Auditory, Visual, and Cognitive Abilities in Normal-Hearing Adults, Hearing Aid Users, and Cochlear Implant Users.

OBJECTIVES: Speech understanding is considered a bimodal and bidirectional process, whereby visual information (i.e., speechreading) and also cognitive functions (i.e., top-down processes) are involved. Therefore, the purpose of the present study is twofold: (1) to investigate the auditory (A), visual (V), and cognitive (C) abilities in normal-hearing individuals, hearing aid (HA) users, and cochlear implant (CI) users, and (2) to determine an auditory, visual, cognitive (AVC)-profile providing a comprehensive overview of a person's speech processing abilities, containing a broader variety of factors involved in speech understanding. DESIGN: Three matched groups of subjects participated in this study: (1) 31 normal-hearing adults (mean age = 58.76), (2) 31 adults with moderate to severe hearing loss using HAs (mean age = 59.31), (3) 31 adults with a severe to profound hearing loss using a CI (mean age = 58.86). The audiological assessments consisted of pure-tone audiometry, speech audiometry in quiet and in noise. For evaluation of the (audio-) visual speech processing abilities, the Test for (Audio) Visual Speech perception was used. The cognitive test battery consisted of the letter-number sequencing task, the letter detection test, and an auditory Stroop test, measuring working memory and processing speed, selective attention, and cognitive flexibility and inhibition, respectively. Differences between the three groups were examined using a one-way analysis of variance or Kruskal-Wallis test, depending on the normality of the variables. Furthermore, a principal component analysis was conducted to determine the AVC-profile. RESULTS: Normal-hearing individuals scored better for both auditory, and cognitive abilities compared to HA users and CI users, listening in a best aided condition. No significant differences were found for speech understanding in a visual condition, despite a larger audiovisual gain for the HA users and CI users. Furthermore, an AVC-profile was composed based on the different auditory, visual, and cognitive assessments. On the basis of that profile, it is possible to determine one comprehensive score for auditory, visual, and cognitive functioning. In the future, these scores could be used in auditory rehabilitation to determine specific strengths and weaknesses per individual patient for the different abilities related to the process of speech understanding in daily life. CONCLUSIONS: It is suggested to evaluate individuals with hearing loss from a broader perspective, considering more than only the typical auditory abilities. Also, cognitive and visual abilities are important to take into account to have a more complete overview of the speech understanding abilities in daily life.

Effect of a Group-Based Narrative Language Training in Typically Developing Turkish-Dutch Children.

INTRODUCTION: Due to the heterogeneity in language trajectories and differences in language exposure, a lot of bilingual children could use some extra support for the acquisition of the school language to reduce the risk of language problems and learning difficulties. Enhancing bilingual children's narrative abilities in the school language could be an efficient approach to advance the general school language abilities as well. Therefore, this study aimed to investigate whether a narrative intervention could improve both general and narrative school language abilities of typically developing bilingual (Turkish-Dutch) children. METHODS: Nineteen Turkish-Dutch bilingual children (6-9.9 years) were enrolled in this single-arm early efficacy study. The intervention procedure was administered in the school language (Dutch) and based on a test-teach-retest principle with two baseline measurements. At baseline 1, the expressive, receptive, and narrative language abilities were determined. The second baseline measurement consisted of a second measurement of the narrative abilities. Subsequently, a weekly 1-h group-based intervention was implemented during 10 sessions. After the intervention phase, the expressive, receptive, and narrative language abilities were tested again. RESULTS: After the intervention, the children produced significantly more story structure elements compared to both baseline measurements. No significant differences were found for microstructure narrative measures. The participants had significantly higher scores on the expressive and receptive language measurements post-intervention. CONCLUSION: These findings suggest that the intervention could be an efficient approach to stimulate the second language development of bilingual children.

Development of the hearing-related quality of life questionnaire for auditory-visual, cognitive and psychosocial functioning (hAVICOP).

INTRODUCTION: There is a need for a validated and standardized self-assessment instrument to assess the subjective effect of hearing aid (HA) use and/or cochlear implantation (CI) on different aspects of functioning in daily life. The aim of this study was to develop a new holistic Patient Reported Outcome Measure (PROM) to assess hearing-related quality of life. The new PROM is titled the hearing-related quality of life questionnaire for Auditory-VIsual, COgnitive and Psychosocial functioning (hAVICOP). METHODS: A conceptual framework was set up and test items were prepared per domain. Preliminary testing involved a semi-structured interview-based assessment in normal-hearing and hearing-impaired adults and an expert panel. For the further psychometric evaluation, a new sample of 15 adult HA users, 20 adult CI users and 20 normal-hearing adults filled in the refined version of the hAVICOP, the Speech, Spatial and Qualities of Hearing Scale, the Nijmegen Cochlear Implant Questionnaire and the TNO-AZL Questionnaire for Adult's Health-Related Quality of Life. Based on these results, a factor analysis was conducted and internal consistency, discriminant validity and concurrent construct validity were determined. RESULTS: The final version of the hAVICOP consists of three domains for hearing-related quality of life: (1) auditory-visual functioning, (2) cognitive functioning, and (3) psychosocial functioning. A sufficient internal consistency was found, and discriminant validity and concurrent construct validity were good. CONCLUSIONS: A new PROM to assess hearing-related quality of life was developed, named the hAVICOP. In the future the validity and reliability should be examined further.

The Effects of Age, Gender and Test Stimuli on Visual Speech Perception: A Preliminary Study.

INTRODUCTION: To the best of our knowledge, there is a lack of reliable, validated, and standardized (Dutch) measuring instruments to document visual speech perception in a structured way. This study aimed to: (1) evaluate the effects of age, gender, and the used word list on visual speech perception examined by a first version of the Dutch Test for (Audio-)Visual Speech Perception on word level (TAUVIS-words) and (2) assess the internal reliability of the TAUVIS-words. METHODS: Thirty-nine normal-hearing adults divided into the following 3 age categories were included: (1) younger adults, age 18-39 years; (2) middle-aged adults, age 40-59 years; and (3) older adults, age >60 years. The TAUVIS-words consist of 4 word lists, i.e., 2 monosyllabic word lists (MS 1 and MS 2) and 2 polysyllabic word lists (PS 1 and PS 2). A first exploration of the effects of age, gender, and test stimuli (i.e., the used word list) on visual speech perception was conducted using the TAUVIS-words. A mixed-design analysis of variance (ANOVA) was conducted to analyze the results statistically. Lastly, the internal reliability of the TAUVIS-words was assessed by calculating the Chronbach α. RESULTS: The results revealed a significant effect of the used list. More specifically, the score for MS 1 was significantly better compared to that for PS 2, and the score for PS 1 was significantly better compared to that for PS 2. Furthermore, a significant main effect of gender was found. Women scored significantly better compared to men. The effect of age was not significant. The TAUVIS-word lists were found to have good internal reliability. CONCLUSION: This study was a first exploration of the effects of age, gender, and test stimuli on visual speech perception using the TAUVIS-words. Further research is necessary to optimize and validate the TAUVIS-words, making use of a larger study sample.

The impact of hormone therapy on vocal quality in postmenopausal women.

OBJECTIVES: The main purpose of this study was to investigate the impact of hormone therapy (HT) on vocal characteristics in postmenopausal women by comparing postmenopausal women with HT (n=59) and postmenopausal women without HT (n=46). The second purpose was to investigate the differences in vocal characteristics between two types of HT: estrogen therapy (ET) and estrogen-progestogen therapy (E-PT). METHODS: To determine the vocal characteristics in both groups, objective (aerodynamic measurements, vocal range measurements, acoustic analysis, and a determination of the dysphonia severity index) and subjective assessment techniques (perceptual evaluation, videostroboscopic evaluation, and voice handicap index) were used. RESULTS: The postmenopausal women without HT showed a significantly lower speaking fundamental frequency and were able to phonate lower compared with postmenopausal women with HT. No differences in vocal characteristics were found between postmenopausal women with ET and postmenopausal women with E-PT. CONCLUSION: HT seems to counteract the vocal changes caused by menopause. The type of HT did not affect the outcome in this study.

The impact of a voice counseling procedure to select students with normal vocal characteristics for starting a master program in speech language pathology: a pilot study.

OBJECTIVE: The purpose of this study is to determine objective vocal quality, vocal characteristics, and vocal habits in future speech language pathology (SLP) students and to evaluate the possible impact of a provided vocal counseling procedure. A comparison of vocal data was done in SLP students who had and who had not undergone vocal counseling procedure. It is hypothesized that counseling results in good vocal quality, adequate vocal performance, and appropriate vocal hygiene. STUDY DESIGN: Randomized controlled study design. METHODS: To determine the vocal quality, questionnaires (Voice Handicap Index [VHI]), subjective (videostroboscopic and perceptual evaluations), and instrumental assessment techniques (aerodynamic, vocal range, acoustic measurements, Dysphonia Severity Index [DSI]) were used. Identical voice assessments were made in 71 students who followed and have not (n=83) followed the vocal counseling procedure. RESULTS: The VHI showed the absence of a psychosocial impact of the vocal quality. Thirty percentage of the subjects mentioned hoarseness as the most common vocal complain. Videostroboscopic evaluations revealed normal vocal anatomy and physiology. A significant difference regarding the DSI value was found between the students with (+3.3, 83%) and without (+1.8, 68%) a followed voice counseling procedure. CONCLUSION: This vocal counseling procedure is added as a standard procedure when future students gain information about the SLP master program. To what extent the presence and content of the vocal education strategy can influence the choice of the profession as an SLP is subject for further research.

A comparison of the perceptual evaluation of speech production between bilaterally implanted children, unilaterally implanted children, children using hearing aids, and normal-hearing children.

OBJECTIVE: The purpose of this study was to compare the perceptual evaluation of several speech characteristics between bilaterally implanted children (biCI), unilaterally implanted children (uniCI), children using hearing aids (HA), and normal-hearing children (NH). DESIGN: Perceptual evaluations of intelligibility, phonation, resonance, and articulation were compared between the several subgroups. STUDY SAMPLE: Thirteen biCI children, 14 uniCI children, 10 HA children using hearing aids and 11 NH children participated. RESULTS: The biCI children did not show statistically significant differences with the NH children for overall intelligibility, phonation, and resonance. Yet, significantly more distortions and consonant cluster reductions were observed in the biCI children compared with the NH children. In comparison with the uniCI and HA children, the NH as well as the biCI children obtained better evaluations for intelligibility, phonation, resonance, and articulation of consonants. CONCLUSIONS: The results of this study demonstrated a possible additional beneficial effect of bilateral implantation on several speech characteristics of prelingually deaf children and as a consequence highlighted the interest of further research.

Objective vocal quality in children using cochlear implants: a multiparameter approach.

OBJECTIVES: The purpose of this study was to determine the objective vocal quality in 36 prelingually deaf children using cochlear implant (CI) with a mean age of 9 years. An additional purpose was to compare the objective vocal quality of these 36 CI users with 25 age-matched children with prelingual severe hearing loss using conventional hearing aids (HAs) and 25 normal hearing (NH) children. STUDY DESIGN: The design for this cross-sectional study was a multigroup posttest-only design. METHODS: The objective vocal quality was measured by means of the dysphonia severity index (DSI). Moreover, perceptual voice assessment using the GRBASI scale was performed. RESULTS: CI children have a vocal quality by means of the DSI of +1.8, corresponding with a DSI% of 68%, indicating a borderline vocal quality situated 2% above the limit of normality. The voice was perceptually characterized by the presence of a very slight grade of hoarseness, roughness, strained phonation, and higher pitch and intensity levels. No significant objective vocal quality differences were measured between the voices of the CI children, HA users, and NH children. CONCLUSIONS: According to the results, one aspect of the vocal approach in children with CI and using HAs must be focused on the improvement of the strained vocal characteristic and the use of a lower pitch and intensity level.

A comparison of vowel productions in prelingually deaf children using cochlear implants, severe hearing-impaired children using conventional hearing aids and normal-hearing children.

OBJECTIVE: The purpose of this study was to compare vowel productions by deaf cochlear implant (CI) children, hearing-impaired hearing aid (HA) children and normal-hearing (NH) children. PATIENTS AND METHODS: 73 children [mean age: 9;14 years (years;months)] participated: 40 deaf CI children, 34 moderately to profoundly hearing-impaired HA children and 42 NH children. For the 3 corner vowels [a], [i] and [u], F(1), F(2) and the intrasubject SD were measured using the Praat software. Spectral separation between these vowel formants and vowel space were calculated. RESULTS: The significant effects in the CI group all pertain to a higher intrasubject variability in formant values, whereas the significant effects in the HA group all pertain to lower formant values. Both hearing-impaired subgroups showed a tendency toward greater intervowel distances and vowel space. CONCLUSION: Several subtle deviations in the vowel production of deaf CI children and hearing-impaired HA children could be established, using a well-defined acoustic analysis. CI children as well as HA children in this study tended to overarticulate, which hypothetically can be explained by a lack of auditory feedback and an attempt to compensate it by proprioceptive feedback during articulatory maneuvers.

Vocal characteristics of middle-aged premenopausal women.

Aging influences the laryngeal anatomy and physiology, leading to altered vocal quality. In middle-aged women, the voice is affected by a combination of aging and menopausal transition. However, in many studies about vocal aging, the menopausal transition is not taken into account. The purpose of this study was to measure and describe the effect of aging on the vocal characteristics by comparing young women (between 20 and 28 years) and middle-aged premenopausal women (between 45 and 52 years). To determine the vocal characteristics in both groups, objective (aerodynamic measurements, vocal performance measurements, acoustic analysis, and a determination of the Dysphonia Severity Index) and subjective assessment techniques (perceptual evaluation, videostroboscopic evaluation, and Voice Handicap Index) were used. The middle-aged premenopausal women showed a smaller frequency and intensity range, a lower habitual fundamental frequency, and a higher soft phonation index compared with the young women. The results of this study are important when studying the voices of middle-aged women. Vocal characteristics of middle-aged women differ from young women, and these changes cannot only be because of hormonal changes during the menopause.

The impact of vocal warm-up exercises on the objective vocal quality in female students training to be speech language pathologists.

PURPOSE: The purpose of this study was to determine the impact of a specific vocal warm-up (WU) program-focused on the improvement of the dynamics of the extrinsic and intrinsic laryngeal muscles-on the objective vocal quality in Dutch female students who are getting trained to be speech language pathologists (SLPs). Hypothetically, one can assume that the objective vocal quality will increase after vocal WU exercises in SLPs in comparison with the matched control group that receives no WU program. METHODS: This was a pretest-posttest control group design study, in which 45 female future SLPs were randomly assigned into two groups. The experimental group received a well-defined vocal WU program, whereas the control group took 30 minutes of vocal rest. Objective assessment techniques (aerodynamic, vocal range, acoustic measurements, and Dysphonia Severity Index [DSI]) were used. RESULTS: After vocal WU, a significant increased DSI value, increased vocal performance (with lower intensity and higher frequency), and increased fundamental frequency (F0) were measured. CONCLUSIONS: Clinically, there is clear evidence that warming up the vocal mechanism is beneficial to the objective vocal quality and the vocal performance in future SLPs. To what extent the repetition of these vocal WU exercises has the possibility to maintain increased objective vocal quality in these future professional voice users is subject to further research.

Intelligibility of hearing impaired children as judged by their parents: A comparison between children using cochlear implants and children using hearing aids.

OBJECTIVES: The aim of this study was to determine the intelligibility of prelingually deaf children with cochlear implants (CI) as judged by their own parents, and to compare these results with prelingually hearing impaired children using hearing aids (HA) and normally hearing (NH) children. The authors hypothesised that subjects using conventional hearing aids would have poorer intelligibility judgements compared to NH and CI children. METHODOLOGY: This is a comparative study of 24 prelingually deaf CI children (m.a. 8.3 years), 24 prelingually hearing impaired HA children (m.a. 9.0 years) and 25 NH children. Recorded speech samples at word-, sentence- and story-level were perceptually judged by two speech pathologists and the child's main caregiver (the mother in most cases) using a five-point hierarchical scale. In addition, the sample of each child was transcribed by the child's main caregiver. The investigators counted and determined a percentage of words correctly understood. RESULTS: The judgements of the speech pathologists and the transcriptions of the mothers were not different between the CI and NH children, although the mothers tended to judge their CI child to be less intelligible. The HA children on the other hand, showed a mean intelligibility inferior to NH and CI children, as demonstrated by the judgements of the mothers and speech pathologists as well as by the percentages of correctly identified words by the mothers. CONCLUSION: The intelligibility of the prelingually deaf CI children is very close to the intelligibility of NH children, while the HA children still show a decreased mean intelligibility.

A comparison of the consonant production between Dutch children using cochlear implants and children using hearing aids.

OBJECTIVES: The main purpose of the present study was to compare the consonant error patterns of Dutch prelingually deaf CI children with prelingually hearing-impaired hearing aid (HA) children. The authors hypothesized that subjects using conventional hearing aids would have poorer consonant production skills. Additionally, the impact of the age at implantation (CI) and the degree of hearing loss (HA) was determined. METHODOLOGY: This is a comparative study of 29 prelingually deaf CI children (m.a. 9;0 y) and 32 prelingually hearing-impaired HA children (m.a. 9;11 y) who received their first hearing aid before the age of 2 years. Nineteen CI children were implanted before the age of 5 years. Nine HA children had thresholds above 90dB (range: 91-105dB), 15 between 70 and 90dB (range: 72-90dB) and 8 below 70dB (range: 58-68dB). Speech samples of all the children were elicited by means of a picture naming test and were video-recorded for further phonetic and phonological analysis. RESULTS: Considerably more phonetic and phonologic errors were observed in the HA children with thresholds above 70dB (range: 72-105dB). No notable differences could be found between deaf CI children and HA children with thresholds below 70dB. Even children implanted after the age of 5 years showed significantly fewer phonetic and phonological errors than HA children. CONCLUSION: The consonant production of implanted children is more adequate than the consonant production of HA children with a hearing loss of 70dB or more. In addition, the results also indicate that even after the age of 5 years, implantation can still have an advantageous effect on a child's consonant production.

Impact of thyroidectomy without laryngeal nerve injury on vocal quality characteristics: an objective multiparameter approach.

OBJECTIVES/HYPOTHESIS: The main purpose of this study was to determine the impact of thyroidectomy on the subjective and objective vocal quality using the Dysphonia Severity Index. It was hypothesized that objective measures of vocal function and other vocal characteristics would change (temporarily or permanently) from the presurgical to the postsurgical conditions, even with the entire preservation of the laryngeal nerve, due to the surgical approach and other influencing factors. STUDY DESIGN: Prospective study in which 44 subjects were studied before (1 week) and three times post-thyroidectomy. METHODS: Subjective (auditory perceptual evaluation and videolaryngostroboscopy) and objective (aerodynamic, vocal range, acoustic, and Dysphonia Severity Index measurements) assessment techniques were used. RESULTS: Paired samples t test indicated a significant decrease of the highest frequency, the highest intensity, the fundamental frequency, and the Dysphonia Severity Index in the first postoperative condition. When a repeated measures analysis of variance was performed with the pre- and all the postoperative moments of evaluation taken into account, no significant difference was noted for any of the objective voice characteristics. CONCLUSIONS: After thyroidectomy subjects had a normal perceptual and objective vocal quality corresponding with a Dysphonia Severity Index of 66%, and there is no permanent change of the vocal performance. Moreover, there is no psychosocial handicapping effect of the vocal quality, but immediately post-thyroidectomy there are more vocal complaints. To what extent thyroidectomy causes (temporary or permanent) alterations of the singing voice in elite vocal performers is subject to further research.

The prevalence of lisping in gay men.

UNLABELLED: This study evaluated the stereotype that gay men lisp. Two clinicians who were unaware of the specific purpose of the study and the populations involved judged randomized audio-recordings of 175 gay males, 100 heterosexual males and 100 heterosexual females for the presence of lisping during reading of a standardized text. In the gay males a significantly higher prevalence of lisping was found than in the heterosexual males and females. Breakdown of the results of the gay participants in two different age groups showed a higher prevalence of lisping in the younger age group than in the older age group. No relation was found between lisping and age of coming-out or lisping and the probability of being gay as assessed by a questionnaire about sexual orientation. The origin of the high prevalence of lisping in gay men needs further investigation. LEARNING OUTCOMES: The readers of this article will able (1) to discuss articulatory behaviour as a possible marker that may distinguish gay from heterosexual men (2) to discuss the prevalence of lisping in gay men.

Speech outcome regarding overall intelligibility, articulation, resonance and voice in Flemish children a year after pharyngeal flap surgery. A pilot study.

OBJECTIVE: The main purpose of this study is to determine the treatment effectiveness of pharyngeal flap surgery by measuring speech outcome 1 year after surgery. The authors hypothesized that flap surgery is an effective technique for velopharyngeal inadequacy resulting in improved intelligibility, decreased hypernasality and nasalance scores and normal voice characteristics. PATIENTS AND METHODS: Objective (Nasometer, Dysphonia Severity Index) as well as subjective (perceptual evaluations) assessment techniques were performed in 7 subjects. Speech evaluations were performed 1 year after flap surgery and comparison was made between the speech results of the preoperative condition (1 week before surgery) and the first postoperative condition (6 weeks after surgery). RESULTS: After pharyngeal flap surgery there was improved though still slightly impaired intelligibility, with normal nasality, normal nasalance values for standard Flemish speech and normal voice characteristics. The normal nasality and nasalance values were not present in the preoperative condition. Persistence of the incorrect production of the thrill sound /r/ and the fricatives /s/ and /sch/ were observed. CONCLUSION: It is likely that the slightly impaired speech intelligibility is determined by the presence of persistent articulation disorders.

Overall intelligibility, language, articulation, voice and resonance characteristics in a child with Shprintzen-Goldberg syndrome.

OBJECTIVE: Recognition of the phenotypic spectrum and prognosis of a genetic disorder is critical to proper patient care. A 7-year-old boy with Sphrintzen-Goldberg syndrome (SGS) was studied to investigate speech, language and voice patterns associated with this syndrome. METHODS: The child's language (expressive and receptive) and speech was characterized with regard to overall intelligibility, articulation (phonetic and phonological errors), voice (flexible videolaryngostroboscopy, quality, pitch and loudness) and resonance (type of disorders). RESULTS: Based on this detailed study the most striking communication characteristics in this child with SGS appear to be a delayed speech and language onset, an expressive and receptive language disorder, a moderately impaired speech intelligbility, relatively good phonetic but poorer phonological abilities, an oral hypotonia, a high-pitched soft voice and a slight hypernasality. CONCLUSIONS: The explanation for this communication disorder is not completely straightforward. It is not clear either to what extent the present case can be considered as typical for SGS. Only more data will allow to determine whether or not SGS is associated with a typical syndrome specific pattern of communication disorders. Not only detailed speech and language analyses of additional cases of SGS are necessary, but also studies that compare the speech and language of individuals with SGS with that of individuals with other genetic syndrome.

Comparison of the overall intelligibility, articulation, resonance, and voice characteristics between children using cochlear implants and those using bilateral hearing aids: a pilot study.

The purpose of this study was to determine and to compare the overall intelligibility, articulation, resonance, and voice characteristics in children using cochlear implants (CI) and children using conventional hearing aids (HA). Nine prelingually deaf children using CI and six children with a prelingual severe hearing loss using HA, were selected to participate. Objective (DSI, nasalance scores) as well as subjective assessment techniques (perceptual evaluations) were used. Both the CI and HA children demonstrated normal vocal quality and resonance but showed the presence of articulation disorders. In the CI children, intelligibility was significantly better compared to the HA children. Significantly more phonetic and phonological disorders were present in the HA children. The results of this study show a poorer intelligibility of the HA children in comparison with the CI children which is probably due to the occurrence of significantly more phonetic and phonological disorders. Future detailed analysis in a larger sample of CI and HA children may help further clarify the issue of speech and voice characteristics and may demonstrate an important prognostic value.