Speech Perception and Language Abilities Among Children Using Cochlear Implants: Findings From a Primary School Age Cohort in South India

Objectives: This study aimed to profile the speech perception and language abilities of a cohort of pediatric cochlear implant (CI) users in primary school years. It also aimed to understand the intercorrelations among audiological, child, and environmental characteristics, speech perception, and language skills and to explore the predictors of speech perception and language skills.

Design: A cross-sectional design was used for the study. The participants were 222 pediatric CI users (106 boys; 116 girls) with a mean chronological age of 10.51 (SD ± 1.28) years. Participants had received CIs at a mean age of 2.93 (SD ± 0.95) years, with the mean duration of CI use being 7.43 (SD ± 1.15) years at the time of assessment. Participants completed an assessment battery comprising speech perception (phoneme discrimination, open-set speech perception in quiet) and language (semantics, syntax) tasks. Selected audiological, child, and environmental characteristics were documented. The mean and SDs of the measures across age categories (8 to 12 years) and the proportion of children attaining scores better than 80%, between 50 and 80%, and poorer than 50% of the total possible score in each task were computed to generate a profile of speech perception and language abilities. Correlational and regression analyses assessed the intercorrelations among the variables and predictors of speech perception and language abilities.

Results: A large proportion (79.0%) of children in the study group obtained scores better than 80% for phoneme discrimination, whereas only 17.8% scored better than 80% for open-set speech perception in quiet. Additionally, 42.8 and 20.8% of children scored better than 80% for semantics and syntax, respectively. Speech perception and language abilities demonstrated moderate-strong intercorrelations, contributing to a significant proportion of the total variance explained in phoneme discrimination (42.9%), open-set speech perception (61.8%), semantics (63.0%), and syntax (60.8%). Phoneme discrimination and open-set speech perception emerged as large contributors to variance in overall language abilities. Among the audiological factors, only hearing age contributed to a small proportion of variance (3 to 6%) across children's speech perception and language performance.

Conclusions: Children using CI demonstrated highly variable performance in speech perception and expressive language skills during primary school. Although children demonstrated improved performance in phoneme discrimination and semantics, they continued to face challenges in the (quiet) speech perception and syntax abilities. The effect of audiological, child, and environmental factors was minimal in explaining the variance in speech perception and language abilities, which shared a bidirectional relationship. The findings relating to mid-term outcomes, ranging from 4 to 9 years after cochlear implantation, suggest the need for continued support and targeted interventions for developing speech perception and language abilities in the primary school years to optimize outcomes among pediatric CI users.