This study aimed to compare the differences in vocal quality between Mandarin-speaking children with cochlear implants and normal-hearing peers and to understand which cochlear implant usage parameters may predict unfavourable voice outcomes.


A cross-sectional, case-controlled study.


A tertiary medical centre.


Thirty-five pre-lingually deaf children (age = 10.3 ± 1.6 years; 17 boys and 18 girls) who had used cochlear implants for >2 years and 35 age- and gender-matched controls with normal hearing.

Main outcome measures

Through sustained phonation of /a/ and reading of the Hare and Tortoise passage, the subjects' voice quality was analysed with aerodynamics and acoustics. A six-point scale was used for auditory-perceptual evaluation. A Pediatric Voice-Related Quality of Life Survey was filled out by the caregivers.


The implanted subjects had significantly lower mean airflow rate (= 0.006), higher phonation threshold pressure (< 0.001), higher fundamental frequency variations (< 0.001) and peak-amplitude variations (< 0.001), wider fundamental frequency range (= 0.043), wider speaking intensity range (= 0.015) and greater perceptual severity level of monotone (< 0.001), resonance (< 0.001), loudness (< 0.001) and strain (= 0.006) than their normal-hearing peers. Duration of postoperative rehabilitation was an independent predictor of unfavourable mean speaking fundamental frequency (odds ratio = 8.56, P = 0.008).


Inadequate postoperative rehabilitation may hinder the normalisation of Mandarin-speaking implantees' voice quality. A multidimensional analysis may precisely evaluate the voice of paediatric implantees; however, the generalisability of these findings requires different forms of validation, including data from other languages and other institutions.