Voice Parameters in Children With Cochlear Implants: A Systematic Review and Meta-Analysis

Andrea Frosolini; Francesco Fantin; Isabella Tundo; Nicholas Pessot; Giulio Badin; Patrizia Bartolotta; Luca Vedovelli; Gino Marioni; Cosimo de Filippis

doi:10.1016/j.jvoice.2023.01.022

Voice Parameters in Children With Cochlear Implants: A Systematic Review and Meta-Analysis

J Voice. 2023 Mar 1:S0892-1997(23)00021-8. doi: 10.1016/j.jvoice.2023.01.022. Online ahead of print.

Authors

Andrea Frosolini¹, Francesco Fantin², Isabella Tundo³, Nicholas Pessot², Giulio Badin⁴, Patrizia Bartolotta⁵, Luca Vedovelli⁵, Gino Marioni⁶, Cosimo de Filippis²

Affiliations

¹ Department of Neuroscience DNS, Audiology Unit at Treviso Hospital, University of Padova, Treviso, Italy; Department of Maxillo-Facial Surgery, Policlinico Le Scotte, University of Siena, Siena, Italy. Electronic address: andrea.frosolini@studenti.unipd.it.
² Department of Neuroscience DNS, Audiology Unit at Treviso Hospital, University of Padova, Treviso, Italy.
³ Department of Neuroscience DNS, Audiology Unit at Treviso Hospital, University of Padova, Treviso, Italy; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", ENT Section, A.O.U. Policlinico "G.Rodolico-San Marco", University of Catania, Catania, Italy.
⁴ Department of Neuroscience DNS, Audiology Unit at Treviso Hospital, University of Padova, Treviso, Italy; Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy.
⁵ Epidemiology, and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Unit of Biostatistics, University of Padova, Padova, Italy.
⁶ Department of Neuroscience DNS, Otolaryngology Section, University of Padova, Padova, Italy.

PMID: 36868956
DOI: 10.1016/j.jvoice.2023.01.022

Abstract

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.

Keywords: Cochlear implants; Fundamental frequency; Jitter; Shimmer.

Publication types

Review