Objectives To evaluate the safety and feasibility of cochlear implantation (CI) in irradiated ears of nasopharyngeal carcinoma (NPC) patients. Study Design A retrospective study. Methods From 2008 to 2017, 10 adults with binaural severe or profound sensorineural hearing loss subsequent to radiotherapy for NPC underwent CI in our center. The mean follow‐up was 63.2 months. Hearing and speech performance were evaluated pre‐ and postoperatively with audiometric and speech discrimination testing, Category of Auditory Performance, Speech Intelligibility Rating, and Chinese version of Nijmegen Cochlear Implant Questionnaire. Results According to the severity of radioactive osteomyelitis of temporal bone, patients were classified into three categories: mild, moderate, and severe. Patients in mild category underwent routine CI. Patients in moderate category underwent extended radical mastoidectomy and CI simultaneously. Patients in severe category underwent subtotal temporal bone resection, external auditory canal elimination, and CI simultaneously or by stage. There was no massive hemorrhage, facial paralysis, or nonunion of incision after operation. One suffered from radiation encephalopathy 13 months postoperatively; since then, the cochlear implant has been idle. The other nine patients demonstrated encouraging results of hearing and speech performance. Conclusion CI for postirradiated ears of NPC is safe and feasible. Strict control of operative indications and extra care during surgery are required. Individual surgical plan should be made according to the severity of radioactive osteomyelitis. Choose one‐stage surgery as much as possible in severe cases to avoid the risk of difficulty in locating round window in second‐stage surgery. Level of Evidence 4 Laryngoscope, 131:649–655, 2021

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Despite pitch being considered the primary cue for discriminating lexical tones, there are secondary cues such as loudness contour and duration, which may allow some cochlear implant (CI) tone discrimination even with severely degraded pitch cues. To isolate pitch cues from other cues, we developed a new disyllabic word stimulus set (Di) whose primary (pitch) and secondary (loudness) cue varied independently. This Di set consists of 270 disyllabic words, each having a distinct meaning depending on the perceived tone. Thus, listeners who hear the primary pitch cue clearly may hear a different meaning from listeners who struggle with the pitch cue and must rely on the secondary loudness contour. A lexical tone recognition experiment was conducted, which compared Di with a monosyllabic set of natural recordings. Seventeen CI users and eight normal-hearing (NH) listeners took part in the experiment. Results showed that CI users had poorer pitch cues encoding and their tone recognition performance was significantly influenced by the “missing” or “confusing” secondary cues with the Di corpus. The pitch-contour-based tone recognition is still far from satisfactory for CI users compared to NH listeners, even if some appear to integrate multiple cues to achieve high scores. This disyllabic corpus could be used to examine the performance of pitch recognition of CI users and the effectiveness of pitch cue enhancement based Mandarin tone enhancement strategies. The Di corpus is freely available online: https://github.com/BetterCI/DiTone.

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