Background and Aim: Hearing handicap, as one of the common health problems among older people, affects life activities. The Hearing Handicap Questionnaire (HHQ) is one of the scales that provide criteria for social withdrawal, participation restriction, and emotional distress. The present study aims to translate the HHQ into Persian and determine its psychometric properties.
Methods: After translation into Persian, the content validity of the questionnaire was determined based on the Lawashe’s method. Then, the Persian HHQ (P-HHQ) and the Persian Hearing Handicap Inventory for Elderly-Screening version (P-HHIE-S) were completed by 110 hearing-impaired seniors (49 females) over 60 years. The concurrent validity was determined by Spearman correlation test, and the discriminant validity was analyzed by Kruskal-Wallis test and independent t-test. The test-retest reliability was assessed in 47 subjects after two weeks by Spearman correlation test and paired t-test.
Results: The P-HHQ had high face validity. The mean total score of P-HHQ was 1.89±1.05. It had a significant positive correlation with the score of P-HHIE-S (r=0.87) and pure tone average of the better ear (r=0.72). There was a significant difference between three groups of elderly with different degrees of hearing impairment (p<0.001). Cronbach’s α values were in the range of 0.94–0.97. There was a strong correlation between test and retest scores of P-HHQ (r=0.97) which indicates a high test-retest reliability.
Conclusion: The P-HHQ has acceptable validity and reliability and can be used as a suitable instrument to evaluate hearing handicap of the elderly in research studies and clinical settings.

Background and Aim: Identifying sound localization defects in children and using appropriate rehabilitation methods lead to improve their problem to use binaural processing skills to successfully suppress background noise and selectively attend to a particular auditory source. This pilot study aims to design a game for auditory training of children with Spatial Processing Disorder (SPD) in Iran and compare their performance in engagement time and speech recognition in noise with those of normal peers.
Methods: The game application was designed based on the spatial separation of target and competing stimuli by applying head-related transfer functions. The child’s task was to identify the picture of the target word from among the displayed options. Participants were 24 children with SPD and 27 normal peers aged 7–9 years, who performed the speech recognition tasks using the designed game.
Results: The game was fascinating and easy to use for most participants. There was no significant difference in mean engagement time between the two groups. The mean engagement time of participants was significantly different between the two groups in terms of age. The children with SPD obtained lower scores in speech recognition in noise tasks. There was no significant difference in speech recognition scores between girls and boys.
Conclusion: The designed game application has the potential for speech recognition innoise training of children with SPD in Iran. It is a fascinating and user-friendly tool for simulating the real-life auditory situations for these children.

Background and Aim: Persistent Postural-Perceptual Dizziness (PPPD) is a type of chronic dizziness without rotation, confusion, or unsteadiness, usually exacerbated by standing, active/passive movements, and complex or moving visual stimuli. Vestibular Rehabilitation Therapy (VRT) is an effective treatment for people with this disease. This study aimed to determine effect of VRT on the daily life aspects of military men with PPPD.
Methods: In this clinical trial, participants were 56 military men with PPPD. They underwent VRT that included exercises for gaze stabilization, adaptation, and habituation. The impact of balance problems caused by PPPD on different physical, emotional, and functional aspects of daily life was evaluated using the Dizziness Handicap Inventory (DHI) before and one month after the intervention.
Results: There was a significant decrease in functional, emotional, physical, and total scores on the DHI after VRT (p<0.001). The DHI scores at baseline showed a moderate handicap (48.64%) which decreased to a mild handicap (24.53%) after VRT. The lowest score at baseline was related to the functional aspect, which showed the highest improvement after VRT.
Conclusion: The VRT can improve all aspects (physical, emotional, and functional) of daily life in military men with PPPD and diminishes the severity of symptoms. Therefore, this treatment can be used as a suitable treatment for these patients.
IRCT Registration Number: IRCT20230520058237N1

Background and Aim: Speech perception is an important auditory need. A test that can evaluate the function of the auditory brain in discovering consonants and understanding meanings in Persian language is necessary. Therefore, this study aims to determine the norm values of the Word-in-Noise Perception (WINP) test for Iranian people aged 18–25 years.
Methods: In this study, participants were 101 people with normal hearing, stress level, night sleep, and mini-mental states. The measures were the 28-item general health questionnaire, mini-mental state examination, Petersburg sleep quality index, acoustic immittance assessment, pure tone audiometry, speech reception threshold evaluation, and the WINP test with Homotonic-Monosyllabic Words (HMWs). Data analysis was performed using the Mann-Whitney U test.
Results: The mean scores of the WINP test at three Signal-to-Noise Ratio (SNRs) of 0, +5, +10 dB were 53.14%, 68.15%, 88.70% for the right ear; 52.95%, 67.83%, 88.13% for the left ear; and 53%, 68%, 88% for both ears, respectively. The mean scores of the right ear were higher than those of the left ear, and the women’s scores were higher compared to men; however, the differences were not statically significant.
Conclusion: By using the WINP test with the HMWs, it is possible to evaluate the function of the auditory brain in understanding the consonants in Persian language. The WINP test scores are similar between both ears and both sexes.

Background and Aim: One of the important loudness perception problems is hyperacusis. It is generally defined as sensitivity to average-intensity sounds, which are perceived as excessively loud or uncomfortable. Assessing symptoms of sound intolerance and their impact on patients’ lives is crucial. The study aims to determine the validity and reliability of the Persian version of the Inventory of Hyperacusis Symptoms (IHS), assess its validity in differentiating normal-hearing and hyperacusis adults, and measure its cutoff point.
Methods: The questionnaire was translated according to the international quality of life assessment protocol. After determining both qualitative and quantitative face validity and content validity, it was completed by 120 adults (60 with normal hearing and 60 with hyperacusis) to evaluate the differential validity and reliability. The reliability assessment was conducted using the test-retest method for all participants. For assessing the convergent validity, the correlation of the Persian IHS score with the score of the Hyperacusis Questionnaire (HQ) was evaluated.
Results: The questionnaire had good face validity and content validity. The Cronbach coefficient α was 0.93 for the overall scale. The Interclass Correlation Coefficient (ICC=0.97) confirmed reliability. The cutoff point of the Persian IHS score was 48, with 91% sensitivity and 96% specificity. Additionally, a strong significant correlation was found between the scores of IHS and HQ (r=0.82).
Conclusion: The Persian version of the IHS has high validity and reliability for use in hyperacusis clinics and research.

Background and Aim: Magnesium is essential for the morphogenesis of otoconia. The imbalance in the chemical composition of otoconia can make people susceptible to Benign Paroxysmal Positional Vertigo (BPPV). The primary outcome was to compare serum magnesium levels in BPPV patients with controls. The Ca/Mg ratios in participants are also recorded and analyzed in the present study.
Methods: In this case-control study, we measured the serum Mg, Ca, and vitamin D in BPPV patients and age-, sex-matched subjects without BPPV. The results were adjusted for Ca, vitamin D, hypertension, and body mass index.
Results: A total of 123 BPPV patients participated in this study. The mean Mg value was higher in patients than controls (2.01 vs. 1.95 mg/dL, p=0.030). Condition logistic regression analyses showed a higher rate of BPPV among subjects with low Ca/Mg ratio (quartile 1), relative to subjects with medium ratio (quartiles 2 and 3) (adjusted OR: 3.92, p=0.003).
Conclusion: The present study demonstrated an imbalance of Ca and Mg in the BPPV patients as significantly higher Mg levels and lower serum Ca/Mg ratio. Although it appears decreased Ca/Mg ratio to be a risk factor for BPPV, this result should be confirmed in confirmatory studies.

Background and Aim: Children with severe to profound sensory-neural hearing loss who use a hearing aid or a Cochlear Implant (CI) are likely to have Decoding (DEC) problems. Various studies recommend auditory processing training to improve auditory processing difficulties in CI users. The aim of the present study was to evaluate phoneme processing difficulties in CI users and to investigate the efficacy of the Persian version of the Phonemic Synthesis Program (P-PSP) in improving phonological abilities in this population.
Methods: A total of 28 prelingually hearing-impaired children aged 8–12 who underwent unilateral (right ear) cochlear implantation were included in this study. They were divided into experimental and control groups. The P-PSP was implemented on the experimental group, and the results were analyzed over three phases: baseline, intervention, and followup.
Results: The present study’s results indicate that P-PSP training is suitable for CI children, particularly for the DEC subcategory. Moreover, the Persian Phonemic Synthesis Test (P-PST) results significantly improved after the intervention phase compared to the baseline evaluations (p<0.05). There was no significant difference between the intervention and follow-up phases’ results (p>0.05), indicating no recurrence of auditory processing difficulties after discontinuing training.
Conclusion: Based on the study’s findings, the Persian version of PSP enhances phonological processing abilities in CI users. Therefore, the use of auditory phonological training in postimplantation rehabilitation programs appears to be highly important.

Background and Aim: Questionnaires are useful tools for clinicians. This study aimed to translate the Dizziness Handicap Inventory for Patient Caregivers (DHI-PC) into Persian (DHI-PC-P) and assess its psychometric properties for children aged 5–12 years.
Methods: This is a descriptive-analytical psychometrics study. After obtaining permission from the developers of the DHI-PC, translation into Persian and cross-cultural adaptation were done according to the international guidelines for self-assessment tools recommended by the American Association of Orthopedic Surgeons. Participants were 21 parents (mean age: 38.05 years, SD=6.1 years, 18 female) and their children with dizziness (mean age 8.69 years, SD=2.41 years, 9 female) between the ages of 5–12 years old. Face validity, content validity, and test-retest reliability at an interval of 14–21 days were evaluated for the DHI-PC-P.
Results: The face validity was confirmed qualitatively by the experts’ opinions and quantitatively by calculating the item impact score. Content validity was confirmed by calculating the content validity index and the content validity ratio (0.97 and 0.86, respectively). The internal consistency was good (Cronbach’s alpha=0.90). For the testretest reliability, the intraclass correlation coefficient was obtained 0.94, indicating an excellent reliability.
Conclusion: The DHI-PC-P can be used clinically as a valid and reliable tool for children with dizziness aged 5–12 years.

Background and Aim: The use of tele-intervention services in audiology has grown exponentially, as it has the potential to address many of the key challenges during the pandemic. The present study focused on the survey of parental satisfaction on listening therapy of their Hearing-Impaired (HI) children in tele and face-to-face mode during COVID-19 pandemic.
Methods: Parents of children with Hearing Impairment (HI) who attended tele and face-toface therapy sessions participated in the study. Group I participants were 25 parents of 0–3 years’ children with HI (mean age 1.8±0.25 y), while Group II had 25 parents of children with HI aged 3.1–5 years (mean age 4.1±0.33 y). The adapted and validated questionnaire was administered.
Results: Frequency count and percentage were detailed for all questions across groups. The chi-square test of association revealed a significant difference between the tele and face-to-face therapy across the ratings in both groups, with parents rating better satisfaction and therapy efficacy in face-to-face therapy compared to tele-therapy. Principal Component Analysis (PCA) revealed that few questions can best categorize the variance in satisfactory ratings between the two therapy conditions.
Conclusion: The findings of the study showed that tele-listening therapy appears to be a promising rehabilitative option in the COVID-19 pandemic when factors affecting its successful implementation are considered, although in the present conditions parental satisfaction ratings are higher for face-to-face therapy.

Background and Aim: Presbyacusis is one of the most common causes of hearing loss for seniors age above 60 years. Yet diagnostic hearing tests are not readily accessible to seniors in the community. Since 2018, the Ministry of Health in Singapore started a pilot program to screen them for their visual, oral, and hearing health in the community and improve accessibility to hearing healthcare. We describe the clinical characteristics of seniors presenting to Community Hearing Clinic (CHC) and compared hearing aid uptake rates with patients seen at a tertiary hospital.
Methods: Retrospective cross-sectional descriptive study on Singaporeans with hearing difficulties presenting to the community clinics.
Results: Attendance rates were generally positive at more than 80% and is comparable to the specialist outpatient clinic at the tertiary hospital. Hearing aid uptake rates were comparable between CHC and tertiary hospital at 61.9% and 66.9% respectively. Despite having better accessibility with direct access to the audiologists, and more financial subsidies, the eventual uptake rates of hearing aids are not clinically different at the CHC.
Conclusion: CHC may be a viable model of improving accessibility to hearing healthcare with audiologists providing the 1st level of triaging safely. However, the cost-effectiveness of this model remains to be seen. Further health service research studies are warranted to determine the cost-effectiveness of sandbox CHC. Right-siting and expanding the sandbox to include access to hearing aid subsidies in private clinics may further help with this move beyond hospital to the community in line with our public health vision.