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Although the cochlear implant has been widely acknowledged as the most successful neural prosthesis, only a fraction of hearing-impaired people who can potentially benefit from a cochlear implant have actually received one due to its limited awareness, accessibility, and affordability. To help overcome these limitations, a 26-electrode cochlear implant has been developed to receive China's Food and Drug Administration (CFDA) approval in 2011 and Conformité Européenne (CE) Marking in 2012. The present article describes design philosophy, system specification, and technical verification of the Nurotron device, which includes advanced digital signal processing and 4 current sources with multiple amplitude resolutions that not only are compatible with perceptual capability but also allow interleaved or simultaneous stimulation. The article also presents 3-year longitudinal evaluation data from 60 human subjects who have received the Nurotron device. The objective measures show that electrode impedance decreased within the first month of device use, but was stable until a slight increase at the end of two years. The subjective loudness measures show that electric stimulation threshold was stable while the maximal comfort level increased over the 3 years. Mandarin sentence recognition increased from the pre-surgical 0%-correct score to a plateau of about 80% correct with 6-month use of the device. Both indirect and direct comparisons indicate indistinguishable performance differences between the Nurotron system and other commercially available devices. The present 26-electrode cochlear implant has already helped to lower the price of cochlear implantation in China and will likely contribute to increased cochlear implant access and success in the rest of the world.This article is part of a Special Issue entitled .

English-speaking bimodal and bilateral cochlear implant (CI) users can segregate competing speech using talker sex cues but not spatial cues. While tonal language experience allows for greater utilization of talker sex cues for listeners with normal hearing, tonal language benefits remain unclear for CI users. The present study assessed the ability of Mandarin-speaking bilateral and bimodal CI users to recognize target sentences amidst speech maskers that varied in terms of spatial cues and/or talker sex cues, relative to the target. Different from English-speaking CI users, Mandarin-speaking CI users exhibited greater utilization of spatial cues, particularly in bimodal listening., (© 2024 Author(s). All article content, except where otherwise noted, is licensed under a Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).)

Differences in spectro-temporal degradation may explain some variability in cochlear implant users' speech outcomes. The present study employs vocoder simulations on listeners with typical hearing to evaluate how differences in degree of channel interaction across ears affects spatial speech recognition. Speech recognition thresholds and spatial release from masking were measured in 16 normal-hearing subjects listening to simulated bilateral cochlear implants. 16-channel sine-vocoded speech simulated limited, broad, or mixed channel interaction, in dichotic and diotic target-masker conditions, across ears. Thresholds were highest with broad channel interaction in both ears but improved when interaction decreased in one ear and again in both ears. Masking release was apparent across conditions. Results from this simulation study on listeners with typical hearing show that channel interaction may impact speech recognition more than masking release, and may have implications for the effects of channel interaction on cochlear implant users' speech recognition outcomes., Competing Interests: Q.F. has a financial interest in Nurotron Biotechnology, Co. Ltd. a medical device company that designs, develops, and markets cochlear implants. This does not alter our adherence to PLOS One policies on sharing data and materials., (Copyright: © 2023 Cychosz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Elderly adults often experience difficulties in speech understanding, possibly due to age-related deficits in frequency perception. It is unclear whether age-related deficits in frequency perception differ between the apical or basal regions of the cochlea. It is also unclear how aging might differently affect frequency discrimination or detection of a change in frequency within a stimulus. In the present study, pure-tone frequency thresholds were measured in 19 older (61-74 years) and 20 younger (22-28 years) typically hearing adults. Participants were asked to discriminate between reference and probe frequencies or to detect changes in frequency within a probe stimulus. Broadband spectro-temporal pattern perception was also measured using the spectro-temporal modulated ripple test (SMRT). Frequency thresholds were significantly poorer in the basal than in the apical region of the cochlea; the deficit in the basal region was 2 times larger for the older than for the younger group. Frequency thresholds were significantly poorer in the older group, especially in the basal region where frequency detection thresholds were 3.9 times poorer for the older than for the younger group. SMRT thresholds were 1.5 times better for the younger than for the older group. Significant age effects were observed for SMRT thresholds and for frequency thresholds only in the basal region. SMRT thresholds were significantly correlated with frequency thresholds only in the older group. The poorer frequency and spectro-temporal pattern perception may contribute to age-related deficits in speech perception, even when audiometric thresholds are nearly normal., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Ltd.)

Speech recognition thresholds were measured as a function of the relative level between two speech maskers that differed in perceptual similarity from the target. Results showed that recognition thresholds were driven by the relative level between the target and perceptually similar masker when the perceptually similar masker was softer, and by the relative level between the target and both maskers when the perceptually similar masker was louder. This suggests that effectiveness of a two-talker masker is primarily determined by the masker stream that is most perceptually similar to the target, but also by the relative levels between the two maskers., (© 2023 Author(s). All article content, except where otherwise noted, is licensed under a Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).)

Hearing loss in the extended high-frequency (EHF) range (>8 kHz) is widespread among young normal-hearing adults and could have perceptual consequences such as difficulty understanding speech in noise. However, it is unclear how EHF hearing loss might affect basic psychoacoustic processes. The hypothesis that EHF hearing loss is associated with poorer auditory resolution in the standard frequencies was tested. Temporal resolution was characterized by amplitude modulation detection thresholds (AMDTs), and spectral resolution was characterized by frequency change detection thresholds (FCDTs). AMDTs and FCDTs were measured in adults with or without EHF loss but with normal clinical audiograms. AMDTs were measured with 0.5- and 4-kHz carrier frequencies; similarly, FCDTs were measured for 0.5- and 4-kHz base frequencies. AMDTs were significantly higher with the 4 kHz than the 0.5 kHz carrier, but there was no significant effect of EHF loss. There was no significant effect of EHF loss on FCDTs at 0.5 kHz; however, FCDTs were significantly higher at 4 kHz for listeners with than without EHF loss. This suggests that some aspects of auditory resolution in the standard audiometric frequency range may be compromised in listeners with EHF hearing loss despite having a normal audiogram., (© 2023 Acoustical Society of America.)

For French cochlear implant (CI) recipients, in-person clinical auditory rehabilitation is typically provided during the first few years post-implantation. However, this is often inconvenient, it requires substantial time resources and can be problematic when appointments are unavailable. In response, we developed a computer-based home training software ("French AngelSound™") for French CI recipients. We recently conducted a pilot study to evaluate the newly developed French AngelSound™ in 15 CI recipients (5 unilateral, 5 bilateral, 5 bimodal). Outcome measures included phoneme recognition in quiet and sentence recognition in noise. Unilateral CI users were tested with the CI alone. Bilateral CI users were tested with each CI ear alone to determine the poorer ear to be trained, as well as with both ears (binaural performance). Bimodal CI users were tested with the CI ear alone, and with the contralateral hearing aid (binaural performance). Participants trained at home over a one-month period (10 hours total). Phonemic contrast training was used; the level of difficulty ranged from phoneme discrimination in quiet to phoneme identification in multi-talker babble. Unilateral and bimodal CI users trained with the CI alone; bilateral CI users trained with the poorer ear alone. Outcomes were measured before training (pre-training), immediately after training was completed (post-training), and one month after training was stopped (follow-up). For all participants, post-training CI-only vowel and consonant recognition scores significantly improved after phoneme training with the CI ear alone. For bilateral and bimodal CI users, binaural vowel and consonant recognition scores also significantly improved after training with a single CI ear. Follow-up measures showed that training benefits were largely retained. These preliminary data suggest that the phonemic contrast training in French AngelSound™ may significantly benefit French CI recipients and may complement clinical auditory rehabilitation, especially when in-person visits are not possible., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kerneis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Bimodal cochlear implant (CI) listeners have difficulty utilizing spatial cues to segregate competing speech, possibly due to tonotopic mismatch between the acoustic input frequency and electrode place of stimulation. The present study investigated the effects of tonotopic mismatch in the context of residual acoustic hearing in the non-CI ear or residual hearing in both ears. Speech recognition thresholds (SRTs) were measured with two co-located or spatially separated speech maskers in normal-hearing adults listening to acoustic simulations of CIs; low frequency acoustic information was available in the non-CI ear (bimodal listening) or in both ears. Bimodal SRTs were significantly better with tonotopically matched than mismatched electric hearing for both co-located and spatially separated speech maskers. When there was no tonotopic mismatch, residual acoustic hearing in both ears provided a significant benefit when maskers were spatially separated, but not when co-located. The simulation data suggest that hearing preservation in the implanted ear for bimodal CI listeners may significantly benefit utilization of spatial cues to segregate competing speech, especially when the residual acoustic hearing is comparable across two ears. Also, the benefits of bilateral residual acoustic hearing may be best ascertained for spatially separated maskers., (© 2023. The Author(s).)

Background: Immune checkpoint inhibitor (ICI) therapy combined with conventional therapies is being broadly applied in non-small cell lung cancer (NSCLC) patients. However, the risk of interstitial pneumonitis (IP) following a combined regimen is incompletely characterized., Methods: A total of 46,127 NSCLC patients were extracted for disproportionality analyses of IP from the Food and Drug Administration's Adverse Event Reporting System (FAERS) database. A total of 1108 NSCLC patients who received ICI treatment at Nanfang Hospital of Southern Medical University were collected and utilized for real-world validation., Results: Of the 46,127 patients with NSCLC, 3830 cases (8.3%; 95% confidence interval [CI], 8.05-8.56) developed IP. Multivariable logistic regression analyses revealed that the adjusted ROR of ICI combined with radiation (RT) was the highest (121.69; 95% CI, 83.60-184.96; P < 0.0001) among all therapies, while that of ICI combined with chemotherapy (CHEMO) or targeted therapy (TARGET) was 0.90 (95% CI, 0.78-1.04; P = 0.160) and 1.49 (95% CI, 0.95-2.23; P = 0.065), respectively, using ICI monotherapy as reference. Furthermore, analyses from our validation cohort of 1108 cases showed that the adjusted odds ratio of ICI combined with RT was the highest (12.25; 95% CI, 3.34-50.22; P < 0.01) among all the therapies, while that of ICI combined with CHEMO or TARGET was 2.32 (95% CI, 0.89-7.92; P = 0.12) and 0.66 (95% CI, 0.03-4.55; P = 0.71), respectively, using ICI monotherapy as reference., Conclusions: Compared with ICI monotherapy, ICI combined with RT, rather than with CHEMO or TARGET, is associated with a higher risk of IP in NSCLC patients. Hence, patients receiving these treatments should be carefully monitored for IP., (© 2022. The Author(s).)

Objectives: Talker sex and spatial cues can facilitate segregation of competing speech. However, the spectrotemporal degradation associated with cochlear implants (CIs) can limit the benefit of talker sex and spatial cues. Acoustic hearing in the nonimplanted ear can improve access to talker sex cues in CI users. However, it's unclear whether the CI can improve segregation of competing speech when maskers are symmetrically placed around the target (i.e., when spatial cues are available), compared with acoustic hearing alone. The aim of this study was to investigate whether a CI can improve segregation of competing speech by individuals with unilateral hearing loss., Design: Speech recognition thresholds (SRTs) for competing speech were measured in 16 normal-hearing (NH) adults and 16 unilaterally deaf CI users. All participants were native speakers of Mandarin Chinese. CI users were divided into two groups according to thresholds in the nonimplanted ear: (1) single-sided deaf (SSD); pure-tone thresholds <25 dB HL at all audiometric frequencies, and (2) Asymmetric hearing loss (AHL; one or more thresholds > 25 dB HL). SRTs were measured for target sentences produced by a male talker in the presence of two masker talkers (different male or female talkers). The target sentence was always presented via loudspeaker directly in front of the listener (0°), and the maskers were either colocated with the target (0°) or spatially separated from the target at ±90°. Three segregation cue conditions were tested to measure masking release (MR) relative to the baseline condition: (1) Talker sex, (2) Spatial, and (3) Talker sex + Spatial. For CI users, SRTs were measured with the CI on or off., Results: Binaural MR was significantly better for the NH group than for the AHL or SSD groups ( P < 0.001 in all cases). For the NH group, mean MR was largest with the Talker sex + spatial cues (18.8 dB) and smallest for the Talker sex cues (10.7 dB). In contrast, mean MR for the SSD group was largest with the Talker sex + spatial cues (14.7 dB), and smallest with the Spatial cues (4.8 dB). For the AHL group, mean MR was largest with the Talker sex + spatial cues (7.8 dB) and smallest with the Talker sex (4.8 dB) and the Spatial cues (4.8 dB). MR was significantly better with the CI on than off for both the AHL ( P = 0.014) and SSD groups ( P < 0.001). Across all unilaterally deaf CI users, monaural (acoustic ear alone) and binaural MR were significantly correlated with unaided pure-tone average thresholds in the nonimplanted ear for the Talker sex and Talker sex + spatial conditions ( P < 0.001 in both cases) but not for the Spatial condition., Conclusion: Although the CI benefitted unilaterally deaf listeners' segregation of competing speech, MR was much poorer than that observed in NH listeners. Different from previous findings with steady noise maskers, the CI benefit for segregation of competing speech from a different talker sex was greater in the SSD group than in the AHL group., Competing Interests: Q.F. has a financial interest at Nurotron Biotechnology Co. Ltd., a medical device company that designs, develops, and markets CI systems. The remaining authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

In the clinical fitting of cochlear implants (CIs), the lowest input acoustic frequency is typically much lower than the characteristic frequency associated with the most apical electrode position, due to the limited electrode insertion depth. For bilateral CI users, electrode positions may differ across ears. However, the same acoustic-to-electrode frequency allocation table (FAT) is typically assigned to both ears. As such, bilateral CI users may experience both intra-aural frequency mismatch within each ear and inter-aural mismatch across ears. This inter-aural mismatch may limit the ability of bilateral CI users to take advantage of spatial cues when attempting to segregate competing speech. Adjusting the FAT to tonotopically match the electrode position in each ear (i.e., increasing the low acoustic input frequency) is theorized to reduce this inter-aural mismatch. Unfortunately, this approach may also introduce the loss of acoustic information below the modified input acoustic frequency. The present study explored the trade-off between reduced inter-aural frequency mismatch and low-frequency information loss for segregation of competing speech. Normal-hearing participants were tested while listening to acoustic simulations of bilateral CIs. Speech reception thresholds (SRTs) were measured for target sentences produced by a male talker in the presence of two different male talkers. Masker speech was either co-located with or spatially separated from the target speech. The bilateral CI simulations were produced by 16-channel sinewave vocoders; the simulated insertion depth was fixed in one ear and varied in the other ear, resulting in an inter-aural mismatch of 0, 2, or 6 mm in terms of cochlear place. Two FAT conditions were compared: 1) clinical (200-8000 Hz in both ears), or 2) matched to the simulated insertion depth in each ear. Results showed that SRTs were significantly lower with the matched than with the clinical FAT, regardless of the insertion depth or spatial configuration of the masker speech. The largest improvement in SRTs with the matched FAT was observed when the inter-aural mismatch was largest (6 mm). These results suggest that minimizing inter-aural mismatch with tonotopically matched FATs may benefit bilateral CI users' ability to segregate competing speech despite substantial low-frequency information loss in ears with shallow insertion depths., Competing Interests: The authors have declared that no competing interests exist.

Chest X-ray (CXR) is widely used to diagnose conditions affecting the chest, its contents, and its nearby structures. In this study, we used a private data set containing 1630 CXR images with disease labels; most of the images were disease-free, but the others contained multiple sites of abnormalities. Here, we used deep convolutional neural network (CNN) models to extract feature representations and to identify possible diseases in these images. We also used transfer learning combined with large open-source image data sets to resolve the problems of insufficient training data and optimize the classification model. The effects of different approaches of reusing pretrained weights (model finetuning and layer transfer), source data sets of different sizes and similarity levels to the target data (ImageNet, ChestX-ray, and CheXpert), methods integrating source data sets into transfer learning (initiating, concatenating, and co-training), and backbone CNN models (ResNet50 and DenseNet121) on transfer learning were also assessed. The results demonstrated that transfer learning applied with the model finetuning approach typically afforded better prediction models. When only one source data set was adopted, ChestX-ray performed better than CheXpert; however, after ImageNet initials were attached, CheXpert performed better. ResNet50 performed better in initiating transfer learning, whereas DenseNet121 performed better in concatenating and co-training transfer learning. Transfer learning with multiple source data sets was preferable to that with a source data set. Overall, transfer learning can further enhance prediction capabilities and reduce computing costs for CXR images.

Acoustic change complex (ACC) is a cortical auditory-evoked potential induced by a change of continuous sound stimulation. This study aimed to explore: (1) whether the change of horizontal sound location can elicit ACC; (2) the relationship between the change of sound location and the amplitude or latency of ACC; (3) the relationship between the behavioral measure of localization, minimum audible angle (MAA), and ACC. A total of 36 normal-hearing adults participated in this study. A 180° horizontal arc-shaped bracket with a 1.2 m radius was set in a sound field where participants sat at the center. MAA was measured in a two-alternative forced-choice setting. The objective electroencephalography recording of ACC was conducted with the location changed at four sets of positions, ±45°, ±15°, ±5°, and ±2°. The test stimulus was a 125-6,000 Hz broadband noise of 1 s at 60 ± 2 dB SPL with a 2 s interval. The N1'-P2' amplitudes, N1' latencies, and P2' latencies of ACC under four positions were evaluated. The influence of electrode sites and the direction of sound position change on ACC waveform was analyzed with analysis of variance. Results suggested that (1) ACC can be elicited successfully by changing the horizontal sound location position. The elicitation rate of ACC increased with the increase of location change. (2) N1'-P2' amplitude increased and N1' and P2' latencies decreased as the change of sound location increased. The effects of test angles on N1'-P2' amplitude [ F (1.91,238.1) = 97.172, p < 0.001], N1' latency [ F (1.78,221.90) = 96.96, p < 0.001], and P2' latency [ F (1.87,233.11) = 79.97, p < 0.001] showed a statistical significance. (3) The direction of sound location change had no significant effect on any of the ACC peak amplitudes or latencies. (4) Sound location discrimination threshold by the ACC test (97.0% elicitation rate at ±5°) was higher than MAA threshold (2.08 ± 0.5°). The current study results show that though the ACC thresholds are higher than the behavioral thresholds on MAA task, ACC can be used as an objective method to evaluate sound localization ability. This article discusses the implications of this research for clinical practice and evaluation of localization skills, especially for children., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Fan, Zhao, Sharma, Valderrama, Fu, Liu, Fu, Li, Zhao, Guo, Fu, Wang and Zhang.)

Background: Organ-specific metastatic context has not been incorporated into the clinical practice of guiding programmed death-(ligand) 1 [PD-(L)1] blockade, due to a lack of understanding of its predictive versus prognostic value. We aim at delineating and then incorporating both the predictive and prognostic effects of the metastatic-organ landscape to dissect PD-(L)1 blockade efficacy in non-small cell lung cancer (NSCLC)., Methods: A total of 2062 NSCLC patients from a double-arm randomized trial (OAK), two immunotherapy trials (FIR, BIRCH), and a real-world cohort (NFyy) were included. The metastatic organs were stratified into two categories based on their treatment-dependent predictive significance versus treatment-independent prognosis. A metastasis-based scoring system (METscore) was developed and validated for guiding PD-(L)1 blockade in clinical trials and real-world practice., Results: Patients harboring various organ-specific metastases presented significantly different responses to immunotherapy, and those with brain and adrenal gland metastases survived longer than others [overall survival (OS), p = 0.0105; progression-free survival (PFS), p = 0.0167]. In contrast, survival outcomes were similar in chemotherapy-treated patients regardless of metastatic sites (OS, p = 0.3742; PFS, p = 0.8242). Intriguingly, the immunotherapeutic predictive significance of the metastatic-organ landscape was specifically presented in PD-L1-positive populations (PD-L1 > 1%). Among them, a paradoxical coexistence of a favorable predictive effect coupled with an unfavorable prognostic effect was observed in metastases to adrenal glands, brain, and liver (category I organs), whereas metastases to bone, pleura, pleural effusion, and mediastinum yielded consistent unfavorable predictive and prognostic effects (category II organs). METscore was capable of integrating both predictive and prognostic effects of the entire landscape and dissected OS outcome of NSCLC patients received PD-(L)1 blockade (p < 0.0001) but not chemotherapy (p = 0.0805) in the OAK training cohort. Meanwhile, general performance of METscore was first validated in FIR (p = 0.0350) and BIRCH (p < 0.0001), and then in the real-world NFyy cohort (p = 0.0181). Notably, METscore was also applicable to patients received PD-(L)1 blockade as first-line treatment both in the clinical trials (OS, p = 0.0087; PFS, p = 0.0290) and in the real-world practice (OS, p = 0.0182; PFS, p = 0.0045)., Conclusions: Organ-specific metastatic landscape served as a potential predictor of immunotherapy, and METscore might enable noninvasive forecast of PD-(L)1 blockade efficacy using baseline radiologic assessments in advanced NSCLC., (© 2022. The Author(s).)

Children with normal hearing (CNH) have greater difficulty segregating competing speech than do adults with normal hearing (ANH). Children with cochlear implants (CCI) have greater difficulty segregating competing speech than do CNH. In the present study, speech reception thresholds (SRTs) in competing speech were measured in Chinese Mandarin-speaking ANH, CNH, and CCIs. Target sentences were produced by a male Mandarin-speaking talker. Maskers were time-forward or -reversed sentences produced by a native Mandarin-speaking male (different from the target) or female or a non-native English-speaking male. The SRTs were lowest (best) for the ANH group, followed by the CNH and CCI groups. The masking release (MR) was comparable between the ANH and CNH group, but much poorer in the CCI group. The temporal properties differed between the native and non-native maskers and between forward and reversed speech. The temporal properties of the maskers were significantly associated with the SRTs for the CCI and CNH groups but not for the ANH group. Whereas the temporal properties of the maskers were significantly associated with the MR for all three groups, the association was stronger for the CCI and CNH groups than for the ANH group.

Objectives : Clinical benefits of immune-checkpoint blockade (ICB) versus standard chemotherapy have been established in unselected non-small cell lung cancer (NSCLC). However, the response to ICB therapy among patients is heterogeneous in clinical practice. Materials and Methods : We retrospectively assessed the predicitive effect of the primary and metastatic lesion spectrum (baseline sum of the longest diameters [SLD], number of metastatic sites and specific organ metastases) on the efficacy of atezolizumab over docetaxel in OAK and POPLAR trial cohorts. A decision model, termed DSO (Diameter-Site-Organ), based on the spectrum was developed and validated for guiding ICB. Results : Higher SLD (>38 mm) and more metastatic sites (≥2) were characterized with pronounced overall survival (OS) benefits from atezolizumab versus docetaxel. Specifically, adrenal gland and brain metastases were identified as favorable predictors of atezolizumab treatment. The DSO model was developed in the discovery cohort to integrate the directive effect of the primary and metastatic lesion spectrum. Remarkably, a general pattern of enhanced efficacy of atezolizumab versus docetaxel was observed along with the increase of the DSO score. For patients with DSO score > 0, atezolizumab yielded a significantly prolonged OS than docetaxel, whereas OS was generally similar between two treatments in patients with DSO score ≤ 0. Equivalent findings were also seen in the internal and external validation cohorts. Conclusions : The response to anti-PD-L1 therapy among patients varied with the primary and metastatic lesion spectrum. The DSO-based system might provide promising medication guidance for ICB treatment in NSCLC patients., (© 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.)

Sounds we hear in our daily life contain changes in the acoustic features (e.g., frequency, intensity, and duration or "what" information) and/or changes in location ("where" information). The purpose of this study was to examine the cortical auditory evoked potentials (CAEPs) to the change within a stimulus, the acoustic change complex (ACC), in frequency (F) and location (L) of the sound in normal hearing listeners. Fifteen right-handed young normal hearing listeners participated in the electroencephalographic (EEG) recordings. The acoustic stimuli were pure tones (base frequency at 250 Hz) of 1 s, with a perceivable change either in location (L, 180°), frequency (F, 5% and 50%), or both location and frequency (L+F) in the middle of the tone. Additionally, the 250 Hz tone of 1 sec without any change was used as a reference. The participants were asked to listen passively to the stimuli and not to move their heads during the testing. Compared to the reference tone, by which only the onset-CAEP was elicited, the tones containing changes (L, F, or L+F) elicited both onset-CAEP and the ACC. The waveform analysis of ACCs from the vertex electrode (electrode Cz) showed that, larger sound changes evoked larger peak amplitudes [e.g., (L+50%F)- > L-change; (L+50%F)- > 5%F-change] and shorter the peak latencies ([(L+5%F)- < 5%F-change; 50%F- < 5%F-change; (L+50%F)- < 5%F-change] . The current density patterns for the ACC N1' peak displayed some differences between L-change vs. F-change, supporting different cortical processing for "where" and "what" information of the sound; regardless of the nature of the sound change, larger changes evoked a stronger activation than smaller changes [e.g., L- > 5%F-change; (L+5%F)- > 5%F-change; 50%F- > 5%F-change] in frontal lobe regions including the cingulate gyrus, medial frontal gyrus (MFG), superior frontal gyrus (SFG), the limbic lobe cingulate gyrus, and the parietal lobe postcentral gyrus. The results suggested that sound change-detection involves memory-based acoustic comparison (the neural encoding for the sound change vs. neural encoding for the pre-change stimulus stored in memory) and involuntary attention switch., (Copyright © 2020 University of Cincinnati. Published by Elsevier B.V. All rights reserved.)

Cochlear implant (CI) users have greater difficulty perceiving talker sex and spatial cues than do normal-hearing (NH) listeners. The present study measured recognition of target sentences in the presence of two co-located or spatially separated speech maskers in NH, bilateral CI, and bimodal CI listeners; masker sex was the same as or different than the target. NH listeners demonstrated a large masking release with masker sex and/or spatial cues. For CI listeners, significant masking release was observed with masker sex cues, but not with spatial cues, at least for the spatially symmetrically placed maskers and listening task used in this study., (© 2021 Author(s).)

In competing speech, recognition of target speech may be limited by the number and characteristics of maskers, which produce energetic, envelope, and/or informational masking. In this study, speech recognition thresholds (SRTs) were measured with one, two, or four maskers. The target and masker sex was the same or different, and SRTs were measured with time-forward or time-reversed maskers. SRTs were significantly affected by target-masker sex differences with time-forward maskers, but not with time-reversed maskers. The multi-masker penalty was much greater with time-reversed maskers than with time-forward maskers when there were more than two talkers., (© 2021 Author(s).)

Many tinnitus patients report difficulties understanding speech in noise or competing talkers, despite having "normal" hearing in terms of audiometric thresholds. The interference caused by tinnitus is more likely central in origin. Release from informational masking (more central in origin) produced by competing speech may further illuminate central interference due to tinnitus. In the present study, masked speech understanding was measured in normal hearing listeners with or without tinnitus. Speech recognition thresholds were measured for target speech in the presence of multi-talker babble or competing speech. For competing speech, speech recognition thresholds were measured for different cue conditions (i.e., with and without target-masker sex differences and/or with and without spatial cues). The present data suggest that tinnitus negatively affected masked speech recognition even in individuals with no measurable hearing loss. Tinnitus severity appeared to especially limit listeners' ability to segregate competing speech using talker sex differences. The data suggest that increased informational masking via lexical interference may tax tinnitus patients' central auditory processing resources.

In bimodal listening, cochlear implant (CI) users combine electric hearing (EH) in one ear and acoustic hearing (AH) in the other ear. In electric-acoustic stimulation (EAS), CI users combine EH and AH in the same ear. In quiet, integration of EH and AH has been shown to be better with EAS, but with greater sensitivity to tonotopic mismatch in EH. The goal of the present study was to evaluate how external noise might affect integration of AH and EH within or across ears. Recognition of monosyllabic words was measured for normal-hearing subjects listening to simulations of unimodal (AH or EH alone), EAS, and bimodal listening in quiet and in speech-shaped steady noise (10 dB, 0 dB signal-to-noise ratio). The input/output frequency range for AH was 0.1-0.6 kHz. EH was simulated using an 8-channel noise vocoder. The output frequency range was 1.2-8.0 kHz to simulate a shallow insertion depth. The input frequency range was either matched (1.2-8.0 kHz) or mismatched (0.6-8.0 kHz) to the output frequency range; the mismatched input range maximized the amount of speech information, while the matched input resulted in some speech information loss. In quiet, tonotopic mismatch differently affected EAS and bimodal performance. In noise, EAS and bimodal performance was similarly affected by tonotopic mismatch. The data suggest that tonotopic mismatch may differently affect integration of EH and AH in quiet and in noise., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Due to interaural frequency mismatch, bilateral cochlear-implant (CI) users may be less able to take advantage of binaural cues that normal-hearing (NH) listeners use for spatial hearing, such as interaural time differences and interaural level differences. As such, bilateral CI users have difficulty segregating competing speech even when the target and competing talkers are spatially separated. The goal of this study was to evaluate the effects of spectral resolution, tonotopic mismatch (the frequency mismatch between the acoustic center frequency assigned to CI electrode within an implanted ear relative to the expected spiral ganglion characteristic frequency), and interaural mismatch (differences in the degree of tonotopic mismatch in each ear) on speech understanding and spatial release from masking (SRM) in the presence of competing talkers in NH subjects listening to bilateral vocoder simulations., Design: During testing, both target and masker speech were presented in five-word sentences that had the same syntax but were not necessarily meaningful. The sentences were composed of five categories in fixed order (Name, Verb, Number, Color, and Clothes), each of which had 10 items, such that multiple sentences could be generated by randomly selecting a word from each category. Speech reception thresholds (SRTs) for the target sentence presented in competing speech maskers were measured. The target speech was delivered to both ears and the two speech maskers were delivered to (1) both ears (diotic masker), or (2) different ears (dichotic masker: one delivered to the left ear and the other delivered to the right ear). Stimuli included the unprocessed speech and four 16-channel sine-vocoder simulations with different interaural mismatch (0, 1, and 2 mm). SRM was calculated as the difference between the diotic and dichotic listening conditions., Results: With unprocessed speech, SRTs were 0.3 and -18.0 dB for the diotic and dichotic maskers, respectively. For the spectrally degraded speech with mild tonotopic mismatch and no interaural mismatch, SRTs were 5.6 and -2.0 dB for the diotic and dichotic maskers, respectively. When the tonotopic mismatch increased in both ears, SRTs worsened to 8.9 and 2.4 dB for the diotic and dichotic maskers, respectively. When the two ears had different tonotopic mismatch (e.g., there was interaural mismatch), the performance drop in SRTs was much larger for the dichotic than for the diotic masker. The largest SRM was observed with unprocessed speech (18.3 dB). With the CI simulations, SRM was significantly reduced to 7.6 dB even with mild tonotopic mismatch but no interaural mismatch; SRM was further reduced with increasing interaural mismatch., Conclusions: The results demonstrate that frequency resolution, tonotopic mismatch, and interaural mismatch have differential effects on speech understanding and SRM in simulation of bilateral CIs. Minimizing interaural mismatch may be critical to optimize binaural benefits and improve CI performance for competing speech, a typical listening environment. SRM (the difference in SRTs between diotic and dichotic maskers) may be a useful clinical tool to assess interaural frequency mismatch in bilateral CI users and to evaluate the benefits of optimization methods that minimize interaural mismatch.

Purpose For colocated targets and maskers, binaural listening typically offers a small but significant advantage over monaural listening. This study investigated how monaural asymmetry and target-masker similarity may limit binaural advantage in adults and children. Method Ten Mandarin-speaking Chinese adults (aged 22-27 years) and 12 children (aged 7-14 years) with normal hearing participated in the study. Monaural and binaural speech recognition thresholds (SRTs) were adaptively measured for colocated competing speech. The target-masker sex was the same or different. Performance was measured using headphones for three listening conditions: left ear, right ear, and both ears. Binaural advantage was calculated relative to the poorer or better ear. Results Mean SRTs were significantly lower for adults than children. When the target-masker sex was the same, SRTs were significantly lower with the better ear than with the poorer ear or both ears ( p < .05). When the target-masker sex was different, SRTs were significantly lower with the better ear or both ears than with the poorer ear ( p < .05). Children and adults similarly benefitted from target-masker sex differences. Substantial monaural asymmetry was observed, but the effects of asymmetry on binaural advantage were similar between adults and children. Monaural asymmetry was significantly correlated with binaural advantage relative to the poorer ear ( p = .004), but not to the better ear ( p = .056). Conclusions Binaural listening may offer little advantage (or even a disadvantage) over monaural listening with the better ear, especially when competing talkers have similar vocal characteristics. Monaural asymmetry appears to limit binaural advantage in listeners with normal hearing, similar to observations in listeners with hearing impairment. While language development may limit perception of competing speech, it does not appear to limit the effects of monaural asymmetry or target-masker sex on binaural advantage.

Purpose The aim of this study was to compare release from masking (RM) between Mandarin-speaking and English-speaking listeners with normal hearing for competing speech when target-masker sex cues, spatial cues, or both were available. Method Speech recognition thresholds (SRTs) for competing speech were measured in 21 Mandarin-speaking and 15 English-speaking adults with normal hearing using a modified coordinate response measure task. SRTs were measured for target sentences produced by a male talker in the presence of two masker talkers (different male talkers or female talkers). The target sentence was always presented directly in front of the listener, and the maskers were either colocated with the target or were spatially separated from the target (+90°, -90°). Stimuli were presented via headphones and were virtually spatialized using head-related transfer functions. Three masker conditions were used to measure RM relative to the baseline condition: (a) talker sex cues, (b) spatial cues, or (c) combined talker sex and spatial cues. Results The results showed large amounts of RM according to talker sex and/or spatial cues. There was no significant difference in SRTs between Chinese and English listeners for the baseline condition, where no talker sex or spatial cues were available. Furthermore, there was no significant difference in RM between Chinese and English listeners when spatial cues were available. However, RM was significantly larger for Chinese listeners when talker sex cues or combined talker sex and spatial cues were available. Conclusion Listeners who speak a tonal language such as Mandarin Chinese may be able to take greater advantage of talker sex cues than listeners who do not speak a tonal language.

Background: Genetic variations of some driver genes in non-small cell lung cancer (NSCLC) had shown potential impact on immune microenvironment and associated with response or resistance to programmed cell death protein 1 (PD-1) blockade immunotherapy. We therefore undertook an exploratory analysis to develop a genomic mutation signature (GMS) and predict the response to anti-PD-(L)1 therapy., Methods: In this multicohort analysis, 316 patients with non-squamous NSCLC treated with anti-PD-(L)1 from three independent cohorts were included in our study. Tumor samples from the patients were molecularly profiled by MSK-IMPACT or whole exome sequencing. We developed a risk model named GMS based on the MSK training cohort (n=123). The predictive model was first validated in the separate internal MSK cohort (n=82) and then validated in an external cohort containing 111 patients from previously published clinical trials., Results: A GMS risk model consisting of eight genes ( TP53 , KRAS , STK11 , EGFR , PTPRD , KMT2C , SMAD4 , and HGF ) was generated to classify patients into high and low GMS groups in the training cohort. Patients with high GMS in the training cohort had longer progression-free survival (hazard ratio (HR) 0.41, 0.28-0.61, p < 0.0001) and overall survival (HR 0.53, 0.32-0.89, p = 0.0275) compared with low GMS. We noted equivalent findings in the internal validation cohort and in the external validation cohort. The GMS was demonstrated as an independent predictive factor for anti-PD-(L)1 therapy comparing with tumor mutational burden. Meanwhile, GMS showed undifferentiated predictive value in patients with different clinicopathological features. Notably, both GMS and PD-L1 were independent predictors and demonstrated poorly correlated; inclusion of PD-L1 with GMS further improved the predictive capacity for PD-1 blockade immunotherapy., Conclusions: Our study highlights the potential predictive value of GMS for immunotherapeutic benefit in non-squamous NSCLC. Besides, the combination of GMS and PD-L1 may serve as an optimal partner in guiding treatment decisions for anti-PD-(L)1 based therapy., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

To investigate the effects of H 2 S on mitochondrial functions under low temperature stress, we analyzed the effects of 0.05 mmol·L -1 NaHS and 15 μmmol·L -1 HT (hypotaurine and H 2 S scavenger) on mitochondria antioxidant enzyme activities and mitochondrial permeability transition pore, mitochondrial membrane fluidity, mitochondrial membrane potential, Cyt c/a ratio and H + -ATPase activity in sweet cherry stigma and ovary with sweet cherry variety Zaodaguo under -2 ℃ low temperature stress. The results showed that low temperature stress increased the concentrations of mitochondrial H 2 O 2 and MDA, enhanced the mitochondrial membrane permeability, but decreased the mitochondrial membrane fluidity, membrane potential, Cyt c/a and H + -ATPase acti-vity. Application of NaHS at 0.05 mmol·L -1 could effectively reduce the concentrations of H 2 O 2 and MDA, and keep higher activities of SOD, POD and CAT of mitochondrial for longer time. Furthermore, application of 0.05 mmol·L -1 NaHS could decrease mitochondrial membrane permeability while increase mitochondrial membrane fluidity, membrane potential, Cyt c/a and H + -ATPase activity in stigma and ovary under low temperature stress. The effects of NaHS were completely offset by HT addition. The results suggested that exogenous H 2 S could alleviate the oxidative damage on stigma and ovary stress through decreasing H 2 O 2 accumulation, regulating mitochondria antioxidant system, increasing H + -ATPase activity, and mitigating mitochondria function under low temperature.

Objectives: While fundamental frequency (F0) cues are important to both lexical tone perception and multitalker segregation, F0 cues are poorly perceived by cochlear implant (CI) users. Adding low-frequency acoustic hearing via a hearing aid in the contralateral ear may improve CI users' F0 perception. For English-speaking CI users, contralateral acoustic hearing has been shown to improve perception of target speech in noise and in competing talkers. For tonal languages such as Mandarin Chinese, F0 information is lexically meaningful. Given competing F0 information from multiple talkers and lexical tones, contralateral acoustic hearing may be especially beneficial for Mandarin-speaking CI users' perception of competing speech., Design: Bimodal benefit (CI+hearing aid - CI-only) was evaluated in 11 pediatric Mandarin-speaking Chinese CI users. In experiment 1, speech recognition thresholds (SRTs) were adaptively measured using a modified coordinated response measure test; subjects were required to correctly identify 2 keywords from among 10 choices in each category. SRTs were measured with CI-only or bimodal listening in the presence of steady state noise (SSN) or competing speech with the same (M+M) or different voice gender (M+F). Unaided thresholds in the non-CI ear and demographic factors were compared with speech performance. In experiment 2, SRTs were adaptively measured in SSN for recognition of 5 keywords, a more difficult listening task than the 2-keyword recognition task in experiment 1., Results: In experiment 1, SRTs were significantly lower for SSN than for competing speech in both the CI-only and bimodal listening conditions. There was no significant difference between CI-only and bimodal listening for SSN and M+F (p > 0.05); SRTs were significantly lower for CI-only than for bimodal listening for M+M (p < 0.05), suggesting bimodal interference. Subjects were able to make use of voice gender differences for bimodal listening (p < 0.05) but not for CI-only listening (p > 0.05). Unaided thresholds in the non-CI ear were positively correlated with bimodal SRTs for M+M (p < 0.006) but not for SSN or M+F. No significant correlations were observed between any demographic variables and SRTs (p > 0.05 in all cases). In experiment 2, SRTs were significantly lower with two than with five keywords (p < 0.05). A significant bimodal benefit was observed only for the 5-keyword condition (p < 0.05)., Conclusions: With the CI alone, subjects experienced greater interference with competing speech than with SSN and were unable to use voice gender difference to segregate talkers. For the coordinated response measure task, subjects experienced no bimodal benefit and even bimodal interference when competing talkers were the same voice gender. A bimodal benefit in SSN was observed for the five-keyword condition but not for the two-keyword condition, suggesting that bimodal listening may be more beneficial as the difficulty of the listening task increased. The present data suggest that bimodal benefit may depend on the type of masker and/or the difficulty of the listening task.

Dynamic frequency changes in sound provide critical cues for speech perception. Most previous studies examining frequency discrimination in cochlear implant (CI) users have employed behavioral tasks in which target and reference tones (differing in frequency) are presented statically in separate time intervals. Participants are required to identify the target frequency by comparing stimuli across these time intervals. However, perceiving dynamic frequency changes in speech requires detection of within-interval frequency change. This study explored the relationship between detection of within-interval frequency changes and speech perception performance of CI users. Frequency change detection thresholds (FCDTs) were measured in 20 adult CI users using a 3-alternative forced-choice (3AFC) procedure. Stimuli were 1-sec pure tones (base frequencies at 0.25, 1, 4 kHz) with frequency changes occurring 0.5 s after the tone onset. Speech tests were 1) Consonant-Nucleus-Consonant (CNC) monosyllabic word recognition, 2) Arizona Biomedical Sentence Recognition (AzBio) in Quiet, 3) AzBio in Noise (AzBio-N, +10 dB signal-to-noise/SNR ratio), and 4) Digits-in-noise (DIN). Participants' subjective satisfaction with the CI was obtained. Results showed that correlations between FCDTs and speech perception were all statistically significant. The satisfaction level of CI use was not related to FCDTs, after controlling for major demographic factors. DIN speech reception thresholds were significantly correlated to AzBio-N scores. The current findings suggest that the ability to detect within-interval frequency changes may play an important role in speech perception performance of CI users. FCDT and DIN can serve as simple and rapid tests that require no or minimal linguistic background for the prediction of CI speech outcomes., (Copyright © 2019 University of Cincinnati. Published by Elsevier B.V. All rights reserved.)

Objectives: Cochlear implants (CIs) have been shown to benefit patients with single-sided deafness (SSD) in terms of tinnitus reduction, localization, speech understanding, and quality of life (QoL). While previous studies have shown cochlear implantation may benefit SSD patients, it is unclear which point of comparison is most relevant: baseline performance before implantation versus performance with normal-hearing (NH) ear after implantation. In this study, CI outcomes were assessed in SSD patients before and up to 6 mo postactivation. Benefits of cochlear implantation were assessed relative to binaural performance before implantation or relative to performance with the NH ear alone after implantation., Design: Here, we report data for 10 patients who completed a longitudinal, prospective, Food and Drug Administration-approved study of cochlear implantation for SSD patients. All subjects had severe to profound unilateral hearing loss in one ear and normal hearing in the other ear. All patients were implanted with the MED-EL CONCERTO Flex 28 device. Speech understanding in quiet and in noise, localization, and tinnitus severity (with the CI on or off) were measured before implantation (baseline) and at 1, 3, 6 mo postactivation of the CI processor. Performance was measured with both ears (binaural), the CI ear alone, and the NH ear alone (the CI ear was plugged and muffed). Tinnitus severity, dizziness severity, and QoL were measured using questionnaires administered before implantation and 6 mo postactivation., Results: Significant CI benefits were observed for tinnitus severity, localization, speech understanding, and QoL. The degree and time course of CI benefit depended on the outcome measure and the reference point. Relative to binaural baseline performance, significant and immediate (1 mo postactivation) CI benefits were observed for tinnitus severity and speech performance in noise, but localization did not significantly improve until 6 mo postactivation; questionnaire data showed significant improvement in QoL 6 mo postactivation. Relative to NH-only performance after implantation, significant and immediate benefits were observed for tinnitus severity and localization; binaural speech understanding in noise did not significantly improve during the 6-mo study period, due to variability in NH-only performance. There were no correlations between behavioral and questionnaire data, except between tinnitus visual analog scale scores at 6 mo postactivation and Tinnitus Functional Index scores at 6 mo postactivation., Conclusions: The present behavioral and subjective data suggest that SSD patients greatly benefit from cochlear implantation. However, to fully understand the degree and time course of CI benefit, the outcome measure and point of comparison should be considered. From a clinical perspective, binaural baseline performance is a relevant point of comparison. The lack of correlation between behavioral and questionnaire data suggest that represent independent measures of CI benefit for SSD patients.

Objectives: Although there is agreement that childhood disability is both a risk and result of maltreatment, the extent of disability in the child welfare system remains unclear. Our objective is to determine the prevalence and severity of child impairment in a national sample of child abuse and neglect investigations in the United States., Methods: We used data from the National Survey of Child and Adolescent Well-Being II, a study of 2644 children older than 3 years who were subjects of child abuse and neglect investigations. Groups of children were identified by latent profile analysis using continuous standardized measures of intelligence, emotional or behavioral impairments, adaptive behaviors, and social skills., Results: Whether the child remained in home or was removed to foster care after an investigation, 3 classes of children were identified: (1) slightly over one-tenth were in an intellectual disability subgroup characterized by marked intellectual impairments alongside delays in daily living functioning, (2) over one-third were in an emotional or behavioral impairment subgroup characterized by both frequent and severe internalizing and externalizing behaviors, and (3) slightly over half were in a typically developing subgroup., Conclusion: When using standardized measures of disability, nearly half of the children investigated by child protection in the United States are not typically developing. These findings suggest that those working for the child welfare system need to be attentive to the complex needs of children with intellectual disabilities and emotional or behavioral impairments and their families, many of whom are under significant stress.

Despite the prior linkages of low resting heart rate to antisocial behavior broadly defined, less work has been done examining possible associations between heart rate to psychopathic traits. The small body of research on the topic that has been conducted so far seems to suggest an inverse relationship between the two constructs. A smaller number of studies has found the opposite result, however, and some of the previous studies have been limited by small sample sizes and unrepresentative samples. The current study attempts to help clarify the relationship between resting heart rate and psychopathic traits in a large, nationally representative sample (analytical N ranged from 14,173-14,220) using an alternative measure of psychopathic traits that is less focused on antisocial processes, and rooted in personality traits. No significant relationship between heart rate and psychopathic traits, or heart rate and a measure of cold-heartedness, was found. It is possible that previous findings of a link between heart rate and psychopathy have been driven by the inclusion of overt antisocial behavior in many traditional psychopathy measures. Further work is needed to confirm the associations (or lack thereof) between heart rate and the behavioral, affective, and personality trait aspects of psychopathy.

Due to poor perception of fundamental frequency ( F 0) cues that are important for lexical tone perception and talker segregation, pediatric Chinese cochlear implant (CI) users may be especially susceptible to informational masking. Here, speech recognition thresholds (SRTs) were measured in steady noise or competing speech in Mandarin-speaking CI and normal-hearing (NH) children. CI children were more susceptible to informational masking and were unable to use F 0 cues to segregate talkers. SRTs were significantly correlated with chronological age in NH children and with duration of deafness in CI children, suggesting that auditory deprivation may limit developmental processes important for talker segregation.

While cochlear implantation has benefitted many patients with single-sided deafness (SSD), there is great variability in cochlear implant (CI) outcomes and binaural performance remains poorer than that of normal-hearing (NH) listeners. Differences in sound quality across ears-temporal fine structure (TFS) information with acoustic hearing vs. coarse spectro-temporal envelope information with electric hearing-may limit integration of acoustic and electric patterns. Binaural performance may also be limited by inter-aural mismatch between the acoustic input frequency and the place of stimulation in the cochlea. SSD CI patients must learn to accommodate these differences between acoustic and electric stimulation to maximize binaural performance. It is possible that training may increase and/or accelerate accommodation and further improve binaural performance. In this study, we evaluated lateralization training in NH subjects listening to broad simulations of SSD CI signal processing. A 16-channel vocoder was used to simulate the coarse spectro-temporal cues available with electric hearing; the degree of inter-aural mismatch was varied by adjusting the simulated insertion depth (SID) to be 25 mm (SID25), 22 mm (SID22) and 19 mm (SID19) from the base of the cochlea. Lateralization was measured using headphones and head-related transfer functions (HRTFs). Baseline lateralization was measured for unprocessed speech (UN) delivered to the left ear to simulate SSD and for binaural performance with the acoustic ear combined with the 16-channel vocoders (UN+SID25, UN+SID22 and UN+SID19). After completing baseline measurements, subjects completed six lateralization training exercises with the UN+SID22 condition, after which performance was re-measured for all baseline conditions. Post-training performance was significantly better than baseline for all conditions ( p < 0.05 in all cases), with no significant difference in training benefits among conditions. Given that there was no significant difference between the SSD and the SSD CI conditions before or after training, the results suggest that NH listeners were unable to integrate TFS and coarse spectro-temporal cues across ears for lateralization, and that inter-aural mismatch played a secondary role at best. While lateralization training may benefit SSD CI patients, the training may largely improve spectral analysis with the acoustic ear alone, rather than improve integration of acoustic and electric hearing.

Mandarin is a tonal language, and it is important to preserve lexical tone information in synthesized speech. With natural speech, Chinese cochlear implant (CI) users have difficulty perceiving voice pitch cues important for lexical tone perception; it is unclear whether this difficulty persists in Mandarin synthesized speech. In this study, intelligibility of naturally produced and synthesized Mandarin speech was measured in Chinese CI listeners; intelligibility was also measured in a control group of normal-hearing (NH) listeners. Five synthesized voices were selected to represent different talker genders (male, female, child), speaking rates (normal, slow), and speaking styles (emotional, accent). The data showed that while modern Mandarin text-to-speech (TTS) systems can provide perfect speech intelligibility for NH listeners, overall intelligibility was much poorer for CI than for NH listeners. CI performance was significantly poorer with synthesized speech than with natural speech (p < 0.001). CI listeners were highly sensitive to the "extra-atypical" synthesized emotional and accented speech. Performance with each of the synthesized speech types was significantly correlated with performance with natural speech in CI users (p < 0.01 in all cases). While modern TTS systems offer educational and communication benefits to CI users and hearing-impaired individuals, the selection of synthesized voices should be carefully considered in education applications of TTS for hearing-impaired individuals, especially CI children, since poor intelligibility performance may affect language learning.

Objective: To assess the effect of the medical consortium policy on the outcomes of cancer patients admitted to secondary hospitals in Shanxi, China., Method: Electronic medical records of lung cancer (n = 8,193), stomach cancer (n = 5,693) and esophagus cancer (n = 2,802) patients hospitalized in secondary hospitals were used. Propensity score matching was used to match each patient enrolled in medical consortium hospitals with a counterpart admitted in non-medical consortium hospitals. Cox proportional hazard models were used to estimate the hazard ratio of patients enrolled different categories of hospitals., Results: The hazards of lung, stomach and esophageal cancer patients admitted in medical consortium hospitals were consistently and significantly lower than those admitted in non-medical consortium hospitals after adjusting for a number of potential confounders. Lower hazard ratios were associated with lung (hazard ratio (HR) = 0.533, p < 0.001), stomach (HR = 0.494, p < 0.001), and esophagus (HR = 0.505, p < 0.001) cancer patients in medical consortium hospitals., Conclusion: The medical consortium provides an effective strategy to improve the outcomes of cancer patients in Shanxi, China. The partnerships between top-tier hospitals and grassroots medical services bridge the gap in resources and plays a critical role in the quality of care in China.

Objective: The aim of this study was to investigate the benefits of residual hair cell function for speech and music perception in bimodal pediatric Mandarin-speaking cochlear implant (CI) listeners., Design: Speech and music performance was measured in 35 Mandarin-speaking pediatric CI users for unilateral (CI-only) and bimodal listening. Mandarin speech perception was measured for vowels, consonants, lexical tones, and sentences in quiet. Music perception was measured for melodic contour identification (MCI)., Results: Combined electric and acoustic hearing significantly improved MCI and Mandarin tone recognition performance, relative to CI-only performance. For MCI, performance was significantly better with bimodal listening for all semitone spacing conditions ( p < 0.05 in all cases). For tone recognition, bimodal performance was significantly better only for tone 2 (rising; p < 0.05). There were no significant differences between CI-only and CI + HA for vowel, consonant, or sentence recognition., Conclusions: The results suggest that combined electric and acoustic hearing can significantly improve perception of music and Mandarin tones in pediatric Mandarin-speaking CI patients. Music and lexical tone perception depends strongly on pitch perception, and the contralateral acoustic hearing coming from residual hair cell function provided pitch cues that are generally not well preserved in electric hearing.

Objectives/hypothesis: Cochlear implantation for patients with common cavity deformity (CCD) can be difficult, with a higher incidence of intra- and postoperative complications; outcomes with CCD patients are also highly variable. In this study, surgical time was compared between the traditional facial recess approach (TFRA) and the transmastoid slotted labyrinthotomy approach (TSLA). Audiological outcomes and the benefit of using customized electrode arrays for CCD patients are also discussed., Study Design: Retrospective review of 13 cochlear implant (CI) patients with CCD., Methods: Six patients were implanted with the TFRA using traditional electrodes, and seven patients were implanted with the TSLA using customized electrodes. Intra- and postoperative complications were reviewed. Audiological outcomes were measured 3 months to 2 years after CI activation., Results: The mean surgical time for TSLA group was nearly half as long as for the TRFA group (P < .05). Although mean audiological outcomes were better for the TSLA group, there was no significant difference between groups (P > .05)., Conclusions: For CCD patients, TSLA for cochlear implantation is recommended due to shortened surgical time; customized electrode arrays may be additionally advantageous in terms of audiological outcomes., Level of Evidence: 4. Laryngoscope, 128:468-472, 2018., (© 2017 The American Laryngological, Rhinological and Otological Society, Inc.)

Patients with single-sided deafness (SSD) often experience poor sound localization, reduced speech understanding in noise, reduced quality of life, and tinnitus. The present study aims to evaluate effects of tinnitus and duration of deafness on sound localization and speech recognition in noise by SSD subjects. Sound localization and speech recognition in noise were measured in 26 SSD and 10 normal-hearing (NH) subjects. Speech was always presented directly in front of the listener. Noise was presented to the deaf ear, in front of the listener, or to the better hearing ear. Tinnitus severity was measured using visual analog scale and Tinnitus Handicap Inventory. Relative to NH subjects, SSD subjects had significant deficits in sound localization and speech recognition in all listening conditions ( p < .001). For SSD subjects, speech recognition in noise was correlated with mean hearing thresholds in the better hearing ear ( p < .001) but not in the deaf ear. SSD subjects with tinnitus performed poorer in sound localization and speech recognition in noise than those without tinnitus. Shorter duration of deafness was associated with greater tinnitus and sound localization difficulty. Tinnitus visual analog scale and Tinnitus Handicap Inventory were highly correlated; the degree of tinnitus was negatively correlated with sound localization and speech recognition in noise. Those experiencing noticeable tinnitus may benefit more from cochlear implantation than those without; subjective tinnitus reduction may be correlated with improved sound localization and speech recognition in noise. Subjects with longer duration of deafness demonstrated better sound localization, suggesting long-term compensation for loss of binaural cues.

Cochlear implantation (CI) can benefit patients with single-sided deafness (SSD) in terms of sound localization, speech understanding in noise, tinnitus severity, and quality of life (QoL). In previous studies, CI outcomes have been largely reported for SSD patients with normal "unrestricted" hearing in the contralateral ear. However, SSD patients may often have some degree of hearing loss in the contralateral ear ("restricted" acoustic hearing). In this study, we report results from a French clinical trial for CI in in SSD patients (NCT02204618). Localization, speech reception thresholds (SRTs) in noise, tinnitus severity, and QoL were evaluated in 18 SSD patients 1 year after CI. Data were analyzed for 2 subject groups according to the pure-tone average thresholds in the non-implanted ear: unrestricted acoustic hearing (UNRES; ≤25 dB HL; n = 10) and restricted acoustic hearing (RES; > 25 dB HL; n = 8). Across all subjects, localization was significantly better with the CI on than off (p = 0.005); there was no significant difference between subject groups (p = 0.301). When speech and noise were co-located (S0N0), there was no significant difference in SRTs with the CI on or off (p = 0.480); SRTs were significantly better for the UNRES than for the RES group (p = 0.005). When speech and noise were spatially separated (SCINNH), SRTs were significantly better with the CI on than off (p < 0.001). While SRTs were better for the UNRES than for the RES group (p = 0.024), the CI benefit was more than 50% greater for the RES group due to the restoration of high-frequency speech cues. Questionnaire data showed that tinnitus severity was significantly reduced (p = 0.045) and QoL was significantly improved after one year of experience with the CI (p < 0.001). Age at testing was significantly correlated with SRTs for the S0N0 condition; duration of deafness was correlated with SRTs for the SCINNH condition. There were relatively few correlations between behavioral and subjective measures, suggesting that both were valuable when assessing CI benefits for SSD patients. The present data suggest that indications for CI should be expanded to include unilaterally deaf patients who have normal hearing or mild-to-moderate hearing loss in the non-implanted ear., (© 2018 S. Karger AG, Basel.)

Due to limited spectral resolution, cochlear implants (CIs) do not convey pitch information very well. Pitch cues are important for perception of music and tonal language; it is possible that music training may improve performance in both listening tasks. In this study, we investigated music training outcomes in terms of perception of music, lexical tones, and sentences in 22 young (4.8 to 9.3 years old), prelingually deaf Mandarin-speaking CI users. Music perception was measured using a melodic contour identification (MCI) task. Speech perception was measured for lexical tones and sentences presented in quiet. Subjects received 8 weeks of MCI training using pitch ranges not used for testing. Music and speech perception were measured at 2, 4, and 8 weeks after training was begun; follow-up measures were made 4 weeks after training was stopped. Mean baseline performance was 33.2%, 76.9%, and 45.8% correct for MCI, lexical tone recognition, and sentence recognition, respectively. After 8 weeks of MCI training, mean performance significantly improved by 22.9, 14.4, and 14.5 percentage points for MCI, lexical tone recognition, and sentence recognition, respectively ( p < .05 in all cases). Four weeks after training was stopped, there was no significant change in posttraining music and speech performance. The results suggest that music training can significantly improve pediatric Mandarin-speaking CI users' music and speech perception.

This study examined music and speech perception in normal-hearing children with some or no musical training. Thirty children (mean age = 11.3 years), 15 with and 15 without formal music training participated in the study. Music perception was measured using a melodic contour identification (MCI) task; stimuli were a piano sample or sung speech with a fixed timbre (same word for each note) or a mixed timbre (different words for each note). Speech perception was measured in quiet and in steady noise using a matrix-styled sentence recognition task; stimuli were naturally intonated speech or sung speech with a fixed pitch (same note for each word) or a mixed pitch (different notes for each word). Significant musician advantages were observed for MCI and speech in noise but not for speech in quiet. MCI performance was significantly poorer with the mixed timbre stimuli. Speech performance in noise was significantly poorer with the fixed or mixed pitch stimuli than with spoken speech. Across all subjects, age at testing and MCI performance were significantly correlated with speech performance in noise. MCI and speech performance in quiet was significantly poorer for children than for adults from a related study using the same stimuli and tasks; speech performance in noise was significantly poorer for young than for older children. Long-term music training appeared to benefit melodic pitch perception and speech understanding in noise in these pediatric listeners.

Differences in current spread and/or spread of excitation may differently affect integration of acoustic and electric hearing within (electric-acoustic stimulation, or EAS) or across ears (bimodal). In this study, vowel recognition was measured in normal-hearing subjects listening to simulations of cochlear implant (CI), EAS, and bimodal listening. Residual acoustic hearing was limited between 0.1 and 0.6 kHz. The carrier bandwidth in the CI simulations was varied across carriers: broad-band noise, narrow-band noise, and sine waves. Results showed that reducing the bandwidth (and the inherent noise fluctuations) in the CI simulations significantly affected CI-only and bimodal performance, but not EAS performance.