Do subjective voice handicap and vocal tract discomfort change within the first year of cochlear implant use?
Abstract
Objectives
Hearing impairment can lead to changes in phonation and articulation. However, so far there are studies showing that this does not necessarily lead to a voice disorder. The change in hearing induced by cochlear implant (CI) is well established, whereas the effects on voice from the patient perspective have not been frequently assessed. Therefore, the main aim of this study was to examine subjective voice handicap and vocal tract discomfort in CI recipients and the relation with improvement in speech comprehension within their first year of CI use. Further, the influence of gender, vocal hygiene, voice usage and voice therapy was investigated.
Study Design
Prospective longitudinal study.
Methods
83 adults (43 female and 40 male) between 24 and 82 years of age, who received a cochlear implant (CI) were investigated at first fitting (FF), at 3 months and at 12 months after FF. Voice-related subjective symptoms were assessed with the Vocal Tract Discomfort Scale (VTD), the internationally validated nine-item Voice Handicap Index (VHI-9i) and a self-developed questionnaire evaluating data regarding voice usage and hygiene, prior therapy and other influence factors like gender. Speech comprehension with the CI was assessed via Freiburger Speech Intelligibility Test (FBM) using monosyllables in a quiet environment. Subjective hearing abilities were assessed via the Speech, Spatial and Qualities of Hearing Scale (SSQ12) questionnaire. Descriptive statistics as well as One-Way Analysis of Variance (ANOVA) for Repeated Measures with Bonferroni correction comparisons over the three intervals for the two voice-related measures (VTD and VHI -9i) and for the two speech comprehension tests Spatial and Qualities of Hearing Scale (SSQ12 and monosyllables) were conducted. T-tests for vocal hygiene aspects and gender were performed for group comparisons. Further, the relation between voice-related measures and speech comprehension tests was assessed with Pearson’s correlation coefficient.
Results
VTD Scale and VHI-9i results were on average under the cut-off score (14 % on average above cut-off in VTD Scale and 7.6 % in VHI-9i) and did not change significantly over time (VTD Scale mean = 11.57, SD = 12.37 at FF and mean = 11, SD = 12.6 at 12 months, VHI-9i mean 5.87, SD = 5.733 at FF and mean = 6.14, SD = 5.93 at 12 months). The number of correct monosyllables (mean = 57.5, SD = 22.8 to 67.1, SD = 22) and SSQ12 scores (mean = 3.5, SD = 1.9 to mean = 4.4, SD = 1.9) improved significantly within the first year of CI use. Gender had an impact on VTD Scale and VHI-9i scores: women scored significantly higher than men. There was a weak correlation for VTD Scale at FF (r = –.220, p < .05) and 3M (r = –.263, p < .05). and for VHI-9i at 3M (r =-.39, p <.001) and 12M (r = -.285, p <.001). In the group of non-vocal professionals, the difference in VTD Scale score from FF to 12M was significant (p = .021), with the mean decreasing from 11.29 (SD = 13.46) points to 7.53 (SD = 11.9). VHI-9i scores stayed the same over all three time points in this group.
Conclusion
In the present study of adult CI users up to 82 years, there were no subjective voice symptoms although speech comprehension did change significantly. Thus, the assumption, that people with CI more often suffer from a voice disorder could not be proved by this study.
© 2026 Julia Lukaschyk, Mareike Billinger-Finke, Angelika Illg, published by Hochschule für angewandte Wissenschaft und Kunst, Hildesheim/Holzminden/Göttingen
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.