Objective To study the normal ranges and features for click-auditory brainstem responses of children in 3~5 years old.Methods Normal results of click-ABR from 132 normal children (224 ears)were ana-lyzed.The children were divided into three groups:Group A (74 ears from children of 3 years old),Group B (78 ears from children of 4 years old)and Group C (72 ears from children of 5 years old).The ABR data were statisti-cally analyzed by ANOVA with SPSS.Results At 80 dB nHL,the wave Ⅰ,Ⅲ,and Ⅴ latencies and intervals of wave Ⅰ- Ⅲ,and wave Ⅰ-Ⅴ of ABR for 3 -year old children were 1.24 ±0.09 ms,3.53 ±0.16 ms,5.39 ± 0.23 ms,2.30±0.15ms and 4.15 ±0.22 ms,respectively,and for 4 -year-old children,they were1.23 ±0.10 ms,3.52±0.39 ms,5.30±0.21 ms,2.28±0.39 ms and 4.07 ±0.22 ms,respectively.For 5 - year-old chil-dren,they were1.24±0.10 ms,3.67±0.63 ms and 5.34±0.19 ms,2.42±0.63 ms and 4.09±0.19 ms,respec-tively.The thresholds for 3-year children were 22.57 ±4.40 dB nHL,for 4 - year children,21.15 ±4.83 dB nHL,and for 5 - year children,21.11±3.48 dB nHL.Among three groups,only latency of wave V and interval of wave I-V had statistical differences,and a further analysis showed the statistical differences in Groups A and B. No statistical differences were observed in Groups B and C.The latency of wave I and thresholds of ABR for the children of different ages were not significantly different.Conclusion The resvits of this study suggest the brainstem may mature at 4 years old.

Objective To investigate the characteristic changes of the metabolism products in the auditory cortex (transverse temporal gyrus)in patients with metabolic syndrome combined with sensorineural deafness using 1 H magnetic resonance spectroscopy (1 H-MRS),and to find out the early warning indicators of sensorineural deafness in patients with metabolic syndrome.Methods The pure tone audiometry (PTA)was performed in 142 pa-tients with metabolic syndrome (diagnosed by endocrinology department),and 15 healthy subjects as the control group.The patients were divided into four groups:the metabolic syndrome group;the metabolic syndrome group with unilateral,the bilateral deafness group,and the control group.Cerebral metabolism was studied by assessing the ratios of nitro-acetyl aspartate contrast to choline (NAA/Cho)as well as to creatine (NAA/Cr),myo-inosi-tol to creatine (mI/Cr)and choline to creatine (Cho/Cr)ratios in the auditory cortical separately in these groups. ROC curves were made for those metabolism markers to find the best diagnostic threshold.Results Significantly lower values of NAA/Cho ratio and higher values of Cho/Cr were observed in metabolic syndrome in the control group (P<0.05),Cho/Cr higher than those (P<0.05).NAA/Cho ratios in the injured and uninjured auditory cortex of MS with unilateral deafness were significantly lower than those in the control group (P<0.05).A self-comparison was made between the inj ured and uninj ured auditory cortex,the result showed that NAA/Cho ratio had significant differences.All of the metabolisms were tested by the curve of ROC.The area of NAA/Cho under the ROC curve was 81%,which had a higher accuracy.NAA/Cho equating to 1 .82 could be used as the boundary indi-cators between metabolic syndrome without deafness and with deafness groups.The areas of the other indicators un-der the ROC curve were <50%.Conclusion NAA/Cho may be the early warning marker of sensorineural deafness in patients with metabolic syndrome.

Objective To investigate the mechanism of hearing loss after focal cerebral ischemia-reperfusion injury in rats.Methods A total of 60 healthy male adult SD rats were included in this study and randomly divided into 2 groups, ischemia-reperfusion(I/R) group and sham operated control, with 30 rats in each group.The rats in I/R group were operated for suture-occluded method to establish middle cerebral artery occlusion(MCAO)model, with ischemia for 60 mins followed by reperfusion for 24 hrs.The control group was only to be isolated cervical vessels, with no thread embolism inserted.The auditory brainstem response (ABR) was tested before operation and at 24 hrs post-operation respectively.At 24 hrs post-operation, we scored neurological functions, measured the changes of water content in the brain using the dry-wet weight method, and determined the infarct volume through TTC method.We also evaluated the integrity of blood-brain barrier(BBB) by viewing the exudation of Evans blue and observed the apoptosis of neurocyte by TUNEL method to conclude apoptotic index(AI).The expression of MMP-9,Claudin-5,Occludin and CX-43 were detected by Western blot.Results Compared with the sham group,the neurological function scores,the infarct volume and water content of the brain increased, with the elevated thresholds of ABR significantly and AI went up in I/R group.The expression levels of MMP-9 and CX-43 were significantly up-regulated,but the expressions of Claudin-5 and Occludin were obviously down-regulated.All of the differences above had statistical significances.Conclusion The mechanism of hearing loss after focal cerebral ischemia-reperfusion injury in rats is possibly related to MMPs activation,neurocyte apoptosis,BBB breakage and gap junction damage.

Objective To explore the clinical value of ITMAIS in the early prelingual auditory development (EPLAD)assessment for bilateral profound hearing impaired children with hearing aids.Methods Profound sensorineural hearing impaired children fitted with hearing aids during October 2008 and July 2011 in our center were recruited in this retrospective study, and they would be tested with the ITMAIS at baseline, 3 months, and 6 months after hearing aids fitting.A total of 51 children were recruited in the study, and divided into 2 age groups according to the age at fitting, 1 yr group (28 children) and 2 yrs group (23 children).Results The EPLAD of children in both groups improved significantly in the first half of year after fitting (P<0.05).The mean EPLAD levels of children in both groups were close to or achieved the mean level of severe sensorineural hearing impaired children without intervention when they had had the hearing aids for 6 months.Conclusion Hearing aids could help the children with profound sensorineural hearing loss to improve the abilities of EPLAD.ITMAIS is a simple, an effective tool for assessing the early outcome of children with hearing aids, especially for the children who could not cooperate with the behavioral hearing test.

Objective To study the validity of a new material, to verify the influence of gender and age differences on normal school children, and give advice to establishing the norms of mean nasalance for normal school children.Methods The mean nasalance of 190 school children in Shanghai was obtained by reading the new, old material and the vowel /a/,/o/,/e/,/i/,/u/, and /ü/, the mean nasalance was analyzed for the standard deviations.The gender and age score differences were compared.Results The new material was more stable than the old.In the test of /i/ and/ü/and the nasal material, the girls'' MNS was higher than the boys''.In testing the vowels /a/,/o/,/e/,/i/,/u/, and /ü/and the new material, there were differences in different ages.Conclusion The validity of new material is more stable than the old.The MNS of the normal children in Shanghai show that it is higher for the girls than the boys, and also higher for the older children than for the younger.

Objective To carry out a Meta-analysis on the published data to evaluate voice after laser surgery versus radiotherapy of T1a glottic carcinoma.Methods The major medical-related databases were used in this study including PubMed, Web of Science,Embase, Cochrane library, CNKI and Wanfang Date.The articles by two co-authors at the same time were screened to read the relevant literatures, extraction of data and research related to the purpose from the selected literature.Results According the necessary conditions,fourteen literatures was included finally, and statistical analysis results showed that owing to the meta-analysis of the maximum time of speech (MPT) [test for overall effect:Z=2.65,MD=-2.26,95%CI(-3.94,-0.59),P=0.008] and the fundamental frequency (F0) [test for overall effect:Z=7.49,MD=14.41,95%CI(10.14,18.19),P<0.000 01], radia-tion therapy was superior to laser surgery,but the Meta-analysis of voice handicap index (VHI) [test for overalleffect:Z=1.04,MD=5.86,95%CI(-5.22,16.94),P=0.30], jitter[test for overall effect:Z=1.43,MD=0.75,95%CI(-0.28,1.79),P=0.15], shimmer[test for overall effect:Z=1.26,MD=1.07,95%CI(-0.60,2.75,P=0.21] and Airflow rate(AFR) [test for overall effect:Z=0.42,MD=21.46,95%CI(-78.79,121.72),P=0.67] don''t show statistically significant difference between the two groups.Conclusion The radiation therapy is slightly superior to the laser surgery in protecting voice in the treatment of T1a glottic carcinoma.

Objective To study the rehabilitation effects of the cochlear implants on prelingually deaf children with alba abnormality.Methods A retrospective analysis of the effects of CIs was conducted in the prelingually deaf children of 11 cases of the children with abnormal alba(the research group) and 18 cases of the children who had normal alba(the control group) at the First Affiliated Hospital of Fujian medical university.All the operations were completed by the same doctor.There were no obvious complications during and after the operation.The cochlear implants were turned on after one month and the prelingually deaf children with extremely severe bilateral sensorineural deafness were trained for speech at the rehabilitation centre.The assessment criteria of the categories of auditory performance(CAP) and speech intelligibility rate(SIR) were used.After six months and twelve months of the operation, the family members were followed who have direct contacts with the children.The evaluation of data between the research and the control groups was administered.Results In the research group, the average level of CAP after six months'' post-operation was 2.41±0.47.But in the control group, the average level was 3.28±0.45.In the research group, the average level of SIR after six months'' post-operation was 1.27±0.44.There were 3 children in the research group at level 2, but in the control group, the average level was 1.89±0.31.Two children in the control group were level 1 while the others were level 2.In the research group, the average level of CAP after twelve months'' post-operation was 4.00±0.43 while only one child at level 3.There was one child at level 5 in the research group, the rest were level 4.There was a statistically significant difference in the average level of the CAP after six months'' post-operation(t=4.983, P<0.05) and in the average level of the SIR after six months'' post-operation(t=4.371, P<0.05).There was no statistical difference in the average level of the CAP after twelve months'' post-operation(t=1.033, P>0.05) and in the average level of the SIR after twelve months'' post-operation(t=0.434, P>0.05).Conclusion There is no significant difference of the rehabilitation effects of post-operation between the prelingually deaf children with alba abnormality and those with normal alba.

Objective To study the auditory perception and speech ability outcomes after cochlear implantation in prelingually deaf children with extremely severe neurosensory hearing loss and comorbid leukoencephalopathy.Methods Our study included 14 prelingually deaf children with leukoencephalopathy (confirmed by preoperative MRI scanning) who were treated with cochlear implantation in the Department of Otorhinolaryngology Head and Neck Surgery of Hainan Provincial People''s Hospital, including 8 males and 6 females of 1~6 yr with a mean age of 3.8 yr.Sixteen synchronous prelingually deaf children without central nervous system (CNS) diseases were also included as the control group, including 11 males and 5 females of 1~6 yr with a mean age of 4.4 yr.All the patients underwent pre-surgical assessments of audiology, radiology, speech ability and intelligence before cochlear implantation via transmastoid facial nerve recess approach was done, after which rehabilitation was provided at the Hainan Rehabilitation Center for Deaf Children.Categories of auditory performance (CAP) and speech intelligibility rate (SIR) were employed as the assessment criteria for the outcome of surgery, the scores of which at different timepoints after surgery were statistically compared through paired t-test between the two groups.Results All the patients gained post-surgical hearing and speech abilities to different degrees, whereas CAP and SIR scores both chronologically improved in the both groups.No statistical difference was revealed either in CAP or in SIR scores between the two groups at 6, 12 and 24 months after surgery (P>0.05).Conclusion Children with extremely severe neurosensory hearing loss can be reated with cochlear implantation even if they have comorbid leukoencephalopathy.The effects of auditory and speech rehabilitation for the same age patients with leukoencephalopathy are similar to those without leukoencephalopathy in 2 years after surgery.

Objective To study the relationship between the development of auditory and speech in children with hearing loss after hearing aid fitting and discuss the development of speech with the ability of auditory in children at different stages of evaluation, with different degrees of hearing loss and different ages respectively.Methods A total of 19 children (14 boys and 5 girls) with hearing loss participated in this study.The age at hearing aid fitting ranged from 3 to 8 years old with a mean of 5.42±1.86 years old.According to their hearing levels, the children in this study were divided into two groups: the moderate hearing loss group (n=10) and the severe group (n=9).According to their ages at hearing aid fitting, all children in this study were divided into two groups: the less than or equal to six years old (n=11) and greater than six years old (n=8).MAIS and MUSS were used to evaluate their abilities of auditory and speech at pre-fitting, 1, 3, 6, 9 and 12 months after hearing aids were worn respectively.A linear and regression analysis was done in the statistic procedure.Results There was a significant correlation between the scores of MAIS and MUSS (R=0.774,P<0.05).There was also a significant correlation between the scores of MAIS and MUSS for the different evaluating stages respectively.The correlations were pre-fitting (R=0.710,P<0.05), 1 month after hearing aid fitting (R=0.774,P<0.05), 3 months after hearing aid fitting (R=0.814,P<0.05), 6 months after hearing aid fitting (R=0.819,P<0.05), 9 months after hearing aid fitting (R=0.707,P<0.05), 12 months after hearing aid fitting (R=0.649,P<0.05).There was also a significant correlation between the scores of MAIS and MUSS for MAIS (items 3~6) (Sound awareness) and MAIS (items 7~10) (Sound understanding).The correlations for MAIS (items 3~6) were (R=0.768,P<0.05), and for MAIS (items 7~10) (Sound understanding) (R=0.794,P<0.05).There was also a significant correlation between the scores of MAIS and MUSS for different group of ages.The correlations for the group of <6years old were (R=0.808,P<0.05), and for the group of the ≥6 years old (R=0.775,P<0.05).There was also a significant correlation between the scores of MAIS and MUSS for different groups of hearing loss levels.The correlation for the group of moderate hearing loss was (R=0.771,P<0.05), and the group of severe hearing loss (R=0.787,P<0.05).Conclusion The development of auditory ability is closely related to the speech ability.The speech abilities increase with the improvement of auditory abilities.The less severe the hearing loss is, the longer the use of hearing aids, the younger the children are, the better the speech ability improved with auditory ability development after hearing aid fitting.

Objective The aim of the study was to evaluate the hearing performance of a new transcutaneous bone conduction hearing aid.Methods One hundred and nine patients with conductive or mix hearing loss and eleven patients with single sided sensorineural hearing loss from four tertiary referral centers were tested under unaided and aided conditions with the sound processors on testbands.Free field test was performed to obtain the hearing thresholds and speech recognition thresholds in quiet.Adverse events were also documented by a self-reported questionnaire.Results ①Conductive or mixed hearing loss patients:for aged≥6 yrs subgroup,the bone conduction PTA average of aided sides was 18.55±8.99 dB HL.For aged<6 yrs subgroup, the bone conduction ABR hearing threshold average was 18.33±8.36 dB HL.②Statistically significant improvements in free field hearing thresholds were seen when compared aided hearing with unaided outcomes.The average PTA (pure tone average in free field) was measured at 32.21±10.00, 37.33±14.15, and 34.38±10.76 dB HL respectively in conductive or mixed hearing loss aged≥6 yrs subgroup;aged<6 yrs subgroup and SSD subgroup.③In aided situations;speech recognition thresholds in quiet were significantly better compared to unaided situation in patients aged≥6yrs.④None of patients presented adverse events related to the devices.Conclusion The Sophono bone conduction hearing aid has satisfactory hearing performance and can be considered an alternative device for patients with conductive or mix hearing loss or with SSD.