International Journal of Speech and Audiology

Background: Word identification in noise, a core aspect of speech perception, requires matching spoken sounds to mental lexical representations. Children with hearing impairments often face challenges in noisy environments due to reduced spectral resolution and limited auditory input. Bimodal auditory stimulation can enhance perception by providing acoustic cues and supporting binaural processing. Understanding how different auditory modes influence word recognition in noise and associated speech - language outcomes is vital for guiding effective interventions. The study evaluated word identification in noise and associated speech–language outcomes in two school aged children using unilateral cochlear implant versus bimodal auditory stimulation.

Method: A comparative case study design was employed with two pediatric CI recipients: S1, a 7-year-old using bimodal stimulation, and S2, an 8-year-old with unilateral CI. Word identification in noise was assessed using the Hindi Word Identification in Noise Test for Children (HWINT-C) at +5 dB and +7 dB SNR with bisyllabic and monosyllabic words. Speech and language abilities, were evaluated using the Integrated Scales of Development (ISD) and the Speech Intelligibility Rating (SIR) scale.

Results: S1 outperformed S2 across all word types and SNR in HWINT-C. ISD scores indicated higher developmental age-equivalents for S1 in audition, receptive and expressive language, speech, and cognition, while social development was comparable. SIR reflected more intelligible speech for S1than S2.

Conclusion: Bimodal stimulation improves word recognition in noise, reduces cognitive load, and enhances phonological processing, supporting better language and cognitive outcomes, emphasizing the need to optimize auditory input for children with cochlear implants.