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Original Paper
Folia Phoniatr Logop 2011;63:154160
DOI: 10.1159/000318879
A Comparison of Vowel Productions in Prelingually
Deaf Children Using Cochlear Implants, Severe
Hearing-Impaired Children Using Conventional
Hearing Aids and Normal-Hearing Children

Department of Otorhinolaryngology, Audiologic and Logopaedic Sciences, Ghent University, and

Health Care Department, University College Ghent, Ghent , Belgium
Speech in prelingually deaf children is characterized
by deficits in articulation of consonants and vowels [1] .
Vowel production by hearing-impaired children con-
tains certain types of articulatory errors such as diph-
thongation, substitutions and neutralization, and supra-
segmental errors such as nasalization and hoarseness
[15] .
Cochlear implantation has become a standard proce-
dure in the treatment of prelingually deaf children. Even
though these implants primarily facilitate speech percep-
tion, 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 es-
pecially of monophthongs, improved after implantation.
Monophthongs were acquired earlier and more accurate-
ly 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 prelin-
gually 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-
Key Words
Vowel production Deafness, prelingual Children
Cochlear implants
Objective: The purpose of this study was to compare vowel
productions by deaf cochlear implant (CI) children, hearing-
impaired 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
and the intrasubject SD were measured using the Praat
software. Spectral separation between these vowel for-
mants and vowel space were calculated. Results: The sig-
nificant effects in the CI group all pertain to a higher intra-
subject 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 to-
ward greater intervowel distances and vowel space. Conclu-
sion: 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 chil-
dren as well as HA children in this study tended to overar-
ticulate, which hypothetically can be explained by a lack of
auditory feedback and an attempt to compensate it by pro-
prioceptive feedback during articulatory maneuvers.
Copyright 2010 S. Karger AG, Basel
Published online: October 8, 2010
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 @
2010 S. Karger AG, Basel
Accessible online at:
Vowel Production in Children with CI Folia Phoniatr Logop 2011;63:154160 155
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 pho-
netic transcription, or an objective acoustic analysis of
formant frequencies. The first two formants (F
and F
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 F
and F
cies 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 frequen-
cies of these vowels in an F
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 pa-
tients, several abnormalities concerning formant fre-
quencies and vowel space are described, such as central-
ization of the first two formants [13] and small articula-
tion 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 [$] of CI children with those of nor-
mal-hearing (NH) children and concluded that nearly all
CI children produced the vowels with F
values within
normal limits (88 and 87% of the children, respectively,
for [i] and [$]). Also the CI children in the study by Cam-
pisi et al. [15] showed F
[a] and F
[a] values comparable
to those of NH children. Yet, in the study by Liker et al.
[16] , the mean F
[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, re-
sulting in a smaller vowel space. The CI children also
showed fronted vowel space due to consistently higher F

frequencies in comparison with the NH controls. The F

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. Hocevar-
Boltezar et al. [17] found a decrease in F
of the Slovenian
vowels [u] and [i] in prelingually deaf children 6 months
after implantation. Those changes caused better phono-
logical differentiation between both vowels and a postim-
plant vowel space expansion.
It seems that acoustic analysis can reveal more and dif-
ferent information on vowel production in hearing-im-
paired children than transcriptions can do. Acoustic
analyses of vowel formants may reveal more subtle dis-
tinctions which are not crossing the phoneme bound-
aries. 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 moder-
ately 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 pro-
duction, deaf CI children were also compared with mod-
erately 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 produc-
tion after implantation as described in other studies, the
authors of the present study hypothesize that vowel pro-
duction by deaf CI children approaches the vowel pro-
duction by NH children at least as much as the produc-
tion by moderately to profoundly hearing-impaired HA
children does.
Subjects and Methods
The protocol was approved by the ethics committee of the Uni-
versity of Ghent (reference No.: 06017) and was in accordance
with the ethical standard stipulated in the Helsinki Declaration
for research involving human subjects.
Seventy-four prelingually hearing-impaired children, all en-
rolled 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 com-
munication 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 Di-
gisonic implant (Neurelec) and 4 with the Clarion implant (Ad-
vanced 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.
Baudonck /VanLierde /Dhooge /Corthals Folia Phoniatr Logop 2011;63:154160 156
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 table1 .
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 re-
cording, the examiners used the Praat software [19] with a sam-
pling frequency of 44,100 Hz.
Acoustic Analyses
For the 3 corner vowels [a], [i] and [u] of each child, 10 mid-
vowel 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 inspec-
tion of the oscillogram and the spectrogram. Fragments showing
the most stable formant patterns were identified, extracted with-
out formant transitions, and regrouped into one comprehensive
sound fragment (mean total duration: 0.81 s), which was then sub-
mitted 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-
sen in such a manner that the formant SD of all analysis frames
were as low as possible). For further verification, the obtained for-
mant values were compared with the formant values from Eng-
lish-speaking children of comparable ages, as described by Vor-
perian 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 ac-
count language and age differences) or because of high intra-
subject variability, another set of 10 midvowel segments was se-
lected and the whole procedure repeated in order to find a plau-
sible formant value.
The 50th percentile value of the first (F
) and second formant
frequency (F
) as well as the intrasubject SD were measured for
each vowel of each child using the Praat software [19] . The euclid-
ian distance between the corner vowels along the axes of an F

scatter plot as well as the surface area of the vowel triangle were
calculated. To guarantee a standardized protocol for all calcula-
tions, 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 proce-
dure. As a control procedure, a remeasurement of formant values
was made by the last author (P.C.) for 8 randomly selected chil-
dren (10%). For F
, the mean difference between the values by both
examiners was 20 Hz (range: 361 Hz). For F
, the mean differ-
ence 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 F
[a], [i] and [u]
and intrasubject SD F
and intrasubject SD F
[a], [i] and [u] de-
viated from a normal distribution (p ! 0.05 on either the Kol-
mogorov-Smirnov or the Shapiro-Wilk test), whereas the remain-
ing variables were normally distributed. For the comparisons be-
tween 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.
Table 1. Demographic information on participants in this study
Number Chronological age
Age at deafness
Age at first HA
Unaided threshold
Aided threshold
Age at implan-
tation, months
NH children 42 9;3 (4;315;3)
HA children 34 9;5 (4;114;2) 0 (00) 13 (236) 80 (58105) 34 (1750)
CI children 40 8;8 (4;215;5) 0 (010) 11 (136) 109 (73120) 33 (1150) 32 (6131)
V alues are means with ranges in parentheses.
Vowel Production in Children with CI Folia Phoniatr Logop 2011;63:154160 157
Table2 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 sig-
nificantly different formant values compared to the NH
children, while there was a significantly lower F
in the
HA children compared to the NH children. The CI chil-
dren, on the other hand, showed a slightly higher but sig-
nificant intrasubject variability for both formants com-
pared 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 F
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 statisti-
cally significant differences between both hearing-im-
paired groups. The HA children showed a significantly
lower F
and F
[u] than the NH children. In the CI group,
a higher intrasubject variability in the F
[u] was found.
As seen in table2 , the hearing-impaired children system-
atically showed the highest values for all intervowel dis-
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 to-
ward 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/ dif-
ference between the CI and NH children were statisti-
cally 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 .
The main purpose of the present study was to compare
prelingually deaf CI children with moderately to pro-
foundly 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 pro-
duction in CI children would be closer to normal than in
HA children. Generally speaking, both hearing-impaired
groups showed several significant differences when com-
pared to the NH group. The significant effects in the CI
group all pertain to a higher intrasubject variability in
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
(n = 40)
(n = 34)
(n = 42)
post hoc
post hoc
post hoc
p p p p
[a], Hz 9928156 9838150 9328161 0.182
Intrasubject SD (F
) 127848 116862 97840 0.024* 0.026* 0.253 0.640
[a], Hz 1,8338240 1,7718240 1,9338257 0.017* 0.188 0.019* 0.557
Intrasubject SD (F
) 191867 162878 154851 0.034* 0.045* 0.882 0.170
[i], Hz 400865 401850 422856 0.166
Intrasubject SD (F
) 67857 60825 54815 0.258
[i], Hz 3,0408249 2,9028227 3,0268242 0.030* 0.965 0.082 0.052
Intrasubject SD (F
) 212882 199870 175859 0.062
[u], Hz 431875 411866 464858 0.003* 0.087 0.003* 0.426
Intrasubject SD (F
) 65823 59818 58820.1 0.008* 0.008* 0.170 0.537
[u], Hz 1,1478223 1,0388189 1,2148254 0.004* 0.403 0.004* 0.122
Intrasubject SD (F
) 267891 230874 232883 0.086
Vowel space, kHz
5398153 5428165 4448200 0.020* 0.054 0.055 0.996
i-u 1,8838289 1,8638333 1,8088351 0.488
a-i 5918157 5828146 5058158 0.023* 0.043* 0.095 0.971
u-a 5608147 5738123 4628155 0.001* 0.010* 0.005* 0.967
F or each formant of each vowel, the mean intrasubject variability is given. For all mean values, the SD is given. * p < 0.05.
Baudonck /VanLierde /Dhooge /Corthals Folia Phoniatr Logop 2011;63:154160 158
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 F
[a] was
lower in the HA children. The CI children showed a high-
er 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 F

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 fre-
quencies 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 vow-
el [i] and back vowel [$] with F
values within normal
limits. On the other hand, for the HA children in the
present study, both formants of the vowel [u] were de-
creased in comparison with normal values. Hypotheti-
cally, the decreased F
[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 en-
hance auditory feedback. In the CI children, the F
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 F
[u], as measured by SD.
The decreased F
[u] in the HA children can indicate
a tendency toward a more dorsal articulation of the vow-
el [u]. The production of the [u] turns out to be a poten-
tially difficult speech parameter for hearing-impaired
children, especially for children using HA. Concerning
the front vowel [i], the F
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 consid-
ering only the means of values for F
in the three sub-
groups in the present study. Although significantly lower
mean F
results were found in the HA group, a huge over-
lap 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 F
ues 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 F
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 consis-
tently higher F
frequencies. In their study, F
of back vowels were clearly increased, yielding vowel
space values for CI children that were, on average, small-
er than in NH controls. This concomitant reduction in
vowel space is also in contrast with the results of the pres-
ent study. The increase in F
[a] values, although not sig-
nificant, 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 re-
search in which a reduction in vowel triangle size was
found in hearing-impaired patients [13] .
3,000 2,500 2,000 1,500 1,000 500
( FRONT) 2nd formant (BACK )
CI children
HA children
NH children



Fig. 1. Vowel triangle in CI, HA and NH children.
Vowel Production in Children with CI Folia Phoniatr Logop 2011;63:154160 159
This contradiction with previous research partly may
have been brought about by language differences, but hy-
pothetically, 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-im-
paired children imitate this trend and even use the exag-
gerated movements themselves in order to enhance pro-
prioceptive feedback. Thus, these unexpected results can
be explained by the same simple rationale, i.e. excessive
articulation movements which hearing-impaired chil-
dren probably use, imitating their models in order to im-
prove visual and proprioceptive feedback. Indeed, since
neonatal hearing screening is well organized in Flanders,
rehabilitation typically starts at a very early age. Hearing-
impaired children receive speech therapy from early
childhood on and are trained intensively to compensate
speech production deficits. Liker et al. [16] found a small-
er 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 par-
ticipants 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 chil-
dren of this study. Yet, overarticulation of vowels has no
harmful effect on speech intelligibility.
Besides processing spoken utterances in a purely lin-
guistic way by extracting canonical categories such as
phoneme and word units, listeners simultaneously en-
code nonlinguistic perceptual characteristics [26] . Those
are audible deviations from the pronunciation standard
that do not necessarily interfere with a correct identifica-
tion of speech sound categories or overall intelligibility.
For instance, the degree of fine-grained variation in syn-
thesized speech is linked to both intelligibility and natu-
ralness 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 acous-
tic formant distinctions, some of which can remain un-
detected 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 chil-
dren, further research should pay more attention to
speech naturalness rather than to intelligibility.
The authors are aware that the variability in the sev-
eral 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 on-
set of deafness, age at first hearing device, age at implan-
tation, 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 com-
pare reliably when children were regrouped on the basis
of a clear difference in months of CI experience. A sub-
stantial number of patients are needed to avoid variabil-
ity 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 par-
ents and therapists and, perhaps, as a side effect of early
and intensive rehabilitation. This conclusion can be ex-
plained by a lack of auditory feedback and the search for
more proprioceptive feedback during articulatory ma-
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-Lieven-
spoort Ghent, De Poolster Brussels and Overleie Kortrijk and the
schools Spermalie Bruges and Kids Hasselt. Thanks to Birgit Phil-
ips and Evelien DHaeseleer for their advice and help. N. Baudonck
is funded by the Research-Foundation Flanders.
Baudonck /VanLierde /Dhooge /Corthals Folia Phoniatr Logop 2011;63:154160 160
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