Incorporating ceiling effects during analysis of speech perception data from a paediatric cochlear implant cohort

Abstract

Objective: To compare speech perception between children with a different age at cochlear implantation. Design: 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. Study sample: 54 children implanted between 8 and 36 months. Results: 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. Conclusions: 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.

Key Words:

• Auditory perception
• child
• cochlear implantation
• cochlear implants
• hearing disorders
• hearing loss
• sensorineural hearing loss
• retrospective studies
• speech audiometry
• speech perception

Acknowledgements

We thank A. Bezdjian, MSc, for reviewing the language and grammar of the manuscript.

In addition, we thank the CI revalidation team of the UMC Utrecht for data collection.

Declaration of interest

The authors report no declarations of interest.

Funding

Wilko Grolman received unrestricted grants from Cochlear, MED-EL and Advanced Bionics under formal legal hospital contract. None of the other authors receives any funding.