Objective Anatomy-Based Fitting (ABF) is a relatively new cochlear implant fitting method launched to minimize frequency-to-place mismatch. This study aimed to assess the benefits of using the ABF map among experienced adult Cochlear Implant (CI) users regarding their subjective experiences and Quality of Life. Methods This prospective observational study compared the outcome measures between the ABF and the regular Conventional-Based Fitting (CBF) CI maps. Using selective sampling, nine ears were examined from eight experienced adult ME-DEL cochlear implant users. All participants underwent postoperative computed tomography scans, which were then analyzed using a surgical planning software called Otoplan® to determine the positions of intracochlear electrodes, their respective angular insertions, and cochlear duct length. The information from the Otoplan® was then imported into the Maestro 9.0 fitting software to generate the ABF map. The outcome measures compared were (i) Subjective ratings of the maps concerning speech understanding, listening comfort, and preferred map; and (ii) Cochlear implant Quality of Life – 35-items (CIQOL-35). The CBF map’s outcome assessment was completed before fitting the experimental ABF map. The review assessments for ABF were taken after six months of ABF use. Finally, their attitude towards the ABF map was obtained. Results The shifts of the ABF center frequencies varied largely concerning the CBF map across participants, ranging from 0.46 semitones to 23.94 semitones. Subjectively, all three domains were rated better for the ABF than the CBF maps (p < 0.05). Overall, the CIQOL-35 scores significantly improved after using the ABF map for six months, with the entertainment domain showing a significant increase in the mean difference (p < 0.05). 87.5% of participants wanted to continue using the ABF map, indicating a positive attitude towards the ABF map. Conclusion Results suggest that the ABF map could be an alternative to improve auditory experience and other QoL determinants.

OBJECTIVE:This study explores the implementation of accommodations and modifications (A&Ms) for deaf and hard-of-hearing (DHH) students in Malaysian schools, addressing the gap between inclusive policy, holistic support, and actual classroom practice. METHODS:A mixed-methods approach was used, combining a cross-sectional survey (n = 196) with focus group discussions involving teachers from inclusive education (IE), special education integration programs (SEIP), and special education schools (SES) across four states. RESULTS:Survey results indicated that communication strategies were the most frequently implemented by teachers, with repetition and rephrasing being the most commonly used techniques. While implementation varied across other domains, the findings revealed areas for growth, including the need for enhanced training, more effective integration of hearing technologies, stronger collaboration with multidisciplinary teams and greater utilization of assistive tools. Teachers also expressed the need for increased access to inclusive teaching resources and more intentional classroom adjustments to support listening needs. DISCUSSION/CONCLUSION:The findings underscore the importance of flexible, multimodal communication strategies tailored to individual student needs. Sustainable participation and equitable access for DHH students require the systemic implementation of inclusive design across curriculum, learning environments, technology, assessment and teacher professional development. Guided by universal design for learning (UDL), the ICF-CY framework and the Malaysia Education Blueprint 2013-2025, strengthening inclusive practices depends on enhanced teacher preparation, effective use of assistive technologies and sustained cross-sector collaboration to translate inclusive policy into meaningful classroom practice.

Phonological development is critical for children's language development and literacy - and yet, it poses unique challenges for bilingual children with cochlear implants (CI), particularly in linguistically diverse societies. This study addresses the dearth of culturally and linguistically appropriate phonological assessment tools through the development and validation of a bilingual Urdu-English Phonology Test (UEPT), designed to assess phonological skills in children aged 3-6 years. Urdu-English bilingual children with normal hearing (NH) and hearing-age-matched children with CIs across four age groups (3.0-3.11, 4.0-4.11, 5.0-5.11, and 6.0-6.11 years) were assessed through spontaneous naming of 136 English-Urdu pictures. Validation was achieved through calculations of item-level (I-CVI), scale-level (S-CVI) content validity indices, internal consistency (Cronbach's alpha), inter-rater reliability (Cohen's kappa), test-retest reliability (ICC), and construct validity. The UEPT had a content validity [S-CVI = 90.1% (Urdu); 96.9% (English)], with Cohen's Kappa = 0.84, for CIs and 0.933 for NHs on Urdu-English (UE) pictures. High internal consistency (alpha = 0.95 for Urdu and 0.97 for English), strong inter-rater reliability (kappa = 0.85 for CIs & 0.93 for NHs) and test-retest reliability (ICC = 0.92 for CIs and 0.97 for NHs) were obtained on SPSS. Significant age-related score differences supported construct validity. The Urdu-English Phonology test is a reliable, culturally and linguistically relevant tool for assessing phonological acquisition in preschool bilingual UE children, addressing the need for the assessment of the CI population, providing insights for clinicians and researchers. It supports collecting normative data for better management of speech sound disorders in bilingual UE children with Normal Hearing and Cochlear Implant.

Background and Aims: Accuracy in speech perception in bilingual children is influenced by two phonological systems. This study compares phonological development in bilingual Urdu-English (UE) children with CIs with their hearing-age-matched peers with normal hearing (NH), by investigating whether bilingualism or any spectral limitations of CI impact perception of UE phonemes. Method and Procedures: Children (n = 57) aged 3; 0-6; 11 years (28 CI, 29 NH) were assessed for speech perception using a custom-designed UE Speech Perception Test (UE-SPT), in quiet and noise (+5 dB SNR). Responses were analysed using confusion matrices, across phonological parameters of place, manner, and voicing to determine error patterns. Outcomes and Results: Significant deficits in CI children were found across all features, with voicing discrimination showing the largest errors (effect sizes d > 6), exacerbated by noise, especially for Urdu aspirated stops. CIs mastered only 8.3% Urdu-aspirated consonants at 6; 11 years compared to 91.7% mastered by NH peers, indicating critical language-specific vulnerabilities. Backing and substitutions errors were particularly seen in CI's speech, whilst manner was preserved. Conclusion and Implications: UE bilingual phonological complexity compounded by inadequate speech processing abilities in CIs challenges them, underscoring urgent need for targeted speech therapy interventions focusing voicing contrasts and aspirated consonants, as well as environmental accommodations that reduce noise interference and enhance listening through CI, to optimise educational outcomes. This research contributes vital clinical guidance for supporting bilingual children with cochlear implants, addressing both environmental, technological and linguistic challenges.

OBJECTIVE:Hearing parents who lack knowledge regarding hearing loss and medical intervention typically experience disorientation and stress when their child is diagnosed with hearing loss and needs a cochlear implant (CI). This study aims to document recommendations experienced parents may provide to new parents based on their experiences. METHODS:Sixteen parents of children with CI were interviewed, with the children's chronological age ranging between 26 and 91 months, averaging 11.7 months (standard deviation = 8.0) at the age of deafness diagnosis. Open-ended questions were asked to encourage parents to provide recommendations based on their interventional experiences. The interviews were transcribed verbatim and analyzed using thematic analysis. RESULTS:The study identified four main themes that emerged based on parents' suggestions to parents about to step into the child's CI intervention journey. These themes included (a) acceptance and action, (b) proactively searching for information, (c) help-seeking from others, and (d) being financially prepared. CONCLUSION:The present qualitative study provides additional evidence to new parents on CI decision-making for their children who need CI. It suggests that new parents may seek guidance from parent-to-parent support groups and fully prepare themselves with essential knowledge and a healthy mentality before initiating their child's CI intervention journey.

PurposeThe present study aimed to explore the support provided by the parent-to-parent support group (PPSG) to families whose children are cochlear implant (CI) users or candidates during each stage of the intervention procedure.Method and MaterialsThe present study conducted semi-structured interviews to explore the helpfulness and supportiveness of the support provided by experienced parents to parents in the PPSG. Sixteen parents of children with CI and candidates (ages 11-90 months) agreed to participate in this study. After sharing their experiences, parents rated the PPSG's helpfulness and supportiveness on a five-point scale.ResultsThe study identified three main themes that emerged from parents' experiences who received support from experienced parents in the PPSG throughout their CI intervention journey. These themes included (a) informational - providing informational support to newly diagnosed families; (b) psychological - providing emotional support; and (c) social - forming a sense of belonging to the community. Additionally, each theme generated several sub-themes that focused on the feelings and experiences of parents during their journey through CI intervention.ConclusionThe findings support the PPSG as a helpful and supportive resource for parents whose children are CI users or candidates throughout their intervention journey.

Background: Hearing loss affects 1.5 billion individuals globally, with profound implications of disability, manifest in delayed speech-language development, difficulty securing mainstream education, and social integration, particularly in children. In Pakistan, challenges such as consanguineous marriages, insufficient healthcare infrastructure, and environmental factors exacerbate the prevalence of pediatric hearing impairments. Methods: This retrospective survey aims to establish the demographic character of children with congenital or prelingual hearing loss, given cochlear implants (CIs) in Pakistan. It investigates intervention timelines, family and educational language status, and outcomes of cochlear implantation in terms of aural rehabilitation and enrolment at school. Data was collected from 81 participating parents of CI children, using a questionnaire that revealed trends in the age of cochlear implantation, linguistic diversity, speech-language therapy given to CI children, and educational integration post-implantation. The data (e.g., multiple-choice questions) was analyzed using methods in descriptive statistics (means, percentages) for the different groups. Results: While advancements in CI technology show promise, the results of this survey show limited accessibility and financial constraints as significant barriers to aural rehabilitation. The majority of the CIs were given to 2, 0-4; 0-year-old children. 90.12% of children in this study received speech and language therapy, of which 49.38% were enrolled in mainstream schools, while 38.27% attended other schools. 43.21% of the children received a donation for their CIs. Conclusion: The study emphasizes the need for subsidized programs, enhanced public awareness, robust post-implantation support, and integration of hearing care into primary health systems to maximize the benefits of early intervention in multilingual settings. DOI: https://doi.org/10.59564/amrj/03.01/017

This preliminary study benchmarks audiovestibular practices among audiologists in Asia-Pacific (APAC) countries with established professional training programs, forming the first phase of a broader initiative covering 17 nations. A structured questionnaire was adapted and updated to include contemporary clinical domains such as vestibular rehabilitation, cochlear implant services, and tele-audiology. The tool underwent expert review and pilot testing, demonstrating strong psychometric properties (Cronbach's α, α = 0.91; KMO = 0.743; Bartlett's p  < 0.001). Responses were obtained from 40 audiologists across India, Malaysia, Singapore, Nepal, and New Zealand. Most participants provided services across screening, diagnostic, therapeutic, and rehabilitative domains. Core procedures such as immittance testing, otoacoustic emissions, and auditory brainstem response were widely implemented, while vestibular and rehabilitative services showed increasing integration. Respondents represented diverse professional contexts, including universities, private hospitals, and government healthcare systems. Notably, there was strong professional consensus in support of regional standardization of guidelines, training, and governance mechanisms. These findings validate the adapted tool, establish a foundational dataset, and highlight readiness for regional collaboration. As the broader 17-country study advances, this work provides a baseline for benchmarking, policy development, and capacity building toward harmonized audiovestibular care across the APAC region.

OBJECTIVES:Parents of children diagnosed with severe-to-profound sensorineural hearing loss may experience a range of emotions owing to a lack of knowledge and experience in dealing with such children. However, most audiology clinics only attend to children with deaf and hard of hearing (DHH) and not their parents. Thus, parents' emotional and support needs are frequently excluded from the intervention sessions, making their own needs invisible. This study aimed to identify academic and clinical instruments used for assessing parental emotional status (PES) and ecological support systems (ESS) in early intervention and determine the factors affecting PES and ESS among parents of DHH children undergoing cochlear implantation. MATERIALS AND METHODS:This scoping review followed the rigorous methodological framework; searched Medline (via OVID and EMBSCO), Scopus, and Web of Science; and selected studies relevant to validated instruments used to evaluate the PES and ESS among parents of DHH children below 6 years old. Before selecting and reviewing relevant articles, two reviewers independently assessed article titles and abstracts from the data sources. Two reviewers verified half of the first reviewer's extracted data. RESULTS:Overall, 3060 articles were retrieved from the database search, and 139 were selected for full-text review following title and abstract reviews. Ultimately, this study included 22 articles. Among them, 23 and 12 validated instruments, most of which are generic measures, were used for assessing PES and ESS, respectively. Three condition-specific instruments were identified and designed to be administered following cochlear implantation surgery. CONCLUSIONS:This study revealed that healthcare professionals who interact with parents of DHH children lack the necessary instruments, particularly for parents of children undergoing cochlear implantation surgery. Therefore, it is necessary to develop condition-specific instruments for parents who consider cochlear implantation for their children.

ObjectivesTo determine the benefits of cochlear implantation in hearing loss children with multiple disabilities (MD) in terms of auditory outcomes, speech performance, and their quality of life.MethodsThis was a cross sectional study from January 2019 to December 2020 in which thirty-one children with hearing loss and multiple disabilities were evaluated. Their improvement in auditory and speech performances were assessed using Categories of Auditory Performance version II (CAP-II) and the Speech Intelligibility Rating (SIR) scales. The assessment was done at 6-month intervals, with the baseline evaluation done at least six months after activation of the implant. Parents were asked to fill the Parents Evaluation of Aural/Oral Performance of Children (PEACH) diary and Perceived Benefit Questionnaire (PBQ) to evaluate the child’s quality of life.ResultsAll 31 children have Global Developmental Delay (GDD), with 11 having an additional disability. Both mean CAP-II and SIR scores showed significant improvement with increased hearing age (p < 0.05) after 6-month intervals. In addition, 20 out of 31 children (64.5%) have achieved verbal communication after implantation. The mean PEACH score in quiet was significantly better than in noise (p = 0.007) and improved with the increased of hearing age. The majority of parents (96%‒100%) perceived a cochlear implant as beneficial to their child in terms of auditory response, awareness, interaction, communication, and speech development.ConclusionsCochlear implantation had shown benefits in children with multiple disabilities. Outcome measures should not only focus on auditory and speech performances but the improvement in quality of life. Hence, individualized each case with realistic expectation from families must be emphasized in this group of children.Level of evidenceLevel 3.

Introduction: Anatomy-based fitting (ABF), a relatively new technique for cochlear implant (CI) programming, attempts to lessen the impact of the electrode insertion location-related frequency-to-place mismatch (FPM). This study aimed to compare vowels and consonant perception in quiet and in noise among experienced adult CI users using the ABF and the regular, conventional-based fitting (CBF) map (pre-ABF) over 6 months. Methods: Nine ears from eight experienced adult CI users were included in the experimental and longitudinal research. Using surgical planning software called Otoplan, postoperative computed computed tomography scans were used to determine the locations of intracochlear electrodes and their angle of insertion. The anatomy-based frequency bands were produced by Maestro 9.0 CI fitting software using the Otoplan data. Nonsense syllables with consonant-vowel-consonant (CVC) recognition scores in quiet and noise (+5 dB SNR) were compared at baseline, 3, and 6 months after ABF. The vowels involved were /a, i, u/, while the consonants were voiced /b, d, g/ and voiceless /p, t, k/ plosives. Speech pieces were presented at 30 dB SL in a sound-treated room through a loudspeaker positioned at 0° azimuth. Results: On average, the ABF maps shifted center frequency ranging from 0.46 semitones (0.04 octave) at (E12) to 23.94 semitones (1.99 octave) at (E1) as compared to the CBF maps. The mean vowel and consonant identification scores in quiet and in noise were significantly higher in ABF than in CBF (p < 0.05) with a large effect size and the trend of improvement was seen with time. Voiced consonants had better scores than the voiceless consonants. Conclusion: The results demonstrated improved perception of vowels and consonants, particularly for sounds containing voicing cues after using the ABF maps. The results also suggested that ABF could be more effective for voice detection in noise. Overall, the findings indicate that correcting place mismatch with an ABF map may improve speech perception, at least among experienced adult CI users.

OBJECTIVES:This study aimed to describe the factors affecting early and late cochlear implantation.MATERIALS AND METHODS:A total of 159 patients from the Hospital Canselor Tuanku Muhriz (HCTM) Cochlear Implant Programme were recruited in this retrospective cross-sectional study. All paediatric Cochlear Implant (CI) recipients with pre-lingual deafness were included in this retrospective study. The study was conducted from January 2019 until December 2020. The pre-lingual cochlear implant recipients' data were analysed based on demographics and interval from diagnosis to hearing aid fitting and implantation. The association between the dependent variables with early and late cochlear implantation was compared.RESULTS:A total of 83 (52%) patients were female. Chinese race constituted most of the patients, which was 90/159 (57%). The majority were from middle-income families (M40); 89 (56%). The most common aetiology of Hearing Loss (HL) was idiopathic; 139 (87%), followed by intrauterine infections, which comprised of congenital CMV; 8 (5%) and congenital Rubella; 1 (1%) and nonspecific intrauterine infection 2 (1%). The relationship between the universal neonatal hearing screening and the interval between diagnosis to implantation was significant (p=0.033). Other variables were not significant.CONCLUSION:UNHS was a significant factor contributing to early and late implantation. The median age of diagnosis of hearing loss was 18 months (interquartile range; 15); the age of CI was 34 months (interquartile range; 24); the interval from diagnosis to hearing aid was 2 months (interquartile range; 5), and the interval from diagnosis to CI was 16 months (interquartile range; 14).

The advancement in cochlear implant (CI) technologies and how CIs help their users have far exceeded expectations. Speech perception remains the focus of many studies related to cochlear implant clinical research to ensure the technology maximizes the benefits to be obtained by CI users. This chapter will discuss the perception of non-native sounds among congenitally deaf pediatric CI users, specifically emphasizing Arabic consonants. This language is used and learned by billions of non-native Arabs worldwide. Non-native auditory signals are perceived differently by children with CI due to speech processor signal processing and native language learning effects. This study measured the perceptual learning of uncategorized-dispersed-assimilated Arabic consonants for a group of non-native children with CI using a newly developed, FizBil© bottom-up, customized software training module. The framework and hypothetical pathway will be discussed.

Objective: The purpose of the present study was to (1) translate and validate the PEACH+Rating Scale in Malay and (2) establish normative curves as a function of age and examine test-retest reliability for the Malay and English versions of PEACH+.Design: This is a cross-sectional study that used a convenient sampling technique.Study sample: One hundred and fifty-seven parents of typically developing children aged between 4 months and 7 years participated in the study. Forty-nine completed the Malay PEACH + in a pen-to-paper format (Aim 1). One hundred and eight parents completed PEACH+online (69 completed the Malay version and 39 the English version), and 20 of them completed the questionnaire twice (Aim 2).Results: The PEACH + in Malay showed high internal consistency and item-total correlation. The norma-tive data revealed that scores for frequency of auditory behaviour increased rapidly with age until about 20 months and reached an asymptote of around 90% by about 40 months of age. A similar trend was observed for ease of listening scores, which asymptoted around 85%.Conclusions: The validated Malay PEACH + Rating Scale can be used as a guide to monitor auditory functional performance and listening efforts of Malaysian children in real-world environments.

OBJECTIVE:This study aimed to compare the error patterns of Arabic phoneme-grapheme correspondence by a group of Malay children with cochlear implants (CIs) and normal hearing (NH) and the effects of the visual graphical features of Arabic graphemes (no-dot, single-dot, and multiple-dots) on the phoneme-grapheme correspondence.METHODS:Participants were matched for hearing age (Mean, M = 7 ± 1.03 years) and duration of exposure to Arabic sounds (M = 2.7 ± 1.2 years). All 28 Arabic phonemes were presented through a loudspeaker and participants pointed to the graphemes associated with the presented phonemes.RESULTS:A total of 336 and 616 tokens were collected for six children with CI and 11 NH children for each task, i.e., phonemes repetition and phoneme-grapheme correspondence. Both groups found it easier to repeat phonemes than the phoneme-grapheme correspondence. The children with CIs showed more confusion ([ظ, ز, ذ, ض, خ, ب, ه, س, ع, & ث] >10% correct scores) in phoneme-grapheme correspondence than the NH children ([ظ:14%] and [ث: 27%]). There was a significant interaction (p = 0.001) among the three visual graphical features and hearing status (CI and NH).CONCLUSION:Our results infer that non-native Malay children with CIs and NH use different strategies to process the Arabic graphemes' visual features for phoneme-grapheme correspondence.

Introduction Prader–Willi Syndrome (PWS) is one of the rare diseases involving genetics and affects various body systems. The disease is known due to the absence of paternal genes on chromosome 15q11-q13. Multisystem complex conditions require interdisciplinary healthcare treatment. However, to the best of our knowledge, there is little evidence of an established successful model of an interdisciplinary approach in managing rare diseases like PWS. Methods and analysis The scoping review process follows the five-staged Arksey and O’Malley (2005) methodology framework excluding the optional consultation stage (stage 6): the definition of the research questions (step 1); the eligibility criteria and search strategy are defined (stage 2); the study selection process based on the eligibility criteria identified will follow (stage 3); a framework developed for this review will then inform the extraction and charting of data from the included studies (step 4) and results will be aggregated and summarised with criteria relevant for health professionals and policymakers (stage 5). We will search for electronic databases (MEDLINE/PubMed, Scopus, Web of Science), grey literature sources and critical studies’ reference lists to determine the appropriate inclusion criteria. Three researchers will review all abstracts and full-text studies for inclusion. Ethics and dissemination This scoping review methodology does not require ethical approval since it aims to synthesise information from available publications. A scoping review article will be submitted for publication to a scientific journal following this protocol.

The spoken language development strongly depends on the normally functioning auditory system. For children with severe or profound hearing loss, cochlear implant has become the best solution in improving and promoting spoken language, quality of life, self-esteem and social well-being. Standardized self-report questionnaires are considered as the most widely used and low-cost approach to measure spoken language development among children. We aimed to provide an overview of the questionnaires available for assessing the spoken language development among children with cochlear implant. In addition, factors that may influence the development of good spoken language were also reviewed. A literature search from January 2010 to December 2020 making use of the Science Direct and PubMed databases was conducted. Medical Subject Headings (MeSH) and other key words for the search were (communication OR language) AND cochlear implant AND (children OR pediatric) AND (questionnaire OR survey). Research articles that were identified in the database using the keywords were refined by year. Only original articles were selected. Articles that quoted all the selected key words in the title and abstract; and written in English with full text were included in the review. Twelve instruments were utilized in the methodology of the 10 articles. Only one instrument was specific for spoken language assessment of children with cochlear implant. The age at which a child received an implant, good rehabilitation program and active involvement of parents was found to influence development of good spoken language skills among the cochlear implanted children. Cochlear implants provide deaf children with the opportunity to develop spoken language skills. Longer use of a cochlear implant dramatically affects the amount of spoken language. Rather, it was cochlear implantation at a younger age that served to assists spoken language competence. Keywords: Cochlear implant; communication; factors; spoken language; questionnaire; children

Background: Attaining socio-emotional competence is challenging for children with hearing impairment. There is wide recognition of children with cochlear implant (CI) indicating significant improvement in their speech and language abilities, however many factors may restrict their chance of having reciprocal social interactions. A significant improvement in speech and language does not automatically affirm the quality of social interactions. This present observation on social-emotional development addressed a more current representative population of children with hearing loss who have benefitted from cochlear implantation. Methods: The research conducted a systematic review of selected articles from Scopus and PubMed databases, retrieved through three search-process keywords, namely socio-emotional, children and CI. The inclusion criteria only included journal articles published in English with empirical data from the year 2010–2019. The initial search had identified 189 potential abstracts and after removal of duplicates, only 38 eligible studies met the inclusion criteria. Results: Among 38 studies reviewed, 19 studies showed comparable socio-emotional skills with peers in social interaction, empathy, emotion theory of mind and comprehension skills. Conversely, the other 19 studies presented underprivileged results in socio-emotional functioning mainly in identifying facial expression, regulating emotion and emotional cues in the auditory domain. Conclusion: This review concluded that the socio-emotional development among children with CI, both at preschool-age and school-age, was not justified due to the heterogeneity in studies across measurement and small sample size. Also, the conclusion recommended extensive crossreferencing, mixed-mode research design, detailed distinguishing of socio-emotional functioning and identification of diverse groups of the population with impaired hearing as an approach to provide empirical evidence on socio-emotional functioning among children with CI in the future.

Digitized Mandarin paediatric speech perception tests are limited in Malaysia for measuring outcomes among children fitted with amplification devices. Mandarin speech perception tests from other countries may not be suitable to be used in Malaysia due to regional vocabulary differences. This study aimed to develop digitized test materials to test Mandarin-speaking preschool children in Malaysia. This is a two-phased cross-sectional study where Mandarin words (n=113) were gathered with test item pictures developed and tested on 40 Mandarin-speaking children (aged 2;0 to 5;11 years old) with normal hearing in Study I. A total of 80 of 113 words with high familiarity among children were selected in Study I. In Study II, digital recordings of the words was conducted, followed by acoustic analysis, and sound quality evaluation. In total, 94 out of the 480 recorded word tokens were excluded in acoustic analysis. The remaining 386 tokens received good quality rating by three professionals. Validation of the recorded word tokens and pictures to select the final test items involved 20 Mandarin-speaking young adults in Study II. A total of 160 tokens were selected as final items and all pictures corresponding to these test items were validated as suitable representation of the test items. In conclusion, digitally recorded stimuli and pictures have been developed for a Mandarin speech perception test appropriate for Mandarin-speaking pre-school children in Malaysia. Ongoing research includes collecting normative data for the test and future research involves evaluating the test application in local audiology clinics.

INTRODUCTION:The Joint Committee of Infant Hearing (JCIH) recommended hearing screening by one month of age, diagnosis of hearing loss by three months of age, and intervention initiated by six months of age. In Malaysia however, the age of diagnosis of hearing loss in children is relatively late. This study aimed to identify the challenges faced by parents in seeking a diagnosis of hearing loss for their children.METHOD:The study utilized a semi-structured interview with open-ended questions to obtain information about parents' experiences during the diagnosis period and their challenges when going through that process. In this study, a total of 16 parents of children who were diagnosed with moderate to profound sensorineural hearing loss and received intervention within three years at the time of the study participated. Ten of the children were cochlear implant users, and six were hearing aid users.RESULTS:Thematic analysis was used to analyse themes generated from the data according to the study objective. Four main themes and 17 subthemes were identified from this study. The four main themes were 1) Parents' emotion; 2) Parental knowledge; 3) Others; 4) Profesional services. Challenges that parents faced often include emotional behaviours such as feeling guilty and devastated during the diagnosis, lack of information-sharing from healthcare givers, lack of knowledge on childhood hearing loss among parents, support from families, seek for a second opinion, worry about others' acceptance, longer time for diagnosis to confirm, late referral to other related profesionals and no priority for the appointment.CONCLUSION:Emotion is identified as the biggest challenge faced by parents in the process of diagnosis for their children with hearing loss. Hence, management of parental emotion needs to be emphasized by health profesionals as it influences the acceptance of parents towards their child's diagnosis.