Summary
Introduction
An intact auditory system is essential for the development and maintenance of voice
quality and speech prosody. On the contrary hearing loss affects the adjustments and
appropriate use of organs involved in speech and voice production. Spectro-acoustic
voice parameters have been evaluated in Cochlear Implant (CI) users, and the authors
of previous systematic reviews on the topic concluded that fundamental frequency (F0)
seemed preliminarily the most reliable parameter to evaluate voice alterations in
adult CI users. The main aim of this systematic review and meta-analysis was to clarify
the vocal parameters and prosodic alterations of speech in pediatric CI users.
Materials and methods
The protocol of the systematic review was registered on the PROSPERO database, International
prospective register of systematic reviews. We conducted a search of the English literature
published in the period between January 1, 2005 and April 1, 2022 on the Pubmed and
Scopus databases. A meta-analysis was conducted to compare the values of voice acoustic
parameters in CI users and non-hearing-impaired controls. The analysis was conducted
using the standardized mean difference as the outcome measure. A random-effects model
was fitted to the data.
Results
A total of 1334 articles were initially evaluated using title and abstract screening.
After applying inclusion/exclusion criteria, 20 articles were considered suitable
for this review. The age of the cases ranged between 25 and 132 months at examination.
The most studied parameters were F0, Jitter, Shimmer and Harmonics-to-Noise Ratio
(HNR); other parameters were seldom reported. A total of 11 studies were included
in the meta-analysis of F0, with the majority of estimates being positive (75%); the
estimated average standardized mean difference based on the random-effects model was
0.3033 (95% CI: 0.0605 to 0.5462; P = 0.0144). For Jitter (0.2229; 95% CI: -0.1862 to 0.7986; P = 0.2229) and shimmer (0.2540; 95% CI: -0.1404 to 0.6485; P = 0.2068) there was a trend toward positive values without reaching statistical significance.
Discussion and conclusions
This meta-analysis confirmed that higher F0 values have been observed in the pediatric
population of CI users compared to age-matched normal hearing volunteers, whereas
the parameters of voice noise were not significantly different between cases and controls.
Prosodic aspects of language need further investigations. In longitudinal contexts,
prolonged auditory experience with CI has brought voice parameters closer to the norm.
Following the available evidence, we stress the utility of inclusion of vocal acoustic
analysis in the clinical evaluation and follow-up of CI patients to optimize the rehabilitation
process of pediatric patients with hearing loss.
Key Words
Abbreviations:
ACE (Advanced Combination Encode), CAG (Case Group), CI (Cochlear Implant), COG (Control Group), EI (Early Implanted), FSP (Fine Structure Processing), F0 (fundamental frequency), F1-F2 (Formant's 1 and 2), HL (Hearing Loss), HNR (Harmonics-to-Noise Ratio), LI (Late Implanted), MDVP (Multi-Dimensional Voice Program), MPT (Mean Phonation Time), mts (Months), NA (Not Applicable), NOS (Newcastle Ottawa Scale), NR (Not Reported), PRAAT (Praat's Voice Program), PTA (Pure Tone Average), SDF0 (Standard Deviation of fundamental frequency)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 02, 2023
Accepted:
January 17,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
