title: Altered phonatory physiology with short-term deactivation of children's cochlear implants.
abstract: OBJECTIVE
  The purposes of this investigation were 1) to determine whether short-term auditory deprivation results in systematic phonatory changes for prelingually deafened children who use cochlear implants (CIs) and 2) to determine whether such changes are similar to those that have been reported for postlingually deafened adults.
  
  
  METHODS
  Participants were two 6-yr-old children with CIs. Both children had been prelingually deafened, had good to excellent speech production and speech perception skills, and had been using their CIs for 2.5 yr. A single-subject design was used. Intraoral air pressure (Po), phonatory air flow (Vl), electroglottograph (EGG) cycle width, fundamental frequency (F0), and intensity were measured during syllable production over two baseline days and three experimental days. Data were collected twice on each baseline day while the children wore their CIs, with a 1 hr break between data collection sessions. On experimental days, data were collected while the children wore their CIs (ON condition) and after their CIs had been removed for 1 hr (OFF condition).
  
  
  RESULTS
  Both children demonstrated highly variable phonatory behaviors in baseline. The child with the more proficient speech production and perception skills showed consistent and significant reductions in Po, F0, and intensity in the OFF condition. These findings were dissimilar to those that occurred with repeated testing in the baseline condition and so were attributed to the sudden loss of auditory feedback. The other child showed a consistent and significant increase in mean Vl in the OFF condition. However, this child exhibited a similar finding with repeated testing in the baseline condition. Therefore, increased Vl in the OFF condition may have represented a practice effect. She also showed a small and consistent decrease in F0 in the OFF condition when F0 was derived from acoustic data, but this effect was not reliable in another data set when F0 was derived from the EGG signal. Our results with prelingually deafened children were inconsistent with reports of increased intensity and F0 in the absence of auditory feedback for postlingually deafened adults with CIs.
  
  
  CONCLUSIONS
  Some prelingually deafened children who are successful CI users appear to use auditory feedback to self-monitor phonation. We suggest that the participant in our investigation who showed systematic phonatory changes in response to diminished auditory feedback was using auditory feedback primarily to stabilize her phonatory behaviors. She may not have had adequate experience with auditory feedback or adequate flexibility in her use of feedback mechanisms to implement the phonatory compensations that late-deafened adults use when auditory feedback suddenly is diminished. We further suggest that the phonatory changes that she exhibited during short-term auditory deprivation reflected disruption of her typical speaking strategies or apprehension about speaking when her ability to self-monitor auditorily was compromised.
authors.affiliation: Boys Town National Research Hospital, Omaha, Nebraska 68131, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Higgins
authors.forename: E A
authors.initials: EA
authors.lastname: McCleary
authors.forename: L
authors.initials: L
authors.lastname: Schulte
mesh_terms: D002648:Child; D019929:Cochlear Implantation; D005246:Feedback; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000601:surgery*; D006801:Humans; D008297:Male; D010699:Phonation / Q000502:physiology*; D013061:Speech Acoustics; D013067:Speech Perception / Q000502:physiology*; D013068:Speech Production Measurement