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Background and Aim: A common complaint of children with learning disability (LD) is difficulty in understanding speech in the presence of background noise. Evidence from animal and human studies has indicated that the medial olivocochlear bundle (MOCB) play a role in hearing in the presence of noise. The MOCB function can be evaluated by the suppression effect of the click evoked otoacoustic emission (CEOAEs) in response to contralateral white noise. The present study was conducted to compare the suppression effect of CEOAEs between LD and normal students.

Materials and Method: This research is an analytic-interventional study. The study group consisted of 20 learning disabled and 20 normal male students. The suppression effect of CEOAEs was evaluated by a comparison between CEOAEs levels in two conditions- with and without presentation of contralateral white noise.

Results: In the absence of noise there was no significant difference between CEOAEs amplitudes of two groups while there was significant difference between CEOAEs of two groups in the presence of noise. The suppression effect of CEOAEs in normal students had significant difference with LD students.

Conclusion: The reduced suppression effect in LD students indicates the reduced activity of the MOCB function and efferent pathway in LD students which affect their ability to hear in the presence of background noise. Consequently, the suppression effect of CEOAEs can be used in the test battery approach of LD children.

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Background and Aim: Physiologic measures of cochlear and auditory nerve function may be of assistance in distinguishing between hearing disorders due primarily to auditory nerve impairment from those due primarily to cochlear hair cells dysfunction. The goal of present study was to measure of cochlear responses (otoacoustic emissions and cochlear microphonics) and auditory brainstem response in some adults with auditory neuropathy/ dys-synchrony and subjects with normal hearing.
Materials and Methods: Patients were 16 adults (32 ears) in age range of 14-30 years with auditory neuropathy/ dys-synchrony and 16 individuals in age range of 16-30 years from both sexes. The results of transient otoacoustic emissions, cochlear microphonics and auditory brainstem response measures were compared in both groups and the effects of age, sex, ear and degree of hearing loss were studied.
Results: The pure-tone average was 48.1 dB HL in auditory neuropathy/dys-synchrony group and the frequency of low tone loss and flat audiograms were higher among other audiogram&aposs shapes. Transient otoacoustic emissions were shown in all auditory neuropathy/dys-synchrony people except two cases and its average was near in both studied groups. The latency and amplitude of the biggest reversed cochlear microphonics response were higher in auditory neuropathy/dys-synchrony patients than control people significantly. The correlation between cochlear microphonics amplitude and degree of hearing loss was not significant, and age had significant effect in some cochlear microphonics measures. Auditory brainstem response had no response in auditory neuropathy/dys-synchrony patients even with low stimuli rates.
Conclusion: In adults with speech understanding worsen than predicted from the degree of hearing loss that suspect to auditory neuropathy/ dys-synchrony, the frequency of low tone loss and flat audiograms are higher. Usually auditory brainstem response is absent in this patients and use of both otoacoustic emissions and cochlear microphonics responses to measure cochlear hair cells function are suggested in them.

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Background and Aim: Matching a mother wavelet to class of signals can be of interest in signal analysis and denoising based on wavelet multiresolution analysis and decomposition. As transient evoked otoacoustic emissions (TEOAES) are contaminated with noise, the aim of this work was to provide a quantitative approach to the problem of matching a mother wavelet to TEOAE signals by using tuning curves and to use it for analysis and denoising TEOAE signals. Approximated mother wavelet for TEOAE signals was calculated using an algorithm for designing wavelet to match a specified signal.
Materials and Methods: In this paper a tuning curve has used as a template for designing a mother wavelet that has maximum matching to the tuning curve. The mother wavelet matching was performed on tuning curves spectrum magnitude and phase independent of one another. The scaling function was calculated from the matched mother wavelet and by using these functions, lowpass and highpass filters were designed for a filter bank and otoacoustic emissions signal analysis and synthesis. After signal analyzing, denoising was performed by time windowing the signal time-frequency component.
Results: Aanalysis indicated more signal reconstruction improvement in comparison with coiflets mother wavelet and by using the purposed denoising algorithm it is possible to enhance signal to noise ratio up to dB.
Conclusion: The wavelet generated from this algorithm was remarkably similar to the biorthogonal wavelets. Therefore, by matching a biorthogonal wavelet to the tuning curve and using wavelet packet analysis, a high resolution time-frequency analysis for the otoacoustic emission signals is possible.

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Background and Aim: Objective measurement is general and acoustic measurements in particular have become a substantial aspect of stuttering assessment during the last few decades. Measurements do not replace the perceptual judgment, but they allow a more precise diagnosis, provide more evidence for therapeutic interventions, and are useful as feedback for patients in therapy. The purpose of this investigation was to compare some adult male stutterers&apos and nonstutterers&apos acoustic features.
Materials and Methods: Adult male stutterers and nonstutterers participated this case-control  study. Their fluent reading of 20 sentences in Farsi, prolongation of  vowels /a/ and /i/, and rhythmic counting from 1 to 20 were analyed with Dr. Speech software.
Results: There were no significant differences between two groups in fundamental frequency (f₀) and standard deviation of f₀ in three speech samples (vowels /a/ and /i/, reading 20 sentences, and rhythmic counting from 1 to 20). No significant difference were between two groups for jitter and shimmer.
Conclusion: Non significant differences between two groups are somewhat due to investigation of this parameters in fluent speech of stutterers  and nonstutterers.

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Background and Aim: Hyperbilirubinemia during the neonatal period is known to be an important risk factor for neonatal auditory impairment, and may reveal as a permanent brain damage, if no proper therapeutic intervention is considered. In the present study some electroacoustic and electrophysiologic tests were used to evaluate function of auditory system in a group of children with severe neonatal Jaundice.
Materials and Methods: Forty five children with mean age of 16.1 14.81 months and 17 mg/dl and higher bilirubin level were studied, and the transient evoked otoacoustic emission, acoustic reflex, auditory brainstem response and auditory steady-state response tests were performed for them.
Results: The mean score of bilirubin was 29.37± 8.95 mg/dl. It was lower than 20 mg/dl in 22.2%, between 20-30 mg/dl in 24.4% and more than 30 mg/dl in 48.0% of children. No therapeutic intervention in 26.7%, phototherapy in 44.4%, and blood exchange in 28.9% of children were reported. 48.9% hypoxia and 26.6% preterm birth history was shown too. TEOAEs was recordable in 71.1% of cases. The normal result in acoustic reflex, ABR and ASSR tests was shown just in 11.1% of cases. The clinical symptoms of auditory neuropathy were revealed in 57.7% of children.
Conclusion: Conducting auditory tests sensitive to hyperbilirubinemia place of injury is necessary to inform from functional effect and severity of disorder. Because the auditory neuropathy/ dys-synchrony is common in neonates with hyperbilirubinemic, the OAEs and ABR are the minimum essential tests to identify this disorder.

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Background and Aim: Tinnitus is the consciousness of sound that arises in the ear or head without any external sound origin. The efficacies of transmeatal low-level laser irradiation for tinnitus treatment were reported before. The aim of this study was to evaluate the effectiveness of low level laser therapy on tinnitus and ECochG and DPOAEs parameters.
Materials and Methods: The study design was prospective, quasi experimental. This investigation conducted on 16 ears (10 patients) with disabling tinnitus. All patients underwent ENT examination, complete audiological evaluation, tinnitus study, ECochG and DPOAEs, and finally completing tinnitus data sheet. The results were compared before and after irradiation.
Results: Means of tinnitus loudness (LMT) and CAP amplitudes were significant different before and after irradiation (p<0.005). There was no any other significant difference before and after low level laser irradiation in subjective loudness, pitch matching annoyance grade of tinnitus and DPOAEs and other ECochG parameters.
Conclusion: Transmeatal low-power laser irradiation with 200 mW seems not to be effective for treatment of tinnitus. This paper is the research brief report. In clinical point of view, this study should be repeated with a greater sample size although our results were statistically important.

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Background and Aim: Hearing has an important role in speech production and making phonological distinction, especially voicing distinction. Voice onset time (VOT) has been a reliable acoustic cue of voicing differences in plosive consonants. The purpose of this study was to measure VOT in initial Persian (Farsi) oral plosives produced by cochlear implanted children, comparing to normal hearing children.
Methods: In this cross-sectional study, 20 cases and 20 controls were assessed. Cases were prelingually deaf children who were cochlear implanted 4.5 years prior to test. Controls were normal hearing children at 4.5 years of age. VOT were measured while children uttered oral plosives. The effect of hearing status, voicing, and gender on VOT were assessed.
Results: The amount of VOT of plosives produced by girls was higher than boys, in both groups. This difference was significantly higher in voiceless plosives than in voiced ones. In both groups, voiceless plosives had long-positive VOT value while the amount of VOT was short-positive regarding voiced plosives.
Conclusion: It was demonstrated that VOT is significantly correlated with voicing. In voiceless plosives, VOT could not be considered as a phonetic correlate of hearing status whereas it made significant differences between cochlear implanted children and hearing controls. Furthermore, it was confirmed that concerning voiceless plosives, the amount of VOT of girls was significantly higher than boys. On the contrary, in voiced plosives, gender had no significant effect on the amount of VOT.

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Background and Aim: Reflux laryngitis is extremely common among patients with voice disorder. Medical therapy approaches are not efficient enough. The main goal of this study is to assess the acoustic and laryngeal characteristics of patients with dysphonia before and after medical or voice therapy, and to evaluate the effectiveness of each.
Methods: In this retrospective study, 16 reflux laryngitis patients were assessed. Five received complete voice therapy, tow ceased voice therapy and nine received medication. Perceptual voice evaluation was performed by a speech-language pathologist, the severity of voice problem was calculated, based on the affected acoustic and laryngeal characteristics pre- and post-treatment.
Results: Post-treatment evaluation in patients who received complete voice therapy indicates 80 percent improvement in the severity of disorder and 100 percent improvement in the perceptual voice evaluation. After medical therapy, we observed that voice disorder and perceptual voice evaluation are improved 44 and 66 percent respectively. The improvement was statistically significant in both treatment approaches: complete voice therapy (P=0.039) and medical therapy (p=0.017).
Conclusion: In patients with reflux laryngitis, most acoustic and laryngeal characteristics were normal and satisfying after the treatment. It can be concluded that the proficiency of voice therapy in improving the acoustic and laryngeal characteristics is comparable to medical therapy.

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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.

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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.

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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: 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.

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Background and Aim: Contralateral suppression of transient evoked otoacoustic emissions (TEOAEs) test evaluates the efferent auditory system. In this test, acoustic reflex is an important confounding variable. In recent years, application of this test is growing especially in children suspect to central auditory processing disorder. Therefore, the magnitude of influence of this confounding variable on the suppression of TEOAEs should be made clear. The aim of this study was to investigate the impact of acoustic reflex on contralateral suppression of TEOAEs.
Methods: This research was performed on 39 normal-hearing adults of both sexes and of 18-26 years of age. Tests were used for the determination of interaural attenuation (IA), acoustic reflex, TEOAEs and contralateral suppression of TEOAEs.
Results: TEOAEs amplitudes and their contralateral suppression were significantly higher in females and males respectively (p=0.01). The amount of TEOAEs suppression before reflex activity ranged between 2000 to 3000 Hz. Activation of acoustic reflex significantly increased the magnitude of suppression in all frequency bands (p≤0.01) and maximum suppression occurred in 500 to 1000 Hz.
Conclusion: For achieving accuracy of clinical findings, clinicians should always use suppressant levels lower than the acoustic reflex threshold. It is recommended that different norms for males and females be used in contralateral suppression of TEOAEs.

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Background and Aim: An imbalance between phonatory subsystems may lead to disturbing phonatory muscular balance and consequently voice disorders. Based on theoretical issues, criterion-based laryngeal manual therapy, as a novel treatment method which is supported by classical laryngeal manual therapy, can improve voice quality using manual maneuvers combined with phonatory tasks. The present study aimed to report the treating effects of this method on hyperfunctional voice disorders.

Methods: Twenty adult participants with hyperfunctional voice disorders by the least three months history of voice disorder were selected. The participant’s voices were assessed multidimensionally using acoustic, audio-pecreptual and stroboscopic assessments before and after treatment.

Results: There were a decrease in jitter (p=0.003) and shimmer (p<0.001) and also, increase in harmonic-to-noise ratio (HNR) (p<0.001) of vowel /a/ after treatment. Besides, there was an increase in harmony to noise ratio (p=0.009) and decrease in jitter (p=0.020) of vowel /i/, too. There were not significant changes in shimmer amount of vowel /i/ (p=0.170) after treatment. There were highly significant changes in all aspects of audio-perceptual (p<0.001) and videostroboscopic (p<0.001) parameters.

Conclusion: Using voice-based laryngeal manual therapy can be a treatment method in handling hyperfunctional voice disorders.

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Background and Aim: Parkinson’s disease (PD) is a progressive neurological disorder resulting from significant decrease of dopamine in the brain. The main and most common symptom of speech disorder associated with Parkinson’s disease, which is kind of dysarthria, is reduction in speech intelligibility. Since this disorder represents damages to acoustic aspects, researchers are attracted to study the relationship between these two disorders. In this study, we assessed the comparison of speech vowels between normal people and patients with Parkinson’s disease.

Methods: In this cross-sectional study, 18 voice samples of patients with Parkinson’s disease and the same number of samples from normal people in a voiceless environment were recorded and analyzed by Praat software. Data analysis was performed by independent samples and Mann-Whitney tests.

Results: All variables investigated in two groups showed significant differences. In adults with Parkinson’s disease , F1-F0 in low vowels showed a considerable reduction in respect to normal people (p <0.001). In addition, F2-F1 in high vowels represented a significant decrease in these patients (p<0.05).

Conclusion: The results indicate that Parkinson’s disease affects formant frequency in patients compared with normal people. Reduction in speech intelligibility can be accurately measured using acoustic procedure.

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Background and Aim : Nasalization of a vowel refers to the addition of nasal resonance to the vocal tract transfer function. Also, vowel nasalization occurs because of coarticulation. Coupling of the nasal resonating space to the oropharyngeal cavity alters the vocal tract formants in complex ways. The purpose of this study was to investigate the effect of nasalization on /a/ vowel formants in before and after nasal consonant.

Methods: In current cross-sectional study, voice samples of 60 normal children ranging the age of four-nine years were investigated. Participants were asked to repeat / ʔ ama/ three times and vowel /a/ after presentation of an auditory model. Then, obtained samples were analyzed using Praat 5.3.13 . Average of F₀, F₁, F₂ and F₃ were calculated for /a/ comes before and after /m/ in production of / ʔ ama/ over three trials.

Results: There were statistically significant differences of F₁, F₂ and F₃ between / a/ which proceeds nasal consonant and /a/ follows nasal consonant , the before nasal consonant /a/ versus single /a/ and the after nasal consonant /a/ versus single /a/ (p=0.001 for all).

Conclusion : F₁, F₂ and F₃ in /a/ before nasal consonant affected by anticipatory nasal coarticulation and in /a/ after nasal consonant affected by carry-over nasal coarticulation . This study showed nasal coarticulation and nasalization result in decreasing F₁, F₂ and F₃ in /a/ vowel.

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Background and Aim: Subjective tinnitus etiology has not been fully understood. Recently, in normal hearing subject one of the tinnitus theories, more specifically the medial olivocochlear tract, is related to the dysfunction of the efferent auditory system. The aim of this study was to determine the potential contribution of a defective cochlear efferent innervations to the chronic tinnitus in patients with normal hearing and determine the relation between tinnitus loudness and the amount of suppression of the transient evoked otoacoustic emission. Methods: This study was conducted on 20 tinnitus patients aged between 20-45 years and 20 controls matched for age and gender in School of Rehabilitation, Tehran University of Medical Sciences. Transient otoacoustic emission testing without and with contralateral white noise at 55 and 65 dB was performed on each subject. Results: The amplitudes of the emissions in the two groups was significantly different (p=0.001), but no correlation between tinnitus loudness and the amplitudes of the emissions in the presence (p=0.3) and absence (p=0.06) of contralateral noise. Conclusion: The suppression of the transient evoked otoacoustic emission by contralateral white noise did not reach statistically significant levels in tinnitus patients while the amplitude in control group reduced significantly.

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Background and Aim: One of the non-pathological factors affect otoacoustic emissions is body position. In the present study, the effect of side-lying position on evoked otoacoustic emission properties and related existing assumptions were investigated.

Methods: The cross-sectional study was performed on 42 adults aged 18-25 years. The results of Transient-evoked otoacoustic emissions (TEOAEs) test were recorded and analyzed in sitting, supine, and side-lying (Ipsi and Contra) positions to compare the total response level, whole wave reproducibility, signal to noise ratio in frequencies of 1 to 5 KHz, and the lasting time of the test.

Results: Changing of the body position had a significant effect on total response level, whole wave reproducibility, and lasting time of the test (p<0.010) while this effect on signal to noise ratio was just found at 1 KHz (p<0.001). The highest total response level and lowest lasting time of the test values were observed in side-lying (contra) position (p<0.050).

Conclusion: Side-lying position (contra) is the best position for the TEOAEs test. The results of this study partly confirm intracranial pressure change hypothesis that intracochlear fluid pressure increase in the auditory system although there are contradictions in this field.

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Background and Aim: Teachers are a large group of professional voice users that several risk factors and voice demands causes various voice complaints among them. As the voice is multidimensional, the aim of this study was acoustic and perceptual measurement of teachers’ voice and comparing the findings between two groups with many and few voice complaints.

Methods: Sixty female teachers of high school in Sari, north of Iran, were chosen by available sampling to participate in this cross-sectional study. According to a voice complaints questionnaire, 21 subjects located in few voice complaints and 31 in many voice complaints group. After a working day, subjects completed a voice self-assessment questionnaire. Also, teachers’voice were recorded during three tasks including sustained vowels /a/ and /i/, text reading and conversational speech. Acoustic parameters were analyzed by Praat software and 2 speech-language pathalogists performed auditory-perceptual assessment by GRBAS ( Grade, Roughness, Breathiness, Asthenia, Strain ) scale.

Results: Comparing of the voice self-assessment between the two groups demonstrated statistically significant difference (p<0.05) however results of the acoustic and auditory-perceptual measurement did not show significant diffrence.

Conclusion: Despite prevalent voice problems in teachers, there are various conditions in terms of complaints and assessments methods. In this study, only a remarkable deviation documented in the client-based assessments in many voice compliants group in comparison with few voice compliants, which would be probably related to different individual’s perception of voice problem between two groups. These results support paying attention to self-assessments in clinical process of voice problems.

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Background and Aim: Universal newborn hearing screening program (UNHS) using otoacoustic emission (OAE) has been expanded dramatically. The aim of this study was to compare the characteristics of OAE in different time periods.

Methods: In this cohort study, 54 well babies were tested using screening transient-evoked otoacoustic emission in 12, 24, 36, 48 hours and 1 week of their age in Tamin Ejtemaii hospital of Zahedan, Iran. Parameters of "pass" and "fail" level, duration of the test, repetition rate for getting definite result and cooperation level of the parents were analyzed.

Results: The failing rate decreased markedly with age. The major part of this decrement concerned to the age of 12 to 24 hours (left ear: p=0.012 and right ear: p=0.057). Only for the age of 12 hours, the test repetition reduced the failing rate significantly (left ear: p=0.001 and right ear: p<0.001). The test duration reduced significantly with age increment and decreased from the 75 second in age 12 hours to 21 second in age of 24 hours. The test time median for 36, 48 hours and one week of age was 13, 8.4 and 14.3 second, respectively. Among the 54 parents requested to come back for retest one week later, 5 (9.3%) cooperated.

Conclusion: Age effect on referral rate were confirmed in this study high referral rate and poor parent cooperation were the main problems in universal newborn hearing screening program in Zahedan city.