International Journal of Pediatric Otorhinolaryngology 75 (2011) 774–781

Standard-Chinese Lexical Neighborhood Test in normal-hearing young children

Chang Liu 1, Sha Liu 1, Ning Zhang, Yilin Yang, Ying Kong, Luo Zhang *

Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Otorhinolaryngology, Key Laboratory of Otolaryngology – Head & Neck Surgery, Capital Medical University,

Ministry of Education, Beijing, PR China

A R T I C L E I N F O

Article history:

Received 15 December 2010

Received in revised form 2 March 2011

Accepted 6 March 2011

Available online 1 April 2011

Keywords:

Standard-Chinese

Lexical Neighborhood Test

Speech perception

Children

A B S T R A C T

Objective: The purposes of the present study were to establish the Standard-Chinese version of Lexical

Neighborhood Test (LNT) and to examine the lexical and age effects on spoken-word recognition in

normal-hearing children.

Methods: Six lists of monosyllabic and six lists of disyllabic words (20 words/list) were selected from the

database of daily speech materials for normal-hearing (NH) children of ages 3–5 years. The lists were

further divided into ‘‘easy’’ and ‘‘hard’’ halves according to the word frequency and neighborhood density

in the database based on the theory of Neighborhood Activation Model (NAM). Ninety-six NH children

(age ranged between 4.0 and 7.0 years) were divided into three different age groups of 1-year intervals.

Speech-perception tests were conducted using the Standard-Chinese monosyllabic and disyllabic LNT.

Results: The inter-list performance was found to be equivalent and inter-rater reliability was high with

92.5–95% consistency. Results of word-recognition scores showed that the lexical effects were all

significant. Children scored higher with disyllabic words than with monosyllabic words. ‘‘Easy’’ words

scored higher than ‘‘hard’’ words. The word-recognition performance also increased with age in each

lexical category. A multiple linear regression analysis showed that neighborhood density, age, and word

frequency appeared to have increasingly more contributions to Chinese word recognition.

Conclusion: The results of the present study indicated that performances of Chinese word recognition

were influenced by word frequency, age, and neighborhood density, with word frequency playing a

major role. These results were consistent with those in other languages, supporting the application of

NAM in the Chinese language. The development of Standard-Chinese version of LNT and the

establishment of a database of children of 4–6 years old can provide a reliable means for spoken-word

recognition test in children with hearing impairment.

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1. Introduction

Kirk et al. developed the Monosyllabic Lexical NeighborhoodTest (LNT) and Multisyllabic Lexical Neighborhood Test (MLNT) toassess English spoken-word recognition in attempt to reveal theperceptual processes in children. The design of the LNT and MLNTwas based on the theory of Neighborhood Activation Model (NAM)proposed by Luce [1] and Luce and Pisoni [2]. In this theory, wordsare organized into neighborhoods based on three lexical proper-ties: (1) their frequency of occurrence in the language (i.e., wordfrequency), (2) the number of acoustically–phonetically similarwords surrounding a particular target item (i.e., neighborhooddensity), and (3) the frequency of occurrence of the neighborhoods(i.e., neighborhood frequency). A neighborhood is defined as all ofthe words that can be generated from a particular word by adding,

* Corresponding author. Tel.: +86 10 65141136.

E-mail address: dr.luozhang@gmail.com (L. Zhang).1 These authors contributed equally to this work.

0165-5876/$ – see front matter � 2011 Elsevier Ireland Ltd. All rights reserved.

doi:10.1016/j.ijporl.2011.03.002

deleting, or substituting a single phoneme. Therefore, words withmany lexical neighbors have a ‘‘dense’’ lexical neighborhood, andwords with few lexical neighbors have a ‘‘sparse’’ lexicalneighborhood [3]. The theory suggested that presentation of astimulus input (i.e., a target word) triggers a set of acoustic–phonetic patterns in memory. A pattern matching is then activatedin the brain based on the acoustic–phonetic similarity between theinput stimulus and the lexical representation. The above-mentioned three lexical properties can influence word recognitioncollectively and independently [4,5]. In the original LNT and MLNT,two word lists were developed, lexically ‘‘easy’’ words with highword frequency and a low neighborhood density and frequency,and lexically ‘‘hard’’ words with low word frequency and a highneighborhood density and frequency [6–8].

Chinese language is different from many western languages instructural features [9]. Basically, each Chinese character is amorpheme, the smallest combination of sound and meaning.Although monosyllabic Chinese characters can convey semanticinformation, a meaningful word is usually composed of two oroccasionally more characters [10]. Another characteristic of

C. Liu et al. / International Journal of Pediatric Otorhinolaryngology 75 (2011) 774–781 775

Chinese is that it is a tonal language in which the pitch patterns ofthe vocalic part of the syllable convey lexical meanings [11].

At present, a Taiwanese Mandarin version of LNT [12,13] and aCantonese version of LNT [14] have been developed. A number ofissues have motivated us to develop a Standard-Chinese version ofLNT. Firstly, there are a number of differences between StandardChinese (also known as Putonghua) [15] that is spoken in mainlandChina and Taiwanese Mandarin that is spoken in Taiwan. Thedifferences include daily expressions, pronunciation, and meaningof some characters or words. Secondly, in both the Taiwanese andCantonese versions of LNT, the effects of homophones (i.e.,monosyllabic Chinese words with identical phonemes and tonesand yet with different meanings as well as orthographies) were notconsidered, which were attributed to the differences in the testresults between the English and Chinese versions of LNT. Thirdly,the age effects on test results in LNT were not examined. Therefore,in the present study, we developed the Standard-Chinese versionof monosyllabic and disyllabic LNT. The development was againbased on the NAM theory and characteristics of Chinese language.We also avoided the effects of homophones on the tests results ofusing LNT and examined the age effects by testing a large numberof normal-hearing participants with ages ranging from 4 to 6 years.

Over the past several decades, the multichannel cochlearimplant (CI) has become an efficient rehabilitative measure forchildren with severe to profound hearing impairment, who deriveminimal benefit from conventional hearing aids. Research hasadvocated early implantation to facilitate development of speechperception skills and speech intelligibility, and thus maximize thebenefit from the hearing devices [16,17]. More and more hearing-impaired young children have received CIs in China. Severalstudies have examined lexical tone perception and production inChinese-speaking children with cochlear implants [18–22]. Resultsof those studies have supported early implantation for Chinesespeaking children. However, the development of hearing andspeech abilities at different ages in those children has not beeninvestigated systematically. The present study was conducted toestablish an age-appropriate normative database for spoken-wordrecognition which can be used to assess auditory perceptualcapabilities in Standard-Chinese speaking, hearing-impairedchildren with CIs.

2. Materials and methods

2.1. Participants

Ninety-six native Standard-Chinese speaking listeners wererandomly selected from the same kindergarten in Beijing toparticipate in the present study. Participants were divided intothree groups according to age: (1) age 4.0–4.11 [39 children (22boys and 17 girls), mean age = 4.48 years], (2) age 5.0–5.10 [33children (19 boys and 14 girls), mean age = 5.29 years], and (3) age6.0–6.11 [24 children (13 boys and 11 girls), mean age = 6.37years]. All participants had normal hearing (thresholds better than

Table 1Mean and standard deviation for lexical properties in Standard-Chinese monosyllabic

Easy

1 2

Monosyllables

Word frequency (S.D.) 37.2 (11.9) 56.3 (17.6)

Neighborhood density (S.D.) 17.5 (1.5) 18.1 (1.4)

Disyllables

Word frequency (S.D.) 26.5 (7.1) 30.2 (9.1)

Neighborhood density (S.D.) 0 (0) 0 (0)

20 dB HL at 500, 1000, and 2000 Hz in both ears). None of theparticipants reported a history of speech or hearing disorders.

2.2. Speech materials

In order to create the word lists for Standard-Chinesemonosyllabic and disyllabic LNT, test items were drawn fromthe database of daily speech materials for normal-hearing childrenof ages 3–5 years that was established previously in our laboratory[23]. In establishing such a database, the principles in the methodsof the Child Language Data Exchange System (CHILDES) Database[24] were applied. Briefly, 8–16 h of speech materials wererecorded from each of the 20 children of ages between 3 and 5years in a span of 4 months. The frequencies of monosyllabic andmultisyllabic words were tallied. This database contains 1979monosyllables and 2745 disyllables and the word frequencies were1–4855 (median = 7) and 1–1878 (median = 2), respectively.Lexical neighborhood density refers to the number of neighborsthat could be found in the same database as acoustic–phoneticallysimilar to a target word, which is formed by adding, substituting, ordeleting one and only one part of the syllables involving the initialconsonant, head vowel, nucleus vowel, the nasal coda (i.e., /n/ or /ng/), or tones. The lexical neighborhood density for monosyllabicwords ranged from 1 to 112, with a median of 29 neighbors pertarget item, while the median lexical neighborhood density ofdisyllables was zero with a range of 0–5 neighbors.

When choosing test stimuli, polyphones (i.e., characters withmultiple pronunciations) were avoided. Also avoided werehomophones (i.e., monosyllabic Chinese words with identicalphonemes and tones and yet with different meanings as well asorthography), because in the testing process participants can onlyreceive acoustical information of the testing stimuli and thediverse lexical properties may affect the test results. For example, /ba4/ could mean ‘‘daddy’’, ‘‘overbearing’’, and so forth. Theneighborhood density for homophones is identical, whereas theirword frequencies can be different (e.g., ‘‘daddy’’ with highfrequency and ‘‘overbearing’’ with low frequency).

The selected monosyllabic and disyllabic items were parti-tioned into two lexical groups by performing median splits onword frequency and neighborhood density [5]. Words withfrequency above the median were coded as high-frequency words,whereas those below the median were coded as low-frequencywords. Similarly, words were coded as high or low neighborhooddensity. Consistent with various language versions, monosyllabicand disyllabic words with high word frequency and lowneighborhood density were identified as ‘‘easy’’ words, whilethose with opposite lexical properties were identified as ‘‘hard’’.Although we did not attempt to phonetically balance the items ineach category, we did include as many kinds of phonemes aspossible in each list and tried to include the same vowels andconsonants in the same lexical category. Finally, 240 items wereselected as test stimuli forming six lists of monosyllables and sixlists of disyllables (20 words/list). Table 1 provides word frequency

LNT and disyllabic LNT.

Hard

3 1 2 3

45.7 (21.1) 3.6 (0.4) 2.6 (0.4) 3.2 (0.5)

19.6 (1.7) 48.2 (1.0) 45.3 (4.0) 51.0 (4.4)

24.1 (5.5) 1 .0 (0) 1 .0 (0) 1.0 (0)

0 (0) 1.0 (0.2) 1.0 (0.4) 1.0 (0.7)

C. Liu et al. / International Journal of Pediatric Otorhinolaryngology 75 (2011) 774–781776

and neighborhood density among lexical categories. According totheir lexical properties, half of lists were ‘‘easy’’ and the remainingwords were ‘‘hard’’. There were 20 items in each list for eithermonosyllables or disyllables. Two 10-item practice lists (onemonosyllabic list and one disyllabic list) were also compiled (seeAppendices I and II for complete listing of the words).

A one-way ANOVA was employed to verify inter-list equiva-lence among three easy word lists and three hard word lists forStandard-Chinese monosyllabic and disyllabic LNT. Both wordfrequency and lexical neighborhood density were not significantlydifferent among easy word lists (P > 0.05) and hard word lists(P > 0.05) for either monosyllables or disyllables. In a pilotexperiment, 30 normal-hearing children (15 boys and 15 girls)were tested with the Standard-Chinese monosyllabic LNT and 34normal-hearing children (15 boys and 19 girls) were tested withthe Standard-Chinese disyllabic LNT. The inter-list performancewith each lexical category were not significantly different(P > 0.05).

The test items were recorded using a high-quality microphonein a double-walled sound-attenuated booth with a backgroundnoise <25 dB (A). The talker was a native Standard-Chinesespeaking male professional announcer. The talker’s mouth and themicrophone were fixed at the same height and were 15 cm apart.He read the words at the same pace as normal conversationalspeed for the entirety of the recording session. All productionswere monitored in the control room. The levels of the recordedindividual words were digitally equated using CoolEdit Pro v2.1software.

2.3. Design and procedure

The open-set speech testing was conducted in a quiet room[background noise <35 dB (A)] for all participants. The recordedwords were presented through a loudspeaker in sound field, andmonitored at 70 dB SPL. The participant was seated at thecalibration point, 1 m from and 08 azimuth at the loudspeaker.Since no significant differences were found among the three lists ofthe same lexical category in a pilot study on inter-list equivalence,one list was randomly selected as test material in each of fourlexical categories (four lists total) for each of the participants.Disyllabic ‘‘easy’’ list was presented first, followed by disyllabic‘‘hard’’ list, monosyllabic ‘‘easy’’ list, and monosyllabic ‘‘hard’’ list.Every child was given the same order of items for each list.Participants responded by verbally repeating the words they hadheard, and their responses were recorded by a digital recorder. Toassess inter-rater reliability, the responses of ten participants weretranscribed separately by two testers, without discussion with[()TD$FIG]

D−E D−H M−E M−H0

10

20

30

40

50

60

70

80

90

100

4−year−old group N = 39

Per

cen

t co

rrec

t

D−E D−H

5−year−old

Lexica

Fig. 1. Mean and individual data of percent correct scores with disyllabic ‘‘easy’’ (D-E), d

lists. The three panels from left to right represent the three age groups (i.e., 4-, 5-, and

each other. The scores were then analyzed and compared. For theresponses from all other participants, the two testers transcribedand then scored the recorded responses as a team. Prior to theexperimental trials, each child received training with one 10-itempractice list for monosyllables and another list for disyllables.These trials were not included in the final analysis, but rather wereused to familiarize the participants with the task.

3. Results

Responses from 10 participants were randomly selected forinter-rater reliability assessment. Consistencies of scorings be-tween the two testers were compared. The results indicated that92.5% and 95.0% consistency were achieved for Standard-Chinesemonosyllabic and disyllabic LNT, respectively. Therefore, all theresults reported here were the scores evaluated by the two testersas a team.

Fig. 1 plots the mean and individual data of percent correctscores with disyllabic ‘‘easy’’, disyllabic ‘‘hard’’, monosyllabic‘‘easy’’ and monosyllabic ‘‘hard’’ lists in the three age groups. Fig. 2shows the mean scores across all age groups. For each of the agegroups, a two-way ANOVA was performed with two factors (i.e.,‘‘easy’’ versus ‘‘hard’’ and monosyllables versus disyllables). It isshown that the main effects for both factors were statisticallysignificant across the age groups. However, there were nostatistically significant interactions between the two factors acrossall age groups.

For each lexical category of Standard-Chinese monosyllabic anddisyllabic LNT, the mean scores increased along with age, as shownin Fig. 3. The average scores for disyllabic ‘‘easy’’ word lists were93.5%, 96.1%, and 97.9% correct for the three age groups of children,respectively. A one-way ANOVA indicating a significant differenceamong these age groups was observed (P < 0.05). Further analysiswith LSD-t test revealed that the mean score of the 6-year-oldgroup was significantly different from that of the 4-year-old group(P < 0.01), whereas the differences of the mean scores between anyother two age groups were not statistically significant (P > 0.05).For the disyllabic ‘‘hard’’ word lists, the perceptual scores were86.41%, 88.48%, and 92.92% correct in the three age groups. Astatistically significant difference among age groups was observed(one-way ANOVA, P < 0.01). Further analysis with LSD-t testindicated that the scores of the 5-year-old group were notsignificantly different from that of the 4-year old group (P > 0.05).The differences on mean percent correct between any other twogroups were statistically significant (P < 0.05).

For monosyllables, perceptual scores for the ‘‘easy’’ lists were82.65%, 93.46%, and 96.04% correct in the three age groups,

M−E M−H

group N = 33

l categoryD−E D−H M−E M−H

6−year−old group N = 24

isyllabic ‘‘hard’’ (D-H), monosyllabic ‘‘easy’’ (M-E), and monosyllabic ‘‘hard’’ (M-H)

6-year-old groups).

[()TD$FIG]

D−E D−H M−E M−H0

10

20

30

40

50

60

70

80

90

100

* * * *

Per

cen

t co

rrec

t

Lexical category

Fig. 2. Mean percent correct scores across all age groups with disyllabic ‘‘easy’’ (D-

E), disyllabic ‘‘hard’’ (D-H), monosyllabic ‘‘easy’’ (M-E), and monosyllabic ‘‘hard’’

(M-H) lists. The asterisks and lines at the top indicate statistical significance

(P < 0.05).

C. Liu et al. / International Journal of Pediatric Otorhinolaryngology 75 (2011) 774–781 777

respectively. A statistically significant difference among the agegroups was observed (P < 0.01). Further analysis with LSD-t testindicated that the scores of the 6-year-old group were notsignificantly different from that of the 5-year-old group (P > 0.05).The differences on mean scores between any other two groupswere statistically significant (P < 0.01). The perceptual scores forthe monosyllabic ‘‘hard’’ words were 77.64%, 85.91%, and 88.13%correct for the three age groups, respectively. There was astatistically significant difference among the age groups(P < 0.01). Similar to the results for monosyllabic ‘‘easy’’ list, therewas not a significant difference in the scores between the 6-year-old and 5-year-old groups (P > 0.05). However, statisticallysignificant differences in the scores were observed between thegroups of 4- and 5-year-olds and 4- and 6-year-olds.

In order to describe the linear association between wordrecognition and a set of exploratory variables (i.e., age, wordfrequency, and neighborhood density), a multiple-linear regres-sion model was carried out [5]. The standardized-beta weightsassociated with each variable were used to estimate the relativevariance proportion of each factor that may have contributed to the

[()TD$FIG]

D−E D−H M−E M−H0

10

20

30

40

50

60

70

80

90

100* * * ** * *

Per

cen

t co

rrec

t

Lexical category

Fig. 3. Mean percent correct scores of the three age groups with disyllabic ‘‘easy’’ (D-

E), disyllabic ‘‘hard’’ (D-H), monosyllabic ‘‘easy’’ (M-E), and monosyllabic ‘‘hard’’

(M-H) lists. The white, gray, and black bars represent 4-, 5-, and 6-year-old groups,

respectively. The asterisks and lines at the top indicate statistical significance

(P < 0.05).

test scores. The R-square values were used to characterize the totalvariance of the criterion factor accounted for by the three factorssimultaneously. A summary of this analysis is provided in Table 2.The results indicate that the variable, word frequency, accounts forapproximately half of the contributions by the three variables inStandard-Chinese monosyllabic and disyllabic LNT test results. Ageof the children accounted for 22 and 44%, and neighborhooddensity accounted for 13% and 17% of the contributions of all threevariables. The specific R-square values were 0.237 in disyllablesand 0.382 in monosyllables. Thus, on average, the three factorsaccounted for approximately 30% of the variance.

4. Discussion

The results of the present study showed that word-recognitionscores with Standard-Chinese monosyllabic and disyllabic LNTincreased with age in each lexical category (see Fig. 3). Differencesin speech perception between children and adults can be caused byfactors of psychology, physiology, language skills, etc. Moore [25]found that improvement in perceptual skills paralleling to theanatomical development process of the auditory cortex reaches ata level that is equivalent to young adults by 11–12 years of age.Additionally, other research shows that development of speechperception increases with age and is not completed untiladolescent [26,27]. The research on semantics [26,28,29] indicatesthat adults can better utilize the clues in the context to identifyvocabulary and sentences than children, because adults are moreadept at word retrieval and other semantic skills. The age rangethat was included in the present study was from 4 to 6 years. This isthe age range in which the development of Chinese language hasbeen shown to be in a process of reaching a stable stage [30]. In anyone of the lexical categories, while the test scores were alwayshigher in the 6-year-old group than those of the 4-year-old group,scores did not differ significantly between some of the age groups(see Fig. 3). There are two potential reasons that may account forthese results. Firstly, language development for children at certainstage of age might be comparatively slow. Therefore, noappreciatively improvement on speech recognition can be identi-fied. Secondly, the test stimuli were derived from the database ofdaily speech materials for children of ages between 3 and 5 years.Therefore, the performance of 5- and 6-year old children mighthave potentially reached the ceiling effect, which might explain thelack of statistically significant differences between the 5- and 6-year-old groups.

Our results also showed that perceptual scores with disyllableswere higher than those with monosyllables in both lexically ‘‘easy’’and ‘‘hard’’ lists (see Figs. 1 and 2). These results were consistentwith those from the previous studies on English LNT and MLNT [4]as well as Taiwanese Mandarin LNT [12,13] and Cantonese LNT[14]. There is more redundant information in the disyllables thanin the monosyllables. Furthermore, Mandarin disyllabic wordswith less phonemically similar neighbors are likely to be moreeasily identifiable than the monosyllables, which may minimize

Table 2Summary of the multiple linear regression analysis. Predictors were word

frequency, neighborhood density, and age.

Predictors Standardized

beta

Proportion of standardized

beta (%)

Monosyllables

Word frequency 0.372 42.6

Neighborhood density �0.110 12.6

Age 0.391 44.8

Disyllables

Word frequency 0.585 58.9

Neighborhood density 0.165 16.6

Age 0.242 24.4

C. Liu et al. / International Journal of Pediatric Otorhinolaryngology 75 (2011) 774–781778

competition in the lexical-selection process and make it easier toscreen and retrieve disyllables in lexicon.

Compared to lexically ‘‘hard’’ words, ‘‘easy’’ words were easierto recognize for children in both monosyllabic and disyllabic wordlists (see Figs. 1 and 2). This result was consistent with what hasbeen found in English [4,5,31]. Children found that words withhigh frequency and sparse neighborhoods are easier to identify.Repeated stimulations with high-frequency words might strength-en memory of the words and consolidate the words in the lexiconcompared to the low-frequency words. The sparser neighborhooddensity might facilitate retrieval of the ‘‘easy’’ words as a result ofthe ‘‘top-down’’ process. Therefore, children have better mastery ofthe ‘‘easy’’ words than the ‘‘hard’’ words. It is worth noting thatresults of LNT tests using other versions of Chinese dialects did notshow lexical effect in monosyllables [12–14]. We believe that theeliminations of homophones in the word lists in the present studymight have contributed to the differences in the results. Thehomophones that were included in the previous studies mightactivate a diverse population of words and could thus influence theselection of the target word in the lexicon.

Word frequency, neighborhood density, and age may exertsignificant influences on speech perception. However, it should notbe expected that any one of these factors will independently besufficient to explain all the variable effects on word recognitionscores. Each test stimuli has its lexical properties. Additionally,each participant has his/her own characteristics, such as age. Thesevariable effects co-vary.

In order to demonstrate the correlative effect of the variableson speech perception, a multiple linear regression analysis wascarried out with word frequency, neighborhood density, and ageas the independent factors and the individual speech perceptionscores as the criterion factor. Based on the R-square value, it issuggested that the three predictors could explain approximately30% of the variance in speech recognition. Based on the

standardized beta values, word frequency accounted for 43%and 59% of overall contributions of the variables for monosyl-labic and disyllabic words, respectively (see Table 2). The reasonmight be that dramatic differences in word frequency exist inthe ‘‘easy’’ and ‘‘hard’’ word lists (see Table 1). In contrast, theneighborhood density only accounted for approximately 13%and 17% of overall contributions of the variables for monosyl-labic and disyllabic words, respectively (see Table 2). Thesevalues were slightly lower than those found in English, whichwas approximately 29% [5]. Note that the sign of the standardbeta value for the disyllabic words was positive. This may be dueto the small differences in the median values of the ‘‘easy’’ and‘‘hard’’ word lists (see Table 1).

In conclusion, the results of the present study provided supportto the NAM theory. In other words, the NAM theory can be appliedto Chinese language as well as other languages. In the design of theword lists, we have considered the potential influences of thehomophones. By eliminating the homophones in the word lists, wedemonstrated the test results are largely consistent with theexisting data in other languages [3,4,32]. Particularly, with arelatively large sample size, we demonstrated that there are clearlexical effects and age effects in children’s speech recognition withthe Chinese language. Word frequency appears to have a strongeffect on speech recognition, consistent with the findings inEnglish [5]. The development of the Standard-Chinese LNT hasimportant clinical applications in assessment of speech develop-ment in hearing impaired children who have received hearing aidsor cochlear implants.

Acknowledgments

This study was supported by the National Natural Science ofFoundation of China (Project # 30872859) and National Scienceand Technology Initiatives (Project # 2008BAI50B01).

Appendix A.

Word lists of the monosyllabic words for the Standard-Chinese version of Lexical Neighborhood Test (LNT)

C. Liu et al. / International Journal of Pediatric Otorhinolaryngology 75 (2011) 774–781 779

Appendix B.

Word lists of the disyllabic words for the Standard-Chinese version of Lexical Neighborhood Test (LNT)

C. Liu et al. / International Journal of Pediatric Otorhinolaryngology 75 (2011) 774–781780

C. Liu et al. / International Journal of Pediatric Otorhinolaryngology 75 (2011) 774–781 781

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