Hearing loss, even when limited to 1 ear, has been indicated as a handicap to communication and learning. Although this does not seem true based on my clinical impressions, there are no objective data available to evaluate, or even infer, what type of hearing loss can become a true handicap to overall academic achievement. Presented herein are findings that imply, although do not prove, the potential academic handicap of unilateral hearing loss. This study prospectively analyzed the audiologic and otologic screening tests in a university over a 9-year period. The University of Tokyo is one of the leading universities in Japan the students examined undoubtedly had academic ability well above average, for the entrance examination is one of the most difficult to pass in Japan. The potential handicap to academic achievement caused by hearing impairment was evaluated by comparing the prevalence of hearing impairment among the study population

Method and Materials :this cross sectional descriptive and analytic survey was done at Golestan navy hospital in Tehran, between June 1998 and March 1999 on total of 69 male subject (104 ears, ) 50 acoustic trauma & 54 noise induced H.L) between 20 to 40 ears old.
Results:1- The mean acoustic reflex threshold at 1 kHz showed there is no significant difference between two groups.
2- The intensity elicited maximum reflex amplitude at 1 kHz didn&apost produce at a significant linear correlation with subject&aposs age and ear canal volume in both groups.
3- The intensity elicited maximum reflex amplitude in NIHL group wasn&apost shown a significant correlation with ear compliance and gradient.
4- The mean Intensity (SPL) elicited maximum reflex amplitude in NIHL group was more than mean intensity (SPL) in acoustic trauma group.
5- The mean intensity (SL) elicited maximum reflex amplitude in NIHL group was More than mean intensity (SL) in acoustic trauma group.
Conclusion: Acoustic reflex amplitude is reduced for subjects with NIHL compared with acoustic trauma subjects.

We expect some people benefit more from their hearing aids, but after a while they complain of inappropriate loudness growth.  Currently fitting hearing aids based on their loudness growth curves one of the best and most acceptable ways of fitting hearing aids we should study this curve based on the disturbed function of inner and outer hair cells. We should also know that based on which curves can make the growth curve of the damaged cells to normal ones.

Objective: The purpose of study was identify hearing loss in thalassemic patients with history of Desferrioxamine (DFO) therapy. This study was carried out in a cross-sectional descriptive survey on 195 thalassemic patients (3-30 years old) in Gazvin Thalassemia center and Tehran pediatrics&apos medical center.
Methods: The patients underwent routine otolaryngologic history and physical examination, along with standard pure-tone audiometry.
Results: Hearing loss was present in 43.1% of patients. 16% of patients had conductive hearing loss and 4.6% of patient had sensory neural hearing loss. 22.5% of thalassemic patients had high-frequency sensory neural hearing loss and more importantly, high-frequency hearing loss attributable to Desferrioxamine ototoxicity was present in 12% of patients. Furthermore, these evaluations showed that there is a significant relationship between hearing loss and DFO usage and hearing loss too. There is no significant relationship between hearing loss and ferritin level between hearing loss and age of DFO usage too.
Conclusion: Management of these patients requires proper dosing of Desferrioxamine, along with regular otolaryngolgic and audiometric follow-up in order to prevent the effect of ototoxicity of desferal.

Objective: A research was conducted to assess the phonological awareness in hearing-impaired children in comparison to normal children. In this context, we discussed about the ability of these children in identification of rhyme and word segmentation to syllables.
Method and Material: The sample of this study is composed of 320 children, 160 normal & 160 hearing-impaired with a hearing-loss. Of over 70 dB, studying in the 1st t 4th grade of the primary schools in Tehran. They are divided into two groups at each level (20 girls & 20 boys).
Results: 1) Hearing-impaired children&aposs scores on test related to rhyme and syllable is lower as compared with normal children. 2) Hearing-impaired children are more potent on test of word segmentation to syllables in comparison to that related to rhyme, while normal children are more successful on test of word segmentation to syllables as compared with that related to rhyme.

Discussion: Hearing is an important factor in phonological awareness. Formal education at special schools doesn&apost compensate for the hearing impairment as to development of the phonological awareness.

Objective: A survey on hearing state of blind schoolboys in Tehran.
Method and Material: This cross-sectional descriptive survey was conducted on 640 ears of 320 blind schoolboys of 5-23 years old as a hearing screening in Tehran blind schools, 2000-01.
Results: 20.94% was hearing-impaired of whom 13.75% had bilateral and 7.19% had unilateral hearing loss. 15.16% of students suffered from sensory-neural hearing loss (SNHL), 1.56% from conductive hearing loss (CHL) and 0.62% from mixed hearing loss (MHL), that is, SNHL occurred 10 times more than CHL. Hearing loss was often mild and moderate, and audiogram configuration was primarily high tone loss (HTL). On the whole, 8.13% of students needed medical treatment, 15.13% needed audiological rehabilitation and 3.44% of them were in need of both medical and rehabilitation Intervention. General information about hearing problem was very low among students, their parents and teachers, which was 26.87%, 20.9% and 22.39%, respectively. There is significant relation between SNHL and parents&apos relationship.
Conclusion: The prevalence of hearing loss in blinds is higher than in normal-visions. It is often sensorineural. So, it is important to identify these children through hearing screening (Using more high frequencies) and to conduct medical as well as rehabilitative intervention.

Objective:Determining the prevalence of hearing loss and correlated factors in clients referring to audiology clinic of Buali hospital.
Method and Material: This cross-sectional analytic-descriptive survery was carried out on six thousand and twenty ears of 3010 clients (1651 ,ae amd 1359 female) in Audiology clinic of Buali hospital , during Sept 2000 to Sept 2001.
Results: Hearing loss is the most common reason for referring the clients (20.5%). 1319 ears (21.9%) Showed sensorineural hearing impairment and conductive and mixed hearing loss are observed in 1059 (17.6%) and 234 (3.9%) ears, respectedly. Hearing loss degree most cases is mild (14%) in both ears. There is no significant difference between male and female hearing threshold means (p>0.05) ‘ but a significant difference between hearing thresholds is observed in terms of age (p<0.05). Audiogram configuration in most cases is flat (55.1%). Otoscopic examination reveals abnormal condition in 2333 ears (38.8%) . 37.2% of the studied cases have abnormal tympanogram mostly type B (15.9%). 2.2% of the clients wear hearing aid that mostly have B.T.E ones (1.5%). 6.2% of the clients , depends on their hearing impairment type and degree need rehabilitation services.
Conclusion: The results are Valid only in the context of this study and it&aposs generaliztion needs further researches.

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: Genetic studies show that consanguineous marriage can increase the probability of incidence of genetic impairments such as hearing impairments. The target of this study is to identify the prevalence of consanguinity among the parents of hearing impaired students in primary schools.

Materials and Methods: We selected all of deaf students of Tehran (614 students). Their mothers answered to questionnaires. The questions were about Risk Factors of deafness in mother pregnancy or in neonatal period.
Results: from 614 students, 389 parents of them (64%) had consanguineous marriage and 223 person (36%) didn&apost have this factor. 2 person did not answer to this question. In this study we observed that there is 32.3% family history of hearing loss, 29.2%deaf sister and brother, 17% ear infection history. Other risk factors were studied too. Also there is significant correlation between consanguinity and more than one deaf children in the family (p<0.005).
Conclusion: According to high incidence of consanguinity (64%)that was observed in this study it may be one of most important causes of sensory neural hearing loss in children, so we should give enough information about this problem to the people.

Objective: Noise measurement and frequency analysis of commercially available noisy toys were the main purposes of the study.
Materials and Methods: 181 noisy toys commonly found in toy stores in different zones of Tehran were selected and categorized into 10 groups. Noise measurement were done at 2, 25, and 50 cm from toys in dBA. The noisiest toy of each group was frequency analyzed in octave bands.
Results: The highest and the lowest intensity levels belonged to the gun (mean=112 dBA and range of 100-127 dBA) and to the rattle-box (mean=84 dBA and range of 74-95 dBA), respectively. Noise intensity levels significantly decreased with increasing distance except for two toys. Noise frequency analysis indicated energy in effective hearing frequencies. Most of the toys energies were in the middle and high frequency region.
Conclusion: As intensity level of the toys is considerable, mostly more than 90 dBA, and also their energy exist in the middle and high frequency region, toys should be considered as a cause of the hearing impairment.

Background and Aim: Hearing sensitivity is so vital for musicians as loud music can cause hearing loss. The aim of this study was to assess hearing sensitivity of musicians in order to determine the effects of music exposure on hearing organ.
Materials and Methods: This case-control study  was conducted on 15 string musicians with musicianship history of more than 10 years and 15 normal hearing subjects. They all were male and 20-30 years old. TEOAEs and DPOAEs performed after otoscopy , immittance and pure tone audiometry in octave frequencies between 250 to 16000 Hz.
Results: There is not significant difference between pure tone thresholds of two groups for all frequencies.A significant difference of TEOAE is found between two groups for total response and amplituds of TEOAEs . DPOAEs amplituds are not significantly different between two groups .
Conclusion: Musicianship may  affect TEOAEs amplitudes , but cannot affect results of PTA and DPOAEs. Therefore this can be useful to detect cochlear lesions secondary to music exposure and also as a tool in hearing protection program.

Background and Aims: As the hearing aid technology progressively promotes toward replacing analog hearing aids with digital and programmable ones, comparison of the patient satisfaction of those kinds of hearing aids by means of a valuable tool seems so necessary. So, the aim of this study was to compare self-reported benefit of analog, digitally controlled programmable and digital hearing aids for reducing disability caused by hearing impairment in mild to severe sensorineural hearing impaired persons.
Materials and Methods: This cross-sectional study was performed on 90 persons with mild to severe sensorineural hearing loss dividing into three groups: 43 subjects were fitted with digital, 15 with programmable, 23 with analog hearing aids. After pure tone audiometry, Abbreviated profile of hearing aid benefit (APHAB) was completed before and one month after using hearing aids to determine the benefit of them.
Results: Global APHAB mean scores for digital, programmable and analog hearing aids were 49.05, 33.19 and 39.53, respectively. Ease of Communication subscale mean scores were 53.46 for digitals, 37.66 for programmables and 39.09 for analogs. Background noise subscale mean scores for digital programmable and analog hearing aids were 46.36, 25.53 and 35.31, respectively. Global and also both subscale mean scores showed significant difference between digital hearing aids and programmable and analog ones. There was no significant difference between reverberation subscale mean scores of three groups.
Conclusion: It seems digital hearing aids may be more beneficial to reduce disability caused by hearing loss than analog and programmable hearing aids are.

Background and Aim: Hearing loss results in impairment of  muscles coordination and survival essential that are engaged in motor speech timing tasks. It will negatively affect the acquisition of speech sounds. The purpose of this study was to compare the oral diadochokinesis in normal-hearing and hearing - impaired adolescents
Materials and Methods: This research was conducted on sixty-one adolescents aged 15-18 years old. Forty-six had moderately severe, severe, or profound hearing loss and fifteen were normal. The time spent to perform each oral diadochokinesis tasks was measured by speech analyzer of Dr. speech software, version four.
Results: Results indicated that hearing - impaired performed significantly slower on all speech timing tasks than their normal hearing peers except those with moderately severe hearing-impaired group. There were significant differences between profound hearing-impaired group and both other groups.
Conclusion: The results of this study point out  the motor speech problems in hearing impairment. The differences, in general, indicate that speech-timing coordination deficits are compromise with hearing loss degree.

Background and Aim:  Among all auditory assessment tools, auditory steady state response (ASSR) is a modern test. Modulation frequency for this test is usually 80 Hz. The purpose of this study, was to examined adult subjects with 40 Hz and 80 Hz ASSR and compare the results.
Materials and Methods: Thirty adult (60 ears) were evaluated by ASSR and PTA test, Results were divided into three groups: normal hearing, mild and moderate sensorineural hearing loss.
Results: In all groups, forty hertz ASSR thresholds were relatively closer to behavioral threshold than those of 80 Hz ASSR(p<0.05). Besides, the more severe hearing loss, the lower the difference between those two thresholds. Correlation coefficients were also higher in 40 Hz ASSR(p<0.05).
Conclusion: Frequency modulation thresholds with 40 Hz are more likely to be closer to the behavioral thresholds. Moreover, it has better results than the thresholds with 80 Hz.

Background and Aim: Regions in the cochlea with no (or very few) functioning inner hair cells and/or neurons are called dead regions. The aim of this study was to identify the cochlear dead regions in moderate to profound sensory neural hearing impaired children through the Threshold equalizing noise (TEN_HL) test.
Materials and Methods: In this cross-sectional study, the TEN(HL) was performed for the all frequencies available on test CD, on 30 children with ages ranging from five to forteen years (mean age, 8.5 ±2.8 years old).
Results: In this study, 58.3% of ears were found to have a dead region for at least one frequency. Classifying by test frequencies, 20% were found to have a dead region, 24% to be inconclusive and 56% to have no dead regions. The difference between mean SNR(T) in ears with and without dead regions was statistically significant. The difference between mean absolute thresholds in two groups was statistically significant at 1000 Hz and below (p <0.05).
Conclusion: The results indicated a relatively high prevalence of dead regions in children with sensory neural hearing impairment, especially for frequencies at which the hearing loss exceeds 70 dB HL.

Background: Fanconi anemia (FA) is an autosomal recessive genetic disorder wich characterized by progressive pancytopenia, multiple congenital anomalies,  increased susceptibility to acute myelogenous leukemia and epithelial cancers specially in head and neck and GUT. Characteristic feature of FA include short stature, café-au-laitspots, small eyes, mental retardation, skeletal and ear anomalies.
Case: A 23-year-old man who was a known case of FA since he was ten reffered to audiology clinic because of severe hearing loss. His initial diagnosis was pneumonia. Audilogic evaluation revealed  bilateral profound hearing loss.
Conclusion: One of the anomalies in FA are  ear anomalies. These included conductive haering loss, external auditory canal stenosis and auricular malformation and progressive sensoryneural hearing loss. In this report external auditory canal and tympanic membrane were normal. The result of tympanometry were type An and audiometry were bilateral profound hearing loss that is a rare finding  in FA patient.

Background and Aim: Balance disturbance is one of the non-auditory effects of noisy industrial environments that is usually neglected. The aim of the current study was to investigate the effect of occupational noise on vestibular system among workers with noise-induced hearing loss (NIHL), based on both vestibular evoked myogenic potentials (VEMP) and caloric tests.

Methods: Thirty male workers with noise-induced hearing loss and thirty male matched controls were examined by VEMP and caloric tests. Study parameters included unilateral weakness, p13 and n23 latencies, and p13-n23 amplitude. Caloric test was performed only for 20 patients.

Results: No significant difference was observed in unilateral weakness between the two groups. On the other hand, the difference in mean latencies of p13 in the right ear (p=0.003) and left ear (p=0.01) was significant between the two groups. However, the difference in n23 latency was significant only in the right ear (p=0.03). There was no significant difference between groups in p13-n23 amplitude.

Conclusion: It seems that pars inferior of vestibule is the susceptible part in individuals with NIHL. In general, abnormal findings in both VEMP and caloric tests were more common compared to functional symptoms such as vertigo, which may be due to central compensation and the symmetry of the disorder.

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: 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: 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.