Factors Affecting Visual-Only Speech Recognition in Individuals With Cochlear Implants.

Objectives: Several reports have underlined the benefits of speechreading (visual-only speech recognition) on speech recognition in individuals with hearing loss after cochlear implantation (CI). However, the factors that would affect the ability of speechreading are unclear. The aim of the present study is to assess the factors that affect speechreading abilities in CI users. Methods: A total of 104 participants were enrolled in this retrospective study. They viewed silent videos of sentences being spoken by a model and were tasked with repeating what they thought had been said. They were tested under audio-only and visual-only conditions. Factors (such as the age, the age of CI; <3 years old vs 3-8 years old; male vs female, etc) believed to affect speechreading abilities were analyzed. Results: The age range of the participants is 8 to 34 years. CI users showed significantly different speechreading abilities among themselves. The authors found that age and hearing loss at 3 to 8 years of age were positively related to superior speechreading recognition scores. Conclusions: CI users followed a more complex method of perceptual compensation. Those who have suffered hearing loss between 3 and 8 years of age are more sensitive to developing an advantage in speech recognition by using speechreading. Older age positively affects speechreading abilities; thus, the more experience CI has, the greater speechreading ability they may exhibit.

Preoperative EABR evaluation of auditory pathway integrity in patients with different etiology and postoperative effect estimation.

OBJECTIVES: To evaluate the effect of electrical auditory brainstem response (EABR) on the integrity evaluation of auditory pathway and the prediction of postoperative effect of cochlear implantation in patients with different etiology of hearing loss. METHODS: A total of 580 patients with neuropathic deafness who underwent cochlear implantation surgery from August 2011 to December 2020 were selected for EABR test. The preoperative EABR waveform was analyzed, and parameters such as V wave amplitude, threshold, latency and interval of each wave, and slope of V wave I/O curve were measured. Neural response telemetry (NRT) test was performed during MAP 1 month after operation, and C and T values of the machine were recorded. RESULTS: The total EABR extraction rate was 98.45% among 580 patients, including 100% for the normal structure group and enlarged vestibular aqueduct group (LVAS), 92.44% for other malformed group. The average threshold of V wave in patients with normal cochlear structure was significantly better than the malformation groups (p < 0.05). The total extraction rate of NRT was 78.62%, including 99.72% in the group with normal structure, 95.65% in the LVAS group, 1.85-88.24% in the group with other malformations, and 0% in the cochlear ossification group. The correlation analysis showed a statistically significant correlation between the average preoperative EABR threshold and the C value of NRT. CONCLUSIONS: Preoperative EABR could evaluate the integrity of auditory conduction pathway of patients with cochlear implantation and predict the postoperative hearing rehabilitation effect.

Evaluation of auditory pathway by EABR before cochlear implantation and the postoperative effect analysis.

OBJECTIVE: To investigate the evaluation value of electrically evoked auditory brainstem response (EABR) monitoring before cochlear implantation in patients with cochlear nerve defects (CND). METHODS: A total of 54 patients with cochlear nerve defects who underwent cochlear implantation in our hospital from 2011 to 2018 were selected as the CND group, and 20 patients with normal cochlear implantation were selected as the control group. The preoperative audiological characteristics, EABR characteristics and follow-up neural response telemetry results of the two groups were retrospectively analysed, and the preoperative EABR threshold and initiation C value were subjected to linear regression and correlation analysis. RESULTS: The EABR waveform of the CND group was significantly different from the control group in terms of average wave V threshold, average dynamic range and V-wave I/O curve slope (P < 0.05). Average C value and dynamic range had a statistically significant difference from the control group (P < 0.05). Statistically significant positive correlations were found between the EABR threshold and C value, wave V I/O slope and postoperative category of auditory perception (P < 0.05). CONCLUSIONS: The EABR test can be used to evaluate the auditory pathway function before cochlear implantation and its postoperative effect in patients with CND.

[Analysis of intraoperative EABR characteristics and postoperative efficacy of cochlear implant in patients with tinnitus].

Objective:To investigate the characteristics of intraoperative electrically stimulated auditory brainstem responses（EABR） in patients with neural deafness and tinnitus, and to analyze the inhibitory effect of cochlear implantation on tinnitus and its correlation with auditory evoked potential. Methods:Twenty-eight adult patients with neuronal deafness accompanied by tinnitus who underwent cochlear implant surgery in the Peking Union Medical College Hospital from 2014 to 2015 were selected, and 10 age-matched patients without tinnitus with the same age were selected as the control group. Preoperative audiology, imaging and tinnitus history of the patients were retrospectively analyzed. During the operation, EABR were used to detect the auditory central functions at all levels, and the electrophysiological characteristics of the two groups were analyzed. The tinnitus handicap inventory（THI） was used to evaluate the severity of tinnitus before and after surgery, and the correlation between EABR results and THI score was analyzed. Results:There were no postoperative complications such as facial paralysis, cerebrospinal fluid leakage, meningitis, etc. , and electroacoustic reactions were observed in all 38 patients. The results of intraoperative EABR showed that there were significant differences in Ⅲ wave amplitude, Ⅴ wave amplitude and Ⅴ wave latency between tinnitus group and control group（P<0.05）. The mean C value of （162.78± 24.57）CL and the mean intraoperative EABR threshold of （158.62± 10.31） CL were collected in the two groups 12 months after starting the machine, and there was a significant correlation according to linear correlation analysis（r=0.903, P<0.01）. The total THI scores of 28 tinnitus patients were 65.00±14.93, 55.00±15.93 and 36.00±21.02 at three time points before, 1 day after and 1 year after cochlear implantation, respectively. The scores of 1 year after cochlear implantation were significantly different by ANOVA（P<0.05）, but there was no statistically significant difference 1 day after operation（P>0.05）. There was significant correlation between the intraoperative EABR wave Ⅲ amplitude and the linear correlation analysis of THI changes 1 year after operation（r=0.873, P<0.05）. Conclusion:There is significant difference in intraoperative EABR between patients with neural deafness accompanied with tinnitus and patients without tinnitus. Cochlear electrical stimulation has a good inhibitory effect on tinnitus, and intraoperative EABR can be used as a objective assessment tool for cochlear implant to inhibit tinnitus.

Sequential Bilateral Cochlear Implantation With Prolonged Time Intervals.

Purpose The aim of the study was to assess whether sequential cochlear implantation (CI) with a prolonged interimplant interval (M = 15.2 years) between the first and second CIs benefited speech recognition and health-related quality of life. Method This prospective study included 14 prelingually deafened participants who received their second CI after a prolonged interimplant interval (M = 15.2 years). Additionally, speech recognition ability over a 12-month period of bilateral implant use was investigated. The results of the speech recognition test in both quiet and noisy conditions were statistically analyzed for each CI alone and both CIs together. Nijmegen Cochlear Implant Questionnaire scores were also collected at activation and at 12 months after activation. Results Improvements in speech recognition ability were observed following the use of the first implant alone and with the use of both implants together; however, progress was much slower with the use of the second implant alone, following its introduction. Furthermore, a significant difference in the trajectory of speech recognition ability was observed between the first and the second implanted ear. According to Nijmegen Cochlear Implant Questionnaire scores, all participants benefitted from bilateral CI after 12 months. Conclusions Prolonged interimplant intervals resulted in asymmetrical speech recognition abilities. A significant improvement in the speech recognition scores was observed with the first implanted ear, and much slower progress was observed with the second implanted ear. However, the "poorer" second implanted ear could provide a considerable beneficial effect on the improved speech recognition and health-related quality of life with the bilateral CI. Supplemental Material https://doi.org/10.23641/asha.12861152.

Evaluating Auditory Pathway by Electrical Auditory Middle Latency Response and Postoperative Hearing Rehabilitation.

Objective: To establish an effective detection method to evaluate auditory pathway in patients by electrical evoked middle latency response (EMLR) before artificial cochlear implantation, and to analyze the relationship between postoperative hearing rehabilitation and auditory cortex functions. Methods: Twenty-three patients with artificial cochlear implant were recruited. EMLR was measured after adjusting the depth of anesthesia. The electrical auditory brainstem response (EABR) mode with monopolar stimulation and two-phase alternating current square waves was selected. The parameters of EMLR waveforms were recorded by the EABR measurement system. Nerve response telemetry (NRT) was examined by measuring threshold level (T value) and comfortable level (C value) 1 month after power-on, and hearing and speech development was followed up 12 months later.Results: The detection rate of EMLR was 95.65%. The waveforms of EMLR were comparable to those of auditory middle latency response (AMLR), showing decreased latency and interval but similar amplitude. The induction rate of NRT was 69.23%, which was much lower than that of EMLR. The EMLR thresholds were significantly correlated to the T and C values, and were comparable to the T values numerically. The Spearman's r value between EMLR waveforms and CAP scores after using the cochlear implant for 12 months was 0.673 (P < 0.01). Conclusion: An effective detection method to measure EMLR before artificial cochlear implant was established. The thresholds of EMLR were lower than those of NRT. The method can be useful for objective evaluation of auditory cortex functions and postoperative hearing rehabilitation.

[Cochlear implantation in patients with cochlear ossification].

OBJECTIVE: To investigate cochlear implantation surgical techniques and postoperative results in patients with cochlear ossification. METHOD: Twenty-nine cochlear ossification patients with cochlear implantation in our department were retrospectively studied during 1997-2011. Preoperative imaging and electrophysiological assessment were done to classify the cochlear ossification of all the patients. Categories of auditory performance and speech intelligibility rating were detected to assess the outcome of cochlear implant postoperatively. RESULT: Among 29 cases with cochlear ossification, 19 cases were grade II, 4 cases were grade I, 4 cases were grade III, and 2 cases were apical turn ossification. Among 23 patients with cochlear ossification grade I and II, 17 cases were totally cochlear array insertion, and 6 cases were partial cochlear array insertion. Patients with cochlear ossification grade III were all partial cochlear array insertion. Most patients achieved good hearing and language ability after cochlear implantation. CONCLUSION: Cochlear implantation can be successfully performed on the basis of systematic preoperative assessment and some patients can achieve good postoperative results in patients with cochlear ossification. Intraoperative electrical stimulation of the auditory evoked response provides a good method to assess the residual spiral nerve function.

[Cochlear implant operation to summarize and postoperative outcome].

OBJECTIVE: The aim of this study was to evaluate the clinical features of cochlear reimplantation. To review our experience of cochlear reimplant surgery. METHOD: Retrospective analysis of all 25 cochlear reimplant surgeries between 2002 and 2012. Causes of revision operations, number of electrode channels inserted, surgical findings and postoperative speech performances were analyzed. RESULT: Causes of reimplantation were eight hard failures; eight poor implanted electrodes position, four poor outcome, three skin flap infection lead to implant device exposure, one postoperative symptoms of facial nerve stimulation, one postoperative temporal bone lesions. All cochlear reimplantations were successfully performed in our hospital, audiologic performances were stable or improved following reimplantation in most of cases. CONCLUSION: Cochlear implant surgeons should have a good knowledge of how to diagnose cochlear implant failures and how to deal with medical complications related to cochlear implantation. Medical and audiologic outcomes are generally excellent. Cochlear reimplantation appears to be a safe and effective.

[Evaluation of intra-operative EABR characteristics and rehabilitation effects of cochlear implantation in patients with internal auditory canal stenosis].

OBJECTIVE: To investigate the intra-operative electrical evoked auditory brain stem response (EABR) characteristics and the hearing and speech rehabilitation effects of cochlear implantation (CI) in patients with internal auditory canal stenosis (IACS). METHOD: A retrospective study was performed on 16 patients with IACS (IACS group) matched with 16 implanted without IACS (control group), who received multi- channel CI because of pre-lingual sensorineural hearing loss. The integrity and functional status of the auditory pathway were assessed by EABR, recording waveforms, thresholds and dynamic ranges intra-operation before CI. Interviewed the implanted parents or teachers, asking them to rate the implanted hearing and speech ability according to Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR). Paired T test was performed to compare scores of CAP and SIR between before and 1 year after CI, while Spearman test was performed to compare correlation between EABR grades and post-operative CAP scores. RESULT: Among the IACS group, 2 cases weren't recorded typical EABR waveforms and without auditory response 1 year after a successful CI. The EABR waveforms in the IACS group were poorer than that in the control group, their EABR thresholds higher than the control group, and their EABR dynamic ranges less than the control group. The hearing and speech rehabilitation after CI showed that the results of CAP and SIR values (3.47 +/- 1.09 and 1.62 +/- 0.50) scored significantly lower than the control group (5.06 +/- 0.79 and 2.59 +/- 0.58) (P < 0.05), but significantly increased compared with pre-operation. Intra-operative EABR grades and post-operative CAP scores showed significant correlation (r = 0.78 , P < 0.05). CONCLUSION: Intra-operative EABR can accurately monitor the integrity and functional status of the auditory pathway, be of important clinical value in predicting whether patients can acquire auditory responses with the aid of CI. CI can help patients with IACS to improve the ability of hearing and speech with EABR to screen out compatible implanted.

[Cochlear implantation in patients with auditory neuropathy assisted by intra-operative EABR and the therapeutic effect evaluation].

OBJECTIVE: To evaluate the pathological position of auditory neuropathy and investigate the hearing and speech rehabilitation results of cochlear implantation in patients with auditory neuropathy. METHOD: In our hospital, among the patients received cochlear implantation, 8 cases with auditory neuropathy were selected, and 8 cases of non-auditory neuropathy patients with profound deafness were selected as matched control group with the background close to the study group. The preoperative hearing data of these two groups were retrospectively analyzed. During operation, the homemade stimulation electrodes were inserted to test the electric evoked auditory brainstem response(EABR) for assessing the auditory pathway; EABR and neural response telemetry(NRT) were tested after implantation, and T, C value were acquired 1 month later. CAP, SIR and speech recognition rate were used to assess hearing and speech rehabilitation effect 12 months after booting. RESULT: Intra-operative EABR wave can be derived in 8 cases of auditory neuropathy, but the wave pattern exhibited variations compared with normal wave. It needed increased stimulation or adjusted parameters, with variable V latency. After cochlear implantation, the waveforms of NRT and EABR were similar between the two groups, and the post-operative V waveform was close to the intra-operative EABR. 8 pairs of patients can present listening response after booting. There was no statistically significant difference in T, C value, CAP (6.50 +/- 0.94 and 6.90 +/- 0.77) and speech recognition rate (85.00% +/- 11.66% and 89.50% +/- 9.02%) between the auditory neuropathy group and the control group 1 year after booting. CONCLUSION: Pre-operative EABR can be used as an effective tool to assess the auditory pathway of auditory neuropathy patients, improving the pre-operative examination and helping with selecting the suitable cochlear implant patient. Cochlear implantation can help patients with auditory neuropathy to improve hearing and speech.

[Cochlear implant patients underwent successful MRI examination after local bandaging: a case report].

A female patient, now 6 years old, received cochlear implant in the right ear at the age of 2 (February, 2006). In August 16, 2010, a cervical spine MRI examination was required due to the cervical spine injury in order to confirm the diagnosis. Considering the cochlea coil may interfere with the MRI examination results, a local bandaging around the ear was given to isolate cochlear magnetic field. The results of cervical spine MRI examinations showed no obvious disturbance, which suggests that we could further explore this method clinically.

[Measurement of electrical evoked middle latency response in cochlear implantation operation].

OBJECTIVE: To establish the method of conducting electrical evoked middle latency response (EMLR) monitoring in cochlear implantation operation and further to assess the neural response of auditory pathway under electrical stimulation. METHODS: Twenty cases of cochlear implantation subjects were investigated in this study. Fourteen cases were pre-lingual deaf and 6 were post-lingual deaf. The surface recording electrodes were placed on the patients under general anesthesia, with language processor connected to the triggering port of the auditory evoked potential device. After the electrode was implanted, the electrode No.3 was selected to conduct. The electrically evoked auditory nerve compound active potentials (ECAP) were firstly tested in all patients, thereafter the EABR mode was selected, and the stimulation parameters were changed to EMLR mode with monopole biphasic, alternation stimulation, pulse width from 50 to 100 µs, the stimulation intensity decreased or increased from 20 CL above the strength of the ECAP threshold to the reaction threshold with a step of 5CL. To evaluate the correlation between the ECAP thresholds and EMLR, another 6 cases of normal hearing healthy subjects were recruited to record their short-sound evoked auditory middle-latency response (AMLR), as the control of morphology and latency of MLR by electrical stimulation. RESULTS: The typical AMLR waveforms could be recorded by the composition of five waves in the 6 cases of normal hearing healthy subjects, with an average response threshold of (12.5±8.6) dBnHL, close to the behavioral audiometric threshold (10.8±7.3) dBHL. The EMLR waveforms could be recorded in 20 patients, which was similar to the AMLR waveforms. However, the wave latency and wave interval shortened. There were lower volatility and longer latency in pre-lingual deaf than post-lingual deaf. The EMLR threshold (140.55±9.92) CL was significantly lower than the ECAP threshold (160.75±13.34) CL (t=10.467, P<0.01), a positive correlation between the thresholds was detected (r=0.763, P<0.01). CONCLUSIONS: We successfully established the method of EMLR monitoring in cochlear implantation surgery. The EMLR threshold is lower than the ECAP threshold but it is close to the behavioral audiometric threshold; EMLR can provide neural response information closer to the auditory center, and can serve as an effective objective method to evaluate the effect of hearing rehabilitation.

[Efficacy in patients with outer and middle ear deformities of using bone-anchored hearing aids].

OBJECTIVE: To evaluate the efficacy and satisfaction of bone-anchored hearing aids (BAHA) in patients with outer and middle ear deformities. METHODS: Seven patients with bilateral microtia and aural atresia, and three patients with unilateral microtia and bilateral middle ear malformation were fitted with soft-band BAHA for a few months, followed by receiving unilateral BAHA implantation. Mean pure-tone thresholds and speech audiometry tests results were compared among patients without hearing aid, with soft-band BAHA, and with implanted BAHA. Scores from the BAHA users' questionnaires and Glasgow children's benefit inventory (GCBI) were used to measure patient satisfaction and subjective health benefit. RESULTS: The mean pure-tone thresholds of the patients were (64.8 ± 5.9) dBHL for those without hearing aid, (30.2 ± 3.7) dBHL for those with soft-band BAHA, and (20.3 ± 3.9) dBHL for those with implanted BAHA. The average decline in pure-tone threshold was (36.2 ± 8.0) dBHL for those with soft-band BAHA, and an additional decline of (12.2 ± 3.4) dBHL was achieved with implanted BAHA. The average gains in speech discrimination scores (SDS) were (3.00 ± 1.07)% for those without hearing aids and (89.39 ± 5.83)% for those with implanted BAHA in sound field of 45dBHL. SDS were (57.55 ± 10.30)% for those without hearing aids and (91.19 ± 4.16)% for those with implanted BAHA in sound field of 65dBHL. The average gains in SDS were (88.21 ± 6.86)% and (38.04 ± 7.56)% tested with 45dBHL and 65dBHL respectively. Sound reception thresholds (SRT) without hearing aids were (63.1 ± 5.9) dBHL and (24.7 ± 3.5) dBHL for those with implanted BAHA. The average gains in SRT was (39.6 ± 6.2) dBHL. The BAHA application questionnaire demonstrated excellent patient satisfaction. The general benefit score was 35.59 ± 14.35. CONCLUSION: BAHA remains one of the most reliable methods of auditory rehabilitation and improves quality of life for patients with ear deformities.

[The assessment of cochlear implantation assisted by EABR in patients with common cavity deformity].

OBJECTIVE: To investigate the hearing and speech rehabilitation results of cochlear implantation in patients with common cavity deformity. METHOD: A retrospective study was performed on 19 patients with common cavity deformity who received multi-channel cochlear implantation from 1995 to 2010 in Peking Union Hospital, with assisted evaluation of auditory nerve pathways by intraoperative electrical evoked auditory brain stem response (EABR); matched with 19 implantees with no deformity. Paired T test was performed to compare T values, dynamic range; Rank-sum test was performed to compare scores of categories of auditory performance (CAP) and speech intelligibility rating (SIR). RESULT: The T value of common cavity inner ear malformation group (172.59 +/- 14.57) was significantly higher than that of the control group (139.63 +/- 19.45) (P < 0.05), no significant difference in dynamic range (P > 0.05); hearing and speech rehabilitation after implantation showed that the results of CAP and SIR values (5.50 +/- 0.94 and 3.00 +/- 0.82) scored significantly lower than the control group (6.90 +/- 0.77 and 3.90 +/- 0. 57) (P < 0.05), but significantly increased compared with that before. Some children appeared facial twitch at boot time caused by electrical stimulation of the facial nerve (surface pumping rate of 31.58%). CONCLUSION: Common cavity is a kind of severe inner ear malformations, but to perform a comprehensive preoperative evaluation, select the appropriate surgical technique, employ personalized postoperative booting, transfer machines and long-term auditory intensive language training, the children can get varying degrees of language and hearing recovery according to the severity of deformity. On the whole, the rehabilitation outcome was significantly worse in patient with deformity than its counterpart without deformity.

[Study for cochlear microphonic potential test in patients with profound sensorineural hearing loss].

OBJECTIVE: To report intraoperative round window cochlear microphonic potential test (CM) in patients with profound sensorineural deafness. METHOD: Intraoperative round window CM test were performed on 40 cases with profound sensorineural deafness during cochlear implantation surgery under general anesthesia in the standard operating room. CM were compared with their reliable preoperation distortion product otoacoustic emission (DPOAE). RESULT: The CM were found in 40 patients. The rate at 0.5, 1.0, 2.0, 4.0. kHz was respectively 90%, 97.5%, 100%, 92.5%. The preoperation DPOAE were found in some frequency in 9 cases. The rate at 0.5, 1.0, 2.0, 4.0 kHz was respectively was 2.5%, 2.5%, 17.5%, 2.5%. CONCLUSION: The elicited rate of CM was obviously higher than the one of DPOAE in the same patient with profound sensorineural deafness. The intraoperative round window CM may objectively and accurately estimate the part of cochlear function in patients with profound sensorineural deafness.

[The research of cochlear implantation with other assident particular diseases].

OBJECTIVE: To Respectively analyze extremely SNHL patients who received cochlear implants with other particular diseases, mainly introducing pre-/intra-/postoperative clinical experiences. METHOD: Eight out of one thousand and three hundred patients who received cochlear implants in PUMC hospital were diagnosed with other assident particular diseases besides SNHL, which included hypopotassaemia, hemophilia, idiopathic thrombocytopenic purpura (ITP), favism, abnormal blood coagulation factor, abnormally high alkaline phosphatase. We would introduce pre-/intra-/postoperative clinical experiences by turns. RESULT: All of the surgery were performed without any complication, and there were no remote complications. CONCLUSION: SNHL patients with other assident particular diseases could accept cochlear implantation with carefully preparations before and during operation.

High prevalence of the connexin 26 (GJB2) mutation in Chinese cochlear implant recipients.

BACKGROUND: The GJB2 gene, mapping to chromosome 13q12, encodes a gap junction protein, connexin 26, and is responsible for certain forms of congenital deafness, such as DFNB1 and DFNA3. Mutations of this gene are responsible for about one half of severe autosomal recessive non-syndromic deafness. METHODS: To determine whether GJB2 mutations are major causes of deafness in Chinese cochlear implant recipients, we enrolled 115 cochlear implant recipients for mutation screening. RESULTS: The results showed that 36.5% (42/115) of all cochlear implant recipients and 41% (41/100) of non-syndromic deafness patients exhibit GJB2 mutations; only 1 inner ear malformation patient was detected with GJB2 mutations. The present study found 11 different variations in the GJB2 gene. CONCLUSION: The 235delC mutation was the most prevalent mutation, found in 18.3% (42/230 alleles) of all cochlear implant recipients and 21.0% (42/200 alleles) of the non-syndromic deafness group. Only 0.6% of GJB2 mutations were detected in the inner ear malformation group. The novel 187G-->T mutations are likely to be pathological mutations.

Application of intraoperative round window electrocochleography for screening the patients with auditory neuropathy.

BACKGROUND: Most patients with auditory neuropathy (AN) could receive good even the best effects after cochlear implantation. How to diagnose AN objectively and accurately is very important. In this study, we screened the patients with AN according to the presence or absence of compound action potential (CAP) of intraoperative round window electrocochleography (RW ECochG). METHODS: Intraoperative RW ECochG was performed on 32 patients with profound sensorineural deafness, who had normal cochlea during cochlear implantation surgery under general anesthesia in the standard operating room. The cochlear microphonic (CM) and CAP of RW ECochG was observed and recorded. RESULTS: The presence of CM but the absence of CAP of RW ECochG occurred in 12 among the 32 patients. They were suspected to suffer from AN. The rest patients who had CM and CAP of RW ECochG were thought not to suffer from AN. CONCLUSION: Application of intraoperative RW ECochG during the cochlear implantation surgery may objectively and accurately screen the patients with AN, and can give a meaningful clue for implanted device working.

Development of the computerized Mandarin pediatric lexical tone and disyllabic-word picture identification test in noise (MAPPID-N).

MAPPID-N was developed to assess the speech-recognition abilities in noise of Mandarin-speaking children on disyllabic words, and lexical tones in monosyllabic words, in a picture-identification test format. Twenty-six normal-hearing children aged four to nine years listened repeatedly to the test materials where noise was spatially mixed with or separated from speech, in different signal-to-noise (SNR) ratios, to obtain performance-SNR functions and SNR for 50% correct scores (SNR-50%). SNR-50% improved with age only when noise was spatially separated from speech but not when noise was mixed with speech, suggesting the improvement with age in the use of intensity and timing cues differences between the two ears. The homogeneity of the test items was improved by adjusting the intensity levels of individual test items to align their SNR-50% to the mean SNR-50% level.