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Updated: Jul 12, 2025
Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages
Published on: March 24, 2023
Ceiling effects for speech perception tests in pediatric cochlear implant users
Emily R Spitzer1, David M Landsberger1, Alexandra J Lichtl1
1Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA.
Insights
Speech perception tests for children with cochlear implants (CI) often show ceiling effects, meaning they may not accurately measure a child's true listening abilities. Early implantation and bilateral devices are linked to higher scores.
Area of Science:
- Audiology
- Pediatric audiology
- Speech-language pathology
Background:
- Cochlear implants (CI) are vital for hearing restoration in children.
- Accurate assessment of speech perception is crucial for monitoring CI effectiveness.
- Ceiling effects in testing can limit the evaluation of high-level performance.
Purpose of the Study:
- To determine the prevalence of ceiling effects in speech perception tests for pediatric cochlear implant (CI) users.
- To identify demographic predictors of ceiling effect achievement in this population.
Main Methods:
- Retrospective chart review of 165 children who received a cochlear implant (CI) before age four.
- Analysis of speech perception test scores and demographic data.
Main Results:
- The majority of speech perception tests exhibited ceiling effects (scores ≥90% correct).
- Earlier implantation, bilateral CI use, and being an oral communicator predicted higher performance.
- Age and CI experience were negatively correlated with performance, indicating potential test non-randomization.
Conclusions:
- Common speech perception tests may overestimate the abilities of children with CIs due to prevalent ceiling effects.
- These tests might not fully capture real-world listening performance in advanced CI users.
Objectives:
The purpose of this study was to determine the prevalence of ceiling effects for commonly used speech perception tests in a large population of children who received a cochlear implant (CI) before the age of four. A secondary goal was to determine the demographic factors that were relevant for predicting which children were more likely to reach ceiling level performance. We hypothesize that ceiling effects are highly prevalent for most tests.
Design:
Retrospective chart review of children receiving a CI between 2002 and 2014.
Results:
165 children were included. Median scores were above ceiling levels (≥90% correct) for the majority of speech perception tests and all distributions of scores were highly skewed. Children who were implanted earlier, received two implants, and were oral communicators were more likely to reach ceiling-level performance. Age and years of CI listening experience at time of test were negatively correlated with performance, suggesting a non-random assignment of tests. Many children were re-tested on tests for which they had already scored at ceiling.
Conclusions:
Commonly used speech perception tests for children with CIs are prone to ceiling effects and may not accurately reflect how a child performs in everyday listening situations.
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