Background and Aim: Metaphor is a vital element of human communication, facilitating the expression of complex ideas and emotions. However, little is known about metaphor in individuals who are Deaf or Hard-of-Hearing (DHH). This systematic review addressed a critical knowledge gap by providing the first comprehensive synthesis of methodologies used to study metaphor competence in individuals who are DHH. It aimed to build a cohesive understanding by examining the types, characteristics, and limitations of the tasks employed, which have not been previously aggregated and analyzed.
Recent Findings: An initial search of 331 articles was narrowed to 53 after removing duplicates and screening titles. An additional 10 articles were found through supplementary searches. After a full-text review, 29 articles were excluded for being irrelevant outcomes or language, leaving 24 eligible studies for the final analysis. 926 DHH and 1234 normal hearing participants were analyzed. Results revealed considerable variability. While some studies report no significant differences between DHH and hearing individuals, others indicate that DHH individuals have difficulties with metaphor, especially with complex or novel forms.
Conclusion: This review provides the first comprehensive overview of metaphor competence in DHH individuals, revealing its multidimensional nature and the impact of multiple linguistic and developmental factors. It underscores the need for targeted research and the creation of suitable assessment tools to inform educational and clinical practices, supporting improved metaphor comprehension and use in DHH populations.

Background and Aim: Due to the annoying nature and prevalence of dizziness, vertigo, and imbalance, the need for rapid diagnosis, and challenges in the differential diagnosis of various vestibular disorders, this study aimed to translate the Dizziness Symptom Profile (DSP), which is a self-report tool that helps clinicians differentiate the most common vestibular system disorders, into the Persian language and evaluate its validity, reliability, sensitivity, and specificity.
Methods: The profile was translated into Persian as DSP-P. Face, known-groups, and concurrent validities, internal consistency, test-retest reliability, sensitivity, and specificity were determined. 253 patients with dizziness and 59 healthy individuals completed the DSP-P before visiting the otolaryngologist, and the agreement between the proposed diagnoses of DSP-P and the final diagnosis of the otolaryngologist (our gold standard) was examined.
Results: The qualitative face validity of DSP-P was confirmed. There was a significant difference between the mean scores of the study groups (p<0.001). The diagnosis of DSP-P was completely in agreement with the gold standard in 53.3% of cases. Internal consistency was excellent (α≥0.81) for all categories except the persistent postural-perceptual dizziness, superior canal dehiscence and unspecified unsteadiness categories (0.62≤α≤0.69). Generally, the test-retest reliability of the DSP-P scores and diagnoses was very good. The sensitivity of DSP-P was 94.4% for diagnosing benign paroxysmal positional vertigo, 93.5% for Meniere’s disease, 100% for vestibular neuritis, 86.3% for vestibular migraine, and 84.2% for persistent postural-perceptual dizziness.
Conclusion: The DSP-P was demonstrated to be a valid and reliable history-based diagnostic tool with high sensitivity and specificity.

Background and Aim: Misophonia is a condition characterized by a reduced tolerance to certain sounds or the stimuli linked to those sounds. Our study aimed to investigate the auditory brainstem functioning using electrophysiological measures in normal-hearing individuals with and without misophonia.
Methods: Thirty participants aged between 18 and 30 years were recruited. They were divided into two primary groups: fifteen individuals diagnosed with misophonia and fifteen controls. The selection of participants with misophonia was based on the diagnostic criteria by Schröder et al. and the MisoQuest questionnaire; Auditory Brainstem Response (ABR) was recorded from all the individuals at lower (11.1/s) and higher stimulus rates (90.1/s).
Results: On analysing the data, individuals with misophonia showed significantly shorter absolute latencies of ABR waves III and V at 11.1/s. Also, there was no significant difference in the absolute amplitude of ABR waves at 11.1/s and 90.1/s between the individuals with and without misophonia.
Conclusion: This study indicates that the shorter absolute latencies of ABR waves III and V in individuals in misophonia could be attributed to hyperactivity at the sub-cortical pathway regions compared to the control group.

Background and Aim: Background noise, especially in noisy environments such as Neonatal Intensive Care Units (NICUs), can compromise the accuracy of Otoacoustic Emission (OAE) tests by activating the Medial Olivocochlear (MOC) reflex, which suppresses the OAE amplitudes. This study aimed to evaluate whether the contralateral ear occlusion can improve the OAE amplitudes of newborns in noisy environments.
Methods: Thirty full-term newborns with no signs of hearing loss were enrolled. The OAEs, including Distortion-Product OAE (DPOAE) and Transient Evoked OAE (TEOAE),were recorded in the presence of three noises (two white noises at 50 and 60 dB SPL, and one recorded NICU noise) without and with contralateral ear occlusion (using a soundproof headphone). The OAE amplitudes were compared between two open and non-occluded conditions using paired t-test.
Results: After occlusion of the contralateral ear, there was a slight overall enhancement in DPOAE and TEOAE amplitudes in the presence of all noise types, which was statistically significant based on the paired t-test results. This improvement was more considerable in the presence of NICU noise than in the presence of white noise. The improvement in TEOAE amplitude was not as remarkable compared to the DPOAE amplitude.
Conclusion: The contralateral ear occlusion can improve the DPOAE and TEOAE levels in newborns, probably by reducing the activation of the MOC reflex, which can improve the accuracy of OAE tests and reduce the false positive results for newborns in noisy environments, consequently lowering the further diagnostic costs and parental concerns.

Background and Aim: Temporal processing deficits are reported to contribute to speech perception difficulties in noise. However, traditional temporal resolution tasks, which are often conducted in quiet conditions, may not always reflect a noticeable decline in temporal resolution abilities until individuals reach their late 40 s or 50 s. By examining temporal processing under background noise, this study aimed to provide new insights into the early manifestations of age-related auditory decline and its impact on speech perception in noise among early adulthood.
Methods: A Cross-sectional 4 x 2 mixed comparative research design was implemented, with four levels of between-group variables (age groups) and two levels of testing conditions (quiet vs noise). 80 participants with normal hearing were recruited across four groups within the age range of 20–40 years. Temporal Modulation Transfer Function (TMTF) was measured under a quiet and noisy background for broadband stimuli for nine modulation frequencies (2 Hz–512 Hz). Signal-to-Noise Ratio 50% (SNR50) was measured using an adaptive procedure for nonsense words.
Results: One-way analysis of variance revealed a significant age-related decline in TMTF after 35 years, with a more pronounced deterioration in noisy conditions, particularly at higher modulation frequencies. Paired t-test revealed a significant impact of background noise became more evident after this age. Additionally, correlation analysis showed a stronger relationship between peak sensitivity, bandwidth, and SNR50 in noisy conditions.
Conclusion: The study concludes that assessing temporal processing in background noise can effectively detect early changes and better explain speech perception difficulties in noisy environments.

Background and Aim: Bacterial meningitis, mainly Streptococcus pneumonia, is a primary cause of profound bilateral sensorineural hearing loss. Post-meningitic cochlear ossification, bony cochlear lumen obliteration, and often complicates Cochlear Implantation (CI) are happen post meningitis. The aim of this study was to evaluate the hearing outcomes and complications of CI in patients with hearing loss due to bacterial meningitis
Methods: A 10-year retrospective review of 45 patients (pediatric and adult) underwent CI after bacterial meningitis at Martyr Gazi Alhariri Hospital, between 2012 and 2022. The outcomes were analyzed using speech perception scores, radiological imaging findings, and surgical reports for each patient.
Results: Early implantation (≤3 months post-meningitis) correlated with higher open-set speech recognition. Ossification severity inversely predicted electrode insertion depth (r=–0.67, p<0.01). In terms of audiological outcomes, open-set speech recognition was achieved in 62.2% of the patients (28/45), and pediatric showed significantly better performance than adults (75.0% vs. 35.3%). Similarly, early CI (≤3 months post-meningitis) was associated with higher rates of open-set speech recognition than was delayed implantation (>3 months) (72.7% vs. 43.5%; p=0.003). The mean Speech Intelligibility Rating (SIR) score for the entire cohort was 3.4±1.2, with pediatric patients scoring significantly higher than adults (4.1±0.8 vs. 2.7±1.1, respectively; p=0.01).
Conclusion: Early CI and computed tomography imaging are critical for achieving better outcomes in post-meningitic deafness. Anticipatory CI within three months of postmeningitis enhances outcomes. Advanced imaging and adaptable surgical strategies can alleviate ossification-related challenges.

Background and Aim: Accurate diagnosis of Middle Ear Effusion (MEE) is a challenging task due to the lack of reliable diagnostic tools available to physicians and audiologists. This study aimed to develop a hyperspectral imaging tympanoscope for diagnosing MEE and evaluate its diagnostic ability.
Methods: The tympanoscope system was constructed using an ear endoscope, lens, camera, and near-infrared wavelengths. Its diagnostic ability was evaluated with a middle earmimicking phantom. Additionally, a pilot study was conducted on middle ear images from 10 children (five healthy and five with MEE).
Results: Phantom experiments revealed a Weber contrast difference of 0.16 and 0.49 between phantoms with and without fluid in visible otoscopy and hyperspectral tympanoscopy, respectively. As a result, in hyperspectral tympanoscopy, the contrast difference between fluid presence and absence was nearly tripled. Furthermore, in the pilot study, a significant difference was found in Weber contrast between healthy children and those with MEE (p<0.001), with higher contrast in the MEE group.
Conclusion: The hyperspectral imaging tympanoscope can quantitatively distinguish between the presence or absence of fluid in the middle ear. It has potential as a diagnostic and monitoring tool for MEE.

Background and Aim: Noise can lead to temporary or permanent changes in the structure and function of the peripheral and central auditory systems when experienced at high sound pressure levels over time. This study aimed to examine the effects of industrial noise and leisure noise from Personal Listening Devices (PLDs) on central auditory processing and cognitive functions in men with normal hearing.
Methods: In this cross-sectional study, 136 men aged 20–40 were divided into three groups: leisure noise-exposed group due to PLD use (n=45), industrial noise-exposed group (n=46; average Leq<90 dB (A)/8 hours), and control group (n=45, with no history of noise exposure). All participants had normal audiograms. To evaluate central auditory processing, we used the dichotic digits test, the duration pattern sequence test, and the quick speech-innoise test. Cognitive abilities were assessed using the Rey auditory verbal learning test and the semantic Stroop test.
Results: The industrial noise-exposed group had significantly lower scores in all central auditory and cognitive tests compared to the leisure noise-exposed and non-exposed groups (except for the reaction time and the semantic Stroop test). The leisure noise-exposed group also showed impairments in speech-in-noise perception, short-term memory, and selective attention relative to the non-exposed group. Additionally, a negative correlation was found between noise exposure level and speech-in-noise performance.
Conclusion: Both industrial and PLD noise exposure can impair central auditory and cognitive functions in men with normal hearing, highlighting the need for broader assessments in noise exposure monitoring.

Background and Aim: Cochlear Implants (CIs) can successfully improve the speech and auditory perception in patients with a severe to profound hearing loss. This study aimed to assess the psychometric properties of the Persian Hearing Implant Sound Quality Index (P HISQUI19) for measuring the perceived auditory benefits of Iranian adult CI users in everyday listening situations.
Methods: Participants included 70 Iranian CI users with post-lingual deafness aged 18–64 years. After translation and cross-cultural adaptation, the content and construct validity of the P HISQUI19 were examined, followed by internal consistency and test–retest reliability assessments using Cronbach’s α and Intra-Class Correlation Coefficient (ICC), respectively.
Results: The mean total P HISQUI19 score was 78.22, indicating a moderate sound quality perception. The P HISQUI19 had excellent internal consistency (Guttman’s splithalf coefficient=0.912; Cronbach’s α=0.956) and test-retest reliability (ICC=0.962). Using factor analysis, the items were loaded on three factors. Age at implantation, duration of deafness, side of implantation, gender, and MED EL implant system (CONCERTO Mi1000 vs. SONATA Ti100) did not significantly affect the sound quality perception.
Conclusion: The P HISQUI19 is a valid and reliable tool to be used in both research and clinical settings for evaluating the auditory benefits of Iranian adults using CI.

Background: It takes some time for a patient to adapt to a Cochlear Implant (CI). Usually, the improved speech perception after cochlear implantation is reported within 3–6 months. In this study, we reported a case of a female child with post-meningitis deafness who showed considerable recovery in speech perception just a few days after cochlear implantation.
The Case: The case was a 14-year-old female with complaints of severe headache, delirium, unresponsiveness to sound, and agitation, diagnosed later with meningitis. Pure tone audiometry showed total deafness in her right ear and severe to profound sensorineural hearing loss in her left ear. Seven months after deafness, she received a CI (Nucleus CI512) in the right ear. Its speech processor was activated two weeks after surgery. The first map was programmed using the advanced combination encoder strategy, along with behavioral measurements of T-levels and C-levels. Four days later, the audiometric test revealed a Pure-Tone Average (PTAve) of 35 dB HL, accompanied by a Speech Discrimination Score (SDS) of 72%. The Bamford-Kowal-Bench (BKB) sentence test yielded a score of 80% in silence. Two weeks after device activation, PTAve was 20 dB HL, the SDS was 86% and the BKB sentence test score in silence was 100%.
Conclusion: It seems that factors such as short duration of deafness, precise mapping of the CI speech processor, consistent device usage, and rich aural environment can lead to significant improvement in speech perception within two weeks after cochlear implantation in patients with post-lingual deafness.