title: Incorporating ceiling effects during analysis of speech perception data from a paediatric cochlear implant cohort.
abstract: To compare speech perception between children with a different age at cochlear implantation.
  
  
  
  We evaluated speech perception by comparing consonant-vowel-consonant (auditory) (CVC(A)) scores at five-year follow-up of children implanted between 1997 and 2010. The proportion of children from each age-at-implantation group reaching the 95%CI of CVC(A) ceiling scores (>95%) was calculated to identify speech perception differences masked by ceiling effects.
  
  
  
  54 children implanted between 8 and 36 months.
  
  
  
  Although ceiling effects occurred, a CVC(A) score difference between age-at-implantation groups was confirmed (H (4) = 30.36; p < 0.001). Outperformance of early (<18 months) compared to later implanted children was demonstrated (p <0.001). A larger proportion of children implanted before 13 months compared to children implanted between 13 and 18 months reached ceiling scores. Logistic regression confirmed that age at implantation predicted whether a child reached a ceiling score.
  
  
  
  Ceiling effects can mask thorough delineation of speech perception. However, this study showed long-term speech perception outperformance of early implanted children (<18 months) either including or not accounting for ceiling effects during analysis. Development of long-term assessment tools not affected by ceiling effects is essential to maintain adequate assessment of young implanted infants.
authors.affiliation: a Department of Otorhinolaryngology and Head and Neck Surgery , University Medical Center Utrecht , Utrecht , the Netherlands.|b Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , the Netherlands.
authors.forename: Hanneke
authors.initials: H
authors.lastname: Bruijnzeel
authors.affiliation: a Department of Otorhinolaryngology and Head and Neck Surgery , University Medical Center Utrecht , Utrecht , the Netherlands.
authors.forename: Guido
authors.initials: G
authors.lastname: Cattani
authors.affiliation: a Department of Otorhinolaryngology and Head and Neck Surgery , University Medical Center Utrecht , Utrecht , the Netherlands.|b Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , the Netherlands.
authors.forename: Inge
authors.initials: I
authors.lastname: Stegeman
authors.affiliation: c Department of Otorhinolaryngology and Head and Neck Surgery , University Hospital Antwerp , Antwerp , Belgium , and.|d Faculty of Medicine and Life Sciences, University of Antwerp , Antwerp , Belgium.
authors.forename: Vedat
authors.initials: V
authors.lastname: Topsakal
authors.affiliation: a Department of Otorhinolaryngology and Head and Neck Surgery , University Medical Center Utrecht , Utrecht , the Netherlands.|b Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , the Netherlands.
authors.forename: Wilko
authors.initials: W
authors.lastname: Grolman
mesh_terms: D002675:Child, Preschool; D003054:Cochlear Implants; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D013067:Speech Perception
keywords: Auditory perception; child; cochlear implantation; cochlear implants; hearing disorders; hearing loss; retrospective studies; sensorineural hearing loss; speech audiometry; speech perception