Background and Aim: The vestibular system, which involves the peripheral vestibular apparatus and central vestibular pathways, is crucial for balance and posture. In addition to its primary functions, the vestibular system is closely linked with cognitive processes, as evidenced by its connections with the neocortex and limbic system. Vestibular dysfunction has been associated with cognitive impairments, particularly in areas of auditory cognition, where allocating cognitive resources for balance maintenance detracts from higher cognitive functions. This review examines the existing literature on the auditory-cognitive consequences of vestibular dysfunction.
Recent Findings: This systematic review gives comprehensive information about the existing research on the impact of vestibular pathology on auditory cognitive abilities. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 226 articles were initially identified, with six studies meeting the inclusion criteria after thorough screening. The review highlights the varied effects of vestibular dysfunction on auditory cognition, revealing significant impairments in auditory working memory and attention, particularly in conditions like bilateral vestibulopathy and vestibular migraine. However, inconsistencies in the literature regarding specific vestibular pathologies and their impact on auditory cognition underscore the need for further targeted research.
Conclusion: The findings suggest a complex interplay between vestibular function and auditory cognition, with implications for the diagnosis and management of cognitive deficits in individuals with vestibular disorders.

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.
Conclusions: 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: 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 is 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 (CT)  imaging are critical for achieving better outcomes in post-meningitic deafness. Anticipatory CI within 3 months of post-meningitis enhances outcomes. Advanced imaging and adaptable surgical strategies can alleviate ossification-related challenges.

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.
Conclusions: The DSP-P was demonstrated to be a valid and reliable history-based diagnostic tool with high sensitivity and specificity.

Background and Aim: Persistent postural-perceptual dizziness (PPPD) is a chronic vestibular disorder characterized by persistent dizziness, non-spinning vertigo, or unsteadiness exacerbated by moving visual stimuli and upright postures. Vestibular rehabilitation therapy (VRT) has shown favorable outcomes. While noisy galvanic vestibular stimulation (nGVS) has been associated with improvements in various psychiatric and neurological conditions, its efficacy in PPPD remains unclear. This study aimed to assess the effectiveness of VRT, nGVS, and their combination on patients with PPPD in terms of postural control, dizziness, anxiety, and depression.
Method: Twenty-seven patients diagnosed with PPPD were randomly assigned to three groups receiving treatment for six weeks: 1) VRT, 2) GVS, and 3) VRT+GVS. Outcome measures included static postural control parameters, Dizziness Handicap Inventory (DHI), and Hospital Anxiety and Depression Scale (HADS) scores.
Results: All groups demonstrated significant improvements in subjective measures (DHI and HADS) following treatment. Postural control improvements were observed only in specific conditions within each group, with no overall significant differences between the groups except for mediolateral (ML) path length with eyes closed on a soft surface. Significant correlations were observed between improvements in postural control outcomes and questionnaire scores within each group. 
Conclusion: VRT and GVS, both individually and in combination, were effective in subjective measurements but had minimal impact on static postural control. Adding nGVS to VRT did not provide additional benefits for PPPD patients. The correlations between postural control and psychological outcomes suggest that improvements in perceived dizziness, anxiety, and depression may be linked to postural stabilization.
Trial Registration Number: The study was registered in the Iranian Registry of Clinical Trials on 18 September 2023 (IRCT20160131026279N6).

Background and Aim: To understand the difficulties of elderly in natural listening situations, the present study assessed the ability of participants to extract phonetic information and semantic information in noise. The main objective was to evaluate the relationship between age and performance in Semantic Information Processing (SIP) and Phonetic Information Processing (PIP) tasks.
Methods: Fifty-three normal hearing participants aged 40 to 65 years were categorized into five age groups. Participants underwent information processing assessments using standardized semantic and phonetic questions from Kannada stories under Signal-to-Noise Ratios (SNR) i.e., quiet, 0 dB SNR, and –4 dB SNR conditions.
Results: Younger participants outperformed older participants in both SIP and PIP tasks. Performance was optimal in quiet conditions, followed by 0 dB and –4 dB SNR. Except at –4 dB, PIP scores exceeded SIP scores. A significant differences was observed between the groups 1–4 and group 5 at 0 dB SNR in PIP condition only. A moderate negative correlations indicated that performance in both SIP and PIP declined with age, with linear regression revealing reductions of 0.216 and 0.210 each year in SIP and PIP respectively.
Conclusion: Age-related declines in PIP were noted at one SNR, while SIP remained stable, aligning with the Transmission Deficit Hypothesis (TDH). Nonetheless, regression analyses indicated a general decline in both SIP and PIP with age, supporting the Inhibitory Deficit Hypothesis (IDH).

Background and aim: Speech prosody, the nonlinguistic elements of speech that convey emotions, is crucial for social interactions and speech comprehension. This study aimed to investigate the Validity and reliability of the Speech Prosody Comprehension Test (SPCT) for Persian-speaking children aged 7-10.
Method: The Persian version of the Speech Prosody Comprehension Test (P-SPCT) was investigated. Face, construct, and discriminant validity, Test-retest reliability, and Internal consistency were examined on 32 children in age 7-10 with 22 (mean age ± SD = 8.63 ± 1.04) normal hearing and 10 (mean age ± SD = 9.20 ± 0.78)with cochlear implant )CI).
Results: Our result demonstrated good face validity. Construct validity revealed strong correlations in intra-sub score items and between subscales and the total score. A significant difference in mean scores was found between normal hearing and cochlear implant user, supporting discriminant validity (P<0.001). High test-retest reliability was demonstrated, with intraclass correlation coefficients (ICCs) ranging from 0.91 to 0.99 for total and all subscales. The measure demonstrated good internal consistency, with a Cronbach's alpha 0.89 for total score.
Conclusion: The Persian version of Speech Prosody Comprehension Test was found to be a valid and reliable clinical tool for assessing speech prosody comprehension in children aged 7-10. Further research with larger samples can confirm the generalizability of these findings.

Objective:  Recent studies try to clarify the difference of neuro-physiological responses of subject with tinnitus. The eye situation (open/close) is challengeable in electroencephalography researches. QEEG analysis are different on eyes close or open, so the recording of brain activities must be clarified by eyes condition. This study aimed to investigate this further in terms of differences in EEG activity between closed and open eyes condition in resting position of tinnitus patients.

Method: QEEG was analyzed in forty-six subjects with tinnitus (34 men and 12 women), in two eye conditions (open/close) for 3 minutes at resting position. Relative power of delta, theta, alpha, beta and gamma bands estimated by sLORETA software. Average of 30 electrodes across the scalp was measured for relative power at each rhythm separately and also, Paired T-test analysis for comparison of Delta/Alpha (DAR), Delta+Theta/Alpha+Beta (DTABR) between open/close eyes were done.

Results: In close eyes condition DAR and DTABR reduced significantly (p=0.009 and p=0.016) in comparison to open eyes. Relative power of delta increased in open eyes whereas surprisingly, alpha reduced significantly in compare to close eyes condition (p<0.001). There was not significant difference between two conditions at theta, beta and gamma rhythms.

Conclusion: Subjects with tinnitus indicate difference EEG activities at two eyes conditions. These changes, in Alpha band is completely revers in comparison to normal subjects that documents at previous researches. Increase of relative power of Alpha in close eyes and reduce of Delta power may be indicate sever tinnitus based on QEEG data. It seems that is better to select open eyes condition for QEEG analysis. Increase of DAR is a good variable in open eye condition and this study suggest the use of it as a potential biomarker for comparison of the severity of tinnitus.

Background and aim: Previous studies have demonstrated that uncompensated Unilateral Vestibular Neuritis (UVN) is a most prevalent cause of dizziness. Despite the many advantages, use of Conventional Vestibular Rehabilitation (CVR) in UVN patients have limitations. The use of tool-based rehabilitation methods can be more pleasant to patients and encourage them to complete the rehabilitation course. This study aimed to compare the effects of combined Whole Body Vibration (WBV), Galvanic Vestibular Stimulation (GVS) and CVR in patients with UVN.
Methods: UVN patients in the age range of 30 to 50 years were randomly divided into three groups with 17 participants each. first group received of CVR, the second group received CVR+WBV, and the third group received CVR+WBV+GVS, which included four weeks of CVR, twenty 5-minute sessions of WBV and eight 20-minute sessions of GVS. Outcome measurements were postural control parameters, Vestibulo-Ocular Reflex (VOR) gain asymmetry, joint position sense error (JPSE) and Dizziness Handicap Inventory (DHI) scores that were assessed at baseline and after four weeks.
Results: There was a significant improvement in all measured variables after the CVR, CVR+WBV and CRV+WBV+GVS treatments. Moreover, the CVR+WBV and CRV+WBV+GVS groups showed significantly greater improvement than the CVR group in posturography results, JPSE and DHI score (p < 0.05) except VOR gain asymmetry (p > 0.05).
Conclusion: CVR, CVR+WBV and CRV+WBV+GVS treatments effectively improve balance function. CVR+WBV and CRV+WBV+GVS training shows additional therapeutic effects in UVN patients. When CVR combined with WBV and GVS, shows additional therapeutic effects in UVN patients.

Background and Aim: This study compared the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria for Meniere's Disease (MD) with vestibular staging methods that address inner ear progression, a consideration not found in the AAO-HNS criteria.
Methods: A cross-sectional study recruited patients with MD, aged 18 to 60, from June 8, 2022, to March 20, 2023; however, we excluded patients with problems such as difficulty rolling their eyes, difficulty turning their head, conductive or mixed hearing loss, cental nerves system disorders, retrocochlear lesions, pregnancy, and receiving psychotropic drugs. Furthermore, patients with a history of labyrinthitis, vestibular migraine, stroke, benign positional vertigo, or bilateral vestibulopathy within the past 6 months were excluded. All patients were tested with audiometry, vestibular evoked myogenic potential, caloric test, and video head impulse test. Two neuro-otologists assessed and classified patients with MD according to the AAO-HNS (1990 and 2020) criteria.
Results: Forty-two patients were enrolled. The correlation between vestibular staging and both AAO-HNS (1990 and 2020) criteria was medium (p=0.02 and p<0.01, respectively). According to AAO-HNS 1995, 69% of definite MD cases were classified as stage C, whereas all probable MD cases and 30% of possible MD cases were categorized as stage B. Regarding AAO-HNS 2020, 70% of definite MD cases were classified as stage C, whereas 33.3% of probable MD cases were classified as stage B.
Conclusion: Definite MD could predict pathology in the cochleo-sacculo-utricular and lateral canals (stage C), whereas probable MD could suggest that the lesion involved the cochleo-sacculo-utricular canal (stage B).
Trial registration: This trial was registered at Thai Clinical Trials Registry on June 6, 2022 (TCTR20220606003)

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: Tinnitus, the perception of sound without an external source, can significantly impact one’s quality of life. Although no definitive cure exists, various treatments aim to reduce symptoms. This study aimed to evaluate the results of the sound therapy, transcranial direct current stimulation (tDCS), and low-level laser therapy (LLLT) in managing chronic tinnitus.
Methods: In a randomized clinical trial, 78 adults with chronic tinnitus and normal hearing were divided into three groups to receive either sound therapy, (tDCS), (LLLT). All participants received treatment over six weeks. Psychoacoustically, we assessed tinnitus pitch, loudness, minimum masking level (MML), and residual inhibition (RI). Loudness and distress were also measured using visual analog scales (VAS), and functional impact was evaluated using the Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI). Auditory Brainstem Response (ABR) testing was performed to assess neural conduction.
Results: All interventions significantly reduced tinnitus loudness, MML, and distress (p < 0.05). Sound therapy showed the most significant improvements in THI, TFI, and VAS scores. No significant changes were found in ABR latencies. Post-hoc analysis revealed greater benefits in the sound therapy group for THI and TFI compared to the others.
Conclusion: While all approaches showed promise in reducing tinnitus symptoms, sound therapy proved to be the most successful intervention. To improve procedures and investigate customized strategies, more research is required.

Background and Aim: Background noise, especially in environments like neonatal intensive care units (NICUs), can compromise the accuracy of otoacoustic emission (OAE) testing by activating the medial olivocochlear (MOC) reflex, which suppresses OAE amplitudes. This study evaluated whether attenuating sound to the contralateral ear could improve OAE measurements in noisy environments.
Method: Thirty full-term newborns with no signs of hearing loss were enrolled. OAEs, including distortion product (DPOAE) and transient evoked (TEOAE), were recorded under three contralateral noise conditions: white noise at 50 and 60 dB SPL, and recorded NICU noise. The recordings were repeated after covering the contralateral ear with a soundproof headphone to attenuate incoming noise. OAE amplitudes were compared between uncovered and covered conditions using paired t-tests.
Results: After covering the contralateral ear, there was a slight overall enhancement of OAE amplitude across all noise conditions that showed statistical significance using a paired t-test. This improvement was more considerable in NICU noise than in white noise. OAE improvement in TEOAE was not as remarkable as in DPOAE.
Conclusion: This method resulted in a modest improvement in OAE levels, likely by reducing the activation of the MOC reflex. Enhancing OAE amplitudes by attenuating contralateral noise, particularly in high ambient noise environments, could improve the accuracy of OAE testing. This may lead to a reduction in false positive results, consequently lowering the costs associated with further diagnostic evaluations and alleviating parental anxiety.

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 40s or 50s. 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). Eighty 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 (2Hz - 512Hz). 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.
Conclusions: 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: Hearing impairment is the third leading cause of years lived with disability in health systems, particularly affecting children through language and speech delays, cognitive issues and vestibular dysfunction. This study aimed to conduct hearing and balance screening for preschool children aged 4 to 6 years in the east of Tehran city during spring 2023.
Methods: In this study, 384 children (180 boys and 204 girls) were participated. After taking history and calculating the children's body mass index (BMI), hearing screening was performed leading to diagnosis and intervention levels. Balance function was screened using  balance subtest of short form of  Bruininks-Oseretsky test of motor proficiency second version (BOT-2) for children with entry criteria.

Results: In hearing screening, out of 768 ears, the frequency of hearing loss (HL( was found to be 11.2% that ranging from slight to moderate HL. Conductive HL had the highest frequency (9.1%), followed by sensori-neural HL(1.3%) and mixed HL(0.8%). Of these, only 3% sought intervention. In balance screening, the mean balance scores of subtest of BOT-2 for ages 4, 5, and 6 were respectively 22.05± 3.40, 26.02±3.72, and 28.13± 4.50. The boys, children with higher BMI, those with hearing loss and less physical activity had statistically significant lower scores (p<0.05).     
Conclusion: Given hearing loss with its characteristics and relationship with balance scores found in this study, the necessity of routine universal screening for hearing and balance in preschool children is mentioned. Also, it’s recommended increased awareness among parents, instructors and healthcare providers to maximize intervention

Background and Aim: Cochlear implants (CIs) successfully improve speech and auditory skills for patients with a severe‑to‑profound degree of hearing loss. The psychometric properties of the Hearing Implant Sound Quality Index Persian version (P‑HISQUI19) were examined to measure auditory benefits in CI recipients in everyday life.
Methods: Seventy post-lingual CI users, aged 18-64 years, completed the P‑HISQUI19. Cross‑cultural adaptation of the P‑HISQUI19 was performed. Internal consistency and test–retest reliability were measured by Cronbach’s α and intra‑class correlation coefficients. The content and construct validity of the questionnaire were also examined.
Results: The P‑HISQUI19 average total score in implanted cases was 78.22, representing a moderate sound quality. The P‑HISQUI19 indicated excellent internal consistency reliability (Guttman’s split‑half‑coefficient = 0.912; Cronbach’s α =0.956) and test–retest reliability (r = 0.962). Our data proceeded to factor analysis, and the questionnaire items were loaded on three factors. In addition, factors such as age at implantation, duration of deafness, side of implantation, and gender factors did not significantly affect sound quality perception.
Conclusion: The P‑HISQUI19 is a valid and reliable measure, which should be beneficial in both research and clinical settings for evaluating the auditory benefits of those using CI during listening.

Background and Aim: Accurate diagnosis of middle ear effusion (MEE) remains one of the most challenging tasks in the medical field due to the lack of reliable diagnostic tools available to physicians and audiologists. This study aimed to design and develop a hyperspectral imaging tympanoscope for diagnosing MEE as the first phase, focusing on system design and preliminary evaluation in a small sample.
Methods: The tympanoscope system was constructed using an ear endoscope, lens, camera, and near-infrared wavelength, and its performance was evaluated with a middle ear-mimicking phantom. Additionally, a preliminary study was conducted on middle ear images from ten children—five healthy and five diagnosed with MEE.
Results: Results from the phantom experiments demonstrated that the Weber contrast difference between phantoms with and without fluid in visible otoscopy and hyperspectral tympanoscopy was 0.16 and 0.49, respectively. As a result, in hyperspectral tympanoscopy, the contrast difference between fluid presence and absence was nearly tripled. Furthermore, in the preliminary human study, significant difference was found in Weber contrast between healthy children and those with MEE (p<0.001), confirming higher contrast in the MEE group.
Conclusion: The hyperspectral imaging tympanoscope could quantitatively distinguish between the presence or absence of fluid in the middle ear and the developed system has potential as a diagnostic and monitoring tool for middle ear effusion.

Background and aim: Standardized speech passages are essential tools in audiological assessments, particularly for verifying hearing aid performance and evaluating speech perception. To ensure linguistic and cultural relevance, these passages must be adapted to reflect the phonetic characteristics of the target language. This study focused on the translation and phonological adaptation of the North Wind and the Sun (NWS) passage into Persian, aiming to provide a linguistically balanced and culturally appropriate stimulus for use in speech-based verification protocols.
Methods: The NWS passage was translated into Persian with targeted phonetic and syntactic adjustments to ensure phoneme balance and linguistic coherence. Phoneme frequencies were compared to reference Persian studies, and expert reviewers evaluated clarity, naturalness, and content validity using Content Validity Ratio (CVR) analysis. Revisions were made based on feedback to optimize semantic integrity and phonetic distribution.
Results: The translated NWS passage contained 558 phoneme occurrences, with /a/ as the most frequent (63 times), aligning with Persian speech studies. The phoneme distribution stayed within the ±1 SD range, confirming linguistic consistency. Expert evaluations yielded a CVR of 0.85, surpassing the 0.78 threshold, validating its relevance for speech research. The Face Validity Ration (FVR) of 4.7 affirmed clarity, phonetic balance, and natural fluency in Persian speech assessments.
Conclusion: The translated NWS passage maintains phonetic balance with Persian linguistic norms, ensuring accuracy in speech mapping and verification of hearing aids. Its adaptability for phonetic research and hearing aid validation highlights its relevance for Persian-speaking populations and cross-linguistic comparisons.

Background and Aim: Hearing loss and vestibular dysfunction frequently co-occur in older adults, affecting balance and mobility. Changes in the vestibular system can alter cervical vestibular myogenic potentials. This study aimed to investigate the amplitude and frequency tuning characteristics of cervical vestibular myogenic potentials (cVEMP) across different degrees of hearing loss in older adults.
Methods: A cross-sectional study was conducted with 30 young adults with normal hearing and 30 older adults (50-70 years) with bilateral sensorineural hearing loss, categorized into mild, moderate and moderately severe hearing loss groups (n=10 per group). CVEMPs were recorded for 500 Hz, 1000 Hz, and 2000 Hz tone bursts. Amplitude and frequency amplitude ratios were analyzed using ANOVA with post hoc tests.
Results: Older adults with hearing loss showed significantly reduced amplitudes compared to young adults across all frequencies. Amplitude progressively decreased with increasing hearing loss severity, though it was not statistically significant between the hearing loss subgroups. Frequency amplitude ratios of persons with moderate and moderately severe hearing loss were significantly different from those of normal hearing.  Frequency tuning shift towards 1000Hz was observed in mild hearing loss group. Responses were absent in a significantly higher proportion of persons with higher degree of hearing loss. 
Conclusion: This study highlights saccular function in older adults across various degrees of hearing loss. It reveals tuning shift in cases of mild hearing loss, and a progressive decline in frequency-specific responsiveness with increasing hearing impairment.

Background and Aim: Noise-induced hearing loss (NIHL) is a prevalent occupational concern, affecting high-frequency hearing sensitivity, which may impair speech perception in noisy environments. This study investigates the relationship between high-frequency hearing thresholds (4000–12500 Hz) and speech perception in noise, using the Persian Quick Speech-in-Noise (Quick SIN) test. The aim was to determine how these thresholds and speech perception in quiet correlate with and predict speech perception difficulties in noise.
Methods: A cross-sectional study was conducted on 288 participants aged 18–60 at the Center for Research on Occupational Diseases, Tehran University of Medical Sciences, from March to August 2024. Participants underwent audiometric testing for conventional (250–8000 Hz) and extended high-frequency (12500 Hz) thresholds, word recognition score (WRS), and the Persian Quick SIN test (basic and high-frequency lists). Pearson’s and Spearman’s correlations and multiple linear regression models evaluated relationships and predictive factors, with significance set at p<0.05.
Results: Strong positive correlations were observed between basic and high-frequency signal-to-noise ratio (SNR) loss and hearing thresholds at 4000–12500 Hz (r/ρ=0.738–0.84, p<0.001), with strong negative correlations with WRS (ρ=-0.756 to -0.785, p<0.001). Regression models identified 8000 and 12500 Hz thresholds, WRS, and education level as significant predictors of SNR loss (R²=0.764–0.812). High-frequency list SNR loss was significantly lower than basic list SNR loss (p<0.001).
Conclusion: High-frequency hearing sensitivity, particularly at 8000 and 12500 Hz, significantly impacts speech perception in noise. Integrating high-frequency audiometry and speech-in-noise testing into occupational health assessments can improve early detection and management of NIHL.

Background and Aim: Tinnitus, the perception of sound without an external source, significantly affects the quality of life for millions worldwide. Although many studies have explored its pathophysiology and neural underpinnings using various methods during resting states, the influence of eye state on neural activity remains poorly understood. This study examined brain activity differences between eyes-closed and eyes-open resting states in individuals with chronic tinnitus.
Methods: In this cross-sectional study, twenty patients with chronic tinnitus underwent Electroencephalography (EEG) during both eyes-closed and eyes-open resting states. EEG power spectra, source localization, and functional connectivity were analyzed across eight frequency bands. Paired-sample t-test and Statistical Non-Parametric Mapping (SnPM) test compared activity between these conditions.
Results: Eyes-closed recordings showed decreased delta, theta, and gamma power, increased alpha 1 and alpha 2 power, and a complex beta pattern (increased beta 1, decreased beta 2 and beta 3) compared to eyes-open. Source localization analysis revealed greater activity in regions associated with memory, attention, and emotional processing during eyes-closed compared to eyes-open. Functional connectivity analysis indicated stronger connections between auditory and memory-related regions in eyes-closed compared to eyes-open.
Conclusions: This preliminary study demonstrated distinct EEG power spectra, source localization, and functional connectivity between eyes-closed and eyes-open states in chronic tinnitus patients, suggesting state-specific neural patterns. Findings highlight interactions of sensory, cognitive, and affective processes, potentially relevant to tinnitus. Further research with control groups and larger samples is needed to confirm tinnitus-specific effects and optimize EEG conditions for elucidating neural mechanisms and guiding targeted interventions.

Background and Aim:  Assessing speech perception in noise (SPIN) in multilingual contexts like India is challenging due to the lack of linguistically appropriate test materials. Recognizing the limitations of existing SPIN tests in multilingual and clinically diverse settings, this study addressed critical need by developing a language-neutral, nonsense SPIN test material tailored for Dravidian languages.
Methods: Nonsense word lists in the Consonant Vowel Consonant Vowel format were generated using a random combination of common phonemes in the Dravidian languages (Kannada, Malayalam, telugu, Tulu, Tamil). These lists were recorded, and Speech recognition threshold in noise (SNR50) were used to select optimized lists based on a criterion of mean ±0.15 SD. The final lists were administered to 50 normal-hearing individuals at 0 dB SNR. Language independence was evaluated by comparing performance across speakers of the five languages. Further performance was also assessed across eight SNR levels to establish a psychometric slope function and goodness of fit was assessed. To evaluate test–retest reliability, 12 participants were retested within a one-week interval.
Results: The study resulted in 4 final optimized lists based on SNR50 selection criteria and further analysis. Lists showed sensitivity to varying SNR levels, as reflected by consistent psychometric function slopes. Comparable performance across language groups confirmed the language-independent nature of the test.
Conclusions: Developed test provides audiologists with a reliable and standardized tool to assess SPIN. By eliminating the influence of familiarity and ensuring language neutrality, the test is well-suited for clinical use across speakers of Dravidian languages.

Background and Aim: Hearing loss in developing countries drives interest in stem cell therapies, though underlying molecular mechanisms remain partly unclear. One key pathway in this process is the retinoic acid (RA) signaling pathway. This study aimed to evaluate the effect of RA on the expression of neural markers, including Nestin, Neurogenin 1 (NGN1), Guanine-Adenine-Thymine-Adenine Binding Protein 3 (GATA3), and Microtubule-Associated Protein 2 (MAP2), in human Adipose-Derived Stem Cells (hADSCs).
Methods: hADSCs were purchased and treated with RA (1 µM) under standard conditions for 7 and 14 days. RNA was extracted using the FavorPrep™ RNA kit and converted to Complementary DNA (cDNA). Nestin, NGN1, GATA3, and MAP2 gene expression was assessed using Real-Time PCR with Glyceraldehyde-3-Phosphate Dehydrogenase (GAPDH) as an internal control. Data analysis was conducted using the 2^^–ΔΔCt method.
Results: RA significantly increased the expression levels of Nestin, NGN1, and MAP2 after 14 days compared to the control group (Day 0). RA also increased Nestin and MAP2 expression after 7 days, although these changes were not statistically significant compared to the control; moreover, RA acid induced morphological changes in hADSCs.
Conclusion: This study demonstrated that RA enhances the neural differentiation of hADSCs by upregulating the neural markers Nestin, NGN1, and MAP2. These findings highlight the potential role of RA in neural differentiation and its clinical applications. These findings suggest that RA’s effects may be dose- and time-dependent, with one µM for 14 days enhancing neural marker expression.

Background and aim: Motion sickness, characterized by conflicting sensory signals, negatively impacts attention and cognitive functions. This study investigated the effects of motion sickness on auditory spatial perception and working memory in adults with normal hearing.
Methods: A Standard group comparison was conducted on  100 adults with motion sickness, classified into three groups—normal-minimal, mild-moderate, and severe—based on Motion Sickness Susceptibility Questionnaire (MSSQ)-short scores. Standardized assessments were used to evaluate auditory spatial perception, including interaural time difference (ITD), interaural level difference (ILD), and the Virtual Acoustic Space Identification (VASI) test, along with working memory assessed through the forward digit span and 2-back test. ITD and ILD tests involved a discrimination task using psychoacoustic staircase procedure, VASI required identification of virtual locations within head, and memory tasks involved repetition digits and 2^nd last digit in sequence, in forward task, and 2-back tasks, respectively.
Results: Participants with motion sickness (mild-moderate and severe groups) performed significantly poorer (p < 0.05) than those without on the VASI test, forward digit span, and 2-back. A moderate negative correlation was observed between MSSQ-short and VASI scores. Discriminant function analysis (DFA) revealed that participants with severe motion sickness could be categorized from the other two less severity groups (normal-minimal, mild-moderate), with VASI and forward digit span emerging as the most sensitive indicators of motion sickness induced changes in spatial and working memory.  
Conclusion: Findings underscores the importance of monitoring motion sickness, as it can impair spatial processing and working memory tasks in auditory domain.

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—specifically from Personal Listening Devices (PLDs)—on central auditory and cognitive processing in adults with normal hearing.
Methods: In this cross-sectional study, 136 males aged 20–40 were divided into three groups: 45 exposed to leisure noise from PLDs, 46 exposed to industrial noise (average [Leq]<90 dB (A)/ 8 hours), and 45 with no history of noise exposure (control group). All participants had normal audiograms. To evaluate central auditory processing, the Dichotic Digits Test (DDT), Duration Pattern Sequence Test (DPST), and Quick Speech-in-Noise Test (Q-SIN) were used. Cognitive abilities were assessed using the Ray Auditory Verbal Learning Test and the Semantic Stroop Test.
Results: The results showed that the industrial noise group performed significantly worse on all central auditory and cognitive tests—except reaction time—compared to both the PLD and control groups. The PLD group also showed impairments in speech-in-noise perception, short-term memory, and selective attention relative to the control group. Additionally, a negative correlation was found between noise exposure and speech-in-noise performance.
Conclusion: These findings suggest that both industrial and PLD-related leisure noise can impair central auditory and cognitive functions in individuals with normal hearing, highlighting the need for broader assessments in noise exposure monitoring.

Background and Aim: Tinnitus has been associated with increased listening effort and reduced working memory (WM) capacity during speech comprehension. A practical approach to enhance cognitive processes is transcranial direct current stimulation (tDCS), a non-invasive neuromodulation technique applying constant low current. Anodal tDCS increases the expression of N-methyl-D-aspartate receptor 1(NR1 and NR2) proteins in blood, which are associated with WM improvement. This study aimed to evaluate the effect of tDCS on listening effort, WM, and N-methyl-D-aspartate (NMDA) receptor subunit protein expression in blood of individuals with tinnitus.
Methods: Thirty-two adults (30–60 years) were randomly assigned to experimental and control groups. The experimental group received anodal tDCS with electrodes on F3 and F4 for 20 minutes at 1.5 mA over 10 sessions, while the control group underwent electrode placement without stimulation. Pre- and post-intervention assessments included audiometry, tympanometry, tinnitus matching, listening effort evaluation (cognitive-behavioral tasks, dual-task, visual analogue scale, and tinnitus functional index), and WM assessment (N-BACK test). Blood samples were analyzed using Western blot to measure NR1 and NR2 protein expression in blood.
Results: Compared to the control group, tDCS significantly reduced listening effort (p<0.001) and improved WM (p<0.001). After intervention, the experimental group showed a 27% increase in NR1 and a 50% increase in NR2 expression.
Conclusion: tDCS effectively reduced listening effort and enhanced WM in individuals with chronic tinnitus. The upregulation of NR1/NR2 protein expression in blood may contribute to improved auditory-cognitive performance, highlighting the potential role of this technique in tinnitus rehabilitation.

Background: West Nile Virus (WNV) encephalitis is reported to cause “ataxia” in up to 31% of patients, and “vertigo” in up to 14% of patients. The mechanism of these symptoms is unclear.
The Case: We report the case of a lady who contracted WNV encephalitis at age 74 years. When evaluated 15 months later she complained both of baseline unsteadiness, and of a fluctuating component of disequilibrium. Instrumented vestibular testing identified bilateral vestibular weakness (in a different pattern on each side). It also identified Periodic Alternating Nystagmus (PAN), presumably acquired (rather than congenital). Acquired PAN has been observed in other encephalidites, but has not been previously reported in association with WNV encephalitis.
Conclusion: In this case, WNV encephalitis appears to have caused both vestibular weakness (likely accounting for the baseline unsteadiness) and periodic alternating nystagmus (likely accounting for the fluctuating disequilibrium).

Background: It takes some time for a patient to adapt to the new hearing experience with a cochlear implant (CI) device. Usually, improvements of speech perception have been reported within 3 to 6 months after the CI surgery. Here, we described a child with post-lingual deafness due to meningitis who recovered considerable speech perception just a few days after CI activation.
The Case: A 14-year-old female with complaints of severe headache, delirium, unresponsiveness to sound, and agitation was diagnosed with meningitis. Pure tone audiometry showed total deafness in right ear and severe to profound sensorineural hearing loss in left ear. Seven months after onset of deafness, she received a Cochlear Nucleus CI512 implant in the right ear. The speech processor was activated 2 weeks after surgery. The first map was programmed using the advanced combinational encoder (ACE) speech coding strategy and behavioral measurement of T-levels and C-levels. Four days later, the audiometric evaluation 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 score in silence was 100%. There are numerous factors related to postoperative function with CI.
Conclusions: It seems that factors like short duration of deafness, precise mapping of CI speech processor, consistent device usage, and rich aural environment have led to extraordinary improvement within 2 weeks after device activation.

Background: Auditory training (AT) is an effective intervention for auditory processing disorder (APD), and its outcomes are usually assessed through behavioral and electrophysiological tests. Among objective tools, speech-evoked auditory brainstem response (s-ABR) has been used to evaluate AT effects, and it has shown promise, but s-ABR recorded in contralateral noise—a method activating both afferent and efferent auditory pathways—has not been applied to monitor rehabilitation progress in APD.
The Case: Here we compare pre- and post-intervention different tests' results of a 7-year-old boy with APD (with documented deficits in dichotic processing and speech-in-noise perception) to investigate which is the most appropriate tool for assessing rehabilitation efficacy. The case underwent behavioral and electrophysiological evaluations, including s-ABR with and without contralateral noise, before and after 15 sessions of targeted AT tailored to the child’s specific processing weaknesses. Post-training results revealed significant improvement in behavioral tests and questionnaire scores. S-ABR assessments also demonstrated improvements, including increased V/A slope as well as improvements in wave latencies and amplitudes, with more pronounced changes observed in recordings with contralateral noise.
Conclusion: This case highlights the novel use of s-ABR in contralateral noise as a promising objective tool for monitoring auditory rehabilitation in APD. While behavioral assessments remain the gold standard, this electrophysiological test may provide valuable complementary information, particularly for patients with limited behavioral test cooperation or when behavioral results are unreliable. As this case report involves a single child with APD, further studies are needed to validate these findings in broader APD populations.