Hearing function can affect communication skills and especially speech and language abilities.As a result, most of the attempts in behavioral audiometry have focused on the improvement and rectification of the techniques for hearing evaluations of the infants and children.Crib-O-gram and the methods suggested by northern & Downs are some of the mentioned protocols.For years a significant advance for evaluating hearing sensitivity of children have been taken place. say, behavioral visual audiometry, VRA, TROCA and play audiometry. some studies also have been performed regarding to the use of BOA technique in mental retarded children and its success in evaluating hearing sensitivity in such children.other protocols use rewarding techniques for reinforcing child's responses which have been demonstrated to be success in the evaluation.In addition,by comparing the results of frequency and intensity discrimination (by means of Luescher test), the changes in the resonance frequency of the outer ear and loudness comfortable level(LDL), one can study the process of hearing development in children.

It is difficult for clinicians to make parents aware of any disease or permanent handicap of their children.It is crucial to have vivid picture of the reactions to such crisis in order to manage severe psychological effects of the mentioned situations such as depression and unhappiness. Confronting the situation parents have diverse feelings regarding the pregnancy period, birth time and handicap diagnosis and these are the factors that shape the parent’s upcoming reactions. Common feedbacks to the crisis are refusing the problem, keeping their child away from society, the emotions that provoke disappointment, asking about the reasons for hearing loss, referring to religion, condemning the physician, feeling sin and changing doctor frequently. When parent accept the situation and that hearing could not recurrent and understanding the natural reasons back on their child’s handicap, they can manage the situation constructively.

A concise Description of Non-linguistic features (Such as Familial, educational and Health information) and linguistic skills in hard of hearing children will be helpful in compensating for their disabilities. In the current study we studied 75 school-Children with average hearing Thresholds of 55-70dB in better ear. All the subjects aged between 8-16years-old with the average age of 11.04.We studied 27 non-linguistic variables by using questionnaire and 32 grammatical variables by studying evoked speech in the participants. The average utterance length of the subjects was estimated 2.763 words. 29% of the all participants' utterances was accurate and just 16.3% of the verbs were produced accurately.One of the most common errors in sentence and verb level, was the mistaken ably omitting of the structural features, the tense problem of the verb and also the mismatching between subject and verb. We also observed a significant correlation between some non-linguistic features such as grade, previous education in conventional schools and the rate of hearing aid usage and the number of accurate utterances in participants.

Materials and Methods: This study was performed in two parts: included development and standardization of the test and the second part was the evaluation stage. In the first section, Watson&aposs crieria fpr valid speech recognition tests for children was considered. In order to balance the lists phonemically, it was necessary to determine Persian phonemes&apos frequency -of- occurences. Thus, the frequency -of- occurences for 29 phonemes of Persian language in children&aposs and adults&apos speech were separately determined. There were significant differences between some phonemes&apos frequencies in the two samples. So&apos their frequencies in children&aposs speech was used to design the test. It should be mentioned that each list could contains only 25 vowels, while almost 32 ones were meeded according to the phonemically balancing procedure. Therefore, vowels and consonants were separately balanced. The required monosyllabic words were extracted from the books written for 4 to 6 years old children. Finally, four closed set (3- picture matrix) 25 word lists were prepared. The lists were recorded on magnetic cassette in one of the IRIB studios.To assess the test validity and reliabity, 33 normal hearing children were randomly selected from kindergartens over the city of Tehranand were tested at the Audiology Clinic of the Rehabilitation Faculty, Tehran University of Medical Sciences in 1998. The tests included: otoscopy, pure tone & immittance audiometry, establishing speech reception threshold, and speech recognition test - retest by these lists.
Findings: 1- Normal hearing children obtained 92-100 percent scores for each list at their most comfortable loudness levels through test - retest.
2- No significant difference was observed in test - retest scores in each list (p>0.05).
3-No significant difference obtained between the lists test or retest scores (p>0.O5).
4-No significant difference was observed between children&aposs scores in terms of their age and gender (p>O.OS)
Conclusion: this study, therefore, is reliable and valid. The lists are phonemically balanced and equal in difficulty. Due to the conditions under which the test was designed (including, phonemic balance, necessity of using the words that could be pictured and of the presence of tow other word in children&aposs vocabulary which is similar in auditory aspects), only the content validity for word familiarity decreased a little that could be overcome by introducing them through pictures prior to the start of the test.

Studying auditory discrimination in children and the role it plays in acquiring language skills is of great importance. Also the relationship between articulation disorder and the ability to discriminate the speech sound is an important topic for speech and language researchers.Previous event- related potentials (ERPs) studies have suggested a possible participation of the visual cortex of the blind subjects were asked to discriminate 100 couple Farsi words (auditory discrimination tack) while they were listening them from recorded tape.The results showed that the blinds were able to discriminate heard material better than sighted subjects. (Prro.05)According to this study in blind subjects conical are as normally reserved for vision may be activated by other sensory modalities.This is in accordance with previous studies. We suggest that auditory cortex expands in blind humans.

In order to develop oral communication, hearing impaired infants and young children must be able to hear speech comfortably and consistently. To day children with all degrees of hearing loss may be condidates for some kinds of amlification.As children differ from adults, many Factors should be consider in hearing aid selection, evaluation and fitting. For example the child age when he or she is candidate for custom instruments? Do we consider programmable Hearing aid? Are multi memory instruments appropriate for them? What about directional microphones? What style of hearing aid do we select? In this paper such questions are responded.

Objective: Infants hearing screening as one of the best methods of identification and hence early intervention to prevent side effects and appropriate rehabilitation if necessary.
Methods and Materials: 175 0-7 day infants were tested in two groups (112 normal history and 63 high risked) with a dumb (for low frequencies)and receiver (for high Frequencies) at 90-95 dB SPL in three hospitals. The acceptable responses were auropalpebral reflex (APR) , startle and stop of movements.
Results: Of the first group 51% showed APR, 10% startle, 22 % Both and 17% no response. Of the second group 47% showed APR, 24% startle, 11% both reflexes and 18% no response.
Conclusion: 14 cases (8 girls and 6 boys) out of 175 infnats showed no response.

Method & Material: This descriptive analytical survey was performed in pars Hospital, Tehran on 45 children (22 girls, 23 boys aged 2-5 years, 1377-78 (solar).Finding: In 2-3 years old group, accurdacy of PTA test (87/7%) was more than FNS test (66%). In 3-5 years old group, Specificity & NPV showed no significant differences, between two test.
Conclusion: Since the PTA showes greater possibility of false positive response than FNST, the accuracy of the latter test is greater the PTA.

In the present longitudinal study, 20 deaf and 20 hearing children were observed during free play with their hearing mothers when the children were 22 months and 3 years of age. Compared to hearing children, deaf children were severely language delayed, with deaf 3-year-olds using less language (speech or sign) than hearing 22-month-olds. Deaf children communicated primarily through nonlinguistic vocalizations, with increasing use of gesture from 22 months to 3 years of age. Although mothers of deaf children used more visual communication than mothers of hearing children, they still primarily communicated through speech. In addition, deaf children did not visually attend to much of their mothers&apos communication. Therefore, deaf children received much less communication than hearing children. These results suggest that intervention efforts should be focused on increasing the quantity of perceived linguistic input by the child.

Objective: To measure external ear resonant amplitude and frequency in children (3-7 years old) and to compare with adult measures.
Method and materials: The external ear resonance peak amplitude and frequency of 63 children 3-7 years old were recorded. All of the children had normal tympanogram and there was no cerumen in external auditory canal. 20 adult of 21-24 years old (10 male , 10 female) were selected in order to compare with children that had normal tympanogram. The tests included : 1-otoscopy 2- tympanometry 3-microphone probe tube test.
Results: The average of resonance peak frequency for children and adult is 4200 Hz and 3200 Hz , respectively. The resonance frequency of children had significantly diffrence with average of resonance frequency in adults. The average of resonance peak amplitude for children and adult is 17.70 dB and 17.17 dB , respectively.
Conclusion: Resonant frequency and amplitude affect the hearing aid prescription and fitting process and calculating insertion gain so, this measures seem should be considered in children hearing aid fitting.

Background and Aim: High frequency audiometry (HFA) provides a valuable tool and optimal index for distinguishing and monitoring many pathologies of the ear. The purpose of this study was to measure the reliability of HFA threshold in children.
Materials and Methods : In this cross-sectional study , 100 normal-hearing children, of 7 to 13 years old, including 50 boys and 50 girls were examined with a Belton 2000 audiometer and Sennheiser HD 250 earphones in Pediatric Clinic  of Audiology Department, Faculty of Rehabilitation of Tehran University of Medical Sciences.
Results: The threshold differences between right and left ears in two test sessions, were not significantly different except for 14 KHz. HFA threshold in two test sessions showed no significant difference in all frequencies between girls and boys but 16 and 20 KHz in right ear and 10 KHz in left ear.
Conclusion : The test-retest thresholds for iudividual ears showed ±0-10 dB SPL for difference at least  in 99.74 % of ears at all frequencies that is clinically reliable and acceptable.

Background and Aim: Most of the studies indicates that the parents of the hearing impaired children show many mental health problems after the diagnosis of their children&aposs hearing impairment. Counselling with the parents of the hearing impaired children is one of the most important goals of any early intervention program. This paper describes a study to determine the effectiveness of a group counselling programme for parents of hearing impaired children.

Materials and Method: It was a semi-experimental study with a single group pretest-post test design. The participants were all the parents of hearing impaired children attending in an early intervention center. First the parents&apos mental health were assessed.Then the group counselling program was implemented. Program has involved six weekly 1.5 hour sessions. The format of each session included both lecture presentation and group discussion using cognitive behavioral procedure. Subjects were assessed before and immediately after group therapy by means of General Health Questionnaire(GHQ) and Symptom Check List 90 (SCL-90) questionnaires.

Resuts: The first part of the project had shown that over the half of the parents had considerable psychosocial morbidity. Comparisons showed a significant reduction from pretreatment to posttreatment in depression, anxiety and most of other psychological problems.

Conclusion: The study supports the effectiveness of group therapy programs in the treatment of parents of hearing impaired children. Concerning the progress of early detection programs for the children&aposs hearing impairment more studies should be done in the field of counseling with their parents.

Background and Aim: Learning disability(LD) is one of the most prevalent problems among elementary school children. Approximately 10 percent of all elementary school children suffer from this problem. It has been determined that learning disability is predominantly accompanied with subtle impairment in central auditory nervous system. The main idea of this study was to evaluate middle latency auditory evoked potential (MLAEPs) in learning disabled children.

Materials and Method: This cross-sectional study investigated middle latency auditory evoked potential in children with learning disability (n = 31) compared to normal children (n = 31). Latencies and amplitudes of MLAEPs results with different stimulus intensity and binaural stimulation were compared between two groups.

Results: Compared to control group, learning disabled children exhibited smaller amplitudes for all the components except the right ear Na and Pa. There is no significant difference between two groups for latencies of the components.

Conclusion: It seems that middle latency auditory evoked potential may be useful in diagnosis and evaluation of learning disabled children although more investigation is required.

Background and Aim: Middle latency auditory evoked potentials (MLAEPs) development takes longer time than the auditory brainstem response (ABR) development does, which makes them difficult to record in some children. The purpose of this study was to investigate the age effect on characteristics and detection of MLAEPs in children and adults.
Materials and Methods: This cross sectional study was conducted on 15 children aged   7-12 yr and 31 adults aged 20-50 yr with normal peripheral hearing. To investigate precisely, children were divided in two subgroups of older and younger than 10 years old, as well. The MLAEPs amplitudes and latencies were recorded by conventional protocol and compared.
Results: Adult Na mean latency, 20.86 ms, was less than that of children, 22.86 ms, (p=0.0025).  In contrast, the adult Nb mean latency, 44.93 ms, was longer (p=0.0001). Children Nb mean latency was 42.02 ms. There was no significant difference in MLAEP amplitudes and latencies between two children subgroups, although variance was more in younger children.
Conclusion: MLAEPs are reliably recorded after 7 years old. Characteristics of MLAEPs are different in adults and children so that the primary MLAEPs generators have a course of development extending beyond the first decade of life. As those potentials were recorded in all children, it is suggested to be used in their test batteries for hearing evaluation.

Background and Aim: Hearing impairment affects all aspect of individual life, specially language and communication skills. When hearing impairment is congenital or occurs early in life, the child's ability to learn optimally through audition, will be affected. The aim of this study was to evaluate linguistic skills of preschool hearing impaired children and compare these skills with normal peers.

Methods: This descriptive cross-sectional study was performed on 38 preschool hearing impaired children that the main handicap was severe to profound hearing loss with ability to communicate orally and 28 normal children with the same cultural and social context. Twenty four non linguistic variables including age, gender, the age of entrance of preschool center, number of hearing aids, etc. were obtained by filling a questionnaire and fifteen linguistics variables including number of utterance, morphemes, correct utterance, noun phrase, ambiguous utterance, correct sentences, compound sentences, etc. were collected by some part of TOLD-P-3 test and three complementary questions. Then we compared the data from two groups.

Results: There were significant differences between number of utterance, number of correct mean length utterance, number of well-formed sentences in normal and hearing impaired group (p<0.000). There were no significant difference between unintelligible utterances, repetitive utterances and bad-formed sentences between two groups(p>0.05).

Conclusion: This study showed a severe deficit in linguistic skills in preschool hearing impaired children.

Background and Aim: phonological awareness skill is an integrated ability that is manifested in 4 skills including syllable, rhyme, and phoneme awareness and alliteration. The aim of the present study is to explore development of syllabic elision skill as an aspect of syllabic awareness.

Methods: It was a descriptive-analytic cross-sectional study. Thirty normal Persian-speaking children, 15 girls and 15 boys, were randomly selected throughout Tehran kindergartens. The participants were monolingual. Children should eliminate a syllable from any word presented, and to state the remaining section of the word. The responses were analyzed using SPSS software.

Results: Ability of 5 to 6 year-old children in eliminating a syllable in two syllabic words was significantly higher than those of three and four syllabic words and syllabic elision of three and four syllable words was significantly different (p=0.000). Two, three and four syllabic task correlations were statistically significant and the correlation between syllabic elision ability and the syllabic construct and the positioning of elision syllable was significant (p<0.05).

Conclusion: Syllabic elision skill blossoms in 5 to 6 year-old Persian-speaking children. The maximum ability of syllabic elision evolves after phonological recoding and after learning reading and writing skills. Syllabic elision ability is also influenced by the syllabic construct and the positioning of elision syllable.

Background and Aim: Despite the abundance of literature about deaf children, few works specifically address the concept and practice of difficulties in parenting hearing-impaired children. The first interactions of the child are with his parents, and parents have the most important role in child improvements during early intervention programs. The main purpose of this paper was to investigate different aspects of parenting hearing-impaired children.   

Methods: In this article, we reviewed all aspects of parenting hearing-impaired children in papers from 1984-2009 in Medline, Scopus and Proquest and relative textbooks. The semi-professional role of parents of hearing-impaired children make them feel under excessive stress and this usually affects their other roles as fathers and mothers. Many factors including child age, type of hearing loss and parents' individual characteristics may influence the impact of child's hearing loss on parents.

Conclusion: Parenting a hearing-impaired child is both similar and different to parenting any other child. Where there are differences, there are usually challenges too. Taking support and advice from professionals and other parents are necessary and invaluable for parents of hearing-impaired children.

Background and Aim: The correlation of stuttering and different linguistic factors is assessed in many studies. The obtained results can pave the way to reach a better understanding of stuttering, as well as finding more appropriate treatments. This study investigates the effect of utterance length on speech dysfluency comparing stuttering Persian(Farsi) -speaking children and nonstuttering ones.
Methods: Ten stuttering and ten nonstuttering Persian-speaking children between 4 and 6 years of age, matched by age and gender where included in this cross-sectional study. All individuals were investigated by ten sets of simple and complex sentences. Morphemes were added one by one to sentences in each set in order to assess the impact of utterance length on dysfluency. Data analysis was performed using SPSS software.
Results: In practicing ten sets of sentences, the speech dysfluency shows significant enhance with increase of utterance length in both stuttering and nonstuttering children (p=0.001). Furthermore, while comparing two groups of simple and complex sentences, significant increase of speech dysfluency was observed by length enhance of utterance, in both stuttering and nonstuttering children (p<0.05). The comparison of stuttering and nonstuttering children showed significant difference between the two groups as well (p=0.001).
Conclusions: The results of this study show that increase in utterance length in both simple and complex sentences lead to increase in dysfluency in stuttering and nonstuttering children. Stuttering children indicated more dysfluency than nonstuttering ones.

Background and Aim: Understanding and defining developmental norms of auditory comprehension is a necessity for detecting auditory-verbal comprehension impairments in children. We hereby investigated lexical auditory development of Persian (Farsi) speaking children.
Methods: In this cross-sectional study, auditory comprehension of four 2-5 year old normal children of adult&aposs child-directed utterance at available nurseries was observed by researchers primarily to gain a great number of comprehendible words for the children of the same age. The words were classified into nouns, verbs and adjectives. Auditory-verbal comprehension task items were also considered in 2 sections of subordinates and superordinates auditory comprehension. Colored pictures were provided for each item. Thirty 2-5 year old normal children were randomly selected from nurseries all over Tehran. Children were tested by this task and subsequently, mean of their correct response were analyzed.
Results: The findings revealed that there is a high positive correlation between auditory-verbal comprehension and age (r=0.804, p=0.001). Comparing children in 3 age groups of 2-3, 3-4 and 4-5 year old, showed that subordinate and superordinate auditory comprehension of the former group is significantly lower (p<0.05) than the others . Intra-group comparisons revealed no significant difference between nouns, verbs and adjectives (p>0.05), while the difference between subordinate and superordinate auditory comprehension was significant in all age groups (p<0.05).
Conclusion: Auditory-verbal comprehension develop much faster at lower than older ages and there is no prominent difference between word linguistic classes including nouns, verbs and adjectives. Slower development of superordinate auditory comprehension implies semantic hierarchical evolution of words.

Background and Aim: Learning language is acquired in early childhood and gradually developed by new words and new structures. Hearing sense is the most important acquisition for learning this skill. Hearing disorders are barriers for natural language learning. The purpose of this study was to investigate the relationship between writing sentences and perception of written sentences in hearing-impaired and normal-hearing students.
Methods: A cross-sectional study was conducted among thirty hearing-impaired students with hearing loss of 70-90 dB and thirty normal hearing students. They were selected from 3^rd grade primary school students in Hamadan, a large city in Western Iran. The language skills and non language information was assessed by questionnaire, Action Picture Test, and Sentence Perception Test.
Results: Results showed that there was a significant relation between writing sentences and perception of written sentences in hearing impaired students (p<0.001), (r=0.8). This significant relation was seen in normal-hearing students as well (p<0.001), (r=0.7).
Conclusion: Disability of hearing-impaired students in verbal communication is not only related to articulation and voice disorders but also is related to their disability to explore and use of language rules. They suffer lack of perception of written sentences, and they are not skilled to convey their feelings and thoughts in order to presenting themselves by using language structures.