Vestibular-Balance Rehabilitation in Patients with Whiplash-Associated Disorders.

BACKGROUND AND OBJECTIVE: Whiplash associated syndrome is one of the neck disorders that is accompanied by several chronic symptoms. Balancing problems arising from common disorders and dizziness are considered as manifestations that are time-consuming to evaluate and treat. The present study aims to investigate the effect of vestibular-balance rehabilitation using a test that can be used for differential diagnosis of these lesions by comparing dizziness handicap inventory (DHI) and Smooth Pursuit Neck Torsion (SPNT) scores. METHOD: This was an analytical cross-sectional study with a two-stage design. Forty patients with whiplash-associated disorders were randomly divided into control and intervention groups. SPNT test and DHI evaluation were performed for both groups. For twenty people selected randomly in the intervention group, vestibular-balance rehabilitation was performed during 12 sessions. Finally, the SPNT and DHI tests were performed again to examine and compare the results. RESULTS: The results of this study showed that there was a statistically significant difference between the scores of smooth pursuit neck torsion gain in the SPNT test, the total score of DHI, the functional components of this questionnaire between the control and intervention groups after the implementation of the rehabilitation, and the differences in the physical, functional, and emotional components of the questionnaires of the control and intervention groups after rehabilitation exercises. CONCLUSION: Vestibular-balance rehabilitation exercises can be an effective treatment for dizziness and improving the quality of life of a person suffering from whiplash-associated disorder, followed by the reduction in dizziness caused by disability.

Oculomotor rehabilitation in children with dyslexia.

Background: Dyslexia is the most common learning disorder. Visual and oculomotor deficits in dyslexic children have been reported. The purpose of this study was to measure oculomotor parameters and analyze the effect of oculomotor rehabilitation strategies on dyslexia. Methods: Binocular eye movements were recorded by oculomotor subtype of videonystagmography (VNG) testing on 30 children with dyslexia and 20 typical reader children (aged 8-12) in both genders. Dyslexic children were diagnosed with DSM-V scale by experts in reading disorder centers. We studied those children with developmental dyslexia, who had deficits in eye movements recording. Dyslexic children were divided into 2 groups of case and control. Oculomotor rehabilitation (including fixation, saccade, and tracking training) was performed in case group for 1 hour, twice weekly for 8 weeks. Before the intervention, results of oculomotor tests were compared between 3 groups (healthy, case, and control). Then, to analyze the effect of the intervention, results of oculomotor tests were compared between case and control groups in pre- and post- intervention stage. Data were analyzed by independent and paired samples t tests, ANOVA, and repeated measures tests in SPSS v. 21. Results: There were significant differences in oculomotor characteristics of dyslexic children in comparison with those reported in typical children. Oculomotor rehabilitation intervention had a positive effect on improvement of oculomotor responses and eye movements in dyslexic children. Moreover, there was no statistically significant difference between dyslexic children and non-dyslexic children in oculomotor skills after the training. Conclusion: Our results showed the positive effects of oculomotor rehabilitation on eye movements. Primary oculomotor assessment in dyslexic children and early use of oculomotor rehabilitation combined with other treatments are highly recommended.

The relationship between ultra-high frequency thresholds and transient evoked otoacoustic emissions in adults with tinnitus.

Background: The possible role of cochlear function in tinnitus generation is still a matter of debate. To assess the role of outer hair cell dysfunction in tinnitus and its possible relationship with ultra-high frequency (UHF) hearing sensitivity, transient evoked otoacoustic emissions (TEOAE) and UHF hearing thresholds were investigated in normal hearing individuals with and without tinnitus. Methods: Eighteen individuals with tinnitus and 22 without tinnitus participated in this study. TEOAE was recorded with click stimulus at 80 dBpeSPL. UHF pure tone audiometry was performed at 10, 12.5, 16, and 18 kHz. Results: TEOAE was significantly abnormal in 72.2% of the tinnitus, and 18.2% of the control groups (p=0.001). The individuals with tinnitus had significantly poorer UHF hearing sensitivity compared to the control group at 12.5 and 18 kHz (p≤0.048). There was a stronger correlation between increasing UHFs hearing threshold and decreasing SNRs of TEOAEs in the tinnitus group compared to the controls. Conclusion: Our study revealed poorer UHF hearing thresholds and more TEOAE abnormalities in normal hearing individuals with tinnitus compared to the controls. Perhaps the alterations in the basal cochlea, following a decrease in UHF hearing sensitivity, affect OAEs that are originated from more apical cochlear parts in tinnitus ears more than non-tinnitus ears.

Effects of stimulus presentation mode and subcortical laterality in speech-evoked auditory brainstem responses.

OBJECTIVE: Speech-evoked auditory brainstem responses (ABR) are sensitive to the manipulation of stimulus parameters, including how the stimulus is presented, i.e. monaurally or binaurally. Therefore, this parametric study was designed to compare the effect of binaural and monaural stimuli presentation on speech-evoked ABR features in the parallel assessment of subcortical asymmetry of speech stimuli acoustic elements. DESIGN: Electrophysiological responses to the speech syllable /da/ were recorded within three stimulus presentation modes. STUDY SAMPLE: Forty-eight normal hearing monolingual Persian speakers were included in the current study as volunteer cases. RESULTS: Shorter right ear latency was observed for peaks A and E, but the overall response timing was comparable within different stimulus presentation modes. Binaural stimulation generally led to larger response than monaural stimulation and affected the encoding of speech spectral elements. Moreover, no significant interpeak interval difference was observed in the sustained portion of responses. Response to the right and left ear stimulation was highly correlated, and a symmetrical pattern was observed between the two ears. CONCLUSIONS: The timing of speech-evoked responses is not related to the stimulus presentation mode; however, binaural stimulation produces more robust responses. Lateral asymmetry in the representation of speech elements was not considerable at the brainstem level.

Eye movement patterns in Iranian dyslexic children compared to non-dyslexic children.

OBJECTIVE: Dyslexia is the most common learning disorder that affects 5-10% of school aged children. Eye movement abnormalities and visual processing deficits have been reported in some of dyslexic children. Objective of this study is to compare the eye-movement patterns of Iranian dyslexic children with those of non-dyslexic children as they perform the oculomotor tests and to explore the relationship between their eye-movement patterns and their reading ability. METHODS: Binocular eye movements were recorded by oculomotor subtype of videonystagmography (VNG) testing on 30 dyslexic children and 20 non-dyslexic age-matched children (aged 8-12) in both genders. Dyslexic children were diagnosed with DSM-V scale by experts in reading disorder centers. Gain of the pursuit and optokinetic tests and the latency, accuracy and velocity of the saccade test were measured in both groups of dyslexic and non-dyslexic children. The independent samples t-test, Chi-square test and linear regression test in SPSS v. 21 were used to analyze behavioral and eye-movement parameters. RESULTS: Compared to the non-dyslexic group, dyslexic children presented lower gain in pursuit and optokinetic tests, and increased latency with decreased accuracy in saccade test. All behavioral and eye-movement parameters without saccade velocity differed significantly among two groups. CONCLUSION: The atypical eye movement patterns observed in dyslexic children suggests a deficiency in the visual information processing and an immaturity of brain structures responsible for oculomotor skills.

The Additional Effect of Vestibular Rehabilitation Therapy on Residual Dizziness After Successful Modified Epley Procedure for Posterior Canal Benign Paroxysmal Positional Vertigo.

Purpose The aim of the study was to evaluate the additional effect of vestibular rehabilitation therapy (VRT) compared with the modified Epley procedure alone on residual dizziness after a successful modified Epley procedure in patients with posterior canal benign paroxysmal positional vertigo (BPPV). Method In this cross-sectional analytical comparative study, 47 patients (35 women and 12 men) aged 18-80 years with posterior canal BPPV were randomly assigned to one of two following groups: the control group, who received the modified Epley procedure only, and the VRT group, who received the modified Epley procedure plus vestibular rehabilitation for 4 weeks. Outcome measures, including the Dizziness Handicap Inventory (DHI), the Vertigo Symptom Scale-Long Version (VSS-L), and the Vertigo Symptom Scale-Short Form (VSS-SF), were conducted on the same session before initial therapy (T1), at 48 hr later (T2), and at 4 weeks later (T3). Presence or absence of residual dizziness was evaluated at T2. Results Residual dizziness was found in 20 (42.6%) patients after a successful modified Epley procedure. There was no statistically significant difference between the mean DHI, VSS-L, and VSS-SF scores at T1, T2, and T3 in patients who manifested with residual dizziness and those without residual dizziness in both groups. The average DHI, VSS-L, and VSS-SF score reduced during the time in both groups. These results were demonstrated that the VRT group and the control group have similar reductions in symptoms after treatment with the VRT plus modified Epley procedure and the modified Epley procedure only, respectively. Conclusions Residual dizziness is a common condition after a successful modified Epley procedure for BPPV. The VRT plus modified Epley procedure is as effective as modified Epley procedure alone in the management of residual dizziness. Further studies with supervised and customized VRT and longer follow-up periods are needed. Supplemental Material https://doi.org/10.23641/asha.14825508.

The Efficacy of the Half Somersault Maneuver in Comparison to the Epley Maneuver in Patients with Benign Paroxysmal Positional Vertigo.

OBJECTIVE: Benign Paroxysmal Positional Vertigo (BPPV) as the most common vestibular disorder can affect the quality of life. This study aimed to compare the effectiveness of the half somersault maneuver (HSM) as a treatment to that of the Epley maneuver (EM) as a clinical-based treatment in subjects with PC-BPPV. METHODS: In this randomized study, 43 participants with unilateral posterior canal BPPV were recruited. The experimental group received the HSM, whereas the control group received the EM. All participants were asked to fill in the Vestibular Rehabilitation Benefit Questionnaire (VRBQ), Dizziness Handicap Inventory (DHI), and Vertigo Symptom Scale (VSS) questionnaires at pretreatment and at 48 hours, 1 week, and 1 month posttreatment. The severity of residual dizziness was determined by the visual analog scale (VAS) weekly for up to 4 weeks after treatment. The success rate and the recurrence rate were assessed after the 3-month follow-up. RESULTS: The differences between the results of pretreatment and post-treatment questionnaires for both groups were significant. However, the differences were not significant between the 2 groups for the DHI scores, the total, dizziness, motion-provoked dizziness, and symptom subscale scores of the VRBQ, and the anxiety subscale scores of the VSS. There were significant differences between the 2 groups for VAS, the total VSS and vertigo subscale scores, and the VRBQ anxiety subscale scores. CONCLUSION: Even though both maneuvers are significantly effective in the treatment of PC-BPPV, subjects in the HSM group reported more improvement in terms of psychometric symptoms and residual dizziness compared to the EM group.

The effects of a temporal processing-based auditory training program on the auditory skills of elderly users of hearing aids: a study protocol for a randomized clinical trial.

Background: One of the most important effects of age-related declines in neural processing speed is the impairment of temporal resolution, which leads to difficulty hearing in noisy environments. Since the central auditory system is highly plastic, by designing and implementing a temporal processing-based auditory training program, we can help the elderly improve their listening skills and speech understanding in noisy environments. Methods: In the first phase of this research, based on the theoretical framework of temporal processing, an auditory training solution was developed as a software program. In the second phase, which will be described in the present study, the effects of the designed program on the listening skills of the elderly users of hearing aids (age: 60-75 years) will be studied in the control and intervention groups. In the intervention group, the auditory training program will be implemented for three months (36 sessions), and the results of central tests (GIN, DPT, QuickSIN) and the electrophysiological speech-ABR test will be compared in both groups before, immediately and one month after the intervention. Discussion: Since temporal processing is not sufficient in auditory training programs for the elderly with hearing impairments, implementation of a temporal processing-based auditory training program can reduce hearing problems in noisy environments among elderly users of hearing aids. Trial registration: This study was registered as a clinical trial in the Iranian Registry of Clinical Trials ( IRCT20190921044838N1) on December 25, 2019.

Effect of Vowel Auditory Training on the Speech-In-Noise Perception among Older Adults with Normal Hearing.

INTRODUCTION: Aging reduces the ability to understand speech in noise. Hearing rehabilitation is one of the ways to help older people communicate effectively. This study aimed to investigate the effect of vowel auditory training on the improvement of speech-in-noise (SIN) perception among elderly listeners. MATERIALS AND METHODS: This study was conducted on 36 elderly listeners (17 males and 15 females) with the mean±SD of 67.6±6.33. They had the normal peripheral auditory ability but had difficulties in SIN perception. The samples were randomly divided into two groups of intervention and control. The intervention group underwent vowel auditory training; however, the control group received no training. RESULTS: After vowel auditory training, the intervention group showed significant changes in the results of the SIN test at two signal-to-noise ratios of 0 and -10 and the Iranian version of the Speech, Spatial, and Qualities of Hearing Scale, compared to the control group (P<0.001). Regarding the Speech Auditory Brainstem Response test, the F0 magnitude was higher in the intervention group (8.42±2.26), compared to the control group (6.68±1.87) (P<0.011). CONCLUSION: This study investigated the effect of vowel auditory training on the improvement of SIN perception which could be probably due to better F0 encoding and receiving. This ability enhancement resulted in the easier perception of speech and its more proper separation from background noise which in turn enhanced the ability of the old people to follow the speech of a specific person and track the discussion.

Brainstem Correlates of Comodulation Masking Release for Speech in Normal Hearing Adults.

BACKGROUND AND OBJECTIVES: Weak signals embedded in fluctuating masker can be perceived more efficiently than similar signals embedded in unmodulated masker. This release from masking is known as comodulation masking release (CMR). In this paper, we investigate, neural correlates of CMR in the human auditory brainstem. SUBJECTS AND METHODS: A total of 26 normal hearing subjects aged 18-30 years participated in this study. First, the impact of CMR was quantified by a behavioral experiment. After that, the brainstem correlates of CMR was investigated by the auditory brainstem response to complex sounds (cABR) in comodulated (CM) and unmodulated (UM) masking conditions. RESULTS: The auditory brainstem responses are less susceptible to degradation in response to the speech syllable /da/ in the CM noise masker in comparison with the UM noise masker. In the CM noise masker, frequency-following response (FFR) and fundamental frequency (F0) were correlated with better behavioral CMR. Furthermore, the subcortical response timing of subjects with higher CMR was less affected by the CM noise masker, having higher stimulus-to-noise response correlations over the FFR range. CONCLUSIONS: The results of the present study revealed a significant link between brainstem auditory processes and CMR. The findings of the present study show that cABR provides objective information about the neural correlates of CMR for speech stimulus.

Effects of Age on Speech-in-Noise Identification: Subjective Ratings of Hearing Difficulties and Encoding of Fundamental Frequency in Older Adults.

BACKGROUND AND OBJECTIVES: Numerous studies have indicated deterioration of speech perception in noisy conditions among the elderly even those with normal hearing capabilities. The aim of this study was to investigate the effects of age on the speech-in-noise identification by speech-in-noise (SIN) test, subjective ratings of hearing difficulties by speech, spatial, and qualities of hearing scale (SSQ) questionnaire and encoding of fundamental frequency (F0) by Speech auditory brainstem response (ABR) in the elderly and comparing the results with young people. SUBJECTS AND METHODS: The present study was conducted on 32 elderly people aged over 60 years old (17 male and 15 female) with the mean age of 68.9 (standard deviation=6.33) possessing normal peripheral hearing and 32 young subjects (16 male and 16 female) aged 18-25 years old. RESULTS: Findings showed that the score of SIN test is lower among the elderly people as compared with young people in signal-to-noise ratios of 0 and -10 based on Iranian version of SSQ questionnaire (p<0.001). The range of F0 amplitude in the elderly people is also lower than young people (p<0.001) in Speech ABR. CONCLUSIONS: It seems that speech processing in older people is deteriorated comparing with young people regardless of their normal peripheral auditory thresholds. This decrease will result in weaker perception and improper segregation of speech from other competing sources.

Tinnitus Impacts on Speech and Non-speech Stimuli.

OBJECTIVE: To investigate how tinnitus affects the processing of speech and non-speech stimuli at the subcortical level. STUDY DESIGN: Cross-sectional analytical study. SETTING: Academic, tertiary referral center. PATIENTS: Eighteen individuals with tinnitus and 20 controls without tinnitus matched based on their age and sex. All subjects had normal hearing sensitivity. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: The effect of tinnitus on the parameters of auditory brainstem responses (ABR) to non-speech (click-ABR), and speech (sABR) stimuli was investigated. RESULTS: Latencies of click ABR in waves III, V, and Vn, as well as inter-peak latency (IPL) of I to V were significantly longer in individuals with tinnitus compared with the controls. Individuals with tinnitus demonstrated significantly longer latencies of all sABR waves than the control group. The tinnitus patients also exhibited a significant decrease in the slope of the V-A complex and reduced encoding of the first and higher formants. A significant difference was observed between the two groups in the spectral magnitudes, the first formant frequency range (F1) and a higher frequency region (HF). CONCLUSIONS: Our findings suggest that maladaptive neural plasticity resulting from tinnitus can be subcortically measured and affects timing processing of both speech and non-speech stimuli. The findings have been discussed based on models of maladaptive plasticity and the interference of tinnitus as an internal noise in synthesizing speech auditory stimuli.

Prevalence of cochlear dead regions in moderate to severe sensorineural hearing impaired children.

OBJECTIVES: To investigate the overall prevalence of cochlear dead regions in children with moderate to severe sensorineural hearing impairment. METHODS: Threshold-equalizing noise (or TEN) test was administered on thirty sensorineural hearing impaired children (8 girls, 22 boys), aged 5-14 years (mean±SD8.5±2.8). RESULTS: Classifying by subject, 76% tested positive for cochlear dead regions in one or both ears at least at one frequency. Classifying by ears, 58.3% had dead regions at one frequency or more. Classifying by the number of frequencies were tested, 20% met the criteria for a dead region. The difference between mean absolute thresholds in two groups was statistically significant at 1000Hz and below (p<0.05). CONCLUSION: The results indicated a relatively high prevalence of dead regions in children with sensory neural hearing impairment, especially for frequencies at which the hearing loss exceeds 70dB HL.

Gender disparity in subcortical encoding of binaurally presented speech stimuli: an auditory evoked potentials study.

OBJECTIVES: To investigate the influence of gender on subcortical representation of speech acoustic parameters where simultaneously presented to both ears. METHODS: Two-channel speech-evoked auditory brainstem responses were obtained in 25 female and 23 male normal hearing young adults by using binaural presentation of the 40 ms synthetic consonant-vowel/da/, and the encoding of the fast and slow elements of speech stimuli at subcortical level were compared in the temporal and spectral domains between the sexes using independent sample, two tailed t-test. RESULTS: Highly detectable responses were established in both groups. Analysis in the time domain revealed earlier and larger Fast-onset-responses in females but there was no gender related difference in sustained segment and offset of the response. Interpeak intervals between Frequency Following Response peaks were also invariant to sex. Based on shorter onset responses in females, composite onset measures were also sex dependent. Analysis in the spectral domain showed more robust and better representation of fundamental frequency as well as the first formant and high frequency components of first formant in females than in males. CONCLUSIONS: Anatomical, biological and biochemical distinctions between females and males could alter the neural encoding of the acoustic cues of speech stimuli at subcortical level. Females have an advantage in binaural processing of the slow and fast elements of speech. This could be a physiological evidence for better identification of speaker and emotional tone of voice, as well as better perceiving the phonetic information of speech in women.