Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 33 1 2023 08 01 1 9 EN Faezeh Azadi Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran Farzaneh Fatahi Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran Saeid Farahani Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran Shohreh Jalaie School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran Ahmad Reza Nazeri Department of Audiology, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2023 03 01 2023 06 03 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. https://avr.tums.ac.ir/index.php/avr/article/view/1149

Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 33 1 2023 10 10 10 19 Sima Tajik Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran AND Department of Audiology, School of Rehabilitation, Babol University of Medical Sciences, Babol, Iran Mansoureh Adel Ghahraman Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran Saeid Farahani Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran Nematollah Rouhbakhsh Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IranDepartment of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran Alireza Taheri Social and Cognitive Robotics Lab, Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran Parsa Bahramsari Social and Cognitive Robotics Lab, Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran Shohreh Jalaie School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran 2023 05 15 2023 06 28 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. https://avr.tums.ac.ir/index.php/avr/article/view/1164

Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 33 1 2023 09 11 20 27 Seyyed Mohammad Reza Taghavi Department of Neurology, Imam Reza Hospital, Aja University of Medical Sciences, Tehran, Iran Farzad Mehrabi Department of Neurology, Imam Reza Hospital, Aja University of Medical Sciences, Tehran, Iran Parsa Cheraghipour Ear, Nose and Throat Clinic, Imam Reza Hospital, Aja University of Medical Sciences, Tehran, Iran Seyed Meead Mousavi Ear, Nose and Throat Clinic, Imam Reza Hospital, Aja University of Medical Sciences, Tehran, Iran Akram Nezhadi Cognitive and Neuroscience Research Center, Aja University of Medical Sciences, Tehran, Iran 2023 05 20 2023 07 26 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 https://avr.tums.ac.ir/index.php/avr/article/view/1165

Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 33 1 2023 09 20 28 33 Seyede Faranak Emami Department of Audiology, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran AND Hearing Disorder Research Center, Hamadan University of Medical Sciences, Hamadan, Iran 2023 05 30 2023 07 27 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. https://avr.tums.ac.ir/index.php/avr/article/view/1170 https://avr.tums.ac.ir/index.php/avr/article/download/1170/538

Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 33 1 2023 10 01 34 39 EN Mina Harati Department of Audiology, University of Social Welfare and Rehabilitation Science, Tehran, Iran Mohanna Javanbakht Department of Audiology, University of Social Welfare and Rehabilitation Science, Tehran, Iran AND Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Science, Tehran, Iran Mohsen Vahedi Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Science, Tehran, Iran AND Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Science, Tehran, Iran 2023 05 27 2023 08 06 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. https://avr.tums.ac.ir/index.php/avr/article/view/1167 https://avr.tums.ac.ir/index.php/avr/article/download/1167/537

Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 33 1 2023 09 19 40 46 EN Maliheh Akbarpour Otorhinolaryngology Research Center, Guilan University of Medical Sciences, Rasht, Iran AND Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Mir Mohammad Jalali Otorhinolaryngology Research Center, Guilan University of Medical Sciences, Rasht, Iran AND Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Nafiseh Sadeghzadeh Otorhinolaryngology Research Center, Guilan University of Medical Sciences, Rasht, Iran AND Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran 2023 07 01 2023 08 15 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. https://avr.tums.ac.ir/index.php/avr/article/view/1182

Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 33 1 2023 10 18 47 56 EN Mahdieh Hasanalifard New Hearing Technologies Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Masoumeh Saeedi New Hearing Technologies Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Mohammad Ajalloueyan New Hearing Technologies Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Reyhaneh https://avr.tums.ac.ir/index.php/avr/article/view/1408

Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 34 4 2025 03 04 347 354 EN Lapphawat Saelee Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Pornthep Kasemsiri Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand AND Khon Kaen Ear Hearing and Balance Research Group, Khon Kaen University, Khon Kaen, Thailand Nichtima Chayaopas Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand AND Khon Kaen Ear Hearing and Balance Research Group, Khon Kaen University, Khon Kaen, Thailand Panida Thanawirattananit Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand AND Khon Kaen Ear Hearing and Balance Research Group, Khon Kaen University, Khon Kaen, Thailand Kwanchanok Yimtae Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand AND Khon Kaen Ear Hearing and Balance Research Group, Khon Kaen University, Khon Kaen, Thailand 2025 01 21 2025 03 03 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 AAOHNS 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). https://avr.tums.ac.ir/index.php/avr/article/view/1411 https://avr.tums.ac.ir/index.php/avr/article/download/1411/626

Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 34 4 2025 05 28 355 364 Bashar Ali Naji Altamimi Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran Ghassem Mohammadkhani Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran Nematollah Rouhbakhsh Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran 2025 03 18 2025 05 26 Background and Aim: Tinnitus, the perception of sound without an external source, can significantly impact the quality of life. Although no definitive cure exists, various treatments are available to reduce tinnitus symptoms. This study aimed to compare the effectiveness of sound therapy, trnscranial Direct Current Stimulation (tDCS), and Low-Level Laser Therapy (LLLT) in managing chronic tinnitus. Methods: In this randomized clinical trial, 78 adults with chronic tinnitus and normal hearing were divided into three groups of sound therapy, tDCS, and LLLT. The groups received interventions for six weeks. Psychoacoustically, we assessed tinnitus pitch, tinnitus loudness, Minimum Masking Level (MML), and residual inhibition (RI). Tinnitus loudness and distress were also measured using the Visual Analog Scales (VAS), and the functional impact was evaluated using the Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI). Auditory Brainstem Response (ABR) test 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 regarding THI and TFI scores compared to the tDCS and LLLT groups. Conclusion: Sound therapy, tDCS, and LLLT are effective in reducing tinnitus symptoms, with sound therapy having greater effects. To improve procedures and investigate customized strategies, more research is recommended. IRCT registration number: IRCT20111113008082N5. https://avr.tums.ac.ir/index.php/avr/article/view/1428

Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 34 4 2025 06 11 365 372 Seyedeh Fatemeh Mousavisadr Department of Audiology, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran Fatemeh Heidari Department of Audiology, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran Amir-Abbas Ebrahimi Department of Rehabilitation, Consultation and Early Intervention Services, Exceptional Education Organization, Tehran, Iran 2025 02 02 2025 05 28 Background and Aim: Hearing impairment is the third leading cause of years lived with disability, particularly affecting children through language and speech delays, cognitive issues, and vestibular dysfunction. This study aimed to conduct both hearing and balance screenings for preschool children aged 4-6 years in Tehran, Iran. Methods: In this study, 384 children (180 boys and 204 girls) from the east of Tehran city during spring 2023 participated. After taking the children’s history and calculating their Body Mass Index (BMI), hearing screening were performed at screening, diagnostic, and intervention levels. Balance function was screened using the balance subtest of the short form of Bruininks-Oseretsky test of motor proficiency- second version (BOT-2). Results: Among 768 ears examined, the prevalence of hearing loss (HL) was 11.2%, ranging from slight to moderate HL. Conductive HL had the highest prevalence (9.1%), followed by sensori-neural HL (1.3%) and mixed HL (0.8%). Of these, only 3% sought intervention. The mean total balance scores for age groups of 4, 5, and 6 years were 22.05±3.40, 26.02±3.72, and 28.13±4.50, respectively. Boys, children with higher BMIs, those with HL, and those with lower physical activity had significantly lower balance scores (p<0.05). Conclusion: Given the type and degree of HL in preschool children and its relationship with balance scores, routine universal hearing and balance screenings for preschool children is recommended. Additionally, it is recommended to increase awareness among parents, child instructors, and pediatric healthcare providers in Iran regarding the importance of hearing and balance screenings for preschool children. https://avr.tums.ac.ir/index.php/avr/article/view/1421

Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 34 4 2025 05 11 373 379 Marcello Cherchi Department of Neurology, University of Chicago, Chicago, Illinois USA 2025 04 12 2025 05 07 Background and Aim: 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 a