Adolescent Cochlear Implant Users Research Articles

Meludia platform as a tool to evaluate music perception in pediatric and adult cochlear implant users

PurposeMusic perception is one of the greatest challenges for cochlear implant (CI) users. The aims of this study were: (i) to evaluate the music perception of CI users using the online Meludia music training program as music testing platform, (ii) to compare performance among three age groups, and (iii) to compare CI users with their normal hearing (NH) peers.Methods138 individuals participated, divided between children (6–10 y), adolescents (11–16 y), and adults (≥ 17 y). Five music perception tasks were evaluated: Rhythm, Spatialization, Stable/unstable, Melody, and Density. We also administered the music related quality of life (MuRQoL) questionnaire for adults, and a music questionnaire for pediatric population (6–16 y) (MuQPP).ResultsA significantly higher percentage of the adolescent CI users completed the five tasks compared to the other age groups. Both pediatric and adolescent CI users had similar performance to their NH peers in most categories. On the MuRQoL, adult NH listeners reported more music exposure than CI users (3.8 ± 0.6 vs 3.0 ± 0.6, p < 0.01), but both groups reported similar levels of perceived music importance (3.4 ± 0.7 vs 3.2 ± 1.1, p = 0.340). On the MuQPP, pediatric CI users who scored highly on music perception also had higher reported questionnaire scores (54.2 ± 12.9 vs 40.9 ± 12.1, p = 0.009).ConclusionsMeludia can be used to evaluate music perception and to use for music training in CI users of all ages. Adolescents had the highest performance in most musical tasks. Pediatric CI users were more similar to their NH peers. The importance of music in adult CI users was comparable to their NH peers.

Foreign Language Acquisition in Adolescent Cochlear Implant Users.

This study explores to what degree adolescent cochlear implant (CI) users can learn a foreign language in a school setting similar to their normal-hearing (NH) peers despite the degraded auditory input. A group of native Dutch adolescent CI users (age range 13 to 17 years) learning English as a foreign language at secondary school and a group of NH controls (age range 12 to 15 years) were assessed on their Dutch and English language skills using various language tasks that either relied on the processing of auditory information (i.e., listening task) or on the processing of orthographic information (i.e., reading and/or gap-fill task). The test battery also included various auditory and cognitive tasks to assess whether the auditory and cognitive functioning of the learners could explain the potential variation in language skills. Results showed that adolescent CI users can learn English as a foreign language, as the English language skills of the CI users and their NH peers were comparable when assessed with reading or gap-fill tasks. However, the performance of the adolescent CI users was lower for English listening tasks. This discrepancy between task performance was not observed in their native language Dutch. The auditory tasks confirmed that the adolescent CI users had coarser temporal and spectral resolution than their NH peers, supporting the notion that the difference in foreign language listening skills may be due to a difference in auditory functioning. No differences in the cognitive functioning of the CI users and their NH peers were found that could explain the variation in the foreign language listening tasks. In short, acquiring a foreign language with degraded auditory input appears to affect foreign language listening skills, yet does not appear to impact foreign language skills when assessed with tasks that rely on the processing of orthographic information. CI users could take advantage of orthographic information to facilitate foreign language acquisition and potentially support the development of listening-based foreign language skills.

The Perception of Regional Dialects and Foreign Accents by Cochlear Implant Users.

Purpose This preliminary research examined (a) the perception of two common sources of indexical variability in speech-regional dialects and foreign accents, and (b) the relation between indexical processing and sentence recognition among prelingually deaf, long-term cochlear implant (CI) users and normal-hearing (NH) peers. Method Forty-three prelingually deaf adolescent and adult CI users and 44 NH peers completed a regional dialect categorization task, which consisted of identifying the region of origin of an unfamiliar talker from six dialect regions of the United States. They also completed an intelligibility rating task, which consisted of rating the intelligibility of short sentences produced by native and nonnative (foreign-accented) speakers of American English on a scale from 1 (not intelligible at all) to 7 (very intelligible). Individual performance was compared to demographic factors and sentence recognition scores. Results Both CI and NH groups demonstrated difficulty with regional dialect categorization, but NH listeners significantly outperformed the CI users. In the intelligibility rating task, both CI and NH listeners rated foreign-accented sentences as less intelligible than native sentences; however, CI users perceived smaller differences in intelligibility between native and foreign-accented sentences. Sensitivity to accent differences was related to sentence recognition accuracy in CI users. Conclusions Prelingually deaf, long-term CI users are sensitive to accent variability in speech, but less so than NH peers. Additionally, individual differences in CI users' sensitivity to indexical variability was related to sentence recognition abilities, suggesting a common source of difficulty in the perception and encoding of fine acoustic-phonetic details in speech.

Verbal Fluency, Speech-Language and Neurocognitive Outcomes in Youth with Cochlear Implants

Background: Cochlear Implants (CIs) restore some hearing to deaf children, although some language domains such as verbal fluency (VF) are at risk for delay. VF, the ability to efficiently retrieve words from the mental lexicon, is critically important for learning, reasoning, and memory. In this study we used a novel assessment paradigm to understand how VF develops in youth with CIs and to investigate associations between VF, speech-language, and neurocognitive functioning. We hypothesized that phonemic VF (retrieving words based on sounds) would show greater delays than semantic VF (retrieving words within category) and that VF would relate to spoken language and memory outcomes. &#x0D; &#x0D; Methods: 28 prelingually deaf, early-implanted (&lt;4 years), long-term (≥7 years) child and adolescent users of CIs were compared with 33 age and nonverbal IQ-matched normal-hearing (NH) peers. VF measures were compared between CI and NH and were correlated with speech, language, and neurocognitive outcomes. &#x0D; &#x0D; Results: Compared to NH peers, youth with CIs retrieved fewer words, had longer start latencies, and fewer word clusters in the phonemic VF test. Stronger phonemic VF in the CI sample was associated with better speech perception and language. Stronger VF in both samples was associated with better short-term/working memory and inhibition/concentration. &#x0D; &#x0D; Conclusion: VF based on phonological (sound) characteristics of words is delayed in youth with CIs, whereas VF based on semantic meaning is relatively spared. Phonemic VF delays have downstream effects on speech perception and language in youth with CIs, whereas both types of VF are associated with verbal short-term/working memory and executive functioning. &#x0D; &#x0D; Clinical Policy Impact and Implications: Study results indicate a need for assessment and intervention targeting VF (especially phonemic) in youth with CIs as a potential method for improving speech perception, language, verbal memory, and inhibition-concentration outcomes.

Music Listening Habits and Music Perception Abilities of Prelingually Deafened Adolescent Cochlear Implant Recipients

Music is a very important art form that can evoke strong emotions and involvement with it can have a considerable impact on cochlear implant (CI) recipients' quality of life. It is well known that music perception is limited in CI with fully electric hearing and CI recipients have significantly poorer music-appraisal ability when compared with normal hearing subjects. Considering the importance of music on the life of an adolescent and negative impact of hearing loss on mental health, understanding and improving music listening habits and perception abilities can have a positive impact on the mental health of CI user adolescents. This study aims to evaluate music listening habits and music perception abilities of prelingually deafened adolescent CI users to reveal the relationship between self-reported assessment and psychophysical measurement. The psychophysical measures of music perception and self-reported music listening habits of adolescent CI users were obtained. Twenty-nine prelingually deafened adolescent CI users were evaluated in this study. The Turkish Clinical Assessment of Music Perception (T-CAMP) test was used to evaluate music perception abilities. These abilities were evaluated with a three-item questionnaire assessing enjoyment of music, listening habits, and comprehension of lyrics. Pearson's correlation coefficients were calculated to assess the relationship between the T-CAMP subtests and questionnaire items. Statistically significant correlations were observed between the melody-recognition subtest of T-CAMP and all three questionnaire items. The correlation between the enjoyment and rate items on the questionnaire was also statistically significant. The present study shows that adolescent CI users also enjoy and listen to music in ways similar to postlingually deafened adult CI users. It also demonstrates that melody-recognition abilities have a significant relationship with music enjoyment and listening habits in prelingually deafened adolescent CI users.

Systematic Review on Late Cochlear Implantation in Early-Deafened Adults and Adolescents: Predictors of Performance.

Early-deafened, late-implanted adolescents and adults constitute a unique group of cochlear implant (CI) users, showing a large variability in outcomes. The current systematic review aimed to determine which preimplantation factors are relevant in predicting postoperative outcomes in this patient group. A systematic search for studies published between 2000 and September 2017 was performed in five electronic databases (PubMed, Embase, the Cochrane library, CINAHL, and PsycInfo). Prognostic studies that assessed the relation between patient-related factors and CI outcomes in early-deafened but late-implanted adolescent and adult CI users were included. Study quality was assessed with the Quality In Prognosis Studies (QUIPS) tool. The systematic search and subsequent full-text evaluation identified 13 studies that had a clear prognostic study goal. Eight out of these 13 studies had a high risk of bias for at least one of the five QUIPS domains. Analysis of the outcomes identified that communication mode (in childhood), preoperative speech intelligibility, and preoperative speech recognition scores were significantly related to speech perception outcomes for this group of CI users. A number of additional factors considered worth for further investigation were also identified. The analysis of the studies assessing the effect of a number of patient-related factors on outcome with CI in early-deafened adolescents and adults identified three potential prognostic factors and a number of additional factors to be incorporated in future research. More high-quality prognosis studies in the investigated patient population are still needed.

Health related quality of life in adolescent cochlear implant users

Objective: Children with significant hearing loss (HL) are at risk for lower self-esteem and lower perceived quality of life (QoL). This study examined how self-reported QoL of adolescents cochlear implant (CI) users compared to that of adolescents with normal hearing, and examined if factors such as socioeconomic status (SES) and communication methodology affect QoL and speech recognition. Methods: Forty-three adolescent CI users completed a 34-item questionnaire that included questions adapted from the QoL of Deaf or Hard-of-Hearing Youth questionnaire (Seattle Quality of Life Group SEAQOL. 2010 Quality of life of deaf or hard-of-hearing youth (YQOL-DHH). Seattle, Washington) and from the Kidscreen-10 Index (The KIDSCREEN Group, Europe, 2006, the KIDSCREEN questionnaires - quality of life questionnaires for children and adolescents handbook. Lengerich: Pabst Science Publishers. All subjects received their first CI prior to the age of 5, and ranged in age from 10–17 years at the time of survey completion. Results: Adolescents with CIs demonstrated self-reported QoL scores similar to children with normal hearing. Lower SES and communication mode appear to influence speech recognition, and also appear to impact self-reported QoL in different ways. Conclusions: Examination of communication outcomes, along with other factors that influence QoL, such as SES, will help clinicians identify children at risk for low QoL. Such identification will help generate appropriate referrals to enhance QoL in adolescent CI users.

Waiting for lexical access: Cochlear implants or severely degraded input lead listeners to process speech less incrementally

Spoken language unfolds over time. Consequently, there are brief periods of ambiguity, when incomplete input can match many possible words. Typical listeners solve this problem by immediately activating multiple candidates which compete for recognition. In two experiments using the visual world paradigm, we examined real-time lexical competition in prelingually deaf cochlear implant (CI) users, and normal hearing (NH) adults listening to severely degraded speech. In Experiment 1, adolescent CI users and NH controls matched spoken words to arrays of pictures including pictures of the target word and phonological competitors. Eye-movements to each referent were monitored asa measure of how strongly that candidate was considered over time. Relative to NH controls, CI users showed a large delay in fixating any object, less competition from onset competitors (e.g., sandwich after hearing sandal), and increased competition from rhyme competitors (e.g., candle after hearing sandal). Experiment 2 observed the same pattern with NH listeners hearing highly degraded speech. These studies suggests that in contrast to all prior studies of word recognition in typical listeners, listeners recognizing words in severely degraded conditions can exhibit a substantively different pattern of dynamics, waiting to begin lexical access until substantial information has accumulated.

Discourse Strategies and the Production of Prosody by Prelingually Deaf Adolescent Cochlear Implant Users.

The purpose of this study is to assess the use of discourse strategies and the production of prosody by prelingually deaf adolescent users of cochlear implants (CIs) when participating in a referential communication task. We predict that CI users will issue more directives (DIRs) and make less use of information requests (IRs) in completing the task than their normally hearing (NH) peers. We also predict that in signaling these IRs and DIRs, the CI users will produce F0 rises of lesser magnitude than the NH speakers. Eight prelingually deaf adolescent CI users and 8 NH adolescents completed a referential communication task, where participants were required to direct their interlocutor around a map. Participants were aged from 12.0 to 14.2 years. The mean age at implantation for the CI group was 2.1 years (SD 0.9). The use of IRs, DIRs, acknowledgments, and comments was compared between the two groups. The use and magnitude of fundamental frequency (F0) rises on IRs and DIRs was also compared. The CI users differed from the NH speakers in how they resolved communication breakdown. The CI users showed a preference for repeating DIRs, rather than seeking information as did the NH speakers. A nonparametric Mann-Whitney U test indicated that the CI users issued more DIRs (U = 8, p = 0.01), produced fewer IRs (U = 13, p = 0.05) and fewer acknowledgments (U = 5, p = 0.003) than their NH counterparts. The CI users also differed in how they used F0 rises as a prosodic cue to signal IRs and DIRs. The CI users produced larger F0 rises on DIRs than on IRs, a pattern opposite to that displayed by the NH speakers. An independent samples t-test revealed that the CI users produced smaller rises on IRs compared with those produced by the NH speakers [t(12) = -2.762, p = 0.02]. The CI users differed from the NH speakers in how they resolved communication breakdown. The CI users showed a preference for repeating DIRs, rather than seeking information to understand their interlocutor's point of view. Their use of prosody to signal discourse function also differed from their NH peers. These differences may indicate a lack of understanding of how prosody is used to signal discourse modality by the CI users. This study highlights the need for further research focused on the interaction of prosody, discourse, and language comprehension.

The Use of Prosodic Cues in Sentence Processing by Prelingually Deaf Users of Cochlear Implants.

The purpose of this study is to assess the use of prosodic and contextual cues to focus by prelingually deaf adolescent users of cochlear implants (CIs) when identifying target phonemes. We predict that CI users will have slower reaction times to target phonemes compared with a group of normally-hearing (NH) peers. We also predict that reaction times will be faster when both prosodic and contextual (semantic) cues are provided. Eight prelingually deaf adolescent users of CIs and 8 adolescents with NH completed 2 phoneme-monitoring experiments. Participants were aged between 13 and 18 years. The mean age at implantation for the CI group was 1.8 years (SD: 1.0). In the prosodic condition, reaction times to a target phoneme in a linguistically focused (i.e., stressed) word were compared between the two groups. The semantic condition compared reaction time with target phonemes when contextual cues to focus were provided in addition to prosodic cues. Reaction times of the CI group were slower than those of the NH group in both the prosodic and semantic conditions. A linear mixed model was used to compare reaction times using Group as a fixed factor and Phoneme and Subject as random factors. When only prosodic cues (prosodic condition) to focus location were provided, the mean reaction time of the CI group was 512 msec compared with 317 msec for the NH group, and this difference was significant (p < 0.001). The provision of contextual cues speeded reaction times for both groups (semantic condition), indicating that top-down processing aided both groups in their search for a focused item. However, even with both prosodic and contextual cues, the CI users' processing times remained slower, compared with the NH group, with mean reaction times of 385 msec for the CI users but 232 msec for the NH listeners (p < 0.001). Prelingually deaf CI users' processing of prosodic cues is less efficient than that of their NH peers, as evidenced by slower reaction times to targets in phoneme monitoring. The provision of contextual cues speeded reaction times for both NH and CI groups, although the CI users were slower in responding than the NH group. These findings contribute to our understanding of how CI users employ/integrate prosodic and semantic cues in speech processing.

Brain responses to musical feature changes in adolescent cochlear implant users.

Cochlear implants (CIs) are primarily designed to assist deaf individuals in perception of speech, although possibilities for music fruition have also been documented. Previous studies have indicated the existence of neural correlates of residual music skills in postlingually deaf adults and children. However, little is known about the behavioral and neural correlates of music perception in the new generation of prelingually deaf adolescents who grew up with CIs. With electroencephalography (EEG), we recorded the mismatch negativity (MMN) of the auditory event-related potential to changes in musical features in adolescent CI users and in normal-hearing (NH) age mates. EEG recordings and behavioral testing were carried out before (T1) and after (T2) a 2-week music training program for the CI users and in two sessions equally separated in time for NH controls. We found significant MMNs in adolescent CI users for deviations in timbre, intensity, and rhythm, indicating residual neural prerequisites for musical feature processing. By contrast, only one of the two pitch deviants elicited an MMN in CI users. This pitch discrimination deficit was supported by behavioral measures, in which CI users scored significantly below the NH level. Overall, MMN amplitudes were significantly smaller in CI users than in NH controls, suggesting poorer music discrimination ability. Despite compliance from the CI participants, we found no effect of the music training, likely resulting from the brevity of the program. This is the first study showing significant brain responses to musical feature changes in prelingually deaf adolescent CI users and their associations with behavioral measures, implying neural predispositions for at least some aspects of music processing. Future studies should test any beneficial effects of a longer lasting music intervention in adolescent CI users.

Unilateral cochlear implant use promotes normal-like loudness perception in adolescents with childhood deafness.

Behavioral measures of cochlear implant (CI) device stimulation levels can be difficult to obtain in individuals with limited or no hearing experience. Loudness measures are particularly challenging. It would therefore be useful to have a battery of objective and behavioral measures to determine CI stimulation levels in listeners with childhood deafness. In the present study, the authors characterized loudness growth in 20 adolescents: 8 with normal hearing and 12 CI participants with pre/perilingual bilateral sensorineural hearing loss. They asked (1) do adolescent CI users with childhood deafness experience similar increases in loudness as their peers with normal hearing? and (2) can loudness be predicted by objective measures of auditory activity? The authors hypothesized that loudness perception would be significantly different between CI and normal-hearing groups and that it would correlate with objective measures. CI users were recruited from the Cochlear Implant Program at The Hospital for Sick Children and all had used unilateral Nucleus CIs for at least 2 years. The dynamic range for each participant was defined as the difference between the behavioral threshold and the electrically evoked stapedius reflex (ESR) threshold. Loudness growth was assessed within this range behaviorally on a continuous visual scale and objectively with physiological measures. Auditory brainstem responses (ABRs) and ESRs were recorded in both groups and electrically evoked compound action potentials (ECAPs) of the auditory nerve were recorded in addition in CI listeners. The regression line slopes of ECAP and ABR amplitude growth functions were then calculated and compared with behavioral loudness growth slopes in the upper portion (40-100%) and lower portion (0-40%) of the dynamic range. Electrical pulse stimuli (in CI users) and acoustic clicks (in normal-hearing participants) were presented within each participant's dynamic range. The mean dynamic range in CI listeners was more variable than in normal-hearing individuals. Despite this difference, loudness at the ESR threshold was not significantly different in CI adolescents from their normal-hearing peers, and CI users exhibited normal-like loudness growth. There was a significantly positive correlation between ECAP amplitude growth and loudness growth in CI users in the upper portion of the dynamic range, while ABR wave V amplitude growth was not related to loudness growth in either group. We confirmed that the ESR threshold is a good measure of comfortably loud levels in adolescents with cochlear implants and their normal-hearing peers. Adolescents using CIs show normal-like rates of loudness growth on average, despite having highly variable dynamic ranges of hearing. Individual rates of loudness growth in the upper dynamic range in CI users can be predicted by the rate of amplitude growth of the ECAP. Thus, the rate of neural recruitment with increasing CI current is important for loudness perception in pre/perilingually deaf listeners and should be considered when programming their CIs.

Discrimination of intonation contours by adolescents with cochlear implants

Objective: Differences in fundamental frequency (F0) contour peak alignment contribute to the perception of pitch accents in speech intonation. The present study assessed the discrimination of differences in F0 contour peak alignment by adolescent users of cochlear implants (CIs). Design: In Experiment 1, subjects discriminated between rise-fall F0 contours located early in the syllable and those aligned late. Recorded utterances with manipulated F0 were used as stimuli and all subjects wore a unilateral CI. In Experiment 2, bilaterally-implanted subjects repeated Experiment 1 in the bilateral condition. Study sample: Twenty-one CI users aged 12–21 years participated. A normally-hearing control group (n = 20) also completed Experiment 1. Results: Listeners with normal hearing (NH) could discriminate between F0 peaks differing by 80 ms or more. Results varied among the CI users, with only four users displaying a pattern of results similar to that of the NH listeners. Sixteen CI users responded inconsistently or at chance levels (p > 0.05; binomial test). Ten CI users who were bilaterally implanted completed the tests in unilateral and bilateral listening conditions. Conclusions: Results suggest that CI users may have difficulty discriminating between F0 alignment and that use of bilateral implants did not provide an advantage to discrimination.

A Longitudinal Study of Speech Perception Skills and Device Characteristics of Adolescent Cochlear Implant Users

For pediatric cochlear implant (CI) users, CI processor technology, map characteristics, and fitting strategies are known to have a substantial impact on speech perception scores at young ages. It is unknown whether these benefits continue over time as these children reach adolescence. To document changes in CI technology, map characteristics, and speech perception scores in children between elementary grades and high school, and to describe relations between map characteristics and speech perception scores over time. A longitudinal design with participants 8-9-yr-old at session 1 and 15-18-yr-old at session 2. Participants were 82 adolescents with unilateral CIs, who are a subset of a larger longitudinal study. Mean age at implantation was 3.4 yr (range: 1.7-5.4), and mean duration of device use was 5.5 yr (range: 3.8-7.5) at session 1 and 13.3 yr (range: 10.9-15) at session 2. Speech perception tests at sessions 1 and 2 were the Lexical Neighborhood Test (LNT) presented at 70 dB SPL (LNT-70) and Bamford-Kowal-Bench sentences in quiet (BKB-Q) presented at 70 dB SPL. At session 2, the LNT was also administered at 50 dB SPL (LNT-50), and BKB sentences were administered in noise with a +10 dB SNR (BKB-N). CI processor technology type and CI map characteristics (coding strategy, number of electrodes, threshold levels, and comfort levels) were obtained at both sessions. Electrical dynamic range was computed, and descriptive statistics, correlations, and repeated-measures ANOVAs were employed. Participants achieved significantly higher LNT and BKB scores, at 70 dB SPL, at ages 15-18 than at ages 8-9 yr. Forty-two participants had 1-3 electrodes either activated or deactivated in their map between test sessions, and 40 had no change in number of active electrodes (mean change: -0.5; range: -3 to +2). After conversion from arbitrary clinical map units to charge-per-phase in nanocoulombs (nC), no significant difference was found for T levels across time. Average comfort levels (C levels) decreased by 19 nC. Seventy-three participants (89%) upgraded their CI processor technology type. At both sessions, significant correlations were found between electrical dynamic range (EDR) and all speech perception measures except LNT-50 (r range: .31 to .47; p < 0.01). Similarly, significant correlations were also found between C levels and all speech perception measures (r range: .29 to .49; p < 0.01). At session 2, a significant correlation was found between processor technology type and the LNT-50 scores (r = .38; p < 0.01). Significant improvement in speech scores was observed between elementary grades and high school for children who had used a CI since preschool. On average, T levels (nC) and electrode function remained stable for these long-term pediatric users. Analyses of maps did not allow for the determination of the exact cause of C level reductions, though power limitations in new processor systems and changes in perceived loudness over time are possible. Larger EDRs and higher C levels were associated with better speech scores. Newer speech processor technology was associated with better speech scores at a softer level.

Spoken Word Recognition in Adolescent Cochlear Implant Users During Quiet and Multispeaker Babble Conditions

To assess overall speech intelligibility in adolescent cochlear implant speakers during quiet and multispeaker babble conditions. A cross-sectional assessment of intelligibility incorporating group (auditory-oral versus total communication speakers), sentence context (high versus low contexts), and background conditions (quiet versus multispeaker babble). A camp designed to assess adolescents over a concentrated period. Fifty-seven adolescents who participated in an earlier study when they were 8 to 9 years old examining functional outcomes of speech perception, speech production, and language were asked to participate in follow-up study. Speech intelligibility was assessed by asking the adolescents to repeat sentences. Sentences were digitally edited and played to normal hearing listeners who either provided broad transcriptions of sound accuracy or wrote down the words they understood when the sentences were presented in quiet and in multispeaker babble. The dependent variables were percent correct consonants, vowels, and total words identified. Very few substitutions or omissions occurred, resulting in high levels of accuracy for consonants and vowels. Speech intelligibility in quiet was significantly greater than in the multispeaker babble condition. Multispeaker babble decreased performance uniformly across sentence context for the 2 groups. Accurate consonant production based on measures of substitutions and omissions fails to account for distortions and allophonic variations. Reductions in speech intelligibility relative to the phoneme correct productions suggest that the allophonic variations related to distortions may influence naive listener's ability to understand the speech of profoundly deaf individuals.

Factors Influencing Speech Production in Elementary and High School-Aged Cochlear Implant Users

The objectives of this study were to (a) evaluate changes in speech intelligibility in a group of 110 adolescent users of cochlear implants who were first assessed in elementary school (CI-E) and later in high school (CI-HS) and (b) examine factors influencing speech intelligibility performance at the CI-E and CI-HS sessions. Participants were 110 adolescents who participated in an earlier study examining 181 young elementary school-aged children. Primary outcome measures included speech intelligibility under quiet and multispeaker background conditions and consonants correct produced in the sentences. Multiple linear regressions were used to evaluate how participant, family, and performance measures influenced their speech production during adolescence. Performance measures included estimates of speech perception, working memory, sign enhancement, and duration of seven-syllable sentences. Participant and family measures included duration of deafness, performance intelligence quotients, gender, family size, and socioeconomic status. Principal component analyses were used to construct common variables across highly intercorrelated measures. Three sets of multiple linear regressions evaluated the contributions of the variables to the variance associated with adolescent speech intelligibility. Speech intelligibility and consonants correct significantly increased nearly 22% between the two test sessions. Speech intelligibility significantly decreased by approximately 20% in the multispeaker babble condition relative to the quiet condition. Duration of seven-syllable sentences significantly decreased during the two test sessions. Data revealed that 65.8% of the variance in adolescent speech intelligibility was predicted from participant, family, and performance measures observed in elementary school. Forty-nine percent of the variance at adolescence was accounted for by the participant, family, and performance measures observed during the high school test session. Evaluation of variance including participant and family measures at both time periods, in conjunction with the adolescent performance measures, accounted for 49% of the variance in adolescence performance. After contributions from participant and family variables at the elementary and adolescent test sessions were removed, 21% of the variance in adolescent speech intelligibility was due to the performance measures at adolescence. Independent predictors of performance at adolescence included negative effects of sign enhancement and duration of seven-syllable sentences. Substantial improvements were made in consonant accuracy, sentence duration, and speech intelligibility between elementary and high school test sessions. Reductions in speech intelligibility performance suggest that allophonic variations, distortions, or use of speech sounds in a nonambient language may contribute to the reductions observed in multispeaker background conditions. Although a significant amount of variance in adolescent performance is accounted for by participant and family characteristics, elementary school speech production and an early reliance on speaking and listening independently account for variance in adolescence speech intelligibility. Over and beyond all the contributions made by participant, family and performance measures, greater reliance on oral communication, and shorter sentence durations independently account for variance at adolescence.

Actor Vocal Training for the Habilitation of Speech in Adolescent Users of Cochlear Implants

This study examined changes to speech production in adolescents with hearing impairment following a period of actor vocal training. In addition to vocal parameters, the study also investigated changes to psychosocial factors such as confidence, self-esteem, and anxiety. The group were adolescent users of cochlear implants (mean age at commencement of training 15.9 years), with approximately half of the group wearing a hearing aid in the contralateral ear. The mean age of implantation of the group was 7.6 years and the participants displayed a range of speech production abilities. Evaluation of posttraining outcomes was performed via a combination of perceptual and acoustic analyses. Significant posttraining changes to vocal parameters included increased pitch range and variability and decreased speaking rate. From a psychosocial perspective, posttraining stress levels were significantly lowered. This study suggested that actor vocal training may benefit young people with hearing impairment, both in the way in which they use their voices and in the way in which they view themselves.

Where Are the Voices of Adolescents? An Examination of Adolescent Cochlear Implant Users' Socio-Emotional Development

Abstract The advancement of cochlear implant technology has led researchers to focus on its functionality, rather than the socio-emotional effects cochlear implants may have on young recipients. This paper will examine recent research on social-emotional development of cochlear implant recipients while discussing the importance of exploring the social emotional responses of adolescents with cochlear implants.