Zhaoli Meng

Development of the Mandarin Early Speech Perception Test: Children with Normal Hearing and the Effects of Dialect Exposure

Objectives: The first objective of this study was to create a recorded Mandarin Early Speech Perception (MESP) test based on the English Early Speech Perception test (Moog & Geers 1990), a closed-set assessment tool for evaluation of early speech perception abilities in children. The second objective was to determine whether each of the MESP subtests is appropriate for children with these abilities. The third objective was to examine the effects of early exposure to and use of Putonghua (Standard Mandarin), as used for the recordings, on performance for each subtest. Design: MESP test items were developed by sampling approximately 200 picturable words, twice the number required for the test, from Chinese childrens books. A sample (N = 17) of 2.0- to 5.0-yr-old developmentally normal children identified the words from pictures and then recognized the words when tested with live voice by pointing to the pictures. Only words that were accurately identified and recognized by children of all ages were selected. An additional sample (N = 92) of 2.0- to 5.0-yr-old developmentally normal children was tested with the subtests of the MESP. Information about each childs daily Putonghua exposure and use was used to separate the sample into two groups. Subtest scores for the two groups were compared to examine the effects of early dialect exposure on performance. Results: Fewer than 2% of the words used in the six subtests of the MESP were incorrectly named and recognized. Each subtest measures a different category of early speech perception. The categories are hierarchically structured. Categories 1, 2, and 3, Speech Sound Detection, Speech Pattern Perception, and Spondee Recognition, parallel the ESP. Categories 4, 5, and 6 of the MESP, Vowel Perception, Consonant Perception, and Tone Perception, are more difficult tests that provide information about segmental and tonal cues for Mandarin speech perception. All children in all age groups reached all MESP categories successfully, with the exception of three children in the youngest age group for the Tone Perception test. The two oldest groups of children who were not exposed primarily to Putonghua had slightly lower scores on both the Consonant and Tone Perception tests than children who were primarily exposed to Putonghua. These results suggest that development of tone perception continues beyond the MESP age range. Nonetheless, children as young as 2 yr of age could be tested on all of the MESP subtests. Conclusions: The development of the MESP has produced a recorded objective test for the evaluation of early speech perception in Mandarin-speaking children using a standardized protocol. The hierarchical structure of the first three MESP categories parallels that of the ESP, while restricting the occurrence of some tones. Additional MESP categories allow control and variation of Mandarin segmental and tonal contrasts. The MESP is part of a Mandarin hierarchical test battery for assessment of speech perception in young children.

A Normative Study of Early Prelingual Auditory Development

The normal trajectory of early prelingual auditory development from birth to 24 months of age was characterized in a sample of 120 normal-hearing infants and toddlers of Mandarin-Chinese-speaking parents. The Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) was administered to parents as a structured interview during routine pediatric health examinations. Developmental trajectories for the overall IT-MAIS score, as well as for scores on the subscales that assess behavioral evidence of spontaneous detection of and responsiveness to sound and of spontaneous recognition and discrimination of sound, were represented by logarithmic regression functions. On average, these regression functions characterized over 80% of the age-related variance in each scale. The developmental trajectories revealed that by 16 months the average infant exhibited spontaneous detection of and responsiveness to sound at all times, while spontaneous recognition and discrimination of sound was seen at all times after 26 months. The trajectory for the overall IT-MAIS scale, which combines the two subscales, reached ceiling at 22 months. The overall trajectory for Chinese infants closely matches the trajectory for normal-hearing infants of Arabic- and Hebrew-speaking parents in Israel. The Chinese IT-MAIS also exhibits similar internal consistency and item reliability to the German, Polish, and British English IT-MAIS scales. These similarities seen across culturally and linguistically diverse populations suggest the early prelingual auditory development follows the same, or a very similar course, in all infants.

Development of the Mandarin pediatric speech intelligibility (MPSI) test

The objective of this research was to create a Mandarin closed-set sentence recognition test based on the English pediatric speech intelligibility (PSI) test (Jerger & Jerger, ) for evaluation of speech perception in children as young as three years of age. Developmentally normal children (N = 93), 3–6 years of age, were administered the Mandarin PSI (MPSI) via a computer-controlled protocol. Perfect performance was observed for all children in quiet and at +10 and +5 dB signal-to-noise ratios (SNRs). Significant age and developmental trends were seen for the more difficult SNRs, 0 dB, −5 dB, and −10 dB, with 75% of 5–6 year olds reaching the most difficult SNR. Children who reached each of the more difficult SNRs, regardless of age, exhibited the same pattern of performance on all easier conditions, indicating that the final SNR achieved, rather than percent correct scores, may be a better descriptor of performance. The MPSI comprises part of a hierarchical assessment battery for pediatric speech perception for evaluation of intervention alternatives for Mandarin-speaking children with hearing impairment.

Early prelingual auditory development and speech perception at 1-year follow-up in Mandarin-speaking children after cochlear implantation

OBJECTIVE The primary purpose of the current study was to evaluate early prelingual auditory development (EPLAD) and early speech perception longitudinally over the first year after cochlear implantation in Mandarin-speaking pediatric cochlear implant (CI) recipients. Outcome measures were designed to allow comparisons of outcomes with those of English-speaking pediatric CI recipients reported in previous research. METHOD A hierarchical outcome assessment battery designed to measure EPLAD and early speech perception was used to evaluate 39 pediatric CI recipients implanted between the ages of 1 and 6 years at baseline and 3, 6, and 12 months after implantation. The battery consists of the Mandarin Infant-Toddler Meaningful Auditory Integration Scale (ITMAIS), the Mandarin Early Speech Perception (MESP) test, and the Mandarin Pediatric Speech Intelligibility (MPSI) test. The effects of age at implantation, duration of pre-implant hearing aid use, and Mandarin dialect exposure on performance were evaluated. EPLAD results were compared with the normal developmental trajectory and with results for English-speaking pediatric CI recipients. MESP and MPSI measures of early speech perception were compared with results for English-speaking recipients obtained with comparable measures. RESULTS EPLAD, as measured with the ITMAIS/MAIS, was comparable in Mandarin- and English-speaking pediatric CI recipients. Both groups exceeded the normal developmental trajectory when hearing age in CI recipients and chronological age in normal were equated. Evidence of significant EPLAD during pre-implant hearing aid use was observed; although at a more gradual rate than after implantation. Early development of speech perception, as measures with the MESP and MPSI tests, was also comparable for Mandarin- and English-speaking CI recipients throughout the first 12 months after implantation. Both Mandarin dialect exposure and the duration of pre-implant hearing aid use significantly affected measures of early speech perception during this time period. CONCLUSIONS EPLAD and early speech perception exhibited similar patterns of improvement during the first 12 months after early cochlear implantation. The duration of pre-implant hearing aid use had a significant positive effect on both categories of outcome measures. Consistent post-implant EPLAD trajectories and early speech perception results provide objective evidence that can guide best practices in early intervention protocols.

Reliability and validity of the chinese (mandarin) tinnitus handicap inventory.

Objectives The Tinnitus Handicap Inventory (THI) is a commonly used self-reporting tinnitus questionnaire. We undertook this study to determine the reliability and validity of the Chinese-Mandarin version of the Tinnitus Handicap Inventory (THI-CM) for measuring tinnitus-related handicaps. Methods We tested the test-retest reliability, internal reliability, and construct validity of the THI-CM. Two-hundred patients seeking treatment for primary or secondary tinnitus in Southwest China were asked to complete THI-CM prior to clinical evaluation. Patients were evaluated by a clinician using standard methods, and 40 patients were asked to complete THI-CM a second time 14±3 days after the initial interview. Results The test-retest reliability of THI-CM was high (Pearson correlation, 0.98), as was the internal reliability (Cronbachs α, 0.93). Factor analysis indicated that THI-CM has a unifactorial structure. Conclusion The THI-CM version is reliable. The total score in THI-CM can be used to measure tinnitus-related handicaps in Mandarin-speaking populations.

Development of Mandarin spoken language after pediatric cochlear implantation

OBJECTIVE The purpose of this study was to evaluate early spoken language development in young Mandarin-speaking children during the first 24 months after cochlear implantation, as measured by receptive and expressive vocabulary growth rates. Growth rates were compared with those of normally hearing children and with growth rates for English-speaking children with cochlear implants. METHOD Receptive and expressive vocabularies were measured with the simplified short form (SSF) version of the Mandarin Communicative Development Inventory (MCDI) in a sample of 112 pediatric implant recipients at baseline, 3, 6, 12, and 24 months after implantation. Implant ages ranged from 1 to 5 years. Scores were expressed in terms of normal equivalent ages, allowing normalized vocabulary growth rates to be determined. Scores for English-speaking children were re-expressed in these terms, allowing direct comparisons of Mandarin and English early spoken language development. RESULTS Vocabulary growth rates during the first 12 months after implantation were similar to those for normally hearing children less than 16 months of age. Comparisons with growth rates for normally hearing children 16-30 months of age showed that the youngest implant age group (1-2 years) had an average growth rate of 0.68 that of normally hearing children; while the middle implant age group (2-3 years) had an average growth rate of 0.65; and the oldest implant age group (>3 years) had an average growth rate of 0.56, significantly less than the other two rates. Growth rates for English-speaking children with cochlear implants were 0.68 in the youngest group, 0.54 in the middle group, and 0.57 in the oldest group. Growth rates in the middle implant age groups for the two languages differed significantly. CONCLUSIONS The SSF version of the MCDI is suitable for assessment of Mandarin language development during the first 24 months after cochlear implantation. Effects of implant age and duration of implantation can be compared directly across languages using normalized vocabulary growth rates. These comparisons for Mandarin and English reveal comparable results, despite the diversity of these languages, underscoring the universal role of plasticity in the developing auditory system.

Evaluation of speech perception in competing noise conditions for normally hearing children

Evaluation of speech perception in noisy environments for normally hearing children was conducted in order to provide normal data for speech perception testing in children with hearing impairments thus improving early intervention alternatives for Mandarin-speaking children with hearing impairments. The speech perception abilities of 174 developmentally normal children ranging aged 2-5 years, in four age groups, were evaluated in environments that were quiet or with high levels of competing noise using the Mandarin pediatric speech intelligibility (MPSI) test. The mean score of MPSI between the four age groups showed notable statistical differences, including a variation in mean score between the four age groups, clearly indicating that the speech perception abilities of young children in noisy environments improved greatly with age, most notably between the ages of 3 and 4 years old. Speech perception ability in noisy environments was shown to be significantly, but weakly, related to age, implying the presence of other, possibly environment factors, in speech perception development. Furthermore, no statistically significant difference between boys and girls was noted in the experimental MPSI scores. The ability of children to increasingly perceive speech in environments containing high competing noise levels was shown to gradually and progressively increase with age. These results indicated that the developing Mandarin speech perception abilities in noisy environments in normal hearing children develops substantially after the age of 3-4 years, suggesting that similar age ranges may be even more critical intervention points for children with hearing impairments. More studies are still needed to confirm that.

Outcome assessment alternatives for young children during the first 12 months after pediatric hearing-aid fittings.

Abstract Objective: Perform longitudinal evaluations of young children during the first 12 months after initial hearing-aid fitting. Document evidence of early prelingual auditory development (EPLAD), identify factors that affect EPLAD, and define performance milestones that can guide best practices. Design: Unblinded, prospective, within-subject, repeated-measures design. Audiological measures and measures of EPLAD were taken at baseline, 3, 6, and 12 months after hearing-aid fitting. Study sample: Subjects were 45 pediatric patients initially fitted with hearing aids between 1 and 5.5 years of age. Four groups were formed for analysis purposes based on severity of hearing loss (moderate-to-severe and profound) and initial fitting age (≤ 30 months and > 30 months). Results: All groups exhibited statistically significant increases in EPLAD within six months of hearing-aid fitting, and those with profound losses exhibited further statistically significant improvement between six and 12 months. Similar EPLAD levels were reached at 12 months regardless of severity of hearing loss. The EPLAD trajectory is similar to that following early cochlear implantation. Conclusions: Measures of EPLAD provide a means of evaluating outcomes following early pediatric hearing-aid intervention, supplementing behavioral audiological measures.

Initial classification of pediatric hearing impairment using behavioral measures of early prelingual auditory development.

Abstract Objective: Determine the sensitivity, specificity, and accuracy of pediatric hearing loss classification using behavioral evidence of early prelingual auditory development (EPLAD). Validate behavioral measures of EPLAD. Design: EPLAD was assessed in a prospective sample of hearing-impaired children using the infant-toddler meaningful auditory integration scale (ITMAIS/MAIS). Hearing losses were classified using tone-burst auditory brainstem response (ABR) and ITMAIS/MAIS scores. This process was repeated in a second retrospective sample. Study sample: The prospective sample was comprised of 139 hearing-impaired children under five years of age. Approximately equal proportions of mild-moderate, severe, and profound losses were included. The second retrospective sample was comprised of case records for 144 hearing-impaired children meeting the same selection criteria. This sample contained more than 80% profound losses. Results: EPLAD trajectories reached different asymptotes after two years of age, depending on the severity of hearing loss, allowing children over this age to be classified. The sensitivity of EPLAD classifications was over 90%; specificity was over 82%; and accuracy was over 88%. Conclusions: Behavioral evidence of EPLAD provides an initial means of classifying pediatric hearing losses which can facilitate initial treatment options prior to diagnostic evaluation with tone-burst ABR.

Psychometric properties of a Mandarin version of the tinnitus questionnaire

Abstract Objective: To develop a Mandarin version of the tinnitus questionnaire (MTQ) and determine the reliability and validity, and to assess whether it could be used clinically in the Chinese population. Design: The MTQ, short-form (36) health survey, hospital anxiety and depression scale, Mandarin (Chinese) tinnitus handicap inventory, and visual analogue scale were completed by the participants. Study sample: We included 192 adults seeking treatment for primary or secondary tinnitus. Results: Five factors, namely, emotional distress, auditory perceptual difficulties, cognitive distress, sleep disturbance, and intrusiveness, were extracted from the MTQ. Thirty-seven items were included. The MTQ had high test-retest reliability (Spearman correlation coefficients: 0.87–1.00). The MTQ and its subscales had good internal consistency and reliability (total α = 0.93, subscales α = 0.71–0.86). A single measure of severity can be acquired by summing the five subscale scores. The MTQ was significantly correlated with psychological distress and tinnitus-related handicap. Conclusion: Our results demonstrated that the MTQ is a reliable and valid measure of tinnitus-related psychopathological symptoms and could be used clinically to evaluate tinnitus-related psychological problems. Questionnaires designed to explore tinnitus-related depression and other symptoms not covered by the scope of the MTQ are needed.