Speech intelligibility and prosody production in children with cochlear implants

Background and Aim: Cochlear implants (CIs) can lead to the development of verbal communication in areas such as sound repertoire, speech intelligibility (SI), and conversational skills. The SI refers to the ability to make recognizable speech sounds. Children with CIs may experience poorer SI than normal- hearing (NH) children. This study aims to compare the SI between children with CIs and NH peers matched for chronological age and hearing age. Methods: The speech samples of 40 monolingual Persian-speaking children, including 20 children with CIs and 20 NH children were used in this study. The children’s SI was analyzed using three measures of the percentage of correct consonants, percentage of correct vowels, and percentage of intelligible words. One speech-language pathologist and two non-professional listeners transcribed each speech sample. Results: The results showed no significant difference in any measures of SI between CI children and NH hearing age-matched peers, but there was a significant difference between CI children and NH chronological age-matched peers (p<0.05). Conclusion: The SI in Persian-speaking children with CIs is the same as in NH hearing age-matched peers, but it was poorer compared to NH chronological age-matched peers. If the children with hearing impairments receive CIs sooner, their SI can be greater. Cochlear implantation improves SI by increasing the hearing experience. Keywords: Speech intelligibility; percentage of correct consonants; percentage of correct vowels; percentage of intelligible words; cochlear implant; hearing age

Background: Following the development of new hearing technologies, assessment of speech intelligibility in hearing-impaired children is of great interest. The main purpose of this study was to compare speech intelligibility and auditory perception abilities in children with normal-hearing (NH) and children with hearing aid (HA) and cochlear implant (CI). Methods: This analytic cross-sectional study consisted of 60 Persian-speaking children aged 5 to 7-years. Participants were classified into 3 groups of 20 people, including NH (mean age, 71.70±5.05 months), CI (mean age, 72.60±8.20 months), and HA (mean age, 71.45±10.56 months) children. The speech intelligibility rating (SIR) and categories of auditory performance (CAP) tests were conducted for all children to measure their speech intelligibility and auditory perception, respectively. A one-way analysis of variance (ANOVA) test was used to compare CAP and SIR scores among the 3 groups. Results: The mean SIR score in the NH children was significantly higher than the HA (p=0.002) and CI (p=0.009) groups. However, these differences between the HA and CI children were not significant (p=0.885). We found a significant difference between the CAP scores in the 3 groups (p=0.038). Furthermore, the post hoc analysis results indicated that the mean CAP scores in NH children were significantly higher than the HA and CI participants. Based on the results, the speech intelligibility and auditory performance abilities in NH children were significantly greater than the hearing-impaired (CI and HA) children. However, these abilities between HA and CI users were not significantly different. Conclusion: Based on the results, the early acoustical amplification on auditory and speech functions in children with hearing loss is of paramount importance.

Background: Literature does show that studies of the vowel space area (VSA) can be helpful to know speech production skills in children with hearing impairment (HI) cochlear implant (CI). The need for the present study was to investigate speech production skills among children with CI, who receive Aural Rehab in nonnative language, i.e., English. The VSA offers an easy quick way to compare speech production accuracy among them to typically developing chidlren (TDC) peer group. Aim of the Study: The study aimed at investigating the VSA in F2 versus F1 space formed by vowels /a/, /i/, and /u/ in two groups of children (typically developing [TD] and children with CIs) and the intelligibility of the vowels spoken in the consonant-vowel-consonant (CVC) contexts. Methods: Two groups of subjects participated in the study, 100 children with CIs and 200 age-matched typically developing children. Recordings of vowels /a/, /i/, and /u/ in CVC were used for formant frequency extraction using Praat software, and the VSA was calculated. The recorded utterances were presented to three judges, for the estimation of the percentage of correct responses for identifying the vowel. The VSA for the vowels and the intelligibility scoring in percentage were valuated. Results: The results showed that the VSA among children with CI was significantly less compared to TDC. The reduced VSA represents limited articulatory movement in children with CI compared to children with TD for primary vowels embedded in CVC syllables. The vowel intelligibility for the three vowels in the CVC context was reduced for children with CI (70%) compared to that of children with TDC (95%). Discussion: Both first- and second-formant frequencies show distinct differences between both groups and consequently in the VSA. F1 is lower for /a/ for the CI group, while it is higher for vowel /i/ and /u/ for the CI group compared to the TDC group, while F2, the values were lower for /i/ but elevated significantly for both /a/ and /u/ compared to children in TDC. The intelligibility of their utterances (CVC) of children with CI was lower than that of TDC. Since the children were age- and gender-matched and were nonnative speakers of English, linguistic influences on measured values were minimum. Reasons for changed formant frequencies have to be explored further in terms of the influence of rehabilitation methods, visibility of articulatory movements required, and formant information coded by speech coding strategies. Correlation studies of the VSA and the speech intelligibility measures may assist in therapy outcomes and improve speech intelligibility in children with HI and modifications to mapping strategies employed. Conclusion: The F1 is lower for /a/ for the CI group, while it is higher for vowel /i/ and /u/ for the CI group compared to the TDC group, while F2, the values were lower for /i/ but elevated significantly for both /a/ and /u/ compared to children in TDC. The vowel triangle area was reduced in the speech of CI group subjects compared to that of the group of TDC.

To evaluate the reliability of the Speech Intelligibility Rating scale to monitor the speech intelligibility of deaf children who have received cochlear implants. A prospective study assessing the speech intelligibility of deaf children with cochlear implants by local and cochlear implant program speech and language therapists. Pediatric tertiary referral center for cochlear implantation. Fifty-four children were each rated by two speech and language therapists, one working with the child locally and the other working with the child at the cochlear implant program. All children were between 1.2 and 10.9 years of age at the time of implantation (median, 4.0 years). The follow-up intervals ranged from before implantation to 9 years after implantation. Correlation coefficient, intraclass correlation coefficient, and kappa statistics were used to assess the interobserver reliability of the Speech Intelligibility Rating scale. Spearman rank correlation coefficient and intraclass correlation coefficient were 0.82 with high statistical significance (p < 0.00001). Kappa statistical analysis revealed a moderate to substantial agreement between the ratings. This agreement also reached a high statistical significance (overall kappa = 0.53, p < 0.000001). The Speech Intelligibility Rating scale was found to be able to discriminate speech intelligibility among subjects, and the ratings covaried with high consistency. The study found a high rate of agreement between observers when they used the Speech Intelligibility Rating scale to assess the speech intelligibility of deaf children after cochlear implantation. Because the scale presents information in a format that is understood by parents, local professionals, and health care purchasers, it will be useful to provide them with accessible information on speech intelligibility outcomes of deaf children who have received cochlear implants.

The present study investigated the development of audiovisual comprehension skills in prelingually deaf children who received cochlear implants. We analyzed results obtained with the Common Phrases (Robbins et al., 1995) test of sentence comprehension from 80 prelingually deaf children with cochlear implants who were enrolled in a longitudinal study, from pre-implantation to 5 years after implantation. The results revealed that prelingually deaf children with cochlear implants performed better under audiovisual (AV) presentation compared with auditory-alone (A-alone) or visual-alone (V-alone) conditions. AV sentence comprehension skills were found to be strongly correlated with several clinical outcome measures of speech perception, speech intelligibility, and language. Finally, pre-implantation V-alone performance on the Common Phrases test was strongly correlated with 3-year postimplantation performance on clinical outcome measures of speech perception, speech intelligibility, and language skills. The results suggest that lipreading skills and AV speech perception reflect a common source of variance associated with the development of phonological processing skills that is shared among a wide range of speech and language outcome measures.

The purpose of this study was twofold: (a) to determine the extent to which 4-channel, slow-acting wide dynamic range amplitude compression (WDRC) can counteract the perceptual effects of reduced auditory dynamic range and (b) to examine the relation between objective measures of speech intelligibility and categorical ratings of speech quality for sentences processed with slow-acting WDRC. Multiband expansion was used to simulate the effects of elevated thresholds and loudness recruitment in normal hearing listeners. While some previous studies have shown that WDRC can improve both speech intelligibility and quality, others have found no benefit. The current experiment shows that moderate amounts of compression can provide a small but significant improvement in speech intelligibility, relative to linear amplification, for simulated-loss listeners with small dynamic ranges (i.e., flat, moderate hearing loss). This benefit was found for speech at conversational levels, both in quiet and in a background of babble. Simulated-loss listeners with large dynamic ranges (i.e., sloping, mild-to-moderate hearing loss) did not show any improvement. Comparison of speech intelligibility scores and subjective ratings of intelligibility showed that listeners with simulated hearing loss could accurately judge the overall intelligibility of speech. However, in all listeners, ratings of pleasantness decreased as the compression ratio increased. These findings suggest that subjective measures of speech quality should be used in conjunction with either objective or subjective measures of speech intelligibility to ensure that participant-selected hearing aid parameters optimize both comfort and intelligibility.

Background and Objectives Although many studies have shown that cochlear implantation promotes restoration of adequate hearing and verbal ability, there is little research showing whether patients with cochlear implants (CI) adapted well to the society by forming a good interpersonal relationship. The purpose of this study was to investigate the interpersonal competence of college students who acquired good verbal ability through CI. Subjects and Method Interpersonal competence was examined using the Korean version of interpersonal competence questionnaire. Participants were 23 college students with CI who had good verbal communication abilities. Their interpersonal competence was compared to that of 28 college students with normal hearing (NH). To identify the factors contributing to the interpersonal competence, regression analysis was performed using speech perception, vocabulary and speech intelligibility as independent variables. Results College students with CI showed significantly weaker interpersonal competence than those with NH. Among 5 sub-factors of interpersonal competence, assertion and conflict management were not significantly different between two groups and initiation, caring others, and appropriate disclosure of CI group were significantly weaker than NH group. But college students with CI who had normal vocabulary and Speech Intelligibility Ratings score of 5 showed good interpersonal competence, which was comparable to those with NH. Conclusion College students with CI who acquired good verbal communication ability demonstrates lower interpersonal competence than those with NH. Therefore, it is necessary to support them to improve interpersonal competence as well as speech-language ability. Key words: Cochlear implants ㆍ Interpersonal competence ㆍ Language ㆍ Speech Intelligibility

Cochlear implants (CIs) are auditory prostheses that restore hearing via electrical stimulation of the auditory nerve. Compared to normal acoustic hearing, sounds transmitted through the CI are spectro-temporally degraded, causing difficulties in challenging listening tasks such as speech intelligibility in noise and perception of music. In normal hearing (NH), musicians have been shown to better perform than non-musicians in auditory processing and perception, especially for challenging listening tasks. This “musician effect” was attributed to better processing of pitch cues, as well as better overall auditory cognitive functioning in musicians. Does the musician effect persist when pitch cues are degraded, as it would be in signals transmitted through a CI? To answer this question, NH musicians and non-musicians were tested while listening to unprocessed signals or to signals processed by an acoustic CI simulation. The task increasingly depended on pitch perception: (1) speech intelligibility (words and sentences) in quiet or in noise, (2) vocal emotion identification, and (3) melodic contour identification (MCI). For speech perception, there was no musician effect with the unprocessed stimuli, and a small musician effect only for word identification in one noise condition, in the CI simulation. For emotion identification, there was a small musician effect for both. For MCI, there was a large musician effect for both. Overall, the effect was stronger as the importance of pitch in the listening task increased. This suggests that the musician effect may be more rooted in pitch perception, rather than in a global advantage in cognitive processing (in which musicians would have performed better in all tasks). The results further suggest that musical training before (and possibly after) implantation might offer some advantage in pitch processing that could partially benefit speech perception, and more strongly emotion and music perception.

The purpose of this study was to describe normative and validation data on the Intelligibility in Context Scale (ICS; McLeod, Harrison, & McCormack, 2012c) for English-speaking children. The ICS is a 7-item, parent-report measure of children's speech intelligibility with a range of communicative partners. Data were collected from the parents of 803 Australian English-speaking children ranging in age from 4;0 (years;months) to 5;5 (37.0% were multilingual). The mean ICS score was 4.4 (SD = 0.7) out of a possible total score of 5. Children's speech was reported to be most intelligible to their parents, followed by their immediate family, friends, and teachers; children's speech was least intelligible to strangers. The ICS had high internal consistency (α = .94). Significant differences in scores were identified on the basis of sex and age but not on the basis of socioeconomic status or the number of languages spoken. There were significant differences in scores between children whose parents had concerns about their child's speech (M = 3.9) and those who did not (M = 4.6). A sensitivity of .82 and a specificity of .58 were established as the optimal cutoff. Test-retest reliability and criterion validity were established for 184 children with a speech sound disorder. There was a significant low correlation between the ICS mean score and percentage of phonemes correct (r = .30), percentage of consonants correct (r = .24), and percentage of vowels correct (r = .30) on the Diagnostic Evaluation of Articulation and Phonology (Dodd, Hua, Crosbie, Holm, & Ozanne, 2002). Thirty-one parents completed the ICS related to English and another language spoken by their child with a speech sound disorder. The significant correlations between the scores suggest that the ICS may be robust between languages. This article provides normative ICS data for English-speaking children and additional validation of the psychometric properties of the ICS. The robustness of the ICS was suggested because mean ICS scores were not affected by socioeconomic status, number of languages spoken, or whether the ICS was completed in relation to English or another language. The ICS is recommended as a screening measure of children's speech intelligibility.

Background/Objectives: Speech produced by individuals with hearing loss differs notably from that of normal-hearing (NH) individuals. Although cochlear implants (CIs) provide sufficient auditory input to support speech acquisition and control, there remains considerable variability in speech intelligibility among CI users. As a result, speech produced by CI talkers often exhibits distinct acoustic characteristics compared to that of NH individuals. Methods: Speech data were obtained from eight cochlear-implant (CI) and eight normal-hearing (NH) talkers, while electroencephalogram (EEG) responses were recorded from 11 NH listeners exposed to the same speech stimuli. Support Vector Machine (SVM) classifiers employing 3-fold cross-validation were evaluated using classification accuracy as the performance metric. This study evaluated the efficacy of Support Vector Machine (SVM) algorithms using four kernel functions (Linear, Polynomial, Gaussian, and Radial Basis Function) to classify speech produced by NH and CI talkers. Six acoustic features—Log Energy, Zero-Crossing Rate (ZCR), Pitch, Linear Predictive Coefficients (LPC), Mel-Frequency Cepstral Coefficients (MFCCs), and Perceptual Linear Predictive Cepstral Coefficients (PLP-CC)—were extracted. These same features were also extracted from electroencephalogram (EEG) recordings of NH listeners who were exposed to the speech stimuli. The EEG analysis leveraged the assumption of quasi-stationarity over short time windows. Results: Classification of speech signals using SVMs yielded the highest accuracies of 100% and 94% for the Energy and MFCC features, respectively, using Gaussian and RBF kernels. EEG responses to speech achieved classification accuracies exceeding 70% for ZCR and Pitch features using the same kernels. Other features such as LPC and PLP-CC yielded moderate to low classification performance. Conclusions: The results indicate that both speech-derived and EEG-derived features can effectively differentiate between CI and NH talkers. Among the tested kernels, Gaussian and RBF provided superior performance, particularly when using Energy and MFCC features. These findings support the application of SVMs for multimodal classification in hearing research, with potential applications in improving CI speech processing and auditory rehabilitation.

Purpose Reduced speech intelligibility limits functional communication for many children with motor speech disorders, and improving intelligibility is often a primary goal of intervention. Objective measurement of intelligibility is important for quantifying severity of speech impairment and tracking progress in therapy; however, there is little standardization of methods for measuring speech intelligibility in clinical settings. The purpose of this tutorial is to review different approaches to measuring speech intelligibility in children with motor speech disorders and to discuss the benefits and limitations of using each approach in clinical practice. Method Intelligibility is defined and compared to related constructs. Factors affecting intelligibility of children with motor speech disorders are reviewed. Methods for measuring intelligibility using word identification approaches and scaled ratings are discussed in detail, and their utility in clinical practice is compared. Results Word identification approaches to intelligibility measurement are optimal for tracking progress in therapy but are relatively time consuming. Scaled rating approaches may be adequate in cases where the goal is to obtain an overall measure of severity or for children who are unable to participate in structured testing. Conclusion Different approaches to intelligibility assessment are warranted depending on the clinical goal and characteristics of the child. Speech-language pathologists should consider multiple factors when selecting and interpreting intelligibility measures for their clients.

Voice emotion recognition declines with age in normally hearing (NH) adults. However, the effects of aging on voice emotion recognition in NH listeners with spectrally degraded stimuli are neither known nor the effects of aging on adult cochlear implant (CI) users. This study explored age-related effects on voice emotion recognition in NH adults listening to spectrally degraded speech and aimed to compare these changes to age-related changes in adult CI users’ voice emotion recognition with unprocessed speech. Participants listened to 12 emotion-neutral sentences, each spoken with 5 emotions (happy, sad, scared, angry, and neutral) by a male and female talker. Participants identified which emotion they heard while listening to sentences that were either unprocessed or CI-simulated. Preliminary results indicate declines in overall percent correct scores and increased reaction time with both age and increasing spectral degradation in NH adults. Results also suggest age-related effects on percent correct scores and reaction times within the CI group alone. These results have important implications in the aging population of adults with NH and with CIs because limitations in the quality peer to peer interactions have been associated with a decrease in perceived quality of life. [Work supported by R01 DC014233 and P20 GM109023.]Voice emotion recognition declines with age in normally hearing (NH) adults. However, the effects of aging on voice emotion recognition in NH listeners with spectrally degraded stimuli are neither known nor the effects of aging on adult cochlear implant (CI) users. This study explored age-related effects on voice emotion recognition in NH adults listening to spectrally degraded speech and aimed to compare these changes to age-related changes in adult CI users’ voice emotion recognition with unprocessed speech. Participants listened to 12 emotion-neutral sentences, each spoken with 5 emotions (happy, sad, scared, angry, and neutral) by a male and female talker. Participants identified which emotion they heard while listening to sentences that were either unprocessed or CI-simulated. Preliminary results indicate declines in overall percent correct scores and increased reaction time with both age and increasing spectral degradation in NH adults. Results also suggest age-related effects on percent correct sco...

ABSTRACTAcoustic measurements have shown that the speech of hearing-impaired (HI) children differs from that of normally hearing (NH) children, even after several years of device use. This study focuses on the perception of HI speech in comparison to NH children’s speech. The purpose of this study was to investigate whether adult listeners can identify the speech of NH and HI children. Moreover, it is studied whether listeners’ experience and the children’s length of device use play a role in that assessment. For this study, short utterances of 7 children with a cochlear implant (CI), 7 children with an acoustic hearing aid (HA) and 7 children with NH were presented to 90 listeners who were required to specify the hearing status of each speech sample. The judges had different degrees of familiarity with hearing disorders: there were 30 audiologists, 30 primary schoolteachers and 30 inexperienced listeners. The results show that the speech of children with NH and HI can reliably be identified. However, listeners do not manage to distinguish between children with CI and HA. Children with CI are increasingly identified as NH with increasing length of device use. For children with HA, there is no similar change with longer device use. Also, experienced listeners seem to display a more lenient attitude towards atypical speech, whereas inexperienced listeners are stricter and generally consider more utterances to be produced by children with HI.

Hearing impaired listeners using cochlear implants (CIs) suffer from a decrease in speech intelligibility (SI) in adverse listening conditions. Time-frequency masks are often applied to perform noise suppression in an attempt to increase SI. Two important masks are the so-called ideal binary mask (IBM) with its binary weights and the ideal Wiener filter (IWF) with its continuous weights. It is unclear which of the masks has the highest potential for SI and speech quality enhancement in CI users. In this study, both approaches for SI and quality enhancement were compared. The investigations were conducted in normal-hearing (NH) subjects listening to noise vocoder CI simulations and in CI users. The potential for SI improvement was assessed in a sentence recognition task with ideal mask estimates in multitalker babble and with an interfering talker. The robustness of the approaches was evaluated with simulated estimation errors. CI users assessed the speech quality in a preference rating. The IWF outperformed the IBM in NH listeners. In contrast, no significant difference was obtained in CI users. Estimation errors degraded SI in CI users for both approaches. In terms of quality, the IWF outperformed, slightly, the IBM processed signals. The outcomes of this study suggest that the mask pattern is not that crucial for CIs. Results of speech enhancement algorithms obtained with NH subjects listening to vocoded or normally processed stimuli do not translate to CI users. This outcome means that the effect of new strategies has to be quantified with the user group considered.

Purpose To evaluate the auditory performance and speech intelligibility of 100 children with bilateral profound sensorineural hearing loss up to 3 years after cochlear implantation. Methods A cohort study was established consisting of 100 children who received cochlear implantation at Shandong Ear Nose and Throat Hospital from 2012 to 2015. Children were examined after 1 month, 1, 2, and 3 years of implantation to assess auditory performance and speech intelligibility using standard tools. The paired Wilcoxon signed-rank test was used to assess whether the scores obtained at different testing points differed significantly. The Mann–Whitney test was utilized to examine the between-group differences (e.g., age at implantation). Results Three years after implantation, 60% out of 100 children reached the maximal category (7) of categorical auditory performance and 37% achieved the highest category (5) of speech intelligibility rating. Significant improvements were found over time in categorical auditory performance category and speech intelligibility rating (from month 1 to year 1, p < 0.001; from year 1 to year 2, p < 0.001; and from year 2 to year 3, p < 0.001). Larger improvements in auditory outcomes and speech intelligibility were observed in children with a younger age at implantation and those who received speech therapy. Conclusions Cochlear implantation appears to make a significant, positive contribution to the development of communication skills of young congenital and prelingually deaf children in China. These improvements continue for up to 3 years after implantation. Positive outcomes appear to be associated with earlier age at implantation and receipt of speech therapy. Implications for rehabilitation Bilateral sensorineural hearing loss. Bilateral sensorineural hearing loss in children can cause delay in speech development, poor language skills and potentially disorders in psychological behaviour and social isolation. Cochlear implantation (CI) is an effective strategy that helps children with bilateral sensorineural hearing loss gain the ability to hear and continue to develop language. This study shows that the auditory performance and speech intelligibility of deaf children who speak Mandarin continued to improve up to 3 years of implantation, when follow-up ceased.