---

Objective : To assess neonates and children suffering from meningitis , during the critical and recovery periods , using ABR , EOAE and Behavioral Audiometry.
Method and Material: 40 neonates to 12-year-old children were assessed. Using ABR test, the hearing of these cases was evaluated during the critical period-that is , 24-72 hours following the diagnosis. This test was repeated when patients recovered from meningitis-that is 24 hours before discharge (recovery period) Hearing function , again , was assessed 7-14 days following discharge through Immittance Audiometry, Behavioral Audiometry (PTA , SF and BOA). And EOAE (TEOAE and DPOAE) tests procedures.Findings: During the critical period , ABR test revealed normal hearing in 35 patients (87.5%) and severe to profound sensorineural hearing loss (unilateral and bilateral) in 5 patients (12.5%-girl=4, boy=1). The same result were obtained in re-evaluation in the recovery period. On the other hand , 7-14 days after of discharge , Immittance Audiometry and Behavioral Audiometry (including PTA , S.F and BOA tests), confirmed the mentioned results (cross - gcheck). EOAE test (DPOAE and TEOAE) in 35 normal hearing patients (according to ABR test) , showed normal cochlear function. 2 out of 5 cases suffering from severe to profound sensorineural hearing loss revealed normal cochlear function. According to EOAE results , abnormal cochlear function was evident in 3 patients.
Conclusion: ABR , EOAE tests , and Behavioral Audiometry in children meningitis during the critical period and recovery period can be used to diagnose any degree of hearing loss with a high level accuracy. The results of persent study is confirmed by previous investigations.

---

Objective: Survery and comparison between the physical characteristics of Distortion-Product Otoacoustic Emissions of 1-59 day-old normal-hearing newborns refered to TUMS, Rehabilitation School , Audiology department , 2002
Method & Material : This analytical-descriptive study was conducted on the ears of 102 easy method selected newborns. The tests included: otoscopy , BOA, Immittance audiometry , DPOAEs, and ABR if necessary. The amplitude and frequency of 2f1-f2 emissions of DPOAEs evoked by two pure tones (L1=65 dBSPL , L2=50 dBSPL and f2/f1=1.2) were also calculated.
Results: 1-All normal hearing newborns have normal DPOAEs. No significant difference was observed in test-retest. 2- The amplitude of the DPOAEs to the right ear is significantly greater than the amplitude of the left ear (P<00.05). 3- No significant difference was observed between newborn&aposs DPOAEs in terms of their gender.
Conclusion: DPOAEs could be measured quickly and noninvasively and are excellent tools for the screening of newborn hearing loss. The results are valid only within the Context of this research.

---

Background and Aim: Hyperbilirubinemia is one of the most common abnormalities during the neonatal period. Approximately 60% full-term and 80% preterm neonates suffer from hyperbilirubinemia. Hearing loss is one of the most prevalent side-effects of hyperbilirubinemia. This happens when the serum concentration of indirect bilirubin increases dramatically. The main purpose of this study is to evaluate the hearing status and to diagnose the probable site of lesion in affected children.
Materiads and Methods: In this cross-sectional study, 33 newborn to two year old subjects uffering from hyperbilirubinemia were evaluated using auditory brainstem response (ABR) and transient evoked otoacoustic emissions (TEOAE) tests In the Audiology department of the Faculty of Rehabilitation Sciences Iran University of Medical Sciences sampling method was accessible.
Results: 21% of the subjects had severe to profound hearing loss and 9% of subjects had mild to moderate hearing loss. In 51% of the subjects there was no response to ABR and TEOAE tests indicating cochlear and/or retrocochlear lesion. The other 15% manifest only abnormal ABR test indicating the presence of the auditory neuropathy.
Conclusion: TEOAEs test has its own limitations in these subjects, that is the hearing status of such patients can not be completely evaluated by using just TEOAE test. Therefore, to detect hearing loss both ABR and TEOAE tests must be performed in these subjects.

---

Background and Aim: Auditory neuropathy is an hearing disorder in which peripheral hearing is normal, but the eighth nerve and brainstem are abnormal. By clinical definition, patient with this disorder have normal OAE, but exhibit an absent or severely abnormal ABR. Auditory neuropathy was first reported in the late 1970s as different methods could identify discrepancy between absent ABR and present hearing threshold. Speech understanding difficulties are worse than can be predicted from other tests of hearing function. Auditory neuropathy may also affect vestibular function.

Case Report: This article presents electrophysiological and behavioral data from a case of auditory neuropathy in a child with normal hearing after bilirubinemia in a 5 years follow-up. Audiological findings demonstrate remarkable changes after multidisciplinary rehabilitation.

Conclusion: auditory neuropathy may involve damage to the inner hair cells-specialized sensory cells in the inner ear that transmit information about sound through the nervous system to the brain. Other causes may include faulty connections between the inner hair cells and the nerve leading from the inner ear to the brain or damage to the nerve itself. People with auditory neuropathy have OAEs response but absent ABR and hearing loss threshold that can be permanent, get worse or get better.

---

Background and Aim: Vestibular evoked myogenic potential (VEMPs) is one of the clinical tools to evaluate vestibular function. The VEMPs can be recorded from sternocleidomastoid muscle by auditory stimulation with various sound stimuli and are thought to have saccular origin. The aim of this study was to compare the VEMP responses evoked by short (500 Hz) tone burst (STB) with those evoked by click stimuli in healthy young individuals.          

Materials and Methods: Thirty healthy volunteers (15 males, 15 females) with ages of 18 to 30 years were enrolled in this study. Subjects were instructed to sit on a chair and rotate their head to the opposite side of the recording muscle. The VEMPs was recorded using 500 Hz STB and then click sound stimuli to each ear. The p13 and n23 latencies, p13-n23 peak-to-peak amplitude and VEMPs thresholds were obtained for further analysis.       

Results: The VEMP responses were present in all subjects for STB and ware not recorded in one subject for click. The latencies of p13 and n23 of STB-VEMP were significantly longer, and the p13- n23 amplitudes were significantly greater for STB-VEMP (p<0.05), and thresholds were higher for clicks (p < 0.05). No significant difference was obtained between both ears and genders. (p > 0.05).

Conclusion: The VEMP responses were significantly different between the stimuli of STB and click, and the norms of different stimuli should be established for clinical interpretations. According to these data, we recommend STB stimuli in comparison with clicks for clinical diagnosis.

---

Background and Aim: Vestibular evoked myogenic potentials (VEMP) originate from the saccule and the inferior vestibular nerve. In this study, the prevalence of VEMP and latency of the p13 and n23 were compared between three groups of individuals, including symptomatic and asymptomatic Meniere's disease cases and normal participants.

Methods: This study was conducted on 42 cases with the mean age of 40.48 years thirty were Meniere's disease patients, of which 19 were symptomatic and 11 were asymptomatic twelve were normal participants. The VEMP were recorded with 500 Hz tone bursts at 120 dBpeSPL. Then the prevalence and latency of the waves were analyzed and compared in the three above mentioned groups.

Results: The prevalence of VEMP in symptomatic Meniere's disease patients (52.6%) was significantly less than asymptomatic individuals (90.9%) and also normal subjects (100%)(p<0.05). There was no significant difference between latencies of the waves in these three groups (p>0.05). The latency of p13 for symptomatic, asymptomatic and normal participants was 16.41, 15.20 and 14.14 ms, respectively and the latency of n23 for these groups was 20.25, 18.77 and 18.50 ms, respectively.

Conclusion: In Meniere's disease, after medical management, the succule probably regains normal function resulting in re-existence of VEMP. It seems that there is no change in the latency of the waves, most likely due to involvement of the inner ear and intactness of the nerve. VEMP may be a useful test for diagnosis of Meniere's disease and additionally for monitoring the trend of medical management.

---

Background and Aim: Laryngeal muscles contribute in sound production play a key role in specific language. Needle electromyography is the specific complementary method for muscle activity evaluation which is awfully painful and needs serenity of patient. The purpose of this study was to use Surface electromyography as a probable new approach for evaluation of laryngeal muscles activity.
Methods: 34 healthy women and 34 healthy men aged 20-30 years old were enrolled in this study. Each individual was seated in an armchair. Recording electrodes were placed bilaterally (right and left) in the low anterior neck at approximately one centimeter from midline on thyroarytenoid and cricothyroid muscles. Silent activity and fricative voice (/z/ , /ž/) and voiceless (/s/ , /š/) activities were recorded for ten seconds followed by 10 seconds of rest, for 5 repetition. All data were processed and frequency and non linear measurements were assessed. And were compared in time and frequency domain.
Results: Muscle activity in fricative voice in both groups was greater than rest condition (p<0.05). Moreover, muscle activity median frequency was significantly more in men than women (p<0.001).
Conclusion: Activity evaluation of thyroarytenoid and cricothyroid muscles using surface electromyography is difficult in women. That may be due to anatomical features such as length and width of neck in women.

---

Background and Aim: Stress is associated with life satisfaction and also development of some physical diseases. Birth of a disabled child with mental or physical disability (especially deaf or blind children), impose an enormous load of stress on their parents especially the mothers. This study compared stress levels of mothers with hearing impaired children and mothers of normal children or with other disabilities.
Methods: In this study, cluster random sampling was performed in Karaj city. 120 mothers in four groups of having a child with mental retardation, low vision, hearing impairment and with normal children were included. Family inventory of life events (FILE) of Mc Cubbin et al. was used to determine stress level in four groups of mothers.
Results: The results of this research indicated a significant difference (p<0.05) between stress levels of mothers with hearing impaired children and mothers of other disabled and normal children in subscales of intra-family stress, finance and business strains, stress of job transitions, stress of illness and family care and family members "in and out&apos&apos. There was no difference between compared groups in other subscales.
Conclusion: Since deafness is a hidden inability, the child with hearing impairment has a set of social and educational problems causing great stress for parents, especially to mother. In order to decrease mother&aposs stress, it is suggested to provide more family consultation, adequate social support and to run educational classes for parents to practice stress coping strategies.

---

Background and Aim: One of the chemical pollutions which is frequently common in industry-other than noise is carbon monoxide. The present study aimed to assess the putative protective effect of N-acetylcysteine on the function of outer hair cells of rabbits exposed simultaneously to noise and carbon monoxide.
Methods: 24 male rabbits are entered in this interventional study. After obtaining baseline distortion product otoacoustic emissions, rabits were randomely devided into four groups. The groups Included: exposed with noise and received saline, exposed with noise and carbon monoxide and received saline, exposed with noise and received N-acetylcysteine, and exposed with noise and carbon monoxide and received N-acetylcysteine. Subsequently, they were evaluated again with distortion product otoacoustic emissions in two stages (two hours and one week after the exposure). Data were recorded and analyzed using paired and independent sample t-tests.
Results: Exposure to noise, and also simultaneous exposure to noise and carbon monoxide, and moreover using N-acetylcysteine in both groups, produced significant changes in distortion product otoacoustic emissions amplitudes (p<0.005).
Conclusion: The findings of the present research reveal that simultaneous exposure to noise and carbon monoxide may potentiate noise induced hearing loss. In addition, utilizing N-acetylcysteine can be used as a preventive agent for noise induced hearing loss and to avoid its potentiation with carbon monoxide.

---

Background and Aim: High incidence of speech disorders in children with cerebral palsy could be related to a deficiency in processing of auditory stimuli. So it is vital to check out any peripheral or central disorders in auditory system using behavioral and electrophysiological auditory tests.
Methods: In a cross-sectional study, 15 children with spastic diplegia, mean age 5.77, SD 2.26 years, and 15 normal children, mean age 5.33, SD 1.80 years, were tested using pure tone audiometry, immittance and auditory brainstem responses. The results were compared between the two groups.
Results: Hearing thresholds and middle ear status were in normal range in all participants however, contralateral acoustic reflex thresholds were mostly elevated. Comparing absolute latency and interpeak latency intervals of auditory brainstem responses between the two groups, absolute latency interval of later waves, and in specific the V wave, was significantly longer in diplegic children (p=0.04) resulting in a longer III-V interpeak latency intervals (p=0.02).
Conclusion: Neurological disorders in ponto-reticulo-spinal pathway, pontine reticular nuclei and upper pons which are adjacent to auditory nuclei of lateral leminiscus and inferior colliculus result in auditory dys-synchrony and increased latency intervals in latter waves of auditory brainstem responses. This could also attributed to functional disorders in wave-generating sites in these patients.

---

Background and Aim: Noise-induced hearing loss is the most common problem in industrial areas. This study aimed to determine effects of excessive noise exposure on measurable characteristics of distortion product otoacoustic emissions (DPOAEs) in rabbits.
Methods: The study was carried out on 12 adult male New Zealand White rabbits including case group - exposed to 500-8000 Hz broadband white noise with 100 dBA SPL for 8 hours per day in 5 consecutive days - and control group. After three days period of acclimatization to the experimental condition, rabbits&apos hearing status in each group were measured by distortion product otoacoustic emissions on days zero means before the study was initiated as a baseline, eight, one hour after the latest exposure to noise, and ten. The recorded results were analyzed using SPSS software.
Results: Highest mean distortion product otoacoustic emissions amplitudes in case group were allocated to frequencies of 5888.50 Hz, 8166.50 Hz, 9855.00 Hz, 3956.00 Hz, and 3098.50 Hz, respectively. However, the lowest mean distortion product otoacoustic emissions amplitude was related to frequency of 588.00 Hz (p=0.001).
Conclusion: This study revealed that distortion product otoacoustic emissions amplitude shifts due to noise occur first in high and then in middle frequencies. Additionally, exposure to noise can decrease distortion product otoacoustic emissions amplitudes. We conclude that distortion product otoacoustic emissions can be a reliable test for estimating personal susceptibility to noise-induced hearing loss.

---

Background and Aim: Sound conditioning is exposure to a non-traumatic, moderate level of sound which increases inner ear resistance against further severe noise. In this study, we aimed to survey the effect of sound conditioning on auditory brainstem response (ABR) threshold shifts using click stimulus, and the effect of the frequency of conditioning on hearing protection.
Methods: Fifteen guinea pigs were randomly divided into 3 groups. Two conditioned groups were exposed to 1 kHz, and 4 kHz octave band noise at 85 dB SPL, 6 hours per day for 5 days, respectively. On the sixth day, the animals were exposed to 4 kHz octave band noise at 105 dB SPL, for 4 hours. The control group was exposed to intense noise, 4 kHz at 105 Db SPL for 4 hours (without conditioning). After exposure, ABR thresholds using click were recorded an hour, and 7 days after noise exposure.
Results: The results of the ABR with click stimulus showed less thresold shifts in conditioned groups than control (p≤0.001). Comparison of the results of conditioned groups, showed less threshold shift by 4 kHz conditioning, however, this difference was not statistically significant (p>0.05).
Conclusion: Electrophysiological data of our study showed that sound conditioning has a protective effect against subsequent intensive noise exposure, and the frequency of conditioning does not have significant effect on ABR threshold shifts when using click stimulus.

---

Background and Aim: Families who have a child with hearing deficiency deal with different challenges, and mothers have a greater responsibility towards these children because of their traditional role of caregiver so, they deal with more psychological problems. The aim of this study was to compare the psychological well-being and coping styles in mothers of deaf and normal children.
Methods: In this cross-sectional and post event study (causal-comparative method), 30 mothers of deaf students and 30 mothers of normal students from elementary schools of Ardabil, Iran, were selected using available sampling. The Ryff psychological well-being (1989) and Billings and Moos coping styles (1981) questionnaires were used in this study. The data were analyzed using MANOVA test.
Results: We found that in mother&aposs of deaf children, psychological well-being and its components was significantly lower than mothers of normal children (p<0.01 and p<0.05, respectively). There was a significant difference between two groups in terms of cognitive coping style, too (p<0.01). However, mothers of deaf children used less cognitive coping style.
Conclusions: It seems that child&aposs hearing loss affects on mothers psychological well-being and coping styles this effect can be visible as psychological problems and lower use of adaptive coping styles.

---

Background and Aim: The majority of people experience problems and stressors, such as job layoffs and illnesses during their lives. However, the way people cope with stress varies. According to previous research, use of effective coping strategies can significantly reduce stress and tension. The aim of the present study was to investigate the effectiveness of stress coping strategies on hearing-impaired students.
Methods: This is a quasi-experimental study with pre-test, post-test, and control group. The sample consisted of 40 hearing-impaired male students of guidance and high schools of the city of Sari, Iran, in the years 2010 and 2011. They were randomly selected and assigned to two experimental and control groups (n=20). The data collection tool was the General Health Questionnaire-28. The experimental group was administered eight sessions of stress coping strategies based on cognitive-behavioral techniques two hours weekly. Data were analyzed using statistical indices including mean, standard deviation, and two-way analysis of variance.
Results: There was a significant difference between the pre-test and post-test scores in the subscales of somatic symptoms, anxiety and insomnia, depression, and social function (p<0.05). Moreover, after the eight sessions the rate of general health of the experimental group was higher than the control group.
Conclusion: Stress coping strategies based on cognitive-behavioral techniques increased the general health of hearing-impaired people. Therefore, stress management training should be developed and expanded as an appropriate intervention.

---

Background and Aim: Studies have shown that most children before age 4 are able to comprehend and express wh-question. In the Persian language, a case study has confirmed these results. The aim of this study is to evaluate the ability of 4-6 year olds to comprehend and express wh-question.
Methods: Seventy two 4-6 year-old Persian-speaking children were selected randomly. Wh-words consist of: what, where, who, why, and when. In the part of comprehension subjects answered questions about two pictures, and in the part of expression they asked questions elicited by a speaking puppet about four pictures. Descriptive analysis and student&aposs t-test were used for data analysis.
Results: In comprehension 4-6 year-old children gained the complete score (2) with SD=0 in all wh-words. However, 4-5 year old children gained the score of 1.89 with SD of 0.32 for the word when. In expression, independent t-test showed the maximum score of 3.52 with SD of 0.84 related to questions with who. 5-6 and 4-5 year old subjects had significant differences in questions with what (p=0.005), where (p=0.003), who (p=0.012), and when (p<0.001). Most errors were expressed in question with when.
Conclusion: Subjects of this study had the ability to comprehend and express wh-words. Comprehension of wh-words is easy for 4-6 year-old children they are able to use them in questions, but have some application errors.

---

Background and Aim: Patients with systemic lupus erythematosus (SLE) may develop hearing and balance disorders as a result of the immune-mediated inner ear damage. Vestibular evoked myogenic potential (VEMP) is a new vestibular test assesses the vestibulospinal tract. Balance disorders such as endolymphatic hydrops may occur as a result of perisaccular deposition of immune complexes in these patients. Although the vestibular system abnormality in the patients has been demonstrated, the function of the part of vestibular system including vestibulospinal tract has not been investigated so far. This study aimed to compare the vestibular evoked myogenic potentials between patients with inactive stage of systemic lupus erythematosus and normal individuals.

Methods: In this cross-sectional study, vestibular evoked myogenic potential was recorded between 26 healthy subjects and 20 patients with lupus erythematosus in inactive stage of disease aged 20 to 50 years old, using 500 Hz-tone bursts at 95 dB nHL.

Results: Vestibular evoked myogenic potentials responses were present in all (100%) of the participants. There was no significant difference in mean peak to peak amplitude and assymetry ratio between two groups. The mean p13 and n23 latencies were significantly higher in patients (p<0.05). Duration of disease had no effect on test parameters.

Conclusion: According to the prolonged latency of vestibular evoked myogenic potentials response in patients with lupus erythematosus , lesions in the retrolabyrinthine, especially in the vestibulospinal tract is suspected. Due to small sample size, there is no possibility for generalizing this result to all patients with lupus lupus erythematosus .

---

Background: Balance disorders are common in patients following stroke. There are a number of physiotherapy modalities to treat balance impairments, one of which is vibration. The effects of vibration on balance disorders after stroke have not been investigated. This case report demonstrates the short-term effects of plantar vibration on the balance impairment of a patient with stroke.

Case presentation: A 72-years-old man with right hemiplegia resulted from stroke was admitted for vibration therapy after not responding to standard rehabilitation interventions. He complained of balance problems despite walking independently. Main studied outcomes were timed up and go test and posturography. Foot sensation, ankle plantar flexor spasticity, and the passive range of ankle dorsiflexion were assessed, as well. Vibration with a frequency of 100 Hz was introduced to the sole of the affected foot for 5 minutes. After intervention, all tests were improved compared to the baselines.

Conclusion: This case showed that the vibration was effective for improving balance disorder after stroke.

---

Background and Aim: Diabetes mellitus is a progressive metabolic disease. Studies about the relationship between diabetes mellitus and auditory impairment have shown variable results in supporting the fact that diabetes may have a complex repercussion on the auditory pathways. We aimed to evaluate hearing in patients with type II diabetes mellitus with behavioral and electrophysiological auditory tests.

Methods: In a cross-sectional study, we assessed 30 patients with type II diabetes mellitus with the mean age of 43.7 (SD: 1.3) years, ranging 40-45 years, and 30 matched healthy subjects with the mean age of 41.5 (SD: 1.5) years. Subjects were evaluated using auditory brainstem response (ABR) and pure tone audiometry. The results were compared between two groups.

Results: Pure tone audiometry was normal. There was a significant increased latency for waves I, III, and V, and also, interpeak latencies of I-III, III-V, and I-V waves (p<0.05).

Conclusion: ABR latency prolongation indicates abnormal nerve conduction velocity in patients with type II diabetes mellitus. ABR can be an important clinical tool for evaluating diabetes influence on cochlear nerve conduction velocity before hearing loss occurs in these patients.

---

Background and Aim: Research indicates that impaired hearing is one of the most stressful disabilities. The parenting stress involved could lead to family malfunction and improper parenting. Therefore, this study aimed to evaluate the effects of positive parenting programs on the parenting stress of mothers with impaired hearing children.

Methods: The statistical population comprised mothers of all 7-12-year-old impaired hearing children in Tehran city. Thereafter, using the random sampling method, 24 individuals were shortlisted as research participants and were randomly assigned to two groups: control and experimental. The experimental group was trained with a positive parenting program based on the Sanders program (1993) over eight sessions. The measurement instrument was the Abidin parenting stress questionnaire.

Results: The mean score for grades in the experimental groups’ parent and child domains at the pre- and post-test stages had reduced more than that in the control group. In addition, the results of a multivariate covariance analysis indicated that positive parenting training was effective in the reduction of parenting stress scores, reinforcement, and child mood components in the child domain, and in the feelings of competence, relationships with the spouse, and role limitation components (p<0.05) in the parent domain.

Conclusion : Considering the benefits of training parents for the reduction of parenting stress of mothers with impaired hearing children, this method is recommended in all learning centers for the deaf.