Acoustic analysis of voice in cochlear implant recipients with post-meningitic hearing loss

Voice Parameters in Children With Cochlear Implants: A Systematic Review and Meta-Analysis

INTRODUCTION

An intact auditory system is essential for the development and maintenance of voice quality and speech prosody. On the contrary hearing loss affects the adjustments and appropriate use of organs involved in speech and voice production. Spectro-acoustic voice parameters have been evaluated in Cochlear Implant (CI) users, and the authors of previous systematic reviews on the topic concluded that fundamental frequency (F0) seemed preliminarily the most reliable parameter to evaluate voice alterations in adult CI users. The main aim of this systematic review and meta-analysis was to clarify the vocal parameters and prosodic alterations of speech in pediatric CI users.

MATERIALS AND METHODS

The protocol of the systematic review was registered on the PROSPERO database, International prospective register of systematic reviews. We conducted a search of the English literature published in the period between January 1, 2005 and April 1, 2022 on the Pubmed and Scopus databases. A meta-analysis was conducted to compare the values of voice acoustic parameters in CI users and non-hearing-impaired controls. The analysis was conducted using the standardized mean difference as the outcome measure. A random-effects model was fitted to the data.

RESULTS

A total of 1334 articles were initially evaluated using title and abstract screening. After applying inclusion/exclusion criteria, 20 articles were considered suitable for this review. The age of the cases ranged between 25 and 132 months at examination. The most studied parameters were F0, Jitter, Shimmer and Harmonics-to-Noise Ratio (HNR); other parameters were seldom reported. A total of 11 studies were included in the meta-analysis of F0, with the majority of estimates being positive (75%); the estimated average standardized mean difference based on the random-effects model was 0.3033 (95% CI: 0.0605 to 0.5462; P = 0.0144). For Jitter (0.2229; 95% CI: -0.1862 to 0.7986; P = 0.2229) and shimmer (0.2540; 95% CI: -0.1404 to 0.6485; P = 0.2068) there was a trend toward positive values without reaching statistical significance.

DISCUSSION AND CONCLUSIONS

This meta-analysis confirmed that higher F0 values have been observed in the pediatric population of CI users compared to age-matched normal hearing volunteers, whereas the parameters of voice noise were not significantly different between cases and controls. Prosodic aspects of language need further investigations. In longitudinal contexts, prolonged auditory experience with CI has brought voice parameters closer to the norm. Following the available evidence, we stress the utility of inclusion of vocal acoustic analysis in the clinical evaluation and follow-up of CI patients to optimize the rehabilitation process of pediatric patients with hearing loss.

Subjective Voice Handicap and Vocal Tract Discomfort in Patients With Cochlear Implant

OBJECTIVES

Changes in the auditory system, for example due to hearing impairment, can cause changes in breathing, phonation, and articulation. Aim of this study was to provide first data on subjective Voice Handicap and Vocal Tract Discomfort in subjects with hearing impairment and cochlear implant (CI) after initial fitting.

STUDY DESIGN

Prospective cross-sectional study METHODS: A total of 111 participants (57 female and 54 male) between 20 and 85 years of age (mean = 58.21, SD = 14.96) were recruited between October 2019 and March 2020 from the Clinic of Otorhinolaryngology at Medical University of Hannover. Participants were tested after initial CI fitting, six weeks after implantation, using the German version of the VTD (Vocal Tract Discomfort) Scale and VHI (9i) (Voice Handicap Index) as well as speech comprehension tests and a specifically developed questionnaire evaluating data concerning voice usage and other influential factors. Statistics included descriptive analysis, group comparisons (t-Test), Pearson correlation coefficient between VTD Scale and VHI, and hearing status.

RESULTS

Patients with CI did show low scores in VTD Scale and VHI-9i (VTD mean = 7.85 [SD = 10.4]; VHI-9i mean = 4.04 [SD = 5.77]). We found neither a correlation between any of the speech comprehension tests and the VTD Scale nor the VHI-9i. Further, we could show no correlation between subjective Voice Handicap and/or Vocal Tract Discomfort and age or the kind of treatment.

CONCLUSION

Patients included in this study did not show more subjective Voice Handicap or Vocal Tract Discomfort than normal hearing peers. Scores of VTD Scale and VHI-9i did not depend on the duration of hearing loss, speech comprehension, kind of treatment or age.

Hearing performance and voice acoustics of cochlear implanted children

INTRODUCTION

The voice of hearing-impaired individuals has been described extensively, and exhibits abnormalities in quality, articulation and resonance. Having an understanding of the aspects that may have an impact on voice characteristics of cochlear implant users is important for users and for professionals in this field.

OBJECTIVE

To verify the existence of correlation between age, time of device use, voice detection threshold, hearing category score and language category score with acoustic data of voices of cochlear implanted children.

METHODS

Retrospective study. Fifty-one children ranging in age from 3 years to 5 years and 11 months who unilaterally used cochlear implants participated. Acoustic analysis of the sustained vowel/a/, sequential speech and spontaneous speech was performed. The results were correlated with demographic data and hearing test results.

RESULTS

Children with worse voice detection threshold showed higher frequency in the sustained vowel (p≤0.001) and in the spontaneous speech (p≤0.005).

CONCLUSION

There was a correlation between the voice detection threshold and the frequency values of the sustained vowel and spontaneous speech of the studied population.

Auditory-verbal therapy for promoting spoken language development in children with permanent hearing impairments

BACKGROUND

Congenital or early-acquired hearing impairment poses a major barrier to the development of spoken language and communication. Early detection and effective (re)habilitative interventions are essential for parents and families who wish their children to achieve age-appropriate spoken language. Auditory-verbal therapy (AVT) is a (re)habilitative approach aimed at children with hearing impairments. AVT comprises intensive early intervention therapy sessions with a focus on audition, technological management and involvement of the child's caregivers in therapy sessions; it is typically the only therapy approach used to specifically promote avoidance or exclusion of non-auditory facial communication. The primary goal of AVT is to achieve age-appropriate spoken language and for this to be used as the primary or sole method of communication. AVT programmes are expanding throughout the world; however, little evidence can be found on the effectiveness of the intervention.

OBJECTIVES

To assess the effectiveness of auditory-verbal therapy (AVT) in developing receptive and expressive spoken language in children who are hearing impaired.

SEARCH METHODS

CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, speechBITE and eight other databases were searched in March 2013. We also searched two trials registers and three theses repositories, checked reference lists and contacted study authors to identify additional studies.

SELECTION CRITERIA

The review considered prospective randomised controlled trials (RCTs) and quasi-randomised studies of children (birth to 18 years) with a significant (≥ 40 dBHL) permanent (congenital or early-acquired) hearing impairment, undergoing a programme of auditory-verbal therapy, administered by a certified auditory-verbal therapist for a period of at least six months. Comparison groups considered for inclusion were waiting list and treatment as usual controls.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed titles and abstracts identified from the searches and obtained full-text versions of all potentially relevant articles. Articles were independently assessed by two review authors for design and risk of bias. In addition to outcome data, a range of variables related to participant groups and outcomes were documented.

MAIN RESULTS

Of 2233 titles and abstracts searched, only 13 abstracts appeared to meet inclusion criteria. All 13 full-text articles were excluded following independent evaluation by two review authors (CGBJ and JW), as they did not meet the inclusion criteria related to the research design. Thus, no studies are included in this review.

AUTHORS' CONCLUSIONS

This review confirms the lack of well-controlled studies addressing the use of AVT as an intervention for promoting spoken language development in children with permanent hearing impairments. Whilst lack of evidence does not necessarily imply lack of effect, it is at present not possible for conclusions to be drawn as to the effectiveness of this intervention in treating children with permanent hearing impairments.

Systematic analysis of the benefits of cochlear implants on voice production

PURPOSE

To perform a systematic analysis of the research regarding vocal characteristics of hearing impaired children or adults with cochlear implants.

RESEARCH STRATEGY

A literature search was conducted in the databases Web of Science, Bireme, and Universidade de São Paulo's and CAPES' thesis and dissertations databases using the keywords voice, voice quality, and cochlear implantation, and their respective correspondents in Brazilian Portuguese.

SELECTION CRITERIA

The selection criteria included: title consistent with the purpose of this review; participants necessarily being children or adults with severe to profound pre-lingual or post-lingual hearing loss using cochlear implants; and data regarding participants' performance on perception and/or acoustic analysis of the voice.

RESULTS

Twenty seven papers were classified according to the levels of evidence and quality indicators recommended by the American Speech-Language-Hearing Association (ASHA). The designs of the studies were considered of low and medium levels of evidence. Six papers were classified as IIb, 20 as III, and one as IV.

CONCLUSION

The voice of hearing impaired children and adults with cochlear implants has been little studied. There is not an effective number of studies with high evidence levels which precisely show the effects of the cochlear implantation on the quality of voice of these individuals.