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Background: Cochlear implant (CI) users are often described as having poorer music perception skills than peers with normal- hearing. Singing is an activity which relies on hearing one's own voice well to modulate the pitch and amplitude with accuracy. Musical appreciation and assessment is largely a subjective exercise. However, when critiquing a musical performance, a trained expert will be best placed to give valid subjective feedback which is based on experience and expertise. Objective: This study sought to quantify the strengths and challenges for singing by a small group of children who use CIs and assess their capacity to perceive deficits in their singing skills. Their ability to learn to modify their own singing production was also assessed. Material: A pilot choral program was developed through a collaboration between SCIC Cochlear Implant Program -- an RIDBC Service and Sydney Children's Choir to bring together experts CI services and children's choral training. A group of six children aged 8--10 yrs who use CIs volunteered for the two-day program. The participants had a variety of hearing loss and device configurations including bilateral CIs and one child with single-sided deafness with a CI. Methods: The children engaged in a series of choral activities including individual assessments with a professional conductor as well as choral singing. The choral singing activities initially involved the small group of CI users alone. The children were then integrated into an existing children's choir where they were paired with buddies who had typical hearing. Individual choristers, their buddies and the professional conductor all completed questionnaires and feedback forms to record various aspects of their experience. Audiological data for the children with CIs was reviewed to investigate any potential correlations with singing accuracy. Results: Subjective Assessment of Singing Ability -- Vocal pitch matching was identified as the area of greatest challenge for the subjects with 67% of the group identified as having signifi- cantly poorer vocal intonation than would be seen in children with typical hearing who volunteer for a choral program. Two of the six participants had difficulty in modulating their voice to the correct range to sing higher notes. Overall, the children performed most accurately on rhythm tasks with the conductor rating 67% as performing in line with typically-hearing choristers of the same age. Reading skills impacted on at least one child's performance. Some improvements in vocal intonation were noted over the course of the training sessions. Audiological Correlations -- Hearing device configuration and residual hearing was not noted as significantly correlating to the subjects' singing accuracy in this pilot study. Conclusions: The children with cochlear implants in this group were most successful at matching rhythm and least successful at matching vocal pitch. However, some showed improvements in the course of the workshops. Audiological profile did not correlate significantly with their success at singing tasks. [ABSTRACT FROM AUTHOR]

Objectives: Hearing loss and ASD can both affect an individual's communication abilities. Factors associated with ASD may have an impact on the clinical management of cochlear implant users. Literature describes that individuals with autism spectrum disorder (ASD) may be less inclined to engage with other children and adults in typical social interactions with the result that they may be less interested in typical play and social/positive reinforcement used to teach a desired behaviour. There are also documented sensory stimulation tolerance issues associated with ASD. Changes in routine have also been shown to be poorly tolerated by some individuals with ASD. For a cohort of cochlear implant (CI) users who have also been diagnosed with ASD, typical assessment techniques and mapping parameters may require modification. This study reviews the clinical practices and audiometric and speech perception results of individuals with ASD who use cochlear implants. Material: A retrospective review of case records and assessment results was conducted for the cohort of CI recipients with ASD from an Australian CI clinic. A range of aetiologies and ages were represented. Methods: Map information and case notes were reviewed along with formal and informal interviews with parents and teachers for some paediatric members of the group. Results from formal testing in the clinic and from observations made when visiting the children in their educational settings were also incorporated in the retrospective analysis. Results: The CI recipients with ASD have been observed to not always tolerate maps with typical or default current levels, program settings or dynamic ranges. Lower map levels or reduced dynamic ranges were at times required. Tactile defensive behaviour related to ASD meant that some subjects did not tolerate wearing their sound processors in the standard configuration. Behavioural therapists and/or desensitization techniques were required to reintroduce sound processor use when it was interrupted for some individuals. Standard audiological tests often produced limited results for the group. Clinical case notes recorded for the subjects describe the challenges in using standard behavioural play-based or functional testing methods. An additional clinician was often needed to assist during testing. Discussions with education professionals working with these children showed that teachers may assume that either the hearing loss or ASD in isolation is contributing to a lack of speech and language development. A child's lack of typical responsiveness to speech directed at them may mean that teachers or others have little faith that the CI technology is working. Conclusions: Flexible approaches are often required when working with CI users who have ASD and will vary with how severe the autistic characteristics may be for an individual. The audiologist needs to be wary of potential for over stimulation and device rejection. Overall, a multidisciplinary team approach is needed to best support these patients and close communication with educators and other professionals can help in optimising case management. [ABSTRACT FROM AUTHOR]