Comparison of different mobile telephones in Combi40+ users

CONCLUSION: Telephone usage is a difficult challenge for cochlear implanted patients. A significant number of cochlear implanted patients are able to carry on a land-line or mobile telephone conversation. The telephone model may be a critical factor for telephone performance. OBJECTIVES: The goals of this study were to evaluate speech discrimination through land-line and mobile telephones in Combi40+ users, and to compare different mobile telephone models to find out which could be more advisable for them. PATIENTS AND METHODS: Eighteen Combi40+ implantees were tested with CID sentences and bisyllabic words presented through land-line and mobile telephones, in both quiet and noisy environments. RESULTS: Mean scores for telephonic speech discrimination were over 85% for CID sentences and 28-59% for bisyllabic words. The Siemens M55 was superior to the other mobile telephones tested.     

Comparison of different mobile telephones in Combi40 + users

Abstract

Conclusion. Telephone usage is a difficult challenge for cochlear implanted patients. A significant number of cochlear implanted patients are able to carry on a land-line or mobile telephone conversation. The telephone model may be a critical factor for telephone performance. Objectives. The goals of this study were to evaluate speech discrimination through land-line and mobile telephones in Combi40 + users, and to compare different mobile telephone models to find out which could be more advisable for them. Patients and methods. Eighteen Combi40 + implantees were tested with CID sentences and bisyllabic words presented through land-line and mobile telephones, in both quiet and noisy environments. Results. Mean scores for telephonic speech discrimination were over 85% for CID sentences and 28–59% for bisyllabic words. The Siemens M55 was superior to the other mobile telephones tested.     

Factors influencing satisfaction of cochlear implant users--a questionnaire-based study

We surveyed on cochlear implant (CI) users using a questionnaire to determine how they use their CIs in daily life and to what degree they are satisfied with them. We also studied the relationship between the degree of satisfaction and speech perception score, age at operation, and deafness duration. Subjects were 37, postlingually-deafened adult CI users were subjected to this study. Average CI use per day was 13.6 hours. Some 60% of subjects understood person-to-person conversation without lipreading, but most could not communicate on the telephone, in meetings, or in noisy places, for example. Most--about 80%--were satisfied with CI, but 20% were not. Those not satisfied tended to be unable to understand person-to-person conversation even with CI and lipreading, indicating that understanding person-to-person conversation is one of the most important reasons for satisfaction in CI users. Speech recognition scores improved in all cases after implantation. Most patients with high speech recognition score-->40% in consonant recognition--were satisfied with CI, but those with recognition scores < 40% in consonant recognition, the degree of satisfaction varied. These results indicate that the degree of satisfaction in CI users does not always correspond to the degree of improvement in speech recognition score. Two patients not satisfied with CI had undergone surgery after the age of 65 years and deafness duration exceeding 20 years. Advanced age and a long deafness duration may thus reduce satisfaction with CIs.     

Psychometrically equivalent bisyllabic words for speech recognition threshold testing in Vietnamese

Objective: This study identified, digitally recorded, edited and evaluated 89 bisyllabic Vietnamese words with the goal of identifying homogeneous words that could be used to measure the speech recognition threshold (SRT) in native talkers of Vietnamese. Design: Native male and female talker productions of 89 Vietnamese bisyllabic words were recorded, edited and then presented at intensities ranging from ?10 to 20 dBHL. Logistic regression was used to identify the best words for measuring the SRT. Forty-eight words were selected and digitally edited to have 50% intelligibility at a level equal to the mean pure-tone average (PTA) for normally hearing participants (5.2 dBHL). Study sample: Twenty normally hearing native Vietnamese participants listened to and repeated bisyllabic Vietnamese words at intensities ranging from ?10 to 20 dBHL. Results: A total of 48 male and female talker recordings of bisyllabic words with steep psychometric functions (>9.0%/dB) were chosen for the final bisyllabic SRT list. Only words homogeneous with respect to threshold audibility with steep psychometric function slopes were chosen for the final list. Conclusions: Digital recordings of bisyllabic Vietnamese words are now available for use in measuring the SRT for patients whose native language is Vietnamese.     

Auditory results from cochlear implants in elderly people

According to data from the Brazilian Institute of Geography and Statistics, the elderly population grew 47.8% in the last decade in Brazil. A portion of this population has severe and/or profound hearing loss and do not benefit from conventional hearing aids. Thus, the use of cochlear implant is required.AimTo analyze the benefits of cochlear implants in the elderly based on the comparison of primary auditory thresholds before and after the operation, discrimination of sentences in speech and in talking on the telephone.MethodologyRetrospective cohort study, analyzing medical records from patients aged over 60 years, users of cochlear implant for at least 1 year.ResultsFourteen medical records were analyzed. Mean age of patients was 63.07 years. The mean pure tone thresholds between 500Hz, 1kHz, 2kHz and 4kHz before the implantation was 113dBHL. None of the patients, before operation, could discriminate sentences in open sets and only 3 scored 17% in closed sets sentence recognition. After one year of implantation, the mean sound field thresholds reached 34dBHL, and open set sentences recognition of 93.57%, while 71% of the patients had become able to have a conversation on the telephone.ConclusionThe elderly users of cochlear implant showed important outcomes, with significant improvement in understanding in the open set and in using the telephone.     

Auditory brainstem and cochlear implants: functional results obtained after one year of rehabilitation

Very little information has been published on the clinical outcome of auditory brainstem implants (ABI). The present paper evaluates results obtained in a patient affected by a bilateral acoustic neuroma in type II neurofibromatosis who received an implant during removal of the residual tumor. One year later surgical revision of the ABI was necessary because no auditory sensation was obtained after ABI activation. Twelve months after the surgical revision, 12 electrodes out of 15 evoked auditory sensation. The results of rehabilitation were compared with those obtained in a group of eight postlingually deaf patients with cochlear implants (CI). Twelve months postoperatively the CI patients identified 97.7 ± 5.1% of bisyllabic words in a closed set while the ABI patient identified 86%. CI patients recognized 87.1 ± 11.3% of sentences and 81.3 ± 14.8% of words with contextual cues while the ABI patient recognized 75% and 65% respectively. Speech recognition improved more slowly in the ABI patient than in the CI patients and his scores for open-set words and sentences without lip reading and contextual cues were poorer. Although the results obtained in the ABI patient were not as good as those obtained in the CI patients, the ABI patient said his quality of life was improved. Received: 19 September 2000 / Accepted: 28 September 2000     

The long-term results of speech perception in elderly cochlear implant users

Objectives: To evaluate the speech discrimination performance of elderly post-lingually deafened cochlear implant (CI) users and the stability of performance over time relative to a control group of younger CI users.

Methods: The study group consisted of 20 native Dutch speaking, post-lingually deafened CI users, aged 70 or older at the time of implantation. Controls were patients aged 40–60 years at implantation and included according to the same inclusion criteria (except age). Linear mixed models assessed speech recognition scores between groups, the variability of their performance, and stability over time.

Results: 20 elderly and 37 controls were included. The mean follow-up was 4.4 and 5.3 years for elderly and controls, respectively. There was no significant difference in average speech discrimination between both groups. The elderly group had a larger intra-subject variability over time. There was no significant effect of follow-up on the speech discrimination, indicating a stable performance over time.

Discussion: This study has a longer follow-up than methodologically comparable previous studies. We found no difference in speech discrimination between elderly patients and controls and no deterioration of performance over time. The subjects in the elderly group exhibit a larger variability around their mean performance.

Conclusion: Speech recognition in both elderly and younger adult CI users is stable over time and is not significantly related to the age of implantation.     

Cochlear implants in elderly people: preliminary results

The objective of this study was to evaluate the benefit of cochlear implantation in adults aged 60 years and over. Twenty-eight patients, older than 60 years and with profound bilateral sensorineural hearing loss, received a cochlear implant between 1991 and 2001. The mean age was 66 years and the median follow-up was 22.5 months. Speech perception scores before and after implantation were analyzed retrospectively in order to evaluate the benefit of cochlear implantation. There was a significant improvement of the disyllabic words and sentences scores after implantation. The patients who were over 70 years performed as well as those who were younger. The surgical procedure was well tolerated in all patients. One patient developed a postoperative vertigo due to a perilymphatic fistula. In conclusion, cochlear implantation offers improvement in speech perception to the elderly population, as in the younger population. A careful assessment of the physical status of these patients remains essential in order to evaluate the risk-benefit of this procedure.     

Mandarin Chinese speech recognition by pediatric cochlear implant users

Objectives

Because of difficulties associated with pediatric speech testing, most pediatric cochlear implant (CI) speech studies necessarily involve basic and simple perceptual tasks. There are relatively few studies regarding Mandarin-speaking pediatric CI users’ perception of more difficult speech materials (e.g., words and sentences produced by multiple talkers). Difficult speech materials and tests necessarily require older pediatric CI users, who may have different etiologies of hearing loss, duration of deafness, CI experience. The present study investigated how pediatric CI patient demographics influence speech recognition performance with relatively difficult test materials and methods.

Methods

In this study, open-set recognition of multi-talker (two males and two females) Mandarin Chinese disyllables and sentences were measured in 37 Mandarin-speaking pediatric CI users. Subjects were grouped according to etiology of deafness and previous acoustic hearing experience. Group 1 subjects were all congenitally deafened with little-to-no acoustic hearing experience. Group 2 subjects were not congenitally deafened and had substantial acoustic hearing experience prior to implantation. Multiple linear regression analyses were performed within each group using subject demographics such as age at implantation and age at testing.

Results

Pediatric CI performance was generally quite good. For Group 1, mean performance was 82.3% correct for disyllables and 82.8% correct for sentences. For Group 2, mean performance was 76.6% correct for disyllables and 84.4% correct for sentences. For Group 1, multiple linear regression analyses showed that age at implantation predicted disyllable recognition, and that age at implantation and age at testing predicted sentence recognition. For Group 2, neither age at implantation nor age at testing predicted disyllable or sentence recognition. Performance was significantly better with the female than with the male talkers.

Conclusions

Consistent with previous studies’ findings, early implantation provided a significant advantage for profoundly deaf children. Performance for both groups was generally quite good for the relatively difficult materials and tasks, suggesting that open-set word and sentence recognition may be useful in evaluating speech performance with older pediatric CI users. Differences in disyllable recognition between Groups 1 and 2 may reflect differences in adaptation to electric stimulation. The Group 1 subjects developed speech patterns exclusively via electric stimulation, while the Group 2 subjects adapted to electric stimulation relative to previous acoustic patterns.     

语速和耳语对人工耳蜗植入者言语识别效果的影响

目的研究不同语速和耳语式的言语是否会影响人工耳蜗植入者的言语识别效果。方法在本研究中,分别对一组人工耳蜗植入者和一组听力正常者进行以下4种不同说话方式的言语识别率测试：慢速言语、常速言语、快速言语和耳语。测试时,人工耳蜗植入者聆听由扬声器播放的未经处理的言语声,正常受试者聆听经4通道人工耳蜗处理的言语声,二者使用相同的原始测试材料。结果人工耳蜗植入组与正常对照组对4种不同说话方式的言语识别结果相似,当说话语速增加时言语识别率逐渐下降,耳语的识别率最差,对于人工耳蜗植入者来说快速言语的识别率显著低于慢速言语识别率。结论人工耳蜗植入者言语识别效果会随着所聆听言语的语速增加而降低,并且聆听耳语式的言语对人工耳蜗植入者来说是非常困难的。     

Short-term study of the effect of speech coding strategy on the auditory performance of pre- and post-lingually deafened adults implanted with the Clarion CII

OBJECTIVE: The auditory performance of cochlear implantees is linked to numerous variables, such as audiological characteristics, age and type of speech coding strategy. In recent years, many different ways of processing sounds have been developed, with possible implications for auditory performance. The purpose of this study was to evaluate the intra-individual differences of patients for speech perception tasks in quiet and in noise as a result of switching from a standard strategy [Continuous Interleaved Sampling (CIS)/Simultaneous Analog Strategy (SAS)] to Hi-Resolution (HiRes). MATERIAL AND METHODS:A total of 14 post-lingual adults implanted with the Clarion CII were selected for trials. At switch-on, six patients chose a CIS strategy and eight an SAS strategy. After an average period of 9.3 months, all patients were switched over to HiRes. All patients were tested (open-set mode) with bisyllabic words and sentences, in both quiet and noise [speech/noise ratio (SNR) = +10]. Testing was carried out after an initial period with the CIS/SAS strategy and 3 months after switching over to HiRes. RESULTS: After switch-over a significant improvement was seen for both speech in quiet (words +25.2%, sentences +10.8%) and speech in noise (words 44.8%, sentences 45.4%). CONCLUSION: Despite individual differences, all patients improved their performance with HiRes use, the greatest improvements being seen under unfavourable listening conditions (SNR = +10). Subjective improvements in speech discrimination and overall sound quality perception were reported even after the first week of HiRes use.     

Zur Wahrnehmung verhallter Sprache mit Cochleaimplantaten

Background

An important parameter for characterization of the acoustic quality of closed rooms is reverberation. There is a rising interest in evaluating the ability of cochlear implant (CI) users to understand speech in real-world environments. Whereas the influence of noise on speech perception has been widely investigated, much less is known about the detrimental effect of reverberation. The present study aimed to investigate the influence of reverberation time on the speech perception of CI users and subjects with normal hearing.

Method

A reverberated version of the sentences of the Oldenburg sentence test (OLSA) which is a widely used German test to measure speech reception thresholds (SRT) in cochlear implant users was generated using professional audio processing software. The reverberation times used were 0.7, 1.0, 1.5 and 2.0 s. For these four reverberation times and for a non-reverberated control condition, the SRT was measured in eight adult CI users and in eight subjects with normal hearing.

Results

To characterize the detrimental effect of reverberation the SRT differences between the reverberated and non-reverberated conditions were calculated. These SRT differences revealed a significant effect of reverberation in CI users with, e.g. a mean SRT increase of 2.9 dB in CI users and 0.9 dB in subjects with normal hearing for a reverberation time of 0.7 s. A strong correlation was found between the SRT increase and the SRT in the non-reverberated condition, highlighting the problems of poor performers in reverberant environments.

Conclusion

The results of the current investigation indicated that reverberation results in decreased speech understanding of CI users.     

Short-term study of the effect of speech coding strategy on the auditory performance of pre- and post-lingually deafened adults implanted with the Clarion CII®

Objective The auditory performance of cochlear implantees is linked to numerous variables, such as audiological characteristics, age and type of speech coding strategy. In recent years, many different ways of processing sounds have been developed, with possible implications for auditory performance. The purpose of this study was to evaluate the intra-individual differences of patients for speech perception tasks in quiet and in noise as a result of switching from a standard strategy [Continuous Interleaved Sampling (CIS)/Simultaneous Analog Strategy (SAS)] to Hi-Resolution (HiRes).

Material and Methods A total of 14 post-lingual adults implanted with the Clarion CII® were selected for trials. At switch-on, six patients chose a CIS strategy and eight an SAS strategy. After an average period of 9.3 months, all patients were switched over to HiRes. All patients were tested (open-set mode) with bisyllabic words and sentences, in both quiet and noise [speech/noise ratio (SNR)=+10]. Testing was carried out after an initial period with the CIS/SAS strategy and 3 months after switching over to HiRes.

Results After switch-over a significant improvement was seen for both speech in quiet (words +25.2%, sentences +10.8%) and speech in noise (words 44.8%, sentences 45.4%).

Conclusion Despite individual differences, all patients improved their performance with HiRes use, the greatest improvements being seen under unfavourable listening conditions (SNR=+10). Subjective improvements in speech discrimination and overall sound quality perception were reported even after the first week of HiRes use.     

Psychometrically equivalent Russian speech audiometry materials by male and female talkers

Despite the large number of individuals who speak Russian, only a limited number of high-quality speech audiometry materials are available in a standard dialect of Russian. Thus, the purpose of this study was to develop and evaluate speech audiometry materials that can be used to measure word recognition and SRT testing in quiet for native speakers of Russian. Familiar monosyllabic and bisyllabic words were digitally recorded by male and female talkers of Russian and subsequently evaluated by native listeners. Using logistic regression, psychometric functions were then calculated for all words. Selected monosyllabic words were digitally adjusted to create word recognition lists which are relatively homogeneous with respect to audibility and psychometric slope. Speech reception threshold materials were developed by selecting twenty-five bisyllabic words with relatively steep psychometric function slopes (12.1%/dB and 9.9 %/dB) and digitally equating their intensity to match the mean PTA of the native listeners. Digital recordings of the resulting psychometrically equivalent speech audiometry materials are available on compact disc.     

Psychometrically equivalent Russian speech audiometry materials by male and female talkers

Despite the large number of individuals who speak Russian, only a limited number of high-quality speech audiometry materials are available in a standard dialect of Russian. Thus, the purpose of this study was to develop and evaluate speech audiometry materials that can be used to measure word recognition and SRT testing in quiet for native speakers of Russian. Familiar monosyllabic and bisyllabic words were digitally recorded by male and female talkers of Russian and subsequently evaluated by native listeners. Using logistic regression, psychometric functions were then calculated for all words. Selected monosyllabic words were digitally adjusted to create word recognition lists which are relatively homogeneous with respect to audibility and psychometric slope. Speech reception threshold materials were developed by selecting twenty-five bisyllabic words with relatively steep psychometric function slopes (12.1%/dB and 9.9 %/dB) and digitally equating their intensity to match the mean PTA of the native listeners. Digital recordings of the resulting psychometrically equivalent speech audiometry materials are available on compact disc.     

Long term results in late implanted adolescent and adult CI recipients

The aim of the present study is to assess long-term outcomes of CI in prelingual deafened adolescents and adults, describing, where present, differences in performance, self perceived benefit and highlighting specific characteristics. Twenty-three patients were enrolled: 10 adolescents, 13 young adults. Each patient underwent speech perception/language development, psychological evaluation and structured interviews on self perception concerning CI. 70 % adolescents and 100 % adults used their cochlear implant for most of the day; two adolescents were partial users and one was a non-user. Adolescents’ average word recognition and comprehension scores improved respectively from 7 to 29.8 % (p = 0.01) and 3 to 26 % (p = 0.1). Adults’ average scores improved significantly from 1.5 to 41.9 % (p = 0.01) and from 18.5 to 52.7% (p = 0.001), respectively. None of the subjects showed a linguistic age adequate to the chronological one: average linguistic age was 7.6 years for adolescents and 19.3 for adults. Structured interviews showed improvement in self-esteem. Adults and most adolescents were fully or moderately satisfied with their implant. Cochlear implantation can be considered a valid option for the rehabilitation of highly motivated and well-selected pre-lingual deafened adolescents and adults. Although there is a substantial variability in both groups of patients and language skills are only marginally influenced by CI, there is still a significant improvement in speech perception. CI was described by both groups as having had a positive impact on their lives; nevertheless adolescents were the ones with a tendency to under-use CI, even those with better hearing outcomes.     

HiResolution and conventional sound processing in the HiResolution bionic ear: using appropriate outcome measures to assess speech recognition ability

OBJECTIVE: This study compared speech perception benefits in adults implanted with the HiResolution (HiRes) Bionic Ear who used both conventional and HiRes sound processing. A battery of speech tests was used to determine which formats were most appropriate for documenting the wide range of benefit experienced by cochlear-implant users. STUDY DESIGN: A repeated-measures design was used to assess postimplantation speech perception in adults who received the HiResolution Bionic Ear in a recent clinical trial. Patients were fit first with conventional strategies and assessed after 3 months of use. Patients were then switched to HiRes sound processing and assessed again after 3 months of use. To assess the immediate effect of HiRes sound processing on speech perception performance, consonant recognition testing was performed in a subset of patients after 3 days of HiRes use and compared with their 3-month performance with conventional processing. SETTING: Subjects were implanted and evaluated at 19 cochlear implant programs in the USA and Canada affiliated primarily with tertiary medical centers. PATIENTS: Patients were 51 postlinguistically deafened adults. MAIN OUTCOME MEASURES: Speech perception was assessed using CNC monosyllabic words, CID sentences and HINT sentences in quiet and noise. Consonant recognition testing was also administered to a subset of patients (n = 30) using the Iowa Consonant Test presented in quiet and noise. All patients completed a strategy preference questionnaire after 6 months of device use. RESULTS: Consonant identification in quiet and noise improved significantly after only 3 days of HiRes use. The mean improvement from conventional to HiRes processing was significant on all speech perception tests. The largest differences occurred for the HINT sentences in noise. Ninety-six percent of the patients preferred HiRes to conventional sound processing. Ceiling effects occurred for both sentence tests in quiet. CONCLUSIONS: Although most patients improved after switching to HiRes sound processing, the greatest differences were seen in the 'poor' performers because 'good' performers often reached ceiling performance, especially on tests in quiet. Future evaluations of cochlear-implant benefit should make use of more difficult measures, especially for 'good' users. Nonetheless, a range of difficulty must remain in test materials to document benefit in the entire population of implant recipients.     

A comparison of the growth of open-set speech perception between the nucleus 22 and nucleus 24 cochlear implant systems.

OBJECTIVE: To compare the short-term development of open-set speech perception between implementations of the spectral peak (SPEAK) strategy in adults using the Nucleus 22 (N22) Spectra processor and the Nucleus 24 (N24) system with the SPrint processor. STUDY DESIGN: Two sets of patients with a follow-up period of 3 months were compared. SETTING: This study was conducted at the New York University (NYU) Medical Center. PATIENTS: Thirty-six profoundly hearing-impaired adults were included in this study. INTERVENTION: Sixteen adults received the N22 cochlear implant with the Spectra speech processor and twenty adults received the N24 cochlear implant with the SPrint speech processor. MAIN OUTCOME MEASURES: Open-set speech perception for the patients with N22 implants was evaluated preoperatively and postoperatively using the following measures: NU-6 monosyllabic words, Iowa sentences, and CID sentences. CNC words, CUNY sentences, and HINT sentences were used to assess the patients with N24 implants. RESULTS: Results revealed that the N22 and N24 cochlear implant recipients had significant open-set speech recognition 3 and 6 months after implantation. The apparent favorable absolute scores for the patients with N24 implants were equalized when a multivariate analysis was performed to account for their younger age at time of implantation and shorter length of deafness. CONCLUSIONS: The growth of open-set word and sentence recognition in similar between the N22 and N24 cochlear implants. Longitudinal studies are needed to determine if higher ceiling scores are present in the N24. Further exploration of monopolar versus bipolar stimulation is warranted.     

Long term results after cochlear implantation in elderly patients

BACKGROUND: Cochlear implantation has become the method of choice for the treatment of deaf patients. A better technology of stimulation opened a wider field of patients suitable for cochlear implantation. Aim of the present study was to evaluate to which extent senior patients benefit by cochlear implantation. PATIENTS AND METHODS: 36 patients between 65 and 85 years were tested by the Freiburger speech test for monosyllabic words and by the HSM sentence test with and without noise. The results were compared to those of younger implanted patients (16 - 64 years, n = 101). RESULTS: The speech perception for monosyllabic words did not differ significantly between both groups. A maximum plateau in speech perception for monosyllabic words was reached after 2 years at 55 %. The HSM sentence test revealed significant differences in the increase of speech perception between senior and younger patients in the first post surgical year. After one year elderly patients reached the same perception score as younger patients with a maximum of approximately 80 % after 3 years. At a signal to noise ratio of 15 % younger patients achieved a maximal perception of 55 % after 1 year whereas senior patients needed 4 years to reach this level. CONCLUSIONS: Senior patients benefited by cochlear implantation to the same extent as younger patients did. Senior patients gained a similar speech perception level as younger implanted patients although the elderly needed more time to reach the same scores. Nevertheless, cochlear implantation should not be denied due to age alone.     

The Intelligibility of Interrupted Speech: Cochlear Implant Users and Normal Hearing Listeners

Compared with normal-hearing listeners, cochlear implant (CI) users display a loss of intelligibility of speech interrupted by silence or noise, possibly due to reduced ability to integrate and restore speech glimpses across silence or noise intervals. The present study was conducted to establish the extent of the deficit typical CI users have in understanding interrupted high-context sentences as a function of a range of interruption rates (1.5 to 24 Hz) and duty cycles (50 and 75 %). Further, factors such as reduced signal quality of CI signal transmission and advanced age, as well as potentially lower speech intelligibility of CI users even in the lack of interruption manipulation, were explored by presenting young, as well as age-matched, normal-hearing (NH) listeners with full-spectrum and vocoded speech (eight-channel and speech intelligibility baseline performance matched). While the actual CI users had more difficulties in understanding interrupted speech and taking advantage of faster interruption rates and increased duty cycle than the eight-channel noise-band vocoded listeners, their performance was similar to the matched noise-band vocoded listeners. These results suggest that while loss of spectro-temporal resolution indeed plays an important role in reduced intelligibility of interrupted speech, these factors alone cannot entirely explain the deficit. Other factors associated with real CIs, such as aging or failure in transmission of essential speech cues, seem to additionally contribute to poor intelligibility of interrupted speech.