Acoustic Voice Analysis in Postlingual Deaf Adult Cochlear Implant Users: A Within-Group Comparison Study.

OBJECTIVES: Cochlear implantation (CI) improves the quality of voice and speech output. However, there are various factors that may interfere with the use of CI to accede desirable voice outcomes. The primary aim of the current study was first to measure three acoustic voice outcomes in postlingual deaf adult CI users who were Persian-speaking, and then, to compare these according to surgery- and auditory-related factors. Of interest was also to determine whether these acoustic measures were influenced by surgery- and auditory-related factors. METHODS: A number of 113 postlingual deaf adults with CI were recruited. The voice samples were recorded in the same silent room to equalize the noise of the environment. The measures of interest were analyzed with the Praat software. RESULTS: Our findings revealed that time duration of CI use (P ≤ 0.008), pattern of deafness onset (P ≤ 0.011), and the interaction between them (P ≤ 0.022) significantly affected all vocal parameters. This means that the quality of voice was significantly better in the participants using CI for more than 2 years than in those using CIs for less than 2 years. On the other hand, patients suffering sudden postlingual deafness for less than 2 years had the best acoustic voice parameters compared with those suffering gradual postlingual deafness for more than 2 years. CONCLUSIONS: Some of the surgery- and auditory-related factors could be the reason for changes of voice parameters in postlingual deaf adult CI users.

Auditory-Perceptual Evaluation of Vocal Characteristics in Patients with the New Coronavirus Disease 2019.

INTRODUCTION: Due to the upper and lower respiratory involvement in coronavirus disease 2019 (COVID-19), the voice quality of these patients is expected to be impaired. In this study, we aimed to conduct an auditory-perceptual evaluation of the vocal characteristics of patients with different severities of COVID-19. METHODS: One hundred two patients with mild, moderate, or severe COVID-19 as well as 30 healthy individuals were recruited to compare their respiratory/phonatory parameters. The Persian version of the CAPE-V and GRBAS scales, along with the maximum phonation time and s/z ratio values were used to evaluate the severity of respiratory/phonatory disorders during verbal tasks in the participants. RESULTS: Significant differences were found between the subgroups of patients and their healthy counterparts in all respiratory/phonatory parameters (p ≤ 0.03) except the s/z ratio (p = 0.81). CONCLUSIONS: Based on auditory-perceptual assessments, patients with COVID-19 showed dysphonia. The severity of dysphonia was significantly different among patients with different severities of COVID-19. Smoking can also play a significant role in vocal dysfunction in COVID-19 patients.

A Cepstral Peak Prominence (CPP) Voice Analysis in Iranian Post-lingual Deaf Adult Cochlear Implant Users.

OBJECTIVE: In standardized connected speech samples, cepstral peak prominence (CPP) and smoothed CPP (CPPS) have been described as accurate parameters to evaluate voice quality. Lack of normal auditory feedback in post-lingually deaf CI users might influence tuning the acoustic parameters in speech production. Based on shreds of evidence, normal hearing results in suitable vocal control through the sensory-motor linkage. The main aim of the present study was to compare the cepstral values between the Iranian cochlear implant group and normal peers. METHOD: Persian CAPE-V sentences were recorded from 30 CI users and 30 healthy speakers (mean age=36.7 years, SD=13.5, range=18-60 years). Thirteen /a/vowels were extracted manually from syllables. Each subject phonated sustained /a/vowel for 5 seconds. PRAAT was used to calculate CPP and CPPS. To compare two age- and gender-matched groups, the independent sample t-test was applied. Then, ANCOVA was used to assess the impact of demographic factors on cepstral scores in CI participants. RESULTS: Significant differences between the CI group and normal peers were discovered based on CPP and CPPS in both tasks (reading sentences and sustained vowel) (P < 0.05). Overall, CI users showed higher cepstral values. The implanted ear and prosthesis model had no significant impact on both CPP and CPPS (P ≥ 0.8). CONCLUSION: Higher CPP and CPPS values in the CI users might be due to increased phonatory instability and spectral noise, with the possibility of decreased vocal control and its quality. The outcome suggests that CI group uses a different voice control strategy. These findings should be kept in mind for intervention methods, especially by assessing vocal characteristics and considering the voice quality in adult CI users.

The use of crossword puzzles as an educational tool.

INTRODUCTION: Instruction in teacher-centered formats may lead to early learning fatigue, which in turn, decelerates students' knowledge retrieval. Presently, teachers try to increase students' participation and their active attention to course content by incorporating effective, applicable, low-cost, and enjoyable teaching apparatuses. METHODS: The participants of this quasi-experimental study were the students of speech therapy in 4th semester (n=83) at Ahvaz Jundishapur University of Medical Sciences. They were simple-randomly divided into two groups of experimental (who received the crossword puzzle accompanied by lecture or the hybrid method as Group A) and control (who received the traditional method as Group B). The students' knowledge level and students' satisfaction with their received instruction methods were assessed as outcome measures throughout the experiment for both groups. The test score of students' initial knowledge of the concepts in Speech Therapy, the score from the semester final exam of the courses in forms of multiple choice questions, and the retained learning score were calculated as the pre-test, post-test and a follow-up measurement, respectively. Independent-samples T-test for comparative analyses of students' satisfaction between the pre-test and post-test, and multivariate repeated measures ANOVA test were used to analyze the students' knowledge level at three time-points (before, immediately after, and one month after the trainings). The data were analyzed using SPSS ver. 18.0 software, and at the level of statistical significance of P≤0.05. RESULTS: Both educational methods significantly improved the students' knowledge level after the trainings (P=0.030); however, the mean score of knowledge and learning of Group A (mean=17.14) were significantly higher than that of Group B (mean=16.02) immediately after (P=0.036) and one month after the trainings (mean=18.26 vs. 16.10) (P=0.001). The mean score of students' satisfaction in Group A was also significantly higher than that in Group B (P=0.010). CONCLUSION: Utilizing the crossword puzzle as an enjoyable and participatory teaching tool accompanied by lecture could improve management quality in Speech Therapy sessions.

Post-lingual deaf adult cochlear implant users' speech and voice characteristics: cochlear implant turned-on versus turned-off.

BACKGROUND: A time-period of turning off cochlear implant (CI) might affect the speech and voice features of the CI users due to loss of auditory feedback monitoring. OBJECTIVES: To evaluate Persian-speaking CI users' speech and voice parameters in a device-on/off experiment. MATERIAL AND METHODS: Forty-eight Persian-speaking adults with post-linguistic deafness who had received a unilateral CI and 50 normally-hearing counterparts were recruited. All CI users had to fulfill three phases of speech sampling, including the device-on, device-off (a 5-hourly period), and once again device-on phase. Their Fundamental frequency, Jitter, Shimmer, Harmonics-to-noise ratio, hyper-nasality score, and the percentage of speech intelligibility were assessed for both groups. RESULTS: The findings revealed that the CI-on/off conditions significantly changed cochlear implanted participants' F0, Shimmer, HNR, and hyper-nasality values. However, no statistical differences were observed in Jitter and the percentage of speech intelligibility between the CI and control groups. CONCLUSIONS: A short-term auditory deprivation in CI recipients could degrade the speech and voice quality in CI users, so that could change the quality of their speech resonance into hyper-nasality. However, when the CIs were turned on again, the quality of their speech and voice returned to normal-sounding.

Phonological Abilities in Persian Speaking Preschool Children with Stuttering and Fluent Peers.

OBJECTIVES: Speech sound production is poorer in stutterers than normally fluent peers. This study was performed to compare speech sound production abilities in Persian speaking children with developmental stuttering. MATERIALS & METHODS: Overall, 34 children with stuttering and 60 children without stuttering aged from 3 to 6 yr old were enrolled from Ahvaz City, Khuzestan Province, southern Iran in 2016. The phonetic information test was used to assess speech sound production in this study and 30-minute mother-child conversations were utilized for calculation of Percentage Consonant Correct. Phonological abilities of these two groups were compared against each other and a correlation between stuttering severity and speech sound articulation was calculated. RESULTS: There was significant difference between children with stuttering and normal peers for articulation error total percentage but not significant difference was found for percentage consonant correct (P=0.16). Moreover, no significant correlation between stuttering severity and speech sound production in this population was found. CONCLUSION: No association seems to exist between stuttering severity and speech sound production abilities in this population. This study may lead to the notion that there was significant difference between the two groups in speech sound production assessment.

The effects of narrative-based language intervention (NBLI) on spoken narrative structures in Persian-speaking cochlear implanted children: A prospective randomized control trial.

BACKGROUND: Previous research has shown that narrative-based language intervention (NBLI) is a feasible approach increasing the narrative skills of hearing-impaired children. OBJECTIVE: In the present study, the efficacy of NBLI on the macrostructure and microstructure components of the spoken narrative of children with cochlear implants (CI) was evaluated in an experimental study. MATERIALS AND METHODS: Thirty-six CI children between the ages of 5.5 and 7 years were randomly divided in three groups of equal size. Group 1 attended 24 1-h sessions of NBLI group therapy. Group 2 participants each attended 24 1-h private sessions of NBLI instruction. Group 3 attended 24 1-h conventional speech therapy (CST) sessions. The subjects' storytelling skills were prompted using pictures from the Persian version of the Language Sample Analysis test. The results were assessed before treatment (T0), after treatment (T1) and two months after treatment (T2) as follow-up. RESULTS: Groups 1 and 2 showed significantly better results over Group 3 on all microstructure components of spoken narrative at the T1 (p ≤ 0.04) and T2 (p ≤ 0.04) levels in comparison with T0, but no differences were observed between the NBLI approaches (p > 0.05). All three intervention programs significantly improved the macrostructure of the spoken narrative in CI children. CONCLUSION: Improvements in spoken narrative structures were observed in CI children that support the efficacy of NBLI over CST for the hearing-impaired population.

Spoken and Written Narrative in Persian-Speaking Students Who Received Cochlear Implant and/or Hearing Aid.

OBJECTIVES: To compare narrative skills between fourth and fifth grades of Persian-speaking students with hearing impairments and typical hearing students of the same grade and also to evaluate the effects of group, sex, hearing age, and educational grade of the students on their spoken/written narrative performance. METHODS: The subjects were 174 students aged 10-13 years, 54 of whom wore cochlear implants, 60 suffered from moderate to severe hearing losses and wore hearing aids, with the remaining 60 students being typical hearing in terms of the sense of hearing. The micro- and macrostructure components of spoken and written narrative were elicited from a pictorial story (The Playful Little Elephant) and then scored by raters. RESULTS: Compared to the typical hearing, the students with hearing impairments had significantly lower scores in all of the microstructure components of narratives. However, the findings showed no significant difference among different groups in macrostructure components of narratives. It was also revealed that the students had equal performance in spoken and written narrative. Finally, factor analysis manifested that group, sex, hearing age, and educational level of children might alter the outcome measures in various interactions. CONCLUSION: Although cochlear implantation was more effective than hearing aid on spoken and written narrative skills, the Persian-speaking students with hearing impairments were seen to need additional trainings on microstructure components of spoken/written narrative.

Speech Intelligibility in Persian Hearing Impaired Children with Cochlear Implants and Hearing Aids.

The aim of present study is to evaluate and compare speech intelligibility in hearing impaired children with cochlear implants (CI) and hearing aid (HA) users and children with normal hearing (NH). The sample consisted of 45 Persian-speaking children aged 3 to 5-years-old. They were divided into three groups, and each group had 15, children, children with CI and children using hearing aids in Hamadan. Participants was evaluated by the test of speech intelligibility level. Results of ANOVA on speech intelligibility test showed that NH children had significantly better reading performance than hearing impaired children with CI and HA. Post-hoc analysis, using Scheffe test, indicated that the mean score of speech intelligibility of normal children was higher than the HA and CI groups; but the difference was not significant between mean of speech intelligibility in children with hearing loss that use cochlear implant and those using HA. It is clear that even with remarkabkle advances in HA technology, many hearing impaired children continue to find speech production a challenging problem. Given that speech intelligibility is a key element in proper communication and social interaction, consequently, educational and rehabilitation programs are essential to improve speech intelligibility of children with hearing loss.

Effect(s) of Language Tasks on Severity of Disfluencies in Preschool Children with Stuttering.

Speech disfluency in children can be increased or decreased depending on the type of linguistic task presented to them. In this study, the effect of sentence imitation and sentence modeling on severity of speech disfluencies in preschool children with stuttering is investigated. In this cross-sectional descriptive analytical study, 58 children with stuttering (29 with mild stuttering and 29 with moderate stuttering) and 58 typical children aged between 4 and 6 years old participated. The severity of speech disfluencies was assessed by SSI-3 and TOCS before and after offering each task. In boys with mild stuttering, The mean stuttering severity scores in two tasks of sentence imitation and sentence modeling were [Formula: see text] and [Formula: see text] respectively ([Formula: see text]). But, in boys with moderate stuttering the stuttering severity in the both tasks were [Formula: see text] and [Formula: see text] respectively ([Formula: see text]). In girls with mild stuttering, the stuttering severity in two tasks of sentence imitation and sentence modeling were [Formula: see text] and [Formula: see text] respectively ([Formula: see text]). But, in girls with moderate stuttering the mean stuttering severity in the both tasks were [Formula: see text] and [Formula: see text] respectively ([Formula: see text]). In both gender of typical children, the score of speech disfluencies had no significant difference between two tasks ([Formula: see text]). In preschool children with mild stuttering and peer non-stutters, performing the tasks of sentence imitation and sentence modeling could not increase the severity of stuttering. But, in preschool children with moderate stuttering, doing the task of sentence modeling increased the stuttering severity score.

Meaningful Words and Non-Words Repetitive Articulatory Rate (Oral Diadochokinesis) in Persian Speaking Children.

Repetitive articulatory rate or Oral Diadochokinesis (oral-DDK) shows a guideline for appraisal and diagnosis of subjects with oral-motor disorder. Traditionally, meaningless words repetition has been utilized in this task and preschool children have challenges with them. Therefore, we aimed to determine some meaningful words in order to test oral-DDK in Persian speaking preschool children. Participants were 142 normally developing children, (age range 4-6 years), who were asked to produce /motæka, golabi/ as two meaningful Persian words and /pa-ta-ka/ as non-word in conventional oral-DDK task. We compared the time taken for 10-times fast repetitions of two meaningful Persian words and the tri-syllabic nonsense word /pa-ta-ka/. Praat software was used to calculate the average time that subjects took to produce the target items. In 4-5 year old children, [Formula: see text] of time taken for 10-times repetitions of /pa-ta-ka, motæka, golabi/ were [Formula: see text], and [Formula: see text] seconds respectively, and in 5-6 year old children were [Formula: see text], and [Formula: see text] seconds respectively. Findings showed that the main effect of type of words on oral diadochokinesis was significant ([Formula: see text]). Children repeated meaningful words /motæka, golabi/ faster than the non-word /pa-ta-ka/. Sex and age factors had no effect on time taken for repetition of oral-DDK test. It is suggested that Speech Therapists can use meaningful words to facilitate oral-DDK test for children.

Vowel Production in Persian Deaf Children with Cochlear Implant: is the Age of Implantation an Important Factor?

Proper production of vowels has great significance in speech intelligibility. Evidence shows that cochlear implantation has a significant impact on language and reading abilities in some children immediately after the surgery. The aim of the present study is comparing the quality of 6 simple Persian vowels between two groups of cochlear-implanted children under and over 2 years old. This was a cross-sectional analytic study conducted on 70 children who were implanted under the age of 2, 70 children who were implanted over the age of 2 and 238 normal children as control group. For data analysis, the SFS win acoustic analysis was used. Result of this study showed that F2/i/, f1/e/, f2/e/, f2/∞/, f1/a/, F2/a/, f1/o/, F2/o/and F2/u/means had significant difference between three groups (P < 0.05). Children implanted under the age of 2 showed similar performance as normal children in vowel production. Early cochlear implantation (under the age of 2) affects the quality of simple Persian vowel production significantly as well as the increase of speech intelligibility.

Effect of aloe cream versus silver sulfadiazine for healing burn wounds in rats.

The management of burn injury remains a problem and it is the major cause of death and disability. The aim of this study was to evaluate the efficacy of Aloe vera cream in the treatment of thermal burn wounds and to compare these results with silver sulfadiazine in rats. Animals were divided into four groups. Animals were administered topical cream (Aloe vera powdered gel 0.5% and silver sulfadiazine) at 24 h of burn injury induced by hot water. On special days, according to study protocol, wound size was determined and skin sample histopathology performed in animal groups administered topical therapies. On day 25, the mean wound size was 5.5, 4, 0.78 and 4.1 cm2 in control, base, aloe and silver group, respectively. The wound size was significantly smaller in aloe group as compared with other groups. Histologic comparison showed aloe to increase reepithelialization in burn wounds significantly as compared with other cream-treated wounds. The results of this study showed aloe cream to significantly increase reepithelialization in burn wounds as compared with silver sulfadiazine.

The effect of saffron (Crocus sativus) extract for healing of second-degree burn wounds in rats.

The aim of this study was to evaluate the efficacy of pollen of saffron extract cream in the treatment of thermal induced burn wounds and to compare its results with silver sulfadiazine (SSD) in rats. Animals were divided into four groups and administrated a topical cream including control, base, saffron (20%) or SSD (1%) at 24 hour after a burn injury that was induced by hot water. In special days, according to a pre-planned schedule, animal's weight, wound size, as well as skin histo-pathology were determined in different groups under topical treatments. On day 25, average size of wound was 5.5, 4, 0.9 and 4.1 cm2 in control, base, saffron and silver groups. The wound size of saffron group was significantly smaller than other groups. Histological comparison has shown that saffron significantly increased re-epithelialization in burn wounds, as compared to other cream-treated wounds. Although the exact mechanism of saffron is unclear, anti-inflammatory and antioxidant effects of saffron may have contributed to the wound healing. The results of this study raise the possibility of potential efficacy of saffron in accelerating wound healing in burn injuries.