Communication Outcomes: Auditory Verbal, Auditory Oral, Bilingual-Bicultural

Choosing the most appropriate methodology is an enormous ongoing issue for families when their child is identified with hearing loss. Professionals all have ideas about what is right and what would be right for the children they see. Unfortunately, professionals have different points of view. What are parents to do?


Look at the data!

When data is available it should provide information to help families make decisions. A very good study was published in in 2013 which provides just that kind of information. Writing in Otology/Neurotology, Dettman et al., looked at performance by children using cochlear implants who are enrolled in auditory-verbal programs, auditory oral programs, and bilingual/bicultural programs. The children were well matched in the three groups.


Who were the children?

The children were all boys, with profound hearing loss, normal IQ, no additional disabilities, monolingual English speakers, with no abnormal radiology, and had received cochlear implants at similar ages.



The children were all tested for speech perception (single words and sentences) and receptive language. For all tests, the boys in the auditory-verbal group did better than those in the other groups. This was true for monosyllabic words and for sentence perception. The study also looked at delays in receptive language. Results are in the table below.


Auditory verbal Auditory Oral Bilingual/Bicultural
CNC words 60% 43% 24%
BKB sentences 77% 77% 56%
Vocabulary Delay(PPVT) 13 months 19 months 26 months



It is likely that because the children in the auditory verbal group had better speech perception than those in the other groups, they had more exposure to language. As a result their language delay was smaller. The auditory oral group had poorer single-word speech perception, and a greater language delay than the auditory verbal group, but did much better than the bilingual/bicultural group. This is really critical information and is one more piece of evidence about the value of auditory verbal therapy. It is one of the things that should be shared with parents.

About Jane Madell

Jane Madell has a consulting practice in pediatric audiology. She is an audiologist, speech-language pathologist, and LSLS auditory verbal therapist, with a BA from Emerson College and an MA and PhD from the University of Wisconsin. Her 45+ years experience ranges from Deaf Nursery programs to positions at the League for the Hard of Hearing (Director), Long Island College Hospital, Downstate Medical Center, Beth Israel Medical Center/New York Eye and Ear Infirmary as director of the Hearing and Learning Center and Cochlear Implant Center. Jane has taught at the University of Tennessee, Columbia University, Downstate Medical School, and Albert Einstein Medical School, published 7 books, and written numerous books chapters and journal articles, and is a well known international lecturer.