Auditory and Vestibular Research
Volume:33 Issue: 2, Spring 2024

Postural stability is monitored by a circuitous system, particularly visual perception, vestibular apparatus, and somatosensory organs. The ability to maintain balance is significantly compromised in children with visual impairment and has higher risks of falls than the normal sighted children. Children with visual disability reported delayed motor dexterity such as eye-hand coordination, gross and fine motor control involving struggle in gait procurement and postural control. Vestibular rehabilitation is the relevant therapy to restitute for maintaining postural control in the absence of visual information. This study aimed to find the effect of vestibular rehabilitation on postural stability in children with visual impairment.

A quasi-experimental study was done in pre and post-test type design on 30 boys in the age group of 7-16 years’ children with visual impairment. Vestibular rehabilitation therapy was used as the exercise protocol to improve functional balance and reduction of falls in children with visual impairment for six weeks.

Statistical analysis was done between pre-test and post-test readings with SPSS 20 and there is a significant difference between the pre-test and post-test of total score and individual scores of Pediatric Balance Scale (PBS) after the intervention, since (p<0.05).

Vestibular rehabilitation therapy improved the capability of postural controlling and reduces the risk of falls to an extent in children with visual impairment.

The Persian version of the University of Cincinnati Auditory Processing Inventory (P-UCAPI) is used to evaluate auditory processing disorders in Iranian people using six subscales, each focusing on different auditory skills. In this study, we aimed to compare the total score and the subscale scores of the P-UCAPI among three age groups to evaluate the impact of aging on auditory processing.

Participants in three age groups of 20, including 21–39 years (group A), 42–60 years (group B), and 61–80 years (group C) completed the P-UCAPI. One-way ANOVA and Welch’s t-test was used to compare the mean scores of each subscale among the three groups.

The mean scores of listening and concentrating (p<0.001), understanding speech (p<0.001), attention (p=0.010), and other (p<0.001) were significantly lower in group C compared to group A. The mean scores of listening and concentrating (p=0.001), understanding speech (p<0.001), and other (p<0.001) were significantly lower in group C compared to group B. The mean total score was not significantly different between groups A and B (p=0.333). However, the difference was significant between groups A and C (p<0.001) and between groups B and C (p<0.001).

The increase of age affects the auditory processing and generally reduces the auditory performance.

Speech is a vital stimulus and the ultimate goal of hearing aid fitting to make the speech an audible signal. The purpose of this research was to investigate whether it is possible to track the threshold with speech phonemes and which of the two fitting methods of Desired Sensation Level version 5.0 (DSL v5.0) and National Acoustic Laboratories-Nonlinear 2 (NAL-NL2) provide better audibility for the phonemes.

In this cross-sectional study, the unaided thresholds of 18 normal-hearing children and the aided thresholds of 15 hearing-impaired children aged 5-8 years were evaluated with two types of stimuli. DSL v5.0 and NAL-NL2 methods were used for hearing aid fitting in hearing-impaired children.

There was a significant relationship between the unaided and aided thresholds of each phoneme and the warble tone threshold at the corresponding frequency (p<0.01), except for the phoneme /s/. The results showed a significant difference between the aided thresholds of each phoneme and the upper limit of the speech banana in the corresponding frequency for each method (Z=–4.99, p≤0.001).

The results showed that phonemes could be used to assess unaided and aided thresholds. In the first fit, both methods estimated the amount of amplification that caused the average aided thresholds for these six phonemes for moderate to severe hearing loss to be positioned within the speech banana range, except for the average aided thresholds for the /s/ phoneme in the NAL-NL2 method that was placed outside the range.

Sensorineural Hearing Loss (SNHL) reduces audibility and causes distortion, which result in difficulty with speech processing, especially in noisy environments. One of the new speech-in-noise tests is the Words-in-Noise (WIN) test. This study aimed to further investigate the Signal-to-Noise Ratio 50% (SNR-50) in subjects with mild to severe SNHL and different configurations using the Persian version of the WIN test compared to normal-hearing people.

This cross-sectional study was conducted on 54 patients with SNHL aged 17– 75 years and 49 normal-hearing people aged 20–48 years. The auditory recognition in the presence of multi-talker babble noise was evaluated by the Persian version of the WIN test (named ARWIN).

The mean SNR-50 in the normal-hearing group was 2.56±1.2 dB, which increased significantly in subgroups with mild (10.13±4.8 dB), moderate (14.51±4.7 dB) and moderate-to-severe (16.61±4.3 dB) SNHL (p<0.001).

People with SNHL need more SNR by nearly 4–6 times than the normalhearing group for recognition of monosyllabic Persian words in the presence of multi-talker babble noise.

Experiencing dizziness/vertigo is often an indication of dysfunction in the vestibular system. Recent findings show a connection between peripheral vestibular dysfunction and cognitive impairments. The Neuropsychological Vertigo Inventory (NVI) can assess physical, emotional, and cognitive issues in individuals with dizziness/vertigo. The aim of this research was to translate, cultural adaptation and evaluation of the reliability and validity of NVI to Persian.

In this descriptive-analytical study, the NVI scale was translated and adapted to the Iranian cultural context following the international quality of life assessment protocol for translation and equivalence. After obtaining face validity, the scale was administered to 140 patients with peripheral vestibular system dysfunction and 70 control group (age between 25 and 80 years). After one week, 50 participants were asked to complete the questionnaire again. Eventually, reliability was evaluated with both methods of internal consistency and test-retest reproducibility.

Out of the 28 items in the NVI scale, 3 items were modified to better align with the cultural conditions of Iranians. The impact scores for most items in this scale were found to be higher than 1.5. The Cronbach’s alpha coefficient values for the overall scale (0.90) and test-retest reliability with intra-class correlation coefficient for the overall scale (0.91) were confirmed.

The Persian version of NVI scale demonstrates excellent validity and reliability, and it exhibits a high level of content alignment with the original version. Therefore, it can be a useful tool to better understand the physical, emotional and cognitive disturbances in patients with vertigo/dizziness.

Evidence-Based Practice (EBP) is recommended by specialists for curing the patients more than other conventional treatments. In tinnitus management, Cognitive-Behavioral Therapy (CBT) is the only EBP-based method. Different factors, such as training, can affect the therapists’ attitudes towards the use of these treatments. This study aimed to investigate the effect of a training program in CBT on Iranian audiologists’ attitudes towards using CBT for tinnitus management.

This descriptive-analytical study was conducted on 88 audiologists (including 65 females) with a mean age of 33±9.54 years, who were randomly divided into two groups of intervention (receiving CBT training) and control (no training). The data were collected by a researcher-made demographic/clinical questionnaire and the Persian version of the Evidence-Based Practice Attitude Scale-35 (EBPAS-P35), which was completed before and after training.

Comparison of the total score of EBPAS-P35 showed a significant difference in the intervention groups before and after training (p<0.001). In addition, all EBPAS-P35 subscales scores were significantly different before and after training in the intervention group (p<0.001). A positive significant correlation was observed between the total score of the EBPAS-P35 and two factors of age (r=0.38, p=0.009) and clinical experience (r=0.34, p=0.009).

Training in CBT can improve the attitude of audiologists in Iran towards using CBT for tinnitus management in patients. The age and clinical experience can affect the attitude of audiologists toward using CBT.

There is evidence of associations between noise exposure and psychological outcomes from noise annoyance. This study aims to examine the mediating role of noise annoyance in the relationship of noise exposure with Emotional Intelligence (EI) and Cognitive Emotion Regulation (CER).

This is a cross-sectional study that was conducted on 58 male workers of a lead mine in Yazd, Iran. Noise exposure was determined based on ISO 9612:2009. Noise annoyance was assessed using the ISO/TS 15666:2003’s numerical rating scale. The Schutte Self-Report Emotional Intelligence Test (modified version) and the Cognitive Emotion Regulation Questionnaire (CERQ) were used for data collection. Mann-Whitney U test, correlation test, and Generalized Structural Equation Modeling (GSEM) were used to analyze the data.

The mean age of workers was 35.78±7.10 years. A significant relationship was found between noise annoyance and noise exposure, such that a unit increase in noise exposure had a multiplicative effect on the odds of experiencing more annoyance (p<0.001). Also, for every one-unit increase in noise annoyance, mean scores for EI and CER decreased by 0.192 and 0.172, respectively.

Noise exposure is directly related to noise annoyance and indirectly related to EI and CER. Further studies in this area are recommended to clarify the issue and the relationships between these variables.

There is limited study on the role of rostral efferent auditory pathway on Outer Hair Cell (OHC) activity. We investigated the effect of integrating alternate auditory attention (ALAUDIN©) tasks with White Noise (WN) and its reliability using contralateral suppression of Transient Evoked Otoacoustic Emission (TEOAE).

This study was conducted at the Audiology Clinic, Universiti Kebangsaan Malaysia, with fifty normal-hearing adults. All subjects underwent standard audiological testing to ensure normal hearing, middle ear, and cochlear function. Contralateral suppressors with and without attention tasks were delivered randomly to the non-test ear while simultaneously measuring TEOAE amplitude in the test ear to investigate the effect of auditory attention on OHC electromotility. Suppressors with and without attention refer to the combination of a 1000 Hz tone and speech stimulus embedded in WN and WN alone, respectively. Subsequently, the difference in TEOAE amplitude during the presence and absence of suppressors was calculated, and thus suppression magnitude was determined.

Intraclass correlation revealed that 4 suppressors produced high reliability. In paired sample t-tests, the tasks significantly reduced the amplitude of the TEOAE in the right ear compared to the left ear (p<0.05). However, the suppression magnitude did not differ significantly between ears (p>0.05). Descriptively, females showed greater TEOAE suppression.

This study demonstrated that directing ALAUDIN© tasks to one ear can affect OHC electromotility, as evidenced by TEOAE amplitude changes, but it did not impact the overall suppression magnitude. Additionally, it hinted at potential gender differences in TEOAE suppression, warranting further investigation.

Several laboratory tools are used to evaluate balance disorders but, there is still no screening test to determine the site and the severity of the lesion. The aim was to investigate whether video Head Impulse Test (vHIT) can be used as a screening test in patients with chronic or recurrent vertigo and dizziness.

The files of 965 patients who were followed up in our vertigo outpatient clinic were reviewed retrospectively. Vestibulo-Ocular Reflex (VOR) gains and saccadic movements of the right and left lateral canals in the vHIT test, and Canal Paresis (CP) in the Caloric Testing (CT) were noted.

A total of 325 patients were included in our study. In CT results, the group that CP was most frequently detected was Menière’s Disease (MD) group (71 patients (74.7%). While vHIT results were found to be pathological in the vast majority of patients in the Vestibular Neuritis (VN) group (72.7%), the results were found to be normal at the highest rate in the vestibular migraine group (77.9%). Correlation analysis showed a significant but weak correlation between the degree of CP in the CT and the VOR gains of the lateral canals in vHIT in all groups.

Although it has high sensitivity in cases with VN and vestibulopathy, we think that vHIT cannot be used as a screening tool in patients with vertigo, especially for chronic cases, since its sensitivity rate differs in the long term according to the cause of the disease.

Path integration refers to the capability of utilizing self-motion information produced by one’s own bodily movements to accurately determine and maintain one’s position in space. Typically, path integration mechanisms come into play when visual information is limited or absent. The objective of this study was to develop a path integration test that relies solely on self-motion cues derived from body movements, without the involvement of visual cues.

The study involved 157 volunteers (86 females and 71 males) aged between 18 and 70 years. Participants were asked to walk on a coordinated ground with their closed eyes and follow the six different commands. They were, after that, requested to return their initial position. Movement time was manually measured by the stopwatch. The distance between the original reference point and estimated starting point was recorded.

The second command that showed the lowest standard deviation out of the six commands given to the participants was observed as the more reliable test among the other commands (47.51±33.75). In addition, the completion time of the second command increased with increasing age (p<0.001).

This study introduces an innovative spatial navigation approach utilizing the second command set. As an alternative, this command can be used to assess the human spatial navigation system.

Mucopolysaccharidosis (MPS II) is a group of rare lysosomal storage disorders, with seven sub-types. MPS II also known as Hunter’s syndrome is the only subtype that is affected by X-linked inheritance, while the others are of autosomal inheritance. 

The Case:

The study aimed to discuss the impact of Hunter syndrome, its pathophysiology, assessment diagnosis, audiological profiling, rehabilitation, and prognostic factors in a child diagnosed with MPS II at the age of 4 years. The auditory symptoms begin around at the age of 2–4 years, as the harmful molecule builds up in the middle ear bone sizes resulting in joint stiffness, and conductive hearing loss gradually progressing into mixed hearing loss with varying degree. Each audiological test finding was linked to the pathophysiology of MPS II, with the discussion emphasising suitable rehabilitative options and importance of multidisciplinary management of hunter syndrome.

The atypical manifestations of MPS II with fluctuating hearing loss is suggestive of the need for early identification, adequate profiling, appropriate rehabilitative measures and role of allied professionals in management of the disorder.