[Application of reverse traction device in preoperative treatment of high-energy tibial plateau fracture].

Objective: To investigate the effectiveness of the reverse traction device in the preoperative treatment of high-energy tibial plateau fractures. Methods: A retrospective study was conducted to analyze the clinical data of 33 patients with high-energy tibial plateau fractures who met the selection criteria between December 2020 and December 2023. All patients were treated by open reduction and internal fixation. According to the preoperative traction method, they were divided into the observation group (16 cases, treated with a reverse traction device on the day of admission) and the control group (17 cases, treated with heel traction on the day of admission). There was no significant difference in baseline data such as gender, age, body mass index, affected side, cause of injury, fracture Schatzker classification between the two groups ( P>0.05). Preoperative waiting time, preoperative related complications (nail channel loosening, nail channel oozing, nail channel infection, soft tissue necrosis, soft tissue infection, deep vein thrombosis of the lower extremity, etc.), operation time, and total hospitalization time were recorded and compared between the two groups. On the 4th day after traction, visual analogue scale (VAS) score was used to evaluate the pain relief of the patients, the swelling value of the affected limb was measured, and the Immobilization Comfort Questionnaire (ICQ) score was used to evaluate the perioperative hospital comfort of the patients. Results: Both groups of patients completed the operation successfully, and the operation time, total hospitalization time, and preoperative waiting time of the observation group were significantly less than those of the control group ( P<0.05). There was no preoperative related complications in the observation group; in the control group, 3 patients had nail channel loosening and oozing, and 2 cases had the deep vein thrombosis of the lower extremity; the difference in the incidence of complication between the two groups was significant ( P<0.05). On the 4th day after traction, the ICQ score, VAS score, and limb swelling value of the observation group were significantly better than those of the control group ( P<0.05). X-ray films showed that the tibial plateau fracture separation and lower limb alignment recovered after calcaneal traction in the control group, but not as obvious as in the observation group. The fracture gap in the observation group significantly reduced, the tibial plateau alignment was good, and the lateral angulation deformity was corrected. Conclusion: The use of reverse traction treatment in patients with high-energy tibial plateau fractures on admission can accelerate the swelling around the soft tissues to subside, reduce patients' pain, shorten the preoperative waiting time, improve the patients' preoperative quality of life, and contribute to the shortening of the operation time, with a good effectiveness.

Prediction of behavioral MCL using electrophysiological responses in children using MED-EL implant.

The present study aimed to correlate the various electrophysiological tests of ECAP, EABR and ESRT with programming parameters. If there is a correlation between them, fitting formulae to be derived to predict programming parameters. Further this fitting formula was validated on a clinical population. 22 children between age range of 5-12 years using MED-EL implant participated study. Electrophysiological tests of Electrically evoked compound Action Potential (ECAP), Electrical Evoked Stapedial Reflex Threshold (ESRT) and Electrically Evoked Auditory Brain Stem Responses (EABR) were measured on electrodes no 1,4, 8, and 11. Based on Pearson correlation analysis, there was a moderate correlation observed between each of electrophysiological tests with MCL level. Fitting formulae of ECAP with either ESRT or EABR were found to be accurately predict the MCL level. These fitting formulae were clinically validated on 6 children using Sonata implant with OPUS 2 processor. Two new programs with MCL were predicted using combination of ECAP with EABR and ECAP with ESRT as parameters in the fitting formulae. These programs were given to the participants to use for two weeks. Predicted MCLs were found to slightly higher (about 2qu to 5qu) than original MCL level. Reliability analysis indicated that the formulae predicted MCL with good accuracy. Speech perception and sound field thresholds were measured in the participants' Everyday program and two predicted programs. When ECAP & EABR were the parameters, the predicted program had improved audibility as reflected in sound field thresholds as compared to those obtained with other two programs. Based on Freidman test, the results indicated that significantly lower thresholds were found for both ECAP & EABR, or ECAP & ESRT based programs when compared to Everyday program. However, speech perception scores were not significantly different among the program as per Freidman test. Thus, both the fitting models were clinically validated. The findings imply that it is not always advisable to run all three electrophysiological testing to predict the MCL levels in clinical population. It would save lot of time to run just two tests to predict the MCL in difficult to test population.

The effect of cochlear implant age and duration of intervention on ESRT in children with cochlear implant.

OBJECTIVE: To study the effect of cochlear implant age and duration of the intervention (auditory rehabilitation post-cochlear implantation) on ESRT in children with cochlear implants. METHODS: A total of 90 pre-lingual cochlear implant users were included. For the measurement of ESRTs the recipient's processor was connected to the programming pod and electrode numbers 22, 11 and 3 (apical, middle and basal), respectively, were activated to give stimulation sequentially and elicit deflection as a response. RESULTS: There were significant differences in the measured T, C and ESRT levels with respect to the duration of the intervention (auditory rehabilitation post-cochlear implantation) and cochlear implant age obtained at p < 0.05*, 0.01**. DISCUSSION: The differences in the T, C and ESRT levels after continued device usage and after attending auditory rehabilitation sessions post-cochlear implantation are subjected to optimal benefit from implantation during the critical period. CONCLUSION: The differences in T, C and ESRT levels can be utilised clinically to study the importance of duration of cochlear implant device usage and the importance of auditory rehabilitation post-cochlear implantation in children with cochlear implantation.

Influence of Speech Recognition Ability on Acceptable Noise Level for Mandarin (Chinese) Speakers with Normal Hearing.

INTRODUCTION: Noise can induce hearing loss and reduce speech understanding. The Acceptable Noise Level (ANL) test has been widely used in audiology. However, strategies used by listeners to determine ANLs are unclear. The current study evaluated the role of speech recognition in selecting ANL and how well ANL could predict speech understanding in a noisy situation. METHODS: Forty-five Mandarin speakers with normal hearing were tested in both ears. ANL is defined as Most Comfortable Level (MCL) minus Background Noise Level (BNL). To obtain ANL monaurally with an earphone, the study measured participants' MCL to hear a Mandarin story in quiet and the maximum BNL to tolerate while following the story. Then, based on the participant's ANL, speech recognition in noise was examined using a set of phonemic-balanced Mandarin words. The signal-to-noise ratio (SNR) was adjusted to ANL, ANL - 10 dB ("degraded noise condition"), and ANL + 10 dB ("improved noise condition"). RESULTS: The mean ANLs were 2.4 dB and 2.6 dB for the left and right ears, respectively. The mean speech recognition with SNR adjusted to ANL was relatively high for both ears (81-83% correct). Even for those ear samples with very low ANL (<0 dB), speech performance obtained at SNR = ANL was still high. The mean speech recognition obtained at SNR = ANL was 5 percentage points lower than the mean speech recognition at the improved noise condition and 14 percentage points higher than the mean speech recognition at the degraded noise condition. Speech recognition obtained at SNR = ANL and ANL - 10 dB correlated significantly with ANL. CONCLUSION: Speech recognition in noise appears to play an important role for listeners with normal hearing in deciding their ANLs. Additionally, ANL can predict speech performance (r-squared = 53-61%) in the degraded noise condition.

Direct Elicitation of Cortical Auditory Evoked Potentials by Electrical Stimulation and Their Use to Verify the Most Comfortable Level of Stimulation in Cochlear Implant Users.

INTRODUCTION: This study was designed to investigate the use of electrically evoked cortical auditory evoked potentials (eCAEPs) as a tool for cochlear implant (CI) verification, the relationships between the site and intensity of stimulation and the detection rates and morphologies of eCAEPs as well as investigate whether correlations exist between the morphologies of eCAEPs and speech perception in quiet and in noise, duration of hearing loss, age at implantation, whether the hearing loss bilateral or single-sided and the electrode current level required to elicit MCL stimulation. METHODS: 32 adult unilateral CI users with postlingual hearing loss were enrolled. The stimuli were 1 kHz biphasic alternating pulses and were presented at either the behaviorally measured MCL or 50% of this value (MCL0.5) via the CI fitting software. Pulses were directed to apical, medial, or basal electrodes. CAEPs were recorded from a scalp electrode placed at the vertex, low forehead, and contralateral mastoid and were evaluated by two electrophysiologists. RESULTS: Overall, eCAEPs could be detected in 31/32 users when stimulating at MCL, and in 29/32 users when stimulating at MCL0.5. The detection rates were 31, 31, and 28/32 for apical, medial, and basal stimulation at MCL, and 29, 29, and 26/32 at MCL0.5. Significant differences in eCAEP amplitudes and latencies were observed across electrodes and stimulation levels. No significant correlations were found between eCAEP latencies and amplitudes and user age, duration of deafness prior to CI surgery, or with bilateral versus single-sided hearing loss, nor with the charge level required to elicit MCL, or with speech perception scores in quiet. Peak latencies correlated with speech perception scores in some configurations of speech-in-noise. CONCLUSION: eCAEPs can readily be elicited in the majority of adult CI users and show normal waveform characteristics at stimulation levels corresponding to MCL, as well as at basal, medial, and apical electrode stimulation sites. Neither the latencies nor amplitudes of eCAEPs are confounded by variables of age, duration of deafness prior to CI surgery, or the laterality of hearing loss. eCAEPs are a useful, objective method evaluate sound perception in CI users.

Evaluation of performance of hearing aid users using Acoustic Change Complex (ACC) and behavioral measures.

OBJECTIVE: To validate the clinical use of Acoustic Change Complex (ACC) as an objective tool in children who use hearing Aids and explore how far ACC response parameters could be correlated to behavioral tests. METHOD: Sixty Arabic speaking children, using binaural Hearing Aids (H.As), participated in the present study. Their age ranged from 6 to 12 years. Evaluation of Hearing aid device performance was performed through questionnaire, speech in noise tests and aided/unaided ACC recordings. Two stimuli '' vowel/o/with SNR (0 &+8) ''were developed and standardized to elicit ACC response. The replicated ACC waveforms were collected and analyzed and the aided ACC responses were compared with unaided ACC and correlated to behavioral tests. RESULTS: The ACC percent identification in children using H.As using vowel/o/with SNR (+8 & 0) stimuli was 75% and 45% respectively in aided condition, the percent decreased to 40% and 15% in unaided condition. Speech in noise stimuli showed significant difference of ACC-N1 latency between the aided and unaided groups being longer in the unaided condition. The correlations between behavioral tests and ACC response (latency and amplitude) were irrelevant. CONCLUSIONS: Hearing-impaired subjects can process speech stimulus at the level of the auditory cortex, and in a more effective manner when they used their H.As. ACC can be used as an objective measure for selective auditory attention ability using vowel-in-noise. However, it couldn't replace Behavioral measures.

Application of Multiplanar Volume Reconstruction Technique for the Assessment of Electrode Location and Analysis of the Correlation to Cochlear Programming and Performance in Common Cavity Deformity.

Purpose: Owing to the characteristic anatomy, cochlear implantation (CI) for common cavity deformity (CCD) has resulted in varied outcomes and frequent facial and vestibular nerve stimulation. The current study analyzed the correlation among the distance between each electrode and cavity wall (abbreviation, D), programming parameters, and performances outcomes. Materials and Methods: The current, retrospective study included 25 patients (27 ears) with CCD underwent CI. The multiplanar volume reconstruction (MPVR) techniques were employed to reconstruct and evaluate the postoperative temporal bone CT. The D and maximum comfortable level (MCL) 6 months after CI, facial and vestibular nerve stimulation, and outcomes 1, 2, and 3 years after CI pertaining to the questionnaires were documented and analyzed. Results: The patients were divided into symptomatic (10, 37%) and asymptomatic (17, 63%) groups according to with or without facial and vestibular nerve stimulation. The MCL pertaining to the symptomatic group was significantly lower than asymptomatic group, but Categories of Auditory Performance (CAP) scores 1 year after surgery was better (p < 0.05). The subjects were divided into flat (12, 44.4%) and curved (15, 55.6%) groups based on the contour of MCL map. The MCL and D were lower and shorter in the curved group than the flat group, and CAP score 1 year after surgery and Speech Intelligibility Rating (SIR) 3 years after surgery were better (p < 0.05). Conclusion: Although abnormal reactions such as facial and vestibular nerve stimulation were observed to be more frequent, lower MCL and better outcomes were observed in relation to the shorter D.

Electrode impedance changes over time in MED El cochlear implant children recipients: Relation to stimulation levels and behavioral measures.

Objective: Electrode impedance measures resistance encountered by electric current passing through wires, electrodes and biological tissue. This study was designed mainly to evaluate changes in electrode impedance values and psycho-electric parameters changes (i.e. threshold levels, comfortable levels, and dynamic range) in cochlear implant patients over time. Methods: It was a prospective study encompassing 20 patients implanted by MED-EL device programd using behavioral programs. Electrical stimulation levels and electrode impedance values were examined at 0, 1, 3 and 6 months after the first fitting session. Results: Electrode impedance values were reduced from the time of activation to the 6 months visit. Most comfortable levels increased and dynamic range widened until the 6 months visit. There was an inverse correlation between impedance values and most comfortable level as well as dynamic range, over time. Conclusion: Frequent monitoring of electrode impedance (for device and electrodes problems) and electric stimulation levels (for better performance, mapping and habituation) during the first 6 months of implant use is recommended.

Mapping of Paediatric Cochlear Implant Using Neural Response Threshold (NRT) and Behavioural Observation Audiometry (BOA).

To measure the correlation between neural response threshold (NRT) and most comfortable level for behavioural response (MCLB) whichever is better for rehabilitation purpose and to calculate the impedance of the electrode in cochlear implant recipient. Mapping may be done by various methods here we did by NRT and behavioral observation audiometry (BOA). NRT is technique by which we measure the response from the auditory nerve using the hi-resolution bionic ear system. Neural response measurement depends on the-neural tissue, stimulus used and recording technique. BOA is used for observing motor response on presenting sound to the implanted child. Most comfortable level for behavioural response (MCLB) is calculated for behavioural response. It measures the useful information about low frequency hearing, it provides more information about the hearing of neurologically immature babies giving indication of uncomfortable loudness levels. The NRT and MCLB is calculated for 2nd, 6th, and 11th electrode for all patients in our study. Auditory response threshold is better for rehabilitations then behavioural observation audiometry for Cochlear implant patients. Mean value and standard deviation of neural response threshold (NRT) (qu) are 10.23, 3.67; 11.27, 4.39; 10.71, 3.88 at 2nd, 6th, and 11th electrode respectively. Mean value and standard deviation of Most comfortable level for behavioral response (qu) are 20.49, 7.08; 21.26, 7.31; 21.01, 6.03 at 2nd, 6th and 11th electrode respectively. NRT is better for post-operative rehabilitations and MCL and threshold vary with different electrode and in different patients.

Effect of noise tolerance on non-restorative sleep: a population-based study in Hong Kong.

OBJECTIVE: The aim of this study was to assess the impact of auditory noise tolerance on non-restorative sleep using an objective audiometric test in a representative sample. DESIGN: A total of 202 Chinese individuals aged 15 years and above were recruited from a population-based household survey. Their non-restorative sleep was assessed by a single item, the degree of feeling refreshed on waking up, on a 0-10 scale, while noise tolerance was measured by the most comfortable level expressed in A-weighted decibels. RESULTS: The 202 individuals (106 women) had a mean degree of feeling refreshed on waking up of 6.5 on the 0-10 scale and a mean maximum comfortable sound level of 69.2 dB. A multivariable analysis showed that a 1 dB increase in noise tolerance was associated with a 0.1-unit increase in the degree of feeling refreshed after adjusting for age, education, marital status, occupation, exercise, smoking, alcohol consumption, household noise level, stress, anxiety and depression. Moreover, housewives, non-smokers and individuals who were less anxious or stressed felt significantly more refreshed on waking up. CONCLUSION: People with higher levels of noise tolerance experienced more refreshing sleep. Additional clinical consideration of enhancing noise tolerance in patients with sleep complaints is needed.

Comparison of Acceptable Noise Levels Using Korean and Non-Semantic Speech Signals in Normal Hearing Subjects / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The acceptable noise level (ANL) test measures the maximum noise level that a subject can tolerate while following speech. Given the limited investigation of ANL across different languages, this study aimed to compare ANLs using both Korean semantic speech and non-semantic speech signals (reversed Korean speech and international speech test signal, ISTS) in normal-hearing subjects. SUBJECTS AND METHOD: Twenty-five subjects with normal hearing (9 males, 16 females, with the mean age of 28.5±3.15 years) were included in the study. ANLs were obtained using three speech materials (Korean speech, reversed Korean speech, and ISTS) as the target speech material and an eight-talker babble noise as the competing background noise. RESULTS: Generally, the inter-subject variability was large. The ANLs did not differ statistically regardless of the type of speech signal. CONCLUSION: The ANLs seemed to be unaffected by the meaningfulness or semantic contents of the target speech, at least in normal-hearing adults. Thus, non-meaningful speech signals or non-semantic material can be considered as the target signal for the implementation of ANL test.

Electrophysiological Correlates of Behavioral Comfort Levels in Cochlear Implantees: A Prospective Study.

Indications for cochlear implantation have expanded today to include very young children and those with syndromes/multiple handicaps. Programming the implant based on behavioral responses may be tedious for audiologists in such cases, wherein matching an effective MAP and appropriate MAP becomes the key issue in the habilitation program. In 'Difficult to MAP' scenarios, objective measures become paramount to predict optimal current levels to be set in the MAP. We aimed, (a) to study the trends in multi-modal electrophysiological tests and behavioral responses sequentially over the first year of implant use, (b) to generate normative data from the above, (c) to correlate the multi-modal electrophysiological thresholds levels with behavioral comfort levels, and (d) to create predictive formulae for deriving optimal comfort levels (if unknown), using linear and multiple regression analysis. This prospective study included ten profoundly hearing impaired children aged between 2 and 7 years with normal inner ear anatomy and no additional handicaps. They received the Advanced Bionics HiRes 90K Implant with Harmony Speech processor and used HiRes-P with Fidelity 120 strategy. They underwent, Impedance Telemetry, Neural Response Imaging, Electrically Evoked Stapedial Response Telemetry and Electrically Evoked Auditory Brainstem Response tests at 1, 4, 8 and 12 months of implant use, in conjunction with behavioral Mapping. Trends in electrophysiological and behavioral responses were analyzed using paired t test. By Karl Pearson's correlation method, electrode-wise correlations were derived for NRI thresholds versus Most Comfortable Levels (M-Levels) and offset based (apical, mid-array and basal array) correlations for EABR and ESRT thresholds versus M-Levels were calculated over time. These were used to derive predictive formulae by linear and multiple regression analysis. Such statistically predicted M-Levels were compared with the behaviorally recorded M-Levels among the cohort, using Cronbach's Alpha Reliability test method for confirming the efficacy of this method. NRI, ESRT and EABR thresholds showed statistically significant positive correlations with behavioral M-Levels, which improved with implant use over time. These correlations were used to derive predicted M-Levels using regression analysis. Such predicted M-Levels were found to be in proximity to the actual behavioral M-Levels recorded among this cohort and proved to be statistically reliable. When clinically applied, this method was found to be successful among subjects of our study group. Although there existed disparities of a few clinical units, between the actual and predicted comfort levels among the subjects, this statistical method was able to provide a working MAP, close to the behavioral MAP used by these children. The results help to infer that behavioral measurements are mandatory to program cochlear implantees, but in cases where they are difficult to obtain, this study method may be used as reference for obtaining additional inputs, in order to set an optimal MAP. The study explores the trends and correlations between electrophysiological tests and behavioral responses, recorded over time among a cohort of cochlear implantees and provides a statistical method which may be used as a guideline to predict optimal behavioral levels in difficult situations among future implantees. In 'Difficult to MAP' scenarios, following a protocol of sequential behavioral programming, in conjunction with electrophysiological correlates will provide the best outcomes.

Analysis of Debugging Results in Congenital Deaf Children after Cochlear Implantation / 中国医科大学学报

Objective To investigate the changes of electrode impedance,threshold(THR),maximum comfortable level(MCL),and dynamic range(DR),providing the basis for debugging after operation in congenital deaf children. Methods A respective study was carried out on 20 cases of congenital deaf children who were implanted with cochlear Med?EL SONATAti100. The measurements and changing ranges of electrode imped?ances,THR,MCL and dynamic range during the operation and at postoperative one month,three months,and six months were statistically analyzed. Results Electrode impedances were the lowest during the operation and the highest at one month after operation(P0.05). Conclusion The electrode impedances varied due to different electrode posi?tion. The vales of THR,MCL and DR were unrelated with electrode impedance. DR was gradually increasing,MCL reached steady state earlier than THR. It is important that THR should be debugged at three months after operation and MCL should be debugged at six months.

The effect of repeated measurements and working memory on the most comfortable level in the ANL test.

OBJECTIVE: To study the effect of a large number of repetitions on the most comfortable level (MCL) when doing the acceptable noise level (ANL) test, and explore if MCL variability is related to central cognitive processes. DESIGN: Twelve MCL repetitions were measured within the ANL test using interleaved methodology during one session using a non-semantic version. Phonological (PWM) and visuospatial working memory (VSWM) was measured. STUDY SAMPLE: Thirty-two normal-hearing adults. RESULTS: Repeated measures ANOVA, intraclass correlations, and the coefficient of repeatability (CR) were used to assess the repeatability. Repeated measures ANOVA and CR indicated poor agreement between the two first repetitions. After excluding the first repetition, analyses showed that the MCL in the ANL test is reliable. A negative association was found between PWM and MCL variability indicating that subjects with higher PWM show less variability. CONCLUSIONS: The findings suggest that, after excluding the first repetition, the MCL in the ANL test is reliable. A single repetition of the MCL in the ANL test should be avoided. If an interleaved methodology is used, a single ANL repetition should be added prior to the actual testing. The findings also suggest that MCL variability is associated to PWM but not VSWM.

A clinical study of electrophysiological correlates of behavioural comfort levels in cochlear implantees.

OBJECTIVES: Indications for cochlear implantation have expanded today to include very young children and those with syndromes/multiple handicaps. Programming the implant based on behavioural responses may be tedious for audiologists in such cases, wherein matching an effective Measurable Auditory Percept (MAP) and appropriate MAP becomes the key issue in the habilitation program. In 'Difficult to MAP' scenarios, objective measures become paramount to predict optimal current levels to be set in the MAP. We aimed to (a) study the trends in multi-modal electrophysiological tests and behavioural responses sequentially over the first year of implant use; (b) generate normative data from the above; (c) correlate the multi-modal electrophysiological thresholds levels with behavioural comfort levels; and (d) create predictive formulae for deriving optimal comfort levels (if unknown), using linear and multiple regression analysis. METHODS: This prospective study included 10 profoundly hearing impaired children aged between 2 and 7 years with normal inner ear anatomy and no additional handicaps. They received the Advanced Bionics HiRes 90 K Implant with Harmony Speech processor and used HiRes-P with Fidelity 120 strategy. They underwent, impedance telemetry, neural response imaging, electrically evoked stapedial response telemetry (ESRT), and electrically evoked auditory brainstem response (EABR) tests at 1, 4, 8, and 12 months of implant use, in conjunction with behavioural mapping. Trends in electrophysiological and behavioural responses were analyzed using paired t-test. By Karl Pearson's correlation method, electrode-wise correlations were derived for neural response imaging (NRI) thresholds versus most comfortable level (M-levels) and offset based (apical, mid-array, and basal array) correlations for EABR and ESRT thresholds versus M-levels were calculated over time. These were used to derive predictive formulae by linear and multiple regression analysis. Such statistically predicted M-levels were compared with the behaviourally recorded M-levels among the cohort, using Cronbach's alpha reliability test method for confirming the efficacy of this method. RESULTS: NRI, ESRT, and EABR thresholds showed statistically significant positive correlations with behavioural M-levels, which improved with implant use over time. These correlations were used to derive predicted M-levels using regression analysis. On an average, predicted M-levels were found to be statistically reliable and they were a fair match to the actual behavioural M-levels. When applied in clinical practice, the predicted values were found to be useful for programming members of the study group. However, individuals showed considerable deviations in behavioural M-levels, above and below the electrophysiologically predicted values, due to various factors. While the current method appears helpful as a reference to predict initial maps in 'difficult to Map' subjects, it is recommended that behavioural measures are mandatory to further optimize the maps for these individuals. CONCLUSION: The study explores the trends, correlations and individual variabilities that occur between electrophysiological tests and behavioural responses, recorded over time among a cohort of cochlear implantees. The statistical method shown may be used as a guideline to predict optimal behavioural levels in difficult situations among future implantees, bearing in mind that optimal M-levels for individuals can vary from predicted values. In 'Difficult to MAP' scenarios, following a protocol of sequential behavioural programming, in conjunction with electrophysiological correlates will provide the best outcomes.

A Study of Clinical Feasibility of Acceptable Noise Level Test / 听力学及言语疾病杂志

Objective To observe the clinical feasibility of the acceptable noise level (ANL) test ,analyze the effect of different test instructions to the result of Mandarin acceptable noise level test .Methods Twelve young peo-ple (24 ears) with normal pure-tone test and acoustic immittance test (threshold≤15 dB HL) were included in this study .They were randomly divided into two groups with 12 ears in each group .Group A received the same test in-struction firstly and then received different instructions depended on the different translation of English instruction by tester .Group B received the reverse test order .The acceptable noise level(ANL) ,most comfortable level(MCL) and back groud noise level(BNL) were analyzed .Results The average value of ANL was 7 .5 ± 6 .61 and 8 .29 ± 6 .54 dB SPL ;the average value of most comfortable level (MCL) was 83 .58 ± 8 .57 and 85 .41 ± 8 .89 dB SPL ;the average value of background noise level (BNL) were 78 .92 ± 10 .56 and 77 .13 ± 7 .91 dB SPL respectivoly .The difference of MCL ,BNL ,ANL in these two groups were not statistically significant (P>0 .05) .Test method 1 re-sulted in great individual differences in ANL ,which it ranged from -6 .4 to 20 .12 dB S/N .While ANL from test method 2 ranged from 2 .50~20 .12 dB S/N .Conclusion Different test instruction do not correlated to the results of acceptable noise level ,testers can translate the English instruction by different ways so that it is convenient to the application and clinical research of ANL test .

The Effects of Cochlear Implantation on Children with Large vestibular Aqueduct Syndrome / 听力学及言语疾病杂志

Objective The purpose of this study is to compare the most comfortable levels and neural re-sponse imaging threshold between children of cochlear implants with large vestibular aqueduct syndrome and normal inner ears. Methods Thirty-eight implanted children participated in this study and were divided into two groups. Group A consisted of 32 patients with normal inner ears and group B 6 patients with radiographically proven large vestibular aqueduct syndrome. All of the patients were the recipients of the cochlear implants by Advanced Bionics. The initial time for the first programming session was approximately one month after surgery. The psychophysical tests included M- level tests. Programming techniques used in the test were suitable for the age of patients. Sound-Wave 1.4 software was used to test tNRI. Results Using the rank sum test, M-level and tNRI of electrode 3,7,11 and 15 did not differ significantly between group A and B(P>0. 05). Conclusion The parameters of mapping are not significantly different between the implanted children with large vestibular aqueduct syndrome and normal inner ear. The management and procedures of mapping used to the subjects with normal inner ear can be applied to the children with large vestibular aqueduct syndrome.

Comparative Study of Multi-channel Cochlear Implanted Patients Using SPrint Speech Processor With Using ESPrit Speech Processor / 听力学及言语疾病杂志

Objective To find out the difference in Multi-channel Cochlear mapping between SPrint speech processor and ESPrit speech processor (ESPrit 3G) for better guidance of the mapping.Methods Nine cases of total deafness patients (aged 2-54 years old) using SPrint changed to using ESPrit 3G after 6 to 24 months. The threshold (T-L) of electro-audiogram using different speech processor, comfortable level, sound field audiometry in various ESPrit 3G programs and questionnaire results were compared and analyzed statistically.Results Using various speech processor programs, four patients(The first group) felt satisfied with hearing effects. There was no difference comparing with SPrint. There was significantly different in T-L and C-L acquired from five patients(The second group) with two speech processors (P0.05). The results of sound field audiometry showed significant difference in the first group and the second group using programs from SPrint(P

Most Comfortable Listening Level and Speech Attenuation by Hearing Protectors.

Hearing protectors attenuate both the background noise and the useful sounds embedded in noise such as the sounds of speech and warning signals. An effective hearing protector is one that attenuates background noise while leaving sufficient energy of speech and warning signals to reach the ear of the worker. At present, however, there are no established criteria for assessing effective change in speech-to-noise ratio caused by hearing protection devices (HPDs). One such criterion could be a change in most comfortable (listening) level (MCL) for speech caused by the presence of HPDs. In this study the HPD-related shift in MCL for speech presented in quiet was measured and compared with two measures of noise attenuation: Noise Reduction Rating (NRR) and high-medium-low (H-M-L). The results indicate that the MCL shift may be a sensitive measure of speech attenuation by HPDs, which together with the appropriate H-M-L may describe technical properties of HPDs.