No AccessEditor's AwardJournal of Speech, Language, and Hearing ResearchResearch Article14 Apr 2017

Speech Recognition in Adults With Cochlear Implants: The Effects of Working Memory, Phonological Sensitivity, and Aging


    Models of speech recognition suggest that “top-down” linguistic and cognitive functions, such as use of phonotactic constraints and working memory, facilitate recognition under conditions of degradation, such as in noise. The question addressed in this study was what happens to these functions when a listener who has experienced years of hearing loss obtains a cochlear implant.


    Thirty adults with cochlear implants and 30 age-matched controls with age-normal hearing underwent testing of verbal working memory using digit span and serial recall of words. Phonological capacities were assessed using a lexical decision task and nonword repetition. Recognition of words in sentences in speech-shaped noise was measured.


    Implant users had only slightly poorer working memory accuracy than did controls and only on serial recall of words; however, phonological sensitivity was highly impaired. Working memory did not facilitate speech recognition in noise for either group. Phonological sensitivity predicted sentence recognition for implant users but not for listeners with normal hearing.


    Clinical speech recognition outcomes for adult implant users relate to the ability of these users to process phonological information. Results suggest that phonological capacities may serve as potential clinical targets through rehabilitative training. Such novel interventions may be particularly helpful for older adult implant users.


    • Ahissar, M. (2007). Dyslexia and the anchoring-deficit hypothesis.Trends in Cognitive Sciences, 11, 458–465.
    • Akeroyd, M. A. (2008). Are individual differences in speech reception related to individual differences in cognitive ability? A survey of twenty experimental studies with normal and hearing-impaired adults.International Journal of Audiology, 47, S53–S71.
    • Alloway, T. P., Gathercole, S. E., & Pickering, S. J. (2006). Verbal and visuospatial short-term and working memory in children: Are they separable?.Child Development, 77, 1698–1716.
    • American Academy of Ophthalmology, Pediatric Ophthalmology Strabismus Panel. (2012). Preferred Practice Pattern® guidelines. Pediatric eye evaluations.San Francisco, CA: Author. Retrieved from
    • Andersson, U. (2001). Cognitive deafness: The deterioration of phonological representations in adults with an acquired severe hearing loss and its implications for speech understanding (Unpublished doctoral dissertation). Linköping University, Sweden.
    • Andersson, U., & Lyxell, B. (2007). Working memory deficit in children with mathematical difficulties: A general or specific deficit?.Journal of Experimental Child Psychology, 96, 197–228.
    • Arehart, K. H., Souza, P., Baca, R., & Kates, J. (2013). Working memory, age and hearing loss: Susceptibility to hearing aid distortion.Ear and Hearing, 34, 251–260.
    • Baddeley, A. (1992). Working memory.Science, 255, 556–559.
    • Boothroyd, A. (2010). Adapting to changed hearing: The potential role of formal training.Journal of the American Academy of Audiology, 21, 601–611.
    • Bopp, K. L., & Verhaeghen, P. (2005). Aging and verbal memory span: A meta-analysis.Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 60, P223–P233.
    • 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.
    • Brysbaert, M., & New, B. (2009). Moving beyond Kučera and Francis: A critical evaluation of current word frequency norms and the introduction of a new and improved word frequency measure for American English.Behavior Research Methods, 41, 977–990.
    • Cervera, T. C., Soler, M. J., Dasi, C., & Ruiz, J. C. (2009). Speech recognition and working memory capacity in young-elderly listeners: Effects of hearing sensitivity.Canadian Journal of Experimental Psychology, 63, 216–226.
    • Classon, E., Rudner, M., Johansson, M., & Rönnberg, J. (2013). Early ERP signature of hearing impairment in visual rhyme judgment.Frontiers in Psychology, 4, 241.
    • Classon, E., Rudner, M., & Rönnberg, J. (2013). Working memory compensates for hearing related phonological processing deficit.Journal of Communication Disorders, 46, 17–29.
    • 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.
    • Daneman, M., & Carpenter, P. A. (1980). Individual differences in working memory and reading.Journal of Verbal Learning and Verbal Behavior, 19, 450–466.
    • Daneman, M., & Hannon, B. (2007). What do working memory span tasks like reading span really measure?.N. Osaka, R. H. Logie, & M. D'Esposito (Eds.), The cognitive neuroscience of working memory (pp. 21–42). Oxford Scholarship Online.
    • Dawson, P. W., Busby, P. A., McKay, C. M., & Clark, G. M. (2002). Short-term auditory memory in children using cochlear implants and its relevance to receptive language.Journal of Speech, Language, and Hearing Research, 45, 789–801.
    • Dillon, M. T., Buss, E., Adunka, M. C., King, E. R., Pillsbury, H. C., III, Adunka, O. F., & Buchman, C. A. (2013). Long-term speech perception in elderly cochlear implant users.Otolaryngology—Head & Neck Surgery, 139, 279–283.
    • Dollaghan, C., & Campbell, T. F. (1998). Nonword repetition and child language impairment.Journal of Speech, Language, and Hearing Research, 41, 1136–1146.
    • Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician.Journal of Psychiatric Research, 12, 189–198.
    • Foo, C., Rudner, M., Rönnberg, J., & Lunner, T. (2007). Recognition of speech in noise with new hearing instrument compression release settings requires explicit cognitive storage and processing capacity.Journal of the American Academy of Audiology, 18, 618–631.
    • Gatehouse, S., Naylor, G., & Elberling, C. (2003). Benefits from hearing aids in relation to the interaction between the user and the environment.International Journal of Audiology, 42, S77–S85.
    • Gatehouse, S., Naylor, G., & Elberling, C. (2006). Linear and nonlinear hearing aid fittings—1. Patterns of benefit.International Journal of Audiology, 45, 130–152.
    • Geers, A. E., Pisoni, D. B., & Brenner, C. (2013). Complex working memory span in cochlear implanted and normal hearing teenagers.Otology & Neurotology, 34, 396–401.
    • Goldstein, E. F. (1975). Selective phonemic and semantic coding in short-term recall.Memory & Cognition, 3, 619–626.
    • Hällgren, M., Larsby, B., Lyxell, B., & Arlinger, S. (2001). Cognitive effects in dichotic speech testing in elderly persons.Ear and Hearing, 22, 120–129.
    • Holden, L. K., Finley, C. C., Firszt, J. B., Holden, T. A., Brenner, C., Potts, L. G., … Skinner, M. W. (2013). Factors affecting open-set word recognition in adults with cochlear implants.Ear and Hearing, 34, 342–360.
    • Holden, L. K., Reeder, R. M., Firszt, J. B., & Finley, C. C. (2011). Optimizing the perception of soft speech and speech in noise with the advanced bionics cochlear implant system.International Journal of Audiology, 50, 255–269.
    • Humes, L. E. (2005). Do ‘auditory processing’ tests measure auditory processing in the elderly?.Ear and Hearing, 26, 109–119.
    • Ingvalson, E. M., & Wong, P. (2013). Training to improve language outcomes in cochlear implant recipients.Frontiers in Psychology, 4, 263.
    • Kenway, B., Tam, Y. C., Vanat, Z., Harris, F., Gray, R., Birchall, J., … Axon, P. (2015). Pitch discrimination: An independent factor in cochlear implant performance outcomes.Otology & Neurotology, 36, 1472–1479.
    • Kronenberger, W. G., Pisoni, D. B., Henning, S. C., Colson, B. G., & Hazzard, L. M. (2011). Working memory training for children with cochlear implants: A pilot study.Journal of Speech, Language, and Hearing Research, 54, 1182–1196.
    • Kumar, N., & Priyadarshi, B. (2014). Differential effect of aging on verbal and visuo-spatial working memory.Aging and Disease, 4, 170–178.
    • Li, T., & Fu, Q. J. (2011). Voice gender discrimination provides a measure of more than pitch-related perception in cochlear implant users.International Journal of Audiology, 50, 498–502.
    • Lin, F. R., Ferrucci, L., Metter, E. J., An, Y., Zonderman, A. B., & Resnick, S. M. (2011). Hearing loss and cognition in the Baltimore Longitudinal Study of Aging.Neuropsychology, 25, 763–770.
    • Lin, F. R., Yaffe, K., Xia, J., Xue, Q. L., Harris, T. B., Purchase-Helzner, E., … Simonsick, E. M. (2013). Health ABC Study Group. Hearing loss and cognitive decline in older adults.Journal of the American Medical Association, Internal Medicine, 173, 293–299.
    • Lunner, T. (2003). Cognitive function in relation to hearing aid use.International Journal of Audiology, 42, S49–S58.
    • Lunner, T., & Sundewall-Thorén, E. (2007). Interactions between cognition, compression, and listening conditions: Effects on speech-in-noise performance in a two-channel hearing aid.Journal of the American Academy of Audiology, 18, 604–617.
    • Luo, X., Fu, Q. J., & Galvin, J. J. (2007). Vocal emotion recognition by normal-hearing listeners and cochlear implant users.Trends in Amplification, 11, 301–315.
    • Lyxell, B., Andersson, J., Andersson, U., Arlinger, S., Bredberg, G., & Harder, H. (1998). Phonological representation and speech understanding with cochlear implants in deafened adults.Scandinavian Journal of Psychology, 39(3), 175–179.
    • Lyxell, B., Andersson, U., Borg, E., & Ohlsson, I. S. (2003). Working-memory capacity and phonological processing in deafened adults and individuals with a severe hearing impairment.International Journal of Audiology, 42, S86–S89.
    • Mann, V. A., & Liberman, I. Y. (1984). Phonological awareness and verbal short-term memory.Journal of Learning Disabilities, 17, 592–599.
    • 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.
    • Moberly, A. C., Lowenstein, J. H., & Nittrouer, S. (2016). Word recognition variability with cochlear implants: The degradation of phonemic sensitivity.Otology & Neurotology, 37, 470–477.
    • Mullennix, J. W., Pisoni, D. B., & Martin, C. S. (1989). Some effects of talker variability on spoken word recognition.Journal of the Acoustical Society of America, 85, 365–378.
    • Nilsson, M., Soli, S. D., & Sullivan, J. A. (1994). Development of the Hearing in Noise Test for the measurement of speech reception thresholds in quiet and in noise.Journal of the Acoustical Society of America, 95, 1085–1099.
    • 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., Caldwell-Tarr, A., & Lowenstein, J. H. (2013). Working memory in children with cochlear implants: Problems are in storage, not processing.International Journal of Pediatric Otorhinolaryngology, 77, 1886–1898.
    • Nittrouer, S., & Lowenstein, J. H. (2010). Learning to perceptually organize speech signals in native fashion.Journal of the Acoustical Society of America, 127, 1624–1635.
    • Nittrouer, S., Lowenstein, J. H., Wucinich, T., & Moberly, A. C. (2016). Verbal working memory in older adults: The roles of phonological capacities and processing speed.Journal of Speech, Language, and Hearing Research, 59, 1520–1532.
    • Nittrouer, S., & Miller, M. E. (1999). The development of phonemic coding strategies for serial recall.Applied Psycholinguistics, 20, 563–588.
    • Oba, S. I., Galvin, J. J., III, & Fu, Q. J. (2013). Minimal effects of visual memory training on the auditory performance of adult cochlear implant users.Journal of Rehabilitation Research and Development, 50, 99–110.
    • Pichora-Fuller, M. K., & Souza, P. E. (2003). Effects of aging on auditory processing of speech.International Journal of Audiology, 42, 11–16.
    • Pickering, S. J. (2001). The development of visuo-spatial working memory.Memory, 9, 423–432.
    • Piquado, T., Benichov, J. I., Brownell, H., & Wingfield, A. (2012). The hidden effect of hearing acuity on speech recall, and compensatory effects of self-paced listening.International Journal of Audiology, 51, 576–583.
    • Pisoni, D. B. (1997). Some thoughts on “normalization” in speech perception.In K. Johnson & J. Mullennix (Eds.), Talker variability in speech processing (pp. 9–32). San Diego, CA: Academic Press.
    • Pisoni, D. B. (2014). Rapid phonological coding and working memory dynamics in children with cochlear implants.In A. W. Farris-Trimble & J. A. Barlow (Eds.), Language acquisition and language disorders: Vol. 56. Perspectives on phonological theory and development: In honor of Daniel A. Dinnsen (pp. 91–112). Amsterdam, the Netherlands: John Benjamins.
    • Pisoni, D. B., & Cleary, M. (2003). Measures of working memory span and verbal rehearsal speed in deaf children after cochlear implantation.Ear and Hearing, 24(1, Suppl.), 106S.
    • Repovš, G., & Baddeley, A. (2006). The multi-component model of working memory: Explorations in experimental cognitive psychology.Neuroscience, 139, 5–21.
    • Rönnberg, J., Lunner, T., Zekveld, A., Sörqvist, P., Danielsson, H., Lyxell, B., … Rudner, M. (2013). The ease of language understanding (ELU) model: Theoretical, empirical, and clinical advances.Frontiers in Systems Neuroscience, 7(31), 1–17.
    • Rudner, M., Foo, C., Sundewall-Thorén, E., Lunner, T., & Rönnberg, J. (2008). Phonological mismatch and explicit cognitive processing in a sample of 102 hearing-aid users.International Journal of Audiology, 47, 91–98.
    • Rudner, M., Rönnberg, J., & Lunner, T. (2011). Working memory supports listening in noise for persons with hearing impairment.Journal of the American Academy of Audiology, 22, 156–167.
    • Schvartz, K. C., Chatterjee, M., & Gordon-Salant, S. (2008). Recognition of spectrally degraded phonemes by younger, middle-aged, and older normal-hearing listeners.Journal of the Acoustical Society of America, 124, 3972–3988.
    • Spring, C., & Perry, L. (1983). Naming speed and serial recall in poor and adequate readers.Contemporary Educational Psychology, 8, 141–145.
    • Tao, D., Deng, R., Jiang, Y., Galvin, J. J., III, Fu, Q. J., & Chen, B. (2014). Contribution of auditory working memory to speech understanding in Mandarin-speaking cochlear implant users.PLoS ONE, 9, e99096.
    • Van Rooij, J. C. G. M., & Plomp, R. (1990). Auditive and cognitive factors in speech perception by elderly listeners. II. Multivariate analyses.Journal of the Acoustical Society of America, 88, 2611–2624.
    • Wechsler, D. (1991). WISC-III: Wechsler intelligence scale for children (Manual). San Antonio, TX: The Psychological Corporation.
    • Wilkinson, G. S., & Robertson, G. J. (2006). WRAT 4: Wide range achievement test (Professional manual). Lutz, FL: Psychological Assessment Resources.
    • Wilson, R. S., Leurgans, S. E., Boyle, P. A., Schneider, J. A., & Bennett, D. A. (2010). Neurodegenerative basis of age-related cognitive decline.Neurology, 75, 1070–1078.

    Additional Resources