Preoperative voice parameters affect the postoperative speech intelligibility in patients with cochlear implantation

The Relationship Between Voice Parameters and Speech Intelligibility: A Scoping Review

OBJECTIVE

To synthesize existing evidence of the relationship between voice parameters and speech intelligibility.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Review (PRISMA-ScR) guidelines, 13 databases were searched and a manual search was conducted. A narrative synthesis of methodological quality, study characteristics, participant demographics, voice parameter categorization, and their relationship to speech intelligibility was conducted. A Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment was also performed.

RESULTS

A total of 5593 studies were retrieved, and 30 eligible studies were included in the final scoping review. The studies were given scores of 10-25 (average 16.93) out of 34 in the methodological quality assessment. Research that analyzed voice parameters related to speech intelligibility, encompassing perceptual, acoustic, and aerodynamic parameters, was included. Validated and nonvalidated perceptual voice assessments showed divergent results regarding the relationship between perceptual parameters and speech intelligibility. The relationship between acoustic parameters and speech intelligibility was found to be complex and the results were inconsistent. The limited research on aerodynamic parameters did not reach a consensus on their relationship with speech intelligibility. Studies in which listeners were not speech-language pathologists (SLPs) far outnumbered those with SLP listeners, and research conducted in English contexts significantly exceeded that in non-English contexts. The GRADE evaluation indicated that the quality of evidence varied from low to moderate.

DISCUSSION

The results for the relationship between voice parameters and intelligibility showed significant heterogeneity. Future research should consider age-related voice changes and include diverse age groups. To enhance validity and comparability, it will be necessary to report effect sizes, tool validity, inter-rater reliability, and calibration procedures. Voice assessments should account for the validation status of tools because of their potential impact on the outcomes. The linguistic context may also influence the results.

Measuring speech intelligibility with deaf and hard-of-hearing children: A systematic review

There is great variability in the ways in which the speech intelligibility of d/Deaf and hard-of-hearing (DHH) children who use spoken language as part, or all, of their communication system is measured. This systematic review examined the measures and methods that have been used when examining the speech intelligibility of children who are DHH and the characteristics of these measures and methods. A systematic database search was conducted of CENTRAL; CINAHL; Cochrane; ERIC; Joanna Briggs; Linguistics, Language and Behavior Abstracts; Medline; Scopus; and Web of Science databases, as well as supplemental searches. A total of 204 included studies reported the use of many different measures/methods which measured segmental aspects of speech, with the most common being Allen et al.'s (2001, The reliability of a rating scale for measuring speech intelligibility following pediatric cochlear implantation. Otology and Neurotology, 22(5), 631-633. https://doi.org/10.1097/00129492-200109000-00012) Speech Intelligibility Rating scale. Many studies included insufficient details to determine the measure that was used. Future research should utilize methods/measures with known psychometric validity, provide clear descriptions of the methods/measures used, and consider using more than one measure to account for limitations inherent in different methods of measuring the speech intelligibility of children who are DHH, and consider and discuss the rationale for the measure/method chosen.

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.

Hearing Aid Use and Auditory Verbal Therapy Improve Voice Quality of Deaf Children

BACKGROUND

Adequate phonation is self-regulated by auditory feedback. Children with bilateral profound hearing loss (PHL) lack this feedback resulting in abnormal voice. Adequate hearing aid use and auditory-verbal therapy (AVT) may improve voice quality in deaf children.

OBJECTIVE

To study whether hearing aid use and AVT approach improve acoustic parameters of voice of children with bilateral PHL.

MATERIALS AND METHODS

Nineteen children with bilateral PHL were studied. Age range 2-5 years (X = 53.04 months; SD = 9.54). All children were fitted with hearing aids according to auditory testing and they underwent a 1-year auditory habilitation period using the AVT approach. Acoustic analysis of voice including F0, shimmer, and jitter was performed at the onset and at the end of the auditory habilitation period. Final acoustic data were compared to a matched control group of 19 children, age range 2-5 years (X = 52.85; SD = 9.74) with normal hearing.

RESULTS

Mean fundamental frequency (F0) was significantly increased after AVT intervention. Shimmer and jitter significantly (P < 0.05) improved after the intervention period. However, despite the improvements, mean F0 at the end of the intervention period was still significantly (P < 0.05) decreased as compared to controls. Also, mean shimmer and jitter at the end of the habilitation period were still significantly (P < 0.05) higher as compared to controls.

CONCLUSIONS

The results of this preliminary study suggest that hearing aid use and auditory habilitation with AVT approach improved acoustic voice parameters of children with PHL. However, acoustic parameters persisted abnormal as compared to matched normal hearing controls. AVT approach and regular hearing aid use seem to be safe and reliable clinical tools for improving voice quality of children with PFL.

Speech Production Quality of Cochlear Implant Users with Respect to Duration and Onset of Hearing Loss

PURPOSE

To assess whether postlingual onset and shorter duration of deafness before cochlear implant (CI) provision predict higher speech intelligibility results of CI users.

METHODS

For an objective judgement of speech intelligibility, we used an automatic speech recognition system computing the word recognition rate (WR) of 50 adult CI users and 50 age-matched control individuals. All subjects were recorded reading a standardized text. Subjects were divided into three groups: pre- or perilingual deafness (A), both >2 years before implantation, postlingual deafness <2 years before implantation (B), or postlingual deafness >2 years before implantation (C).

RESULTS

CI users with short duration of postlingual deafness (B) had a significantly higher WR (median 74%) than CI users with long duration of postlingual deafness (C; 68%, p < 0.001) or pre-/perilingual onset (A; 56%, p < 0.001). Compared to their control groups only CI users with short duration of postlingual deafness reached similar WR, others showed significantly lower WR. Other factors such as hearing loss onset, duration of CI use, or duration of amplified hearing showed no consistent influence on speech quality.

CONCLUSIONS

The speech production quality of adult CI users shows dependencies on the onset and duration of deafness. These features need to be considered while planning rehabilitation.

Effects of residual hearing on cochlear implant outcomes in children: A systematic-review

OBJECTIVES

to investigate if preoperative residual hearing in prelingually deafened children can interfere on cochlear implant indication and outcomes.

METHODS

a systematic-review was conducted in five international databases up to November-2016, to locate articles that evaluated cochlear implantation in children with some degree of preoperative residual hearing. Outcomes were auditory, language and cognition performances after cochlear implant. The quality of the studies was assessed and classified according to the Oxford Levels of Evidence table - 2011. Risk of biases were also described.

RESULTS

From the 30 articles reviewed, two types of questions were identified: (a) what are the benefits of cochlear implantation in children with residual hearing? (b) is the preoperative residual hearing a predictor of cochlear implant outcome? Studies ranged from 04 to 188 subjects, evaluating populations between 1.8 and 10.3 years old. The definition of residual hearing varied between studies. The majority of articles (n = 22) evaluated speech perception as the outcome and 14 also assessed language and speech production.

CONCLUSION

There is evidence that cochlear implant is beneficial to children with residual hearing. Preoperative residual hearing seems to be valuable to predict speech perception outcomes after cochlear implantation, even though the mechanism of how it happens is not clear. More extensive researches must be conducted in order to make recommendations and to set prognosis for cochlear implants based on children preoperative residual hearing.

Factors Affecting Speech Perception Improvement Post Implantation in Congenitally Deaf Adults

OBJECTIVES

To identify factors preimplantation associated with postimplantation speech perception improvement in the adult congenitally deaf population.

DESIGN

Forty-four adult cochlear implant (CI) patients who had a severe to profound hearing loss from birth were identified from this centre's database. Eight preimplantation factors, speech intelligibility, preimplantation hearing levels, communication mode, preimplantation speech perception scores, progression of hearing loss, age at implantation, hearing aid use preimplantation, and gender, were recorded during the CI assessment process. These factors were investigated to determine their effect on speech perception improvement postimplantation. The outcome measures were the improvement in scores for the BKB Sentence test and CUNY Sentence test with lipreading after implantation. In the final analysis, 26 patients were included in the CUNY analysis, and 30 patients were included in the BKB analysis.

RESULTS

Speech intelligibility rating, preimplantation hearing levels, and communication mode were shown to be significantly associated with improvements in speech perception postimplantation.

CONCLUSION

Three factors were identified that affected speech perception improvement postimplantation: speech intelligibility, preimplantation hearing levels, and communication mode. These factors can be used to counsel CI patients regarding potential speech perception improvements from cochlear implantation, although these are based on average data and may not reflect individual performance.

Acoustic improvements after surgical correction in congenital heart disease

BACKGROUND

Hoarse or asthenic voice is frequently associated with various pediatric cardiac disorders. The aim of this study was to investigate the changes in voice physiology after surgical correction in patients with congenital heart diseases.

METHODS

We performed voice analysis using induced crying of 40 infants with congenital heart disease (CHD) such as ventricular septal defect (VSD), patent ductus arteriosus (PDA), and atrial septal defect (ASD; 31 girls, 24 boys; mean age, 11 ± 8.9 months). Cries were serially recorded immediately prior to operation, then 1 week, and 1 month after surgical correction, respectively. Acoustic parameters, fundamental frequency (F0 ), duration of cry, noise to harmonic ratio (NHR), jitter, and shimmer, were extracted using Multi-Dimensional Voice Program™ (MDVP) a computerized speech analysis system. Cries were compared with 30 normal healthy infants of corresponding age.

RESULTS

Among the 25 infants with VSD, cry duration, jitter, and shimmer improved after the operation (P < 0.05). F0 and NHR, however, were not significantly different. F0 in patients with PDA improved, but was not statistically significant. The duration of cry, jitter, shimmer, and NHR improved in the PDA group (P < 0.05). The jitter and shimmer parameters improved significantly (P < 0.05), but F0 , cry duration, and NHR in patients with ASD did not show any significant changes.

CONCLUSIONS

Deviated voice patterns in pediatric patients with CHD can normalize after surgical correction. In addition, non-invasive analysis such as MDVP can be used to identify vocal paralysis, even in the early postoperative period.

Preliminary study of acoustic analysis for evaluating speech-aid oral prostheses: Characteristic dips in octave spectrum for comparison of nasality

BACKGROUND/PURPOSE

Acoustic analysis is often used in speech evaluation but seldom for the evaluation of oral prostheses designed for reconstruction of surgical defect. This study aimed to introduce the application of acoustic analysis for patients with velopharyngeal insufficiency (VPI) due to oral surgery and rehabilitated with oral speech-aid prostheses.

METHODS

The pre- and postprosthetic rehabilitation acoustic features of sustained vowel sounds from two patients with VPI were analyzed and compared with the acoustic analysis software Praat.

RESULTS

There were significant differences in the octave spectrum of sustained vowel speech sound between the pre- and postprosthetic rehabilitation. Acoustic measurements of sustained vowels for patients before and after prosthetic treatment showed no significant differences for all parameters of fundamental frequency, jitter, shimmer, noise-to-harmonics ratio, formant frequency, F1 bandwidth, and band energy difference. The decrease in objective nasality perceptions correlated very well with the decrease in dips of the spectra for the male patient with a higher speech bulb height.

CONCLUSION

Acoustic analysis may be a potential technique for evaluating the functions of oral speech-aid prostheses, which eliminates dysfunctions due to the surgical defect and contributes to a high percentage of intelligible speech. Octave spectrum analysis may also be a valuable tool for detecting changes in nasality characteristics of the voice during prosthetic treatment of VPI.