{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:02:24Z","timestamp":1780635744119,"version":"3.54.1"},"reference-count":42,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Nahtional Institute of Health Health Research Institute","award":["RIG-22\/R2-54"],"award-info":[{"award-number":["RIG-22\/R2-54"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Audiology Research"],"abstract":"<jats:p>Background and Aims: Accuracy in speech perception in bilingual children is influenced by two phonological systems. This study compares phonological development in bilingual Urdu\u2013English (UE) children with CIs with their hearing-age-matched peers with normal hearing (NH), by investigating whether bilingualism or any spectral limitations of CI impact perception of UE phonemes. Method and Procedures: Children (n = 57) aged 3; 0\u20136; 11 years (28 CI, 29 NH) were assessed for speech perception using a custom-designed UE Speech Perception Test (UE-SPT), in quiet and noise (+5 dB SNR). Responses were analysed using confusion matrices, across phonological parameters of place, manner, and voicing to determine error patterns. Outcomes and Results: Significant deficits in CI children were found across all features, with voicing discrimination showing the largest errors (effect sizes d &gt; 6), exacerbated by noise, especially for Urdu aspirated stops. CIs mastered only 8.3% Urdu-aspirated consonants at 6; 11 years compared to 91.7% mastered by NH peers, indicating critical language-specific vulnerabilities. Backing and substitutions errors were particularly seen in CI\u2019s speech, whilst manner was preserved. Conclusion and Implications: UE bilingual phonological complexity compounded by inadequate speech processing abilities in CIs challenges them, underscoring urgent need for targeted speech therapy interventions focusing voicing contrasts and aspirated consonants, as well as environmental accommodations that reduce noise interference and enhance listening through CI, to optimise educational outcomes. This research contributes vital clinical guidance for supporting bilingual children with cochlear implants, addressing both environmental, technological and linguistic challenges.<\/jats:p>","DOI":"10.3390\/audiolres16030084","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T01:08:02Z","timestamp":1780535282000},"page":"84","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Urdu\u2013English Perceptual Confusions in Bilingual Children with Normal Hearing and Cochlear Implants: An Analysis of Place, Manner, and Voicing Features"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9696-225X","authenticated-orcid":false,"given":"Amina Asif","family":"Siddiqui","sequence":"first","affiliation":[{"name":"Centre for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia"},{"name":"College of Speech Language and Hearing Sciences, Ziauddin University, Karachi 75600, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9619-4756","authenticated-orcid":false,"given":"Cila","family":"Umat","sequence":"additional","affiliation":[{"name":"Centre for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia"},{"name":"Center of Ear, Hearing & Speech (HEARS), Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farheen Naz","family":"Anis","sequence":"additional","affiliation":[{"name":"Faculty of Allied Health Sciences and Rehabilitation, Riphah International University, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1910-5924","authenticated-orcid":false,"given":"Ayesha","family":"Butt","sequence":"additional","affiliation":[{"name":"Department of Health Professions, Manchester Metropolitan University, Manchester M15 6GX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2160-8480","authenticated-orcid":false,"given":"Kehkashan","family":"Kanwal","sequence":"additional","affiliation":[{"name":"College of Speech Language and Hearing Sciences, Ziauddin University, Karachi 75600, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"36","DOI":"10.21037\/ajo-24-57","article-title":"Cochlear Implantation in Children Under 12 Months of Age: Surgical Outcomes and Considerations\u2014A Western Australian Perspective","volume":"8","author":"Hannigan","year":"2025","journal-title":"Aust. 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