Vol 22 No 3 (2013)

Published: 2013-10-30

Review Article(s)

  • XML | views: 256 | pages: 1-13

    Background and Aim: Cervicogenic dizziness is induced by a specific neck position and the earth’s gravity has no effect on provoking of it. The precise incidence of cervicogenic dizziness is not certain but, 20-58% of patients following sudden head injuries experience its symptoms. In this article, the etiology, diagnosis and treatment of cervicogenic vertigo is discussed.
    Methods: At first, articles of cervicogenic dizziness from electronic databases of Google scholar, PubMed, Scopus, Ovid and CINAHL were searched from 1987 up to 2012. Then, the articles in them vertigo, disequilibrium or nystagmus were consistent with neck disorders were searched.
    Conclusion: Articles with title of cervicogenic vertigo (cervical vertigo) were limited. Clinical researches about cervicogenic vertigo up to now implicate on several points; all signify that we cannot diagnose it certainly and there is not any specific single test for that. Recently, smooth pursuit neck torsion test (SPNTT) has introduced for diagnosis of cervicogenic vertigo that is not valid yet. There is no protocol for diagnosis of cervicogenic vertigo and diagnosis is often based on limited clinical experiences of clinicians. Physiotherapy, medication and manual therapies are options for treatment but there is no distinct and effective treatment for it and in just one article, a combination of treatments for cervicogenic vertigo as a protocol has recommended.

Research Article(s)

  • XML | views: 132 | pages: 14-22

    Background and Aim: As word recognition score test is one of the most important tests in audiologic test battery and there is no study on reliability and validity of existing monosyllabic word lists, we decided to investigate this in people with noise induced hearing loss.
    Methods: In this non-randomized descriptive-analytic study, 30 adults with noise induced high frequency hearing loss with the age of 18 to 46 years were evaluated. Construct validity was evaluated by comparing Mosleh lists with list NU-6 and reliability was achieved by test-retest (-two-week interval).
    Results: The mean (SD) score of word recognition was 94.01 (3.95) percent for list 2, 90.40 (4.90) percent for list 4, 89.08 (4.43) percent for list 5, and 94.10 (4.11) percent for list 9. A reliability of 94% was achieved in all four lists. Regression analysis revealed that word recognition score (WRS) had decreased in proportion to pure tone average.
    Conclusion: Four lists have good construct validity. All word lists are phonetically reliable too.

  • XML | views: 136 | pages: 23-30

    Background and Aim: Diabetes mellitus is a progressive metabolic disease. Studies about the relationship between diabetes mellitus and auditory impairment have shown variable results in supporting the fact that diabetes may have a complex repercussion on the auditory pathways. We aimed to evaluate hearing in patients with type II diabetes mellitus with behavioral and electrophysiological auditory tests.
    Methods: In a cross-sectional study, we assessed 30 patients with type II diabetes mellitus with the mean age of 43.7 (SD: 1.3) years, ranging 40-45 years, and 30 matched healthy subjects with the mean age of 41.5 (SD: 1.5) years. Subjects were evaluated using auditory brainstem response (ABR) and pure tone audiometry. The results were compared between two groups.
    Results: Pure tone audiometry was normal. There was a significant increased latency for waves I, III, and V, and also, interpeak latencies of I-III, III-V, and I-V waves (p<0.05).
    Conclusion: ABR latency prolongation indicates abnormal nerve conduction velocity in patients with type II diabetes mellitus. ABR can be an important clinical tool for evaluating diabetes influence on cochlear nerve conduction velocity before hearing loss occurs in these patients.

  • XML | views: 136 | pages: 31-41

    Background and Aim: Dichotic listening means presentation of two different auditory stimuli to each ear simultaneously. This study deals with the development of Persian version of Bergen dichotic listening test and its preliminary results on auditory attention and language laterality in adults with normal hearing.
    Methods: Persian version of the Bergen dichotic listening test was instructed by six consonant-vowel syllables to evaluate three conditions of non-forced attention, attention to right and attention to left ears separately. Then, it was performed on 54 right-handed young adults with normal hearing and the mean age of 23.24 (SD=2.78) years from both genders.
    Results: Frequency of correct response in the right ear was higher significantly in two conditions of non-forced attention (83.3%) and attention to the right ear (98.1%), and also was higher significantly in the left ear (-79.6%) in attention to the left (p<0.0001). Laterality index was 31.33% in non-forced attention, 73.30% in attention to the right and -37.50% in attention to the left which was significantly different (p<0.0001).
    Conclusion: Right ear advantage was revealed in non-forced attention that was altered with selective attention to the right and left remarkably result from the effect of top-down processing of brain cortex on bottom-top processing of speech stimulus. These preliminary results showed the performance of Bergen dichotic listening test to test auditory attention and language laterality.

  • XML | views: 151 | pages: 42-51

    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.

  • XML | views: 280 | pages: 52-62

    Background and Aim: An imbalance between phonatory subsystems may lead to disturbing phonatory muscular balance and consequently voice disorders. Based on theoretical issues, criterionbased laryngeal manual therapy, as a novel treatment method which is supported by classical laryngealmanual therapy, can improve voice quality using manual maneuvers combined with phonatory tasks. The present study aimed to report the treating effects of this method on hyperfunctional voice disorders.
    Methods: Twenty adult participants with hyperfunctional voice disorders by the least three months history of voice disorder were selected. The participant’s voices were assessed multidimensionally using acoustic, audio-pecreptual and stroboscopic assessments before and after treatment.
    Results: There were a decrease in jitter (p=0.003) and shimmer (p<0.001) and also, increase in harmonic-to-noise ratio (HNR) (p<0.001) of vowel /a/ after treatment. Besides, there was an increase in harmony to noise ratio (p=0.009) and decrease in jitter (p=0.020) of vowel /i/, too. There were not significant changes in shimmer amount of vowel /i/ (p=0.170) after treatment. There were highly significant changes in all aspects of audio-perceptual (p<0.001) and videostroboscopic (p<0.001) parameters.
    Conclusion: Using voice-based laryngeal manual therapy can be a treatment method in handling
    hyperfunctional voice disorders

  • XML | views: 109 | pages: 63-73

    Background and Aim: Developing appropriate curriculum for the education of deaf children depends on identifying the needs of this group. We aimed to examine educational rehabilitating needs of hearing-impaired children from the point of view of their parents.
    Methods: In this descriptive survey study, data gathering tool was a researcher-made questionnaire completed by 64 parents of deaf children.
    Results: Parents expressed that fitness of training with the students in school, willingness to participate in the program, and the use of auditory-verbal therapy as a good way were the main notification preferences to families of hearing-impaired children, exceptional centers, and advertisements. They emphesied that lack of appropriate facilities, children's pertinacity, and their lack of cooperation prevented the implementation of training programs and curriculum in educational enters and home. Good verbal communication and speech was as the parents' first priority expectation of their child at the end of course. There was a significant difference between parents' opinions about the educational needs and rehabilitation (p<0.05). No significant difference was seen between the parents' suggestions about educational problems of hearing-impaired children (p>0.05). Also, there was no significantly association between the gender of child or the educational level of parents with the parents' view.
    Conclusion: It seems that parents should be supported by training workshops and consulting. Also, most of the children in this study were trained auditory-verbally and the results do not mean that other educational and rehabilitation methods have not the discussed characteristics.

  • XML | views: 169 | pages: 74-82

    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.

  • XML | views: 123 | pages: 83-88

    Background and Aim: Parkinson’s disease (PD) is a progressive neurological disorder resulting from significant decrease of dopamine in the brain. The main and most common symptom of speech disorder associated with Parkinson’s disease, which is kind of dysarthria, is reduction in speech intelligibility. Since this disorder represents damages to acoustic aspects, researchers are attracted to study the relationship between these two disorders. In this study, we assessed the comparison of speech vowels between normal people and patients with Parkinson’s disease.
    Methods: In this cross-sectional study, 18 voice samples of patients with Parkinson’s disease and the same number of samples from normal people in a voiceless environment were recorded and analyzed by Praat software. Data analysis was performed by independent samples and Mann-Whitney tests.
    Results: All variables investigated in two groups showed significant differences. In adults with Parkinson’s disease, F1-F0 in low vowels showed a considerable reduction in respect to normal people (p<0.001). In addition, F2-F1 in high vowels represented a significant decrease in these patients (p<0.05).
    Conclusion: The results indicate that Parkinson’s disease affects formant frequency in patients compared with normal people. Reduction in speech intelligibility can be accurately measured using acoustic procedure.

  • XML | views: 121 | pages: 89-101

    Background and Aim: Behavioral audiometry is the best method of hearing evaluation. Hearing thresholds are estimated with auditory evoked responses in patients who are not able to cooperate in behavioral audiometry. Because rehabilitative decisions are based on behavioral thresholds, it is essential to determine the amount of difference between behavioral and evoked response thresholds. The purpose of this study was to evaluate the difference between functional and auditory steady-state response (ASSR) gains.
    Methods: Twenty six moderate to severe hearing impaired adolescents and adults (age range: 14 to 55 years) participated in this interventional-comparative study. Audiometery and ASSR testing was performed (without hearing aid and then with hearing aid). Finally, functional gain with ASSR gain, and behavioral thresholds with ASSR thresholds were compared using paired t-test and correlation statistical methods. All tests were performed in the sound field.
    Results: The mean difference was 6.19 dB between unaided behavioral and ASSR thresholds, 4.33 dB between aided thresholds, and 2.43 dB between functional and ASSR gains. There was no significant difference between functional and ASSR gains (p>0.05).
    Conclusion: The difference between functional and ASSR gains is less than the difference between behavioral and ASSR thresholds and it has less variability between different frequencies. So, it may be better to use ASSR gain instead of ASSR thresholds in hearing aid fitting in difficult-to-test population.

  • XML | views: 177 | pages: 102-111

    Background and Aim: Staggered spondaic words (SSW) test examines central auditory nervous system. Some researches show stuttering causes hyperactivity in motor system of the right hemisphere and cerebellum and decreases activity in the left hemisphere. During stuttering also, central auditory processing is decreased. The aim of this study was to compare the Persian staggered spondaic word test results between persistent developmental stutterers and normal subjects.
    Methods: Thirty people with persistent developmental stuttering were participants of this crosssectional descriptive-analytic study, which were aged 11 to 40 years. The control group matched for gender and number with stutters. They were 8 females and 22 males, with the age of 11 to 40 years, without any stuttering history, neurological diseases and auditory disorders.
    Results: Stutterers were in normal category in corrected staggered spondaic words test. The mean scores of errors of right compete, right ear, left compete, left ear and total in corrected staggered spondaic words between control and stuttering group showed significant differences. There was a significant relationship between stuttering and effect, too (p<0.05).
    Conclusion: Based on the obtained results of this study, stutterers may have different cortical and subcortical brain activity than people who have not stutter. Central auditory processing abilities of stutterers are weaker than normal people.

Cases Series

  • XML | views: 117 | pages: 112-123

    Background and Aim: Pragmatic impairment is the main cause of communication difficulties in hearing-impaired children and teaching pragmatic skills in these children is too challenging for clinicians. Thus, creating written and formalized therapy plans can be useful for rehabilitation team, clients and therapists.
    Methods: A therapy-plan was designed and content validity of it was determined. A single case subject design (a multiple baselines research design) was used to determine the efficacy of the therapy plan to improve four domains of pragmatic in five hearing-impaired children (5 to 8 years). The experiment was divided into three phases including baseline, treatment and follow-up. Treatment phase consisted of 16 sessions and subjects were enrolled in the phase in stair way. The data were analyzed with effect size and visual analysis.
    Results: According to expert's opinions, the therapy plan of pragmatic skills was valid. Visual analysis of diagrams showed that all subjects progressed in turn-taking, topic maintenance and response to request for clarification domains and the effect sizes (ES) were high (ES>0.8). Also, there were medium effect sizes (0.8≥ES≥0.2) in certain subjects. In request for clarification domain, some of subjects did not show desired improvement by visual analysis and effect sizes were medium. But, others showed improvement and had high effect sizes.
    Conclusion: The therapy plan of pragmatic skills can improve pragmatic skills of moderate-to-severe hearing-impaired children.