Applied Evidence

Impact of Presentation Order on Pitch Ranking Sensitivity in Cochlear Implant Users and Normal-Hearing Listeners and Its Mitigation.

Trends in hearing · 2026 · Other · SLP

Carmen Marie Castañeda González, Manuela Huber, Florian Völk and 6 others

PMID 42453039

The order in which you present two electrodes changes which one a CI user calls 'higher' — but only for adjacent electrodes.

At wider spacings the order doesn't matter. Testing pairs in isolation reduces the bias, but don't show the full set first.

Key findings

1A significant interaction between presentation order and electrode location was found for adjacent electrodes in both CI users and NH listeners, but no significant presentation order effects were observed at 2- or 3-electrode distances.

2CI users and NH listeners showed highly similar pitch ranking performances across all three distance conditions, and the authors concluded that shallow bandpass-filtered noise effectively approximated CI pitch ranking difficulty at the group level.

3Testing stimulus pairs in isolation on a reduced set reduced the presentation order bias, but subjects must not be exposed to the full stimulus set beforehand, as that exposure can reintroduce the bias.

Still to come

How it was doneWhat they foundWhat it means for SLPs


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What it does not show

Small samples: 10 CI users and 9 NH listeners in the main experiment, limiting statistical power for small effects at individual electrode pairs. All CI users had 12-channel arrays; current devices have 16–24 channels, so the findings may not generalise to longer arrays. The study did not explicitly control for sequential effects or starting-point bias, which the authors acknowledge could also influence results. One CI ear was excluded from analysis due to missing data on three electrodes. The NH noise-band stimuli approximate but do not replicate electric stimulation; the authors note the turning point between ascending and descending advantage occurred at different locations in the two groups.

Declared interests

Funded by MED-EL (a cochlear implant manufacturer) and the German Research Foundation (DFG, project 415658392). W. H.'s institution has received research grants from MED-EL.

The easy way to misread this

Do not assume that pooling ascending and descending presentation orders cancels out the bias — the paper shows the effect interacts with electrode location in a non-symmetric way (descending better at the apex, ascending better at the base), so simple averaging does not remove it. Check for the interaction before pooling.

Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →