Voice Quality in Cochlear Implant Recipients: An Observational Cross Sectional Study

  • Madhukar Upadhyay
  • Rakesh DattaEmail author
  • Ajith Nilakantan
  • Sunil Goyal
  • Abhishek Gupta
  • Salil Gupta
  • Loknath Sahoo
Original Article


Children with hearing loss are more likely to suffer from voice and speech disorders than with normal hearing due to their poor and less robust auditory feedback mechanisms. Prelingually deaf children are not able to supervise their own voice due to lack of auditory feedback. Cochlear implanted children achieve better hearing and consequently enhanced speech intelligibility. Various parameters of voice improve with continous usage of cochlear implant. However all the vocal parameters do not show similar degree of change. Previous studies have assessed the voice quality of cochlear implantees and have given inconsistent results. The aim of the study is to compare the voice quality of cochlear implant children with normal subjects using objective and subjective methods. The study was undertaken after obtaining clearance from the Institutional Ethics committee. Written informed consent for carrying out voice analysis was taken from the parents. The voice analysis of 42 normal and 42 cochlear implant children were done using the Dr Voice software by Tiger Inc. All the children were age and sex matched. The parameters assessed were fundamental frequency, maximum phonation time, jitter%, shimmer% and harmonics to noise ratio. The findings of both the group were compared. The cochlear implanted children showed significant deviation of all the measured parameters as compared to the normal children. The voice quality of the implanted children is poor and deviant from the normal. Even after continuous usage of cochlear implant for 1 year the voice quality of these children did not reach to the levels of their normal hearing peers.


Voice Voice quality Cochlear implant India Prelingual Deafness 


Compliance with Ethical Standards

Conflict of interest

The author declares no conflict of interest.


  1. 1.
    Lee G-S (2012) Variability in voice fundamental frequency of sustained vowels in speakers with sensorineural hearing loss. J Voice 26(1):24–29CrossRefGoogle Scholar
  2. 2.
    Svirsky MA, Jones D, Osberger MJ, Miyamoto RT (1998) The effect of auditory feedback on the control of oral-nasal balance by pediatric cochlear implant users. Ear Hear 19(5):385–393CrossRefGoogle Scholar
  3. 3.
    Madeira FB, Tomita S (2010) Voice Handicap Index evaluation in patients with moderate to profound bilateral sensorineural hearing loss. Braz J Otorhinolaryngol 76(1):59–70CrossRefGoogle Scholar
  4. 4.
    Pruszewicz A, Demenko G, Wika T (1993) Variability analysis of Fo parameter in the voice of individuals with hearing disturbances. Acta Otolaryngol (Stockh) 113(3):450–454CrossRefGoogle Scholar
  5. 5.
    Van Lierde KM, Vinck BM, Baudonck N, De Vel E, Dhooge I (2005) Comparison of the overall intelligibility, articulation, resonance, and voice characteristics between children using cochlear implants and those using bilateral hearing aids: a pilot study: comparación de la inteligibilidad global, la articulación, la resonancia y las características de la voz entre niños con implante coclear y niños con auxiliar auditivo bilateral: un estudio piloto. Int J Audiol 44(8):452–465CrossRefGoogle Scholar
  6. 6.
    Campisi P, Low AJ, Papsin BC, Mount RJ, Harrison RV (2006) Multidimensional voice program analysis in profoundly deaf children: quantifying frequency and amplitude control. Percept Mot Skills 103(1):40–50CrossRefGoogle Scholar
  7. 7.
    Garcia JV, Rovira JMV, Sanvicens LG (2010) The influence of the auditory prosthesis type on deaf children’s voice quality. Int J Pediatr Otorhinolaryngol 74(8):843–848CrossRefGoogle Scholar
  8. 8.
    Holler T, Campisi P, Allegro J, Chadha NK, Harrison RV, Papsin B et al (2010) Abnormal voicing in children using cochlear implants. Arch Otolaryngol Neck Surg 136(1):17–21CrossRefGoogle Scholar
  9. 9.
    Hocevar-Boltezar I, Radsel Z, Vatovec J, Geczy B, Cernelc S, Gros A et al (2006) Change of phonation control after cochlear implantation. Otol Neurotol 27(4):499–503PubMedGoogle Scholar
  10. 10.
    Archbold S, Lutman ME, Nikolopoulos T (1998) Categories of auditory performance: inter-user reliability. Br J Audiol 32(1):7–12CrossRefGoogle Scholar
  11. 11.
    Hsu H-W, Fang T-J, Lee L-A, Tsou Y-T, Chen SH, Wu C-M (2014) Multidimensional evaluation of vocal quality in children with cochlear implants: a cross-sectional, case-controlled study. Clin Otolaryngol 39(1):32–38CrossRefGoogle Scholar
  12. 12.
    Harden JR, Looney NA (1984) Duration of sustained phonation in kindergarten children. Int J Pediatr Otorhinolaryngol 7(1):11–19CrossRefGoogle Scholar
  13. 13.
    Baudonck N, D’haeseleer E, Dhooge I, Van Lierde K (2011) Objective vocal quality in children using cochlear implants: a multiparameter approach. J Voice 25(6):683–691CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  1. 1.Department of ORL-HNSArmed Forces Medical CollegeWanowariIndia
  2. 2.167 Military HospitalPathankotIndia
  3. 3.Department of ORL-HNSArmy Hospital R&RNew DelhiIndia
  4. 4.Department of ORL-HNSMilitary Hospital Jalandhar CanttJalandharIndia
  5. 5.Department of ORL-HNSCommand Hospital (Eastern Command)KolkataIndia
  6. 6.Audiologist and Speech Language Pathologist, Department of ORL-HNSCommand Hospital (Southern Command)PuneIndia

Personalised recommendations