دکتر منصوره عادل قهرمان

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.

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.

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.

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.

Vestibular Rehabilitation (VR) is a well-accepted treatment for Unilateral Vestibulopathy (UVP). Since noisy Galvanic Vestibular Stimulation (nGVS) improves the processing of vestibular inputs, we assessed the synergistic effects of adding nGVS to vestibular rehabilitation for the treatment of UVP.

Patients with UVP were randomly assigned into two groups receiving either VR for four weeks (VR group, n=12) or VR for four weeks combined with nGVS for three sessions (VR+nGVS group; n=12). Outcome measurements were postural control parameters measured with eyes open/closed conditions on hard/soft surfaces, Vestibulo-Ocular Reflex (VOR) gain, and Dizziness Handicap Inventory (DHI) scores that were assessed at baseline and after four weeks.

All postural control parameters, mean total and subscale scores of DHI, and mean VOR gain in directions of affected canals significantly improved in both groups after interventions (p<0.05) except mean mediolateral displacement in conditions with eyes closed on hard surface and with eyes open on soft surface, mean mediolateral velocity in conditions with eyes closed on hard surface, ability to stance with eye closed condition on soft surface and mean emotional subscale of DHI in VR group. Improvements were significantly higher in postural control outcomes measured in stances with eyes closed on hard surface and with eyes open and closed on soft surface, mean VOR gains in directions of affected horizontal and anterior canals, and mean total, physical, and functional scores of DHI in VR+nGVS group (p<0.05).

When combined with VR, nGVS shows additional therapeutic effects in UVP patients.

Considering the critical input of the vestibular system to the hippocampus as an area involved in cognition, and vestibular disorders reported in patients with amnestic Mild Cognitive Impairment (aMCI), we aimed to investigate the effects of Vestibular Rehabilitation (VR) with and without noisy Galvanic Vestibular Stimulation (nGVS) on cognitive function in patients with aMCI.

In a randomized controlled trial, twenty-two patients with aMCI were randomly assigned to two groups receiving: 1) VR for four weeks (VR group); 2) VR for four weeks with nGVS for three sessions (GVS+VR group). Outcome measures were Rey's Auditory-Verbal Learning Test (RAVLT), Corsi blocks, Visual Search (VS), and match to sample tests.

Mean immediate and delayed recalls of RAVLT, all of the outcomes of Corsi blocks and VS tests, and the error rate of the match to sample tests improved significantly after intervention in VR and GVS+VR groups. Between-group differences were observed for learning and delayed recalls of RAVLT (p=0.001, d=0.444 and p<0.001, d=0.512 respectively), reaction times 1 and 2 in VS (p=0.007, d=0.325 and p=0.001, d=0.446 respectively), the total correct trial of Corsi blocks (p=0.026, d=0.235), and error rate of the match to sample (p=0.017, d=0.266) tests.

The synergistic effect of VR and GVS suggested that simultaneous use of both stimulations improves verbal and visuospatial memory in aMCI patients. Study protocol location: https://irct.ir/trial/47249 Trial registration number: IRCT20160131026279N3

Speech perception problem in noise is the most common complaint among elderly people. Based on previous evidence, auditory training improves central auditory system plasticity in the elderly. The aim of the present study was to evaluate the effectiveness of the designed hearing rehabilitation program in overcoming this problem.

This randomized, controlled clinical trial was performed on 80 elderly people aged 60-75 years old who were randomly assigned to four equal groups. One group received only dynamic spatial hearing rehabilitation (DSHR) while the other group received the DSHR combined with transcranial direct current stimulation (DSHRWTDCS). Groups 3 and 4 were the control and sham groups, respectively. All participants were evaluated by behavioral and electrophysiological tests and a questionnaire was administered before, after, and one month after the end of the intervention.

Based on the results of behavioral, electrophysiological tests and the intended questionnaire, there was a significant difference between the means of the second and third stages with the first stage in ODSHR and DSHRWTDCS groups. Further, there was a significant difference between the means of the second and third stages in both ODSHR and DSHRWTDCS groups and those of the other two groups.

The positive effects of the spatial hearing rehabilitation program with tDCS are confirmed by various aspects of self-assessment, electrophysiological and behavioral tests, and thus can be the basis for developing comprehensive rehabilitation programs

Vestibular system has several anatomical connections with cognitive regions of the brain. Vestibular disorders have negative effects on cognitive performance. Hearing-impaired patients, particularly cochlear implant users, have concomitant vestibular disorders. Previous studies have shown that attention assigned to postural control decreases while performing a cognitive task (dual task) in hearing-impaired children. Since the vestibular system and postural control performance develop around 15−16 years of age, the aim of this study was to compare postural control performance during dual task in adolescent boys with normal hearing and cochlear implant (CI) users with congenital hearing-impairment.

Postural control was assessed in twenty 16−19 year old cochlear implant boys and 40 normal hearing peers with force plate. The main outcomes were displacement in posterior- anterior and medial-lateral planes, and mean speed with and without cognitive task and under on/off-device conditions. Caloric test was performed for CI users in order to examine the peripheral vestibular system.

Ninety-five percent of CI users showed caloric weakness. There were no significant diff erences in postural control parameters between groups. All performances deteriorated in the foam pad condition compared to the hard surface in all groups. Total mean velocity significantly increased during dual task in normal hearing group and in CI users with off-device.

Although CI users had apparent vestibular disorders, their postural control in both single and dual-task conditions was identical to the normal peers. These effects can be attributed to the vestibular compensation that takes place during growing.

Presbycusis is a prevalent chronic condition in the elderly which may have potential adverse effects on social and emotional aspects of their life. There is no one to one relationship between audiogram and the perceived handicap in elderly. A good way to measure hearing handicap are self-assessment tools. This study was aimed to translate, adapt and establish face validity of Short form of Hearing Handicap Inventory for the Elderly (HHIE-S) and the correlation with pure-tone and speech audiometry results as well as score of the other self-assessmnet tool (Self-Assessment of Communication: SAC) in the Iranian elderly.

HHIE-S was translated into Persian and face validity was established.  It was administered in 80 elderly participants. Correlation of their scores with their pure tone averages of 3 and 4 frequencies (PTA0.5-1-2 and PTA0.5-1-2-4), word recognition score (WRS) in quiet, and SAC sco res was determined.

The experts mean scores to PHHIE-S was 99.63%. There were significant correlations between PHHIE-S with SAC (r = 0.89; p < 0.001), PTA0.5-1-2 (r = 0.4; p < 0.001), PTA0.5-1-2-4 (r = 0.6; p <0.001) and WRS (r = -0.4; p < 0.001). There was no significant gender effect on any of the measures (p > 0.05).

Simply evaluation of the hearing levels is not adequate in elderly. Self-assessment tools can shed light on the specific disability induced by hearing loss. PHHIE-S appears to be an easy and fast tool that may helpful to distin guish patients who might need rehabilitative services.

Spatial hearing plays an important role in listening in complex hearing situations, including contributing to localization, lateralization, spatial release from masking, distance estimation from a sound source, and perceiving a signal in noise. Questionnaires are useful tools for assessing spatial processing disorder in adults. Given the high prevalence of this disorder in children and that the extent of children’s ability in completing questionnaires is not clear, this study aimed to evaluate the response validity of children to the Persian translation of the child version of the Speech, Spatial and Quality of Hearing Scale (PSSQ-Ch).

The child version of the SSQ was translated into Persian and cross-culturally adapted. The final version was administered to 150 children (6 to 12 years of age) with normal hearing. The children’s response validity was evaluated qualitatively and the percentage of valid responses calculated for each of 7 age groups.

Across the three sections, the percentage of valid responses for children under age 10 was minimum 44.4% and maximum 83.3%, and the mode was around 60%. There was no child in the under-10 age group who answered all questions validly. The response validity of children aged 10 or more was higher with a minimum of 93.3%, a maximum of 100% and mode of 100%.

Children ≥ 10 years can reliably respond to the PSSQ-Ch. The response validity of children below 10 years is low; therefore, this questionnaire cannot be used as a self-assessment questionnaire in children below age 10.