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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: 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: 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: Children with severe and profound hearing loss have difficulties in communicating with others and educating at school. Effects of learning environment on children&aposs language skills have been recently focused and educating those students in ordinary schools has been proposed. According to this view, we compared perception of antonyms and synonyms as a semantic aspect of language in students of ordinary, integrated and special schools.
Methods: It was an analytic cross-sectional study. Three groups of students were enrolled: normal-hearing students of ordinary schools and hearing-loss students of integrated and specials schools. Each group consisted of 25 students in fifth grade of elementary schools in Tehran city. Two written tests were used. Subjects wrote synonyms and antonyms for each word in the tests.
Results: Results denoted significant differences between scores of normal-hearing and hearing-loss students and also between hearing-loss students of integrated schools and hearing-loss students of special schools (p<0.05). In all three groups of the students, perception of antonyms was better than antonyms (p<0.001). Speech processing rate in normal-hearing students were higher than both groups of hearing-loss students (p<0.001).
Conclusion: The differences between normal-hearing and hearing-loss students shows that similar to other language skills, perception of synonyms and antonyms as a semantic aspect of speech is related to the hearing conditions and type of education. Moreover, the differences between two groups of hearing-loss students represent that speech stimulants and interaction with normal-hearing children could improve semantic aspect of speech in hearing-loss students.

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Background and Aim: In different language approaches, reading is considered as a major skill. Language skills comprising listening, speaking, reading and writing are completely interlinked with each other. Thus, providing active application of listening and speaking skills, children will learn reading and writing skills easily. The aim of this research was to compare reading skills of hearing-loss students studying at exceptional schools with normal students of different degrees.
Methods: The research was conducted post-traumatically using standardized 2006 PIRLS test. 80 students in fifth grade of exceptional primary schools, and first and fourth grade of exceptional high schools in Tehran City who had severe and or profound hearing loss were randomly selected along with 80 normal students in ordinary schools who were selected using available sampling method.
Results: There were significant differences between reading comprehension of hearing-loss and normal students of all three grades (p<0.001). Reading comprehension in female students was significantly higher than the male ones (p<0.001). There were not any significant differences in mean reading comprehension scores of hearing-loss students in different grades which demonstrate that their reading skills had not developed in tandem with their age and school educations.
Conclusion: This study shows that one of the significant concerns regarding hearing-loss students is their reading comprehension ability. Considering reading ability as one of the most important acquisitive abilities which students learn at school, evaluation of reading skills of hearing loss students as well as recognition of their strengths and weaknesses in this field is indispensable.

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Background and Aim: Early diagnosis of hearing loss lead to early intervention and improvement of developmental skills of children with hearing loss. The present study aimed to determine the mean age of hearing loss diagnosis and cochlear implantation (CI) in hearing impaired children and to compare the age of performing cochlear implantation in children who were identified by newborn hearing screening with those who were not.
Methods: This cross-sectional study was conducted on 96 children with severe to profound sensorineural hearing loss who received cochlear implantation in Amir-e-Alam cochlear implantation center between the years 2008 and 2010. For data gathering, we assessed subjects&apos medical archives, interviewed with their parents and took medical history including demographic information, birth history and hearing loss history.
Results: Mean age of hearing loss suspicion, diagnosis, hearing aids administration, Initiation of rehabilitation program, performing cochlear implantation and mean age when cochlear implantation was utilized were 6.73 (SD=5.79), 9.35 (SD=5.79), 13.41 (SD=6.10), 16 (SD=6.36), 41.25 (SD=11.12), and 42.15 (SD=11.00) months, respectively. There was statistically significant difference between them (p<0.05). 43.8% of hearing impaired children had been identified by newborn hearing screening. There was statistically significant difference between cochlear implantation operation age of children who were identified by newborn hearing screening with those who were not (p<0.0001).
Conclusion: In spite of notable reduction in the age of hearing loss diagnosis and intervention during recent years, compared to international indices it is still tardy. Conducting newborn hearing screening can significantly reduce these ages.

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

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Background and Aim: Oral stereognosis is the ability to recognize the objects placed in the mouth this plays a significant role in speech sounds production. Since the children with hearing loss have articulation disorders, this study aimed to clear the relation of hearing loss degrees and oral stereognosis in 5-year-old children.
Methods: In this cross-sectional non-invasive study, 40 children of 5-year-old (30 children with different degrees of hearing loss and 10 normal children) were involved. Oral steriognostic test was done for all of them and the Mann-Whitney U was used for statistical analysis.
Results: There were significant differences between the mean of oral stereognostic ability between the normal children and the children with severe (p<0.01) or profound hearing loss (p=0.05). There was no significant difference between the mean of oral stereognostic ability among the children with moderate, severe and profound hearing loss compared with together. Besides, there was no significant difference between the mean of the time of diagnosis among all of hearing loss and normal children.
Conclusion: The study shows that the children with moderate, severe and profound hearing loss have inefficient oral stereognosis in comparison with the normal children.

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Background and Aim: Reading is the most important human need for learning. In normal-hearing people working memory is a predictor of reading comprehension. In this study the relationship between working memory and reading comprehension skills was studied in hearing-impaired children, and then compared with the normal-hearing group.
Methods: This was a descriptive-analytic study. The working memory and reading comprehension skills of 18 (8 male, 10 female) sever hearing-impaired children in year five of exceptional schools were compared by means of a reading test with 18 hearing children as control group. The subjects in the control group were of the same gender and educational level of the sample group.
Results: The children with hearing loss performed similarly to the normal-hearing children in tasks related to auditory-verbal memory of sounds (reverse), visual-verbal memory of letters, and visual-verbal memory of pictures. However, they showed lower levels of performance in reading comprehension (p<0.001). Moreover, no significant relationship was observed between working memory and reading comprehension skills.
Conclusion: Findings indicated that children with hearing loss have a significant impairment in the reading comprehension skill. Impairment in language knowledge and vocabulary may be the main cause of poor reading comprehension in these children. In hearing-impaired children working memory is not a strong predictor of reading comprehension.

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Background and Aim: Pragmatics refers to speech interactions and the social aspect of communication in language contexts. Due to the crucial role of hearing in language skill development, hearing-impaired children have problems with all aspects of language, including pragmatics. These skills are crucial in children's daily life. There is a lack of Persian studies on hearing-impaired children. Therefore, the purpose of the present study is to describe some pragmatic skills of hearing and hearing-impaired children.
Methods: This descriptive case study was conducted on five hearing-impaired and two normal-hearing 6 year old children. Their pragmatic language skills were studied by the Persian story retelling test. in a quiet room. The children's re-told story was recorded, analyzed, and scored.
Results: There was no difference between the scores of hearing and severe hearing-impaired children. However, children with severe hearing loss and cochlear implant, and hearing children were different in maintaining the subject and sequence of events. Children with profound hearing loss and hearing aid, and hearing children had a significant difference in all aspects except main information. All subjects used conjunctions correctly.
Conclusion: The pragmatic skills of hearing-impaired children are weaker than hearing children. There are also differences between hearing-impaired children's abilities. This difference in pragmatic skills shows the difference in amount of hearing loss, kind of assistive device, effective use of remaining hearing, onset and quality of aural rehabilitation program, and other factors. Therefore, a research with a greater sample size is necessary to explain these differences.

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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: Behavioral audiometry is the best method of hearing evaluation. Hearing thresholds are estimated with auditory evoked responses in patients who are not able to cooperate in behavioral audiometry. Because rehabilitative decisions are based on behavioral thresholds, it is essential to determine the amount of difference between behavioral and evoked response thresholds. The purpose of this study was to evaluate the difference between functional and auditory steady-state response (ASSR) gains.

Methods: Twenty six moderate to severe hearing impaired adolescents and adults (age range: 14 to 55 years) participated in this interventional-comparative study. Audiometery and ASSR testing was performed (without hearing aid and then with hearing aid). Finally, functional gain with ASSR gain, and behavioral thresholds with ASSR thresholds were compared using paired t-test and correlation statistical methods. All tests were performed in the sound field.

Results: The mean difference was 6.19 dB between unaided behavioral and ASSR thresholds, 4.33 dB between aided thresholds, and 2.43 dB between functional and ASSR gains. There was no significant difference between functional and ASSR gains (p>0.05).

Conclusion: The difference between functional and ASSR gains is less than the difference between behavioral and ASSR thresholds and it has less variability between different frequencies. So, it may be better to use ASSR gain instead of ASSR thresholds in hearing aid fitting in difficult-to-test population.

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Background and Aim: The auditory steady state response is a modern test for estimating hearing thresholds, especially in difficult to test individuals . However, there are few bone conduction auditory steady state response data, particularly for individuals with hearing loss. The objective of this study was to investigate bone conduction auditory steady state response thresholds in individuals with sensorineural hearing loss and normal hearing.

Methods: In a cross-sectional study, 10 individuals with normal hearing and 10 with sensorineural hearing loss at the age of 15-30 years were selected by non-probability sampling. Auditory steady state response and pure tone audiometry to bone conduction stimuli in 500 and 2000 Hz were recorded in two groups. Paired and independent t-test were used to compare data between the groups.

Results: There was low correlation between bone conduction auditory steady state response and pure tone audiometry in both groups (p>0.05 for both). The difference of behavioral thresholds and auditory steady state response in 500 Hz was higher than 2000 Hz in both groups (p=0.033 for normal hearing and p=0.017 for sensorineural hearing loss groups). Comparison of these results showed significant differences between the two groups (p<0.001).

Conclusion: In both groups, there was low correlation between bone conduction auditory steady state response and pure tone audiometry thresholds. In individuals with sensorineural hearing loss and in higher frequencies , bone conduction auditory steady state response thresholds was closer to pure tone audiometery thresholds.

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Background and Aim: Studies have shown that long-term use of monaural hearing aid in symmetrical hearing losses may lead to physiological changes. In this research, the possibility of plasticity occurrence in bilaterally hearing impaired listeners fitted with only one hearing aid was investigated.

Methods: Our study was carried out on 12 elderly listeners with a mean age of 61.92 years who had symmetrical moderate to severe sensory neural hearing loss in both ears. All of the participants had minimum monaural hearing aid experience of 2 years. We used auditory brainstem response (ABR) testing in order to compare absolute latency and amplitude of wave V between the two ears of cases. Air conduction click stimuli were presented monaurally at 80, 90 and 100 dB nHL.

Results: Despite the shorter absolute latency of wave V in the fitted ear, no significant difference was found between the two ears (p>0.389). The difference between wave V amplitude of both ears was greater in 90 dB nHL level (p=0.043). Women showed shorter mean latency than men and the mean amplitude of women was greater than men. Significant gender difference was observed in absolute latency of wave V (p<0.037).

Conclusion: Our findings indicate that the use of monaural hearing aid in symmetrical hearing losses can induce neural plasticity within auditory brainstem pathways which can be displayed by auditory brainstem response test.

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Background and Aim: American Academy of Pediatrics (AAP) established standards for neonatal hearing screening programs in 1999. The main purpose of this study was to achieve exact statistical data of this program in Ahvaz, Iran, and to compare these results with the standards of American Academy of Pediatrics.

Methods: In this cross-sectional descriptive study, the data of neonatal hearing program in Ahvaz west health center from 2008 to 2011 were reviewed. Data were analysed by descriptive statistics.

Results: From 25073 neonates, 25 had hearing loss. The false positive and referral ratio to the diagnosis stage were 2.6 and 0.48 percent, respectively. 92 percent of hard of hearing infants were diagnosed before three months of life.

Conclusion: In comparison with the standards of American Academy of Pediatrics, all of the items, except two, were included completely or relatively complete. But, more efforts must be done to achieve the whole standards which are available.

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Background and Aim: The cochlea and vestibule are related developmentally. Therefore individuals with severe to profound sensourineural hearing loss have additional risk for vestibular dysfunction. The aim of this study was to assess saccular function using vestibular evoked myogenic potentials (VEMP) in children with severe to profound sensorineural hearing loss (SNHL) who are candidates for cochlear implant.

Methods: Thirty children (17 males and 13 females) with bilateral severe to profound sensorineural hearing loss in the age range of 3-15 years participated in this study. 17 children (9 males and 8 females) with normal hearing in the age range of 3-13 years participated as the control group. All children in each group were evaluated for saccular function by performing vestibular-evoked myogenic potentials in both ears.

Results: Comparison of mean threshold values between the two groups revealed statistically significant difference (p<0.05). In addition, comparison of mean amplitude values between the two groups revealed statistically significant difference (p<0.05). However, comparison of p1 3 and n23 latency values between the two groups revealed no significant difference (p>0.05). Out of the 30 children with bilateral severe to profound sensorineural hearing loss eight children (26.66%) had absent VEMP responses in both ears.

Conclusion: Children with severe to profound sensorineural hearing loss who are candidates for cochlear implant ha d more potential for saccular abnormalities compared to normal-hearing children. Therefore, assessment of vestibular function is very important in this population.

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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.

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Background and Aim: Many studies have demonstrated a close relationship between phonological working memory and language abilities in normal children and children with language developmental disorders, such as those with cochlear implants. A review of these studies would clarify communication and learning in such children and provide more comprehensive information regarding their education and treatment. In this study, the characteristics of phonological working memory and its relationship with language abilities in children with cochlear implants was examined.

Recent Findings: In this study, the authors studied the characteristics of phonological working memory and its relationship with language abilities of children with cochlear implants. These studies showed that in addition to demographic variables, phonological working memory is a factor that affects language development in children with cochlear implants. Children with cochlear implants typically have a shorter memory span.

Conclusion: It is thought that the deficiency in primary auditory sensory input and language stimulation caused by difficulties in the processing and rehearsal of auditory information in phonological working memory is the main cause of the short memory span in such children. Conversely, phonological working memory problems may have adverse effects on the language abilities in such children. Therefore, to provide comprehensive and appropriate treatment for children with cochlear implants, the reciprocal relationship between language abilities and phonological working memory should be considered.

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Background and Aim: Conversational repair skills are essential for establishing mutually successful verbal communication. Cognitive and linguistic disorders can have negative effects on these skills. Children with hearing loss have special cognitive and linguistic issues. This study was performed to contribute to the paucity of data on conversational repair strategies used by hearing impaired children.

Methods: The participants included 58 children with moderate hearing loss (38 boys and 20 girls) aged 6 to 7 from Ahvaz city. A cross-sectional study design was used. Frequency of using different types of repair strategies in ten repair situations was calculated. Scores of intelligence, memory, word finding, lexical richness, and mean length of sentences was obtained through cognitive-linguistic tests. Data was analyzed employing an independent t-test, Pearson correlation coefficient, and logistic regression.

Results: A direct correlation was observed between clarification strategy and communicative social intelligence (p=0.045). A direct correlation was observed between applying different types of conversational repair strategies and linguistic abilities in children with moderate hearing loss (p<0.05).

Conclusion: Children with moderate hearing loss (age: 6-7 years) use repetition more than any other strategy to repair conversation. One unit increase in word finding ability or in mean length of sentence predicts one unit increase in the degree of using repetition strategy.

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Background and Aim: Hearing loss is one of the most prevalent chronic diseases in the elderly using a hearing aid to alleviate auditory impairment can positively affect their quality of life. This research aimed to determine the level of satisfaction concerning hearing aids in elderly people with hearing impairment based on the type and degree of hearing loss.

Methods: An analytic cross-sectional research design was used the sample included 40 elderly people who used hearing aids. According to the World Health Organization (WHO) age classification, participants were divided into two age groups: 65-74 years (n=20) and 75-90 years (n=20). Satisfaction levels were assessed using a standard satisfaction with amplification in daily life (SADL) questionnaire.

Results: Satisfaction levels in the 65-74 age group were significantly higher than that in the 75-90 age group (p=0.02). Participants with mixed hearing loss revealed higher satisfaction levels than participants with sensorineural hearing loss (p=0.02). On the negative effects dimension, participants with severe hearing loss exhibited significantly higher satisfaction levels than participants with moderate or moderate to severe hearing loss (p=0.01).

Conclusion: Total satisfaction mean scores were relatively high in the elderly participants . Negative features could be reduced via careful consultation regarding the aids’ amplifying capabilities and limitations in groups with moderate or moderate to severe hearing loss.