Preferences and Listening Efficiency of Adults With Cochlear Implants During Online Communication

In recent years, there has been a profound increase in the use of remote online communication as a supplement to, and in many cases a replacement for, in-person interactions. While online communication tools hold potential to improve accessibility, previous studies have suggested that increased reliance on remote communication poses additional challenges for people with hearing loss, including those with a cochlear implant (CI). This study aimed to investigate the preferences and speech-reception performance of adults with a CI during online communication.

An online experiment was designed to study user preferences and listening efficiency during online communication under three presentation modes: "audio" (audio only), "video" (audio-visual), and "captions" (audio-visual plus captions). Fifty adults with at least 1 CI and 50 approximately age-matched people with acoustic hearing (AH) who did not use any hearing devices participated in the experiment. While viewing examples of prerecorded online conversations, participants were asked to indicate which presentation mode they would have preferred had they been participating in those online conversations themselves, and to explain why. Subsequently, participants performed a behavioral test of speech recognition using the same three presentation modes. A joint analysis of accuracy and response time was performed using a hierarchical linear ballistic accumulator model of choice decision-making to derive a measure of listening efficiency.

While people with AH preferred traditional audio-visual presentation, most people with a CI preferred the caption presentation mode, reporting that this helped them follow the conversations more easily. However, participants also reported some perceived drawbacks of captions, related to having to attend to an additional stream of information. In the speech-recognition test, people with AH achieved similar performance across all three presentation modes, while for people with a CI listening efficiency was enhanced by the addition of visual cues: relative to audio-only presentation, people with a CI benefited from the addition of video (i.e., being able to see the talker's face), and benefited further from the addition of captions. However, even with captions, listening efficiency for people with a CI remained below that achieved by people with AH.

Captions to online conversations are valued by, and beneficial to, people with a CI, but are not without some drawbacks. Lower listening efficiency for people with a CI, even when captions are enabled, may be one reason behind reports in the literature that people with a CI often find online communication to be a cognitively effortful task. Further research is warranted into solutions to help close the performance gap that exists between people with a CI and their AH peers during online communication.