Articulation Abilities of Children with Hearing Impairment Using Hearing Aids and Cochlear Implant: A Comparison in Telugu

Abstract

Background: The most damaging effect of hearing loss reflects on the speech and language development of children with hearing impairment. The technological advancements in recent years have paved the way for improved amplification devices for these children to develop age-adequate language skills. However, good articulatory skills still elude them. Hence understanding their articulatory performances and differences in the articulatory production of children using CI and HA is paramount for both SLPs and Audiologists for effective rehabilitation. Aim: The aim of the study is to examine and compare the articulation abilities of Telugu-speaking children using Digital hearing aids or are fitted with Cochlear implants with age and gender matched typically developing children. Methods: A total of 15 Telugu-speaking children aged 4 to 6 years were recruited for the study. Participants were divided into three groups (Group-1) consisting of 5 children using digital Hearing Aids had a minimum hearing age of 2 years, (Group-2) consisting of 5 children using Cochlear implants fitted with multichannel cochlear implants and had an implant age of a minimum of 2 years Group-3 consisting 5 of age-matched typically developing children. For all the groups of participants, revised norms of the Test of Articulation and Discrimination in Telugu-(Padmaja,1988), by Usha and Sreedevi (2010) were administered. The recorded speech sample compared the consonant productions to target productions, error categories were identified at the segmental level based on SODA and PMV analysis. Frequent phonological processes exhibited by all participants were documented. Appropriate Statistical analysis for the results obtained was carried out using SPSS software. Results: Statistical comparisons for vowels, diphthongs, and consonants classified based on place of articulation were made using the nonparametric Kruskal Wallis test across the HA, CI, and TDC groups. No significant difference was obtained for vowels and diphthongs across the three groups. However, few apparent vowels errors were seen in CI and HA groups. Considering consonant articulation, participants in the CI group performed better than the HA group, and both groups had prominent substitution errors There was a statistically significant difference for the consonants across the three groups. In the HA group, for the consonants, the most to least accurately produced consonants are as follows, bilabial>labiodental>dentals>palatal>velar>alveolar>clusters. For the CI group, the most to least accurately produced consonants are as follows, bilabials>dentals>alveolar>labiodentals>velars>palatals>clusters. Production of consonants was better in CI participants. Statistical comparison for the SODA errors revealed a statistical difference across the three groups. From the qualitative and statistical analysis of the SODA, errors reveal that substitution errors were more prevalent among the SODA errors for HA and CI (HA>CI). However, the omission errors were prevalent in the HA group only. And distortion errors were more prevalent in HA, followed by CI, and minimal errors were observed in TDC (HA>CI>TDC). From PMV analysis, it was observed that in HA and CI groups place errors were more, followed by voicing and manner errors (Place>voicing>manner). A comparison of phonological processes analysis across the three groups reveals that partial and total cluster reduction, rhotacism, and deaspiration are commonly observed in both HA and CI groups. Initial consonant deletion and stopping were present only in the HA group. Deaffrication was observed only in the CI group. And in TDC, partial cluster reduction which was the only articulatory error in them was occasionally seen. Conclusion: The present study indicated similarities and differences in the articulatory errors produced by children using digital HA and CI in Telugu. The study represents the detailed information on the phonemes that are most frequently produced correctly and erroneously. This would assist SLPs in developing effective articulation training intervention strategies to promote speech intelligibility in children who use HA and CI.