In this clinical assignment, a patient is a 40-year-old man with congenital severe-to-profound hearing loss who has a cochlear implant in one ear (during the last six months) and a hearing aid in another ear. His medical history includes using binaural hearing aids to yield aided thresholds in the moderate hearing loss range. Periodic tests for patients with cochlear implants and hearing aids should be taken bimodally and individually to enhance adjustment when necessary (Warren & Dunbar, 2018). With time, the client’s intelligibility has been significantly affected, requiring speech therapy. Additional acoustic and kinematic measures are required to assess his speech production and define the most appropriate treatment methods. Acoustic analysis focuses on vocal frequency, amplitude, and other physical characteristics of spoken language, while kinematic analysis addresses instrumental techniques for evaluating movement patterns (Ferrand, 2018). Auditory and kinematic feedback (control of F0, voice intensity, and quality) through electroglottography (EGG), electropalatography (EPG), and glossometry introduce the most useful types of measurements for the patient with hearing impairment and cochlear implantation at segmental and suprasegmental levels.
The client’s assessment and treatment depend on the information a clinician obtains from acoustic and kinematic analyses. Severe-to-profound hearing loss is one of the most challenging auditory problems as people are challenged by the inability to communicate due to inaudible conversational-level speech (Souza et al., 2018). Such speakers usually have vocal quality abnormalities, atypical F0 levels, and intensity variations (Ferrand, 2018). EGG is an indirect visualization method to define the necessary acoustic information about the patient’s jitter, shimmer, and harmonic-to-noise ratio (HNR) (Ferrand, 2018). EPG is a kinematic device to examine the location of the tongue and the palatometric contacts (Zin et al., 2021). This method is safe due to its non-invasive approach and the visualization possibility in real time. Glossometry is another way to visualize tongue positions and check the distance between the tongue and hard palate (Zin et al., 2021). This method allows patients to practice less centralized vowels and expand the use of the oral space (Ferrand, 2018). Other measurements like ultrasound, videokymography, and magnetic resonance imaging contribute to acoustic and kinematic analyses, but their application may not be appropriate for this particular patient.
I choose these measures because of the possibility of obtaining enough information about the patient’s condition, introducing the most effective therapy, and stabilizing his intelligibility as a bimodal listener. Intelligibility is based on correct, precise articulation and the ability to understand another person’s speech (Ferrand, 2018). It includes speech rate, utterance length, loudness, pitch, and voice quality, and its reduction provokes social devastation and the necessity of problem management (Ferrand, 2018). The awareness of articulatory movements contributes to producing correct sounds and accepting acoustic information. The combination of EPG, EGG, and glossometry helps people with severe-to-profound hearing loss and cochlear implantation. The information about tongue dynamics and vocal folds helps understand vital articulatory patterns and achieve the most significant purposes for the speaker with hearing impairment. It is expected to identify the current difficulties, improve his tongue position, and differentiate vowels.
In conclusion, acoustic and kinematic measures vary depending on the patient’s conditions, needs, and therapy expectations. They allow clinicians to evaluate and treat people with hearing impairment and cochlear implantation and identify their segmental errors like vowel problems or tongue movements and suprasegmental errors like F0 abnormalities or insufficient intensity levels. Compared to other measures, EPG, EGG, and glossometry introduce the most effective clinical combination to manage the patient’s hearing impairment and improve his intelligibility.
References
Ferrand, C. T. (2018). Speech science: An integrated approach to theory and clinical practice (4th ed.). Pearson.
Souza, P., Hoover, E., Blackburn, M., & Gallun, F. (2018). The characteristics of adults with severe hearing loss.Journal of the American Academy of Audiology, 29(8), 764-779. Web.
Warren, S. E., & Dunbar, M. N. (2018). Bimodal hearing in individuals with severe-to-profound hearing loss: Benefits, challenges, and management.Seminars in Hearing, 39(4), 405-413. Web.
Zin, S. M., Rasib, S. Z. M., Suhaimi, F. M., & Mariatti, M. (2021). The technology of tongue and hard palate contact detection: A review.Biomedical Engineering Online, 20(1). Web.