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Int J Pediatr Otorhinolaryngol. 2014 May;78(5):821-7. doi: 10.1016/j.ijporl.2014.02.022. Epub 2014 Feb 26.

Inferences and metaphoric comprehension in unilaterally implanted children with adequate formal oral language performance.

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Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 31, 00161 Rome, Italy.
Department of Otorhinolaryngology "Guglielmo da Saliceto" Hospital, Via Cantone del Cristo 40, 29121 Piacenza, Italy.
Department of Neurology and Psychiatry, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 31, 00161 Rome, Italy. Electronic address:



To assess skills in inferences during conversations and in metaphors comprehension of unilaterally cochlear implanted children with adequate abilities at the formal language tests, comparing them with well-matched hearing peers; to verify the influence of age of implantation on overall skills.


The study was designed as a matched case-control study. 31 deaf children, unilateral cochlear implant users, with normal linguistic competence at formal language tests were compared with 31 normal hearing matched peers. Inferences and metaphor comprehension skills were assessed through the Implicit Meaning Comprehension, Situations and Metaphors subtests of the Italian Standardized Battery of "Pragmatic Language Skills MEDEA". Differences between patient and control groups were tested by the Mann-Whitney U test. Correlations between age at implantation and time of implant use with each subtest were investigated by the Spearman rank correlation coefficient.


No significant differences between the two groups were found in inferencing skills (p=0.24 and p=0.011 respectively for Situations and Implicit Meaning Comprehension). Regarding figurative language, unilaterally cochlear implanted children performed significantly below their normal hearing peers in Verbal Metaphor comprehension (p=0.001). Performances were related to age at implantation, but not with time of implant use.


Unilaterally cochlear implanted children with normal language level showed responses similar to NH children in discourse inferences, but not in figurative language comprehension. Metaphors still remains a challenge for unilateral implant users and above all when they have not any reference, as demonstrated by the significant difference in verbal rather than figurative metaphors comprehension. Older age at implantation was related to worse performance for all items. These aspects, until now less investigated, had to receive more attention to deeply understand specific mechanisms involved and possible effects of different levels of figurative language complexity (presence or absence of contextual input, degree of transparency and syntactic frozenness). New insight is needed to orient programs in early intervention settings in considering and adequately responding to all these complex communicative need of children with hearing loss.


Cochlear implants; Inference; Language skills; Metaphor

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