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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.

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The major focus of this research is on the differential disruption of language abilities subsequent to brain damages as they relate to site and size of lesion, especially left hemisphere lesions which disrupt the production and processing of "Nouns" vs. "Verbs" as two functionally different lexical categories. Several clinical as well as experimental studies reported on different language have shown that nouns and verbs can be independently disrupted due to brain damage. A prevalent impairment in naming actions (Producing verbs) is reported in non-fluent aphasic patients, with lesions involving left frontal lobe, whereas a selective in naming objects (Producing nouns) has been observed in amnesic patients, with lesions involving the temporal lobe and the temporal lobe and the posterior association aresas. This research is a theoretical and fundamental based on descriptive and analytical method. The aphasic data in this research were obtained by assessing each patient&aposs aphasic symptoms using a standard Persian aphasia test (Paradis, Nilipoure, Paribakht, 1989) as well as post-test analysis of each patient&apos connected descriptive speech. The subjects were selected form among aphasics who referred to speech therapy centers in Tehran during a pe5iod of one year since autumn 1999. The subjects selected in the study were a homogenous group with left hemisphere lesions due to CVA. They were educated adult right handed. Speakers of Persian without any risk factor such as nicotine, alcohol or any addiction and diabetes with no gross depression or anxiety problems or face and oral paralysis and hemiaopsia. The subjects in this study comprised to adults ranging between 33 and 76 years of age. The results indicated that there are significant correlation between: 1) The production of nouns and left hemisphere lesion. 2) The production of verbs and left hemisphere lesion. 3) Brain lesion and language deficits. 4) The site of lesion and language abilities. Although the data are limited and the generalization of the study has certain restrictions, the present data indicate some specific and reliable avidence on the selective impairment of nouns and verbs due to different lesions in the left hemisphere.

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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.

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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.

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Background and Aim: Agrammatism is a phenomenon of neuropsychological relevance which has been recently investigated from conceptual and empirical aspects. The present study focuses on grammatical deficit in agrammatic aphasia. We evaluated the impairment of correct use of tenses of Persian verbs in agrammatic Broca&aposs aphasia.
Methods: Eight patients (mean age 57 years) participated in this descriptive - analytic study. They were classified as agrammatic Broca&aposs aphasia according to the Persian aphasia test, their CT Scan and MRI reports and other inclusion criteria. All patients but one were monolingual native speakers of Persian (Farsi). The other individual was bilingual whose dominant language was Persian. All subjects had a left unilateral brain lesion for at least one year after the onset of brain damage. The written sentence completion and picture sentence completion tests were designed and performed.
Results: Results do not indicate significant difference between Past Tenses of verb however, comparison of means showed best scores in Simple Past, Past Continuous, Present Perfect and Past Perfect, respectively. A main result of this study was significant difference between the mean of responses to Past Tense in comparison with Present Tense and Future (p=0.02).
Conclusion: Use of tense is impaired in agrammatic Broca&aposs aphasia in Persian. Our findings point out that use of Past Tense is impaired significantly more than the other tenses of verb.

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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.

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Background and Aim: Asking questions is one of the basic skills for getting information. "What", "Who", "Where", "Why", "How much", "How, etc. are question words frequently used for asking questions. Studies on the sequence of acquisition of question words in English speaking children follow a unique sequence. "What" is the first question word used by these children. We aimed to study whether Persian speaking children follow a unique pattern in the acquisition and use of question words as well.
Case: Two normal Persian speaking children (a boy and a girl) who were sent to the kindergarten of Faculty of Rehabilitation Sciences, Iran University of Medical Sciences by their parents were investigated. Children's spontaneous speech from 12 to 36 months was videotaped, and question words were extracted from phonetic transcription of both children's speech. In order to ask a question, both children initially used rising tone with /m/ or /hum/ before saying the first question word. Two first question words were "what" and "where" in both children's speech samples. Asking about the time with the question word /when/ was not appeared in their speech samples until 36 months. These two Persian speaking children also used Wh-question sequentially.
Conclusion: The result of this study was consistent with the results of other studies on English speaking children.

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Background and Aim: valid identification, prevention, and treatment of language disorders are a high priority for the speech and language professionals. One method for studying language development is sentence repetition that is faster to implement and analysis than other procedures. The aim of this project was constructing sentence repetition test as a quick measure of grammatical potency in 2.5 to 4 year old children.
Methods: Sentences appropriate for 2.5 to 4 year old children were selected during several stages by speech and language pathologist and linguists. The validity of sentences was assessed by professional masters in this theme. Subsequently, 41 sentences including those with 80% high validity were selected as the test sentences. Appropriate pictures were also provided with sentences. The test was administrated to 72 children in 3 groups (2.5-3, 3-3.5, and 3.5-4 year olds, gender matched). The reliability was administered with a test-retest design across a 2 weeks interval.
Results: Content validity Index for this test was 80%. "Test-retest reliability" was used for reliability of this test. The Interclass correlation coefficient for this test was 0.95 and standard error measurement was 7.45. The average of scores for sentence repetition, between groups was significant (p<0.001, p<0.001, p= 0.014).
Conclusion: This sentence repetition test has the appropriate validity and reliability as well as the capability of proper and quick assessment (screening) of grammatical development in 2.5 to 4 year old Persian speaking children.

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Background: Treacher-Collins syndrome is a congenital craniofacial disorder with multiple anomalies. This syndrome affects the maxilla, mandible, eyes, middle and outer ears, and soft palate. Conductive hearing loss due to the deformities of the middle and external ears is prevalent. The characteristics of this syndrome include multiple and serious threats to normal communication development in children. In this study, speech and language features of a Persian speaking child with this syndrome are presented.
Case: The case was an 8-year old girl with Treacher-Collins syndrome and bilateral moderate conductive hearing loss due to atretic canal. In language and speech assessments, moderate hypernasality, numerous compensatory errors and morphosyntactic deficits were observed. There were 13 phonemes that were incorrectly produced at least in one position. Besides, she used 22 types of phonological processes that were abnormal and disappear before the age of three in normal Persian speaking children.
Conclusion: Moderate hearing loss, velopharyngeal incompetency, malocclusion and dental anomalies, attention deficit/hyperactivity disorder (ADHD) and environmental factors resulted in severe speech and language disorders in this case. These disorders affected her academic performance as well. Moderate hypernasality, numerous compensatory errors, and excessive and abnormal use of phonological processes were not presented as prevalent characteristics of Treacher-Collins syndrome in other resources.

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Background and Aim: Formant structure and vowel space are the most important acoustic characteristics of speech sounds. The purpose of this study was to determine formant frequency and vowel space in six Persian vowels.
Methods: This cross-sectional descriptive-analytic study was performed on 60 Persian students of Tehran University of Medical Sciences (30 males, 30 females) with their age ranging from 18 to 24 years. The subject articulated six Persian vowels in isolation and data was recorded by real-analyzer software. Then, the first three formant frequency of each vowel was determined for each subject. Vowel formant frequency averages were measured separately for each vowel and each gender. Vowel space was plotted. The difference between F0 in two groups was compared by Leven and independent sample t tests.
Results: Maximum and minimum values of F0 in both group was related to /æ/ and /a/ (135 Hz in males and 239 Hz in females) and /i/ (146 Hz in males and 239 Hz in females). Besides, F0 in females was significantly higher than males (p<0.001). Maximum and minimum values of F1 were related to /æ/ and /i/. Furthermore, maximum and minimum values of F2 were related to /i/ and /u/. Maximum and minimum values of F3 were related to /i/ and /u/.
Conclusion: The lowest vowels were /æ/ and /a/ and the highest was /i/. The frontest was /i/ and the backest was /u/. the spreadest vowel was /i/ and the roundest was /u/.

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Background and Aim: Specific language impairment (SLI) is one of the most prevalent developmental language disorders which is less considered in Persian researches. The aim of this study was to investigate the differences in some morpho-syntactic features of speech and other language skills between Persian children with specific language impairment and their normal age-matched peers. Moreover, the usefulness of the test of language development-3 (TOLD-3), Persian version, as a tool in identifing Persian-speaking children with this impairment, was investigated.
Methods: In a case-control study, the results of the test of language development and speech samples analysis of 13 Persian-speaking children (5 to 7 years old) with specific language impairment were compared with 13 age-matched normal children.
Results: The results of this study showed that there were significant differences between the scores of specific language impairment group and control group in all measured aspects of the TOLD-3 (p<0.001) the children with specific language impairment had a shorter mean length of utterance (p<0.001) and made less use of functional words in their speech (p=0.002) compared with their peers.
Conclusion: Such as specific language impairment children in other languages, all language abilities of Persian-speaking children with specific language impairment are less than expected stage for their age. Furthermore, the Persian version of TOLD-3 is a useful assessment instrument in identifying children with specific language impairment which is comparable to the

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Background and Aim: A system that could make speech visible to deaf people has been dreamt of for long time. Several systems have been developed during recent decades with the most popular being cued speech invented 50 years ago by Cornett (1967). The aim of this article is to review researches about cued speech and its efficacy on different language skills of hearing impaired children.
Methods: In this article we reviewed researches on cued peech and its impacts on speech and literacy of hearing impaired children. We searched Medline, Proquest and Scopus search engines with the "cued speech" keyword and read all textbooks and thesis published between 1972 and 2011. Cued speech is an oral system which makes the sounds visible and accessible. It makes speech perception much simpler and improves lip-reading skills and ability of using residual hearing in hearing impaired children.
Conclusion: Cued speech enhances children's communication and speech perception and discrimination from early ages. It improves speech and ability to benefit from cochlear implantation. The original impetus behind cued speech was to improve literacy levels of hearing impaired children and it has been found to be uniquely successful.

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Background and Aim: Due to limitation of standardized tests for Persian-speakers with language disorders, spontaneous language sampling collection is an important part of assessment of language protocol. Therefore, selection of a language sampling method, which will provide information of linguistic competence in a short time, is important. Therefore, in this study, we compared the language samples elicited with picture description and storytelling methods in order to determine the effectiveness of the two methods.
Methods: In this study 30 first-grade elementary school girls were selected with simple sampling. To investigate picture description method, we used two illustrated stories with four pictures. Language samples were collected through storytelling by telling a famous children&aposs story. To determine the effectiveness of these two methods the two indices of duration of sampling and mean length of utterance (MLU) were compared.
Results: There was no significant difference between MLU in description and storytelling methods (p>0.05). However, duration of sampling was shorter in the picture description method than the story telling method (p<0.05).
Conclusion: Findings show that, the two methods of picture description and storytelling have the same potential in language sampling. Since, picture description method can provide language samples with the same complexity in a shorter time than storytelling, it can be used as a beneficial method for clinical purposes.

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Background and Aim: Valid identification, prevention, and treatment of language disorders have a high priority for the clinicians. Story retelling is a method for studying language development which is faster than other procedures in implementing and analyzing, and has a reliable scoring system. The aim of this project is to construct story retelling test for assessing language structure in 6-7 year old, Persian children.
Methods: An appropriate story for 6-7 year old children was written by the help of a speech pathologist, a linguist, and a novelist. The validity of the constructed story was checked by 14 experts. Then related pictures were design and their validity was examined. The test was conducted on 72 children (36 girls, 36 boys) of 6-7 years. The reliability was administered with a test-retest design with a two week interval. The reliability of the scoring system was evaluated with inter-rater method.
Results: Content validity index for this test was 89%, interclass correlation was 83%, and standard error of measurement was 2.76. The interclass correlation for scoring system was 93% and Pearson&aposs correlation was 90%. Correlation of the test-retest scores was statistically significant (p<0.01).
Conclusion: This story retelling test has appropriate validity and reliability. It is suitable for quick assessment of language structure in 6-7 year old, Persian children.

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Background and Aim: Social interaction plays an essential role in acquisition of speech and language as one of the most important developmental factors. The recent studies indicated that language abilities have a close relationship to social skills. The aim of this study was to determine the relationship of development of expressive language and dimensions of social skills in 4-6-years-old Persian-speaking children.
Methods: In this study, 123 normal Persian-speaking 4-6-year-old children (76 boys and 47 girls) who had all the specific criteria for normality were randomly selected from several preschools in Shiraz, Iran. During the first stage of testing, test of language development (TOLD) was administered to investigate language development of participants later, the social skills rating system (SSRS) including the teachers&apos and parents&apos forms were completed by the parents and teachers of participants. The data were analyzed using Pearson&aposs correlation coefficients.
Results: The correlations between expressive language and dimensions of social skills were significant (p<0.001), but teachers&apos form had a greater correlation with language development (p=0.031). Besides, Pearson&aposs correlations between teachers&apos and parents&apos forms was not significant (p=0.27).
Conclusion: According to our results, expressive language develops along with social skills development. On the other hand, these results are based on the differences between home and educational environment in social skills achievements of children. These findings are to be considered to provide crucial training in both environments for the children to improve the development of their expressive language.

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Background and Aim: Studies have shown that most children before age 4 are able to comprehend and express wh-question. In the Persian language, a case study has confirmed these results. The aim of this study is to evaluate the ability of 4-6 year olds to comprehend and express wh-question.
Methods: Seventy two 4-6 year-old Persian-speaking children were selected randomly. Wh-words consist of: what, where, who, why, and when. In the part of comprehension subjects answered questions about two pictures, and in the part of expression they asked questions elicited by a speaking puppet about four pictures. Descriptive analysis and student&aposs t-test were used for data analysis.
Results: In comprehension 4-6 year-old children gained the complete score (2) with SD=0 in all wh-words. However, 4-5 year old children gained the score of 1.89 with SD of 0.32 for the word when. In expression, independent t-test showed the maximum score of 3.52 with SD of 0.84 related to questions with who. 5-6 and 4-5 year old subjects had significant differences in questions with what (p=0.005), where (p=0.003), who (p=0.012), and when (p<0.001). Most errors were expressed in question with when.
Conclusion: Subjects of this study had the ability to comprehend and express wh-words. Comprehension of wh-words is easy for 4-6 year-old children they are able to use them in questions, but have some application errors.

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Background and Aim : Learning and memory are two high level cognitive performances in human that hearing loss influences them. In our study, mini-mental state examination (MMSE) and Ray auditory-verbal learning test (RAVLT) was conducted to study cognitive stat us and lexical learning and memory in deaf adults using sign language.

Methods: This cross-sectional comparative study was conducted on 30 available congenitally deaf adults using sign language in Persian and 46 normal adults aged 19 to 27 years for both sexes, with a minimum of diploma level of education. After mini-mental state examination, Rey auditory-verbal learning test was run through computers to evaluate lexical learning and memory with visual presentation.

Results: Mean scores of mini-mental state examination and Rey auditory-verbal learning test in congenitally deaf adults were significantly lower than normal individuals in all scores (p=0.018) except in the two parts of the Rey test. Significant correlation was found between results of two tests just in the normal group (p=0.043). Gender had no effect on test results.

Conclusion: Cognitive status and lexical memory and learning in congenitally deaf individuals is weaker than in normal subjects. It seems that using sign language as the main way of communication in deaf people causes poor lexical memory and learning.

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Background and Aim: Phenylketonuria (PKU) is an inherited metabolic disease. The aim of this study was investigation the intelligence and language function in children with PKU based on the age of treatment onset and quality of dietary control.

Methods: In this cross-sectional study, the language and intelligence of 31 children with PKU at the age of 4 to 6.5 years were investigated by test of language development-third edition ( TOLD-3) and Wechsler preschool and primary scale of intelligence (WIPPSI), respectively the data compared with of 42 normal children. Patients were classified into 2 groups with different level of dietary control as good and poor [serum phenylalanine (Phe) level less and more than 6 mg/dl, respectively].

Results: There were significantly differences (p=0.001) between children with PKU and controls in intelligence and language scores. Early treatment improved significantly the intelligence and language scores in comparison with late treatment (p=0.019). Comparing late treatment before and after the age of 1 year showed that late treatment until 1 years of age improved significantly (p=0.050) all of functions except performance intelligence quotient (IQ). In early treated PKU, good dietary control improved significantly (p=0.021) and also, verbal and total IQ in comparison with poor dietary control.

Conclusion: Although, the language development in children with PKU is affected by age of treatment onset, cognitive development features such as verbal and total IQ is affected not only by the time of treatment onset but also by the quality of dietary control.

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Background and Aim : Nasalization of a vowel refers to the addition of nasal resonance to the vocal tract transfer function. Also, vowel nasalization occurs because of coarticulation. Coupling of the nasal resonating space to the oropharyngeal cavity alters the vocal tract formants in complex ways. The purpose of this study was to investigate the effect of nasalization on /a/ vowel formants in before and after nasal consonant.

Methods: In current cross-sectional study, voice samples of 60 normal children ranging the age of four-nine years were investigated. Participants were asked to repeat / ʔ ama/ three times and vowel /a/ after presentation of an auditory model. Then, obtained samples were analyzed using Praat 5.3.13 . Average of F₀, F₁, F₂ and F₃ were calculated for /a/ comes before and after /m/ in production of / ʔ ama/ over three trials.

Results: There were statistically significant differences of F₁, F₂ and F₃ between / a/ which proceeds nasal consonant and /a/ follows nasal consonant , the before nasal consonant /a/ versus single /a/ and the after nasal consonant /a/ versus single /a/ (p=0.001 for all).

Conclusion : F₁, F₂ and F₃ in /a/ before nasal consonant affected by anticipatory nasal coarticulation and in /a/ after nasal consonant affected by carry-over nasal coarticulation . This study showed nasal coarticulation and nasalization result in decreasing F₁, F₂ and F₃ in /a/ vowel.

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Backgrand and Aim: The measurement of speech intelligibility refer to determining the measure of speech intelligibility in communication. The speech intelligibility is used for decision-making in intervention, the determination of intervention goals, and the measurement of intervention outcomes. This study aimed to investigate the speech intelligibility among the children aged 36 to 60 months.

Methods: In this cross-sectional study, 360 healthy children (180 girls and 180 boys) were chosen among children of kindergardens in Khorramabad city, Iran. Speech sample of subjects was collected by calling pictures of Hydari et al 2010, speech intelligibility measurement test (2010). The voices of the subjects were tape-recorded and speech intelligibility of children was studied within 12 age-groups arranged by two months.

Results: The minimum speech intelligibility was concerned to 36 and 37 months old and the maximum was concerned to 58 and 59 months old. There was a significant differences among age-group 36 and 37 months old with 44 and 45 months old and above, age-group 38 and 39 months old with 55 and 54 months old and above, and age-group 40 and 41 months old with 58 and 59 months old (p<0.05 for all). There was no significant difference among other age groups. There was no significant difference between boys and girls.

Conclusion: Speech intelligibility has the highest growth during the age of 36 to 46 months and it had lowest growth during the age of 46 months and elder range.