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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.

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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.

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Background and Aim: To date, the function of auditory efferent system remains unclear. There is evidence that medial olivocochlear bundle receives descending input from the cortex. In this study, the effect of auditory selective attention on stimulus-frequency otoacoustic emissions (SFOAE) was analyzed to investigate the modification of peripheral auditory system by auditory cortex activity in frequency specific mode.
Methods: Thirty-six normal hearing adult subjects with their age ranging from 18 to 30 years (mean age: 21.9 years) participated in this cross-sectional study. Contralateral suppression of stimulus-frequency otoacoustic emissions was recorded in the right ear at 2 KHz. In order to eliminate the auditory attention, subjects were instructed to read a text. Besides, in order to evaluate the effect of auditory attention on contralateral suppression, subjects were instructed to detect target tones in background noise at 1000, 2000, and 4000 KHz.
Results: A significant increase at contralateral suppression of stimulus-frequency otoacoustic emissions was observed in auditory selective attention conditions (p≤0.001). The largest magnitude of stimulus-frequency otoacoustic emissions suppression was seen at 2 KHz.
Conclusion: The results of this study indicated that the activities of medial olivocochlear bundle enhanced by contralateral auditory selective attention increase the magnitude of stimulus-frequency otoacoustic emissions suppression. In fact, these results provided evidence for influence of auditory cortex on the peripheral auditory system via corticofugal pathways in a frequency specific way.

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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

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Background and Aim: The communication process includes both verbal and nonverbal elements. Nonverbal behavior or body language includes facial expression, eye contact, posture and prosody. Prosody conveys semantic or affective information to a listener. Nonetheless, so far in Iran no report on assessment of speech prosody comprehension in patients has ever been published. The aim of this study was to measure the validity and reliability of the prosody comprehension test specifically designed for the Persian language and culture.
Methods: This study is a type of test development. 73 sentences were orated by 22 professional vocalists in eight different prosodies. A total of 6582 voices were prepared which were listened by 200, 18-30 year-old students and a voice specialist. Having the content validity calculated for all voices, 1473 voices were found to be unanimously agreed upon by all participants in terms of emotional status which were analyzed by a voice specialist. Eventually, 169 voices were selected for developing the prosody comprehension test including the following four subtests: none motional prosody discrimination, emotional discrimination, naming of prosody and naming conflicts. Reliability of the test was determined by performing the test on 32, 18-60 year-old normal people.
Results: The designed test of comprehension prosody had 100% content validity ratio and 94% reliability and the correlation of test of prosody was 89% (p=0.001).
Conclusion: This test in Persian language has appropriate validity and reliability and is appropriate for assessment of prosody comprehension.

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Background and Aim: In view of improvement in therapeutic outcome of cancer treatment in children resulting in increased survival rates and the importance of hearing in speech and language development, this research project was intended to assess the effects of cisplatin group on hearing ability in children aged 6 months to 12 years.
Methods: In this cross-sectional study, hearing of 10 children on cisplatin group medication for cancer who met the inclusion criteria was examined by recording auditory brainstem responses (ABR) using the three stimulants of click and 4 and 8 kHz tone bursts. All children were examined twice: before drug administration and within 72 hours after receiving the last dose. Then the results were compared with each other.
Results: There was a significant difference between hearing thresholds before and after drug administration (p<0.05). Right and left ear threshold comparison revealed no significant difference.
Conclusion: Ototoxic effects of cisplatin group were confirmed in this study. Insignificant difference observed in comparing right and left ear hearing thresholds could be due to small sample size. auditory brainstem responses test especially with frequency specificity proved to be a useful method in assessing cisplatin ototoxicity.

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Background and Aim: A negative deflection with a 3-4 ms latency period has been reported to exist within the auditory brainstem response of some patients with profound hearing loss following a strong acoustic stimulus. This deflection, namingly the n3 or the acoustically evoked short latency negative response is assumed to be a vestibular-evoked potential, especially of saccular origin. Since the myogenic potential is also saccular in origin, the purpose of the present study was to investigate the relationship between these two tests in adults with profound hearing loss.
Methods: The present cross sectional study was performed on 20 profoundly deaf volunteers(39 ears) who aged between 18-40 years old, randomly selected from available deaf adults in Tehran. The auditory brainstem response of all subjects was recorded following a 1000 Hz tone burst in 70-100dB nHL. Subjects were also tested for vestibular evoked myogenic potential.
Results: Only 34 of 39 ears recorded myogenic potential that negative response was recorded in 27 of 34 ears with normal p13 and n23. In seven ears with normal p13 and n23, the negative response was absent. In 3 ears with no p13 and n23, the negative response was observed, and two none.
Conclusion: In view of the high prevalance of the negative response in profoundly deaf ears with normal p13 and n23, it could be concluded that the negative response can be used when for any reason, it is not possible to record myogenic potential and be considered as a new test in vestibular test battery.

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Background and Aim: Ocular vestibular-evoked myogenic potential (oVEMP) is a novel vestibular function test. This short-latency response can be recorded through contracting extraocular muscles by high-intensity acoustic stimulation and can be used to evaluate contralateral ocular-vestibular reflex. The aim of this study was to record and compare the amplitude, latency, asymmetry ratio and occurrence percentage of oVEMP (n10) and cervical VEMP (p13) responses in a group of normal adult subjects.
Methods: We carried out a cross-sectional study on 20 adult subjects&apos mean age 22.18 years, SD=2.19 with normal hearing sensitivity and no history of vestibular diseases. oVEMP and cVEMP responses in both ears were recorded using air conducted stimuli 500 Hz short tone burst, 95 dB nHL via insert earphone and compared.
Results: cVEMP was recorded in all subjects but oVEMP was absent in two subjects. Mean amplitude and latency were 140.77 μv and 15.56 ms in p13 and 3.18 μv and 9.32 ms in n10. There were statistically significant differences between p13 and n10 amplitudes (p<0.001).
Conclusion: This study showed that occurrence percentage and amplitude of oVEMP were less than those of cVEMP. Since these two tests originate from different sections of vestibular nerve, we can consider them as parallel vestibular function tests and utilize them for evaluation of vestibular disorders.

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Background and Aim: Valid identification, prevention, and treatment of language disorders have a high priority for the clinicians. Story retelling is a method for studying language development which is faster than other procedures in implementing and analyzing, and has a reliable scoring system. The aim of this project is to construct story retelling test for assessing language structure in 6-7 year old, Persian children.
Methods: An appropriate story for 6-7 year old children was written by the help of a speech pathologist, a linguist, and a novelist. The validity of the constructed story was checked by 14 experts. Then related pictures were design and their validity was examined. The test was conducted on 72 children (36 girls, 36 boys) of 6-7 years. The reliability was administered with a test-retest design with a two week interval. The reliability of the scoring system was evaluated with inter-rater method.
Results: Content validity index for this test was 89%, interclass correlation was 83%, and standard error of measurement was 2.76. The interclass correlation for scoring system was 93% and Pearson&aposs correlation was 90%. Correlation of the test-retest scores was statistically significant (p<0.01).
Conclusion: This story retelling test has appropriate validity and reliability. It is suitable for quick assessment of language structure in 6-7 year old, Persian children.

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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.

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Background and Aim: Bilingualism, as one of the discussing issues of psychology and linguistics, can influence the speech processing. Of several tests for assessing auditory processing, dichotic digit test has been designed to study divided auditory attention. Our study was performed to compare the auditory attention between Iranian bilingual and monolingual young adults.

Methods: This cross-sectional study was conducted on 60 students including 30 Turkish-Persian bilinguals and 30 Persian monolinguals aged between 18 to 30 years in both genders. Dichotic digit test was performed on young individuals with normal peripheral hearing and right hand preference.

Results: No significant correlation was found between the results of dichotic digit test of monolinguals and bilinguals (p=0.195), and also between the results of right and left ears in monolingual (p=0.460) and bilingual (p=0.054) groups. The mean score of women was significantly more than men (p=0.031).

Conclusion: There was no significant difference between bilinguals and monolinguals in divided auditory attention and it seems that acquisition of second language in lower ages has no noticeable effect on this type of auditory attention.

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Background and Aim: Time compressed speech test is one of the most common types of monaural central auditory processing tests assesses the temporal resolution. The aim of the present study was to evaluate the impact of compression rate and sex on results of this test among the young individuals with normal hearing.

Methods: The Persian version of time compressed speech test with six lists of 25 monosyllabic words was prepared in three compression rates of 0, 40 and 60 percent. 36 young people with normal hearing and age range of 18 to 30 years were assessed with time compressed speech test in the most comfortable level in each ear separately. Then scores were compared between two ears, genders and three compression rates.

Results: There was a significant difference between word recognition scores of three compression rates (p<0.0001). Significant difference was revealed between word recognition scores of both ears, just in the 60% compression rates. No significant difference was found between the word recognition scores of the two genders.

Conclusion: Word recognition scores decreases with increase of the presentation rate of speech stimuli. Time compressed speech test accompany with other audiologic tests can be used to examin the auditory temporal processing and speed of speech processing as a test battery.

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Background and Aim: Patients with type I diabetes mellitus commonly complain about dizziness, floating sensation, tinnitus, weakness, and sweating. The aim of this study was comparing vestibular evoked myogenic potentials (VEMPs) between these patients and normal people.

Methods: Twenty-four patients with type I diabetes mellitus and twenty-four healthy volunteers with the age range of 15-40 years were enrolled in this study. A tone burst of 500 Hz, with the intensity of 95 dB nHL, was delivered through a insert earphone and vestibular evoked myogenic potential was recorded. The t-test was used to compare the results between the two groups. To investigate the effect of glycated hemoglobin (HbA1c) on VEMP responses (latency, absolute and relative amplitude), the regression analysis was used.

Results: The mean p13 and n23 latency were significantly more in patients with type Ι diabetes mellitus (for P13 latency, p=0.013 in right and p=0.010 in left ear, and for n23 latency, p<0.001 in right and p=0.005 in left ear). There was no significant difference between two groups in absolute and relative amplitude and prevalence of the VEMP (p>0.050). There was no correlation between VEMPs and HbA1c in patients with type 1 diabetes mellitus (p>0.05).

Conclusion: Prolonged latencies of the VEMP in patients with type 1 diabetes mellitus suggest lesions in the retrolabyrinthine, especially in the vestibulospinal tract. Nevertheless, due to the limited number of examined samples, further investigation with more patients should be performed.

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Background and Aim: As word recognition score test is one of the most important tests in audiologic test battery and there is no study on reliability and validity of existing monosyllabic word lists, we decided to investigate this in people with noise induced hearing loss.

Methods: In this non-randomized descriptive-analytic study, 30 adults with noise induced high frequency hearing loss with the age of 18 to 46 years were evaluated. Construct validity was evaluated by comparing Mosleh lists with list NU-6 and reliability was achieved by test-retest (-two-week interval).

Results: The mean (SD) score of word recognition was 94.01 (3.95) percent for list 2, 90.40 (4.90) percent for list 4, 89.08 (4.43) percent for list 5, and 94.10 (4.11) percent for list 9. A reliability of 94% was achieved in all four lists . Regression analysis revealed that word recognition score (WRS) had decreased in proportion to pure tone average.

Conclusion: Four lists have good construct validity. All word lists are phonetically reliable too.

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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.

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Background and Aim: Concerning the important role of parents of hearing-impaired children in auditory-verbal therapy, this study mainly focused on preparing a Persian version of the “Parental needs questionnaire” and analyzing its validity and reliability.

Methods: First, the original English version of the questionnaire “the needs of hearing-impaired Children’s Parents in Auditory-Verbal Therapy” translated to Persian, based on the approved translation protocol of International Quality of Life Assessment by world health organization. Then, the Persian version presented to seven experts for validating the content and their feedbacks were applied into the questionnaire. Finally, the questionnaire presented to parents of 51 hearing-impaired children who attend in auditory-verbal therapy, and the collected results were analyzed statistically.

Results: The overall mean of content validity index in 32 items of the questionnaire was 0.87. The overall Cronbach’s alpha of this questionnaire was 0.86 in the test and 0.99 in the re-test phases.

Conclusion: Based on the obtained results, the Persian version of the questionnaire has a satisfactory content validity and reliability and could be used in clinics and medical centers for analysis of parental needs.

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Background and Aim: In the process of assessing the nasalance scores in patient’s speech, it is vital to know about normative data in the speech of normal subjects. The main objective in this study was to obtain normative data on nasalance scores in normal Persian-speaking children aged 3.5 to 6.5 years.

Methods: In this cross-sectional and comparative study, nasalance was measured in the speech of 112 children (55 boys and 57 girls) in Tehran, Iran. After auditory screening and speech assessments, the subjects who get the sufficient criterions entered the study. Speech sample was obtained by imitation and repeating sentences (14 oral and 3 nasal sentences) and mean nasalance score was measured by Nasal view software.

Results: A mean nasalance score of 46.25% was obtained for nasal sentences and a mean score of 43.67% for fricative sentences, 43.41% for affricative sentences and 42.21% for stop sentences. There was higher nasalance scores in girls but the difference was not significant (p=0.201) there was a significant difference in nasalance scores between different age groups in stop (p=0.037), fricative (p=0.036) and nasal sentences (p=0.032).

Conclusion: Findings of this study prepared good statistical data about nasalance scores in normal Persian-speaking children aged 3.5-6.5 years. The study also revealed that nasalance scores can be different in sentences with same manner of articulation and can be affected by presence or absence of nasal consonants and even age.

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Background and Aim: Auditory-perceptual assessment of voice a main approach in the diagnosis and therapy improvement of voice disorders. Despite, there are few Iranian studies about auditory-perceptual assessment of voice. The aim of present study was development and determination of validity and rater reliability of Persian version of the Consensus Auditory Perceptual Evaluation of Voice (CAPE -V).

Methods: The qualitative content validity was detected by collecting 10 questionnaires from 9 experienced speech and language pathologists and a linguist. For reliability purposes, the voice samples of 40 dysphonic (neurogenic, functional with and without laryngeal lesions) adults (20-45 years of age) and 10 normal healthy speakers were recorded. The samples included sustain of vowels and reading the 6 sentences of Persian version of the consensus auditory perceptual evaluation of voice called the ATSHA.

Results: The qualitative content validity was proved for developed Persian version of the consensus auditory perceptual evaluation of voice. Cronbach’s alpha was high (0.95). Intra-rater reliability coefficients ranged from 0.86 for overall severity to 0.42 for pitch inter-rater reliability ranged from 0.85 for overall severity to 0.32 for pitch (p<0.05).

Conclusion: The ATSHA can be used as a valid and reliable Persian scale for auditory perceptual assessment of voice in adults.

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Background and Aim: During speech development in normal children, cluster reduction is one of the natural phonological processes. Children begin to produce some consonant clusters from the age of 2 years but ability to produce all consonant clusters continues up to 9. The main objective of this investigation was assessing the ability of Persian-speaking children in production of consonant clusters in mono-syllable CVCC words.

Methods: In this cross-sectional and comparative study, production of 19 clusters with stop, fricative, affricate, nasal, and glide consonants in 38 words were tested in 200 Persian-speaking children at the age of 3 to 6 years in kindergartens of Tehran, Iran. Content validity indexes of 38 words were above 0.80 and Cronbach’s alpha of split half was 0.91.

Results: More than 75% of 3-years-old children were able to produce /xl/, /bz/, /rs/, and /xm/ clusters. Age was positively correlated with correct production scores of words (p=0.001) and was negatively correlated with cluster reduction scores (p=0.001).

Conclusion: Three-years-old normal Persian-speaking children may use cluster reduction in words with consonant clusters but this phonological process decreased by increasing of age so, most of the 6-years-old children could produce consonant clusters correctly. Place of articulation more than manner of articulation affect on correct production of consonant clusters.

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Background and Aim: Some children with speech sound disorder (SSD) have difficulty with phonological awareness skills therefore, the purpose of this study was to survey the correlation between phonological processes and phonological awareness.

Methods: Twenty-one children with speech sound disorder, aged between 5 and 6, participated in this cross-sectional study. They were recruited from speech therapy clinics at the Tehran University of Medical Sciences. They were selected using the convenience sampling method . Language, speech sound, and phonological awareness skills were investigated by the test of language development-third edition (TOLD-3), the Persian diagnostic evaluation articulation and phonology test, and the phonological awareness test. Both Pearson’s and Spearman’s correlations were used to analyze the data.

Results: There was a significant correlation between the atypical phonological processes and alliteration awareness (p=0.005), rhyme awareness (p=0.009), blending phonemes (p=0.006), identification of words with the same initial phoneme (p=0.007), and identification of words with the same final phoneme (p=0.007). Analyzing the correlation on the basis of the phoneme and syllable structure separately showed there was a significant correlation between the atypical phoneme structure and alliteration awareness (p=0.001), rhyme awareness (p=0.008), blending phonemes (p=0.029), identification of words with the same initial phoneme (p=0.007), and identification of words with the same final phoneme (p=0.003).

Conclusion: Results revealed a relationship between phonological processes and phonological awareness in children with speech sound disorder. Poor phonological awareness was associated with atypical phonological processes especially at the phoneme level.