Purpose This study aimed to explore the effects of Mandarin congenital amusia with or without lexical tone deficit (i.e., tone agnosia and pure amusia) on Mandarin vowel and tone identification in different types of vowels (e.g., monophthong, diphthongs, and triphthongs) embedded in consonant-vowel contexts with and without semantic content. Method Thirteen pure amusics (i.e., amusics with normal lexical processing), 5 tone agnosics (i.e., with lexical tone deficit), and 12 controls were screened with Montreal Battery of Evaluation of Amusia and lexical tone tests (Nan et al., 2010; Peretz et al., 2003). Vowel-plus-tone identification tasks with the factors of vowel type and syllables with and without semantic content (e.g., real and nonsense words) were examined among the 3 groups, and identification scores were calculated in 3 formats: vowel-plus-tone identification, vowel identification, and tone identification. Results Tone agnosics showed significantly poorer performances on identifications of vowel, tone, and vowel plus tone across monophthongs, diphthongs, and triphthongs in both real and nonsense words compared to pure amusics and controls. Their deficits were similar across the 3 types of vowels, while the deficit on vowel-plus-tone identification was more severe in nonsense words than in real words. On the other hand, pure amusics performed similarly with controls across all these conditions. Conclusions Tone agnosia might affect both musical pitch and phonological processing, resulting in deficits in lexical tone and vowel perception. On the contrary, pure amusics's effect is primarily on musical pitch perception but not on lexical tone or phonemic deficit. Vowel type did not affect speech deficits for tone agnosics, while they relied more on semantic content as a compensation.