Background and Aim: Recently, more attention was paid to the direct protective effect of aldosterone against hearing impairment in elderly patients. The aim of this study was determination of possible correlation between serum aldosterone level and hearing condition of elderly patients that referred to the Otolaryngology services of Hamadan in 2005-2006.

Methods: In this case control study 54 (27 males,27 females) persons above 60 years old were evaluated. They contained twenty eight cases with normal hearing and 26 cases with presbycusis. Persons with any abnormal biochemical finding or history of conditions that predispose them to the sensorineural hearing loss (SNHL) were excluded. In both groups serum level of sodium, potassium and aldosterone were measured and hearing condition evaluated by puretone, speech and immitance audiometry.

Results: Statistical relationship between serum aldostrone level and hearing condition, sex, configuration of audiogram and speech discrimination score (SDS) were not significant. In addition, no significant relationship between sodium and potassium levels with hearing condition was found (p>0.05). Conclusion: This study could not confirm protective effect of aldostrone against presbycusis. This discrepancy may originate from epidemiologic differences, laboratory errors or small sample size.

Background and Aim: Despite the abundance of literature about deaf children, few works specifically address the concept and practice of difficulties in parenting hearing-impaired children. The first interactions of the child are with his parents, and parents have the most important role in child improvements during early intervention programs. The main purpose of this paper was to investigate different aspects of parenting hearing-impaired children.   

Methods: In this article, we reviewed all aspects of parenting hearing-impaired children in papers from 1984-2009 in Medline, Scopus and Proquest and relative textbooks. The semi-professional role of parents of hearing-impaired children make them feel under excessive stress and this usually affects their other roles as fathers and mothers. Many factors including child age, type of hearing loss and parents' individual characteristics may influence the impact of child's hearing loss on parents.

Conclusion: Parenting a hearing-impaired child is both similar and different to parenting any other child. Where there are differences, there are usually challenges too. Taking support and advice from professionals and other parents are necessary and invaluable for parents of hearing-impaired children.

Background and Aim: Turner syndrome is the most common sex chromosome abnormality in females, affecting an estimated 3% of all conceiving females. Otologic disease is a common problem in Turner syndrome patients that is due to a combination of small dysfunction Eustachian tube, palatal dysfunction and cochlear malformation.
Methods: This study assessed the otologic and audiologic characteristics of a group of Turner syndrome patients. We studied 40 Turner patients aged 10 to 20 years (mean age: 15.84 years, SD=2.67). Pure tone audiometry was carried out for all of them.
Results: Forty percent of the patients reported a history of middle ear disease. Analysis of audiometric data in 40 patients tested reveals normal hearing in 47.5%, pure sensorineural hearing loss in 32.5%, pure conductive hearing loss in 17.5% and mixed hearing loss in 2.5% of patients.
Conclusion: Careful follow up during early childhood of children with Turner syndrome is necessary to detect middle ear disease and prevent the probable sequel. However, long term periodic follow up is mandatory even after resolution of middle ear disease to detect sensorineural hearing loss.

Background and Aim: Learning language is acquired in early childhood and gradually developed by new words and new structures. Hearing sense is the most important acquisition for learning this skill. Hearing disorders are barriers for natural language learning. The purpose of this study was to investigate the relationship between writing sentences and perception of written sentences in hearing-impaired and normal-hearing students.
Methods: A cross-sectional study was conducted among thirty hearing-impaired students with hearing loss of 70-90 dB and thirty normal hearing students. They were selected from 3^rd grade primary school students in Hamadan, a large city in Western Iran. The language skills and non language information was assessed by questionnaire, Action Picture Test, and Sentence Perception Test.
Results: Results showed that there was a significant relation between writing sentences and perception of written sentences in hearing impaired students (p<0.001), (r=0.8). This significant relation was seen in normal-hearing students as well (p<0.001), (r=0.7).
Conclusion: Disability of hearing-impaired students in verbal communication is not only related to articulation and voice disorders but also is related to their disability to explore and use of language rules. They suffer lack of perception of written sentences, and they are not skilled to convey their feelings and thoughts in order to presenting themselves by using language structures.

Background and Aim: listening, speaking, reading and writing are considered the lingual skills. These skills are in direct relation with each other. Listening is the first skill learnt by the individual through development. If damaged by hearing impairment, listening can cause serious defect to lingual skills. The goal of our research was to study the effect of hearing loss on reading literacy in hearing impairment students in comparison with normal hearing students.
Methods: Study was performed using the examination booklets of Progress in International Reading Literacy Study (PIRLS) 2001. 119 hearing impairment students of 4^th grade primary school, last year guidance school, and last year high school levels in schools providing exceptional student education were included. These individuals were compared to 46 normal hearing students of 4^th grade primary school of ordinary schools. Comparative statistical analysis was performed using t-test.
Results: Reading literacy and literal contents understanding was shown to have a significant difference between normal hearing and whole hearing impaired student (p<0.05), except the ones in high school level with moderate hearing loss. There was also seen a significant difference between normal hearing and hearing impairment students in understanding of information contents (p=0.03).
Conclusion: Hearing loss has a negative effect on reading literacy. Consequently, curriculum change and evolution of educational programs in exceptional centers is needed, in order to promote reading literacy and to enhance rest hearing

Background and Aim: Evaluation of hearing-impaired children&aposs auditory skills by a valid test is very important before starting auditory training. There are many different tests available for languages other than Persian, and some limited Persian tests for children above 5 year of age as well. Accordingly considering the importance of early intervention, we aimed to design a test for evaluating auditory skills of 3-4 year-old hearing-impaired Persian (Farsi) children, which is not available to date.
Methods: The study method was test (scale) construction. The test named Tavana includes four subtests: detection, discrimination, identification and sentence comprehension. For determining content validity of the test, the vocabulary of 3-4 year-old normal-hearing and hearing-impaired children and also the comments of seven specialists were applied. We classified 10,10,8 and 6 sub skills for 1^st to 4^th subtests, respectively.
Results: The content validity of Tavana test&aposs subskills were 100%, 83%, 96% and 95%, respectively (mean=94%). Mean time for test performance was 82 minutes.
Conclusion: Content validity of Tavana test was 94% which was statistically valid compared to Modarres test (97%) and Mazaheryazdi test (88%).

Background and Aim: Cued speech as a kind of communication method, is a system which utilizes several hand configurations and locations to supplement the normal visible manifestations of speech. This study was aimed to investigate the effects of Persian cued speech on the speech discrimination scores of hearing impaired children.
Methods: Sixteen 9-12 years old profoundly hearing impaired children were divided into two matched-groups of cases and controls. Cases were taught cued speech in a five-month period of 45-60 minutes daily therapy. Speech discrimination score test was tested pretest, post-test and three-week follow-up test in both groups. Mixed repeated measurement was used to analyze the repeated measures data.
Results: There was a significant difference between pretest (without cued speech) and the other two tests of post-test and follow-up (both with cued speech) in cases. The speech perception scores of the cases were almost completed (p=0.001) after cued speech practicing but no significant difference was seen in speech perception scores of control group.(p>0.05)
Conclusion: The results indicate that Persian cued speech is an efficient tool to increase speech discrimination scores of hearing impaired children.

Background and Aim: Reading skill is one of the most important necessities of students&apos learning in everyday life. This skill is referred to the ability of comprehension, comment and conclusion from texts and receiving the meaning of the massage which is composed. Educational development in any student has a direct relation with the ability of the comprehension. This study is designed to investigate the effects of hearing loss on reading comprehension in hearing-impaired students compared to normal-hearing ones.
Methods: Seventeen hearing-impaired students in 4^th year of primary exceptional schools in Karaj, Robatkarim and Shahriyar, Iran, were enrolled in this cross-sectional study. Seventeen normal-hearing students were randomly selected from ordinary schools next to exceptional ones as control group. They were compared for different levels of reading comprehension using the international standard booklet (PIRLS 2001).
Results: There was a significant difference in performance between hearing-impaired and normal- hearing students in different levels of reading comprehension (p<0.05).
Conclusion: Hearing loss has negative effects on different levels of reading comprehension, so in exceptional centers, reconsideration in educational planning in order to direct education from memorizing to comprehension and deeper layers of learning seems necessary.

Background and Aim: Hearing aid users complain about a phenomenon called "occlusion effect". The aim of this study was to compare the occlusion effect in normal hearing individuals and those with slight and mild sensory neural hearing loss via Real Ear Measurement.
Methods: Sixty volunteers (30 male, 30 female) aged 18-55 years were enrolled in this study. Subjects were instructed to vocalize /e/ and /i/ for 5 seconds. Sound pressure level was measured by a probe- microphone and recorded in the ear canal. Occlusion effect and the frequency in which maximum occlusion effect occurs were obtained for each individuals for further analysis.
Results: The peak of occlusion effect for /e/ was 10.25 dB and 9.77 dB respectively in 751.9 Hz and 542.98 Hz frequencies in female and male individuals. The maximum occlusion effect occurred with 19.03 dB and 19.10 dB for /i/ and in 518.88 Hz and 440.28 Hz in female and male individuals, in respect. In addition, no significant difference was seen among hearing levels and between genders.
Conclusion: The peak of occlusion effect varies significantly among hearing aid users so that the hearing aid must be tuned. Probe-microphone measures will assist in determination where frequency- specific adjustments are needed.

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: N-acetylcysteine, a glutathione precursor and reactive oxygen species scavenger, is reported to be effective in reducing noise-induced hearing loss. Many workers in industry are exposed simultaneously to noise and chemical pollutants such as carbon monoxide. We investigated effectiveness of N-acetylcysteine in protecting the cochlea from simultaneous noise and carbon monoxide damages.
Methods: Twelve rabbits were exposed simeltaneously to 100 dB sound pressure level of broad band noise and carbon monoxide 8 hours a day for 5 days. One hour before exposure, experimental group received 325 mg/kg of N-acetylcysteine while normal saline was administered for the control group. The protective effect of N-acetylcysteine was evaluated 3 weeks after exposure by histological assessment of the hair cells.
Results: Simultaneous exposure to noise and carbon monoxide resulted in a considerable damage to the outer hair cells however, the inner hair cells and the pillar cells remained intact. Use of N-acetylcysteine in the experimental group significantly reduced the extent of outer hair cell loss.
Conclusion: N-acetylcysteine attenuates simultaneous noise and carbon monoxide induced hair cell damage in rabbits.
Ke

Background and Aim: Hearing impairment is the most prevalent sensorineural defect in human. Epidemiological studies and the following preventive programs are the first steps to save many individuals from being handicapped and non-productive. Hereby, we aimed to study the prevalence of hearing impairment in Ardabil province and to assess the prevalent causes of hearing impairment in Ardabil.
Methods: In this study, 10718 cases were selected by random cluster sampling from rural and urban population in Ardabil province. Data was gathered using screening questionnaire, normal- and impaired-hearing individual questionnaire, and clinical audiometry. Statistical indices were calculated and data was analyzed using chi-square test.
Results: 7.1 per thousand individuals suffer hearing impairment and 4.3 per thousand are deaf. Hearing impairment was significantly more among villagers and aged individuals (p=0.46). However, there was no significant deference between two genders (p>0.05). Our results also showed significant deference in consanguineous marriage (p=0.031), accidents in pregnancy (p=0.007), older age of mother (p=0.007), parents hearing loss, severe illness during childhood (p=0.001), low family income (p=0.004), rural housing and educational level of parents (p=0.001) with hearing impairment.
Conclusion: Health status, economical, cultural and educational level of society are the most important factors associated with hearing impairment in Ardabil province. Consequently, extensive preventive programs are required to limit such factors.

Background and Aim: Hearing-impaired children make a lot of stress for the parents. Providing the parents of these children with suitable consultation and rehabilitation services results in increased satisfaction and reduced anxiety level. In this study we investigated the relationship between audiology service satisfaction and level of anxiety in parents of hearing-impaired children.
Methods: Seventy-five parents of hearing-impaired children, whose problem was diagnosed during the last year, participated in the study. The mothers were interviewed using satisfaction and anxiety questionnaires.
Results: There was no association between level of service satisfaction and parental state and trait anxiety level however, the group with a higher level of satisfaction (score 64-90) recorded a lower anxiety score (0-20). There was also a significant association between parental state and trait anxiety level (p<0.001). Considering the demographic data, only the living place (Tehran compared with other provinces) showed a significant association with satisfaction and anxiety levels people living in small provinces had a significantly less satisfaction level (p=0.002) and a more anxiety score (p=0.017).
Conclusion: Lack of durability of services was the concern of people living in small provinces which resulted in being more anxious and less satisfied.

Background and Aim: Hearing impairment through the primary episode of development has an undeniable effect on communicative language and cognitive ability of children. The purpose of this study was to compare primary verbal, nonverbal and mathematical concept formation, between children with and without hearing impairment.
Methods: In this study 88 children with normal and impaired hearing were compared in four-, five- and six-year old age groups. Normal children were selected randomly and the other group consisted of the available children with impaired hearing. To evaluate verbal, nonverbal and mathematic concepts, a test was designed and developed based on language and cognitive developmental scale in normal children.
Results: Significant difference was seen in the average scores in each concept class between normal and impaired hearing group in all age groups (p<0.05). There was no statistical significance between girls and boys. Hearing groups had statistical significant difference in each group of concepts (p<0.001). Age had statistical significance only in mathematics&apos concepts (p=0.001).
Conclusions: This study supports the necessity of assessing the understanding of verbal, nonverbal and mathematic concepts, as well as cognitive and verbal skills in children with hearing impairment, prior to any formal education program planning. The curriculum should be arranged according to these abilities and skills. Otherwise it would be hardly practical and functional for these children to go through the curriculum which is planned without any notion to their basic abilities.

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: Research conducted since the early 1900s has consistently identified differences between deaf and hearing children on performance of a wide variety of motor tasks, most notably balance. Our study was performed to test static and dynamic balance skills in congenital severe to profound hearing impaired children in comparison with normal age-matched children.
Methods: This cross-sectional study was conducted on 30 severe to profound hearing impaired and 40 normal children with age 6 to 10 years old. Bruininks-Oseretsky test of motor proficiency 2, balance subset with 9 parts was used for evaluation of balance skills.
Results: Hearing-impaired children showed 16.7 to 100% fail results in 7 parts of the balance subset. In normal children fail result was revealed just in 3 parts of the balance subset from 2.5 to 57.5%, and differences between two groups were significant (p<0.0001). There was a significant difference between two groups in two static balance skills of standing on one leg on a line and standing on one leg on a balance beam with eyes closed (p<0.0001).
Conclusion: It seems that development of static balance skills are longer than dynamic ones. Because severe to profound hearing-impaired children showed more weakness than normal children in both static and dynamic balance abilities, functional tests of balance proficiency can help to identify balance disorders in these children.

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: Hearing-impaired students have some delays in learning language skills such as reading because of hearing loss. To study the effect of promoting educational level on the development of reading comprehension, the students of the 4^th grade of elementary and last year guidance school were compared based on international test of reading literacy.
Methods: The project was cross-sectional and the tool used was the international standard booklet of PIRLS 2001. Thirty-six students selected with moderately severe and severe hearing loss from the 4^th grade of elementary and last year guidance school from Shahriar, Robatkarim, Karaj and Hashtgerd, Iran, exceptional schools. Comparative statistical analysis was performed using t-test.
Results: The first level (focus on and retrieve explicity information) showed a meaningful difference between the last year guidance school and the 4^th grade of elementary students (p<0.05), but there were no significant differences in other levels, make straightforward information-interpret and integrate ideas-examine and evaluate content, (p> 0.05).
Conclusion: Hearing-impaired students have difficulties in understanding in deep levels of reading despite promoting educational level. Thus, in making policies for special trainings, continuing the rehabilitation in guidance and high school levels to promote the complex levels of comprehension should be taken more into consideration.

Background and Aim: It is well established that adult sensory systems can reorganize following environmental changes hearing aid stimulates a deprived auditory system resulting in changes in received stimuli and may be capable of inducing changes within the auditory system abilities such as difference limen for intensity. Hearing aid fitting induces perceptual and physiological modifications. The present study was conducted to evaluate the effects of hearing aid use on the intensity discrimination performance.
Methods: The study group consisted of 30 monaural users of hearing aid with symmetrical moderate or moderately severe sensorineural hearing loss in both ears (15 males, 15 females), aged 45-65 years old with the mean of 57.73 and SD of 8.12 years. difference limen for intensity was measured at two frequencies, 500 Hz, 2000 Hz, and two intensity levels (10 dB SL, 40 dB SL). The results of fitted ears were compared with not-fitted ones.
Results: The results of the study showed better difference limen for intensity scores at high frequency and high intensity levels. A significant lower difference limen for intensity in fitted ears was observed compared with not-fitted ears (p<0.05), while there was no significant difference between the difference limen for intensity in the two groups at 500 Hz with 10 dB SL intensity (p=0.132).
Conclusion: Hearing aid use affects intensity discrimination performance. Besides, perceptual modification following use of hearing aid is confirmed by our study which suggests a possible functional plasticity due to hearing aid use. However, further

Background and Aim: Vestibular evoked myogenic potentials and acoustically evoked short latency negative response are two non-cochlear responses with probably saccular origin. The present study was conducted to determine the percentage of presence and the relation between these two responses in children with hearing loss.
Methods: Thirty children with profound congenital sensorineural hearing loss were studied.  Vestibular evoked myogenic potentials ellicitedby tone burst stimuli and acoustically evoked short latency negative response ellicited by click stimuli were recorded. Both responses were recorded at air conduction threshold level monaurally via an internal receiver.
Results: Vestibular evoked myogenic potentials in 53.3% of children and acoustically evoked short latency negative response in 40.0% of cases were recorded. There was a significant correlation between the percentage of recording these two responses (p=0.005). Gender and the stimulated ear had no effect on the results.
Conclusion: In almost half of these disabled children, both vestibular evoked myogenic potentials and acoustically evoked short latency negative response were recoreded. This finding may both indicate that hearing loss has no effect on the function of otolith organs in some children and vestibular deficits probably exist along with hearing impairment in others. This findng reiterates the importance of evaluation of vestibular system as part of standard auditory evaluations.