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Developmental, Audiological, and Speech Perception Functioning in Children After Cochlear Implant Surgery: A Reply

Developmental, Audiological, and Speech Perception Functioning in Children After Cochlear Implant... As more children receive and use cochlear implants in this country, more research becomes available regarding improvements in speech, language, and development. One such study by Pulsifer et al1 entitled "Developmental, Audiological, and Speech Perception Functioning in Children After Cochlear Implant Surgery" appeared in the June issue of ARCHIVES. We applaud the authors' use of functional performance measures, such as nonverbal IQ testing and open-set speech recognition. However, we question the use of parametric statistics in the "speech perception" category of evaluation. Speech perception is critical regarding cochlear implant outcomes, given the importance that parents and society place on the ability to communicate.2 According to the study, "test results were converted . . . to a speech perception category score ranging from 1 (the lowest level of simple detection) to 6 (consistent open-set recognition, for which the listener verbally responds accurately to a question without first being presented with possible responses)."1(p553) Speech perception increased from the lowest score to the highest but not by a fixed interval. Therefore, these data are ordinal and require nonparametric statistics for analysis.2 The authors, however, used means and standard deviations to describe these data and paired t tests to compare the 2 groups. It is inappropriate to use parametric tests on nonparametric data.3 In the article, the authors directly referenced a previous study describing speech recognition scales, which recognized this fact. That study, a speech perception meta-analysis of children with cochlear implants, stated that the scale was ordinal and therefore required nonparametric testing: This conversion . . . introduced statistical constraints so that parametric testing could not be applied. Therefore, the ordinal data were compared by the nonparametric Wilcoxon test statistic. The disadvantage to this nonparametric analysis is that there is less statistical power when differences between subject groups are found.4(pp125,126) It is therefore impossible, given the incompatibility between the type of data and the testing methods used, to state that there is a significant improvement in speech perception postimplantation in this study. The authors may want to consider using a more suitable test such as the Wilcoxon rank sum test or the Mann-Whitney U3 test in order to determine the statistical significance of their findings. Corresponding author and reprints: Rachel St John, MD, Kids Clinic for the Deaf, Georgetown University Medical Center, 3800 Reservoir Rd, 2 PHC, Washington, DC 20007 (e-mail: stjohnmd@hotmail.com). References 1. Pulsifer MBSalorio CFNiparko JK Developmental, audiological, and speech perception functioning in children after cochlear implant surgery. Arch Pediatr Adolesc Med. 2003;157552- 558PubMedGoogle ScholarCrossref 2. Spencer LJBarker BATomblin JB Exploring the language and literacy outcomes of pediatric cochlear implant users. Ear Hear. 2003;24236- 247PubMedGoogle ScholarCrossref 3. Runyon RPHaber A Fundamentals of Behavioral Statistics. Reading, Mass Addison-Wesley Publishing Co1968; 4. Cheng AKGrant GDNiparko JK Meta-analysis of pediatric cochlear implant literature. Ann Otol Rhinol Laryngol Suppl. 1999;177124- 128PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Developmental, Audiological, and Speech Perception Functioning in Children After Cochlear Implant Surgery: A Reply

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Developmental, Audiological, and Speech Perception Functioning in Children After Cochlear Implant Surgery: A Reply

Abstract

As more children receive and use cochlear implants in this country, more research becomes available regarding improvements in speech, language, and development. One such study by Pulsifer et al1 entitled "Developmental, Audiological, and Speech Perception Functioning in Children After Cochlear Implant Surgery" appeared in the June issue of ARCHIVES. We applaud the authors' use of functional performance measures, such as nonverbal IQ testing and open-set speech recognition....
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Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.158.4.401-a
Publisher site
See Article on Publisher Site

Abstract

As more children receive and use cochlear implants in this country, more research becomes available regarding improvements in speech, language, and development. One such study by Pulsifer et al1 entitled "Developmental, Audiological, and Speech Perception Functioning in Children After Cochlear Implant Surgery" appeared in the June issue of ARCHIVES. We applaud the authors' use of functional performance measures, such as nonverbal IQ testing and open-set speech recognition. However, we question the use of parametric statistics in the "speech perception" category of evaluation. Speech perception is critical regarding cochlear implant outcomes, given the importance that parents and society place on the ability to communicate.2 According to the study, "test results were converted . . . to a speech perception category score ranging from 1 (the lowest level of simple detection) to 6 (consistent open-set recognition, for which the listener verbally responds accurately to a question without first being presented with possible responses)."1(p553) Speech perception increased from the lowest score to the highest but not by a fixed interval. Therefore, these data are ordinal and require nonparametric statistics for analysis.2 The authors, however, used means and standard deviations to describe these data and paired t tests to compare the 2 groups. It is inappropriate to use parametric tests on nonparametric data.3 In the article, the authors directly referenced a previous study describing speech recognition scales, which recognized this fact. That study, a speech perception meta-analysis of children with cochlear implants, stated that the scale was ordinal and therefore required nonparametric testing: This conversion . . . introduced statistical constraints so that parametric testing could not be applied. Therefore, the ordinal data were compared by the nonparametric Wilcoxon test statistic. The disadvantage to this nonparametric analysis is that there is less statistical power when differences between subject groups are found.4(pp125,126) It is therefore impossible, given the incompatibility between the type of data and the testing methods used, to state that there is a significant improvement in speech perception postimplantation in this study. The authors may want to consider using a more suitable test such as the Wilcoxon rank sum test or the Mann-Whitney U3 test in order to determine the statistical significance of their findings. Corresponding author and reprints: Rachel St John, MD, Kids Clinic for the Deaf, Georgetown University Medical Center, 3800 Reservoir Rd, 2 PHC, Washington, DC 20007 (e-mail: stjohnmd@hotmail.com). References 1. Pulsifer MBSalorio CFNiparko JK Developmental, audiological, and speech perception functioning in children after cochlear implant surgery. Arch Pediatr Adolesc Med. 2003;157552- 558PubMedGoogle ScholarCrossref 2. Spencer LJBarker BATomblin JB Exploring the language and literacy outcomes of pediatric cochlear implant users. Ear Hear. 2003;24236- 247PubMedGoogle ScholarCrossref 3. Runyon RPHaber A Fundamentals of Behavioral Statistics. Reading, Mass Addison-Wesley Publishing Co1968; 4. Cheng AKGrant GDNiparko JK Meta-analysis of pediatric cochlear implant literature. Ann Otol Rhinol Laryngol Suppl. 1999;177124- 128PubMedGoogle Scholar

Journal

Archives of Pediatrics & Adolescent Medicine – American Medical Association

Published: Apr 1, 2004

Keywords: child,cochlear implantation,speech perception

References

  • Developmental, audiological, and speech perception functioning in children after cochlear implant surgery.
    Niparko JK; Arch Pediatr Adolesc Med.
  • Exploring the language and literacy outcomes of pediatric cochlear implant users.
    Tomblin JB; Ear Hear.
  • Fundamentals of Behavioral Statistics.
    Haber A
  • Meta-analysis of pediatric cochlear implant literature.
    Niparko JK; Ann Otol Rhinol Laryngol Suppl.