"Do You Hear What I Hear?" Speech and Voice Alterations in Hearing Loss: A Systematic Review

Background: Although hearing loss influences voice characteristics, such changes may be under-recognized during clinical consultations. This systematic review examines voice alterations in adults with post-lingual hearing loss, considering diagnostic and rehabilitative implications. Methods: A comprehensive search of PubMed, Scopus, and Google Scholar was conducted following PRISMA guidelines, targeting studies reporting quantitative data on vocal parameters in adults with sensorineural hearing loss. Exclusion criteria included pre-lingual hearing loss and non-English studies. Data extraction focused on pitch, loudness, and prosody, with study quality assessed using NIH tools. Results: Eleven case-control studies, involving 594 patients with sensorineural hearing loss and 326 control patients, were analyzed. Patients with untreated hearing loss exhibited elevated fundamental frequency, F₀ (males: 158-169 Hz; females: 206-251 Hz) and loudness levels (males: 79-96 dB; females: 89-116 dB) compared to controls (F₀-males: 75-150 Hz; females: 150-300 Hz; loudness-males: 30-70 dB; females: 40-68 dB). Alterations in jitter, shimmer, and maximum phonation time (MPT) contributed to the distinct "hearing loss voice". Cochlear implants (CIs) and hearing aids improved vocal parameters, with CIs reducing F₀ by approximately 12-15 Hz. Continuous hearing aid use normalized pitch and loudness within four months. Prosody alterations, such as monotone speech, were reported in long-term cases. In noisy environments, individuals with hearing loss exhibited exaggerated increases in pitch and loudness, indicative of compensatory mechanisms. Conclusions: Post-lingual hearing loss disrupts the central regulation of voice, altering pitch, loudness, and other vocal parameters. Recognizing these changes, particularly in noisy environments, could facilitate the early diagnosis and timely rehabilitation of hearing deficits, potentially mitigating associated risks of cognitive decline.