Listening Effort In Children With Normal Hearing And Cochlear Implants: Behavioral, Physiological, And Subjective Measures

Background/Purpose: Adverse listening conditions increase cognitive demands and listening effort. This study evaluated how children with cochlear implants (CI) and normal hearing (NH) process compressed speech and speech in noise, using behavioral, physiological, and subjective measures.

Methods: Fifty-two children (aged 8-12 years) participated: 25 NH children and 27 CI users. Participants identified disyllabic words under three conditions: quiet, compressed speech, and speech in noise. Compression thresholds and signal-to-noise ratios were set adaptively per participant for 50% recognition accuracy. Effort was assessed via reaction times (RTs), peak pupil dilation (PPD), and self-reported ratings.

Results: CI users required more favorable thresholds than NH children for both noise and compression. RTs differed across conditions (longest for compressed speech) but did not differ between groups. CI users showed consistently smaller PPD responses than NH children across all conditions. Significant subjective condition effects emerged only for NH children, who rated speech in noise as more effortful than compressed speech, whereas CI users rated the two conditions as similarly demanding.

Conclusion: The three measures index distinct dimensions: reaction time reflects cognitive processing, pupil dilation reflects autonomic engagement, and ratings reflect perceived effort. In NH children these dimensions align with stimulus-driven task demands, yielding an integrated effort profile. In CI users, however, the three measures showed less agreement: despite comparable RTs, children exhibited smaller pupil dilation and similar effort ratings across conditions, suggesting a different pattern of effort allocation. These findings highlight the value of multidimensional assessment when evaluating listening effort in pediatric CI users.