---

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.

---

Background and Aim: Pragmatic impairment is the main cause of communication difficulties in hearing-impaired children and teaching pragmatic skills in these children is too challenging for clinicians. Thus, creating written and formalized therapy plans can be useful for rehabilitation team, clients and therapists.

Methods: A therapy-plan was designed and content validity of it was determined. A single case subject design (a multiple baselines research design) was used to determine the efficacy of the therapy plan to improve four domains of pragmatic in five hearing-impaired children (5 to 8 years). The experiment was divided into three phases including baseline, treatment and follow-up. Treatment phase consisted of 16 sessions and subjects were enrolled in the phase in stair way. The data were analyzed with effect size and visual analysis.

Results: According to expert's opinions, the therapy plan of pragmatic skills was valid. Visual analysis of diagrams showed that all subjects progressed in turn-taking, topic maintenance and response to request for clarification domains and the effect sizes (ES) were high (ES>0.8). Also, there were medium effect sizes (0.8≥ES≥0.2) in certain subjects. In request for clarification domain, some of subjects did not show desired improvement by visual analysis and effect sizes were medium. But, others showed improvement and had high effect sizes.

Conclusion: The therapy plan of pragmatic skills can improve pragmatic skills of moderate-to-severe hearing-impaired children.

---

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.

---

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.

---

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.

---

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.

---

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.

---

Background and Aim: Hearing is one of the most vital sensational abilities. Learning, which is the most basic ability for human compatibility to mental development, is affected by hearing ability. The main goal of this article was to review the effect of hearing impairment on educational achievement of hearing-impaired students, especially in the field of basic learning skills (reading, writing, and mathematics).

Methods: In this article, the researches on the effect of hearing impairment on educational achievement were reviewed. There were 37 articles extracted from different databases such as Iran Medex, Scopus, PubMed, Magiran, Iran Journal, Google Scholar, and 12 credible books published from 1944 to 2013. In order to search in these databases, educational achievement and other related keywords were used.

Conclusion: Hearing impairment affects listening skills, which is a mental process and is known as the first lingual skill. Subsequently, other lingual skills and learning abilities like educational achievement are affected as well. In order to decrease the educational gap in hearing-impaired students, it is very important to interfere in early stages and use of presentation methods to improve lingual skills in educational system.

---

Background and Aim: Some evidence suggests that hearing impairment has negative effect on psychological characters of hearing-impaired adolescences and they are more vulnerable to mental health problems than their hearing peers are. This was a comparative study of social skills, life satisfaction and external and internal locus of control in normal-hearing and hearing-impaired students.

Methods: T his multi-stage random sampling method consisted of 50 students with hearing impairment (boy and girls) and 50 matched normal-hearing students. The participants completed Matson evaluation of social skills with youngster, students life satisfaction, and Levenson multidimensional locus of control scales.

Results: The results of multivariate analysis of variance showed statistically meaningful differences in social skills , life satisfaction and locus of control between the two groups (p=0.002 for all).

Conclusion: Social skills in normal-hearing students were higher than students with hearing impairment and locus of control in normal student was more internally. Training the parents and school-staff on development of locus of control and making it more internally in hearing-impaired students is suggested.

---

Background and Aim: While most of the people with tinnitus have some degrees of hearing impairment, a small percent of patients admitted to ear, nose and throat clinics or hearing evaluation centers are those who complain of tinnitus despite having normal hearing thresholds. This study was performed to better understanding of the reasons of probable causes of tinnitus and to investigate possible changes in the auditory brainstem function in normal-hearing patients with chronic tinnitus.

Methods: In this comparative cross-sectional, descriptive and analytic study, 52 ears (26 with and 26 without tinnitus) were examined. Components of the auditory brainstem response (ABR) including wave latencies and wave amplitudes were determined in the two groups and analyzed using appropriate statistical methods.

Results: The mean differences between the absolute latencies of waves I, III and V was less than 0.1 ms between the two groups that was not statistically significant. Also, the interpeak latency values of waves I-III, III-V and I-V in both groups had no significant difference. Only, the V/I amplitude ratio in the tinnitus group was significantly higher (p=0.04).

Conclusion: The changes observed in amplitude of waves, especially in the latter ones, can be considered as an indication of plastic changes in neuronal activity and its possible role in generation of tinnitus in normal-hearing patients.

---

Background and Aim: Hearing impairment can have an impact on adolescents’ quality of life and can lead to their isolation and depression. The main purpose of this research was to study the effectiveness of a mental rehabilitation program based on positive thinking skills training on increasing happiness in a group of hearing impaired girls and boys.

Methods: In this experimental study, pre- and post-test plan with a control group was used. All of the hearing impaired students (girls and boys) in all high schools of southern parts of Tehran, Iran, in year 2012-13 were our statistical research community. 48 hearing impaired girls and boys were selected by multistage sampling including stratified, purposive, and random sampling. They were randomly divided into two groups of experimental and control. Each group consists of 12 boys and 12 girls. Positive thinking skills were trained to experimental groups during eight 45-minutes sessions, twice a week. We used the Oxford happiness questionnaire to assess the level of happiness.

Results: Using analysis of covariance showed that positive thinking skills training had meaningful and positive effect on increasing happiness of hearing impaired boys and girls in the experimental groups (p<0.01). Also, the mean happiness scores of boys and girls were meaningfully different (p<0.01).

Conclusion: Positive thinking skills training increases the happiness scores of hearing impaired adolescents. So, the approach taken in this study can be considered as an appropriate method for psychological-education interventions, counseling and treatment in hearing impaired adolescent.

---

Background and Aim: CE-Chirp stimulus has been developed for stimulating more apical regions of the cochlea. Inadequacy of clinical information on the latency and amplitude characteristics of ABR evoked by CE-chirp at different levels in addition to discrepancy in identifying earlier ABR waveforms using CE-chirp stimulus are the reasons of this study.

Methods: This study was done by recoding ABR to click and broad-band CE-chirp stimuli in the right ear of 15 non-randomly selected normal-hearing individuals with age range of 20-30 years old. Frequency of recordable waves I and III, as well as threshold, amplitude, and latency of wave V were compared in response to click and CE-Chirp at 20-80 dB nHL.

Results: At 80 dB nHL, click stimulus evokes waves I and III more frequently than chirp stimulus (p=0.012 and p=0.016 respectively). At 20 and 40 dB nHL, wave V latency evoked by CE-Chirp is significantly longer than wave V latency evoked by click (p=0.012 and p=0.0001 respectively) however, at 80 dB nHL wave V latency evoked by CE-Chirp is shorter than click (p=0.0001). Wave V amplitude for CE-Chirp is significantly larger than for click at levels of 20, 40 and 60 dB nHL (p=0.0001, p=0.0001 and p=0.013 respectively). Wave V threshold is approximately 5 dB lower with CE-chirp compared to click (p=0.014).

Conclusion: Except at high levels, CE-Chirp evokes wave V with larger amplitude and lower threshold than click. Possibility of recording earlier ABR waves is reduced with CE-chirp stimulus.

---

Background and Aim: Auditory lateralization is a binaural phenomenon that is the result of processing of interaural time and intensity cues in the central auditory system. The main advantage of this phenomenon in human is understanding speech in noisy environments due to the auditory sciene analysis and cocktail party effects . The aim of the present study was to assess the auditory lateralization ability in normal children.

Methods: Participants were 80 normal school age children (8-11 years) of both genders, 42 girls and 38 boys. Lateralization functions were determined by interaural time difference (ITD) ranging from -880 to +880 µs and interaural intensity difference (IID) ranging from -10 to +10 dB for high-pass and low-pass noise.

Results: Interaural intensity difference lateralization functions were linear , while the interaural time difference lateralization functions were S-shaped with a clear linear component from -220 to +220 µs and with an asymptote from -440 to -880 µs and +440 to +880 µs. Generally, interaural intensity difference errors were significantly less than interaural time difference tasks (p<0.0001). Age effect was only present in interaural time difference tasks (p=0.001).

Conclusion: According to these results, children with the age of 11 years performed better in lateralization using interaural time difference cues compared to other children whereas there was no difference in performance in all ages when using interaural intensity difference cues.

---

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.

---

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.

---

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.

---

Background and Aim: Hearing impairment is one of the most stressful disabilities. The mental health of parents caring for children with hearing impairment is at risk. Therefore, technical support and intervention are very valuable for these families. These services are also useful for children’s development. The aim of this study was to assess the effectiveness of social work services on the social adjustment of parents of children with hearing impairment.

Methods: In this study, 37 parents of children with hearing impairment were selected as the sample population. Interviews and case studies were conducted to determine whether the parents were receiving social work services. The social adjustment scale was used to assess parents’ social adjustment. Analysis of variance (F) was used to analyze the data and information obtained from parents.

Results: Data analysis showed that there is a significant difference between parents who had received social work services and parents who had not received social work services (p<0.001).

Conclusion: According to the obtained results, parents who had received social work services experienced higher social adjustment. It can be said that providing assistance to parents of children with hearing impairment can improve their social integration.

---

Background and Aim: Grammatical skills development of hearing-impaired children depends on using appropriate educational rehabilitation programs. This study aims to investigate the effectiveness of linguistic plays on the grammatical skills in hearing-impaired children with hearing aids.

Methods: Ten hearing-impaired children with hearing aids, aged between 5 and 7, were randomly assigned to two groups (5 children in each group). Each treatment group received 12 sessions on linguistic plays. The grammatical skills of these children were evaluated via the TOLD-P: 3 (Persian version) in addition, their level of intelligence was assessed by the Raven test.

Results: The difference between the scores of both control and treatment groups revealed a statistically significant difference in grammatical skills (t=7.61, p=0.001) and three subskills of the children who participated in the linguistic plays. These subskills include syntactic understanding (t=3.16, p=0.013), sentence imitation (t=1.71, p=0.006), and morphological completion (t=6.55, p=0.001). In other words, the findings suggest that linguistic plays have a significant impact on the improvement of the aforementioned skills in hearing-impaired children.

Conclusion: Results suggest that it would be beneficial to include linguistic plays as part of routine rehabilitation programs as a means of improving the grammatical difficulties of children. After partaking in linguistic plays, children significantly improved their ability to comprehend the meaning of sentences and also to recognize, understand, and use common Persian morphological forms.

---

Background and Aim: Studies have found that deaf individuals have higher rates of psychiatric disorders, such as behavioral problems, than those who can hear. The aim of this review was to provide a summary of the literature on behavioral problems, with specific reference to deaf individuals. The objectives of the review were to establish the prevalence of behavioral problems in deaf populations describe the risk factor for behavioral problems in deaf populations and describe approaches to intervention and behavioral problems prevention that have been used in deaf populations.

Recent Findings: A review of articles published between 1991 and 2013 showed that the prevalence of behavioral problems in deaf people is higher than that of hearing people. Risk factors for behavioral problems in deaf populations include language impairments, communication problems, the role of parents, and the community’s beliefs and attitudes regarding the issue.

Conclusion: Given the high prevalence of behavioral problems in deaf people, the effectiveness of prevention strategies should be examined. Consequently, it would be advantageous to increase the availability of specialist mental health services, promote deaf awareness including their abilities, promote awareness and skills development among teachers, staff, and specialists and implement behavior change programs.

---

Background and Aim: Empathy is a basic human skill that is important in daily life. The purpose of this study was to evaluate the role of the theory of mind in predicting empathy.

Methods: This study adopted a causal-comparative design. 40 students with profound hearing impairment and 40 students with normal hearing, aged between 8 and 14, participated in the study. Instruments including false belief tasks and empathy questionnaires were distributed to the participants. For multivariate analysis of variance, a correlation analysis and multiple regression methods were used.

Results: Results indicated a significant difference between the total score of false belief tasks and empathy in students with hearing impairment and those with normal hearing (p<0.001 ). A significant relationship between the theory of mind and empathy was found in both groups (p<0.01). Also theory of mind could predict the empathy (p=0.001).

Conclusion: Based on the obtained results, significant reduction in the theory of mind and empathy was seen in students with hearing impairment. Therefore, training programs that focus on social skills are required for students with hearing impairment in order to address this problem. Moreover, training materials need to be tailored to their cognitive understanding.