Retrospective analysis of auditory neuropathy patients after cochlear implantation / 中华耳鼻咽喉头颈外科杂志

Objectives@#To study an effects on hearing ability and speech performance of the patients with auditory neuropathy (AN) after cochlear implantation (CI).@*Methods@#Thirty-five AN patients (26 males and 9 females) after CI in our center since 2007 were chosen, including 5 postlingual patients (implanted age from 14.3 to 38.6 years old) and 30 prelingual patients (implanted age from 1.1 to 13.7 years old). Hearing sensitivity and speech performance were estimated via following methods: (1) implanted hearing thresholds by sound field audiometry; (2) speech audiometry, including monosyllable, disyllable and sentences recognition test by computer-controlled software and sentence recognition test under noise condition (signal to noise ratio=+ 10dB); (3) Mandarin Early Speech Perception test (MESP), Mandarin Pediatric Speech Intelligibility test (MPSI), MAIS, or IT-MAIS for prelingual AN implantees.@*Results@#The average implanted hearing threshold (250-4 000 Hz) was (41.1±11.7) dBHL in 22 AN implantees, while those prelingual implantees was (39.1±10.9) dBHL, and (44.9±12.3) dBHL in postlingual implantees. Speech audiometry were implemented in four of 5 postlingual AN implantees, the results showed increasing tendency in monosyllable recognition scores, dramatic individual variation in computer-controlled disyllable and sentences recognition test, and poor scores (<30%) in speech recognition test in noise condition. Four of 30 prelingual implantees reconstruct their speech recognition ability within 1-3 years after switch-on, characterized as recognition scores (>60%) in monosyllable, disyllable and sentences. The one of prelingual implantee gained recognition scores of speech in noise within 1 year after switch-on. MAIS or IT-MAIS were implemented in twenty-five prelingual implantees, the average score in these patients was 28.6±11.7.@*Conclusion@#Cochlear implant can improve the hearing thresholds of AN patients, however, the improvement in speech performance presented significant variations among the implanted individuals.

Development of early auditory and speech perception skills within one year after cochlear implantion in prelingual deaf children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the development of early auditory capability and speech perception in the prelingual deaf children after cochlear implantation, and to study the feasibility of currently available Chinese assessment instruments for the evaluation of early auditory skill and speech perception in hearing-impaired children.</p><p><b>METHODS</b>A total of 83 children with severe-to-profound prelingual hearing impairment participated in this study. Participants were divided into four groups according to the age for surgery: A (1-2 years), B (2-3 years), C (3-4 years) and D (4-5 years). The auditory skill and speech perception ability of CI children were evaluated by trained audiologists using the infant-toddler/meaningful auditory integration scale (IT-MAIS/MAIS) questionnaire, the Mandarin Early Speech Perception (MESP) test and the Mandarin Pediatric Speech Intelligibility (MPSI) test. The questionnaires were used in face to face interviews with the parents or guardians. Each child was assessed before the operation and 3 months, 6 months, 12 months after switch-on.</p><p><b>RESULTS</b>After cochlear implantation, early postoperative auditory development and speech perception gradually improved. All MAIS/IT-MAIS scores showed a similar increasing trend with the rehabilitation duration (F=5.743, P=0.007). Preoperative and post operative MAIS/IT-MAIS scores of children in age group C (3-4 years) was higher than that of other groups. Children who had longer hearing aid experience before operation demonstrated higher MAIS/IT-MAIS scores than those with little or no hearing aid experience (F=4.947, P=0.000). The MESP test showed that, children were not able to perceive speech as well as detecting speech signals. However as the duration of CI use increased, speech perception ability also improved substantially. However, only about 40% of the subjects could be evaluated using the most difficult subtest on the MPSI in quiet at 12 months after switch-on. As MCR decreased, the proportion of children who could be tested using the MPSI reduced.</p><p><b>CONCLUSIONS</b>Within one year after CI, children develop early auditory and speech perception capabilities with time. Chinese versions of the IT-MAIS/MAIS, MESP and MPSI are useful instruments to document early auditory and speech perception skills in children after CI implantation.</p>

The development of vocabulary capability at 2-year follow-up in the prelingual deaf children with cochlear implants / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the development of early vocabulary capability in the prelingual deaf children after cochlear implantation (CI) , and to study the feasibility of current Chinese assessment procedures about language development for hearing-impaired children.@*METHOD@#A total of 56 cases with severe-to-profound prelingual deaf children were participated in this study. The vocabulary development of CI children were evaluated by trained audiologists using the vocabulary assessment tools: Chinese communicative development inventory (CCDI) and mandarin expressive and receptive vocabulary test (MERVT). The questionnaire assessed by parents or guardians answered the questionnaire; vocabulary tests were evaluated by children accompanied with audiologists. Patients were assessed before operation and in 2 years after switch-on.@*RESULT@#With the rehabilitation, early post-operative vocabulary development gradually improved. The vocabulary increased with an increase in the duration of CI use, and the receptive vocabulary developed earlier than the expressive ones.@*CONCLUSION@#After 2 years of CI use, the child partly developed the vocabulary capability. Children's vocabulary test, CCDI and MERVT test, is an important index to evaluate the development of children's language ability after cochlear implantation. Vocabulary test, together with auditory and speech perception assessment procedures, constitute a more complete auditory-speech-language evaluation system for Chinese children after cochlear implants.

Study of auditory brainstem response to speech sounds in sex differences / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the electrophysiological characteristics of the Auditory Brainstem Response to Speech Sounds (s-ABR) in healthy adults, and then analyze its relationship between noise speech recognition ability and sex.@*METHOD@#We accessed the auditory brainstem response to a synthesized stop-consonant speech syllable / da/in 40 native-Chinese speech adults. Timing components of the response were compared between males and females to determine which aspects of the response are affected by sex. The relationship of the slope between the onset peak (V) and though (A) (V/A slope) and the noise speech recognition ability was analyzed.@*RESULT@#A dissimilarity between males and females was observed in the response to the component that change rapidly over time(P 0.05). Noise speech recognition and the V/A slope was negatively correlated (r = 0.478, P < 0.05), which indicated that the greater slope of V/A, the lower of the speech recognition threshold under noise.@*CONCLUSION@#The verbal components change rapidly over time, and high-frequency consonants evoked neural response obviously affected by gender. In the slower changing, lower frequency information in the stimulus was minimally affected by sex. The subjects with better abilities of processing transient and rapid information can show lower noise speech recognition threshold.

Application of electrocochleography and ABR in the diagnosis of auditory neuropathy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze and compare the clinical application of alternating click evoked electrocochleography (ECochG) and auditory brainstem response (ABR) in the diagnosis of auditory neuropathy (AN) subjects.@*METHOD@#ECochGs and ABRs were recorded in 16 patients (32 ears) with AN/AD as AN group and 20 patients (26 ears) with sensorineural hearing loss(SNHL) as control group. Test stimuli were alternating polarity clicks. (1) To compare the occurrence rate of ECochGs and ABRs in AN patients. (2) To compare the peak latency of CAPs, absolute amplitude of CAPs, and amplitude ratios of -SP and CAP between AN group and control group.@*RESULT@#ECochGs (--SPs or CAPs) presented in 78.1% (25 among 32 ears) of AN patients. CAPs latency of AN group was shorter than control group (P < 0.05), CAP absolute amplitude of AN group was lower than normal group (P < 0.05), while --SP/CAP was higher than control group (P < 0.01). Deformed ABRs presented in only 5 ears among 32 tested AN ears, while relative good ABR waveforms were evoked in control group. The occurrence rate of ABRs (15.6%) was significantly lower than that of ECochGs in AN patients (P < 0.01).@*CONCLUSION@#Both ECochGs and ABRs play important role in the diagnosis of AN. The capacity of temporal processing is significantly impaired while the intensity perception related capability is intact in AN patients.

Test-retest Reliability Study in Hearing Loss Group of 18 Mandarin Monosyllable Lists with Equivalency in Audibility / 听力学及言语疾病杂志

Objective To evaluate Test-retest reliability of Mandarin monosyllable lists with equivalency in audibility in hearing loss group. Methods Mandarin monosyllable lists were used to test 18 adults with moderate-to-severe sensorineural hearing loss. Each people was tested twice with an interval of several days and with same test conditions including same lists order, same presentation level, and same tester. List number to begin with was different between people. All test lists for one patient were presented by 30 dB above his hearing threshold levels. Recognition scores were recorded in both tests. The results were analyzed using SPSS. Results Pearson product-moment correlation between the scores of two tests was 0. 931 (P<0. 001). The average critical difference was 16.3 % at the 95 % confidence level after the scores transformed into "rationalized" arcsine unit (RAU). Conclusion The average critical difference is 16. 3% at the 95% confidence level which is less than in the normal hearing group. All the lists have good test-retest reliability, and can be used in extensive clinical practice.

Standardized Mandarin Sentence Perception in Babble Noise Test Materials for Children / 听力学及言语疾病杂志

Objective To examine among preschool children the validity, reliability and sensitivity of a new assessment tool of Mandarin sentence recognition in babble noise, consisting of twenty-seven equivalent lists, as well as to investigate the effect of age and gender on children's speech recognition. Methods Fifty-four normalhearing children aged 4 to 6 years were recruited from Beijing and were divided into three age groups (4～, 4.5～,and 5.0～6.0 years) containing 18 children each, half boys and half girls. According to randomized split-plot design, we examined their speech recognition ability with 27 sentence-in-babble-noise lists in a sound-treated booth in a kindergarten (ambient noise ＜40 dB). The sentences were presented at fixed intensity of 65 dB SPL, paired with competing babble noise at three different signal to noise ratios (SNR= +1, -2, -5 dB) by the same loudspeaker with 0° azimuth. Speech recognition score were calculated based on the children's repetition of keySNR functions exhibited that the threshold was -1.96±0. 19 dB SNR and the slope was 15.8%±1.1%/dB for of variance and Post- Hoc Scheffe test indicated that significant differences in performance were most pronounced between the 4～ year group and the other two groups (P＜0.001), while there was no significant difference between 4.5～ year group and 5.0～6. 0 year group (P=0. 90). The girls' performance was also significantly better than boys' (P＜0. 001). Conclusion The 27 lists of Mandarin speech recognition in babble noise were equivalent among children, and the sensitivity of performance versus SNR was 15.8%/dB. Both of them were below the adult averchildren aged 4.5～ up years. Even though the performance differed between boys and girls, the difference was relatively small compared to 24.6%, the critical difference as the reliability indicator.

Meniere's disease in the elderly / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To focus on the prevalence of rare Meniere's disease in the elderly(> or = 60 yrs) and to investigate its clinical characteristics.@*METHOD@#To observe the elderly with Meniere's disease from 2004-01-2007-7 and to investigate its clinical manifestation, electrocochleography (ECoG), vestibular evoked myogenic potential (VEMP), caloric test and pure tone audiogram.@*RESULT@#There were 13 cases of Meniere's disease in the elderly. And the prevalence of Meniere's disease was 2.22% (13/586). The initial symptoms were as following: 2 cases with cochlear and vestibular symptoms, 9 cases with mere cochlear symptoms, 1 cases with mere spinning vertigo and 1 case with mere drop attack. The audiogram in the elderly were varied: low and high frequency hearing loss, flat, and high-frequency hearing loss. And the high frequency hearing loss had no relation with the duration of Meniere's disease. The results of vestibular function were varied. The percentage of positive result of ECoG was 63.6% (7/11, 2 cases not determined).@*CONCLUSION@#The prevalence of Meniere's disease in children was 2.22%. The initial symptoms was cochlear and vestibular symptoms, mere cochlear symptoms, mere spinning vertigo and mere drop attack, respectively. The audiogram showed prominent high frequency hearing loss. The percentage of positive result of ECoG was high. And the results of vestibular function tests were varied.

Differential diagnosis between vertigo of posterior circulation ischemia and migrainous vertigo / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze two groups of patients with migrainous vertigo (MV )and vertigo resulting from posterior circulation ischemia (PCIV) and investigate the differential diagnosis between them.@*METHOD@#There were 60 patients with MV and 64 patients with PCIV. Clinical tests include high risk factors of posterior circulation ischemia (PCI), cerebral MRI, ocular motion and high stimulating rate ABR.@*RESULT@#Among 64 patients with PCIV, 29 had abnormal blood pressure and 14 had abnormal blood fat and/or pathoglycemia; 37 had abnormality in cervical vascular ultrasound; 14 suffered from amaurosis or dizziness upon fast getting up. Twenty two had abnormal high stimulating rate ABR and 4 had cerebral lacunar infarction in MRI. As for 60 patients with MV, 45 suffered from motion sickness; 20 were sensitive to motion; 32 had photophobia and (or) phonophobia; 45 had migraine; 16 had abnormal ocular motion function; 3 had abnormal cerebral MRI and 40 had abnormal results in high stimulating rate ABR. The percentage of abnormal high stimulating rate ABR in MV and PCIV were 53% (22/42) and 67% (40/60) respectively.@*CONCLUSION@#The mean age of MV is younger than that of PCIV. Female is more prone to MV than male (2.75 : 1. 00); the sex difference in PCIV is lesser (1.46 : 1.00). Motion sickness, motion sensitivity, photophobia and (or) phonophobia are principal differential highlights to MV. The major characteristics of PCIV include abnormal blood pressure, abnormal blood fat, pathoglycemia and arteriosclerosis. Vestibular function tests could not serve as a differential point; Cerebral MRI might be helpful to differential diagnosis. The results of high stimulating rate ABR is not a differential point between PCIV and MV, but it might play a role in differentiating other kinds of vertigo.