Tone, rhythm, and timbre perception in school-age children using cochlear implants and hearing aids

Hamish Innes-Brown, Jeremy Marozeau, Christine M. Storey, Peter J. Blamey

Research output: Contribution to journalJournal articleResearchpeer-review


Background: Children with hearing impairments, especially those using hearing devices such as the cochlear implant (CI) or hearing aid (HA), are sometimes not encouraged to attend music classes, as they or their parents and teachers may be unsure whether the child can perform basic musical tasks. Purpose: The objective of the current study was to provide a baseline for the performance of children using CIs and HAs on standardized tests of rhythm and pitch perception as well as an instrument timbre identification task. An additional aim was to determine the effect of structured music training on these measures during the course of a school year. Research Design: The Intermediate Measures of Music Audiation (IMMA) Tonal and Rhythmic subtests were administered four times, with 6 wk between tests. All children in the study were also enrolled in "Music Club" teaching sessions. Measures were compared between groups and across the four testing sessions. Study Sample: Twenty children from a single school in Melbourne, Australia, were recruited. Eleven (four girls) had impaired hearing, including six with a unilateral CI or CI and HA together (two girls) and five with bilateral HAs (two girls). Nine were normally hearing, selected to match the age and gender of the hearing-impaired children. Ages ranged from 9-13 yr. Intervention: All children participated in a weekly Music Club - a 45 min session of musical activities based around vocal play and the integration of aural, visual, and kinesthetic modes of learning. Data Collection and Analysis: Audiological data were collected from clinical files. IMMA scores were converted to percentile ranks using published norms. Between-group differences were tested using repeated-measures analysis of variance, and between-session differences were tested using a linear mixed model. Linear regression was used to model the effect of hearing loss on the test scores. Results: In the first session, normally hearing children had a mean percentile rank of ∼50 in both the Tonal and Rhythmic subtests of the IMMA. Children using CIs showed trends toward lower scores in the Tonal, but not the Rhythmic, subtests. No significant improvements were found between sessions. In the timbre test, children generally made fewer errors within the set of percussive compared to nonpercussive instruments. The hearing loss level partially predicted performance in the Tonal, but not the Rhythmic, task, and predictions were more significant for nonpercussive compared to percussive instruments. Conclusions: The findings highlight the importance of temporal cues in the perception of music, and indicate that temporal cues may be used by children with CIs and HAs in the perception of not only rhythm, but also of some aspects of timbre. We were not able to link participation in the Music Club with increased scores on the Tonal, Rhythmic, and Timbre tests. However, anecdotal evidence from the children and their teachers suggested a wide range of benefits from participation in the Music Club that extended from increased engagement and interest in music classes into the children's social situations.
Original languageEnglish
JournalAmerican Academy of Audiology. Journal
Issue number9
Pages (from-to)789-806
Publication statusPublished - 2013
Externally publishedYes


  • Cochlear implants
  • Hearing Loss
  • Children
  • Music perception
  • Pitch perception
  • Teaching


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