People with profound hearing loss are not able to use some kinds of conventional amplifiers due to the nature of their loss . In these people, hearing sense is stimulated only when the auditory nerve is activated via electrical stimulation. This stimulation is possible through cochlear implant. In fact, for the deaf people who have good mental health and can not use surgical and medical treatment and also can not benefit from air and bone conduction hearing aids, this device is used if they have normal central auditory system. The basic parts of the device included: Microphone, speech processor, transmitter,  stimulator and receiver, and electrode array.

 People with profound hearing loss are not able to use some kinds of conventional amplifiers due to the nature of their loss. In these people, hearing sense is stimulated only when the auditory nerve is activated via electrical stimulation. This stimulation is possible through cochlear implant. In fact, for the deaf people who have good mental health and can not use surgical and medical treatment and also can not benefit from air and bone conduction hearing aids, this device is used if they have normal central auditory system. The basic parts of the device included: Microphone, speech processor, transmitter,  stimulator and receiver, and electrode array.

The disastrous effects of Hearing loss on speech and language development can be minimized by early interventions. Profoundly deaf or hard of hearing children not benefitting enough from other kinds of hearing aids are referred for surgically implanted electronic cochlear implant that provides a sense of sound or comprehension of speech. Evaluation and management of pediatric patients is performed by cochlear implant team which consists of different specialists and doctors. Selecting children for the implant surgery is performed based on the certain criteria suggested by Staller et. al. in 1991. All the patients undergo comprehensive medical and Audiological evaluations before the surgery.In this article we will review different process of cochlear implant surgery and pre- surgery Audio logical evaluations in brief.

Cochlear implant surgery is aimed at making a comprehensive packet of information for the deaf by mixing the data acquired by implanted device and the communicational grammar. Although language production and ability of communication are not main factors in determining the candidacy for cochlear implant surgery, they play crucial role in determining cochlear implant success. we should study the communication skills much deeper than a simple perception and production of speech to have a reasonable evaluation of  development of Auditory integration and grammatical language structure. Hence in the current article we will first discuss the grammatical structure  in  language and then have a look at the pragmatics , semantics  and phonological aspects in children with cochlear implant in Virginia college in USA.

Methods and Materials: Investigation of electrically evoked auditory brain stem response (EABR) is a new issue, especially in implanted patients. Experiments were performed in C.I Center of Iranian Institute for Science and research expansion,1996 on 30 implanted patients with 22 spectra and MSP cochlear implant system and 30 normal subjects with the range of 3-33 years.Findings:1- EABR was obtained in the implanted patients.2- Absolute latency of EABR waves is 1-1.5 ms shorter than ABR waves ‘P<0.05).3-Absolute latency of wave V decreases as a function of electric stimulus magnitude (P<0.05).4- No significant difference was observed in IPL Ill-V between ABR and EABR.

Cochlear implant is the result of a great combination and collaboration of engineering and medicine. It is mainly because it has the most conflict with the human nervous system among all prosthesis. Cochlear implant helps a child with profound hearing loss to understand and articulate speech and let an adult person with hearing loss communicate with people by phone. Although these wonderful results could not be seen in all patients, will let us know about the great scientific findings.

Background and Aim: Speech is the essential need of the social life. To acquire that, children highly rely on the normal senses and speech full environment. The normal auditory senseis the most important need. Early amplification intervention in children with hearing difficulties is advised. Cochlear implant technology provides an effective help for hearing-impaired children in recent decades. With regards to new and limited implantation services in Iran, the effects of operation age on speech and language of implanted children was not studied yet. The purpose of this study was to compare articulation errors in cochlear implanted children with different operation age.
Materials and methods: In this cross-sectional study, ten cochlear implanted children before three and eleven after four years old were evaluated. The participants were without any anatomical, visual, and intelligence abnormality and 2.5-3 years was passed from their operation. Then, by using Picture Pho-netic Test (PPT), the articulation errors of individuals were extracted and for more evaluation of the er-rors and complete of PPT, we, also used their excited connected speech by presenting pictures. By application of t-test and using SPSS software, the data was analyzed.
Results: Data analysis indicated that, there was meaningful significant difference between substitute errors and whole errors in two gropes but there was not meaningful significant difference between de-stroyed errors in two gropes.
Conclusion: The children who undergoing operation after 4 years old had severed articulation disorder than other grope. These issues indicated that the earlier operation of children will lead to improve the speech skills and reduced the articulation errors.

Background and Aim: In neural response telemetry (NRT), intracochlear electrodes stimulate the auditory nerve and record the neural responses. The electrical stimulation send to the auditory nerve by an electrode and the resulted response, called electrically evoked compound action potential (ECAP), is recorded by an adjacent electrode. The most important clinical applications of this test are evaluation and monitoring the intra and postoperative responses of auditory nerve and help to primary setting of speech processor. The aim of this study was evaluating of the potential&aposs threshold changes in three monthes after receiving the devise in pediatric cochlear implant recipients.
Materials and Methods: This longitudinal study evaluated the potential&aposs threshold in four given electrodes in four sessions after receiving the device by approximately one months intervals in children implanted in Amir Alam and Hazrat-e-Rasoul hospitals in 2007, July to December.
Results: ECAP mean threshold level of each electrode did not significantly change in differnent sessions, while there was significant difference between apical and basal electrodes&apos responses in every session(p<0.001).
Conclusion: The reliabiliy of the responses result in more certainty of clinician to fit the speech processor for a long time. Better responses in apical electrodes may lead to develope an effective coding strategy.

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.

Background and Aim: Vestibular evoked myogenic potential in response to click or short tone burst stimuli have been used as a clinical test for distinguish saccule and inferior vestibular nerve diseases. Different studies show that cochlear implant could have inverse effects on vestibular structures. We aimed to investigate vestibular evoked myogenic potential in unilateral cochlear implanted individuals in compare to normal individuals.
Methods: Thirty-three unilateral cochlear implanted patients (mean age 19.96 years) and 30 normal hearing individuals (mean age 24-27 years) as control group were enrolled in this cross- sectional study. Absolute latencies and amplitudes of myogenic potential responses were measured and compared in both groups.
Results: Myogenic potential recorded in both ears of all controls were normal. No response could be recorded in 16 patients (48.48%) from both ears. In three patients, responses were recorded in both ears though the amplitude of waves was reduced in implanted ear. Unilateral response could be recorded in 14 patients only in their non-implanted ear.
Conclusion: Vestibular evoked myogenic potential test is a useful tool for assessing saccular function in cochlear implant patients. Damages of osseous spiral lamina and basilar membrane after cochlear implantation could result in dysfunctions of vestibular organs specially saccule. It seems that saccule could be easily damaged after cochlear implantation. This would cause absence or reduced amplitudes in myogenic potential.

Background and Aim: Although the ability of speech perception has been improved in implanted subjects with recent progress in technology, cochlear implantation alone is not enough and more aural rehabilitation is necessary. The aim of this study was to assess improvement of speech perception in children with cochlear implant.
Methods: Fourteen cochlear implanted children with a mean age of 5.5 years participated in this study. Auditory training was performed in 10 to 43 sessions. Speech recognition and perception were evaluated every 3 months. Third evaluation was done only for 4 patients.
Results: Mean total score of the first evaluation was 43.21%, of the second was 63.76%, and of the third evaluation was 78%. All children obtained complete score for sound awareness at the first evaluation. In environmental sounds discrimination, 71.3%, 84.36%, and 100% answered completely to the questions of three evaluations respectively. In speech sounds discrimination, 34.7% in the first, 57.04% in the second, and 85% in the third evaluation obtained the complete score, and in auditory memory, complete responses were 21% for the first, 57.12% for the second, and 83% for third evaluation. In story rephrasing and comprehension, no one answered to questions completely. However, 12.83% obtained the complete score in the second and third evaluations. There were statistically significant differences between the first and the second evaluation (p=0.002(.
Conclusion: Sound awareness ability seems to be achieved rapidly. Development of speech and environmental sound discrimination abilities, particularly speech comprehension which is the most important skill, need more impressive training.

Background and Aim: Due to defects of auditory feedback, children with hearing loss have inappropriate speech intonation. Consistently, results of previous studies have shown that cochlear-implanted children have some difficulties in their intonation. Intonation shows the type of the sentence which can be statement or question sentences. The purpose of this study was comparison of speech intonation in cochlear-implanted children and normal hearing children.
Methods: The present study was performed on 25 cochlear-implanted children and 50 normal hearing children. Different pictures were shown to the subjects and they said statement and question sentences. All sentences were heard by eight speech therapists and perceptually judged. Using praat software mean base frequency and pitch alterations were measured.
Results: In cochlear-implanted group, mean speech base frequency was higher and mean pitch alteration was lower than the control group. Mean experts&apos scores in cochlear-implanted group were lower than the control group. Differences in all three variables were statistically significant (p<0.05). There was a significant direct correlation between duration of time that the children had cochlear implant and perceptual judgment scores (p<0.05).
Conclusion: According to the results, cochlear implant prosthesis has limited efficacy in improving speech intonation although their ability to produce speech intonation improves by increasing duration of the time that children have cochlear implant. Thus speech therapists should consider intervening on speech intonation in treatment program of cochlear-implanted children.

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.

Background and Aim: Hearing impaired individuals, who have undergone cochlear implantation, do not have satisfactory relationships with their peers and cannot be fully integrated into the hearing communities. The main purpose of this study was to examine the effect of a family-oriented social skills training program on cochlear implant users.
Methods: In this experimental study, 16 volunteer families consisting of mothers and their 12-19 year old children, who had undergone cochlear implantation at least two years in advance, were chosen from 328 families, members of the Hearing Rehabilitation Association of Iran. They responded to social skills rating scale as pre-test after they were randomly assigned to control and experimental groups. The experimental group underwent a 12-session social skills training. The social skills rating scale was then administered as a post-test in the two groups.
Results: The results showed the effectiveness of the family-oriented social skills training program on assertion (p<0.01), self-controlling (p<0.01), and general social skills (p<0.01) however, they showed no significant effect on cooperation (p>0.05).
Conclusion: The study revealed that family-oriented social skills training program is effective in improving the social skills of individuals with cochlear implantation. Therefore, this training program can be employed to improve these skills as an integral part of the rehabilitation program.

Background and Aim: Fundamental frequency (F0) of onset is a reliable acoustic cue of voicing differences in plosive consonants. The purpose of present study was to acoustically analyze of the F0 amount of oral plosive consonants in the initial position of words in cochlear-implanted children and normal hearings.

Methods: In this study, the F0 of onset was measured in the speech production of 47 prelingual deaf children who were cochlear implanted about 61 months before the test (range: 47-76 months, SD: 8.6) and the results were compared with 60 normal hearing children who were 60 months old (range: 49-73, SD: 6.5).

Results: Using repeated measurement tests, it was shown that in all places of articulation, the amount of F0 of onset in voiceless plosives was higher than that of voiced ones, because of the low position of larynx and hyoid bone in voiced plosives. On the other hand, in most cases, the F0 of cochlear-implanted children was lower than that of normal hearings and in voiced plosives, there were significant differences (p=0.005) between cochlear implanted and normal hearing children. There was not any significant difference between the F0 of onset in girls and boys.

Conclusion: In all places of articulation, the mean amount of F0 of onset for voiceless plosives was higher than that of voiced plosives. There was significant difference between F0 of onset in cochlear implanted and normal hearing children.

Background and Aim : Theory of mind refers to the ability to understand the others have mental states that can be different from one's own mental states or facts. This study aimed to investigate the relationship of theory of mind and executive functions in normal hearing, deaf, and cochlear-implanted children.

Methods: The study population consisted of normal, deaf and cochlear-implanted girl students in Mashhad city, Iran. Using random sampling, 30 children (10 normal, 10 deaf and 10 cochlear-implanted) in age groups of 8-12 years old were selected. To measure the theoty of mind, theory of mind 38-item scale and to assess executive function, Coolidge neuropsychological and personality test was used. Research data were analyzed using the Spearman correlation coefficient, analysis of variance and Kruskal-Wallis tests.

Results: There was a significant difference between the groups in the theory of mind and executive function subscales, organization, planning-decision-making, and inhibition. Between normal and deaf groups (p=0.01), as well as cochlear-implanted and deaf groups (p=0.01), there was significant difference in planning decision-making subscale. There was not any significant relationship between the theory of mind and executive functions generally or the theory of mind and executive function subscales in these three groups independently.

Conclusion: Based on our findings, cochlear-implanted and deaf children have lower performance in theory of mind and executive function compared with normal hearing children.

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: 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: Clinicians and researchers always need standard measures for the evaluation of auditory perception and speech production in deaf children, particularly those with cochlear implants. This study addresses the reliability and validity of the Persian version of categorization of auditory performance (CAP) scale and speech intelligibility rating (SIR) in cochlear-implanted prelingual deaf children.

Methods: A total of 92 cochlear-implanted deaf children aged 1.3-15.7 years participated in the study. Test-retest reliability, inter-rater reliability, and criterion and construct validity of the scales were investigated.

Results: The obtained test-retest reliability for categorization of the auditory performance scale and speech intelligibility rating was 0.82 and 0.99 (p<0.01), respectively, whereas the suggested inter-rater reliability based on average Cohen’s kappa coefficient was 0.73 and 0.70 for the two scales (p<0.01), which appear acceptable. The concurrent validity of the scales was 0.64 and 0.69 (p<0.01). The construct validity for categorization of the auditory performance scale ranged between 0.58 and 0.74 (p<0.01), whereas the same feature for the speech intelligibility rating indicated a range between 0.66 and 0.69 (p<0.01).

Conclusion: The findings of this investigation indicated that both CAPII and SIR scales are reliable and valid instruments for the assessment of auditory perception and speech production of cochlear-implant deaf children.