Anda di halaman 1dari 14

Original Paper

Folia Phoniatr Logop 2011;63:154160


DOI: 10.1159/000318879

Published online: October 8, 2010

A Comparison of Vowel Productions in Prelingually


Deaf Children Using Cochlear Implants, Severe
Hearing-Impaired Children Using Conventional
Hearing Aids and Normal-Hearing Children
N. Baudonck a K. Van Lierde a I. Dhooge a P. Corthals a, b
a Department of
b Health

Otorhinolaryngology, Audiologic and Logopaedic Sciences, Ghent University, and


Care Department, University College Ghent, Ghent, Belgium

Key Words
Vowel production Deafness, prelingual Children
Cochlear implants

Abstract
Objective: The purpose of this study was to compare vowel
productions by deaf cochlear implant (CI) children, hearingimpaired hearing aid (HA) children and normal-hearing (NH)
children. Patients and Methods: 73 children [mean age: 9;14
years (years;months)] participated: 40 deaf CI children, 34
moderately to profoundly hearing-impaired HA children
and 42 NH children. For the 3 corner vowels [a], [i] and [u], F 1,
F2 and the intrasubject SD were measured using the Praat
software. Spectral separation between these vowel formants and vowel space were calculated. Results: The significant effects in the CI group all pertain to a higher intrasubject variability in formant values, whereas the significant
effects in the HA group all pertain to lower formant values.
Both hearing-impaired subgroups showed a tendency toward greater intervowel distances and vowel space. Conclusion: Several subtle deviations in the vowel production of
deaf CI children and hearing-impaired HA children could be
established, using a well-defined acoustic analysis. CI children as well as HA children in this study tended to overarticulate, which hypothetically can be explained by a lack of
auditory feedback and an attempt to compensate it by proprioceptive feedback during articulatory maneuvers.

Introduction

Speech in prelingually deaf children is characterized


by deficits in articulation of consonants and vowels [1].
Vowel production by hearing-impaired children contains certain types of articulatory errors such as diphthongation, substitutions and neutralization, and suprasegmental errors such as nasalization and hoarseness
[15].
Cochlear implantation has become a standard procedure in the treatment of prelingually deaf children. Even
though these implants primarily facilitate speech perception, they are also an important aid to the development
of several aspects of speech production such as overall
intelligibility [6], suprasegmental features [7] and the
production of consonants [8] and vowels [9]. Serry and
Blamey [9] found that the production of vowels, and especially of monophthongs, improved after implantation.
Monophthongs were acquired earlier and more accurately than diphthongs and consonants, suggesting a relative
ease of production of monophthongs compared to the
other sound classes [9]. This difference between vowel
and consonant production was confirmed by Van Lierde
et al. [8], who found normal vowel production in prelingually deaf children with cochlear implants (CI), whereas
consonant production showed several deviations such as
distortions, substitutions and omissions. However, in the
study by Tobey et al. [10], the accuracy of phoneme pro-

Copyright 2010 S. Karger AG, Basel

2010 S. Karger AG, Basel


10217762/11/06330154$38.00/0
Fax +41 61 306 12 34
E-Mail karger@karger.ch
www.karger.com

Accessible online at:


www.karger.com/fpl

Nele Baudonck
UZ Gent 2P1, Dienst Logopedie
De Pintelaan 185
BE9000 Ghent (Belgium)
Tel. +32 9332 4462, Fax +32 9332 4993, E-Mail nele.baudonck @ ugent.be

duction in CI children was even lower for vowels (61.6%)


than for consonants (68%).
To describe the quality of vowel production, one can
apply either a subjective descriptive analysis such as phonetic transcription, or an objective acoustic analysis of
formant frequencies. The first two formants (F1 and F2)
are considered to be the most important because, based
on those two formants, a listener will be able to identify
a specific vowel [11]. Determination of F1 and F2 frequencies of vowels offers the possibility to describe vowels in
terms of high/low and front/back placement of the tongue
in the oral cavity. The vowels [a], [i] and [u] represent the
extreme articulatory positions of the tongue in English as
well as in Dutch [12]. Representing the formant frequencies of these vowels in an F1:F2 diagram yields a so-called
vowel triangle. This triangle is a graphic representation
of the articulation space for vowel production with [a], [i]
and [u] acting as corner vowels. In hearing-impaired patients, several abnormalities concerning formant frequencies and vowel space are described, such as centralization of the first two formants [13] and small articulation movements, which implies a reduction in articulation
space and vowel triangle size [2]. Yet, children with CI
experience show vowel features closer to normal values.
Uchanski and Geers [14] compared the second formant
frequencies of the American English anterior vowel [i]
and posterior vowel [$] of CI children with those of normal-hearing (NH) children and concluded that nearly all
CI children produced the vowels with F2 values within
normal limits (88 and 87% of the children, respectively,
for [i] and [$]). Also the CI children in the study by Campisi et al. [15] showed F1 [a] and F2 [a] values comparable
to those of NH children. Yet, in the study by Liker et al.
[16], the mean F1 [a] of the CI children was significantly
lower in comparison with NH controls at 2 of the 3 test
moments, indicating reduced movements of the jaw, resulting in a smaller vowel space. The CI children also
showed fronted vowel space due to consistently higher F 2
frequencies in comparison with the NH controls. The F2
frequencies were higher for the back vowels, indicating
that the vowel space in the CI children is, on average,
smaller in comparison with the controls. Liker et al. [16]
explained the fronting of the vowel space by the tendency
of therapists, family and the children themselves to move
the articulation to where it is more visible. HocevarBoltezar et al. [17] found a decrease in F1 of the Slovenian
vowels [u] and [i] in prelingually deaf children 6 months
after implantation. Those changes caused better phonological differentiation between both vowels and a postimplant vowel space expansion.

It seems that acoustic analysis can reveal more and different information on vowel production in hearing-impaired children than transcriptions can do. Acoustic
analyses of vowel formants may reveal more subtle distinctions which are not crossing the phoneme boundaries. In the study by Horga and Liker [18], CI children
approached the vowel space of NH children more than
profoundly deaf hearing aid (HA) children. The main
purpose of the present study was to compare the vowel
production of prelingually deaf CI children with moderately to profoundly hearing-impaired HA children who
had better hearing thresholds, and NH children. An
acoustical analysis of the three corner vowels [a], [i] and
[u] was made using the Praat software [19]. In a previous
study by Baudonck et al. [20] concerning consonant production, deaf CI children were also compared with moderately to profoundly deaf HA children. In this study, the
CI children performed better although the HA children
had better thresholds. Based on those results concerning
consonant production and the improved vowel production after implantation as described in other studies, the
authors of the present study hypothesize that vowel production by deaf CI children approaches the vowel production by NH children at least as much as the production by moderately to profoundly hearing-impaired HA
children does.

Vowel Production in Children with CI

Folia Phoniatr Logop 2011;63:154160

Subjects and Methods


The protocol was approved by the ethics committee of the University of Ghent (reference No.: 06017) and was in accordance
with the ethical standard stipulated in the Helsinki Declaration
for research involving human subjects.
Subjects
Seventy-four prelingually hearing-impaired children, all enrolled in Flemish oral/aural rehabilitation programs before the
age of 3 years, were selected to participate in this study. They all
suffered from nonsyndromal congenital hearing loss, and each
child received its first HA before the age of 3 years. A minimal
nonverbal intelligence score of 80 and use of the Dutch oral communication mode was required. Forty prelingually deaf children
[mean age: 8;8 years (years;months)] received a multichannel CI
at an average age of 2;8 years. Thirty-one of them were implanted
with the Nucleus implant (Cochlear Corporation), 5 with the Digisonic implant (Neurelec) and 4 with the Clarion implant (Advanced Bionics). Thirty-four children (mean age: 9;6 years) were
bilateral conventional HA users with a moderate-to-profound
hearing loss. All children had at least 2 years of experience with
their current device (HA or CI), which was fitted by experienced
audiologists. During testing, all devices were adjusted to each
childs usual amplification and processing settings. The control
group consisted of 42 NH children with a mean age of 9;3 years.

155

Table 1. Demographic information on participants in this study

NH children
HA children
CI children

Number

Chronological age
years

Age at deafness
months

Age at first HA
months

Unaided threshold
PTA dB HL

Aided threshold
PTA dB HL

Age at implantation, months

42
34
40

9;3 (4;315;3)
9;5 (4;114;2)
8;8 (4;215;5)

0 (00)
0 (010)

13 (236)
11 (136)

80 (58105)
109 (73120)

34 (1750)
33 (1150)

32 (6131)

Values are means with ranges in parentheses.

For the 3 subgroups, information concerning chronological age


and, where appropriate, age at first HA fitting, the most recent
better-ear unaided hearing threshold (pure tone audiometry,
PTA), the most recent free-field aided hearing threshold, and age
at implantation is provided in table 1.
A Mann-Whitney U test showed that mean chronological age,
duration of initial hearing loss and mean nonverbal intelligence
quotient of the CI and HA groups did not differ significantly (p 1
0.05). Regarding the audiometric data, recent better-ear unaided
thresholds were significantly better in both HA groups (p ! 0.001)
compared to the CI group, while the aided thresholds in the free
field condition showed no marked difference between the HA and
CI groups.

Recording Procedure
All recordings were made in a quiet room at the childrens
school or in the University Hospital Ghent. Speech samples were
elicited by means of a picture naming test [21] in which children
are asked to name black-and-white drawings of common objects
and actions in order to elicit instances of all Dutch single speech
sounds in all permissible syllable positions. Those speech samples
were recorded directly on a portable computer (Toshiba M70 with
Harman Kardon sound card), under standard conditions using a
condenser stereo microphone (Sony ECM-MS907). For the recording, the examiners used the Praat software [19] with a sampling frequency of 44,100 Hz.

Acoustic Analyses
For the 3 corner vowels [a], [i] and [u] of each child, 10 midvowel fragments with stable formant patterns were selected from
the same 10 monosyllabic words or stressed syllables of bisyllabic
words. The midvowel segments were selected using visual inspection of the oscillogram and the spectrogram. Fragments showing
the most stable formant patterns were identified, extracted without formant transitions, and regrouped into one comprehensive
sound fragment (mean total duration: 0.81 s), which was then submitted to the formant detection algorithm. The Burg algorithm
for formant detection was used with a 0.025-second gaussian
analysis window (effective duration) and +6 dB preemphasis from
50 Hz onwards. The formant search range was limited to 8,000 Hz
to adapt the algorithm to the dimensions of childrens vocal tracts.
For each vowel fragment of each child, a specific amount of linear
predictive coding coefficients was determined, based on visual
inspection of the spectrogram and spectrum, and on intrasubject
variability in formant values (the number of coefficients was cho-

156

Folia Phoniatr Logop 2011;63:154160

sen in such a manner that the formant SD of all analysis frames


were as low as possible). For further verification, the obtained formant values were compared with the formant values from English-speaking children of comparable ages, as described by Vorperian and Kent [22] as well as with formant values from Dutch
men as described by Pols [23]. In case of doubt, because of a salient
contrast with the values from the latter references (taking into account language and age differences) or because of high intrasubject variability, another set of 10 midvowel segments was selected and the whole procedure repeated in order to find a plausible formant value.
The 50th percentile value of the first (F1) and second formant
frequency (F2) as well as the intrasubject SD were measured for
each vowel of each child using the Praat software [19]. The euclidian distance between the corner vowels along the axes of an F1:F2
scatter plot as well as the surface area of the vowel triangle were
calculated. To guarantee a standardized protocol for all calculations, a Praat script (by P.C.) was systematically applied. Those
calculations were completed accurately by the first author (N.B.)
individually, consistently following the above-described procedure. As a control procedure, a remeasurement of formant values
was made by the last author (P.C.) for 8 randomly selected children (10%). For F1, the mean difference between the values by both
examiners was 20 Hz (range: 361 Hz). For F2, the mean difference between the values by both examiners was 58 Hz (range:
2101 Hz).

Statistical Analyses
SPSS for Windows (version 15.0) was used for the statistical
analysis. The results of the CI children were compared with the
results of the HA and NH children. The Kolmogorov-Smirnov
test ( = 0.01) and the Shapiro-Wilk test were performed to study
the distribution of the variables. The variables F2 [a], [i] and [u]
and intrasubject SD F1 and intrasubject SD F2 [a], [i] and [u] deviated from a normal distribution (p ! 0.05 on either the Kolmogorov-Smirnov or the Shapiro-Wilk test), whereas the remaining variables were normally distributed. For the comparisons between the 3 subgroups, a one-way ANOVA in combination with a
post hoc Scheff test was applied in case of normal distribution.
In case of a deviation from a normal distribution, Kruskal-Wallis
tests were executed to document possible differences between the
3 subgroups. When the obtained p was smaller than 0.05, pairwise
comparisons were executed using a Mann-Whitney procedure.
The significance level was set at = 0.05 in all tests.

Baudonck /Van Lierde /Dhooge /Corthals

Table 2. Formant frequencies, intrasubject SD of the formant frequencies, intervowel distances, vowel space of the acoustic analysis

and p of comparisons between 3 subgroups

F1 [a], Hz
Intrasubject SD (F1)
F2 [a], Hz
Intrasubject SD (F2)
F1 [i], Hz
Intrasubject SD (F1)
F2 [i], Hz
Intrasubject SD (F2)
F1 [u], Hz
Intrasubject SD (F1)
F2 [u], Hz
Intrasubject SD (F2)
Vowel space, kHz2
i-u
a-i
u-a

CI
(n = 40)

HA
(n = 34)

NH
(n = 42)

Kruskal-Wallis/ CI-NH
ANOVApost hoc
pp

HA-NH
post hoc
p

CI-HA
post hoc
p

9928156
127848
1,8338240
191867
400865
67857
3,0408249
212882
431875
65823
1,1478223
267891
5398153
1,8838289
5918157
5608147

9838150
116862
1,7718240
162878
401850
60825
2,9028227
199870
411866
59818
1,0388189
230874
5428165
1,8638333
5828146
5738123

9328161
97840
1,9338257
154851
422856
54815
3,0268242
175859
464858
58820.1
1,2148254
232883
4448200
1,8088351
5058158
4628155

0.182
0.024*
0.017*
0.034*
0.166
0.258
0.030*
0.062
0.003*
0.008*
0.004*
0.086
0.020*
0.488
0.023*
0.001*

0.026*
0.188
0.045*

0.253
0.019*
0.882

0.640
0.557
0.170

0.965

0.082

0.052

0.087
0.008*
0.403

0.003*
0.170
0.004*

0.426
0.537
0.122

0.054

0.055

0.996

0.043*
0.010*

0.095
0.005*

0.971
0.967

For each formant of each vowel, the mean intrasubject variability is given. For all mean values, the SD is given. * p < 0.05.

Results

Table 2 represents the mean formant frequencies, the


mean intrasubject SD of the formant frequencies, the
mean intervowel distances, the mean vowel space and the
p values of the comparisons between the 3 subgroups.
Concerning vowel [a], the CI children did not show significantly different formant values compared to the NH
children, while there was a significantly lower F2 in the
HA children compared to the NH children. The CI children, on the other hand, showed a slightly higher but significant intrasubject variability for both formants compared to the NH children, as shown by the higher SD. No
significant differences were detected between the CI and
the HA groups for vowel [a] parameters. For the vowel [i],
a scarcely significant lower F2 value was found for the HA
group compared to the CI group. No differences could be
found between the formants of the vowel [i] of CI and NH
children. Concerning the vowel [u], there were no statistically significant differences between both hearing-impaired groups. The HA children showed a significantly
lower F1 and F2 [u] than the NH children. In the CI group,
a higher intrasubject variability in the F1 [u] was found.
As seen in table 2, the hearing-impaired children systematically showed the highest values for all intervowel dis-

Vowel Production in Children with CI

tances /i-u/, /a-i/ and /u-a/ as well as for the vowel space,
whereas the NH children systematically had the lowest
values. In both hearing-impaired groups, a tendency toward an increased vowel space compared to NH children
was found. The /a-u/ difference between the NH children
and both hearing-impaired subgroups, and the /a-i/ difference between the CI and NH children were statistically significant, while no significant differences between
the HA and CI children were found. The vowel triangles
of the 3 subgroups are represented in figure 1.

Discussion

The main purpose of the present study was to compare


prelingually deaf CI children with moderately to profoundly hearing-impaired HA children and NH children
with regard to vowel production. An acoustical analysis
of the three corner vowels [a], [i] and [u] was made using
the Praat software. The hypothesis was that vowel production in CI children would be closer to normal than in
HA children. Generally speaking, both hearing-impaired
groups showed several significant differences when compared to the NH group. The significant effects in the CI
group all pertain to a higher intrasubject variability in

Folia Phoniatr Logop 2011;63:154160

157

Color version
available online

CI children
HA children
NH children

5,000

( OPEN) 1st
formant
(CLOSED )

1,000

script P.C.

( FRONT) 2nd formant (BACK )


1,500
3,500

3,000

2,500

2,000

1,500

1,000

500

Fig. 1. Vowel triangle in CI, HA and NH children.

formant values, whereas the significant effects in the HA


group all pertain to lower formant values.
The first remarkable formant differences were related
to the vowel [a]. Compared to NH children, the F2 [a] was
lower in the HA children. The CI children showed a higher intrasubject variability for both formants of the vowel
[a], as measured by SD, which hypothetically indicates
some articulatory vacillation in the production of [a] even
after implantation. However, based on the fact that the F2
values of the CI children in the present study resemble
normal values more than those of the HA children do,
one can conclude that cochlear implantation probably
has a subtly positive impact on the place of articulation of
[a]. In the study by Campisi et al. [15], the values of CI
children were compared with age-matched control data
[24]. In agreement with the present study, no differences
between CI and NH children were found for formant frequencies of [a].
Concerning the formants of the front vowel [i] and
dorsal vowel [u], the CI children in this study did not
show significant differences from their NH peers. This is
in agreement with Uchanski and Geers [14], who found
that nearly all of 181 CI patients produced the front vowel [i] and back vowel [$] with F2 values within normal
limits. On the other hand, for the HA children in the

158

Folia Phoniatr Logop 2011;63:154160

present study, both formants of the vowel [u] were decreased in comparison with normal values. Hypothetically, the decreased F1 [u] can be explained by the fact that
HA children usually show more residual hearing at low
frequencies. On that account, it seems that they seek to
produce the first formant, which is also the most intense
among formants, as low as possible in an attempt to enhance auditory feedback. In the CI children, the F1 [u]
was also lower compared to the NH children although
this difference was not significant. As was the case for [a],
CI children showed an increased intrasubject variability
in F1 [u], as measured by SD.
The decreased F2 [u] in the HA children can indicate
a tendency toward a more dorsal articulation of the vowel [u]. The production of the [u] turns out to be a potentially difficult speech parameter for hearing-impaired
children, especially for children using HA. Concerning
the front vowel [i], the F2 was slightly decreased in the HA
children in comparison with NH and CI children. This
trend was also seen for the vowels [a] and [u]. It seems to
support Boones theory that hearing-impaired children
tend to keep their tongues too far back in their mouths
[25]. Nevertheless, one should pay attention when considering only the means of values for F2 in the three subgroups in the present study. Although significantly lower
mean F2 results were found in the HA group, a huge overlap between the three subgroups cannot be denied when
looking at the range and SD. This means that although,
on average, the HA group shows decreased mean F2 values in comparison with the normal hearing controls,
many hearing-impaired children still perform within
normal ranges.
In the CI children, no significant differences were
found for F2 frequencies, thus backing or fronting of the
vowel space was not observed. Liker et al. [16], however,
found fronted vowel space in CI children due to consistently higher F2 frequencies. In their study, F2 frequencies
of back vowels were clearly increased, yielding vowel
space values for CI children that were, on average, smaller than in NH controls. This concomitant reduction in
vowel space is also in contrast with the results of the present study. The increase in F1 [a] values, although not significant, caused more salient /i-a/ and /u-a/ contrasts in
both hearing-impaired groups of the present study, in
comparison with the NH subjects. As a consequence, the
area of the vowel triangle tends to be larger in the CI as
well as in the HA groups. In some respect, these results
are rather surprising and contradictory to previous research in which a reduction in vowel triangle size was
found in hearing-impaired patients [13].

Baudonck /Van Lierde /Dhooge /Corthals

This contradiction with previous research partly may


have been brought about by language differences, but hypothetically, the phenomenon of an increased vowel
space could also be explained by a tendency of therapists
and family to exaggerate their articulation movements in
order to facilitate speech reading. Probably, hearing-impaired children imitate this trend and even use the exaggerated movements themselves in order to enhance proprioceptive feedback. Thus, these unexpected results can
be explained by the same simple rationale, i.e. excessive
articulation movements which hearing-impaired children probably use, imitating their models in order to improve visual and proprioceptive feedback. Indeed, since
neonatal hearing screening is well organized in Flanders,
rehabilitation typically starts at a very early age. Hearingimpaired children receive speech therapy from early
childhood on and are trained intensively to compensate
speech production deficits. Liker et al. [16] found a smaller vowel space for CI children in comparison with NH
controls. It is worth mentioning that the children in the
study by Huber et al. [24] started rehabilitation at a later
age (mean: 4;5 years; range: 1;107;8 years) than the participants in the present study (before the age of 3 years).
Hypothetically, early and intensive articulation training
in order to compensate speech production deficits could
have led to overarticulation in the hearing-impaired children of this study. Yet, overarticulation of vowels has no
harmful effect on speech intelligibility.
Besides processing spoken utterances in a purely linguistic way by extracting canonical categories such as
phoneme and word units, listeners simultaneously encode nonlinguistic perceptual characteristics [26]. Those
are audible deviations from the pronunciation standard
that do not necessarily interfere with a correct identification of speech sound categories or overall intelligibility.
For instance, the degree of fine-grained variation in synthesized speech is linked to both intelligibility and naturalness ratings [27]. The formant values and dispersions
in the speech of the CI and HA children of the present
study are possible candidates too. Thus, besides being
correlated with intelligibility, the observed subtle acoustic formant distinctions, some of which can remain undetected by the naked ear, may perhaps signal deficits in
naturalness of a childs speech. When it comes to vowel
production in early-rehabilitated hearing-impaired children, further research should pay more attention to
speech naturalness rather than to intelligibility.
The authors are aware that the variability in the several subgroups is great, and that the number of possibly
influencing factors is considerable. Multiple variables can

affect the speech performance of children. The age at onset of deafness, age at first hearing device, age at implantation, type of device and degree of hearing loss are
known variables in this study. In contrast, variables such
as the quality of an educational program, childrens and
parents self-efficacy beliefs [28], childrens motivation
[29] as well as other family, school and community factors
are unknown and are all factors which can influence
speech production. Since there was a considerable range
of age at implantation relative to age at time of testing in
this study, there was also a wide range of CI experience.
It would be very interesting to investigate the influence of
CI experience on the evolution of vowel formants. Yet, in
the present study, the subgroups were too small to compare reliably when children were regrouped on the basis
of a clear difference in months of CI experience. A substantial number of patients are needed to avoid variability and find significant differences. However, such a
number of patients are not available in Flanders. It should
also be noted that the CI group in Flanders and, as a
consequence, the participants in this study consists of
unilaterally as well as bilaterally implanted children. To
what extend bilateral implantation has an impact on the
speech production skills of prelingually deaf children is
a subject of further research.
In conclusion, we can state that, in this study, several
subtle deviations in the vowel production of prelingually
deaf children could be established using an objective
acoustic analysis. Children using HA showed a tendency
toward a more dorsal articulation of the vowels, which
was not seen in the CI children. Both hearing-impaired
groups showed a tendency toward overcompensation
while articulating, possibly following the example of parents and therapists and, perhaps, as a side effect of early
and intensive rehabilitation. This conclusion can be explained by a lack of auditory feedback and the search for
more proprioceptive feedback during articulatory maneuvers.

Vowel Production in Children with CI

Folia Phoniatr Logop 2011;63:154160

Acknowledgments
The authors wish to express their deep appreciation for the
hearing-impaired subjects who spent their time on this research.
We gratefully acknowledge the contribution of the speech and
language pathologists of the rehabilitation centers Sint-Lievenspoort Ghent, De Poolster Brussels and Overleie Kortrijk and the
schools Spermalie Bruges and Kids Hasselt. Thanks to Birgit Philips and Evelien DHaeseleer for their advice and help. N. Baudonck
is funded by the Research-Foundation Flanders.

159

References
1 Smith CR: Residual hearing and speech production in deaf children. J Speech Hear Res
1975;18:795811.
2 Angelocci AA, Kopp GA, Holbrook A: The
vowel formants of deaf and normal-hearing
eleven-to-fourteen-year-old boys. J Speech
Hear Disord 1964;29:156160.
3 Hudgins CV, Numbers GD: An investigation
of the intelligibility of the speech of the deaf.
Genet Psychol Monogr 1942;25:289392.
4 Markides A: The speech of deaf and partially-hearing children with special reference to
factors affecting intelligibility. Br J Disord
Commun 1970;5:126140.
5 Nober EH: Articulation of the deaf. Except
Child 1967;33:611621.
6 Allen MC, Nikolopoulos TP, ODonoghue
GM: Speech intelligibility in children after
cochlear implantation. Am J Otol 1998; 19:
742746.
7 Tye-Murray N, Spencer L, Woodworth GG:
Acquisition of speech by children who have
prolonged cochlear implant experience. J
Speech Hear Res 1995;38:327337.
8 van Lierde KM, Vinck BM, Baudonck N, de
Vel E, Dhooge I: Comparison of the overall
intelligibility, articulation, resonance, and
voice characteristics between children using
cochlear implants and those using bilateral
hearing aids: a pilot study. Int J Audiol 2005;
8:452465.
9 Serry TA, Blamey PJ: A 4-year investigation
into phonetic inventory development in
young cochlear implant users. J Speech Lang
Hear Res 1999;42:141154.

160

10 Tobey EA, Geers AE, Brenner C, Altuna D,


Gabbert G: Factors associated with development of speech production skills in children
implanted by age five. Ear Hear 2003; 24:
36S45S.
11 Steven KN: Articulatory-acoustic-auditory
relationships; in Hardcastle WJ, Laver J
(eds): The Handbook of Phonetic Sciences.
Oxford, Blackwell, 1999, pp 462506.
12 Pols LCW, van der Kamp LJT, Plomp R: Perceptual and physical space of vowel sounds.
J Acoust Soc Am 1969;46:458467.
13 Monsen R: Normal and reduced phonological space: the production of English vowels
by deaf adolescents. J Phon 1976;4:189198.
14 Uchanski RM, Geers AE: Acoustic characteristics of the speech of young cochlear implant users: a comparison with normal-hearing age mates. Ear Hear 2003;24:90S105S.
15 Campisi P, Low AJ, Papsin BC, Mount RJ,
Harrison RV: Multidimensional voice program analysis in profoundly deaf children:
quantifying frequency and amplitude control. Percept Mot Skills 2006;103:4050.
16 Liker M, Mildner V, Sindija B: Acoustic analysis of the speech of children with cochlear
implants: a longitudinal study. Clin Linguist
Phon 2007;21:111.
17 Hocevar-Boltezar I, Boltezar M, Zargi M:
The influence of cochlear implantation on
vowel articulation. Wien Klin Wochenschr
2008;120:228233.
18 Horga D, Liker M: Voice and pronunciation
of cochlear implant speakers. Clin Linguist
Phon 2006;20:211217.
19 Boersma P, Weenink D: Praat: doing phonetics by computer (version 5.1.05). http://www.
praat.org/ (accessed May 1, 2009).

Folia Phoniatr Logop 2011;63:154160

20 Baudonck N, Dhooge I, DHaeseleer E, van


Lierde K: A comparison of consonant productions between children using cochlear
implants or hearing aids. Int J Pediatr Otorhinolaryngol 2010;74:416421.
21 van Borsel J: Articulation in Downs syndrome adolescents and adults. Eur J Disord
Commun 1996;31:415444.
22 Vorperian HK, Kent RD: Vowel acoustic
space development in children: a synthesis of
acoustic and anatomic data. J Speech Lang
Hear Res 2007;50:15101545.
23 Pols LCW: Spectral Analysis and Identification of Dutch Vowels in Monosyllabic
Words. Amsterdam, VU University, 1977.
24 Huber JE, Stathopoulos ET, Curione GM,
Ash TA, Johnson K: Formants of children,
women, and men: the effects of vocal intensity variation. J Acoust Soc Am 1999; 106:
15321542.
25 Boone D: Modification of the voices of deaf
children. Volta Rev 1966;68:686692.
26 Nygaard LC: Perceptual integration of linguistic and non-linguistic properties of
speech; in Pisoni DB, Remez RE (eds): The
Handbook of Speech Perception. Oxford,
Blackwell, 2005, pp 391413.
27 Wouters J, Macon MW: Effects of prosodic
factors on spectral dynamics. 2. Synthesis. J
Acoust Soc Am 2002;111:428438.
28 Bandura A, Barbaranelli C, Caprara GV,
Pastorelli C: Multifaceted impact of self-efficacy beliefs on academic functioning. Child
Dev 1996;67:206222.
29 Eccles JS, Wigfield A, Schiefele U: Motivation to succeed; in Eisenberg N (ed): Handbook of Child Psychology. New York, Wiley,
1998, pp 10511075.

Baudonck /Van Lierde /Dhooge /Corthals

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.