Towards a description of vocal features in adults with acquired hearing loss presenting for cochlear implantation

Aims: To describe vocal characteristics (airstream mechanism, voicing, voice quality,voice pitch/range, loudness, articulatory placement/resonance, rhythm, intonation) of adults presenting for cochlear implantation.

Human voices carry information independently of the words spoken. Production of a well-controlled voice, however, requires a relaxed vocal tract and the ability to self monitor vocal output. Profound bilateral hearing loss can compromise both these abilities.1

Dysphonia is known to correlate with low Quality of Life (QOL) scores and

can negatively affect the way a person is perceived.2,3

MethodVideo-taped data of conversations routinely collected during assessment for cochlear implant suitability, were independently scored by a panel of 8 specialist speech and language therapists (S&LTs) using the PETAL4 prosodic assessment for spontaneous speech. All adults were video-taped with hearing aids (if worn) in place.

Population Studied25 adults (age range 25 – 91 yrs). 11 females and 7 males presented with acquired bilateral profound loss (mean self-reported duration 22 years, range 2-54 yrs). 5 females and 2 males presented with congenital bilateral severe/profound loss (mean self-reported duration 36 years, range 24-47 yrs).

Exclusion criteria: co-existing dysarthria

Results•All adults presented with non-normative voice regardless of aetiology or duration of deafness.

•The vocal qualities causing greatest disruption to voice production differed between the acquired and congenital groups.

•Results of 3 adults with co-morbid dysarthria were excluded but fell within the parameters of the group

AcknowledgementsCI recipients and their families, and colleagues at SOECIC (Julie Brinton, Nikki Stephens, Kirsty Carey, Sarah Paganga, Nicola Cole, Nourah Al Ajroush)

Results-continued•For the adults with an acquired loss, reduced pitch and vocal range, self-monitoring of volume and abnormal voice quality were the principal features of their dysphonia. The vocal characteristics of the adults with congenital hearing loss were most strongly affected by poor voice quality; articulation and resonance difficulties were more prominent. Loudness control was less affected for this group.

Background

Amy Stephens (as@isvr.soton.ac.uk), Sarah Worsfold (smw3@isvr.soton.ac.uk)South of England Cochlear Implant Centre, UK www.soecic.org

*References - See attached sheet

Conclusions and Clinical Implications •This audit reveals the extent of dysphonia in adults presenting for cochlear implant (CI) and the need for provision of clinical intervention to reduce sequelae.

•PETAL allowed quick measurement of relevant vocal parameters with good inter-rater reliability, although this was not formally recorded.

•Vocal differences as rated by S&LTs are reported here. No measure of the individual’s rating of their own voices or the impact on social and emotional function are reported.

• Further work is required to establish QOL implications of dysphonia in those referred for CI, for both CI recipients and their frequent communication partners.

•Voice therapy is not routinely carried out in adult CI rehabilitation. It is, however, an effective intervention,5,6 which S&LTs on CI programmes are uniquely placed to deliver.

•S&LTs working on CI programmes would benefit from maintaining and updating their skills in dysphonia management.

Relative contribution of characteristics of the dysphonia – adults with congenital

hearing loss

Relative contribution of characteristics of the dysphonia – adults with acquired

hearing loss

Mean score on PETAL Prosodic Assessment

Characteristics ranked from lowest to highest mean group score