Perception and comprehension of environmental sounds and auditory scenes in cochlear implant users

Access to environmental sounds in everyday settings is essential for situational awareness, safety, and well-being but can be compromised by hearing loss. Cochlear implants (CI) improve speech recognition, yet their benefits for environmental sound perception remain unclear. Prior research, centered on sound identification, suggests persistent deficits, but may not adequately represent CI users' abilities because identification alone offers limited insight into everyday listening. To provide a broader assessment, we examined environmental sound perception and comprehension in 25 CI users, 21 hard of hearing (HoH), and 22 normal-hearing controls using three tasks: semantic discrimination, single sound identification, and auditory scene comprehension. Normal hearing and HoH performed similarly and significantly better than CI users across tasks. Mean performance across the groups was highest for semantic discrimination (93.4%-82.9%), followed by identification (86.7%-67.0%) and scene comprehension (88.1%-66.9%). CI users showed difficulty with comprehension tasks requiring semantic integration and inference in complex scenes. Scene comprehension scores correlated with perceived hearing handicap in HoH and CI participants. These findings suggest that environmental sound perception deficits in CI users extend beyond sound identification and include semantic discrimination and scene comprehension. They highlight the need for ecologically valid assessment and rehabilitation approaches that address real-world listening demands.