The Effect of Learning Modality and Auditory Feedback on Word Memory: Cochlear-Implanted versus Normal-Hearing Adults

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In recent years, the effect of cognitive abilities on the achievements of cochlear implant (CI) users has been evaluated. Some studies have suggested that gaps between CI users and normalhearing (NH) peers in cognitive tasks are modality specific, and occur only in auditory tasks.


The present study focused on the effect of learning modality (auditory, visual) and auditory feedback on word memory in young adults who were prelingually deafened and received CIs before the age of 5 yr, and their NH peers.

Research Design:

A production effect (PE) paradigm was used, in which participants learned familiar study words by vocal production (saying aloud) or by no-production (silent reading or listening). Words were presented (1) in the visual modality (written) and (2) in the auditory modality (heard). CI users performed the visual condition twice—once with the implant ON and once with it OFF. All conditions were followed by free recall tests.

Study Sample:

Twelve young adults, long-term CI users, implanted between ages 1.7 and 4.5 yr, and who showed ≥50% in monosyllabic consonant-vowel-consonant open-set test with their implants were enrolled. A group of 14 age-matched NH young adults served as the comparison group.

Data Collection and Analysis:

For each condition, we calculated the proportion of study words recalled. Mixed-measures analysis of variances were carried out with group (NH, CI) as a between-subjects variable, and learning condition (aloud or silent reading) as a within-subject variable. Following this, paired sample t tests were used to evaluate the PE size (differences between aloud and silent words) and overall recall ratios (aloud and silent words combined) in each of the learning conditions.


With visual word presentation, young adults with CIs (regardless of implant status CI-ON or CI-OFF), showed comparable memory performance (and a similar PE) to NH peers. However, with auditory presentation, young adults with CIs showed poorer memory for nonproduced words (hence a larger PE) relative to their NH peers.


The results support the construct that young adults with CIs will benefit more from learning via the visual modality (reading), rather than the auditory modality (listening). Importantly, vocal production can largely improve auditory word memory, especially for the CI group.

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