Jia-Nan Li

Development of a corpus of Mandarin sentences in babble with homogeneity optimized via psychometric evaluation

Abstract Objective: To develop a corpus of sentences in babble noise that is suitable for Mandarin-speaking children. Two experiments were conducted with specific aims of (1) developing sentence material that is grammatically and semantically within the linguistic abilities of children; and (2) improving the efficiency of the test by equalizing the relative intelligibility of individual items in sentences. Design and Study sample: Sentences were extracted from spoken material of Chinese children aged between 4 and 5 years of age. The sentences were tested for intelligibility in a four-talker babble by 96 adult native speakers of Mandarin. Psychometric functions were generated, and used for adjusting signal-to-noise ratios of individual items by varying the level of the time-locked babble to equate intelligibility of the target speech. These adjusted stimuli were tested for intelligibility using a different group of 64 adult listeners. Results: The signal-to-noise ratio for 50% correct was not different before and after adjustments (− 6.1 dB and − 6.0 dB, respectively). However, there was a significant reduction in standard deviation from 2.3 dB before adjustment to 1.1 dB after adjustment (p < 0.05). Conclusions: The experiments established a corpus of Mandarin BKB-like sentences with four-talker babble as competing noise, in which the test items’ homogeneity was optimized via psychometric evaluation (HOPE).

The diagnosis and surgical treatment of occult otogenic CSF leakage

Abstract Conclusions: The diagnosis of occult otogenic cerebrospinal fluid (CSF) leakage is challenging and it can easily be misdiagnosed. Some characteristics of clinical presentation can supply important clues and confirmed diagnosis should be obtained according to these clues and suitable imaging studies before meningitis develops. Different surgical techniques should be adopted to treat the CSF leakage according to different leakage etiologies, and good results can be obtained. Objective: The aim of the study was to evaluate the diagnosis and surgical treatment of occult otogenic CSF leakage, including the characteristics of clinical presentation, imaging studies, and operation methods in order to decrease the rate of misdiagnosis and obtain a good curative effect. Methods: We performed a retrospective review of 11 cases of CSF leakage that were all misdiagnosed and accompanied by meningitis, operated in our department from 2007 to 2012 after a mean follow-up of 3 years. In this context, the characteristics of clinical presentation, imaging studies, and management of CSF leakage were studied. Results: The CSF leakage had arisen traumatically (n = 9) or congenitally (n = 2). The medical history and special clinical presentation such as repeated otorrhea or rhinorrhea, fever, headache, and unilateral deafness can supply important diagnostic clues. Imaging studies including high-resolution noncontrast CT (HRCT), CT cisternography, and magnetic resonance imaging (MRI) are very important diagnostic methods. The surgical repairs were performed via a transmastoid approach (n = 8), packing the vestibule (n = 1) or a translabyrithine approach (n = 2). Recurrent leakage did not occur.

The temporal bone microdissection of miniature pigs as a useful large animal model for otologic research

Abstract Conclusion: Compared with traditional animal models, the miniature pig may be a better model for biomedical research because its morphology has many similarities with that of humans. Objective: To investigate the suitability of the miniature pig as an animal model for otological research as regards morphology. Methods: Microdissection of the temporal bone of 10 miniature pigs was performed and recorded on photographs. Results: The morphology and measurements of the external, middle, and inner ear, and the lateral recess of the miniature pigs were completed by microdissection. The temporal bone structures, including the external, middle, inner ear, and the lateral recess, were similar in the miniature pig and humans.

NRT test in auditory neuropathy patients with cochlear implants

Abstract Conclusion: In patients with auditory neuropathy (AN), waveforms of neural response telemetry (NRT) could be present, showing characteristics of low incidence, low differentiation, and large variation. Objective: To study the characteristics of NRT in AN patients who had received cochlear implants (CIs). Methods: NRT data for seven AN patients who had received Nucleus CIs were retrospectively analyzed. Twenty-one CI implantees with sensorineural hearing loss (SNHL) were included as the control group. The incidence of electrically evoked compound action potentials (ECAPs), threshold of wave N1, and amplitude of N1-P2 in the AN group were analyzed and compared between groups. Results: The intraoperative incidence of valid ECAPs in the AN group was 42.9%, and the postoperative incidence was 66.7%, both of which were lower than those in the SNHL group, which were 95.2% and 100%, respectively. NRT in the AN group showed larger variation and lower differentiation than in the SNHL group. Wilcoxon’s non-parametric test results indicated no significant difference between AN and SNHL groups in either the threshold of ECAP or N1-P2 amplitude.

Successful cochlear implantation in a patient with MNGIE syndrome

Abstract A 28-year-old woman with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE syndrome) undergoing evaluation for multichannel cochlear implantation is described. The case history, diagnosis of mitochondrial disease, and assessment of the benefits of cochlear implantation are documented. The hearing level with cochlear implant and speech recognition were improved significantly for this patient. MNGIE syndrome is a rare congenital disorder of mitochondrial DNA (mt-DNA). It is crucial for the otolaryngologist to have awareness of MNGIE syndrome and other mitochondrial encephalomyopathies when patients present with sensorineural hearing loss (SNHL). Cochlear implantation can be recommended to patients with MNGIE syndrome and satisfactory results can be achieved.

Determination of benefits of cochlear implantation in children with auditory neuropathy.

Background Auditory neuropathy (AN) is a recently recognized hearing disorder characterized by intact outer hair cell function, disrupted auditory nerve synchronization and poor speech perception and recognition. Cochlear implants (CIs) are currently the most promising intervention for improving hearing and speech in individuals with AN. Although previous studies have shown optimistic results, there was large variability concerning benefits of CIs among individuals with AN. The data indicate that different criteria are needed to evaluate the benefit of CIs in these children compared to those with sensorineural hearing loss. We hypothesized that a hierarchic assessment would be more appropriate to evaluate the benefits of cochlear implantation in AN individuals. Methods Eight prelingual children with AN who received unilateral CIs were included in this study. Hearing sensitivity and speech recognition were evaluated pre- and postoperatively within each subject. The efficacy of cochlear implantation was assessed using a stepwise hierarchic evaluation for achieving: (1) effective audibility, (2) improved speech recognition, (3) effective speech, and (4) effective communication. Results The postoperative hearing and speech performance varied among the subjects. According to the hierarchic assessment, all eight subjects approached the primary level of effective audibility, with an average implanted hearing threshold of 43.8 ± 10.2 dB HL. Five subjects (62.5%) attained the level of improved speech recognition, one (12.5%) reached the level of effective speech, and none of the subjects (0.0%) achieved effective communication. Conclusion CIs benefit prelingual children with AN to varying extents. A hierarchic evaluation provides a more suitable method to determine the benefits that AN individuals will likely receive from cochlear implantation.

Preliminary performance of cochlear implants in post-lingual patients with auditory neuropathy

Abstract Conclusions: Auditory restoration can be obtained by using cochlear implants (CIs) in post-lingual patients with auditory neuropathy (AN). However, improvements in postoperative speech recognition for these patients varied. Objectives: The primary purpose of this study was to assess the postoperative performances of two post-lingual AN patients after receiving CIs. Methods: Two post-lingual AN patients received unilateral CIs and the efficacy of the implants was then evaluated. One patient was female with bilateral mid-severe hearing loss and received an implant at age 28 years. The second patient was male with severe hearing loss and he received an implant at age 15 years. The postoperative performance for both patients was evaluated. Results: After using the CI for 6 months, the hearing ability of both subjects was improved by the CI with an average post-implant threshold of 35 dB and 44 dB, respectively. The woman made significant progress in speech recognition with an open-set spondee recognition score of 55% and sentence recognition in quiet score of 90%. Sentence recognition in noise scores were 94% (SNR = +10 dB), 88% (SNR = +5 dB), and 80% (SNR = 0 dB). The boy achieved improved recognition scores for monosyllables (40%) and disyllables (26%), but poor sentence recognition both in quiet (0%) and in noise (0%).

Interaction of tinnitus suppression and hearing ability after cochlear implantation

Abstract Objectives: To study the postoperative impact of cochlear implants (CIs) on tinnitus, as well as the impact of tinnitus on speech recognition with CI switched on. Methods: Fifty-two postlingual deafened CI recipients (21 males and 31 females) were assessed using an established Tinnitus Characteristics Questionnaire and Tinnitus Handicap Inventory (THI) before and after cochlear implantation. The tinnitus loudness was investigated when CI was switched on and off in CI recipients with persistent tinnitus. The relation between tinnitus loudness and recipients’ satisfaction of cochlear implantation was analyzed by the visual analogue scale (VAS) score. Results: With CI ‘OFF’, 42 CI recipients experienced tinnitus postimplant ipsilaterally and 44 contralaterally. Tinnitus was totally suppressed ipsilateral to the CI with CI ‘ON’ in 42.9%, partially suppressed in 42.9%, unchanged in 11.9% and aggravated in 2.4%. Tinnitus was totally suppressed contralaterally with CI ‘ON’ in 31.8% of CI recipients, partially suppressed in 47.7%, unchanged in 20.5%. Pearson correlation analysis showed that tinnitus loudness and the results of cochlear implant patients satisfaction was negatively correlated (r = .674, p < .001). Conclusion: The study suggests six-month CI activation can be effective for suppressing tinnitus. The tinnitus loudness may affect patients’ satisfaction with the use of CI.

Establishing the standard method of cochlear implant in Rongchang pig

Abstract Conclusions: In this investigation, a large mammal, Rongchang pigs were used to successfully establish a research platform for cochlear implant study on the routine use of it in clinic. Objective: The aim of this study was to establish a standard method of cochlear implant in a large mammal—pig. Methods: Rongchang pigs were selected, then divided into two groups: normal-hearing group (Mitf +/+) and mutation group with hearing loss (Mitf −/−). Cochlear implants were used and ABR and EABR were recorded. The implanted electrodes were observed by X-ray and HE stains. Results: The success with cochlear implant and the best electrode position could be defined in all animals, the coiling of the cochlea reached 1.5–1.75 turns. Immediately after the operation of cochlear implants, the ABR threshold of the operated ear (right) could not be derived for each frequency at 120 dB SPL. Moreover, 7 days after surgery, the low-frequency ABR threshold of the operated ear (right) could be derived partly at 100 dB SPL, but the high-frequency ABR threshold could not be derived at 120 dB SPL. Immediately or 1 week after cochlear implants, the EABR threshold was 90 CL in the Mitf +/+ group. This was obviously lower than the 190 CL in the Mitf −/− group.

One-stage coclear implantation via a facial recess approach in children with otitis media with effusion

Objective To investigate surgical indications, operative techniques, complications and auditory and speech rehabilitation for cochlear implant (CI) in children with otitis media with effusion (OME). Material and methods This is a retrospective review of records of 24children with bilateral profound sensorineural hearing loss and OME who were implanted during January 2011 to November 2014 in the Department of Otorhinolaryngology and Head and Neck Surgery at the PLA Hospital, using one-stage implantation via the facial recess approach and round window insertion. The incus was removed in 8 cases during the implantation procedure. Local infiltration of dexamethasone and adrenaline in the middle ear was also performed. Postoperative complications were examined. Preoperative and postoperative questionnaires including Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), and the Meaningful Auditory Integration Scale (MAIS) were collected. Results All electrodes were implanted successfully without any immediate or delayed complications. Inflammatory changes of middle ear mucosa with effusion were noted in all implanted ears. The scores of post-implant CAP and SIR increased significantly in all 24 cases (t = −25.95 and −14.09, respectively for CAP and SIR, p < 0.05). Conclusions One-stage CI via the facial recess approach with round window insertion is safe and effective in cochlear implant candidates with OME, as seen in the 24 children in our study who achieved improved auditory performance and speech intelligibility after CI.