Qi B

Cost-effectiveness analysis of neonatal hearing screening program in china: should universal screening be prioritized?

BackgroundNeonatal hearing screening (NHS) has been routinely offered as a vital component of early childhood care in developed countries, whereas such a screening program is still at the pilot or preliminary stage as regards its nationwide implementation in developing countries. To provide significant evidence for health policy making in China, this study aims to determine the cost-effectiveness of NHS program implementation in case of eight provinces of China.MethodsA cost-effectiveness model was conducted and all neonates annually born from 2007 to 2009 in eight provinces of China were simulated in this model. The model parameters were estimated from the established databases in the general hospitals or maternal and child health hospitals of these eight provinces, supplemented from the published literature. The model estimated changes in program implementation costs, disability-adjusted life years (DALYs), average cost-effectiveness ratio (ACER), and incremental cost-effectiveness ratio (ICER) for universal screening compared to targeted screening in eight provinces.Results and discussionA multivariate sensitivity analysis was performed to determine uncertainty in health effect estimates and cost-effectiveness ratios using a probabilistic modeling technique. Targeted strategy trended to be cost-effective in Guangxi, Jiangxi, Henan, Guangdong, Zhejiang, Hebei, Shandong, and Beijing from the level of 9%, 9%, 8%, 4%, 3%, 7%, 5%, and 2%, respectively; while universal strategy trended to be cost-effective in those provinces from the level of 70%, 70%, 48%, 10%, 8%, 28%, 15%, 4%, respectively. This study showed although there was a huge disparity in the implementation of the NHS program in the surveyed provinces, both universal strategy and targeted strategy showed cost-effectiveness in those relatively developed provinces, while neither of the screening strategy showed cost-effectiveness in those relatively developing provinces. This study also showed that both strategies especially universal strategy achieve a good economic effect in the long term costs.ConclusionsUniversal screening might be considered as the prioritized implementation goal especially in those relatively developed provinces of China as it provides the best health and economic effects, while targeted screening might be temporarily more realistic than universal screening in those relatively developing provinces of China.

Music and lexical tone perception in Chinese adult cochlear implant users.

The present studys aim was to assess the music perception ability for Chinese adult cochlear implant users and to investigate the correlation between music and Mandarin‐Chinese lexical tone perception.

The contribution of apical stimulation to Mandarin speech perception in users of the MED-EL COMBI 40+ cochlear implant.

Abstract Conclusion: Not stimulating the apical cochlear region in tonal language speaking cochlear implantees significantly reduces discrimination of Mandarin vowels. The data presented here suggest that electrode arrays that allow complete cochlear coverage with stimulation pulses seem to be preferable over shorter arrays for use in cochlear implant (CI) indications. Objective: To assess the contribution of electrical stimulation beyond the first cochlear turn on tonal language speech perception. Methods: Twelve Mandarin-speaking users of the MED-EL COMBI 40+ cochlear implant with complete insertion of the standard COMBI 40+ electrode array participated in the study. Acute speech tests were performed in seven electrode configurations with stimulation either distributed over the whole length of the cochlea or restricted to the apical, middle or basal regions. The test battery comprised tone, consonant, and vowel identification in quiet as well as a sentence recognition task in quiet and noise. Results: While neither tone nor consonant identification depended crucially on the placement of the active electrodes, vowel identification and sentence recognition decreased significantly when the four apical electrodes were not stimulated.

Mandarin lexical tone recognition in sensorineural hearing-impaired listeners and cochlear implant users

Abstract Conclusions: As the hearing loss becomes more severe, the tone recognition performance of hearing-impaired listeners gradually but slowly reduces. The tone recognition performance of cochlear implant listeners is below or close to the performance of severely hearing-impaired listeners. Objectives: The present study aimed to investigate the Mandarin lexical tone recognition performance of sensorineural hearing-impaired listeners and post-lingually deafened cochlear implant users. Methods: Tone recognition performance was measured for 30 normal-hearing subjects, 41sensorineural hearing-impaired listeners, and 12 cochlear implant users using 128 monosyllables recorded by a male and a female adult native Mandarin speaker. Results: The results indicated that the accuracy of tone recognition was 99.3%, 96.4%, 93.7%, 83.9%, and 81.0% for the normal-hearing, moderate, moderate to severe, severely hearing-impaired, and cochlear implant subjects, respectively. For the hearing-impaired subjects, a significantly negative correlation was observed between tone recognition performance and the audiometric hearing thresholds. For cochlear implant subjects, Tone 3 was the easiest one to perceive and Tone 2 was the hardest one to perceive. They tended to misperceive Tone 1 as Tone 2, and misperceive Tone 2 as Tones 1 and 3.

Assessment of the feasibility and coverage of a modified universal hearing screening protocol for use with newborn babies of migrant workers in Beijing

BackgroundAlthough migrant workers account for the majority of newborns in Beijing, their children are less likely to undergo appropriate universal newborn hearing screening/rescreening (UNHS) than newborns of local non-migrant residents. We hypothesised that this was at least in part due to the inadequacy of the UNHS protocol currently employed for newborn babies, and therefore aimed to modify the protocol to specifically reflect the needs of the migrant population.MethodsA total of 10,983 healthy babies born to migrant mothers between January 2007 and December 2009 at a Beijing public hospital were investigated for hearing abnormalities according to a modified UNHS protocol. This incorporated two additional/optional otoacoustic emissions (OAE) tests at 24–48 hours and 2 months after birth. Infants not passing a screening test were referred to the next test, until any hearing loss was confirmed by the auditory brainstem response (ABR) test.ResultsA total of 98.91% (10983/11104) of all newborn children underwent the initial OAE test, of which 27.22% (2990/10983) failed the test. 1712 of the failed babies underwent the second inpatient OAE test, with739 failing again; thus significantly decreasing the overall positive rate for abnormal hearing from 27.22% to 18.36% ([2990–973 /10983)]; p = 0). Overall, 1147(56.87%) babies underwent the outpatient OAE test again after1-month, of whom 228 failed and were referred for the second outpatient OAE test (i.e. 2.08% (228/10983) referral rate at 1month of age). 141 of these infants underwent the referral test, of whom 103 (73.05%) tested positive again and were referred for a final ABR test for hearing loss (i.e. final referral rate of 1.73% ([228-38/10983] at 2 months of age). Only 54 infants attended the ABR test and 35 (0.32% of the original cohort tested) were diagnosed with abnormal hearing.ConclusionsOur study shows that it is feasible and practical to achieve high coverage rates for screening hearing loss and decrease the referral rates in newborn babies of migrant workers, using a modification of the currently employed UNHS protocol.

Effects of temporal fine structure stimulation on Mandarin speech recognition in cochlear implant users.

Abstract Conclusion: The investigated experimental coding strategies significantly improved tone identification as compared with the participants’ everyday audio processor settings. However, this benefit could not be attributed entirely to temporal fine structure stimulation but seems to be caused by decreasing the lower corner frequency of the filter bank. The 6 week habituation period used in this study might have been too short to allow the listeners to derive additional lexical information from the unfamiliar stimulation patterns. Objectives: To evaluate a cochlear implant coding strategy that explicitly conveys temporal fine structure information in the context of the tonal language Mandarin. Methods: The study was designed as a longitudinal, monocentric, prospective, controlled, and randomized cross-over study and included 12 postlingually deafened adults, who were experienced cochlear implant users. Two experimental coding strategies, one of which explicitly presents temporal fine structure information, were compared to the participants’ personal TEMPO+ speech processors, which do not convey fine structure information. Results: Both experimental coding strategies improved tone identification by approximately 11 percentage points. This improvement was significant in the female speaker test. Sentence perception, as assessed with the M-HINT test, and quality of life scores were identical with all three coding strategies.

Development and applications of alternative methods of segmentation for Mandarin Hearing in Noise Test in normal-hearing listeners and cochlear implant users

Abstract Conclusion: The study demonstrates that two methods of segmentation, i.e. word and character segmentations, produce equivalent results in the Mandarin Hearing in Noise Test (MHINT). Potentially, both methods of segmentation can be used clinically. A majority of the Mandarin-speaking cochlear implant subjects could complete MHINT – with the more relaxed adaptive rules. The results make it possible to compare the performance of cochlear implant users across languages. Objectives: The primary purpose of the present study was to evaluate the modified adaptive scoring rules and to develop alternative methods of segmentations in MHINT that are suitable for the Chinese language. Methods: Thirty Mandarin-speaking normal-hearing adults were tested with MHINT using three adaptive rules based on character and/or word segmentation of the sentences. Twenty-three Mandarin-speaking post-lingually deafened cochlear implant patients were also recruited to participate in the testing. Results: There were no significant differences in the reception threshold for sentences and speech recognition scores obtained with either method of segmentation (p > 0.05). Fifteen of the 23 cochlear implant subjects (65%) could be tested with the modified adaptive scoring rules. The performance-intensity functions of the cochlear implant subjects were shifted at least 8−10 dB to higher signal-to-noise ratios as compared with those of the normal-hearing subjects.

Characterization of spontaneous otoacoustic emissions in full-term newborns

OBJECTIVE To analyze the characteristics of spontaneous otoacoustic emissions (SOAEs) in full-term newborns. METHODS A total of 236 ears from 147 randomly selected full-term Chinese neonates (82 females and 65 males), who had passed the initial newborn hearing screening, were assessed for SOAEs using the Capella OAE equipment (Madsen, Denmark). The test was performed in a sound booth. RESULTS (1) The overall prevalence of SOAE was 56.77% of the ears. The prevalence of SOAEs was significantly higher in females (69.23%) than in males (41.51%, p<0.01), as well as in the right ears (64.17%) than in the left ears (49.14%, p<0.05). (2) The overall mean level of SOAE was 11.78±8.36dB SPL, with no significant differences between males (11.73±8.25dB SPL) and females (11.81±8.43dB SPL) or between the left (11.97±8.56dB SPL) and the right ears (11.65±8.22dB SPL). (3) The 25th and 75th percentiles of SOAE frequencies were 2.31 and 4.36kHz in females and 1.93 and 3.94kHz in males, which were statistically significantly different (p<0.01). In contrast, the SOAE frequency was not significantly different between ears (2.22-4.18kHz in the left ears and 2.17-4.14kHz in right ears). (4) The overall mean number of SOAEs was 3.70±2.75, with no significant differences in females (3.62±2.70) and males (3.86±2.87) or in right (3.70±2.55) and left ears (3.70±3.02). CONCLUSIONS The prevalence rate of SOAE is significantly higher in females than in males and in the right ears than in the left ears in Chinese newborns. The frequencies of the SOAEs in newborns appeared to be higher than those reported in normal-hearing adults in the literature.

Speech recognition outcomes in Mandarin-speaking cochlear implant users with fine structure processing

Abstract Conclusion: Mandarin-speaking adults can use the Fine Structure Processing (FSP) coding strategy as well as the Continuous Interleaved Sampling (CIS+) coding strategy. No loss in performance was observed after switch-over. Tone identification improves over time with the FSP coding strategy, which is of benefit to tonal-language users. After some time, fine structure was preferred. Objective: This study aimed to determine speech perception, tone perception, and the subjective preferences of Mandarin-speaking adults who received the FSP coding strategy, at upgrade from the CIS + coding strategy. Methods: Thirteen Mandarin-speaking subjects were tested at switch-over from CIS + to the FSP coding strategy ∼1-month after switch-over, 2-months after switch-over, and 3-months after switch-over with the Mandarin Hearing in Noise Test (M-HINT), the Mandarin Tone Identification in Noise Test (M-TINT), and a visual analogue scale assessing Sound and Speech Assessment (SSA). Results: There were no significant differences in the M-HINT between presentation levels (62 dB SPL vs 65 dB SPL), over time, nor when compared to the CIS + coding strategy. Tone perception improved significantly over time with the FSP coding strategy. Subjects rated the FSP coding strategy with the OPUS 2 as significantly more ‘full’ and ‘rich’ than with the CIS + coding strategy after 3-months.

Speech development in young children with Mondini dysplasia who had undergone cochlear implantation

OBJECTIVE The purpose of this study was to investigate the development of speech skills in young children with Mondini dysplasia and age-matched deaf children with radiologically normal inner ears over a period of 5 years after cochlear implantation (CI). METHODS In total, 700 congenitally severely to profoundly deaf children (281 girls and 419 boys) participated in this study. All of the participants had undergone unilateral CI surgery before 36 months of age. The participants were categorized into two groups based on the absence or presence of Mondini dysplasia in the implanted ear, as assessed via high-resolution, thin-slice computerized tomography or magnetic resonance imaging: group A comprised 592 children with radiologically normal inner ears and group B comprised 108 children with Mondini dysplasia. The Meaningful Use of Speech Scale (MUSS) and Speech Intelligibility Rating (SIR) were used to evaluate the speech performance of all young children at various time points: pre-surgery and at 1, 3, 6, 12, 24, 36, 48, and 60 months after switch-on programming. RESULTS The mean scores of SIR and MUSS in children from both group A and group B showed significant improvements over time. No significant differences were found in the mean scores of SIR between the two groups at any time interval during the 5-year follow-up. The mean score of MUSS was significantly different between group A and group B at 12, 24, and 36 months after implantation, whereas no obvious differences were noted pre-surgery, and at 1, 3, 6, 48, and 60 months post-operation. CONCLUSIONS Young children with Mondini dysplasia develop their speech skills at a fast rate and achieve similar speech acquisition compared to age-matched children with radiologically normal inner ears 5 years post-operation. Therefore, CI is an effective intervention method for young children with Mondini dysplasia.