Development of Mandarin monosyllabic speech test materials in China

Chinese Emotional Speech Audiometry Project (CESAP): Establishment and Validation of a New Material Set With Emotionally Neutral Disyllabic Words

PURPOSE

The Chinese Emotional Speech Audiometry Project (CESAP) aims to establish a new material set for Chinese speech audiometry tests, which can be used in both neutral and emotional prosody settings. As the first endeavor of CESAP, this study demonstrates the development of the material foundation and reports its validation in neutral prosody.

METHOD

In the development step, 40 phonetically balanced word lists consisting of 30 Chinese disyllabic words with neutral valence were first generated. In a following affective rating experiment, 35 word lists were qualified for validation based on the familiarity and valence ratings from 30 normal-hearing (NH) participants. For validation, performance-intensity functions of each word list were fitted with responses from 60 NH subjects under six presentation levels (-1, 3, 5, 7, 11, and 20 dB HL). The final material set was determined by the intelligibility scores at each decibel level and the mean slopes.

RESULTS

First, 35 lists satisfied the criteria of phonetic balance, limited repetitions, high familiarity, and neutral valence and were selected for validation. Second, 15 lists were compiled in the final material set based on the pairwise differences in intelligibility scores and the fitted 20%-80% slopes. The established material set had high reliability and validity and was sensitive to detect intelligibility changes (50% slope: 6.20%/dB; 20%-80% slope: 5.45%/dB), with small covariance of variation for thresholds (15%), 50% slope (12%), and 20%-80% slope (12%).

CONCLUSION

Our final material set of 15 word lists takes the initiative to control the emotional aspect of audiometry tests, which enriches available Mandarin speech recognition materials and warrants future assessments in emotional prosody among populations with hearing impairments.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25742814.

Evaluating Hearing Status and Word Recognition Ability in the Hmong Population Using Four Validated Monosyllabic White Hmong Dialect Word Recognition Tests

PURPOSE

The study's aims were (a) to evaluate hearing status and (b) word recognition ability of Hmong speakers using four validated monosyllabic word recognition tests in the White Hmong dialect and (c) to assess the relationship between the participant's language and the average word recognition percent correct scores, adjusting for age, gender, and degree of hearing loss.

METHOD

Participants listened to two randomly assigned validated Hmong word lists (male/female talker) for each ear. Pure-tone air- and bone-conduction thresholds as well as word recognition ability were measured. Descriptive statistics were calculated to analyze the percent correct of word lists and classify hearing status. A nonparametric regression analysis was used to assess the relationship between the participant's language and the average word recognition percent correct scores, adjusting for age, gender, and degree of hearing loss.

RESULTS

Forty-eight Hmong (25 females, 23 males; Mage = 44.4) participated in this study. Thirty-three participants had hearing loss in at least one ear, and 15 had hearing within normal limits bilaterally. Participants with normal, mild, or steeply sloping hearing loss reached an average word recognition score of > 94% on Hmong lists by both male and female talkers. Participants with moderate-to-severe hearing loss scored 68% on average for the male talker Hmong lists and 60% on average for the female talker Hmong lists. Gender was significantly positively associated with average word recognition percent correct on the female word lists (b = -0.224, p = .047) but not statistically significant for the male word lists (b = 7.579, p = .141).

CONCLUSION

Findings provide support for the use of the four Hmong word lists in clinical settings.

Validating Four Hmong Word Recognition Tests With Normal-Hearing Bilingual Hmong Individuals

Purpose:

The purpose of this study was to validate four digitally recorded and phonetically balanced 50-word recognition lists in the White Hmong dialect with normal-hearing bilingual Hmong adults.

Method:

Using a randomized, incomplete-block design, each participant listened to and repeated four unique Hmong lists delivered by a female and a male talker. Participants were also tested with an English word list—List 1A of the Northwestern University Auditory Test No. 6. Participants' correct pronunciation of each word was scored. A nonparametric Mann–Whitney U Location Difference Test for Equivalence using two one-sided tests equivalence hypothesis: −0.02 < [(List_1) – (List_2)] < 0.02 was conducted to assess equivalence among all four Hmong and the English lists.

Results:

Seventy Hmong speakers participated in this study (35 women, 35 men; M age = 29.5 years, SD = 7.1). In all four Hmong lists, 93.5% (187/200) words met the validation criteria for ≥ 92% correct pronunciation. The 13 difficult words were deemed adequate by a Hmong panel and, therefore, were included to maintain four unique, balanced word lists. The test revealed that the Hmong and English word lists were considered equivalent at the 2% bound.

Conclusion:

The four Hmong word lists were validated to ensure an equal range of word difficulty across the lists.

Development and Validation of a Mandarin Chinese Adaptation of AzBio Sentence Test (CMnBio)

A new sentence recognition test in Mandarin Chinese was developed and validated following the principles and procedures of development of the English AzBio sentence materials. The study was conducted in two stages. In the first stage, 1,020 sentences spoken by 4 talkers (2 males and 2 females) were processed through a 5-channel noise vocoder and presented to 17 normal-hearing Mandarin-speaking adults for recognition. A total of 600 sentences (150 from each talker) in the range of approximately 62 to 92% correct (mean = 78.0% correct) were subsequently selected to compile 30, 20-sentence lists. In the second stage, 30 adult CI users were recruited to verify the list equivalency. A repeated-measures analysis of variance followed by the post hoc Tukey's test revealed that 26 of the 30 lists were equivalent. Finally, a binomial distribution model was adopted to account for the inherent variability in the lists. It was found that the inter-list variability could be best accounted for with a 65-item binomial distribution model. The lower and upper limits of the 95% critical differences for one- and two-list recognition scores were then generated to provide guidance for detection of a significant difference in recognition scores in clinical settings. The final set of 26 equivalent lists contains sentence materials more difficult than those found in other speech audiometry materials in Mandarin Chinese. This test should help minimize the ceiling effects when testing sentence recognition in Mandarin-speaking CI users.

Effect of Electrode Insertion Angle on Cochlear Implantation Outcomes in Adult and Children Patients with Sensorineural Hearing Loss

Purpose

To determine the role played by electrode insertion angle in cochlear implantation (CI) outcomes in adult and children patients with sensorineural hearing loss (SNHL).

Methods

Adults (n = 10) and children (n = 19) with SNHL undergoing CI in a tertiary specialized hospital were retrospectively enrolled. The measurements were evaluated before and after CI surgery using sound field audiometry and speech recognition tests. Questionnaires were used to assess subjective benefits. Electrode insertion angles were determined using postoperative X-rays.

Results

Both adult and children patients showed significant improvements in hearing, speech performance, and audiology and speech-related quality of life after CI. The angular insertion depths of adult and children group were 323.70 ± 43.57° and 341.53 ± 57.07°, respectively, showing no significant difference. In the adult group, deeper insertion depths were found to be strongly linked to lower postoperative pure tone thresholds at 12 months and higher postoperative disyllabic Word Recognition and Sentence Recognition Scores at 6 months (all P < 0.05). In the children group, deeper insertion depth had a positive correlation with postoperative monosyllabic Word Recognition Scores 6 and 12 months after CI surgery (both P < 0.05). Multiple linear regression models were constructed to predict disyllabic Word Recognition Scores at 6 and 12 months postoperatively in the children group, in which insertion angle, duration of hearing loss, and preoperative questionnaire result were identified as dependent variables.

Conclusions

Greater angular insertion depths resulted in improved hearing and speech performances after CI. The benefits of greater angular insertion depths can be found in both adult and children patients and last for at least 12 months. Clinicians are expected to determine the optimal implantation direction during CI and ensure the insertion depth to improve the speech rehabilitation of patients.

Total auricular reconstruction concomitant with BONEBRIDGE implantation using a retrosigmoid sinus approach

BACKGROUND

Retrosigmoid sinus (RS) approach was not the dominant choice for BONEBRIDGE implantation.

OBJECTIVE

To investigate the efficacy and safety of auricular reconstruction concomitant with BONEBRIDGE implantation using retrosigmoid approach for aural atresia patients.

MATERIALS AND METHODS

A retrospective analysis was conducted of 15 children (28 ears) who underwent auricular reconstruction using a completely expanded postauricular flap with a skin expander concomitant with retrosigmoid BONEBRIDGE implantation from July 2019 to September 2020.

RESULTS

All 15 patients healed well and had no bone conduction shift. Average SFT improvement was 27.1 dB HL (p < .001). Comparison between aided and unaided speech recognition rate in quiet and in noise showed significant improvements, respectively (p < .001). After a follow-up of 21-35 months, the hearing results were stable and the aesthetic outcomes were satisfying.

CONCLUSIONS AND SIGNIFICANCE

For patients who undergo auricle reconstruction using expanded postauricular flap, retrosigmoid approach can avoid interfering the flap of reconstructed auricular without increasing the surgical risk or impact the clinical efficacy, and without significantly prolonging the total anesthesia time. The integrated surgical approach is a safe, and convenient option for patients who require simultaneous auricular reconstruction with BONEBRIDGE implantation.

Lists of monosyllables for logoaudiometric tests: elaboration, content validation and search for equivalence

PURPOSE

Develop new lists of monosyllables for conducting logoaudiometric tests in Portuguese, perform content validation, considering ear side and education and check the equivalence between the lists.

METHODS

Were selected 125 monosyllables with different syllabic structures, which were submitted to the content validation process, which included judgment on familiarity, organization of lists, recording of material and auditory recognition. After content validation, the monosyllable lists were subjected to equivalence research, in order to obtain evidence of reliability for the proposed test instrument.

RESULTS

Five lists with 25 monosyllables were elaborated and analyzed for content, of these, four lists were validated. There was no statistically significant difference between the responses obtained in the right and left ears. The education of the subjects did not influence the recognition of words. As for the equivalence search, it was found that two lists were equivalent, one not equivalent, but similar and one list was different from the others, and then excluded.

CONCLUSION

Two monosyllable lists were validated for content and considered equivalent, with the same level of difficulty between them, and one list was considered similar, which can be used as training to apply the test on the audiological battery. The validated lists were not influenced by ear and education.

Development of SC-10: A psychometrically equivalent Singapore Mandarin disyllabic word list for clinical speech audiometry use

Objective

The aim of this study is to develop and evaluate a set of psychometrically equivalent disyllabic wordlist (SC-10) in Singapore Mandarin for clinical use.

Study design

A preliminary set of 1000 words were obtained from a dictionary of frequently used words by Singapore students. Ten native judges rate the familiarity level of each word. This is followed by a face-to-face public survey to rank the shortlisted word set from most to least familiar. The final 108 disyllabic words were recorded by a native female talker. 20 normal hearing subjects were used to obtain the percentage of correct word recognition at 24 intensity levels (−10 dB HL to 26 dB HL in 2 dB increment). Psychometric function slopes were calculated for each word. 100 words were eventually chosen and assigned into ten 10-word lists based on a psychometric balancing protocol. Minor digital adjustments were made to the intensity of each wordlist to improve their auditory homogeneity.

The developed SC-10 wordlists were validated by a separate group of 25 normal hearing subjects. Test-retest reliability was carried out on 20 out of 25 participants at the selected intensity levels (SRT-5, SRT, SRT+5).

Results

The calculated regression slopes in the psychometric functions for the ten lists are between 8.0 and 9.8%/dB. Single factor ANOVA analysis showed no significant difference in both the mean intensity required to obtain 50% recognition score (f = 0.109, df = 9, p = 0.999) and the slopes of the psychometric functions (f = 0.078, df = 9, p = 0.999) between the ten word lists. List validation on 25 normal hearing participants (PTA = 11.0 dB HL, SD = 4.3) showed a mean speech recognition threshold (SRT) of 9.3 dB HL (SD = 3.5)and regression slope of 8.395%/dB. Quadratic regression analysis showed a positive correlation (r² = 0.923) between presentation level and word recognition score (WRS). The difference between PTA and SRT of each subject all fall within the clinically acceptable difference of 10 dB HL. Test-retest reliability, carried out on 20 subjects at three levels (SRT-5, SRT, and SRT+5 dB), showed no significance difference between word recognition score when the same participant is tested again at the same intensity level using a different wordlist.

Conclusion

All in all, it shows that the SC-10 speech materials are valid for clinical use for Mandarin speech audiometry in Singapore.

A review of Mandarin speech recognition test materials for use in Singapore

OBJECTIVE

This study aimed to evaluate word lists of current Mandarin speech recognition test materials on their adaptability for use on adult Singapore Mandarin speakers.

DESIGN

This scoping review involved literature search through electronic databases for studies published in English or Mandarin, detailing the development or validation of Mandarin speech recognition test materials meant to be used in quiet. Word lists of materials were evaluated for phonemic balance (Stage 1) and familiarity to Singapore Mandarin speakers by comparing the test items against a list of 1,000 common Singapore Mandarin words (Stage 2).

STUDY SAMPLE

Thirty articles that fulfilled the inclusion and exclusion criteria were reviewed.

RESULTS

Nine sets of materials were found and evaluated in Stage 1. Among these, two sets of materials did not contain phonemically balanced word lists. The remaining seven sets of materials were evaluated in Stage 2. The percentage of unfamiliar characters to Singapore Mandarin speakers was found to be between 15% and 41% across the word lists.

CONCLUSION

None of the currently available materials contain word lists that can be readily adapted for re-recording with the voice of a Singapore Mandarin speaker. There is a need to develop original Singapore Mandarin speech recognition test materials.

The characteristics of monosyllable recognition in Mandarin-speaking patients with auditory neuropathy

Background: A set of Chinese Mandarin monosyllable test lists has been widely used in clinical diagnosis, while the performance of the Mandarin-speaking patients with auditory neuropathy (AN) in the monosyllable tests was still unknown.Objectives: To analyze the characteristics of monosyllable recognition in Mandarin-speaking patients with AN.Materials and methods: Nineteen Mandarin-speaking patients diagnosed with AN were recruited to obtain the performance-intensity (P-I) functions. They were divided into two paired groups according to two conditions: (1) the rising-slope (RS) and the non-rising-slope pattern (NRS) group for the audiogram; or (2) the male and the female group for gender.Results: The performance at 20 and 30 dB SL showed negative correlation with the pure tone-averaged thresholds of 0.5, 1.0, 2.0 and 4.0 kHz (4FA). We found significant differences between the P-I functions of the RS and the NRS group, and surprisingly found that between the male and female as well although there was no difference in 4FA between the paired groups. A notable rollover phenomenon in P-I functions was detected in each group.Conclusions: The monosyllable recognition scores of Mandarin-speaking AN patients showed numerous particular characteristics reflected by P-I functions. Acquiring the complete P-I functions at multiple presentation levels and the rollover index may give us more information about the diagnosis and prognosis.

Modernising speech audiometry: using a smartphone application to test word recognition

OBJECTIVE

This study aimed to develop and assess a method to measure word recognition abilities using a smartphone application (App) connected to an audiometer.

DESIGN

Word lists were recorded in South African English and Afrikaans. Analyses were conducted to determine the effect of hardware used for presentation (computer, compact-disc player, or smartphone) on the frequency content of recordings. An Android App was developed to enable presentation of recorded materials via a smartphone connected to the auxiliary input of the audiometer. Experiments were performed to test feasibility and validity of the developed App and recordings.

STUDY SAMPLE

Participants were 100 young adults (18-30 years) with pure tone thresholds ≤15 dB across the frequency spectrum (250-8000 Hz).

RESULTS

Hardware used for presentation had no significant effect on the frequency content of recordings. Listening experiments indicated good inter-list reliability for recordings in both languages, with no significant differences between scores on different lists at each of the tested intensities. Performance-intensity functions had slopes of 4.05%/dB for English and 4.75%/dB for Afrikaans lists at the 50% point.

CONCLUSIONS

The developed smartphone App constitutes a feasible and valid method for measuring word recognition scores, and can support standardisation and accessibility of recorded speech audiometry.

Variability of word discrimination scores in clinical practice and consequences on their sensitivity to hearing loss

Speech perception scores are widely used to assess patient's functional hearing, yet most linguistic material used in these audiometric tests dates to before the availability of large computerized linguistic databases. In an ENT clinic population of 120 patients with median hearing loss of 43-dB HL, we quantified the variability and the sensitivity of speech perception scores to hearing loss, measured using disyllabic word lists, as a function of both the number of ten-word lists and type of scoring used (word, syllables or phonemes). The mean word recognition scores varied significantly across lists from 54 to 68%. The median of the variability of the word recognition score ranged from 30% for one ten-word list down to 20% for three ten-word lists. Syllabic and phonemic scores showed much less variability with standard deviations decreasing by 1.15 with the use of syllabic scores and by 1.45 with phonemic scores. The sensitivity of each list to hearing loss and distortions varied significantly. There was an increase in the minimum effect size that could be seen for syllabic scores compared to word scores, with no significant further improvement with phonemic scores. The use of at least two ten-word lists, quoted in syllables rather than in whole words, contributed to a large decrease in variability and an increase in sensitivity to hearing loss. However, those results emphasize the need of using updated linguistic material for clinical speech score assessments.

Validation of list equivalency for Mandarin speech materials to use with cochlear implant listeners

OBJECTIVES

Speech materials validated with normal-hearing listeners may not be appropriate for clinical assessment of cochlear implant (CI) users. The aim of this study was to validate list equivalency of the Mandarin Speech Perception (MSP) sentences, disyllables, and monosyllables in Mandarin-speaking CI patients.

DESIGN

Recognition of MSP sentences, disyllables, and monosyllables each were measured for all 10 lists.

STUDY SAMPLE

67 adult and 32 pediatric Mandarin-speaking CI users.

RESULTS

There was no significant difference between adult and pediatric subject groups for all test materials. Significant differences were observed among lists within each test. After removing one or two lists within each test, no significant differences were observed among the remaining lists. While there was equal variance among lists within a given test, the variance was larger for children than for adults, and increased from monosyllables to disyllables to sentences.

CONCLUSIONS

Some adjustment to test lists previously validated with CI simulations was needed to create perceptually equivalent lists for real CI users, suggesting that test materials should be validated in the targeted population. Differences in mean scores and variance across test materials suggest that CI users may differ in their ability to make use of contextual cues available in sentences and disyllables.

Lexical Influences on Spoken Spondaic Word Recognition in Hearing-Impaired Patients

Top-down contextual influences play a major part in speech understanding, especially in hearing-impaired patients with deteriorated auditory input. Those influences are most obvious in difficult listening situations, such as listening to sentences in noise but can also be observed at the word level under more favorable conditions, as in one of the most commonly used tasks in audiology, i.e., repeating isolated words in silence. This study aimed to explore the role of top-down contextual influences and their dependence on lexical factors and patient-specific factors using standard clinical linguistic material. Spondaic word perception was tested in 160 hearing-impaired patients aged 23-88 years with a four-frequency average pure-tone threshold ranging from 21 to 88 dB HL. Sixty spondaic words were randomly presented at a level adjusted to correspond to a speech perception score ranging between 40 and 70% of the performance intensity function obtained using monosyllabic words. Phoneme and whole-word recognition scores were used to calculate two context-influence indices (the j factor and the ratio of word scores to phonemic scores) and were correlated with linguistic factors, such as the phonological neighborhood density and several indices of word occurrence frequencies. Contextual influence was greater for spondaic words than in similar studies using monosyllabic words, with an overall j factor of 2.07 (SD = 0.5). For both indices, context use decreased with increasing hearing loss once the average hearing loss exceeded 55 dB HL. In right-handed patients, significantly greater context influence was observed for words presented in the right ears than for words presented in the left, especially in patients with many years of education. The correlations between raw word scores (and context influence indices) and word occurrence frequencies showed a significant age-dependent effect, with a stronger correlation between perception scores and word occurrence frequencies when the occurrence frequencies were based on the years corresponding to the patients' youth, showing a "historic" word frequency effect. This effect was still observed for patients with few years of formal education, but recent occurrence frequencies based on current word exposure had a stronger influence for those patients, especially for younger ones.

Psychometric properties of the Standard-Chinese lexical neighborhood test

CONCLUSION

The psychometric characteristics of Standard-Chinese lexical neighborhood test (LNT) confirmed the lexical effects of the four word categories. The established normative baseline can be used in evaluating the word-recognition performance of the hearing-impaired listeners.

OBJECTIVES

The purpose of the present study was to examine the psychometric characteristics and evaluate the reliability of Standard-Chinese LNT in children and adults.

METHODS

Twenty-six normal-hearing adults and 13 normal-hearing children were recruited. Word recognition was tested with the Standard-Chinese LNT materials that consisted of four types of word list: monosyllable easy words, monosyllable hard words, disyllable easy words, and disyllable hard words.

RESULTS

The thresholds at 50% correct performance for the easy word lists and disyllable word lists were lower than those for the hard word lists and monosyllable word lists, respectively (all p < 0.001). The slopes for disyllable words were steeper than the monosyllable words (p < 0.05). In addition, the recognition threshold of the four categories for children was higher than that for adults (all p < 0.05). The critical difference was on average 26.6% for adults and 30.0% for children.

Cochlear implants with fine structure processing improve speech and tone perception in Mandarin-speaking adults

CONCLUSION

This study indicates that Mandarin-speaking subjects acquire significant benefit from a cochlear implant (CI) and audio processor with the fine structure processing (FSP) coding strategy. It can take adult Mandarin CI users time to become accustomed to their CI and appreciate the benefits.

OBJECTIVES

This study aimed to determine speech perception outcomes in Mandarin-speaking adults who received the FSP coding strategy.

METHODS

This was a prospective study. Ten adults who were implanted unilaterally with a PULSARCI(100), and received an OPUS 1 or OPUS 2 speech processor, were included in this study. The mean age at implantation was 31.1 years. We determined the benefit to postlingually deafened Mandarin-speaking adults with a severe to profound hearing loss using the tests: monosyllables in quiet, sentences in quiet and the Mandarin Hearing in Noise Test (MHINT). Tone perception was evaluated using a tone perception test. A visual analog scale (VAS) was used to score sound quality and ease of listening.

RESULTS

The results showed a significant improvement between first fitting and 6 months in all speech tests and in tone perception. The VAS scores showed a significant improvement over 6 months in sound quality and an immediate benefit in ease of listening.

Performance-Intensity Functions of Mandarin Word Recognition Tests in Noise: Test Dialect and Listener Language Effects

Purpose

This study established the performance-intensity function for Beijing and Taiwan Mandarin bisyllabic word recognition tests in noise in native speakers of Wu Chinese. Effects of the test dialect and listeners' first language on psychometric variables (i.e., slope and 50%-correct threshold) were analyzed.

Method

Thirty-two normal-hearing Wu-speaking adults who used Mandarin since early childhood were compared to 16 native Mandarin-speaking adults. Both Beijing and Taiwan bisyllabic word recognition tests were presented at 8 signal-to-noise ratios (SNRs) in 4-dB steps (−12 dB to +16 dB). At each SNR, a half list (25 words) was presented in speech-spectrum noise to listeners' right ear. The order of the test, SNR, and half list was randomized across listeners. Listeners responded orally and in writing.

Results

Overall, the Wu-speaking listeners performed comparably to the Mandarin-speaking listeners on both tests. Compared to the Taiwan test, the Beijing test yielded a significantly lower threshold for both the Mandarin- and Wu-speaking listeners, as well as a significantly steeper slope for the Wu-speaking listeners.

Conclusion

Both Mandarin tests can be used to evaluate Wu-speaking listeners. Of the 2, the Taiwan Mandarin test results in more comparable functions across listener groups. Differences in the performance-intensity function between listener groups and between tests indicate a first language and dialectal effect, respectively.

Development and validation of the Mandarin disyllable recognition test

CONCLUSION

Given the phonetic balancing across lists and the validation with spectrally degraded speech, the present Mandarin disyllable recognition test (DRT) materials may be useful for assessing speech performance of Mandarin-speaking cochlear implant (CI) users. If combined with the previously developed sentence materials, these materials would help to establish standardized speech perception tests for Mandarin-speaking hearing-impaired (HI) and CI patients.

OBJECTIVES

To develop standardized Mandarin DRT materials that can be used to evaluate the speech performance of Mandarin-speaking HI and CI patients, and to establish standardized Mandarin speech perception test materials that include both disyllables and sentences.

METHODS

Ten phonetically balanced Mandarin DRT lists were developed. The DRT materials were validated in 8 normal-hearing (NH) subjects listening to unprocessed speech and in 10 NH subjects listening to a 4-channel, sine-wave vocoded acoustic simulation of CI speech processing. Performance with the DRT materials was compared to that with Mandarin sentence materials previously developed by our group.

RESULTS

The distribution of vowels, consonants, and tones within each DRT list was similar to that observed across commonly used Chinese characters. There was no significant difference in disyllable word recognition across lists in both unprocessed and four-channel vocoded speech. There was a significant correlation between disyllable and sentence recognition performance.