MENC: The National Association for Music Education

Music Education to Train Hearing Abilities in Children with Cochlear Implants

Author(s): James L. Reifinger Jr.
Source: Music Educators Journal , December 2018, Vol. 105, No. 2 (December 2018), pp. 57-
63
Published by: Sage Publications, Inc. on behalf of MENC: The National Association for
Music Education

Stable URL: https://www.jstor.org/stable/10.2307/26588694

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 by James L. Reifinger Jr.

Music Education to
Train Hearing Abilities in
Children with Cochlear
Implants
Abstract: Music education is being explored by researchers as a means of improving hearing
acuity for children with hearing loss, particularly those with cochlear implants. Music educa-
tors are uniquely positioned to contribute to this important endeavor. This article describes
normal and impaired hearing and how music perception is affected for students with cochlear
implants. Current research is discussed, and guidance is provided for planning and leading
music activities for students with cochlear implants.
Keywords: cochlear implants, hearing, impairment, music perception, research, special learners

M If you have one or

usic teachers working with several
hundred children a week may be
aware that a few students in their
classes have a hearing impairment, but
teachers may not be aware of how these
students experience music activities or what
important outcomes music education expe-
riences could have for them. Experiences
with music have been shown to help in the
development of general auditory skills that
are also used in speech perception.
Psychologist and neuroscientists are find-
ing evidence that neural mechanisms for
auditory processing of music and speech
overlap and that music education may play
an important role in the development and
remediation of language and reading skills.1
Consequently, music education is being
explored as a training tool to improve speech
perception abilities of children with hearing
impairment, particularly those with cochlear more students with
implants.2 Even though music experiences
are being used as a rehabilitative tool to
cochlear implants in
train the hearing abilities of these students, your music classes,
the development of music skills and appre-
ciation for music remain important goals of here are some things
music instruction for students with hearing you need to know.
impairment, consistent with the goals for all
students.
According to the Centers for Disease
Control and Prevention, approximately one
tenth of one percent of children have a hear-
ing loss greater than 40 decibels (dB HL).3
To provide some perspective, normal con-
versation is about 50 to 60 dB HL; there-
fore, these individuals would have great

James L. Reifinger Jr. is an assistant professor of music education at Southern Illinois University in Carbondale. He can be
contacted at Reifinger@siu.edu.

NAfME is glad to offer one hour of professional development recognition to you for reading this article.
Copyright © 2018 National Association
Please follow the link below and complete a short quiz to receive your certificate of completion. for Music Education
http://bit.ly/ChildrenWithCochlearImplants DOI: 10.1177/0027432118809404
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difficulty hearing speech. Fortunately,
over 97 percent of newborns in the
United States are now screened for hear-
ing loss, so intervention can begin very
early in life, a critical period for devel-
opment of speech and language com-
prehension skills. Without remediation,
children with hearing loss are likely to
fall behind their peers in cognitive and
social development.
Auditory stimulation is essential dur-
ing infancy and early childhood for the
normal development and maturation of
the central auditory neural pathways.
Neural responses in the auditory path-
ways of most children receiving a coch-
lear implant after age three and a half
reportedly do not typically reach nor-
mal levels, even after years of experi-
ence with the implant.4 Support for even
earlier intervention is offered by a recent
study that examined children’s language
skills three years after intervention.5 The
children who had received a cochlear
implant by the age of twelve months
had language skills similar to peers
with normal hearing, whereas the chil-
dren implanted between thirteen and
twenty-four months had significant lan-
guage delay. Because timing in relation-
ship to language development is of such
critical importance, the point in time of
hearing loss onset and intervention is
qualified as either prelingual or post-
lingual. The next two sections explain
the physiology of normal and impaired
hearing and provide background on
the development and function of coch-
lear implants, and the sections that fol-
low provide information more directly
related to music instruction for children
with cochlear implants.
Normal versus Impaired
Hearing
In normal hearing, soundwaves from
the air are received and converted to
physical vibrations by the eardrum.6 Via
a series of tiny bones, the physical vibra-
tions pass to the fluid-filled cochlea in
the inner ear, where they produce fluid
waves, similar to waves created by a rock
tossed into a lake. The movement of the
fluid in the cochlea stimulates thousands
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of fine sensory hair cells that convert
the physical energy into electric energy
that becomes nerve impulses. Different
frequencies stimulate hair cells at differ-
ent points in the cochlea, the layout of
which might be conceptualized like that
of a coiled music keyboard. The electri-
cal signals are passed to the auditory
nerve that transports them to auditory
centers in the brain, where the sounds
are processed and interpreted.
At the most basic level, the four
properties of sounds are perceived and
processed: pitch, duration, timbre, and
loudness. Relevant for pitch and tim-
bre perception, both music and speech
sounds can contain a fundamental fre-
quency as well as harmonic frequencies,
often referred to as overtones in music.
Thus, pitch perception usually involves
the integration of signals from many
places within the cochlea. Pitch deter-
minations are made by evoking a sense
of the lowest frequency of the harmonic
series, the fundamental, but overtones
contribute to evoking this sensation.
Timbre perception also involves per-
ceptual integration of the harmonics
at various levels of strength that are
part of the sound, producing different
musical colors. Similarly, speech per-
ception involves the perception of the
higher frequencies that are part of the
harmonics of speech sounds, producing
different vowel and consonant sounds.
Timbre and speech perception are also
affected by duration characteristics, such
as the rate of attack and cessation of a
sound.
Hearing impairment can vary in
degree across the pitch spectrum and
between ears and is labeled by level of
severity as slight, mild, moderate, severe,
or profound. Most individuals with
hearing loss have some hearing capac-
ity without a hearing device, which is
referred to as residual hearing. Greater
residual hearing for lower pitches than
higher pitches is common. For individu-
als with residual hearing, hearing aids
make sounds louder, and some modern
hearing aids that are professionally fitted
can be programmed to amplify the spe-
cific pitch ranges where an individual’s
residual hearing is weaker.7 Perception
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of high pitches is essential to support
speech and language development;
conversely, researchers believe that
residual hearing in the low pitch range
is essential to enhance music percep-
tion.8 Hearing loss that is the result of
an impediment in the process of con-
verting mechanical energy to electric
energy within the cochlea—usually as
the result of damage to or loss of fine
sensory hair cells—is referred to as sen-
sorineural hearing loss. It is the most
common form of hearing loss and can-
not be remediated with conventional
hearing aids. For individuals with sen-
sorineural hearing impairment, a coch-
lear implant can offer the possibility of
restoring hearing.
Cochlear Implants
The cochlear implant is indeed a mir-
acle of modern medicine. It may be
considered the first electronic device
to restore a human sense. No effective
treatment option existed for individuals
with severe to profound sensorineural
hearing loss prior to the late 1970s, but
today, with the aid of a cochlear implant,
individuals with this type of hearing loss
can hear well enough to engage in con-
versation on a cell phone. As recently
as the early 1980s, the scientific commu-
nity was skeptical that the device would
be able to restore any useful hearing.9
Experts believed that the best that could
be hoped for with uses of this new
device was basic sound awareness and
an aid to lip-reading. Even in the 1990s
after the Food and Drug Administration
(FDA) approved cochlear implants for
children meeting certain criteria, contro-
versy persisted, in part because parents
had to make the decision of whether
their child should be implanted and out-
comes in terms of language acquisition
were still uncertain.
Over time, the candidacy criteria for
cochlear implantation has continued
to expand, both in terms of age and
degree of hearing loss. Individuals with
significant levels of residual hearing are
now being considered, and techniques
to preserve this hearing during implan-
tation have been developed. The FDA
Music Educators Journal  December 2018
has approved cochlear implants for
children as young as twelve months of
age, though they are routinely placed in
eligible children as young as six months
of age.10 Once it became the norm that
speech perception was achieved in
most implant users, interest increased
in investigating music perception with
users of cochlear implants.
Cochlear implants simulate the nor-
mal function of the inner ear by convert-
ing sounds into electrical impulses that
are used to directly stimulate the audi-
tory nerve. Sounds are first segregated
into bands of frequencies, which are
then mapped to specific electrodes in
an array surgically implanted through-
out the cochlea. Creating bands of fre-
quencies results in degradation of the
sound input before it is even sent to
the electrodes.11 Currently, systems use
between sixteen and twenty-two elec-
trodes, reaching a sufficient technical
standard to restore speech perception
even in cases of profound hearing loss.
More detailed information on the com-
ponents of cochlear implants, along
with additional considerations for music
teachers working with students with
cochlear implants, can be found in an
article written by music professors Lyn
Schraer-Joiner and Manuela Prause-
Weber in the September 2009 Music
Educators Journal.12
Cochlear implants do not restore nor-
mal hearing. Low-frequency areas of the
cochlea are normally not accessed by
implants, making perception of funda-
mental frequencies difficult. Accessible
pitch ranges differ by device manufac-
turer and individual user settings, but
generally only pitches above G3 are
transmitted. 13 Researchers have sug-
gested that children with cochlear
implants who have better music per-
ception may be those who have better
residual hearing in the low-frequency
range.14 Placement of the electrodes is
imprecise, further degrading pitch per-
ception.15 The coarser frequency reso-
lution resulting from segregating the
sounds into frequency bands affects not
only pitch perception but also timbre
perception. With impaired timbre per-
ception, the ability to track individual
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instruments or a particular voice in
a mix of sounds becomes more diffi-
cult. Dynamic range is also much more
compressed with cochlear implants
than in normal hearing. However, beat
and rhythm perceptual abilities remain
largely intact.
Music to Train Hearing Ability
Perhaps most consequential for music
educators, efforts are underway to
develop post-implant auditory training
programs that use music to help optimize
the hearing acuity attained by cochlear
implant recipients. As experts who train
students in the domain of sound, music
educators are uniquely positioned to
contribute to this important endeavor.
The fact that music education can play
an important role in the development
and remediation of language and read-
ing skills is supported by a growing
body of evidence from psychologists
and neuroscientists that suggests the
neural mechanisms for auditory process-
ing of music and speech overlap.16 One
research study analyzed the results of
eighteen experimental studies involv-
ing children with normal hearing rang-
ing in age from four to nine years and
concluded that students who received
music training experienced significantly
greater gains in phonological skills com-
pared to peers who did not participate
in music.17
Because music training has been
shown to enhance speech perception in
children with normal hearing, research-
ers are beginning to investigate the
potential for music education to improve
auditory perceptual and auditory cogni-
tive skills in children and adults with
hearing impairments.18 While the pri-
mary aim of most post-implant training
programs is to improve speech percep-
tion, the additional objective of improv-
ing music perception and appreciation
is also being pursued, as it can enhance
the quality of life.
In terms of speech perception, two
areas that remain particularly chal-
lenging for individuals with cochlear
implants are the ability to understand
speech in the presence of background
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noise—referred to as hearing in noise—
and the ability to perceive the pitch vari-
ations in speech that provide additional
cues to meaning.19 Hearing speech in
noise is accomplished by following the
particular pitch range and timbre of a
target voice, such as that of the teach-
er’s voice in a noisy classroom. It is
also accomplished by focusing on the
direction of the sound, which can be
aided by bilateral implants. Music edu-
cation focuses on improving pitch and
timbre perception with musical sounds
and therefore may improve pitch and
timbre perception of speech sounds.
Indeed, for children with normal hear-
ing, those who participated in musical
training were found to have significantly
greater ability to understand speech in
noise than were peers without musical
training.20
Research investigating the effects
of music instruction on improving the
hearing ability of children with cochlear
implants is in the very early stages. In
2016, a systematic review of published
research identified nine studies that
examined music training as an interven-
tion for children with cochlear implants,
though additional studies using music
training with adults have been con-
ducted.21 In one of the first experimental
studies to involve a professional music
teacher, published in 2014, children
between the ages of seven and ten with
profound hearing loss who used hear-
ing aids alone or hearing aids in con-
junction with cochlear implants received
music instruction for one hour weekly
for an average of 2.6 years.22 Instruction
included exploring vocal and instrumen-
tal timbres, moving to musical sounds,
remembering and producing rhyth-
mic patterns and timbres, determining
emotion content of pieces, and writing
and performing simple rhythm pieces.
Results indicated that compared with
peers having similar hearing impairments
who received no music instruction, the
group of students that participated in
music education showed significantly
greater ability to discriminate between
two similar vowel or consonant speech
sounds, which is particularly important
because it suggests that a sharpening of
59
the language perception skills of chil-
dren with hearing impairment may be
achieved with music training.
Researchers are also investigat-
ing singing and its effects on auditory
development of children with cochlear
implants. A 2014 study was reportedly
the first neuroscience study to show that
among children with cochlear implants,
those who sang showed enhanced brain
responses when passively listening to
musical sounds compared to those who
did not sing.23 The children were watch-
ing a silent video while hearing random
changes in music sounds but were not
instructed to focus attention on the
sounds. The enhanced brain responses
to music changes found with the chil-
dren who enjoyed singing suggest that
training involving singing may result in
a stronger involuntary shift of attention
to musical sounds and possibly other
sounds, though the study design does
not allow for a determination that sing-
ing was the cause of enhancements.
A study published in 2015 investi-
gated the extent of singing improvement
that might be achieved with instruction,
comparing the progress of children
ages five to seven with hearing aids and
cochlear implants to peers with normal
hearing.24 All the children participated
together in instruction that included
vocal exploration, learning to sing
songs, using movements to accompany
singing, and associating sounds visu-
ally with physical gestures and simple
notation. After twenty weeks of instruc-
tion, the children with hearing impair-
ment showed significant improvement
in singing competency, vocal range,
and pitch perception, although not to
the same extent as their peers with
normal hearing. These results indicate
that music skills of children with hear-
ing impairment can improve with train-
ing. To examine possible improvement
in speech perception following music
instruction, the study also examined
ability to hear speech in noise but found
no significant improvement. However,
no improvement with this skill was
found for the children with normal hear-
ing, which would be expected based
on findings from other studies. This
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suggests that the study design may have
had some limitation in bringing about
improvement with this skill, such as a
training duration that may have been
too short.
Music training involving practice with
hearing and identifying melodic con-
tours is being investigated as a way of
possibly improving speech perception
for both hearing in noise and spoken
pitch inflection. A study published in
2017 assigned children with cochlear
implants to either piano instruction or art
instruction.25 As might be expected, after
six months, the students receiving piano
instruction performed significantly better
than the students receiving art instruc-
tion in hearing changes in melodic con-
tour, in accordance with other studies
showing improved melodic contour per-
ception after training for children with
cochlear implants.26 To assess possible
improvement of speech perception, the
children were also asked to correctly
identify, by sound only, which of four
emotions was conveyed by the man-
ner in which emotionally neutral sen-
tences were spoken. The children who
received contour training with piano
instruction made significant pretest to
posttest gains in correctly identifying the
emotion, whereas the art training group
showed no significant improvement.
Music and Children with
Cochlear Implants
Hearing ability among individuals
with cochlear implants varies consid-
erably, as does an interest in listening
to music. Some individuals may have a
great interest in music, and others may
not. Researchers believe that children
will likely enjoy music if they received
implants at a very young age and that
music perception and appreciation can
improve considerably with training and
experience.27 The following suggestions
for instruction and adaptations when
teaching music to children with cochlear
implants are offered, recognizing that,
as with students with normal hearing,
abilities among individuals vary consid-
erably. In terms of more fundamental
considerations, instruction should take
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place in a room that is acoustically dry.
Children with hearing aids or cochlear
implants should be situated near the
sound source. Background noise should
be minimized as much as possible, both
from within and outside of the room.
Extremes in dynamics of music should
be avoided. As when teaching children
with normal hearing, instructional activi-
ties should be multisensory when possi-
ble, incorporating visual and kinesthetic
experiences to reinforce aural concepts.
Most children with cochlear implants
will likely have the ability to hear rhyth-
mic qualities of music nearly as well,
if not just as well, as their peers with
normal hearing. Few to no adaptations
may be necessary for instruction involv-
ing discrimination, identification, and
production of steady beat, simple and
compound meter (subdivisions of twos
or threes), duple and triple meter, and
rhythm patterns. Students can be chal-
lenged to maintain an internal beat or
synchronize rhythmic movement to
sounds. Rhythmic patterns of a predeter-
mined number of beats can be created
and performed as an ostinato. A focus on
tempo comparisons using movements
with varying levels of energy can be a
useful way to help students internalize
mood or emotional qualities of music
because fidelity of pitch and timbre ele-
ments may be somewhat degraded.
To build on students’ strengths, tim-
bre concepts can be initially addressed
with rhythm activities. Different rhythms
can be played on a variety of instru-
ments. It may be easiest to initially select
instruments that have greatly contrasting
attacks and decays. Students can learn to
associate an instrument with its sound,
both visually and aurally, and later by
sound only, matching a rhythm pattern
to the instrument that played it. Using a
combination of two to four instruments,
each instrument can play different parts
of a rhythm pattern. Students can iden-
tify the rhythm and instruments used in
patterns they hear, or they can re-create
it, then create and perform their own
patterns. Instruments should be played
individually at first. With pitched instru-
ments, a variety of pitch ranges should
be used when exploring timbres.
Music Educators Journal  December 2018
 FIGURE 1
Cochlear Implant (CI) Developments
1957 First attempted human cochlear implantation; a single channel provided basic sound awareness1
1970s No approved treatment options for severe to profound hearing loss2
1975 A study funded by the National Institutes of Health investigated all 13 CI users in the U.S.; users could not understand speech,
although benefits of CIs were noted.3
1978 First multichannel cochlear implant used, a requirement for speech comprehension.
1984 Food and Drug Administration (FDA) approves cochlear implants for adults age 18 and older.
1988 Of 3000 CI users worldwide, about 1 in 20 could hear well enough to understand speech.4
1990 FDA approves cochlear implants for children ages 2 to 17.
1995 12,000 CI users worldwide.
1998 FDA approves cochlear implants for children as young as 18 months of age.
2000 FDA approves cochlear implants for children as young as 12 months of age.
2002 First adult partial deafness cochlear implantation.5
006 Technique developed to monitor cochlea function during CI implantation to preserve residual hearing.6
2007 Melodic Contour Identification Test developed to assess music perception of CI users.7
2008 Clinical Assessment of Music Perception test developed for use with CI users.8
2010 188,000 CI users worldwide: In the United States 41,00 adults and 26,000 children have CIs.9
2014 Music in Children With Cochlear Implants test battery developed specifically for use with children under the age of 9 years.10
2015 Software developed for pitch discrimination training for children with CIs.11
2017 Music training shown to improve perception of emotional speech prosody for children with CIs.12
Notes for Figure 1

1. Blake S. Wilson and Michael F. Dorman, “Cochlear Implants: A Remarkable Past and a Brilliant Future,” Hearing Research 242 (2008): 3–21.
2. Robert Shepherd, Andrew Wise, and James Fallon, “Cochlear Implants,” Disorders of Peripheral and Central Auditory Processing (2006): 315–31.
3. Wilson and Dorman, “Cochlear Implants.”
4. Ibid.
5. Henryk Skarzynski and Artur Lorens, “Electric Acoustic Stimulation in Children,” in Cochlear Implants and Hearing Preservation, ed. Paul van de Heyning
and Andrea Kleine Punte (New York: Karger, 2010), 135–43.
6. Oliver Adunka, Patricia Roush, John Grose, Corinne Macpherson, and Craig A. Buchman, “Monitoring of Cochlear Function during Cochlear
Implantation,” The Laryngoscope 116, no. 6 (2006): 1017–20.
7. John J. Galvin III, Qian-Jie Fu, and Geraldine Nogaki, “Melodic Contour Identification by Cochlear Implant Listeners,” Ear and Hearing 28, no. 3 (2007):
302–19.
8. Grace L. Nimmons, Robert S. Kang, Ward R. Drennan, Jeff Longnion, Chad Ruffin, Tina Worman, Bevan Yueh, and Jay T. Rubinstein, “Clinical
Assessment of Music Perception in Cochlear Implant Listeners,” Otology & Neurotology 29, no. 2 (2008): 149–55.
9. “National Institutes of Health Fact Sheet—Cochlear Implants,” 2010, https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=83, accessed
October 4, 2018.
10. Alexis T. Roy, Lindsay Scattergood-Keepper, Courtney Carver, Patpong Jiradejvong, Caty Butler, and Charles J. Limb, “Evaluation of a Test Battery to
Assess Perception of Music in Children with Cochlear Implants,” JAMA Otolaryngology—Head & Neck Surgery 140, no. 6 (2014): 540–47.
11. Walter Di Nardo, Lorenzo Schinaia, Roberta Anzivino, Eugenio De Corso, Alberto Ciacciarelli, and G. Paludetti, “Musical Training Software for Children
with Cochlear Implants,” Acta Otorhinolaryngologica Italica 35, no. 4 (2015): 249–57.
12. Arla Good, Karen A. Gordon, Blake C. Papsin, Gabe Nespoli, Talar Hopyan, Isabelle Peretz, and Frank A. Russo, “Benefits of Music Training for
Perception of Emotional Speech Prosody in Deaf Children with Cochlear Implants,” Ear & Hearing 38, no. 4 (2017): 455–64.

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 With pitch and melody concepts,
students can learn to identify and
play different contours. Music training
involving identification and playing dif-
ferent melodic contours has been used
in a number of research studies. 28 When
discriminating whether the second of
two pitches moves up or down or stays
the same, very wide intervals should
be used initially, with the pitch differ-
ence between notes decreasing gradu-
ally. Likewise, contours initially can be
comprised of skips rather than steps.
Two sequential tonal patterns can be
discriminated as same or different. If
lyrics or rhythms are included in pitch
activities, students will tend to focus
on the rhythmic and text dimensions
rather than aspects related to pitch. To
help students focus on pitch, melo-
dies or pitch patterns being compared
should have identical rhythms. Har-
mony perception is particularly difficult
for students with cochlear implants.
When hearing more than one pitch
at a time, the students may perceptu-
ally fuse the different notes into one
sound. 29 As a result, students would
have difficulty identifying chords and
even distinguishing a melody from an
accompaniment.
As to music listening, it would be
advantageous to select monophonic
examples initially. When using pieces
performed by ensembles, small ensem-
bles and thin textures would likely be
easier to perceptually process. Because
cochlear implant users have difficulty
perceiving timbre, they would have dif-
ficulty perceptually parsing the different
musical parts sounding simultaneously
in a composition. When listening to
music with two or more different parts
sounding at the same time, cochlear
implant users may be more attentive to
rhythm contrasts than timbre contrasts
among different parts.
Previously cited research suggests
that singing may be an important activ-
ity for children with cochlear implants.
Students may sing rhythms accurately,
though pitches may be considerably
inaccurate. To get a general sense of
the singing ability of children with coch-
lear implants, researchers in one study
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asked nineteen children ages four to
twelve with cochlear implants to sing
“Twinkle, Twinkle Little Star.”30 All the
children could sing the lyrics and the
rhythm correctly or partially correctly. In
terms of pitch accuracy, one child sang
most pitches correctly, five varied the
pitch partially correctly, seven varied the
pitch inaccurately, and six sang without
varying the pitch. Another study com-
paring singing accuracy of children with
cochlear implants with normal-hearing
peers found that correct contour direc-
tions were sung 52 percent of the time
by children with cochlear implants,
whereas children with normal hearing
sang correct contour directions 94 per-
cent of the time.31 This study points out,
however, that singing performance that
would be deemed as within the normal
range was observed with a small num-
ber of children with cochlear implants,
indicating a need to further investigate
what factors may contribute to individ-
ual differences. As with previous instruc-
tional suggestions for pitch, singing of
pitch can initially focus on perception
and production of interval direction and
melodic contours. Singing of rhythms
should not require any special adapta-
tions. Given the accessibility and central
role of singing in music education with
young children, future research inves-
tigating the effects of singing on the
auditory development of children with
cochlear implants is essential.
Future Directions
Cochlear implant technology is con-
tinuing to improve rapidly. Music per-
ception and appreciation will likely be
enhanced by refinements in devices.
These refinements will enable an
expanded dynamic range and improved
representation of the fine structure of
sounds used in pitch and sound qual-
ity perception. 32 Bilateral implanta-
tion will likely become more common,
improving localization ability, although
implantation of both sides needs to be
performed at the same time or with a
minimum of delay for best results. 33
This allows the neural networks serv-
ing each ear to develop simultaneously.
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Another approach to overcome the
limitations of current cochlear implant
technology being explored is the use
of a combination of a hearing aid and
a cochlear implant, sometimes referred
to as bimodal hearing or electric acous-
tic stimulation.34 Thus, the preservation
of any residual hearing has become an
increased priority during implantation.
Enhancement of music perception is
the next frontier to be pursued in the
quest to expand the success of cochlear
implants, not only because music has
been shown to improve auditory abil-
ity in general but also because appre-
ciation of music enriches the quality
of life. As a tool that can be used in
auditory training programs for children
with cochlear implants, music can be
especially effective because it is a dif-
ferent type of sound stimulus that may
pique interest and increase motivation.
Music activities also provide opportuni-
ties for social engagement with peers.
As reported by psychologists who study
how music affects children, “[i]t is clear
that deaf children with cochlear implants
enjoy music, remember aspects of the
music they hear regularly, and, in many
cases, sing for their own pleasure. In
that sense, their motivation for music is
much like that of hearing children.”35 As
music educators, we assert that musical
experiences and expression are part of
human behavior that should be available
to all students regardless of their level
of ability. The use of music instruction
as an effective auditory training tool for
children with cochlear implants is yet
another indication in a growing body
of information that affirms the vital role
that music instruction plays in the audi-
tory development of children.
Notes
1. Adam Tierney and Nina Kraus, “Music
Training for the Development of Reading
Skills,” in Changing Brains: Applying
Brain Plasticity to Advance and
Recover Human Ability, ed. Michael M.
Merzenich, Mor Nahum, and Thomas
M. Van Vleet (Burlington, VT: Academic
Press, 2013), 209–41.
2. Kate Gfeller, “Music-Based Training for
Pediatric CI Recipients: A Systematic
Music Educators Journal  December 2018
 Analysis of Published Studies,” European
Annals of Otorhinolaryngology, Head and
Neck Diseases 133S (2016): S50–S56.
3. See https://www.cdc.gov/ncbddd/hearing
loss/data.html, accessed June 27, 2017.
4. Anu Sharma, Amy A. Nash, and Michael
Dorman, “Cortical Development,
Plasticity and Re-Organization in
Children with Cochlear Implants,”
Journal of Communication Disorders 42
(2009): 272–79.
5. Jaime Leigh, Shani Dettman,
Richard Dowell, and Robert Briggs,
“Communication Development in
Children Who Receive a Cochlear
Implant by 12 Months of Age,” Otology
& Neurotology 34 (2013): 443–50.
6. Jan Schnupp, Israel Nelken, and Andrew
King, Auditory Neuroscience: Making
Sense of Sound (Cambridge, MA: The
MIT Press, 2011).
7. Sara K. Mamo, Nicholas S. Reed, Carrie
L. Nieman, Esther S. Oh, and Frank R.
Lin, “Personal Sound Amplifiers for Adults
with Hearing Loss,” The American Journal
of Medicine 129, no. 3 (2016): 245–50.
8. Françoise Rochette, Aline Moussard,
and Emmanuel Bigand, “Music Lessons
Improve Auditory Perceptual and
Cognitive Performance in Deaf Children,”
Frontiers in Human Neuroscience 8
(2014): article 488.
9. Adrien A. Eshragi, Ronen Nazarian, Fred
F. Telischi, Suhrud M. Rajguru, Eric
Truy, and Chhavi Gupta, “The Cochlear
Implant: Historical Aspects and Future
Prospects,” The Anatomical Record 295,
no. 11 (2012): 1967–80.
10. James D. Ramsden and Payal Mukherjee,
“The Future of Pediatric Cochlear
Implants,” Journal of ENT Masterclass
7, no. 1 (2014): 26–31.
11. Charles J. Limb and Alexis T. Roy,
“Technological, Biological, and
Acoustical Constraints to Music
Perception in Cochlear Implant Users,”
Hearing Research 308 (2014): 13–26.
12. Lyn Schraer-Joiner and Manuela Prause-
Weber, “Strategies for Working with
Children with Cochlear Implants,” Music
Educators Journal 96, no. 1 (2009):
48–55.
13. Limb and Roy, “Technological,
Biological, and Acoustical Constraints.”
14. Talar Hopyan, Isabelle Peretz, Lisa
P. Chan, Blake C. Papsin, and Karen
A. Gordon, “Children Using Cochlear
Implants Capitalize on Acoustical
www.nafme.org
132.248.9.8 on Sat, 03 Sep 2022 21:43:13 UTC
Hearing for Music Perception,” Frontiers
in Psychology 3 (2012): article 425.
15. Limb and Roy, “Technological,
Biological, and Acoustical Constraints.”
16. Aniruddh D. Patel, “Why Would Musical
Training Benefit the Neural Encoding
of Speech? The OPERA Hypothesis,”
Frontiers in Psychology 2 (2011): article
142. See also Tierney and Kraus, “Music
Training for the Development of Reading
Skills.”
17. Reyna L. Gordon, Hilda M. Fehd, and
Bruce D. McCandliss, “Does Music
Training Enhance Literacy Skills? A
Meta-Analysis,” Frontiers in Psychology
6 (2015): article 1777.
18. Kate Gfeller, Emily Guthe, Virginia
Driscoll, and Carolyn J. Brown, “A
Preliminary Report of Music-Based
Training for Adult Cochlear Implant Users:
Rationales and Development,” Cochlear
Implants International 16, supplement
3 (2015): S22–S31. See also Gfeller,
“Music-Based Training for Pediatric.”
19. Aniruddh D. Patel, “Can Nonlinguistic
Musical Training Change the Way the
Brain Processes Speech? The Expanded
OPERA Hypothesis,” Hearing Research
308 (2014): 98–108.
20. Dana L. Strait, Alexandra Parbery-
Clark, Emily Hittner, and Nina Kraus,
“Musical Training During Early Childhood
Enhances the Neural Encoding of
Speech in Noise,” Brain & Language
123 (2012): 191–201.
21. Gfeller et al., “Music-Based Training for
Adult”; see also Gfeller, “Music-Based
Training.”
22. Rochette, Moussard, and Bigand, “Music
Lessons Improve Auditory Perceptual and
Cognitive Performance.”
23. Ritva Torppa, Minna Huotilainen,
Miika Leminen, Jari Lipsanen, and
Mari Tervaniemi, “Interplay between
Singing and Cortical Processing of
Music: A Longitudinal Study in Children
with Cochlear Implants,” Frontiers in
Psychology 5 (2014): article 1389.
24. Graham F. Welch, Jo Saunders, Sian
Edwards, Zoe Palmer, Evangelos
Himonides, Julian Knight, Merle Mahon,
Susanna Griffin, and Deborah A. Vickers,
“Using Singing to Nurture Children’s
Hearing? A Pilot Study,” Cochlear
Implants International 16, no. S3
(2015): S63–S70.
25. Arla Good, Karen A. Gordon, Blake
C. Papsin, Gabe Nespoli, Talar
This content downloaded from
All use subject to https://about.jstor.org/terms
Hopyan, Isabelle Peretz, and Frank
A. Russo, “Benefits of Music Training
for Perception of Emotional Speech
Prosody in Deaf Children with Cochlear
Implants,” Ear & Hearing 38, no. 4
(2017): 455–64.
26. Qian-Jie Fu, John J. Galvin III, Xiaosong
Wang, and Jiunn-Liang Wu, “Benefits
of Music Training in Mandarin-Speaking
Pediatric Cochlear Implant Users,”
Journal of Speech, Language, and Hearing
Research 58 (2015): 163–69; also Patel,
“Nonlinguistic Music Training.”
27. Chisato Mitani, Takayuki Nakata,
Sandra E. Trehub, Yukihiko Kanda,
Hidetaka Kumagami, Kenji Takasaki,
Ikue Miyamoto, and Haruo Takahashi,
“Music Recognition, Music Listening,
and Word Recognition by Deaf Children
with Cochlear Implants,” Ear and
Hearing 28, no. 2 (2007): 29S–33S; see
also John J. Galvin III, Qian-Jie Fu, and
Robert V. Shannon, “Melodic Contour
Identification and Music Perception by
Cochlear Implant Users,” Annals of the
New York Academy of Science 1169, no.
1 (2009): 518–33.
28. Patel, “Expanded OPERA Hypothesis.”
29. Charles J. Limb and Jay T. Rubinstein,
“Current Research on Music
Perception in Cochlear Implant Users,”
Otolaryngologic Clinics of North America
45, no. 1 (2012): 129–40.
30. Torppa et al., “Interplay between Singing
and Cortical Processing.”
31. Li Xu, Ning Zhou, Xiuwu Chen, Yongxin
Li, Heather M. Schultz, Xiaoyan Zhao, and
Demin Han. “Vocal Singing by Prelingually-
Deafened Children with Cochlear Implants,”
Hearing Research 255 (2009): 129–34.
32. Limb and Roy, “Technological,
Biological, and Acoustical Constraints”;
see also Ramsden and Mukherjee,
“Future of Pediatric Cochlear
Implants.”
33. Ramsden and Mukherjee, “Future of
Pediatric Cochlear Implants.”
34. Henryk Skarzynski and Artur Lorens,
“Electric Acoustic Stimulation in
Children,” in Cochlear Implants and
Hearing Preservation, ed. Paul van de
Heyning and Andrea Kleine Punte (New
York: Karger, 2010), 135–43.
35. Sandra E. Trehub, Tara Vongpaisal, and
Takayuki Nakata, “Music in the Lives of
Deaf Children with Cochlear Implants,”
Annals of the New York Academy of
Sciences 1169, no. 1 (2009): 538.
63