Objective Voice Analysis of Pediatric Cochlear Implant Recipients and Comparison With Hearing Aids Users and Hearing Controls

Comparative Study on the Acoustic Analysis of Voice in Auditory Brainstem Implantees, Cochlear Implantees, and Normal Hearing Children

The aim of the study was to compare the acoustic characteristics of voice between Auditory Brainstem Implantees, Cochlear Implantees and normal hearing children. Voice parameters such as fundamental frequency, formant frequencies, perturbation measures, and harmonic to noise ratio were measured in a total of 30 children out of which 10 were Auditory Brainstem Implantees, 10 were Cochlear Implantees and 10 were normal hearing children. Parametric and nonparametric statistics were done to establish the nature of significance between the three groups. Overall deviancies were seen in the implanted group for all acoustic parameters. However abnormal deviations were seen in individuals with Auditory Brainstem Implants indicating the deficit in the feedback loop impacting the voice characteristics. The deviancy in feedback could attribute to the poor performance in ABI and CI. The CI performed comparatively better when compared to the ABI group indicating a slight feedback loop due to the type of Implant. However, there needs to be additional evidence supporting this and there is a need to carry out the same study using a larger sample size and a longitudinal design.

Voice acoustic characteristics of children with late-onset cochlear implantation: Correlation to auditory performance

OBJECTIVES

To study the voice acoustic parameters of congenitally deaf children with delayed access to sounds due to late-onset cochlear implantation and to correlate their voice characteristics with their auditory performance.

METHODS

The study included 84 children: a control group consisting of 50 children with normal hearing and normal speech development; and a study group consisting of 34 paediatric cochlear implant (CI) recipients who had suffered profound hearing loss since birth. According to speech recognition scores and pure-tone thresholds, the study group was further subdivided into two subgroups: 24 children with excellent auditory performance and 10 children with fair auditory performance. The mean age at the time of implantation was 3.6 years for excellent auditory performance group and 3.2 years for fair auditory performance group. Voice acoustic analysis was conducted on all study participants.

RESULTS

Analysis of voice acoustic parameters revealed a statistically significant delay in both study groups in comparison to the control group. However, there was no statistically significant difference between the two study groups.

DISCUSSION

Interestingly, in both excellent and fair performance study groups, the gap in comparison to normal hearing children was still present. While late-implanted children performed better on segmental perception (e.g. word recognition), suprasegmental perception (e.g. as demonstrated by objective acoustic voice analysis) did not progress to the same extent.

CONCLUSION

On the suprasegmental speech performance level, objective acoustic voice measurements demonstrated a significant delay in the suprasegmental speech performance of children with late-onset CI, even those with excellent auditory performance.

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.

Vocal acoustic features may be objective biomarkers of negative symptoms in schizophrenia: A cross-sectional study

BACKGROUND

There are currently no objective biomarkers that allow the quantification of negative symptoms of schizophrenia. This study therefore explored the use of acoustic features in identifying the severity of negative symptoms in patients with schizophrenia.

METHODS

We recruited 79 inpatients who were diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (the schizophrenia group) at the Huilongguan Hospital in Beijing, China, and 79 healthy controls from the surrounding community (the control group). We assessed the clinical symptoms of the patients with schizophrenia using the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS) and recorded the voice of each participant as they read emotionally positive, neutral, and negative texts. The Praat software was used to analyse and extract acoustic characteristics from the recordings, such as jitter, shimmer, and pitch. The acoustic differences between the two groups of participants and the relationship between acoustic characteristics and clinical symptoms in the patient group were analysed.

RESULTS

There were significant differences between the schizophrenia and control groups in pitch, voice breaks, jitter, shimmer, and the mean harmonics-to-noise ratio (p < 0.05). Jitter was negatively correlated with the blunted affect and alogia subscale scores of the BNSS, both in the positive and neutral emotion conditions, but the correlation disappeared in the negative emotion condition. However, shimmer exhibited a stable negative correlation with the blunted affect and alogia subscale scores of the BNSS in all three emotion conditions. A linear regression analysis showed that pitch, jitter, shimmer, and age were statistically significant predictors of BNSS subscale scores.

CONCLUSIONS

Acoustic emotional expression differs between patients with schizophrenia and healthy controls. Some acoustic characteristics are related to the severity of negative symptoms, regardless of semantic emotions, and may therefore be objective biomarkers of negative symptoms. A systematic method for assessing vocal acoustic characteristics could provide an accurate and feasible means of assessing negative symptoms in schizophrenia.

TWEET

Acoustic emotional expression differs between patients with schizophrenia and healthy controls. A systematic method for assessing vocal acoustics could provide an accurate and feasible means of assessing negative symptoms in schizophrenia.

Quality of Voice in Patients With Partial Deafness Before and After Cochlear Implantation

Partial deafness is a condition characterised by normal hearing thresholds in low frequencies and increased hearing thresholds (nearly deafness) for high frequencies. Typical hearing aids are rather of a very limited use in this condition as they do not improve understanding of speech. Patients with partial deafness can be presently treated with cochlear implants, which had not been used before due to the risk of damage of hearing remains by electrode introduced into cochlea. The purpose of our study was an objective and subjective assessment of voice quality in partial deafness patients before and after cochlear implantation. The subjects in this study were 25 post-lingual, bilaterally partially deaf patients, 13 females and 12 males. The reference group composed of 55 normal hearing individuals (28 females and 27 males). The acoustic analysis was performed with a multidimensional voice analysis MDVP (Multi Dimension Voice Program), and the subjective assessment was done with GRBAS scale. Initial analysis of voice changes in partial deafness patients was performed versus normal hearing individuals, then voice parameters were measured and perceptual voice assessment was done before and 9 months after cochlear implantation. Measurements of acoustic voice parameters in partially deaf patients showed changes in most of frequency, amplitude, noise and subharmonic components versus normal hearing control group. The most significant, statistically important changes were observed in fundamental frequency variation (vF0), absolute jitter (Jita), jitter percent (Jitt), amplitude perturbation quotient (APQ), smoothed amplitude perturbation quotient (sAPQ), relative average perturbation (RAP), peak amplitude variation (vAm), relative amplitude modulation (Shim), percent shimmer (%Shim), pitch perturbation quotient (PPQ), smoothed pitched perturbation quotient (sPPQ), degree of subharmonics (DSH), degree of voiceless (DUV), number of subharmonic segments (NSH), noise-to-harmonic ratio (NHR), voice turbulence index (VTI). All patients in the study group were subjects to cochlear implantation. After 9 months objective and subjective assessment of patients` voices were performed again. Statistically important changes were identified in average fundamental frequency variability (vF0), relative amplitude modulation index (ShdB), noise-to-harmonic ratio (NHR), number of subharmonics NSH, degree of subharmonics (DSH) and the degree of voiceless (DUV). Comparison of the objective voice parameters changes after cochlear implantation with subjective, perceptual voice quality assessments leads to observation, that improvement of subjective voice quality after cochlear implantation takes place parallelly with improvement of certain objective acoustic voice parameters and some correlations exist. We found, that G correlates with vF0 and Shim, R correlates with DSH and NSH, B correlates with NSH and NHR, A correlates with DUV. We did not prove correlation of S with any of the objective parameters in our research group. Our study proved, that acoustic and perceptual features of voice in partially deaf adults are different than in normally hearing people and cochlear implantation in partial deafness patients is an effective tool to improve hearing and leads to improvement of the acoustic structure of the voice.Partial deafness is a condition characterised by normal hearing thresholds in low frequencies and increased hearing thresholds (nearly deafness) for high frequencies. Typical hearing aids are rather of a very limited use in this condition as they do not improve understanding of speech. Patients with partial deafness can be presently treated with cochlear implants, which had not been used before due to the risk of damage of hearing remains by electrode introduced into cochlea. The purpose of our study was an objective and subjective assessment of voice quality in partial deafness patients before and after cochlear implantation. The subjects in this study were 25 post-lingual, bilaterally partially deaf patients, 13 females and 12 males. The reference group composed of 55 normal hearing individuals (28 females and 27 males). The acoustic analysis was performed with a multidimensional voice analysis MDVP (Multi Dimension Voice Program), and the subjective assessment was done with GRBAS scale. Initial analysis of voice changes in partial deafness patients was performed versus normal hearing individuals, then voice parameters were measured and perceptual voice assessment was done before and 9 months after cochlear implantation. Measurements of acoustic voice parameters in partially deaf patients showed changes in most of frequency, amplitude, noise and subharmonic components versus normal hearing control group. The most significant, statistically important changes were observed in fundamental frequency variation (vF0), absolute jitter (Jita), jitter percent (Jitt), amplitude perturbation quotient (APQ), smoothed amplitude perturbation quotient (sAPQ), relative average perturbation (RAP), peak amplitude variation (vAm), relative amplitude modulation (Shim), percent shimmer (%Shim), pitch perturbation quotient (PPQ), smoothed pitched perturbation quotient (sPPQ), degree of subharmonics (DSH), degree of voiceless (DUV), number of subharmonic segments (NSH), noise-to-harmonic ratio (NHR), voice turbulence index (VTI). All patients in the study group were subjects to cochlear implantation. After 9 months objective and subjective assessment of patients` voices were performed again. Statistically important changes were identified in average fundamental frequency variability (vF0), relative amplitude modulation index (ShdB), noise-to-harmonic ratio (NHR), number of subharmonics NSH, degree of subharmonics (DSH) and the degree of voiceless (DUV). Comparison of the objective voice parameters changes after cochlear implantation with subjective, perceptual voice quality assessments leads to observation, that improvement of subjective voice quality after cochlear implantation takes place parallelly with improvement of certain objective acoustic voice parameters and some correlations exist. We found, that G correlates with vF0 and Shim, R correlates with DSH and NSH, B correlates with NSH and NHR, A correlates with DUV. We did not prove correlation of S with any of the objective parameters in our research group. Our study proved, that acoustic and perceptual features of voice in partially deaf adults are different than in normally hearing people and cochlear implantation in partial deafness patients is an effective tool to improve hearing and leads to improvement of the acoustic structure of the voice.

Vowel duration measurement in school-age children with cochlear implant

OBJECTIVES

Normal hearing system is an essential factor for accurate production of speech segments. It seems that cochlear implant prosthesis helps children with hearing impairment to speak more accurately than before receiving prosthesis. The current research aimed to compare the vowel duration in school-aged children with cochlear implants and that in children with normal hearing. Additionally, the performance of girls and boys in two groups were investigated.

METHODS

A cross-sectional and descriptive-analytical study was carried out to compare the vowel duration in 9- to 12-year-old children with cochlear implant and those with normal hearing. Participants were 52 children who were matched by age and sex. We asked the children to read the target words with each word including one vowel and then participants' voice samples were recorded. Then, vowel duration was measured using Praat software. Finally, the vowel duration was compared between the two groups running independent sample t-test. The level of significance was (P < 0.05).

RESULTS

There was no statistically significant difference observed between the two groups in the mean values of the vowel duration for the six Persian vowels (P > 0.05). Also, no significant difference was found between boys and girls in the mean value of the vowel duration between the two groups (P > 0.05).

CONCLUSION

Persian vowels in school-aged children with cochlear implant and with typical hearing are produced with similar durations. This finding is probably related to the increased duration of using prosthesis in this age range and speech mode used to measure vowel duration in the present study.

Voz de crianças e adolescentes deficientes auditivos e pares ouvintes: influência da percepção auditiva da fala na produção vocal

RESUMO Objetivo: Comparar os resultados acústicos e perceptivo-auditivos da voz de crianças e adolescentes deficientes auditivos com pares ouvintes e correlacionar estes resultados com o relato dos pais em relação à percepção auditiva da fala. Método: Os participantes foram divididos em dois grupos: grupo I, 20 crianças e adolescentes deficientes auditivos, e grupo II, 20 crianças e adolescentes ouvintes. Foi realizada análise acústica da vogal /a/ e avaliação perceptivo-uditiva da vogal /a/ e da fala. A percepção auditiva do GI foi avaliada utilizando a Escala de Integração Auditiva Significativa para Crianças Pequenas e a Escala de Integração Auditiva Significativa, com adaptação para participantes adolescentes. Os resultados acústicos e perceptivo-auditivos da voz de GI e GII foram comparados e, para o GI, estes resultados foram correlacionados com o desempenho na percepção auditiva. Resultados: Os grupos I e II apresentaram resultados similares, diferenciando-se estatisticamente nos parâmetros variação da frequência fundamental (vF0) e variação da amplitude (vAm) da vogal /a/ e ressonância da fala. Houve correlação negativa entre o desempenho na percepção auditiva com os parâmetros de jitter, vF0 e grau geral da vogal /a/. Conclusão: A qualidade vocal do GI foi semelhante em praticamente todos os parâmetros vocais analisados a dos seus pares ouvintes (G2). A percepção auditiva influenciou os parâmetros jitter, vF0 e grau geral do impacto da voz, em que crianças e adolescentes deficientes auditivos que apresentaram maiores escores para a percepção auditiva também foram capazes de manter a emissão vocal mais equilibrada.

Development and validation of the protocol for the evaluation of voice in patients with hearing impairment (PEV-SHI)

Introduction

The voice of individuals with hearing impairment has been widely described, and can be compromised in all levels of the phonatory system.

Objective

To develop and validate an instrument for evaluating the voice of this population.

Methods

The instrument underwent the validation steps suggested by the Scientific Advisory Committee of the Medical Outcomes Trust. The study sample consisted of seventy-eight Brazilian people with cochlear implants (experimental group) and 78 individuals with normal hearing (control group), divided in groups by age range — children from 3 to 5 years; children from 6 to 10 years and adults from 18 to 46 years. The study sample participated in a voice recording of the sustained vowel /a/, connected speech and spontaneous conversation, in which three voice specialists rated using the proposed instrument. It consists of visual-analog scales of suprasegmental aspects, respiratory-phonatory coordination, resonance, phonation, additional parameters and general vocal perception.

Results

Evaluation by an expert committee and a pilot test established content validity. Reliability measures showed excellent test-retest reproducibility for the majority of the parameters. Analysis with the ROC curve showed that perceptual evaluation with the sustained vowel did not strongly differentiate individuals with cochlear implants from those with normal hearing, and the parameter “speech rate” did not differentiate the groups at all. For the connected speech and spontaneous conversation, the majority of the parameters differentiated the experimental group from the control group with an area under the curve ≥0.7. The cutoff values with maximum specificity and sensitivity were 30.5 for mild, 49.0 for moderate and 69.5 for intense deviation.

Conclusions

The protocol for the evaluation of voice in subjects with hearing impairment, PEV-SHI, is a reliable and useful tool for assessing the particularities of the voice of individuals with hearing impairment treated with cochlear implants and can be used in research and clinical settings to standardize evaluation and facilitate information exchange among services.

Acoustic characteristics of Arabic pharyngealized obstruents in children with cochlear implants

Speech production of children with cochlear implants (CIs) is generally characterized by low intelligibility and reduced phoneme accuracy. However, limited research investigated their speech production using acoustic measures. The current study examined voice onset time (VOT) for pharyngealized plosives [t,d], and spectral moments and noise duration for pharyngealized fricatives [s,ð] produced by Arabic speaking children with CIs. Productions from children with CIs were compared with both chronological age-matched and hearing experience-matched normal hearing children. Results showed that children with CIs exhibited difficulty producing distinct VOTs between plosives and produced different spectral patterns of both fricatives relative to both comparison groups; however, they were able to produce an acoustic distinction between both fricatives. Children with CIs produced the fricatives with lower spectral mean and higher skewness and kurtosis. The sources for inter-group differences in the acoustic measures appeared to be due in part to limitations in the quality of auditory input provided by CIs as well as reduced motor experience in speech production. Results suggest that VOT and spectral moments are sensitive to changes in perceived sound quality. Spectral moments analysis appears to give details on subtle aspects of fricative production at the phonetic level beyond that available using perceptual judgments.

Vocal Biomarkers of Mild-to-Moderate Hearing Loss in Children and Adults: Voiceless Sibilants

PURPOSE

The purpose of this study was to determine if an objective measure of speech production could serve as a vocal biomarker for the effects of high-frequency hearing loss on speech perception. It was hypothesized that production of voiceless sibilants is governed sufficiently by auditory feedback that high-frequency hearing loss results in subtle but significant shifts in the spectral characteristics of these sibilants.

METHOD

Sibilant production was examined in individuals with mild to moderately severe congenital (22 children; 8-17 years old) and acquired (23 adults; 55-80 years old) hearing losses. Measures of hearing level (pure-tone average thresholds at 4 and 8 kHz), speech perception (detection of nonsense words within sentences), and speech production (spectral center of gravity [COG] for /s/ and /ʃ/) were obtained in unaided and aided conditions.

RESULTS

For both children and adults, detection of nonsense words increased significantly as hearing thresholds improved. Spectral COG for /ʃ/ was unaffected by hearing loss in both listening conditions, whereas the spectral COG for /s/ significantly decreased as high-frequency hearing loss increased. The distance in spectral COG between /s/ and /ʃ/ decreased significantly with increasing hearing level. COG distance significantly predicted nonsense-word detection in children but not in adults.

CONCLUSIONS

At least one aspect of speech production (voiceless sibilants) is measurably affected by high-frequency hearing loss and is related to speech perception in children. Speech production did not predict speech perception in adults, suggesting a more complex relationship between auditory feedback and feedforward mechanisms with age. Even so, these results suggest that this vocal biomarker may be useful for identifying the presence of high-frequency hearing loss in adults and children and for predicting the impact of hearing loss in children.