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«Studies on speech intelligibility of cochlear implant have been attempted in western countries and few studies in India have been attempted in ...»

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Language in India www.languageinindia.com ISSN 1930-2940 Vol. 15:12 December 2015

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Speech Intelligibility of Malayalam Speaking

Cochlear Implant Children

Soumya Ann Zachariah

Satish Kumaraswamy

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Abstract

Cochlear implant (CI) is an electronic device that is designed to provide hearing to those with profound deafness. Part of the device is surgically implanted into the inner ear and part is worn externally. As a prosthetic device, the cochlear implant stimulates the auditory nerve directly bypassing the damaged part of the inner ear or cochlea. Many viable nerve fibers remain in the auditory nerve even in cases of profound deafness, and the cochlear implant can restore activity to this nerve and hearing pathway. That much of the speech signal is redundant explains why cochlear implant only needs to transmit a small fraction of the information that is contained in speech sounds to achieve good speech intelligibility, Susan (2011).

Studies on speech intelligibility of cochlear implant have been attempted in western countries and few studies in India have been attempted in different language like Telugu, etc. In Kerala the cochlear implantation program have made a drastic change. By providing adequate speech and language therapy after cochlear implantation will enhance the speech and measuring the speech intelligibility gives an insight of rehabilitation program in these children. No attempts have been made to study speech intelligibility in Malayalam cochlear implant children.

Three groups of listeners participated in the study. First group of listeners consisted of ten Speech Language Pathologist. Second group consisted of individual who were not experienced with hearing impaired. The third group of listeners were mothers of implanted children. The cochlear implant children were given 5 tasks to repeat familiar words, unfamiliar words, and nonsense words said by the tester, to describe a picture given and general conversation. These were recorded using PRAAT software and saved as WAV files.

Language in India www.languageinindia.com ISSN 1930-2940 15:12 December 2015 Soumya Ann Zachariah and Satish Kumaraswamy Speech Intelligibility of Malayalam Speaking Cochlear Implant Children 211 Result showed that familiar persons – mothers and Speech language pathologist rated speech intelligibility better when compared to NON SLPs. Familiar topics like repletion of familiar words were rated better when compared to all other tasks.

Keywords: Cochlear implant, Malayalam speaking children, speech intelligibility.

Introduction Speech is the fundamental communication method of human kind. It is crucial to have a good understanding of speech, not only in daily communication but also in emergency situation.

The percentage of speech correctly understood is speech intelligibility. Speech intelligibility is the measure of the effectiveness of speech. The measurement is usually expressed as a percentage of a message that is understood correctly. Speech intelligibility does not imply speech quality. There are many factors affecting speech intelligibility including interference, noise, reverberation, echoes, etc.

Cochlear Implants There are many reasons why cochlear implants are successful in providing speech intelligibility and identification of environmental sounds despite they do not replace all the function of normal cochlea. Much natural speech signals are redundant. Much of the normal processing capabilities of the ear are redundant. Much of the processing that normally occurs in the auditory nervous system is redundant. The central nervous system has an enormous ability to adapt to changing demands through expression of neural plasticity. That much of the speech signal is redundant explains why cochlear implant only needs to transmit a small fraction of the information that is contained in speech sounds to achieve good speech intelligibility, Susan (2011).

Cochlear implant (CI) is an electronic device that is designed to provide hearing to those with profound deafness. Part of the device is surgically implanted into the inner ear and part is worn externally. As a prosthetic device, the cochlear implant stimulates the auditory nerve directly bypassing the damaged part of the inner ear or cochlea. Many viable nerve fibers remain in the auditory nerve even in cases of profound deafness, and the cochlear implant can restore Language in India www.languageinindia.com ISSN 1930-2940 15:12 December 2015 Soumya Ann Zachariah and Satish Kumaraswamy Speech Intelligibility of Malayalam Speaking Cochlear Implant Children 212 activity to this nerve and hearing pathway. One of the first rehabilitation decisions that parents of the children with hearing impairment must face is whether or not to select a cochlear implant as the sensory aid of choice for their child.

Speech Intelligibility Cochlear implant rehabilitation is a preferred choice of speech rehabilitation of hearing impaired because it allows children to use the natural aural-oral method of developing speech.

Some factors that affect the outcome of language comprehension are early fitting, training duration, additional amplification, etc. All these factors indicate the success of speech intelligibility in cochlear implantation (Clark 2003).





Speech Intelligibility of Profoundly Deaf Children Several studies have compared the speech intelligibility of profoundly deaf children before and after implantation Tobey (2011) examined speech intelligibility of children with CI using sentences and result shows that speech intelligibility was significantly higher after implantation. Osberger compared speech intelligibility in pediatric users of single channel multichannel CI and tactile aids. Materials used were sentences. Children with early – onset deafness (before 4 year) who received CI before age 10 had the highest intelligibility scores whereas children who do not receive CI until after 10 year had lowest score.

The “speech intelligibility” refers to the degree to which a speaker intended message can be recovered by other listener (Kent & Duffy, 2001) Abijith (2010) examined post-treatment rating of speech intelligibility in cochlear implanted children. Results indicated there is a significant difference between rating done by mothers and other group for general conversation and picture description and there is a significant difference between general conversation and picture description. Hence it is concluded that there is a significant improvement in speech intelligibility after cochlear implantation.

Language in India www.languageinindia.com ISSN 1930-2940 15:12 December 2015 Soumya Ann Zachariah and Satish Kumaraswamy Speech Intelligibility of Malayalam Speaking Cochlear Implant Children 213 Patil, Sindhura & Reddy (2010) examined acoustic features of speech stress fundamental frequency, duration and intensity in children using cochlear implant and compared these features with those in normal hearing. Children with cochlear implant distinctly produced sentence stress but the acoustic correlates of stress are significantly different from those produced by individual with normal hearing.

From the above review of literature it could be said that, speech intelligibility plays a crucial role in understanding once speech. Speech intelligibility of cochlear implantee will apparently make an impact on listeners.

Cochlear Implantation in Kerala for Malayalam Speaking Children Studies on speech intelligibility of cochlear implant have been attempted in western countries and few studies in India have been attempted in different language like Telugu etc.

In Kerala the cochlear implantation program have made a drastic change. By providing adequate speech and language therapy after cochlear implantation will enhance the speech and measuring the speech intelligibility gives an insight of rehabilitation program in these children.

No attempts have been made to study speech intelligibility in Malayalam cochlear implant children.

Hence the present study has been taken up to measure the speech intelligibility of Malayalam speaking cochlear implanted children Review of Literature Intelligibility refers to the recoverability of a speaker’s linguistic message, differing from articulatory or phonological measures in that some aspects of meaning is involved. In cochlear implantation research, intelligibility range from morpheme to whole sentence, intelligibility is most often measured with rating scales (Yan 2006).

Cochlear implant is an electronic device that is designed to provide hearing to those with profound deafness. Part of the device is surgically implanted into the inner ear and part is worn Language in India www.languageinindia.com ISSN 1930-2940 15:12 December 2015 Soumya Ann Zachariah and Satish Kumaraswamy Speech Intelligibility of Malayalam Speaking Cochlear Implant Children 214 externally. As a prosthetic device, the cochlear implant stimulates the auditory nerve directly bypassing the damaged part of the inner ear or cochlea. Many viable nerve fibers remain in the auditory nerve even in cases of profound deafness, and the cochlear implant can restore activity to this nerve and hearing pathway. One of the first rehabilitation decisions that parents of the children with hearing impairment must face is whether or not to select a cochlear implant as the sensory aid of choice for their child.

Cochlear implant rehabilitation is a preferred choice of speech rehabilitation of hearing impaired because it allows children to use the natural aural-oral method of developing speech.

Some factors that affect the outcome of language comprehension are early fitting, training duration, additional amplification, etc. All these factors indicate the success of speech intelligibility in cochlear implantation.

Speech intelligibility of hearing impaired individuals has long been the platform of discussion on how they should be educated. Although there may be considerable difference of opinion as to whether good speech intelligibility is in fact achieved for a given hearing impaired individual or as to how speech may best be achieved in the broad context of other educational objectives, the overall importance of oral speech intelligibility for success in the hearing world is difficult to deny. However, competent a person may be it is usually only through oral performance that is competence becomes apparent. In fact good speech intelligibility is stated goal of most of or all contemporary educational methodologies (Susan 2011).

It is generally accepted that degree of hearing loss is one of the most important factors affecting the speech intelligibility of hearing impaired children. Hudgins and number (1924). As hearing loss increases, articulation error increases and overall speech intelligibility become worse.

Western studies Gao (2003) compared the connected speech intelligibility of children who use cochlear implants with children who have normal hearing. Results showed that for children with CI greater intelligibility associated with both increased chronological age and increased duration of Language in India www.languageinindia.com ISSN 1930-2940 15:12 December 2015 Soumya Ann Zachariah and Satish Kumaraswamy Speech Intelligibility of Malayalam Speaking Cochlear Implant Children 215 cochlear implant use. As a whole children with cochlear implant were significantly less intelligible than children with normal hearing.

Peng (2004) investigated speech intelligibility of 24 prelingually deaf pediatric cochlear implant recipients with 84 months of device experience by Each CI participant’s speech sample was judged by a panel of 3 listeners. Both age at implantation and different speech coding strategies contribute to the variability of CI participant’s speech intelligibility. Implantation at a younger age and use of the spectral peak speech coding strategy yielded higher intelligibility scores than implantation at an older age and the use of multipeak speech - coding strategy. These results serve for clinical applications of long term advancements in spoken language development are considered for pediatric CI recipients.

Musselman (1990) studied the relationship between hearing loss and speech intelligibility was investigated in a sample of 121 young deaf children. Significant independent effects were associated with the unaided hearing threshold level (HTL), but not with the aided HTL or with shape. Further analysis of the data suggested the existence of 3 distinct groups. Most children with losses of 70-89 dB developed some intelligible speech and unaided HTL had additional predictive validity. Between 90 and 104 dB, considerable variability occurred, and the aided HTL had additional predictive validity. Above 105 dB, few children developed any intelligible speech.

Osberger (1994) studied the speech intelligibility of 18 children with pre lingual deafness using cochlear implants for an average of 3 year. The average speech intelligibility score of 9 children using oral communication was significantly higher than that of 9 children using total communication.

Nikolopoulos (2009) assessed the influence of age at implantation on speech perception and speech intelligibility following pediatric cochlear implantation. Age at implantation positively correlated with pre implantation assessment performance and with most of the outcome measures up to 24 months following implantation. However, at the 3 and 4 year intervals following implantation, age at implantation was found to be a strong negative predictor Language in India www.languageinindia.com ISSN 1930-2940 15:12 December 2015 Soumya Ann Zachariah and Satish Kumaraswamy Speech Intelligibility of Malayalam Speaking Cochlear Implant Children 216 of all the outcomes studied. The result of the present study provide strong evidence that pre lingually deaf children should receive implants as early as possible to facilitate the later development of speech perception skills and speech intelligibility and thus maximize the health gain from the intervention. However, because of the wide variation in individual outcomes, age alone should not be used as a criterion to decide implant candidacy.



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