception scores in long-term pediatric cochlear implant users.Ear and Hearing, 32, 19S–26S.
  • Firszt, J. B., Holden, L. K., Skinner, M. W., Tobey, E. A., Peterson, A., Gaggl, W., & Wackym, P. A. (2004). Recognition of speech presented at soft to loud levels by adult cochlear implant recipients of three cochlear implant systems.Ear and Hearing, 25, 375–387.
  • Flege, J. E., MacKay, I. R., & Meador, D. (1999). Native Italian speakers' perception and production of English vowels.The Journal of the Acoustical Society of America, 106, 2973–2987.
  • Friesen, L. M., Shannon, R. V., Baskent, D., & Wang, X. (2001). Speech recognition in noise as a function of the number of spectral channels: Comparison of acoustic hearing and cochlear implants.The Journal of the Acoustical Society of America, 110, 1150–1163.
  • Fu, Q. J., Shannon, R. V., & Wang, X. (1998). Effects of noise and spectral resolution on vowel and consonant recognition: Acoustic and electric hearing.The Journal of the Acoustical Society of America, 104, 3586–3596.
  • Gaab, N., Gabrieli, J. D., Deutsch, G. K., Tallal, P., & Temple, E. (2007). Neural correlates of rapid auditory processing are disrupted in children with developmental dyslexia and ameliorated with training: An fMRI study.Restorative Neurology and Neuroscience, 25, 295–310.
  • Geers, A. E., & Hayes, H. (2011). Reading, writing, and phonological processing skills of adolescents with 10 or more years of cochlear implant experience.Ear and Hearing, 32, 49S–59S.
  • Giezen, M. R., Escudero, P., & Baker, A. (2010). Use of acoustic cues by children with cochlear implants.Journal of Speech, Language, and Hearing Research, 53, 1440–1457.
  • Glasberg, B. R., & Moore, B. C. (1986). Auditory filter shapes in subjects with unilateral and bilateral cochlear impairments.The Journal of the Acoustical Society of America, 79, 1020–1033.
  • Godfrey, J. J., Syrdal-Lasky, A. K., Millay, K. K., & Knox, C. M. (1981). Performance of dyslexic children on speech perception tests.Journal of Experimental Child Psychology, 32, 401–424.
  • Hayes, H., Geers, A. E., Treiman, R., & Moog, J. S. (2009). Receptive vocabulary development in deaf children with cochlear implants: Achievement in an intensive auditory-oral educational setting.Ear and Hearing, 30, 128–135.
  • Hirsh, I. J., Reynolds, E. G., & Joseph, M. (1954). Intelligibility of different speech materials.The Journal of the Acoustical Society of America, 26, 530–538.
  • Hochberg, I., Boothroyd, A., Weiss, M., & Hellman, S. (1992). Effects of noise and noise suppression on speech perception by cochlear implant users.Ear and Hearing, 13, 263–271.
  • James, D., Rajput, K., Brinton, J., & Goswami, U. (2009). Orthographic influences, vocabulary development, and phonological awareness in deaf children who use cochlear implants.Applied Psycholinguistics, 30, 659–684.
  • Johnson, C., & Goswami, U. (2010). Phonological awareness, vocabulary, and reading in deaf children with cochlear implants.Journal of Speech, Language, and Hearing Research, 53, 237–261.
  • Leek, M. R., Dorman, M. F., & Summerfield, Q. (1987). Minimum spectral contrast for vowel identification by normal-hearing and hearing-impaired listeners.The Journal of the Acoustical Society of America, 81, 148–154.
  • Lorenzi, C., Gilbert, G., Carn, H., Garnier, S., & Moore, B. C. J. (2006). Speech perception problems of the hearing impaired reflect inability to use temporal fine structure.Proceedings of the National Academy of Sciences of the United States of America, 103, 18866–18869.
  • Mackersie, C. L., Boothroyd, A., & Minniear, D. (2001). Evaluation of the Computer-Assisted Speech Perception Assessment Test (CASPA).Journal of the American Academy of Audiology, 12, 390–396.
  • Manis, F. R., McBride-Chang, C., Seidenberg, M. S., Keating, P., Doi, L. M., Munson, B., & Petersen, A. (1997). Are speech perception deficits associated with developmental dyslexia?.Journal of Experimental Child Psychology, 66, 211–235.
  • Merzenich, M. M., Jenkins, W. M., Johnston, P., Schreiner, C., Miller, S. L., & Tallal, P. (1996, January5). Temporal processing deficits of language-learning impaired children ameliorated by training.Science, 271, 77–81.
  • Miller, G. A., Heise, G. A., & Lichten, W. (1951). The intelligibility of speech as a function of the context of the test materials.Journal of Experimental Psychology, 41, 329–335.
  • Niparko, J. K., Tobey, E. A., Thal, D. J., Eisenberg, L. S., Wang, N. Y., & Quittner, A. L., … CDaCl Investigative Team (2010). Spoken language development in children following cochlear implantation.Journal of the American Medical Association, 303, 1498–1506.
  • Nittrouer, S. (1999). Do temporal processing deficits cause phonological processing problems?.Journal of Speech, Language, and Hearing Research, 42, 925–942.
  • Nittrouer, S. (2010). Early development of children with hearing loss. San Diego, CA: Plural Publishing.
  • Nittrouer, S., & Boothroyd, A. (1990). Context effects in phoneme and word recognition by young children and older adults.The Journal of the Acoustical Society of America, 87, 2705–2715.
  • Nittrouer, S., & Burton, L. T. (2005). The role of early language experience in the development of speech perception and phonological processing abilities: Evidence from 5-year-olds with histories of otitis media with effusion and low socioeconomic status.Journal of Communication Disorders, 38, 29–63.
  • Nittrouer, S., & Miller, M. E. (1999). The development of phonemic coding strategies for serial recall.Applied Psycholinguistics, 20, 563–588.
  • Nittrouer, S., Shune, S., & Lowenstein, J. H. (2011). What is the deficit in phonological processing deficits: Auditory sensitivity, masking, or category formation?.Journal of Experimental Child Psychology, 108, 762–785.
  • Pinet, M., & Iverson, P. (2010). Talker–listener accent interactions in speech-in-noise recognition: Effects of prosodic manipulation as a function of language experience.The Journal of the Acoustical Society of America, 128, 1357–1365.
  • Pisoni, D. B., Kronenberger, W. G., Roman, A. S., & Geers, A. E. (2011). Measures of digit span and verbal rehearsal speed in deaf children after more than 10 years of cochlear implantation.Ear and Hearing, 32, 60S–74S.
  • Pollack, I., Rubenstein, H., & Decker, L. (1959). Intelligibility of known and unknown message sets.The Journal of the Acoustical Society of America, 31, 273–279.
  • Revoile, S. G., Pickett, J. M., & Kozma-Spyteck, L. (1991). Spectral cues to perception of /d, n, l/ by normal- and impaired-hearing listeners.The Journal of the Acoustical Society of America, 90, 787–798.
  • Rogers, C. L., Lister, J. J., Febo, D. M., Besing, J. M., & Abrams, H. B. (2006). Effects of bilingualism, noise, and reverberation on speech perception by listeners with normal hearing.Applied Psycholinguistics, 27, 465–485.
  • Rubinstein, J. T. (2004). How cochlear implants encode speech.Current Opinion in Otolaryngology & Head and Neck Surgery, 12, 444–448.
  • Serniclaes, W., Ventura, P., Morais, J., & Kolinsky, R. (2005). Categorical perception of speech sounds in illiterate adults.Cognition, 98, B35–B44.
  • Stanovich, K. E., Cunningham, A. E., & Cramer, B. B. (1984). Assessing phonological awareness in kindergarten children: Issues of task comparability.Journal of Experimental Child Psychology, 38, 175–190.
  • Tallal, P. (1980). Auditory temporal perception, phonics, and reading disabilities in children.Brain and Language, 9, 182–198.
  • Tallal, P., Miller, S., & Fitch, R. H. (1993). Neurobiological basis of speech: A case for the preeminence of temporal processing.In P. Tallal (Ed.), Annals of the New York Academy of Sciences: Vol. 682. Temporal information processing in the central nervous system: Special reference to dyslexia and dysphasia (pp. 27–47). New York, NY: New York Academy of Sciences.
  • Tallal, P., & Piercy, M. (1973, February16). Defects of non-verbal auditory perception in children with developmental aphasia.Nature, 241, 468–469.
  • Tallal, P., & Piercy, M. (1974). Developmental aphasia: Rate of auditory processing and selective impairment of consonant perception.Neuropsychologia, 12, 83–93.
  • Tomblin, J. B., Spencer, L., Flock, S., Tyler, R., & Gantz, B. (1999). A comparison of language achievement in children with cochlear implants and children using hearing aids.Journal of Speech, Language, and Hearing Research, 42, 497–511.
  • Vance, M., & Martindale, N. (2011). Assessing speech perception in children with language difficulties: Effects of background noise and phonetic contrast.International Journal of Speech-Language Pathology, 14, 48–58.
  • von Hapsburg, D., Champlin, C. A., & Shetty, S. R. (2004). Reception thresholds for sentences in bilingual (Spanish/English) and monolingual (English) listeners.Journal of the American Academy of Audiology, 15, 88–98.
  • Wagner, R. K., Torgesen, J. K., & Rashotte, C. A. (1999). The Comprehensive Test of Phonological Processing. Austin, TX: Pro-Ed.
  • Zeng, F. G., & Galvin, J. (1999). Amplitude mapping and phoneme recognition in cochlear implant listeners.Ear and Hearing, 20, 60–74.
  • Ziegler, J. C., Pech-Georgel, C., George, F., Alario, F. X., & Lorenzi, C. (2005). Deficits in speech perception predict language learning impairment.Proceedings of the National Academy of Sciences of the United States of America, 102, 14110–14115.
  • Ziegler, J. C., Pech-Georgel, C., George, F., & Lorenzi, C. (2011). Noise on, voicing off: Speech perception deficits in children with specific language impairment.Journal of Experimental Child Psychology, 110, 362–372.
  • Zimmerman, I. L., Steiner, V. G., & Pond, R. E. (2002). Preschool Language Scale, Fourth Edition. San Antonio, TX: The Psychological Corporation.

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