Interdependence of linguistic and indexical speech perception skills in school-age children with early cochlear implantation

Speech Perception and Language Abilities Among Children Using Cochlear Implants: Findings From a Primary School Age Cohort in South India

OBJECTIVES

This study aimed to profile the speech perception and language abilities of a cohort of pediatric cochlear implant (CI) users in primary school years. It also aimed to understand the intercorrelations among audiological, child, and environmental characteristics, speech perception, and language skills and to explore the predictors of speech perception and language skills.

DESIGN

A cross-sectional design was used for the study. The participants were 222 pediatric CI users (106 boys; 116 girls) with a mean chronological age of 10.51 (SD ± 1.28) years. Participants had received CIs at a mean age of 2.93 (SD ± 0.95) years, with the mean duration of CI use being 7.43 (SD ± 1.15) years at the time of assessment. Participants completed an assessment battery comprising speech perception (phoneme discrimination, open-set speech perception in quiet) and language (semantics, syntax) tasks. Selected audiological, child, and environmental characteristics were documented. The mean and SDs of the measures across age categories (8 to 12 years) and the proportion of children attaining scores better than 80%, between 50 and 80%, and poorer than 50% of the total possible score in each task were computed to generate a profile of speech perception and language abilities. Correlational and regression analyses assessed the intercorrelations among the variables and predictors of speech perception and language abilities.

RESULTS

A large proportion (79.0%) of children in the study group obtained scores better than 80% for phoneme discrimination, whereas only 17.8% scored better than 80% for open-set speech perception in quiet. Additionally, 42.8 and 20.8% of children scored better than 80% for semantics and syntax, respectively. Speech perception and language abilities demonstrated moderate-strong intercorrelations, contributing to a significant proportion of the total variance explained in phoneme discrimination (42.9%), open-set speech perception (61.8%), semantics (63.0%), and syntax (60.8%). Phoneme discrimination and open-set speech perception emerged as large contributors to variance in overall language abilities. Among the audiological factors, only hearing age contributed to a small proportion of variance (3 to 6%) across children's speech perception and language performance.

CONCLUSIONS

Children using CI demonstrated highly variable performance in speech perception and expressive language skills during primary school. Although children demonstrated improved performance in phoneme discrimination and semantics, they continued to face challenges in the (quiet) speech perception and syntax abilities. The effect of audiological, child, and environmental factors was minimal in explaining the variance in speech perception and language abilities, which shared a bidirectional relationship. The findings relating to mid-term outcomes, ranging from 4 to 9 years after cochlear implantation, suggest the need for continued support and targeted interventions for developing speech perception and language abilities in the primary school years to optimize outcomes among pediatric CI users.

Vocal Emotion Recognition in School-Age Children With Hearing Aids

OBJECTIVES

In individuals with normal hearing, vocal emotion recognition continues to develop over many years during childhood. In children with hearing loss, vocal emotion recognition may be affected by combined effects from loss of audibility due to elevated thresholds, suprathreshold distortions from hearing loss, and the compensatory features of hearing aids. These effects could be acute, affecting the perceived signal quality, or accumulated over time, affecting emotion recognition development. This study investigates if, and to what degree, children with hearing aids have difficulties in perceiving vocal emotions, beyond what would be expected from age-typical levels.

DESIGN

We used a vocal emotion recognition test with non-language-specific pseudospeech audio sentences expressed in three basic emotions: happy, sad, and angry, along with a child-friendly gamified test interface. The test group consisted of 55 school-age children (5.4 to 17.8 years) with bilateral hearing aids, all with sensorineural hearing loss with no further exclusion based on hearing loss degree or configuration. For characterization of complete developmental trajectories, the control group with normal audiometric thresholds consisted of 86 age-matched children (6.0 to 17.1 years), and 68 relatively young adults (19.1 to 35.0 years).

RESULTS

Vocal emotion recognition of the control group with normal-hearing children and adults improved across age and reached a plateau around age 20. Although vocal emotion recognition in children with hearing aids also improved with age, it seemed to lag compared with the control group of children with normal hearing. A group comparison showed a significant difference from around age 8 years. Individual data indicated that a number of hearing-aided children, even with severe degrees of hearing loss, performed at age-expected levels, while some others scored lower than age-expected levels, even at chance levels. The recognition scores of hearing-aided children were not predicted by unaided or aided hearing thresholds, nor by previously measured voice cue discrimination sensitivity, for example, related to mean pitch or vocal tract length perception.

CONCLUSIONS

In line with previous literature, even in normal hearing, vocal emotion recognition develops over many years toward adulthood, likely due to interactions with linguistic and cognitive development. Given the long development period, any potential difficulties for vocal emotion recognition in children with hearing loss can only be identified with respect to what would be realistic based on their age. With such a comparison, we were able to show that, as a group, children with hearing aids also develop in vocal emotion recognition, however, seemingly at a slower pace. Individual data indicated a number of the hearing-aided children showed age-expected vocal emotion recognition. Hence, even though hearing aids have been developed and optimized for speech perception, these data indicate that hearing aids can also support age-typical development of vocal emotion recognition. For the children whose recognition scores were lower than age-expected levels, there were no predictive hearing-related factors. This could be potentially reflecting inherent variations related to development of relevant cognitive mechanisms, but a role from cumulative effects from hearing loss is also a possibility. As follow-up research, we plan to investigate if vocal emotion recognition will improve over time for these children.

Factors Associated With Social-Pragmatic Understanding in Deaf and Hard of Hearing and Typically Hearing 6-Year-Old Children

PURPOSE

Children develop social-pragmatic understanding with the help of sensory, cognitive, and linguistic functions by interacting with other people. This study aimed to explore (a) associations between auditory, demographic, cognitive, and linguistic factors and social-pragmatic understanding in children who use bilateral hearing aids (BiHAs) or bilateral cochlear implants (BiCIs) and in typically hearing (TH) children and (b) the effect of the group (BiHA, BiCI, TH) on social-pragmatic understanding when the effects of demographic, cognitive, and linguistic factors are controlled for.

METHOD

The Pragma test was used to assess social-pragmatic understanding in 119 six-year-old children: 25 children who use BiHAs, 29 who use BiCIs, and 65 TH children. The Pragma test is a standardized test that requires answering socially and contextually demanding questions with varying focuses and thus enables a comprehensive assessment of social-pragmatic understanding. Associations between auditory, demographic, cognitive, and linguistic factors and the Pragma test performance were analyzed. Between-groups differences in the Pragma test performance were analyzed while statistically controlling for the effects of factors that were associated with the Pragma test scores.

RESULTS

The BiHA users who had better unaided pure-tone average hearing thresholds had better social-pragmatic understanding. A higher level of maternal education and nonverbal intelligence were associated with a better social-pragmatic understanding in the BiHA and BiCI groups. Linguistic abilities correlated strongly with social-pragmatic understanding in all groups. The deaf and hard of hearing (DHH) groups differed from the TH children in social-pragmatic understanding even after the effects of maternal education, nonverbal intelligence, and linguistic skills were controlled for.

CONCLUSIONS

Despite early diagnosis of hearing loss and intervention, many DHH children are still at risk for social-pragmatic difficulties. Several factors may associate with social-pragmatic understanding in DHH children, which highlights the importance of a wide-ranging, multidisciplinary assessment, and the planning of focused, assessment-based interventions.

A Methodological Review of Stimuli Used for Classroom Speech-in-Noise Tests

PURPOSE

Listening is the gateway to learning in the mainstream classroom; however, classrooms are noisy environments, making listening challenging. Therefore, speech-in-noise tests that realistically incorporate the complexity of the classroom listening environment are needed. The aim of this article was to review the speech stimuli, noise stimuli, presentation mode, and presentation levels of current classroom speech-in-noise tests to determine how representative they are of real-world classroom listening.

METHOD

A comprehensive search of Scopus database following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines was conducted to identify classroom speech-in-noise tests used in the research literature. The search term was classroom AND (listening OR (speech AND (perception OR intelligibility OR recognition OR discrimination) AND noise) OR speech-in-noise) AND (test OR task OR measure OR assessment) AND children in the article title, abstract, and key word fields.

RESULTS

A total of 97 papers met the criteria to be included in the review. While the speech and noise stimuli were generally presented at realistic speech and noise levels, the speech materials were not representative of real-world classroom listening. Additionally, unrealistic noise and presentation modes were used in several studies.

CONCLUSION

This review will help researchers choose appropriate speech-in-noise test stimuli in future research and also help researchers understand what to consider when creating new speech-in-noise tests for classroom listening.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27659619.

Emotional prosodic expression of children with hearing aids or cochlear implants, rated by adults and peers

OBJECTIVE

The emotional prosodic expression potential of children with cochlear implants is poorer than that of normal hearing peers. Though little is known about children with hearing aids.

DESIGN

This study was set up to generate a better understanding of hearing aid users' prosodic identifiability compared to cochlear implant users and peers without hearing loss.

STUDY SAMPLE

Emotional utterances of 75 Dutch speaking children (7 - 12 yr; 26 CHA, 23 CCI, 26 CNH) were gathered. Utterances were evaluated blindly by normal hearing Dutch listeners: 22 children and 9 adults (17 - 24 yrs) for resemblance to three emotions (happiness, sadness, anger).

RESULTS

Emotions were more accurately recognised by adults than by children. Both children and adults correctly judged happiness significantly less often in CCI than in CNH. Also, adult listeners confused happiness with sadness more often in both CHA and CCI than in CNH.

CONCLUSIONS

Children and adults are able to accurately evaluate the emotions expressed through speech by children with varying degrees of hearing loss, ranging from mild to profound, nearly as well as they can with typically hearing children. The favourable outcomes emphasise the resilience of children with hearing loss in developing effective emotional communication skills.

Self-reported Hearing Quality of Life for Adolescent Cochlear Implant Recipients: A Longitudinal Study

BACKGROUND

 Clinicians are increasingly interested in self-reported hearing-specific quality of life (HQoL) for cochlear implant (CI) recipients, including pediatric CI recipients.

PURPOSE

 (1) To compare HQoL of adolescent CI recipients to those of peers with typical hearing (TH); (2) to examine, longitudinally, HQoL for a set of CI recipients; and (3) to determine the effects of child, demographic, audiological, speech perception, and language variables on adolescent HQoL.

RESEARCH DESIGN

 Hearing Environments and Reflections on Quality of Life (HEARQL) questionnaires were completed by children with CIs at elementary (HEARQL-26) and adolescent (HEARQL-28) ages.

STUDY SAMPLE

 Eighty CI recipients and 21 children with TH.

DATA COLLECTION AND ANALYSIS

 HEARQL-28 scores for the CI and TH groups were compared using nonparametric tests. Regression models were used to examine longitudinal results and to explore predictor variables for adolescent CI participants' HEARQL-28 scores.

RESULTS

 HEARQL-28 scores for CI participants were lower than those of peers with TH. For both CI and TH adolescents, the HEARQL subscale with the lowest score is "Hearing Situations." CI participants' HEARQL scores at elementary age were not significantly correlated with scores at adolescence. Over 70% of unexplained variance remains even after inclusion of variables with established contributions to traditional CI benefit.

CONCLUSIONS

 Self-reported HEARQL scores are largely unexplained for pediatric CI recipients; multidisciplinary explorations of other sources of variance, such as social, emotional, and psychosocial factors, should be pursued.

The Sound of Emotional Prosody: Nearly 3 Decades of Research and Future Directions

Emotional voices attract considerable attention. A search on any browser using "emotional prosody" as a key phrase leads to more than a million entries. Such interest is evident in the scientific literature as well; readers are reminded in the introductory paragraphs of countless articles of the great importance of prosody and that listeners easily infer the emotional state of speakers through acoustic information. However, despite decades of research on this topic and important achievements, the mapping between acoustics and emotional states is still unclear. In this article, we chart the rich literature on emotional prosody for both newcomers to the field and researchers seeking updates. We also summarize problems revealed by a sample of the literature of the last decades and propose concrete research directions for addressing them, ultimately to satisfy the need for more mechanistic knowledge of emotional prosody.

The effect of stimulus type and testing method on talker discrimination of school-age children

Efficient talker discrimination (TD) improves speech understanding under multi-talker conditions. So far, TD of children has been assessed using various testing parameters, making it difficult to draw comparative conclusions. This study explored the effects of the stimulus type and variability on children's TD. Thirty-two children (7-10 years old) underwent eight TD assessments with fundamental frequency + formant changes using an adaptive procedure. Stimuli included consonant-vowel-consonant words or three-word sentences and were either fixed by run or by trial (changing throughout the run). Cognitive skills were also assessed. Thirty-one adults (18-35 years old) served as controls. The results showed (1) poorer TD for the fixed-by-trial than the fixed-by-run method, with both stimulus types for the adults but only with the words for the children; (2) poorer TD for the words than the sentences with the fixed-by-trial method only for the children; and (3) significant correlations between the children's age and TD. These results support a developmental trajectory in the use of perceptual anchoring for TD and in its reliance on comprehensive acoustic and linguistic information. The finding that the testing parameters may influence the top-down and bottom-up processing for TD should be considered when comparing data across studies or when planning new TD experiments.

Is Early Cochlear Implantation Leads to Better Speech and Language Outcomes?

A cochlear implant is an electronic sensory system that converts mechanical energy into coded electrical signals that directly activate the auditory nerve fibers. Present review article investigates the findings of previous research papers which have assessed speech and language outcome in children who underwent early cochlear implantation. Several databases, including PubMed, Google, Google Scholar, and Medline, were investigated for research papers on the speech and language outcomes of children who had early-life implants. According to previous research, early detection and intervention of hearing loss are critical for the growth of speech and language skills. The effect of early detection of hearing loss and early cochlear implantation on a child's overall speech-language and auditory growth is highlighted in this article.

Effects of Segmental and Suprasegmental Speech Perception on Reading in Pediatric Cochlear Implant Recipients

PURPOSE

The aim of this study was to determine whether suprasegmental speech perception contributes unique variance in predictions of reading decoding and comprehension for prelingually deaf children using two devices, at least one of which is a cochlear implant (CI).

METHOD

A total of 104, 5- to 9-year-old CI recipients completed tests of segmental perception (e.g., word recognition in quiet and noise, recognition of vowels and consonants in quiet), suprasegmental perception (e.g., talker and stress discrimination, nonword stress repetition, and emotion identification), and nonverbal intelligence. Two years later, participants completed standardized tests of reading decoding and comprehension. Using regression analyses, the unique contribution of suprasegmental perception to reading skills was determined after controlling for demographic characteristics and segmental perception performance.

RESULTS

Standardized reading scores of the CI recipients increased with nonverbal intelligence for both decoding and comprehension. Female gender was associated with higher comprehension scores. After controlling for gender and nonverbal intelligence, segmental perception accounted for approximately 4% and 2% of the variance in decoding and comprehension, respectively. After controlling for nonverbal intelligence, gender, and segmental perception, suprasegmental perception accounted for an extra 4% and 7% unique variance in reading decoding and reading comprehension, respectively.

CONCLUSIONS

Suprasegmental perception operates independently from segmental perception to facilitate good reading outcomes for these children with CIs. Clinicians and educators should be mindful that early perceptual skills may have long-term benefits for literacy. Research on how to optimize suprasegmental perception, perhaps through hearing-device programming and/or training strategies, is needed.

Considerations in pediatric device candidacy: An emphasis on spoken language

As cochlear implant (CI) candidacy expands to consider children with more residual hearing, the use of a CI and a hearing aid (HA) at the non-implanted ear (bimodal devices) is increasing. This case study examines the contributions of acoustic and electric input to speech perception performance for a pediatric bimodal device user (S1) who is a borderline bilateral cochlear implant candidate. S1 completed a battery of perceptual tests in CI-only, HA-only and bimodal conditions. Since CIs and HAs differ in their ability to transmit cues related to segmental and suprasegmental perception, both types of perception were tested. Performance in all three device conditions were generally similar across tests, showing no clear device-condition benefit. Further, S1's spoken language performance was compared to those of a large group of children with prelingual severe-profound hearing loss who used two devices from a young age, at least one of which was a CI. S1's speech perception and language scores were average or above-average compared to these other pediatric CI recipients. Both segmental and suprasegmental speech perception, and spoken language skills should be examined to determine the broad-scale performance level of bimodal recipients, especially when deciding whether to move from bimodal devices to bilateral CIs.

Recognizing Voices Through a Cochlear Implant: A Systematic Review of Voice Perception, Talker Discrimination, and Talker Identification

OBJECTIVE

Some cochlear implant (CI) users report having difficulty accessing indexical information in the speech signal, presumably due to limitations in the transmission of fine spectrotemporal cues. The purpose of this review article was to systematically review and evaluate the existing research on talker processing in CI users. Specifically, we reviewed the performance of CI users in three types of talker- and voice-related tasks. We also examined the different factors (such as participant, hearing, and device characteristics) that might influence performance in these specific tasks.

DESIGN

We completed a systematic search of the literature with select key words using citation aggregation software to search Google Scholar. We included primary reports that tested (a) talker discrimination, (b) voice perception, and (c) talker identification. Each report must have had at least one group of participants with CIs. Each included study was also evaluated for quality of evidence.

RESULTS

The searches resulted in 1,561 references, which were first screened for inclusion and then evaluated in full. Forty-three studies examining talker discrimination, voice perception, and talker identification were included in the final review. Most studies were focused on postlingually deafened and implanted adult CI users, with fewer studies focused on prelingual implant users. In general, CI users performed above chance in these tasks. When there was a difference between groups, CI users performed less accurately than their normal-hearing (NH) peers. A subset of CI users reached the same level of performance as NH participants exposed to noise-vocoded stimuli. Some studies found that CI users and NH participants relied on different cues for talker perception. Within groups of CI users, there is moderate evidence for a bimodal benefit for talker processing, and there are mixed findings about the effects of hearing experience.

CONCLUSIONS

The current review highlights the challenges faced by CI users in tracking and recognizing voices and how they adapt to it. Although large variability exists, there is evidence that CI users can process indexical information from speech, though with less accuracy than their NH peers. Recent work has described some of the factors that might ease the challenges of talker processing in CI users. We conclude by suggesting some future avenues of research to optimize real-world speech outcomes.

Benefit of sequential bilateral cochlear implantation in children between 5 to 18 years old: A prospective cohort study

Objective

To determine the benefit of sequential cochlear implantation after a long inter-implantation interval in children with bilateral deafness receiving their second implant between 5 and 18 years of age.

Study design

Prospective cohort-study.

Setting

Tertiary multicenter.

Patients

85 children with bilateral deafness and unilateral implantation receiving a contralateral cochlear implant at the age of 5 to 18 years.

Method

The primary outcomes were speech recognition in quiet and noise (CVC) scores. The secondary outcomes were language outcomes and subjective hearing abilities, all measured before and 12 months after sequential bilateral cochlear implantation. Medians of the paired data were compared using the Wilcoxon signed-rank test. Univariable linear regression analyses was used to analyze associations between variables and performance outcomes.

Results

A significant benefit was found for speech recognition in quiet (96% [89–98] vs 91% [85–96]; p < 0.01) and noise (65% [57–75] vs 54% [47–71]; p = 0.01) in the bilateral CI condition compared to unilateral (n = 75, excluded 10 non-users). No benefit was seen for language outcomes. The subjective sound quality score was statistically significant higher in bilateral compared to the unilateral CI condition. Pre-operative residual hearing level in the ear of the second implant, the inter-implant interval and age at time of second implantation was not significantly associated with performance scores.

Conclusion

After 12 months of use, sequential bilateral cochlear implantation showed improved speech perception in quiet and noise and improved subjective sound quality outcomes in children despite a great inter-implantation interval (median of 8 years [range 1–16 years]).

Verbal Working Memory Error Patterns and Speech-Language Outcomes in Youth With Cochlear Implants

PURPOSE

Verbal working memory (VWM) delays are commonly found in prelingually deaf youth with cochlear implants (CIs), albeit with considerable interindividual variability. However, little is known about the neurocognitive information-processing mechanisms underlying these delays and how these mechanisms relate to spoken language outcomes. The goal of this study was to use error analysis of the letter-number sequencing (LNS) task to test the hypothesis that VWM delays in CI users are due, in part, to fragile, underspecified phonological representations in short-term memory.

METHOD

Fifty-one CI users aged 7-22 years and 53 normal hearing (NH) peers completed a battery of speech, language, and neurocognitive tests. LNS raw scores and error profiles were compared between samples, and a hierarchical regression model was used to test for associations with measures of speech, language, and hearing.

RESULTS

Youth with CIs scored lower on the LNS test than NH peers and committed a significantly higher number of errors involving phonological confusions (recalling an incorrect letter/digit in place of a phonologically similar one). More phonological errors were associated with poorer performance on measures of nonword repetition and following spoken directions but not with hearing quality.

CONCLUSIONS

Study findings support the hypothesis that poorer VWM in deaf children with CIs is due, in part, to fragile, underspecified phonological representations in short-term/working memory, which underlie spoken language delays. Programs aimed at strengthening phonological representations may improve VWM and spoken language outcomes in CI users.

Spectral Modulation Detection Performance and Speech Perception in Pediatric Cochlear Implant Recipients

PURPOSE

The aims of this study were, for pediatric cochlear implant (CI) recipients, (a) to determine the effect of age on their spectral modulation detection (SMD) ability and compare their age effect to that of their typically hearing (TH) peers; (b) to identify demographic, cognitive, and audiological factors associated with SMD ability; and (c) to determine the unique contribution of SMD ability to segmental and suprasegmental speech perception performance.

METHOD

A total of 104 pediatric CI recipients and 38 TH peers (ages 6-11 years) completed a test of SMD. CI recipients completed tests of segmental (e.g., word recognition in noise and vowels and consonants in quiet) and suprasegmental (e.g., talker discrimination, stress discrimination, and emotion identification) perception, nonverbal intelligence, and working memory. Regressions analyses were used to examine the effects of group and age on percent-correct SMD scores. For the CI group, the effects of demographic, audiological, and cognitive variables on SMD performance and the effects of SMD on speech perception were examined.

RESULTS

The TH group performed significantly better than the CI group on SMD. Both groups showed better performance with increasing age. Significant predictors of SMD performance for the CI group were age and nonverbal intelligence. SMD performance predicted significant variance in segmental and suprasegmental perception. The variance predicted by SMD performance was nearly double for suprasegmental than for segmental perception.

CONCLUSIONS

Children in the CI group, on average, scored lower than their TH peers. The slopes of improvement in SMD with age did not differ between the groups. The significant effect of nonverbal intelligence on SMD performance in CI recipients indicates that difficulties inherent in the task affect outcomes. SMD ability predicted speech perception scores, with a more prominent role in suprasegmental than in segmental speech perception. SMD ability may provide a useful nonlinguistic tool for predicting speech perception benefit, with cautious interpretation based on age and cognitive function.

Do Acoustic Environment Characteristics Affect the Lexical Development of Children With Cochlear Implants? A Longitudinal Study Before and After Cochlear Implant Activation

Purpose This study investigates the acoustic environment of children with cochlear implants (CIs) and the relationship between exposure to speech, in noise and in quiet, and the children's lexical production up to 1 year after CI activation, while controlling for the effect of early individual differences in receptive vocabulary growth. Method Eighteen children with CIs were observed at 3, 6, and 12 months after CI activation. Children's spontaneous word production during interaction with their mothers (types and tokens) and their expressive and receptive vocabulary size were considered. The characteristics of the acoustic environments in terms of acoustic scenes (speech in noise or in quiet, quiet, noise, music, and other) and of loudness ranges were assessed using data logging of the children's devices. Results Data analysis showed that both the number of tokens and the number of types produced 1 year after CI activation were affected by the children's exposure to speech in quiet with a loudness range between 40 and 69 dB. Expressive vocabulary size and types were affected by the receptive vocabulary knowledge that the children achieved over the first 3 months after CI activation. Conclusions Our data support the role of speech environment and individual differences in early comprehension on lexical production. The importance of exposure to speech with particular characteristics for the lexical development of children with CIs and the implications for clinical practice are discussed.

The Neural Processing of Vocal Emotion After Hearing Reconstruction in Prelingual Deaf Children: A Functional Near-Infrared Spectroscopy Brain Imaging Study

As elucidated by prior research, children with hearing loss have impaired vocal emotion recognition compared with their normal-hearing peers. Cochlear implants (CIs) have achieved significant success in facilitating hearing and speech abilities for people with severe-to-profound sensorineural hearing loss. However, due to the current limitations in neuroimaging tools, existing research has been unable to detail the neural processing for perception and the recognition of vocal emotions during early stage CI use in infant and toddler CI users (ITCI). In the present study, functional near-infrared spectroscopy (fNIRS) imaging was employed during preoperative and postoperative tests to describe the early neural processing of perception in prelingual deaf ITCIs and their recognition of four vocal emotions (fear, anger, happiness, and neutral). The results revealed that the cortical response elicited by vocal emotional stimulation on the left pre-motor and supplementary motor area (pre-SMA), right middle temporal gyrus (MTG), and right superior temporal gyrus (STG) were significantly different between preoperative and postoperative tests. These findings indicate differences between the preoperative and postoperative neural processing associated with vocal emotional stimulation. Further results revealed that the recognition of vocal emotional stimuli appeared in the right supramarginal gyrus (SMG) after CI implantation, and the response elicited by fear was significantly greater than the response elicited by anger, indicating a negative bias. These findings indicate that the development of emotional bias and the development of emotional perception and recognition capabilities in ITCIs occur on a different timeline and involve different neural processing from those in normal-hearing peers. To assess the speech perception and production abilities, the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and Speech Intelligibility Rating (SIR) were used. The results revealed no significant differences between preoperative and postoperative tests. Finally, the correlates of the neurobehavioral results were investigated, and the results demonstrated that the preoperative response of the right SMG to anger stimuli was significantly and positively correlated with the evaluation of postoperative behavioral outcomes. And the postoperative response of the right SMG to anger stimuli was significantly and negatively correlated with the evaluation of postoperative behavioral outcomes.

Voice Emotion Recognition by Mandarin-Speaking Children with Cochlear Implants

Objectives

Emotional expressions are very important in social interactions. Children with cochlear implants can have voice emotion recognition deficits due to device limitations. Mandarin-speaking children with cochlear implants may face greater challenges than those speaking nontonal languages; the pitch information is not well preserved in cochlear implants, and such children could benefit from child-directed speech, which carries more exaggerated distinctive acoustic cues for different emotions. This study investigated voice emotion recognition, using both adult-directed and child-directed materials, in Mandarin-speaking children with cochlear implants compared with normal hearing peers. The authors hypothesized that both the children with cochlear implants and those with normal hearing would perform better with child-directed materials than with adult-directed materials.

Design

Thirty children (7.17-17 years of age) with cochlear implants and 27 children with normal hearing (6.92-17.08 years of age) were recruited in this study. Participants completed a nonverbal reasoning test, speech recognition tests, and a voice emotion recognition task. Children with cochlear implants over the age of 10 years also completed the Chinese version of the Nijmegen Cochlear Implant Questionnaire to evaluate the health-related quality of life. The voice emotion recognition task was a five-alternative, forced-choice paradigm, which contains sentences spoken with five emotions (happy, angry, sad, scared, and neutral) in a child-directed or adult-directed manner.

Results

Acoustic analyses showed substantial variations across emotions in all materials, mainly on measures of mean fundamental frequency and fundamental frequency range. Mandarin-speaking children with cochlear implants displayed a significantly poorer performance than normal hearing peers in voice emotion perception tasks, regardless of whether the performance is measured in accuracy scores, Hu value, or reaction time. Children with cochlear implants and children with normal hearing were mainly affected by the mean fundamental frequency in speech emotion recognition tasks. Chronological age had a significant effect on speech emotion recognition in children with normal hearing; however, there was no significant correlation between chronological age and accuracy scores in speech emotion recognition in children with implants. Significant effects of specific emotion and test materials (better performance with child-directed materials) in both groups of children were observed. Among the children with cochlear implants, age at implantation, percentage scores of nonverbal intelligence quotient test, and sentence recognition threshold in quiet could predict recognition performance in both accuracy scores and Hu values. Time wearing cochlear implant could predict reaction time in emotion perception tasks among children with cochlear implants. No correlation was observed between the accuracy score in voice emotion perception and the self-reported scores of health-related quality of life; however, the latter were significantly correlated with speech recognition skills among Mandarin-speaking children with cochlear implants.

Conclusions

Mandarin-speaking children with cochlear implants could have significant deficits in voice emotion recognition tasks compared with their normally hearing peers and can benefit from the exaggerated prosody of child-directed speech. The effects of age at cochlear implantation, speech and language development, and cognition could play an important role in voice emotion perception by Mandarin-speaking children with cochlear implants.

Perception of Child-Directed Versus Adult-Directed Emotional Speech in Pediatric Cochlear Implant Users

OBJECTIVES

Cochlear implants (CIs) are remarkable in allowing individuals with severe to profound hearing loss to perceive speech. Despite these gains in speech understanding, however, CI users often struggle to perceive elements such as vocal emotion and prosody, as CIs are unable to transmit the spectro-temporal detail needed to decode affective cues. This issue becomes particularly important for children with CIs, but little is known about their emotional development. In a previous study, pediatric CI users showed deficits in voice emotion recognition with child-directed stimuli featuring exaggerated prosody. However, the large intersubject variability and differential developmental trajectory known in this population incited us to question the extent to which exaggerated prosody would facilitate performance in this task. Thus, the authors revisited the question with both adult-directed and child-directed stimuli.

DESIGN

Vocal emotion recognition was measured using both child-directed (CDS) and adult-directed (ADS) speech conditions. Pediatric CI users, aged 7-19 years old, with no cognitive or visual impairments and who communicated through oral communication with English as the primary language participated in the experiment (n = 27). Stimuli comprised 12 sentences selected from the HINT database. The sentences were spoken by male and female talkers in a CDS or ADS manner, in each of the five target emotions (happy, sad, neutral, scared, and angry). The chosen sentences were semantically emotion-neutral. Percent correct emotion recognition scores were analyzed for each participant in each condition (CDS vs. ADS). Children also completed cognitive tests of nonverbal IQ and receptive vocabulary, while parents completed questionnaires of CI and hearing history. It was predicted that the reduced prosodic variations found in the ADS condition would result in lower vocal emotion recognition scores compared with the CDS condition. Moreover, it was hypothesized that cognitive factors, perceptual sensitivity to complex pitch changes, and elements of each child's hearing history may serve as predictors of performance on vocal emotion recognition.

RESULTS

Consistent with our hypothesis, pediatric CI users scored higher on CDS compared with ADS speech stimuli, suggesting that speaking with an exaggerated prosody-akin to "motherese"-may be a viable way to convey emotional content. Significant talker effects were also observed in that higher scores were found for the female talker for both conditions. Multiple regression analysis showed that nonverbal IQ was a significant predictor of CDS emotion recognition scores while Years using CI was a significant predictor of ADS scores. Confusion matrix analyses revealed a dependence of results on specific emotions; for the CDS condition's female talker, participants had high sensitivity (d' scores) to happy and low sensitivity to the neutral sentences while for the ADS condition, low sensitivity was found for the scared sentences.

CONCLUSIONS

In general, participants had higher vocal emotion recognition to the CDS condition which also had more variability in pitch and intensity and thus more exaggerated prosody, in comparison to the ADS condition. Results suggest that pediatric CI users struggle with vocal emotion perception in general, particularly to adult-directed speech. The authors believe these results have broad implications for understanding how CI users perceive emotions both from an auditory communication standpoint and a socio-developmental perspective.

Meta-Analysis on the Identification of Linguistic and Emotional Prosody in Cochlear Implant Users and Vocoder Simulations

OBJECTIVES

This study quantitatively assesses how cochlear implants (CIs) and vocoder simulations of CIs influence the identification of linguistic and emotional prosody in nontonal languages. By means of meta-analysis, it was explored how accurately CI users and normal-hearing (NH) listeners of vocoder simulations (henceforth: simulation listeners) identify prosody compared with NH listeners of unprocessed speech (henceforth: NH listeners), whether this effect of electric hearing differs between CI users and simulation listeners, and whether the effect of electric hearing is influenced by the type of prosody that listeners identify or by the availability of specific cues in the speech signal.

DESIGN

Records were found by searching the PubMed Central, Web of Science, Scopus, Science Direct, and PsycINFO databases (January 2018) using the search terms "cochlear implant prosody" and "vocoder prosody." Records (published in English) were included that reported results of experimental studies comparing CI users' and/or simulation listeners' identification of linguistic and/or emotional prosody in nontonal languages to that of NH listeners (all ages included). Studies that met the inclusion criteria were subjected to a multilevel random-effects meta-analysis.

RESULTS

Sixty-four studies reported in 28 records were included in the meta-analysis. The analysis indicated that CI users and simulation listeners were less accurate in correctly identifying linguistic and emotional prosody compared with NH listeners, that the identification of emotional prosody was more strongly compromised by the electric hearing speech signal than linguistic prosody was, and that the low quality of transmission of fundamental frequency (f0) through the electric hearing speech signal was the main cause of compromised prosody identification in CI users and simulation listeners. Moreover, results indicated that the accuracy with which CI users and simulation listeners identified linguistic and emotional prosody was comparable, suggesting that vocoder simulations with carefully selected parameters can provide a good estimate of how prosody may be identified by CI users.

CONCLUSIONS

The meta-analysis revealed a robust negative effect of electric hearing, where CIs and vocoder simulations had a similar negative influence on the identification of linguistic and emotional prosody, which seemed mainly due to inadequate transmission of f0 cues through the degraded electric hearing speech signal of CIs and vocoder simulations.

Higher Right Hemisphere Gamma Band Lateralization and Suggestion of a Sensitive Period for Vocal Auditory Emotional Stimuli Recognition in Unilateral Cochlear Implant Children: An EEG Study

In deaf children, huge emphasis was given to language; however, emotional cues decoding and production appear of pivotal importance for communication capabilities. Concerning neurophysiological correlates of emotional processing, the gamma band activity appears a useful tool adopted for emotion classification and related to the conscious elaboration of emotions. Starting from these considerations, the following items have been investigated: (i) whether emotional auditory stimuli processing differs between normal-hearing (NH) children and children using a cochlear implant (CI), given the non-physiological development of the auditory system in the latter group; (ii) whether the age at CI surgery influences emotion recognition capabilities; and (iii) in light of the right hemisphere hypothesis for emotional processing, whether the CI side influences the processing of emotional cues in unilateral CI (UCI) children. To answer these matters, 9 UCI (9.47 ± 2.33 years old) and 10 NH (10.95 ± 2.11 years old) children were asked to recognize nonverbal vocalizations belonging to three emotional states: positive (achievement, amusement, contentment, relief), negative (anger, disgust, fear, sadness), and neutral (neutral, surprise). Results showed better performances in NH than UCI children in emotional states recognition. The UCI group showed increased gamma activity lateralization index (LI) (relative higher right hemisphere activity) in comparison to the NH group in response to emotional auditory cues. Moreover, LI gamma values were negatively correlated with the percentage of correct responses in emotion recognition. Such observations could be explained by a deficit in UCI children in engaging the left hemisphere for more demanding emotional task, or alternatively by a higher conscious elaboration in UCI than NH children. Additionally, for the UCI group, there was no difference between the CI side and the contralateral side in gamma activity, but a higher gamma activity in the right in comparison to the left hemisphere was found. Therefore, the CI side did not appear to influence the physiologic hemispheric lateralization of emotional processing. Finally, a negative correlation was shown between the age at the CI surgery and the percentage of correct responses in emotion recognition and then suggesting the occurrence of a sensitive period for CI surgery for best emotion recognition skills development.

Cochlear Implantation

BACKGROUND

Hearing impairment that is too severe to be adequately treated with conventional hearing aids can lead, in children, to severe developmental disturbances of hearing and language, and, in adults, to communicative and social deprivation. Recent advances in medical device technology and in microsurgical techniques have led to an expansion of the indications for cochlear implantation (CI) for adults with progressive hearing loss in older age, and to a restructuring of the process of care for these patients in Germany.

METHODS

This review is based on pertinent publications retrieved by a selective search in PubMed, as well as on the CI guidelines and CI "white book" of the German Society of Otolaryngology and Head and Neck Surgery.

RESULTS

Early and accurate diagnosis is crucial for the successful auditory rehabilitation of high-grade hearing impairment. In children, a key role is played by newborn auditory screening, which is mandatory in Germany and enables the provision of a CI in the first year of life when necessary. 86% of the children receiving a CI achieve linguistic comprehension of fluently spoken sentences. For adults, positive prognostic factors for hearing after the provision of a CI include a highly motivated patient, "postlingual" onset of the hearing impairment (i.e., after the acquisition of language), and a brief duration of deafness. Auditory rehabilitation is associated with significant improvement, not just of hearing and of the comprehension of spoken language, but also of quality of life, particularly in elderly patients. For patients of any age with bilateral hearing loss, CIs should be provided on both sides, if possible. The more common complications of the procedure, with a probability of 2-4% each, are technical implant defects, dizziness, and wound-healing disturbances.

CONCLUSION

Cochlear implantation, performed in specialized centers, is a safe and reliable technique and regularly enables the successful rehabilitation of hearing in both children and adults.

Does early cochlear implantation promote better reading comprehension skills?

OBJECTIVE

to investigate the effect of age at CI activation and to explore the role of other variables such as linguistic skills, stimulation modality and gender on reading comprehension.

STUDY DESIGN

Prospective observational nonrandomized study.

METHODS

89 children with profound congenital sensorineural hearing loss were included in the study. The mean age at CI activation was 21 months (DS ± 11; range 7-50). The Italian reading standardized test, "Prove di lettura MT", was used to assess reading comprehension. The individual raw data MT score were converted into z scores (expected values: means = 0 and SD = 1). The positive values indicated better performance and negative values indicated worse performance.

RESULTS

Early implanted children achieved significantly better reading comprehension skills, 55 out of 89 children are within 1 SD from the overall mean. 34 children (38.2%) attainted MT z-scores less than 1 SD below the mean. Children with unilateral CI performed somewhat worse if compared to bilateral CI and bimodal stimulation mode, although the differences were weakly significant from a statistical point of view. A strong and positive correlation (rho .69, p < .001) was found with the lexical and morphosyntactic comprehension (rho .70, p < .001). Not significantly different values were observed for gender and parental education level.

CONCLUSION

Early cochlear implantation promoted better development of reading skills in children with cochlear implantation. LEVEL OF EVIDENCES: outcomes research.

Self-reported hearing quality of life measures in pediatric cochlear implant recipients with bilateral input

Objective: Self-reported hearing quality of life (QoL) for pediatric cochlear implant (CI) recipients was examined, asking whether 1) children with CIs have similar QoL as those with less severe hearing loss (HL); 2) children with different bilateral CI (BCI) device configurations report different QoL; and 3) do audiological, demographic and spoken language factors affect hearing QoL?Design: One hundred four children (ages 7-11 years) using bimodal devices or BCIs participated. The Hearing Environments and Reflection of Quality of Life (HEAR-QL) questionnaire, receptive language and speech perception tests were administered. HEAR-QL scores of CI recipients were compared to scores of age-mates with normal hearing and mild to profound HL.Results: HEAR-QL scores for CI participants were similar to those of children with less severe HL and did not differ with device configuration. Emotion identification and word recognition in noise correlated significantly with HEAR-QL scores.Discussion: CI recipients reported that HL hinders social participation. Better understanding of speech in noise and emotional content was associated with fewer hearing-related difficulties on the HEAR-QL.Conclusions: Noisy situations encountered in educational settings should be addressed for children with HL. The link between perception of emotion and hearing-related QoL for CI recipients should be further examined.

Evaluation of a New Algorithm to Optimize Audibility in Cochlear Implant Recipients

OBJECTIVES

A positive relation between audibility and speech understanding has been established for cochlear implant (CI) recipients. Sound field thresholds of 20 dB HL across the frequency range provide CI users the opportunity to understand soft and very soft speech. However, programming the sound processor to attain good audibility can be time-consuming and difficult for some patients. To address these issues, Advanced Bionics (AB) developed the SoftVoice algorithm designed to remove system noise and thereby improve audibility of soft speech. The present study aimed to evaluate the efficacy of SoftVoice in optimizing AB CI recipients' soft-speech perception.

DESIGN

Two studies were conducted. Study 1 had two phases, 1A and 1B. Sixteen adult, AB CI recipients participated in Study 1A. Acute testing was performed in the unilateral CI condition using a Harmony processor programmed with participants' everyday-use program (Everyday) and that same program but with SoftVoice implemented. Speech recognition measures were administered at several presentation levels in quiet (35 to 60 dB SPL) and in noise (60 dB SPL). In Study 1B, 10 of the participants compared Everyday and SoftVoice at home to obtain feedback regarding the use of SoftVoice in various environments. During Study 2, soft-speech perception was acutely measured with Everyday and SoftVoice for 10 participants using the Naida CI Q70 processor. Results with the Harmony (Study 1A) and Naida processors were compared. Additionally, Study 2 evaluated programming options for setting electrode threshold levels (T-levels or Ts) to improve the usability of SoftVoice in daily life.

RESULTS

Study 1A showed significantly higher scores with SoftVoice than Everyday at soft presentation levels (35, 40, 45, and 50 dB SPL) and no significant differences between programs at a conversational level (60 dB SPL) in quiet or in noise. After take-home experience with SoftVoice and Everyday (Study 1B), 5 of 10 participants reported preferring SoftVoice over Everyday; however, 6 reported bothersome environmental sound when listening with SoftVoice at home. Results of Study 2 indicated similar soft-speech perception between Harmony and Naida processors. Additionally, implementing SoftVoice with Ts at the manufacturer's default setting of 10% of Ms reduced reports of bothersome environmental sound during take-home experience; however, soft-speech perception was best with SoftVoice when Ts were behaviorally set above 10% of Ms.

CONCLUSIONS

Results indicate that SoftVoice may be a potential tool for optimizing AB users' audibility and, in turn, soft-speech perception. To achieve optimal performance at soft levels and comfortable use in daily environments, setting Ts must be considered with SoftVoice. Future research should examine program parameters that may benefit soft-speech perception when used in combination with SoftVoice (e.g., increased input dynamic range).

Quality of life of children with hearing loss in special and mainstream education: A longitudinal study

OBJECTIVES

To compare the quality of life (QoL) of children with hearing loss (HL) and children with normal hearing (NH) and to examine how the QoL of children with HL changes over time, considering language skills, type of hearing device, degree of HL, and type of education.

METHODS AND MATERIALS

This longitudinal study included 62 children with HL and their parents. Developmental outcome data were collected at two time points, when the mean ages of the children were 4 and 11 years. The Pediatric Quality of Life (PedsQL™) questionnaire, which includes assessments of Physical, Emotional, Social, and School functioning, was completed by parents at both time points and by the children with HL at the second time point. Receptive and expressive language skills at 4 years were assessed by the Reynell Developmental Language Scale. Results were compared with a Dutch normative sample.

RESULTS

The QoL of children with HL was similar to that of children with NH at both time points on two of the four QoL scales, Emotional and Physical functioning. On the other two scales, Social and School functioning, children with HL who attended special education and children who switched to mainstream education showed lower scores than children with HL who were consistently in mainstream education and lower scores than children with NH. The School QoL of children with HL decreased over time, as did the School QoL of children with NH. Social QoL of children with cochlear implants decreased over time, but this was not the case in children with hearing aids. Language skills and the degree of HL did not clinically improve the QoL over time of preschool children with HL.

CONCLUSIONS

The QoL of children with HL in mainstream education and the Physical and Emotional QoL of all children with HL were satisfactory. It is essential to develop specific guidance regarding school activities for children with HL in special education and for children with HL who switch to mainstream education in order to increase their social QoL.

Voice Emotion Recognition by Children With Mild-to-Moderate Hearing Loss

OBJECTIVES

Emotional communication is important in children's social development. Previous studies have shown deficits in voice emotion recognition by children with moderate-to-severe hearing loss or with cochlear implants. Little, however, is known about emotion recognition in children with mild-to-moderate hearing loss. The objective of this study was to compare voice emotion recognition by children with mild-to-moderate hearing loss relative to their peers with normal hearing, under conditions in which the emotional prosody was either more or less exaggerated (child-directed or adult-directed speech, respectively). We hypothesized that the performance of children with mild-to-moderate hearing loss would be comparable to their normally hearing peers when tested with child-directed materials but would show significant deficits in emotion recognition when tested with adult-directed materials, which have reduced prosodic cues.

DESIGN

Nineteen school-aged children (8 to 14 years of age) with mild-to-moderate hearing loss and 20 children with normal hearing aged 6 to 17 years participated in the study. A group of 11 young, normally hearing adults was also tested. Stimuli comprised sentences spoken in one of five emotions (angry, happy, sad, neutral, and scared), either in a child-directed or in an adult-directed manner. The task was a single-interval, five-alternative forced-choice paradigm, in which the participants heard each sentence in turn and indicated which of the five emotions was associated with that sentence. Reaction time was also recorded as a measure of cognitive load.

RESULTS

Acoustic analyses confirmed the exaggerated prosodic cues in the child-directed materials relative to the adult-directed materials. Results showed significant effects of age, specific emotion (happy, sad, etc.), and test materials (better performance with child-directed materials) in both groups of children, as well as susceptibility to talker variability. Contrary to our hypothesis, no significant differences were observed between the 2 groups of children in either emotion recognition (percent correct or d' values) or in reaction time, with either child- or adult-directed materials. Among children with hearing loss, degree of hearing loss (mild or moderate) did not predict performance. In children with hearing loss, interactions between vocabulary, materials, and age were observed, such that older children with stronger vocabulary showed better performance with child-directed speech. Such interactions were not observed in children with normal hearing. The pattern of results was broadly consistent across the different measures of accuracy, d', and reaction time.

CONCLUSIONS

Children with mild-to-moderate hearing loss do not have significant deficits in overall voice emotion recognition compared with their normally hearing peers, but mechanisms involved may be different between the 2 groups. The results suggest a stronger role for linguistic ability in emotion recognition by children with normal hearing than by children with hearing loss.

Effects of Early Acoustic Hearing on Speech Perception and Language for Pediatric Cochlear Implant Recipients

Purpose The overall goal of the current study was to identify an optimal level and duration of acoustic experience that facilitates language development for pediatric cochlear implant (CI) recipients-specifically, to determine whether there is an optimal duration of hearing aid (HA) use and unaided threshold levels that should be considered before proceeding to bilateral CIs. Method A total of 117 pediatric CI recipients (ages 5-9 years) were given speech perception and standardized tests of receptive vocabulary and language. The speech perception battery included tests of segmental perception (e.g., word recognition in quiet and noise, and vowels and consonants in quiet) and of suprasegmental perception (e.g., talker and stress discrimination, and emotion identification). Hierarchical regression analyses were used to determine the effects of speech perception on language scores, and the effects of residual hearing level (unaided pure-tone average [PTA]) and duration of HA use on speech perception. Results A continuum of residual hearing levels and the length of HA use were represented by calculating the unaided PTA of the ear with the longest duration of HA use for each child. All children wore 2 devices: Some wore bimodal devices, while others received their 2nd CI either simultaneously or sequentially, representing a wide range of HA use (0.03-9.05 years). Regression analyses indicate that suprasegmental perception contributes unique variance to receptive language scores and that both segmental and suprasegmental skills each contribute independently to receptive vocabulary scores. Also, analyses revealed an optimal duration of HA use for each of 3 ranges of hearing loss severity (with mean PTAs of 73, 92, and 111 dB HL) that maximizes suprasegmental perception. Conclusions For children with the most profound losses, early bilateral CIs provide the greatest opportunity for developing good spoken language skills. For those with moderate-to-severe losses, however, a prescribed period of bimodal use may be more advantageous for developing good spoken language skills.

Recognition of emotional prosody by Mandarin-speaking adults with cochlear implants

To understand how cochlear implant processing affects emotional prosody recognition in tonal languages, how normal-hearing (NH) and cochlear-implanted (CI) adults identify four emotions ("angry," "happy," "sad," and "neutral") in short, semantically neutral, Mandarin sentences are compared. Depending on hearing status (CI, NH), adults heard natural speech and/or noise-vocoded speech conditions (4-, 8-, and 16-spectral channels). Results suggest that Mandarin-speaking adults with CIs recognize emotions with similar accuracy as NH listeners attending to spectrally degraded (4-channel) vocoded speech. The accuracy noted for Mandarin appears to be lower than that described in previous studies of English.

Preimplant Hearing Aid Fittings and Aided Audibility for Pediatric Cochlear Implant Recipients

BACKGROUND

Audibility of speech for children with hearing loss (HL) depends on the degree of HL and the fitting of the hearing aids (HAs) themselves. Many studies on cochlear implant (CI) users have demonstrated that preimplant hearing is associated with postimplant outcomes, but there have been very few reports on the fitting of HAs before surgery.

PURPOSE

The aims of this study were to characterize HA fittings and aided audibility of speech for pediatric HA users with severe to profound HL and to examine the relation between preimplant aided audibility and postimplant speech perception.

RESEARCH DESIGN

A descriptive/observational and correlational study. Audiologic records of pediatric CI participants involved in a larger study examining the effects of early acoustic hearing were analyzed retrospectively; when available, these records included HA verification and speech recognition performance.

STUDY SAMPLE

The CI participants were enrolled in audiology centers and oral schools for the deaf across the United States.

DATA COLLECTION AND ANALYSIS

To determine whether deviations from prescribed DSL target were significantly greater than zero, 95% confidence intervals of the mean deviation were calculated for each frequency (250, 500, 1000, 2000, and 4000 Hz). Correlational analyses were used to examine the relationship between preimplant aided Speech Intelligibility Indices (SIIs) and postimplant speech perception in noise. Correlational analyses were also used to explore the relationship between preimplant aided SIIs and demographic data. T-tests were used to compare preimplant-aided SIIs of HAs of listeners who later became users of either sequential CIs, simultaneous CIs, or bimodal devices.

RESULTS

Preimplant fittings of HAs were generally very close to prescriptive targets, except at 4000 Hz for those HAs with active frequency-lowering processing, and preimplant SIIs, albeit low, were correlated with postimplant speech recognition performance in noise. These results suggest that aided audibility should be maximized throughout the HA trial for later speech recognition purposes.

CONCLUSIONS

It is recommended that HA fittings be optimized to support speech audibility even when considering implantation. In addition to the age at which HA use begins, the aided audibility itself is important in determining CI candidacy and decisions regarding bimodal HA use.

Children's Recognition of Emotional Prosody in Spectrally Degraded Speech Is Predicted by Their Age and Cognitive Status

OBJECTIVES

It is known that school-aged children with cochlear implants show deficits in voice emotion recognition relative to normal-hearing peers. Little, however, is known about normal-hearing children's processing of emotional cues in cochlear implant-simulated, spectrally degraded speech. The objective of this study was to investigate school-aged, normal-hearing children's recognition of voice emotion, and the degree to which their performance could be predicted by their age, vocabulary, and cognitive factors such as nonverbal intelligence and executive function.

DESIGN

Normal-hearing children (6-19 years old) and young adults were tested on a voice emotion recognition task under three different conditions of spectral degradation using cochlear implant simulations (full-spectrum, 16-channel, and 8-channel noise-vocoded speech). Measures of vocabulary, nonverbal intelligence, and executive function were obtained as well.

RESULTS

Adults outperformed children on all tasks, and a strong developmental effect was observed. The children's age, the degree of spectral resolution, and nonverbal intelligence were predictors of performance, but vocabulary and executive functions were not, and no interactions were observed between age and spectral resolution.

CONCLUSIONS

These results indicate that cognitive function and age play important roles in children's ability to process emotional prosody in spectrally degraded speech. The lack of an interaction between the degree of spectral resolution and children's age further suggests that younger and older children may benefit similarly from improvements in spectral resolution. The findings imply that younger and older children with cochlear implants may benefit similarly from technical advances that improve spectral resolution.

Prosody perception and production by children with cochlear implants

The perception and production of emotional and linguistic (focus) prosody were compared in children with cochlear implants (CI) and normally hearing (NH) peers. Thirteen CI and thirteen hearing-age-matched school-aged NH children were tested, as baseline, on non-verbal emotion understanding, non-word repetition, and stimulus identification and naming. Main tests were verbal emotion discrimination, verbal focus position discrimination, acted emotion production, and focus production. Productions were evaluated by NH adult Dutch listeners. All scores between groups were comparable, except a lower score for the CI group for non-word repetition. Emotional prosody perception and production scores correlated weakly for CI children but were uncorrelated for NH children. In general, hearing age weakly predicted emotion production but not perception. Non-verbal emotional (but not linguistic) understanding predicted CI children's (but not controls') emotion perception and production. In conclusion, increasing time in sound might facilitate vocal emotional expression, possibly requiring independently maturing emotion perception skills.

Development of Phonological, Lexical, and Syntactic Abilities in Children With Cochlear Implants Across the Elementary Grades

PURPOSE

This study assessed phonological, lexical, and morphosyntactic abilities at 6th grade for a group of children previously tested at 2nd grade to address 4 questions: (a) Do children with cochlear implants (CIs) demonstrate deficits at 6th grade? (b) Are those deficits greater, the same, or lesser in magnitude than those observed at 2nd grade? (c) How do the measured skills relate to each other? and (d) How do treatment variables affect outcome measures?

PARTICIPANTS

Sixty-two 6th graders (29 with normal hearing, 33 with CIs) participated, all of whom had their language assessed at 2nd grade.

METHOD

Data are reported for 12 measures obtained at 6th grade, assessing phonological, lexical, and morphosyntactic abilities. Between-groups analyses were conducted on 6th-grade measures and the magnitude of observed effects compared with those observed at 2nd grade. Correlational analyses were performed among the measures at 6th grade. Cross-lagged analyses were performed on specific 2nd- and 6th-grade measures of phonological awareness, vocabulary, and literacy to assess factors promoting phonological and lexical development. Treatment effects of age of 1st CI, preimplant thresholds, and bimodal experience were evaluated.

RESULTS

Deficits remained fairly consistent in type and magnitude across elementary school. The largest deficits were found for phonological skills and the least for morphosyntactic skills, with lexical skills intermediate. Phonological and morphosyntactic skills were largely independent of each other; lexical skills were moderately related to phonological skills but not morphosyntactic skills. Literacy acquisition strongly promoted both phonological and lexical development. Of the treatment variables, only bimodal experience affected outcomes and did so positively.

CONCLUSIONS

Congenital hearing loss puts children at continued risk of language deficits, especially for phonologically based skills. Two interventions that appear to ameliorate that risk are providing a period of bimodal stimulation and strong literacy instruction.

Segmental and Suprasegmental Perception in Children Using Hearing Aids

BACKGROUND

Suprasegmental perception (perception of stress, intonation, "how something is said" and "who says it") and segmental speech perception (perception of individual phonemes or perception of "what is said") are perceptual abilities that provide the foundation for the development of spoken language and effective communication. While there are numerous studies examining segmental perception in children with hearing aids (HAs), there are far fewer studies examining suprasegmental perception, especially for children with greater degrees of residual hearing. Examining the relation between acoustic hearing thresholds, and both segmental and suprasegmental perception for children with HAs, may ultimately enable better device recommendations (bilateral HAs, bimodal devices [one CI and one HA in opposite ears], bilateral CIs) for a particular degree of residual hearing. Examining both types of speech perception is important because segmental and suprasegmental cues are affected differentially by the type of hearing device(s) used (i.e., cochlear implant [CI] and/or HA). Additionally, suprathreshold measures, such as frequency resolution ability, may partially predict benefit from amplification and may assist audiologists in making hearing device recommendations.

PURPOSE

The purpose of this study is to explore the relationship between audibility (via hearing thresholds and speech intelligibility indices), and segmental and suprasegmental speech perception for children with HAs. A secondary goal is to explore the relationships among frequency resolution ability (via spectral modulation detection [SMD] measures), segmental and suprasegmental speech perception, and receptive language in these same children.

RESEARCH DESIGN

A prospective cross-sectional design.

STUDY SAMPLE

Twenty-three children, ages 4 yr 11 mo to 11 yr 11 mo, participated in the study. Participants were recruited from pediatric clinic populations, oral schools for the deaf, and mainstream schools.

DATA COLLECTION AND ANALYSIS

Audiological history and hearing device information were collected from participants and their families. Segmental and suprasegmental speech perception, SMD, and receptive vocabulary skills were assessed. Correlations were calculated to examine the significance (p < 0.05) of relations between audibility and outcome measures.

RESULTS

Measures of audibility and segmental speech perception are not significantly correlated, while low-frequency pure-tone average (unaided) is significantly correlated with suprasegmental speech perception. SMD is significantly correlated with all measures (measures of audibility, segmental and suprasegmental perception and vocabulary). Lastly, although age is not significantly correlated with measures of audibility, it is significantly correlated with all other outcome measures.

CONCLUSIONS

The absence of a significant correlation between audibility and segmental speech perception might be attributed to overall audibility being maximized through well-fit HAs. The significant correlation between low-frequency unaided audibility and suprasegmental measures is likely due to the strong, predominantly low-frequency nature of suprasegmental acoustic properties. Frequency resolution ability, via SMD performance, is significantly correlated with all outcomes and requires further investigation; its significant correlation with vocabulary suggests that linguistic ability may be partially related to frequency resolution ability. Last, all of the outcome measures are significantly correlated with age, suggestive of developmental effects.

Personality Traits of Profoundly Hearing Impaired Adolescents with Cochlear Implants - A Comparison with Normal Hearing Peers

The aim of this study was to compare the personality traits of adolescents with cochlear implants (CIs) to a reference group (normal-hearing peers). In the past, the personality development of hearing impaired adolescents was severely compromised. Improved speech perception with CI significantly increased their perspectives. In addition, differences between the reference group and CI users were investigated on personality traits according to level of speech perception skills (high/low) and level of language comprehension (adequate/poor). A cohort of 59 adolescents was assessed 10 years after CI implantation. Personality traits were measured using the standardized Dutch Personality Questionnaire, which consists of 5 scales: Inadequacy, Social Inadequacy, Recalcitrance (RE), Perseverance, and Dominance. Speech perception and language comprehension were tested with standardized tests. The distributions of personality scores, in the clinical or non-clinical range, for the CI group were compared to the reference group using the Chi-Square test for Goodness of Fit. Adolescents with CI showed normal or favorable distributions on all personality scales except for the RE scale. There was a significant influence of speech perception and language comprehension on this scale. Consequently, adolescents with CI who demonstrated high speech perception and adequate language comprehension scores showed similar distribution patterns as the reference group on all personality scales. In conclusion; personality traits that reflect social relations, self-conscience, and school- and task orientation in adolescents with CI are similar to those in normal-hearing peers. This holds, despite variations in speech perception ability and language comprehension levels, for the CI group. On the RE scale, the adolescents with CI with low speech perception and poor language comprehension scores are more likely to score in the clinical deviant range and are at risk.

Evaluation of hearing aid frequency response fittings in pediatric and young adult bimodal recipients

BACKGROUND

A coordinated fitting of a cochlear implant (CI) and contralateral hearing aid (HA) for bimodal device use should emphasize balanced audibility and loudness across devices. However, guidelines for allocating frequency information to the CI and HA are not well established for the growing population of bimodal recipients.

PURPOSE

The study aim was to compare the effects of three different HA frequency responses, when fitting a CI and an HA for bimodal use, on speech recognition and localization in children/young adults. Specifically, the three frequency responses were wideband, restricted high frequency, and nonlinear frequency compression (NLFC), which were compared with measures of word recognition in quiet, sentence recognition in noise, talker discrimination, and sound localization.

RESEARCH DESIGN

The HA frequency responses were evaluated using an A B₁ A B₂ test design: wideband frequency response (baseline-A), restricted high-frequency response (experimental-B₁), and NLFC-activated (experimental-B2). All participants were allowed 3-4 weeks between each test session for acclimatization to each new HA setting. Bimodal benefit was determined by comparing the bimodal score to the CI-alone score.

STUDY SAMPLE

Participants were 14 children and young adults (ages 7-21 yr) who were experienced users of bimodal devices. All had been unilaterally implanted with a Nucleus CI24 internal system and used either a Freedom or CP810 speech processor. All received a Phonak Naida IX UP behind-the-ear HA at the beginning of the study.

DATA COLLECTION AND ANALYSIS

Group results for the three bimodal conditions (HA frequency response with wideband, restricted high frequency, and NLFC) on each outcome measure were analyzed using a repeated measures analysis of variance. Group results using the individual "best bimodal" score were analyzed and confirmed using a resampling procedure. Correlation analyses examined the effects of audibility (aided and unaided hearing) in each bimodal condition for each outcome measure. Individual data were analyzed for word recognition in quiet, sentence recognition in noise, and localization. Individual preference for the three bimodal conditions was also assessed.

RESULTS

Group data revealed no significant difference between the three bimodal conditions for word recognition in quiet, sentence recognition in noise, and talker discrimination. However, group data for the localization measure revealed that both wideband and NLFC resulted in significantly improved bimodal performance. The condition that yielded the "best bimodal" score varied across participants. Because of this individual variability, the "best bimodal" score was chosen for each participant to reassess group data within word recognition in quiet, sentence recognition in noise, and talker discrimination. This method revealed a bimodal benefit for word recognition in quiet after a randomization test was used to confirm significance. The majority of the participants preferred NLFC at the conclusion of the study, although a few preferred a restricted high-frequency response or reported no preference.

CONCLUSIONS

These results support consideration of restricted high-frequency and NLFC HA responses in addition to traditional wideband response for bimodal device users.

Gaze Patterns in Auditory-Visual Perception of Emotion by Children with Hearing Aids and Hearing Children

This study investigated eye-movement patterns during emotion perception for children with hearing aids and hearing children. Seventy-eight participants aged from 3 to 7 were asked to watch videos with a facial expression followed by an oral statement, and these two cues were either congruent or incongruent in emotional valence. Results showed that while hearing children paid more attention to the upper part of the face, children with hearing aids paid more attention to the lower part of the face after the oral statement was presented, especially for the neutral facial expression/neutral oral statement condition. These results suggest that children with hearing aids have an altered eye contact pattern with others and a difficulty in matching visual and voice cues in emotion perception. The negative cause and effect of these gaze patterns should be avoided in earlier rehabilitation for hearing-impaired children with assistive devices.

Deficits in the Sensitivity to Pitch Sweeps by School-Aged Children Wearing Cochlear Implants

Sensitivity to static changes in pitch has been shown to be poorer in school-aged children wearing cochlear implants (CIs) than children with normal hearing (NH), but it is unclear whether this is also the case for dynamic changes in pitch. Yet, dynamically changing pitch has considerable ecological relevance in terms of natural speech, particularly aspects such as intonation, emotion, or lexical tone information. Twenty one children with NH and 23 children wearing a CI participated in this study, along with 18 NH adults and 6 CI adults for comparison. Listeners with CIs used their clinically assigned settings with envelope-based coding strategies. Percent correct was measured in one- or three-interval two-alternative forced choice tasks, for the direction or discrimination of harmonic complexes based on a linearly rising or falling fundamental frequency. Sweep rates were adjusted per subject, in a logarithmic scale, so as to cover the full extent of the psychometric function. Data for up- and down-sweeps were fitted separately, using a maximum-likelihood technique. Fits were similar for up- and down-sweeps in the discrimination task, but diverged in the direction task because psychometric functions for down-sweeps were very shallow. Hits and false alarms were then converted into d′ and beta values, from which a threshold was extracted at a d′ of 0.77. Thresholds were very consistent between the two tasks and considerably higher (worse) for CI listeners than for their NH peers. Thresholds were also higher for children than adults. Factors such as age at implantation, age at profound hearing loss, and duration of CI experience did not play any major role in this sensitivity. Thresholds of dynamic pitch sensitivity (in either task) also correlated with thresholds for static pitch sensitivity and with performance in tasks related to speech prosody.

Voice emotion recognition by cochlear-implanted children and their normally-hearing peers

Despite their remarkable success in bringing spoken language to hearing impaired listeners, the signal transmitted through cochlear implants (CIs) remains impoverished in spectro-temporal fine structure. As a consequence, pitch-dominant information such as voice emotion, is diminished. For young children, the ability to correctly identify the mood/intent of the speaker (which may not always be visible in their facial expression) is an important aspect of social and linguistic development. Previous work in the field has shown that children with cochlear implants (cCI) have significant deficits in voice emotion recognition relative to their normally hearing peers (cNH). Here, we report on voice emotion recognition by a cohort of 36 school-aged cCI. Additionally, we provide for the first time, a comparison of their performance to that of cNH and NH adults (aNH) listening to CI simulations of the same stimuli. We also provide comparisons to the performance of adult listeners with CIs (aCI), most of whom learned language primarily through normal acoustic hearing. Results indicate that, despite strong variability, on average, cCI perform similarly to their adult counterparts; that both groups' mean performance is similar to aNHs' performance with 8-channel noise-vocoded speech; that cNH achieve excellent scores in voice emotion recognition with full-spectrum speech, but on average, show significantly poorer scores than aNH with 8-channel noise-vocoded speech. A strong developmental effect was observed in the cNH with noise-vocoded speech in this task. These results point to the considerable benefit obtained by cochlear-implanted children from their devices, but also underscore the need for further research and development in this important and neglected area. This article is part of a Special Issue entitled .

Mandarin lexical tones identification among children with cochlear implants or hearing aids

OBJECTIVES

Mandarin Chinese is a lexical tone language that has four tones, with a change in tone denoting a change in lexical meaning. There are few studies regarding lexical tone identification abilities in deafened children using either cochlear implants (CIs) or hearing aids (HAs). Furthermore, no study has compared the lexical tone identification abilities of deafened children with their hearing devices turned on and off. The present study aimed to investigate the lexical tone identification abilities of deafened children with CIs or HAs.

METHODS

Forty prelingually deafened children (20 with CIs and 20 with HAs) participated in the study. In the HA group, 20 children were binaurally aided. In the CI group, all of the children were unilaterally implanted. All of the subjects completed a computerized lexical tone pairs test with their hearing devices turned on and off. The correct answers of all items were recorded as the total score and the correct answers of the tone pairs were recorded as subtotal scores.

RESULTS

No significant differences in the tone pair identification scores were found between the CI group and HA group either with the devices turned on or off (t=1.62, p=0.11; t=1.863, p=0.07, respectively). The scores in the aided condition were higher than in the unaided condition regardless of the device used (t=22.09, p<0.001, in the HA group; t=20.20, p<0.001, in the CI group). Significantly higher scores were found in the tone pairs that contained tone 4. Age at fitting of the devices was correlated with tone identification abilities in both the CI and HA groups. Other demographic factors were not correlated with tone identification ability.

CONCLUSIONS

The hearing device, whether a hearing aid or cochlear implant, is beneficial for tone identification. The lexical tone identification abilities were similar regardless of whether the subjects wore a HA or CI. Lexical tone pairs with different durations and dissimilar tone contour patterns are more easily identified. Receiving devices at earlier age tends to produce better lexical tone identification abilities in prelingually deafened children.

Surgical outcomes with subperiosteal pocket technique for cochlear implantation in very young children

OBJECTIVES

As data continue to emerge demonstrating improved hearing outcomes associated with younger age at time of cochlear implantation, more children aged 12 months or younger are undergoing this procedure. Drilling a well to house the cochlear implant receiver/stimulator (R/S) may carry an increased risk in this group of patients as the calvarium is thin and drilling an adequate well may require exposure of the underlying dura. Our group has employed a technique in this age group which involves securing the R/S in a subperiosteal pocket without creating a bony well. We report our experience with six infants 12 months of age or younger undergoing cochlear implantation with the subperiosteal pocket technique.

METHODS

Cases were identified by searching an IRB approved research registry. Charts were reviewed for demographics, surgical technique, and clinical outcomes. Descriptive statistics were calculated.

RESULTS

Six patients 12 months of age or younger underwent cochlear implantation over a one year period. Simultaneous bilateral implantation was performed in all cases, for a total of 12 implanted ears. The average age at time of implantation was 9.8 months (SD 2.1 months). There were no postoperative wound complications. No evidence of device migration was noted in any patient as of the most recent follow-up appointment. There was one device hard failure at 32 months. Average length of follow-up was 28.4 months (SD 13.8 months).

CONCLUSIONS

No wound complications or device migrations occurred in 12 cochlear implantations in six children aged 12 months or younger. Advantages of this technique include no risk to the dura in this location, smaller incisions, and shorter surgical time. A potential disadvantage is the increased device profile from the lack of a well. New thinner implant designs may minimize this concern. Further prospective study is justified to confirm our initial experience in this small group.

Pre-school children have better spoken language when early implanted

OBJECTIVES

The objectives of this study were: (1) to investigate the effect of age at cochlear implantation (CI) on vocabulary development; (2) to evaluate the age effect at CI surgery on the syntactic development; and (3) to examine the role of gender, age at first diagnosis and maternal education level on spoken language development.

MATERIAL AND METHODS

Retrospective study. Thirty children with congenital severe- to -profound sensorineural hearing loss (SNHL) were sampled. They were diagnosed and fitted with hearing aids through six months of age. They were implanted between 8 and 17 months of age. The MacArthur-Bates Communicative Development Inventory (MCDI) was administrated at the age of 36 months. The total productive vocabulary (word number raw score), the mean length of utterance (M3L) and the sentences complexity were analysed.

RESULTS

The average word number raw score was 566.3 for the children implanted before 12 months of age versus 355 for those implanted later. The M3L was 8.3 for those implanted under 1 year versus 4.2 of those implanted later. The average sentences complexity was 82.3% for those receiving CI before 12 months, while it was 24.4% for those underwent at CI after 12 months. Regression analysis revealed a highly significant and negative linear effect of age at CI surgery on all outcomes. Females had better outcomes. Age at diagnosis was not correlated with the linguistic results. The mother's education level had a positive significant effect on sentences complexity.

CONCLUSION

The CI in pre-school children with SNHL implanted under 1 year has a positive effect on spoken language. Females seem to have better linguistic results. Finally high maternal educational level appears to have some positive effect on language development.