title: Multidimensional evaluation of vocal quality in children with cochlear implants: a cross-sectional, case-controlled study.
abstract: OBJECTIVE
  This study aimed to compare the differences in vocal quality between Mandarin-speaking children with cochlear implants and normal-hearing peers and to understand which cochlear implant usage parameters may predict unfavourable voice outcomes.
  
  
  METHODS
  A cross-sectional, case-controlled study.
  
  
  METHODS
  A tertiary medical centre.
  
  
  METHODS
  Thirty-five pre-lingually deaf children (age = 10.3 ± 1.6 years; 17 boys and 18 girls) who had used cochlear implants for >2 years and 35 age- and gender-matched controls with normal hearing.
  
  
  METHODS
  Through sustained phonation of /a/ and reading of the Hare and Tortoise passage, the subjects' voice quality was analysed with aerodynamics and acoustics. A six-point scale was used for auditory-perceptual evaluation. A Pediatric Voice-Related Quality of Life Survey was filled out by the caregivers.
  
  
  RESULTS
  The implanted subjects had significantly lower mean airflow rate (P = 0.006), higher phonation threshold pressure (P < 0.001), higher fundamental frequency variations (P < 0.001) and peak-amplitude variations (P < 0.001), wider fundamental frequency range (P = 0.043), wider speaking intensity range (P = 0.015) and greater perceptual severity level of monotone (P < 0.001), resonance (P < 0.001), loudness (P < 0.001) and strain (P = 0.006) than their normal-hearing peers. Duration of postoperative rehabilitation was an independent predictor of unfavourable mean speaking fundamental frequency (odds ratio = 8.56, P = 0.008).
  
  
  CONCLUSIONS
  Inadequate postoperative rehabilitation may hinder the normalisation of Mandarin-speaking implantees' voice quality. A multidimensional analysis may precisely evaluate the voice of paediatric implantees; however, the generalisability of these findings requires different forms of validation, including data from other languages and other institutions.
authors.affiliation: Graduate Institute of Speech and Hearing Disorders and Sciences, National Taipei University of Nursing and Health Science, Taipei, Taiwan.
authors.forename: H-W
authors.initials: HW
authors.lastname: Hsu
authors.forename: T-J
authors.initials: TJ
authors.lastname: Fang
authors.forename: L-A
authors.initials: LA
authors.lastname: Lee
authors.forename: Y-T
authors.initials: YT
authors.lastname: Tsou
authors.forename: S H
authors.initials: SH
authors.lastname: Chen
authors.forename: C-M
authors.initials: CM
authors.lastname: Wu
mesh_terms: D000162:Acoustics; D016022:Case-Control Studies; D002648:Child; D003054:Cochlear Implants; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010699:Phonation; D011788:Quality of Life; D014833:Voice Quality