{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T17:49:55Z","timestamp":1767203395110,"version":"build-2238731810"},"reference-count":32,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Audiology Research"],"abstract":"<jats:p>Background: Ear advantage (EA) reflects hemispheric asymmetries in auditory processing. While a right-ear advantage (REA) for speech and a left-ear advantage (LEA) for music are well documented in typically developing individuals, it is unclear how these patterns manifest in young children with cochlear implants (CIs). This study investigated whether pupillometry could reveal asymmetric listening efforts in toddlers with bilateral CIs when listening to speech and music under monaural stimulation. Methods: Thirteen toddlers (mean age = 36.2 months) with early bilateral CIs participated. Pupillary responses were recorded during passive listening to speech and music stimuli, presented in quiet or with background noise. Each child was tested twice, once with only the left CI active and once with only the right CI active. Linear mixed-effects models assessed the influence of session (left\/right CI), signal type (speech\/music), and background noise. Results: A significant interaction between session and signal type was observed (p = 0.047). Speech elicited larger pupil sizes when processed through the left CI, while music showed no significant lateralized effects. Age and speech therapy frequency moderated pupil responses in speech and music trials, respectively. Conclusions: Pupillometry reveals subtle asymmetric listening effort in young CI users depending on the listening ear, suggesting early emerging functional lateralization despite sensory deprivation and device-mediated hearing.<\/jats:p>","DOI":"10.3390\/audiolres15040108","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T14:51:46Z","timestamp":1755183106000},"page":"108","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Is Pupil Response to Speech and Music in Toddlers with Cochlear Implants Asymmetric?"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7434-9625","authenticated-orcid":false,"given":"Amanda","family":"Saksida","sequence":"first","affiliation":[{"name":"Institute for Maternal and Child Health\u2014IRCCS \u201cBurlo Garofolo\u201d\u2013Trieste, via dell\u2019Istria 65\/1, 34137 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0155-880X","authenticated-orcid":false,"given":"Marta","family":"Fantoni","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health\u2014IRCCS \u201cBurlo Garofolo\u201d\u2013Trieste, via dell\u2019Istria 65\/1, 34137 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1214-0807","authenticated-orcid":false,"given":"Sara","family":"Ghiselli","sequence":"additional","affiliation":[{"name":"AUSL Piacenza\u2014Guglielmo da Saliceto Hospital, Via Antonio Anguissola 15, 29121 Piacenza, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7465-1066","authenticated-orcid":false,"given":"Eva","family":"Orzan","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health\u2014IRCCS \u201cBurlo Garofolo\u201d\u2013Trieste, via dell\u2019Istria 65\/1, 34137 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1080\/1357650X.2010.541464","article-title":"Laterality of basic auditory perception","volume":"17","author":"Sininger","year":"2012","journal-title":"Laterality"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.heares.2004.07.019","article-title":"Hemispheric asymmetry of the right ear advantage in dichotic listening","volume":"198","author":"Jerger","year":"2004","journal-title":"Hear. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1037\/h0047762","article-title":"Speech lateralization in young children as determined by an auditory test","volume":"56","author":"Kimura","year":"1963","journal-title":"J. Comp. Physiol. Psychol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/0093-934X(89)90113-2","article-title":"Dichotic perception and laterality in neonates","volume":"37","author":"Bertoncini","year":"1989","journal-title":"Brain Lang."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.bandc.2011.03.013","article-title":"Dichotic listening in children: Age-related changes in direction and magnitude of ear advantage","volume":"76","author":"Moncrieff","year":"2011","journal-title":"Brain Cogn."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2331216516681168","DOI":"10.1177\/2331216516681168","article-title":"Evidence for a Right-Ear Advantage in Newborn Hearing Screening Results","volume":"20","author":"Roth","year":"2016","journal-title":"Trends Hear."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.heares.2016.10.012","article-title":"The influence of memory and attention on the ear advantage in dichotic listening","volume":"342","author":"Marzoli","year":"2016","journal-title":"Hear. Res."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Moulin, A. (2022). Ear Asymmetry and Contextual Influences on Speech Perception in Hearing-Impaired Patients. Front. Neurosci., 16.","DOI":"10.3389\/fnins.2022.801699"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"23312165231215916","DOI":"10.1177\/23312165231215916","article-title":"The Right-Ear Advantage in Static and Dynamic Cocktail-Party Situations","volume":"28","author":"Sandmann","year":"2024","journal-title":"Trends Hear."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1097\/MAO.0000000000001756","article-title":"Right Ear Advantage of Speech Audiometry in Single-sided Deafness","volume":"39","author":"Wettstein","year":"2018","journal-title":"Otol. Neurotol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3109\/14767058.2011.607614","article-title":"A sensitive period for cochlear implantation in deaf children","volume":"24","author":"Sharma","year":"2011","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"109984","DOI":"10.1016\/j.ijporl.2020.109984","article-title":"Hearing and Speech Benefits of Cochlear Implantation in Children: A Review of the Literature","volume":"133","author":"Sharma","year":"2020","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"111521","DOI":"10.1016\/j.ijporl.2023.111521","article-title":"Dichotic listening deficits in children with hearing loss","volume":"168","author":"Moncrieff","year":"2023","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e208","DOI":"10.1097\/MAO.0000000000002456","article-title":"Speech Perception, Dichotic Listening, and Ear Advantage in Simultaneous Bilateral Cochlear Implanted Children","volume":"41","author":"Koopmann","year":"2020","journal-title":"Otol. Neurotol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"23312165241287391","DOI":"10.1177\/23312165241287391","article-title":"Music Perception, Appreciation, and Participation in Postlingually Deafened Adults and Cochlear Implant Users: A Systematic Literature Review","volume":"28","author":"Bleckly","year":"2024","journal-title":"Trends Hear."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Steel, M.M., Polonenko, M.J., Giannantonio, S., Hopyan, T., Papsin, B.C., and Gordon, K.A. (2020). Music Perception Testing Reveals Advantages and Continued Challenges for Children Using Bilateral Cochlear Implants. Front. Psychol., 10.","DOI":"10.3389\/fpsyg.2019.03015"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2331216515598971","DOI":"10.1177\/2331216515598971","article-title":"Dichotic listening can improve perceived clarity of music in cochlear implant users","volume":"19","author":"Vannson","year":"2015","journal-title":"Trends Hear."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1097\/AUD.0b013e3181d4f251","article-title":"Pupil response as an indication of effortful listening: The influence of sentence intelligibility","volume":"31","author":"Zekveld","year":"2010","journal-title":"Ear Hear."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1097\/AUD.0000000000000950","article-title":"Comparisons of the Sensitivity and Reliability of Multiple Measures of Listening Effort","volume":"42","author":"Giuliani","year":"2021","journal-title":"Ear Hear."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3269","DOI":"10.1121\/1.4970374","article-title":"Using pupillometry to investigate the better ear advantage","volume":"140","author":"Kan","year":"2016","journal-title":"J. Acoust. Soc. Am."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Saksida, A., Ghiselli, S., Picinali, L., Pintonello, S., Battelino, S., and Orzan, E. (2022). Attention to Speech and Music in Young Children with Bilateral Cochlear Implants: A Pupillometry Study. J. Clin. Med., 11.","DOI":"10.3390\/jcm11061745"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1097\/AUD.0000000000000454","article-title":"Impact of noise and noise reduction on processing effort: A pupillometry study","volume":"38","author":"Wendt","year":"2017","journal-title":"Ear Hear."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.heares.2018.05.006","article-title":"Toward a more comprehensive understanding of the impact of masker type and signal-to-noise ratio on the pupillary response while performing a speech-in-noise test","volume":"369","author":"Wendt","year":"2018","journal-title":"Hear. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1111\/cdev.12559","article-title":"Learning in Complex Environments: The Effects of Background Speech on Early Word Learning","volume":"87","author":"McMillan","year":"2016","journal-title":"Child. Dev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1177\/0956797614547918","article-title":"The Invariance Problem in Infancy: A Pupillometry Study","volume":"25","author":"Hochmann","year":"2014","journal-title":"Psychol. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2331216519832483","DOI":"10.1177\/2331216519832483","article-title":"Analyzing the Time Course of Pupillometric Data","volume":"23","author":"Hendriks","year":"2019","journal-title":"Trends Hear."},{"key":"ref_27","unstructured":"The R Core Team (2016). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: http:\/\/www.r-project.org\/."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wickham, H. (2009). ggplot2: Elegant Graphics for Data Analysis, Springer. Available online: https:\/\/ggplot2.tidyverse.org\/.","DOI":"10.1007\/978-0-387-98141-3"},{"key":"ref_29","unstructured":"Voeten, C.C. (2025, August 01). Analyzing Time Series Data Using clusterperm.lmer. Available online: https:\/\/cran.r-project.org\/web\/packages\/permutes\/vignettes\/buildmer.pdf."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v067.i01","article-title":"Fitting Linear Mixed-Effects Models Using lme4","volume":"67","author":"Bates","year":"2015","journal-title":"J. Stat. Softw."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1937","DOI":"10.1002\/lary.24635","article-title":"Evidence for a Right Cochlear Implant Advantage in Simultaneous Bilateral Cochlear Implantation","volume":"124","author":"Henkin","year":"2014","journal-title":"Laryngoscope"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1097\/AUD.0000000000001651","article-title":"Let\u2019s See If You Can Hear: The Effect of Stimulus Type and Intensity to Pupil Diameter Response in Infants and Adults","volume":"46","author":"Saksida","year":"2025","journal-title":"Ear Hear."}],"updated-by":[{"DOI":"10.3390\/audiolres15050134","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000}}],"container-title":["Audiology Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4349\/15\/4\/108\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T10:41:02Z","timestamp":1760092862000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4349\/15\/4\/108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,14]]},"references-count":32,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["audiolres15040108"],"URL":"https:\/\/doi.org\/10.3390\/audiolres15040108","relation":{},"ISSN":["2039-4349"],"issn-type":[{"value":"2039-4349","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,14]]}}}