The frequency-dependent transmission delay in the auditory pathway, which occurs in the cochlea, can be counteracted with chirps. These rapid upward frequency sweeps maximally stimulate auditory brainstem structures due to neural synchrony. This study investigated whether improved neural synchrony from priming with chirps could benefit phonetic perception. Priming conditions were 1) regular isochronous presentation with a chirp onset asynchrony of 45 ms, 2) randomly presented chirps, and 3) pink noise only. After a 2.6 s priming window a vowel discrimination task was performed where syllable pairs were either of the same duration, or the second member of the pair was 45 ms longer. EEG data was acquired from participants (N=14) and behavioral, sensor- (electrode) and source-level (auditory α clusters) measures were analyzed. Behavioral results showed no effect of priming but significantly lower discrimination accuracy when the syllables were different in duration. Sensor-level analyses, from FCz and Global Field Potentials, showed no effect of priming or syllable pair. An auditory α cluster localized to the left Medial Temporal Gyrus showed a divergence in event-related spectral perturbation results whereby there was synchronization in the noise only condition and desynchronization for both chirp conditions. These results are not consistent with operational descriptions of priming involving temporal expectancy and anticipatory attending. They indicate that perceptual priming, based on chirps that compensate for cochlear temporal dispersion, influences the cortical processing involved in the maintenance of a speech discrimination task, possibly by introducing a perceptual background or by upregulating subcortical instances of the auditory pathway.

Continuous Discourse Tracking (CDT) is a functional test of speech perceptual ability, which has been criticised on account of the procedural variation inherent in the method. This study sought to reduce this variation by using synthetic speech, which was subsequently vocoded to simulate listening with a cochlear implant. We also assessed the complexity of three text excerpts with auditory (n = 10) and written Cloze tests (n = 10). These same passages were used in an auditory-only CDT experiment (n = 12) performed with the synthetic-vocoded material. Mean tracking rates were lower, and the number of blockages was higher for the most difficult text as determined by the Cloze results. We also noted some anomalous realisations from the speech synthesis, but these were unlikely to have contributed to the differences in tracking rates that were observed for text complexity. These results show that Cloze testing is suitable to predict text complexity for CDT performed with synthesised speech. Furthermore, they indicate that the use of text-speech synthesis is viable and may be a useful addition to rehabilitation where functional measures are used to assess communication aptitude.

There is an established linkage between dyslexia and anomalous processing of speech sounds. We probed this in a Danish language context with vowel length tasks based on “kugle” ball /ku:lə/ and sequential deletions of the vowel portion to yield “kulde” coldness /kulə/. Vowel length continua are methodologically advantageous as they do not involve the perception of a sudden phonetic change that may instead tap other auditory processing abilities. Identification and discrimination tasks were administered to tertiary (n = 28), reading impaired (n = 26), and lower secondary students (n = 20), and the latter were approximately aged matched to the reading-impaired group. Identification functions derived from regression modelling of the responses showed that the dyslexics had significantly flatter curves than the other groups. Moreover, the secondary and dyslexic groups differed at the long vowel extremity of the continuum. Discrimination results showed that mean peak sensitivity of the tertiary students was higher than that of the secondary and dyslexic students. These results indicate that the phonological-coding deficit observed in dyslexics may be indexed by vowel length identification. Furthermore, identification results suggest that the nature of the phonological-coding deficit concomitant with dyslexia may stem from a lack of precision in processing the minimally modified longer vowel stimuli.

Primary immunodeficiency disease (PIDD) comprises a group of disorders of immune function. Some of the most severe PIDD can be treated with hematopoietic cell transplant (HCT). Hizentra® is a 20

BACKGROUND & AIM To assess consonant proficiency and velopharyngeal function in 10-year-old children born with unilateral cleft lip and palate (UCLP) within the Scandcleft project. METHODS & PROCEDURES Three parallel group, randomized, clinical trials were undertaken as an international multicentre study by nine cleft teams in five countries. Three different surgical protocols for primary palate repair (Arm B-Lip and soft palate closure at 3-4 months, hard palate closure at 36 months, Arm C-Lip closure at 3-4 months, hard and soft palate closure at 12 months, and Arm D-Lip closure at 3-4 months combined with a single-layer closure of the hard palate using a vomer flap, soft palate closure at 12 months) were tested against a common procedure (Arm A-Lip and soft palate closure at 3-4 months followed by hard palate closure at 12 months) in the total cohort of 431 children born with a non-syndromic UCLP. Speech audio and video recordings of 399 children were available and perceptually analysed. Percentage of consonants correct (PCC) from a naming test, an overall rating of velopharyngeal competence (VPC) (VPC-Rate), and a composite measure (VPC-Sum) were reported. OUTCOMES & RESULTS The mean levels of consonant proficiency (PCC score) in the trial arms were 86-92% and between 58% and 83% of the children had VPC (VPC-Sum). Only 50-73% of the participants had a consonant proficiency level with their peers. Girls performed better throughout. Long delay of the hard palate repair (Arm B) indicated lower PCC and simultaneous hard and soft palate closure higher (Arm C). However, the proportion of participants with primary VPC (not including velopharyngeal surgeries) was highest in Arm B (68%) and lowest in Arm C (47%). CONCLUSIONS & IMPLICATIONS The speech outcome in terms of PCC and VPC was low across the trials. The different protocols had their pros and cons and there is no obvious evidence to recommend any of the protocols as superior. Aspects other than primary surgical method, such as time after velopharyngeal surgery, surgical experience, hearing level, language difficulties and speech therapy, need to be thoroughly reviewed for a better understanding of what has affected speech outcome at 10 years. WHAT THIS PAPER ADDS What is already known on the subject Speech outcomes at 10 years of age in children treated for UCLP are sparse and contradictory. Previous studies have examined speech outcomes and the relationship with surgical intervention in 5-year-olds. What this study adds to the existing knowledge Speech outcomes based on standardized assessment in a large group of 10-year-old children born with UCLP and surgically treated according to different protocols are presented. While speech therapy had been provided, a large proportion of the children across treatment protocols still needed further speech therapy. What are the potential or actual clinical implications of this work? Aspects other than surgery and speech function might add to the understanding of what affects speech outcome. Effective speech therapy should be available for children in addition to primary surgical repair of the cleft and secondary surgeries if needed.

Danish is a quantity language in which the length of vowels is either short or long. This study investigates vowel length in order to determine the degree to which we can ascribe the conventional categorical tag to vowel quantity perception. In a pilot study (n = 18) the gradual shortening of long vowels was identified as methodologically preferable for deriving stimuli continua, as complete identification functions could be fitted to the mean data. We employed this method to derive stimuli for identification and discrimination experiments (n = 32) that included the words used in the pilot and another word pair. This pair has phonetically similar variation in vowel duration although, due to recent language change, quantity is no longer contrastive. Results from the phonologically contrastive word pairs showed sigmoidal identification functions and discrimination peaks in the middle of the continua, while the identification slope for the non-contrastive pair was approximately linear and there was no clear discrimination peak. These differences show that the perception of speech contrasts is influenced by the linguistic experience of listeners as well as auditory and articulatory factors.

Hearing loss is a symptom associated with multiple disease processes, a receptive communication condition that corrodes social interaction and, as an acquired condition, it is a curse with many concomitant effects. This chapter reviews recent advances in the causes of, and problems associated with, hearing loss, while presenting advances in the treatment of these, particularly those ushered in by the mainstream adoption of the cochlear implant (CI). A device that is essentially similar to CIs is the auditory brainstem implant (ABI). ABI systems were developed to address the auditory communication needs of patients with neurofibromatosis type-2. The chapter reviews literature that examines speech perception by CI recipients according to a teleological framework that addresses the gamut of speech perceptual competencies that are drawn on during receptive communication, from identifying segmental attributes to deducing the inferred communicative intent of a speaker.

A Correction to this paper has been published: https://doi.org/10.1007/s10875-021-00976-x

Introduction: Preparatory motor cortical responses like the lateralized readiness potential (LRP) may be useful in revealing persistent attempts to feign hearing loss. Previous studies suggest only a marginal effect of stimulus intensity on the amplitude of the LRP. However, this has not been investigated using low-intensity auditory stimuli to cue NoGo trials. We address this in an experiment where subjects were instructed not to give a manual response to low-instensity stimuli, a situation that is akin to simulating hearing loss. Methods: The LRP was recorded from normal hearing listeners (N = 10) with 500 and 4,000-Hz pure tones and trains of 4,000 Hz (2-1-2) tonebursts. Electrophysiologic data underwent processing to (i) analyze the effect of the stimulus type on the LRP, (ii) classify results according to manual response with both logistic regression and linear support vector machine (SVM) models, and (iii) derive auditory brainstem responses (ABRs) from the tonebursts. Results: The amplitude of the LRP did not differ between the 3 stimuli used to elicit the response. Single-trial electrode data from Go and NoGo trials were submitted to supervised binary classification, and the logistic regression model gave a mean accuracy of close to 0.7. The Jewett wave V latencies of the resultant ABRs from some subjects were found to increase between the high (Go) and low (NoGo) intensity tonebursts. Conclusion: This study shows that auditory stimulus type does not affect the amplitude of the LRP and that the response can be recorded with stimuli that are near the auditory threshold. It can also be recorded with transient stimuli, and this allows for the possibility of simultaneously recording other confirmatory measurements, like ABR.

Background: Willfully not responding to auditory stimuli hampers accurate behavioral measurements. An objective measure of covert manual suppression recorded during response tasks may be useful to assess the veracity of responses to stimuli. Purpose: To investigate whether the lateralized readiness potential (LRP), an electrophysiological measure of corticomotor response and suppression, may be of use in determining when participants hear but do not respond to pure tones. Research Design: Within-subject repeated measures with a Go NoGo paradigm. Study Sample: Five males and five females (mean age = 38.8 years, standard deviation = 8.8) underwent electrophysiology testing. All had normal hearing, except one. Intervention: Participants were tested in a condition where they consistently responded to tonal stimuli, and in a condition where intensity cued whether they should respond or not. Scalp-recorded cortical potentials and behavioral responses were recorded, along with a question that probed the perceived effort required to suppress responses to the stimuli. Data Collection and Analysis: Electrophysiology data were processed with independent component analysis and epoch-based artifact rejection. Averaged group and individual LRPs were calculated. Results: Group averaged waveforms show that suppressed responses, cued by NoGo stimuli, diverge positively at approximately 300 msec poststimulus, when compared with performed (Go) responses. LRPs were comparable when Go responses were recorded in a separate condition in which participants responded to all stimuli, and when Go and NoGo trials were included in the same condition. The LRP was not observed in one participant. Conclusions: Subsequent to further investigation, the LRP may prove suitable in assessing the suppression of responses to audiometric stimuli, and, thereby, useful in cases where functional hearing loss is suspected.

This paper investigates the salience of speech contrasts in noise, in relation to how listening attention affects scalp-recorded cortical responses. The contrasts that were examined with consonant-vowel syllables, were place of articulation, vowel length and voice-onset time (VOT) and our analysis focuses on the correspondence between the effect of attention on the electrophysiology and the decrement in behavioral results when noise was added to the stimuli. Normal-hearing subjects (n = 20) performed closed-set syllable identification in no noise, 0, 4 and 8 dB signal-noise ratio (SNR). Identification in noise decreased markedly for place of articulation, moderately for vowel length and marginally for VOT. The same syllables were used in two electrophysiology conditions, where subjects attended to the stimuli, and also while their attention was diverted to a visual discrimination task. Differences in global field power between the attention conditions from each contrast showed that that the effect of attention was negligible for place of articulation. They implied offset encoding of vowel length and were early (starting at 117 ms), and of high amplitude (>3 μV) for VOT. There were significant correlations between the difference in syllable identification in no noise and 0 dB SNR and the electrophysiology results between attention conditions for the VOT contrast. Comparison of the two attention conditions with microstate analysis showed a significant difference in the duration of microstate class D. These results show differential integration of attention and syllable processing according to speech contrast and they suggest that there is correspondence between the salience of a contrast in noise and the effect of attention on the evoked electrical response.

Assessment of prosody perception may be useful in a number of clinical scenarios, including the rehabilitation of cochlear implant recipients. It is with this group in mind that we have derived and standardized a battery of tests that assess speech prosody perception in the Danish language. The prosodic contrasts included in the battery are vowel length, compounds and phrases, emotions, questions and statements, prominence and pronoun reference, all of which are commonly encountered in everyday communication. Lists of candidate stimuli were compiled and recorded by a representative speaker of Danish. All candidate stimuli were presented to normal hearing subjects (n = 12) in both unprocessed and 8-channel noise vocoded conditions. Subjects performed closed-set identification and the results were used to derive the final stimulus set. We report the results of the six subtests, in which we observed a bias to compounds in the compound/phrase subtest, and to statements in question/statement subtest. The pronoun reference subtest assessed the ability of a listener to infer a referent from the stress status of a pronoun, and we found high accuracy rates on this task indicating that it is suitable for inclusion in the battery. We discuss the possible uses of the Prosody in Use Battery in cochlear implant mapping and device verification. We also consider the role of the results from the test battery in guiding clinicians to material suitable for aural rehabilitation.

This paper explores the linkage between intonation nested in conversation turns where the speaker is introducing something delicate (e.g., presenting information liable to provoke distancing) or pre‐empting resistance to their proposal when there is a strong risk of rejection. These movements, which appear prosodically marked, deviate not only from the local context of the conversation, but from the conversation as a whole. A speech acoustic analysis of three examples of prosodic signalling within these turns suggests that speakers employ a distinct design and delivery which includes a high terminal peak in the intonation contour. We interpret this signalling to represent responsive and resistant local social actions in a rejection implicative sequential environment. Finally, they show evidence of being pre‐planned and important to the speaker.

Due to phonemic restoration, listeners can reliably perceive words when a phoneme is replaced with noise. The cost associated with this process was investigated along with the effect of lexical uniqueness on phonemic restoration, using data from a lexical decision experiment where noise replaced phonemes that were either uniqueness points (the phoneme at which a word deviates from all nonrelated words that share the same onset) or phonemes immediately prior to these. A baseline condition was also included with no noise-interrupted stimuli. Results showed a significant cost of phonemic restoration, with 100 ms longer word identification times and a 14% decrease in word identification accuracy for interrupted stimuli compared to the baseline. Regression analysis of response times from the interrupted conditions showed no effect of whether the interrupted phoneme was a uniqueness point, but significant effects for several temporal attributes of the stimuli, including the duration and position of the interrupted segment. These results indicate that uniqueness points are not distinct breakpoints in the cohort reduction that occurs during lexical processing, but that temporal properties of the interrupted stimuli are central to auditory word recognition. These results are interpreted in the context of models of speech perception.

Objective: Children's own ratings and opinions on their schools sound environments add important information on noise sources. They can also provide information on how to further improve and optimize children's learning situation in their classrooms. This study reports on the Swedish translation and application of an evidence-based questionnaire that measures how children perceive the acoustic environment of their school. Study Design: The Swedish version was made using a back-to-back translation. Responses on the questionnaire along with demographic data were collected for 149 children aged 9-13 years of age. Results: The Swedish translation of the questionnaire can be reduced from 93 to 27 items. The 27 items were distributed over five separate factors measuring different underlying constructs with high internal consistency and high inter-item correlations. The responses demonstrated that the dining hall/ canteen and the corridors are the school spaces with the poorest listening conditions. The highest annoyance was reported for tests and reading; next, student-generated sounds occur more frequently within the classroom than any sudden unexpected sounds, and finally, road traffic noise and teachers in adjoining classrooms are the most frequently occurring sounds from outside the classroom. Several demographic characteristics could be used to predict the outcome on these factors. Conclusion: The findings suggest that crowded spaces are most challenging; the children themselves generate most of the noise inside the classroom, but it is also common to hear road traffic noise and teachers in adjoining classrooms. The extent of annoyance that noise causes depends on the task but seems most detrimental in tasks, wherein the demands of verbal processing are higher. Finally, children with special support seem to report that they are more susceptible to noise than the typical child.

Purpose The cognitive load generated by online speech production may vary with the nature of the speech task. This article examines 3 speech tasks used in voice therapy carry-over exercises, in which a patient is required to adopt and automatize new voice behaviors, ultimately in daily spontaneous communication. Method Twelve subjects produced speech in 3 conditions: rote speech (weekdays), sentences in a set form, and semispontaneous speech. Subjects simultaneously performed a secondary visual discrimination task for which response times were measured. On completion of each speech task, subjects rated their experience on a questionnaire. Results Response times from the secondary, visual task were found to be shortest for the rote speech, longer for the semispontaneous speech, and longest for the sentences within the set framework. Principal components derived from the subjective ratings were found to be linked to response times on the secondary visual task. Acoustic measures reflecting fundamental frequency distribution and vocal fold compression varied across the speech tasks. Conclusions The results indicate that consideration should be given to the selection of speech tasks during the process leading to automation of revised speech behavior and that self-reports may be a reliable index of cognitive load.

The modulation of auditory event-related potentials (ERP) by attention generally results in larger amplitudes when stimuli are attended. We measured the P1-N1-P2 acoustic change complex elicited with synthetic overt (second formant, F2Δ=1000Hz) and subtle (F2Δ=100Hz) diphthongs, while subjects (i) attended to the auditory stimuli, (ii) ignored the auditory stimuli and watched a film, and (iii) diverted their attention to a visual discrimination task. Responses elicited by diphthongs where F2 values rose and fell were found to be different and this precluded their combined analysis. Multivariate analysis of ERP components from the rising F2 changes showed main effects of attention on P2 amplitude and latency, and N1-P2 amplitude. P2 amplitude decreased by 40% between the attend and ignore conditions, and by 60% between the attend and divert conditions. The effect of diphthong magnitude was significant for components from a broader temporal window which included P1 latency and N1 amplitude. N1 latency did not vary between attention conditions, a finding that may be related to stimulation with a continuous vowel. These data show that a discernible P1-N1-P2 response can be observed to subtle vowel quality transitions, even when the attention of a subject is diverted to an unrelated visual task.

Onsets are generally considered to play an important role in the determination of syllable identity by human listeners. We measured P1-N1-P2 event-related potentials (ERP) from subjects (n = 11) in response to the syllable [sdʁə]. The complex onset of this syllable was sequentially gated at the consonant boundaries to yield three distinct tokens. Group ERPs to the three tokens were most different within a narrow latency window around 160 ms. This latency corresponded approximately to the lower portion of the ensemble N1-P2 deflection. Single-trial samples from the vertex channel at a range of poststimulus latencies around this point were submitted to multi-class classification by a support vector machine. The three tokens were used as class labels in a one-versus-one machine with a radial basis function kernel. Classification was trained and tested on subsets of the ERP data, and precision was found to be significantly better than chance. As the auditory stimuli used in this experiment differed only in in...

Hizentra® (IGSC 20 %) is a 20 % liquid IgG product approved for subcutaneous administration in adults and children 2 years of age and older who have primary immunodeficiency disease (PIDD). There is limited information about the use of IGSC 20 % in very young children including those less than 5 years of age.