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Multidimensional evaluation of vocal quality in children with cochlear implants: a cross-sectional, case-controlled study

Authors

  • H.-W. Hsu,

    1. Graduate Institute of Speech and Hearing Disorders and Sciences, National Taipei University of Nursing and Health Science, Taipei, Taiwan
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  • T.-J. Fang,

    1. Department of Otorhinolaryngology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Linkou, Taoyuan, Taiwan
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  • L.-A. Lee,

    1. Department of Otorhinolaryngology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Linkou, Taoyuan, Taiwan
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  • Y.-T. Tsou,

    1. Department of Otorhinolaryngology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Linkou, Taoyuan, Taiwan
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  • S.H. Chen,

    Corresponding author
    1. Graduate Institute of Speech and Hearing Disorders and Sciences, National Taipei University of Nursing and Health Science, Taipei, Taiwan
    • Correspondence: S. H. Chen, Department of Speech and Hearing Disorders and Sciences, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.

      Fax +886 2 2871 3733; e-mail: shchen@ntunhs.edu.tw

      and C.-M. Wu, Department of Otolaryngology, Chang-Gang Memorial Hospital, College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan

      Fax +886 3 3979361; e-mail: bobwu506@hotmail.com

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  • C.-M. Wu

    Corresponding author
    1. Department of Otorhinolaryngology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Linkou, Taoyuan, Taiwan
    • Correspondence: S. H. Chen, Department of Speech and Hearing Disorders and Sciences, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.

      Fax +886 2 2871 3733; e-mail: shchen@ntunhs.edu.tw

      and C.-M. Wu, Department of Otolaryngology, Chang-Gang Memorial Hospital, College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan

      Fax +886 3 3979361; e-mail: bobwu506@hotmail.com

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    • Co-first author.

Abstract

Objectives

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.

Design

A cross-sectional, case-controlled study.

Setting

A tertiary medical centre.

Participants

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.

Results

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).

Conclusion

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.

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