Validation of the Acoustic Voice Quality Index and the Acoustic Breathiness Index in the Persian Language.

OBJECTIVES/HYPOTHESIS: This study aimed to validate the acoustic voice quality index version 03.01 (AVQIv3) and the acoustic breathiness index (ABI) in the Persian language. METHODS: Six judges assessed the severity degree of the abnormal overall voice quality (hoarseness) and breathiness from continuous speech (cs) and sustained vowel (sv) in 136 voices samples of dysphonic and 45 vocally healthy participants. Firstly, the time length of cs and sv was balanced out for a higher level of ecological validity. Secondly, the concurrent validity and diagnostic accuracy were statistically analyzed with the Spearman rank-order correlation, and the receiver operating characteristics, likelihood ratio, and Youden index. RESULTS: There was substantial inter-rater reliability between judges regarding hoarseness and breathiness. Twenty syllables were identified as the standardized number of syllables for the cs part. Sufficient correlations were found between AVQI and hoarseness (rs = 0.74), and between ABI and breathiness (rs = 0.74), respectively. The thresholds of 1.63 (sensitivity of 73.2% and specificity of 91%) and 2.97 (sensitivity of 70% and specificity of 87%) yielded the highest level of diagnostic findings for AVQI and ABI, respectively. CONCLUSION: The AVQIv3 and ABI are reliable indices to quantify the abnormal overall voice quality and breathiness in the Persian language.

The comparison between vocal facilitating techniques, manual circumlaryngeal therapy, and combined voice therapy in teachers with muscle tension dysphonia: a randomized clinical trial.

PURPOSE: Although voice therapy (VT) has been known effective in muscle tension dysphonia (MTD), it is not obviously clear which VT approach is more effective. This study aimed to compare the effectiveness of Vocal Facilitating Techniques (VFTs), Manual Circumlaryngeal Therapy (MCT), and combined VT in teachers with MTD. METHODS: This study was a double-blind parallel randomized clinical trial. Thirty elementary female teachers with MTD were divided into three treatment groups including VFTs; MCT, and combined VT. In addition, vocal hygiene was presented to all groups. All participants received 10 individual 45-min sessions of VT twice a week. The effectiveness was assessed using Vocal Tract Discomfort (VTD) scale and Dysphonia Severity Index (DSI) before and after treatment and improvement measurement was calculated. The participants and data analyzer were blinded to the type of VT. RESULTS: All groups showed significantly better results on the subscales of VTD scale and DSI score after VT (p ≤ 0.001; η2 ≥ 0.90). There was a significant difference between the three groups on the results of VTD scale and DSI score (p ≤ 0.05). The improvement measurement on the VTD severity subscale and DSI score following the combined VT was the greatest compared with other groups (η2 = 0.99 and 0.98, respectively). The significant interactive effect of treatment and time was observed on the VTD severity subscale and DSI score (p < 0.05; η2 ≥ 0.56). CONCLUSIONS: This study showed that the VFTs, MCT, and combined VT were effective for MTD teachers, and the combined VT is the most effective one. It seems the combination of different approaches is recommended for the VT of MTD patients.

Hearing handicaps, communication difficulties and depression in the older adults: a comparison of hearing aid users and non-users.

BACKGROUND AND AIM: Age-related hearing loss has potential effects on communication, cognitive, emotional, and social aspects of the older person's life. Evaluating the role of hearing aids in reducing these difficulties is important. This study aimed to evaluate communication difficulties, self-perceived handicaps, and depression in hearing-impaired older adults who are either hearing aid users or non-users. METHODS: A total of 114 older adults in the age range of 55-85 years with moderate to moderately severe hearing loss (two hearing-matched groups; hearing aid users: n = 57; hearing aid non-users: n = 57) took part in this study during the COVID-19 pandemic. Self-perceived hearing handicaps and communication were evaluated using the Hearing Handicap Inventory in the Elderly-Screening (HHIE-S) and Self-Assessment Communication (SAC) questionnaires. Depression was assessed using the geriatric depression scale (GDS). RESULTS: The average score of HHIE-S was significantly higher in the hearing aid users than the non-users (16.61 ± 10.39 vs. 12.49 ± 9.84; p = 0.01). Differences between groups were not significant for SAC or GDS scores (p ≥ 0.05). There were strong positive correlations between HHIE-S and SAC scores in both groups. Moderate correlations were found between SAC and GDS scores in the hearing aid users and between the duration of using hearing aid with SAC and HHIE-S scores. CONCLUSION: It seems that self-perceived handicaps, communication difficulties and depression are affected by many factors, and only receiving hearing aids without subsequent support such as auditory rehabilitation and programming services cannot bring the expected output. The effect of these factors was clearly observed due to reduced access to services in the COVID-19 era.

Relationship Between Aerodynamic Measurement of Maximum Phonation Time With Acoustic Analysis and the Effects of Sex and Dysphonia Type.

OBJECTIVES/HYPOTHESIS: This study set out to uncover the correlation between maximum phonation time (MPT) with acoustic and cepstral analysis in the dysphonic and control groups, considering the effects of sex and dysphonia type. METHODS: For this cross-sectional study, a sample of 179 attendees (141 dysphonic and 38 control) were randomly selected and requested to sustain the vowel /a/ as long as they could with their habitual pitch and loudness. Reading standard sentences and conversational connected speech tasks were obtained too. Using Praat, the MPT, jitter, shimmer, noise-to-harmonic ratio, cepstral peak prominence (CPP), and smoothed cepstral peak prominence (CPPS) were calculated in the target vocal tasks. RESULTS: There was a very low to low significant correlation (r = 0.00-0.50) between MPT amounts and acoustic analysis in the dysphonic group (P < 0.05), except for between MPT with shimmer (P > 0.05). In contrast, findings showed no significant correlation between MPT and acoustic analysis in the control group, not even separated by sex (P > 0.05). There was a very low to low correlation between MPT amounts and acoustic analysis in the male dysphonic group (P < 0.05), except for the MPT with shimmer (P > 0.05). There was no significant correlation between MPT and acoustic analysis in the female dysphonic group (P > 0.05), except for MPT with CPP (sustained vowel) (P < 0.05). Finally, very low to high correlations between MPT and some of the acoustic analysis in all the different dysphonia types were observed (P < 0.05). CONCLUSIONS: MPT contains some information about the acoustic features of the dysphonic voice, specifically the CPP and smoothed cepstral peak prominence. The data suggested that the observed relationship between MPT and the acoustic analysis has the capacity to be considered for the development of new multiparametric tests of voice assessment in dysphonia, regarding the sex and dysphonia type.

Relationship of cepstral analysis with voice self-assessments in dysphonic and normal speakers.

PURPOSE: This study aimed to investigate the relationship of cepstral analysis (Cepstral Peak Prominence [CPP] and Cepstral Peak Prominence-Smoothed [CPPS]) with voice self-assessments (The Persian version of vocal tract discomfort [VTDp] scale and non-standard hoarseness self-assessment [NHS] questionnaire). METHODS: 223 participants (159 with and 64 without dysphonia) were asked to utter the vocal tasks namely vowels /a/ and /e/, six standard sentences, and a non-standard connected speech sample. CPP and CPPS were calculated in these three vocal tasks using the "Praat" software. The participants also asked to complete the VTDp scale and the NHS questionnaire. RESULTS: The means of frequency and severity the VTDp and the means of NHS were statistically different between the dysphonic and normal voice groups (P < 0.05), except for tickling (P > 0.05). There was a very low significant correlation between cepstral analysis with aching and in the dysphonic group (P < 0.05). However, a very low to low significant correlation between cepstral analysis with burning, tight, aching, tickling, sore, and both frequency and severity subscales scores of the VTDp in the normal voice group (P < 0.05). Moreover, the means of the cepstral analysis did not differ significantly between all scores of the NHS in the dysphonic the normal voice groups (P > 0.05), except for 1 with 3, 4, and 5 in the dysphonic group (P < 0.05). CONCLUSION: The cepstral analysis can provide some information about the status of vocal tract and person's perception of his/her own voice quality.

Development and psychometric evaluation of the Persian version of the Phoneme Recognition Test: A central auditory processing measure.

Objectives: The present study aimed to evaluate the psychometric properties of the Persian version of the Phoneme Recognition Test (P-PRT) in normal subjects and cochlear implant (CI) users. Material & Methods: This study includes developing the Persian phoneme recognition test (PRT), determining its validity and reliability, and comparing the results of a control group versus CI users. The test reliability was examined through a test-retest with an approximately five-week interval. In the present survey, 363 subjects were investigated in three stages. The face validity evaluation stage was conducted on 40 subjects. The psychometric properties of the P-PRT were evaluated in 323 individuals (225 normal subjects and 98 CI users). The test-retest reliability was examined in all the 225 subjects in the control group and 40 CI users. Results: The results confirmed the face validity of the P-PRT. No significant differences were observed between the two genders in terms of performance in the P-PRT. Significant differences were observed between the control and CI groups. Evaluating the test-retest reliability suggested perfect reliability (r>0.9) in both groups. Significant differences were observed in the P-PRT between the adults and the 7-year-old subjects compared to other age groups. Conclusion: The P-PRT can be used as a valid and reliable test for clinically evaluating phoneme recognition abilities and monitoring the rehabilitation progress.

The Validity of Cepstral Analysis to Distinguish Between Different Levels of Perceptual Dysphonia in the Persian Vocal Tasks

OBJECTIVES/HYPOTHESIS: The validity of cepstral analysis (Cepstral Peak Prominence [CPP] and Cepstral Peak Prominence-Smoothed [CPPS]) as an indicator of perceptual dysphonia was investigated in the Persian language STUDY DESIGN: Cross-sectional study. METHODS: A total of 223 participants (159 with and 64 without dysphonia) uttered vowels /a/ and /i/, six standard sentences, and non-standard connected speech. All vocal samples were perceptually evaluated by three raters on a visual analog scale and put into four groups (normal voice, mild, moderate, and severe perpetual dysphonia). CPP and CPPS of sustained vowel /a/, reading the second standard sentence, and a sentence extracted from non-standard connected speech were established using "Praat" software. Statistical analysis involved a one-way factorial analysis of variance (ANOVA), Kruskal-Wallis H, Kendall's Tau-b correlation, t test, and receiver operating characteristics (ROC) curve. RESULTS: The results showed that CPP of sustained vowels and reading the standard sentence and CPPS of sustained vowel differed significantly (P < 0.05), except between the normal voice and mild perpetual dysphonia groups (P > 0.05). The CPP of non-standard connected speech, CPPS of reading the standard sentence, and non-standard connected speech differed significantly between all groups (P < 0.05). The mean of cepstral analysis of all tasks, "averaged CPP," and "averaged CPPS" were significantly different between two groups of the normal voice and perceptual dysphonia (P < 0.05). Correlation between the cepstral analysis and the perceptual ratings demonstrated that the correlation coefficients for CPP and CPPS were between 0.4 and 0.6 (P < 0.05). ROC curve analysis revealed that the area under the ROC curve for "averaged CPP" and "averaged CPPS" was greater than 0.8 (P < 0.05). The values of 22.11 and 12.29 were determined as cut-off scores of "averaged CPP" and "averaged CPPS," respectively. CONCLUSIONS: Cepstral analysis was known as useful clinical tool for diagnosis of perpetual dysphonia and determining its severity level in the Persian language.

Developing Verb Picture Naming Test for Persian adults and determining its psychometric properties.

There are a few standardized assessment tools in Persian language. The present study was carried out to develop a Verb Picture Naming Test and assessing its psychometric properties. In this cross-sectional study, a total of 230 verbs were selected based on their frequency, familiarity, age of acquisition, visual complexity, name agreement, image agreement, syllable length, transitivity, and compound or simple verbs. To determine content and face validity, 230 pictures of verbs were given to 15 experts, and then 180 final pictures were divided into original and parallel versions. Both versions of the test were performed on 50 healthy adults and 20 patients with Alzheimer's diseases. Results showed that face and content validity of these versions was more than .85 and .98. Intraclass Correlation Coefficient (ICC) for total scores was equal to .98 (p < .001, 95%CI: .97-.99) and .96 (p < .001, 95%CI: .93-.98). Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) of total scores were equal to .93 and 2.66 in version1 and 1.27 and 3.12 in version 2, respectively. The two versions of Persian Verb Picture Naming Test were found to be valid and reliable, so the clinicians can use it in clinical settings.

Preliminary psychometric properties of the Autism Classification System of Functioning: Social Communication (ACSF: SC) in Farsi speaking children.

BACKGROUND: Autism Classification System of Functioning: Social Communication (ACSF: SC) assesses typical performance and capacity of communication. Farsi version of ACSF: SC was developed and its psychometric properties investigated. MATERIAL AND METHODS: The English version of ACSF: SC was translated into Farsi and cultural adaptation was completed. The content validity of the adapted version was evaluated by experts and parents. The back-translated version was approved by www.canchild.ca. Therapists and parents assessed face validity. Correlation between ACSF: SC and the Children's Communication Checklist (CCC) was analyzed to determine concurrent validity. For inter-rater reliability, 5 speech and language pathologists, 5 occupational therapists, and 35 parents participated to assess the communication level of 35 autistic children aged 3-6. The test-retest reliability was performed at the interval of 14 days. RESULT: The results of analyses for typical performance and capacity showed the communication levels of children in ACSF: CS were directly related to subscales of CCC including inappropriate initiation (r ≥ 0.46) and stereotypical conversation (r ≥ 0.45). The weighted kappa inter-rater reliability ranged from good (0.54) to excellent (0.77); and the test-retest reliability varied from good (0.63) to excellent (0.85). CONCLUSION: Adapted version of ACSF: CS is able to estimate the communication function of Farsi- speaking autism spectrum disorder children.

Effect of Muscle Tension Dysphonia on Self-perceived Voice Handicap and Multiparametric Measurement and Their Relation in Female Teachers.

OBJECTIVES: Muscle tension dysphonia (MTD) is a common voice disorder in teachers in which subjective and objective dimensions of quality of voice can be impaired. The study aimed to compare voice handicap index (VHI) and dysphonia severity index (DSI) in teachers with and without MTD as well as study correlation between them. STUDY DESIGN: Cross-sectional survey. METHOD: Fifty female teachers were enrolled in the study in two different groups (1) twenty-five teachers with MTD (with mean age of 42.62 ± 3.58 years) and (2) 25 teachers without MTD (with mean age of 44.50 ± 3.49 years). All participants completed the Persian version of VHI and underwent multiparametric measurement of voice by the DSI; these subjective and objective voice measures were compared between two groups and their relation was studied. RESULTS: There was significant difference in the VHI, DSI, and their components in teachers with and without MTD (P < 0.05). No significant correlation was found between the total score of VHI and DSI score in the teachers with MTD (rPearson: 0.04, p: 0.82), although there was significant correlation between them in the teachers without MTD (rPearson: -0.75, p: 0.001). CONCLUSION: Teachers with MTD demonstrated higher voice handicap and lower voice quality compared to the teachers without MTD. Moreover, dysphonia interrupted relation between the results of self-perceived evaluation and multiparametric measurement of voice in the teachers with MTD in while these assessments were parallel in the healthy teachers. Further studies are recommended to transparent relation between objective and subjective voice assessments in healthy population.

Cross-cultural adaptation, validity, and reliability of the Wexner questionnaire in patients with functional constipation in an Iranian population.

AIM: The present study aimed to cross-culturally adapt and assess the validity and reliability of the English version of the Wexner questionnaire translated into the Persian language in Iranian patients. BACKGROUND: Constipation is one of the most common gastrointestinal disorders; therefore, it is necessary to utilize an index for both the clinic and research studies. METHODS: In the first phase, the English version of the Wexner questionnaire was translated into the Persian language. In the second phase, the Persian version was assessed to evaluate the psychometric properties in 136 patients with functional constipation who referred to gastrointestinal and physical medicine clinics. Content validity was assessed by face validity. Construct validity was tested based on hypothesis testing and structural validity. The correlation of the total scores of the Wexner questionnaire and the Patient Assessment Constipation Quality Of Life (PAC-QOL) questionnaire was used for concurrent criterion validity. Internal consistency and test-retest reliability were calculated using Cronbach's α and intraclass correlation coefficient (ICC).The floor/ceiling effect of the questionnaire was also evaluated. RESULTS: The content validity of the Persian version of Wexner's questionnaire was acceptable. The construct and concurrent criteria validity showed moderate correlation. The internal consistency and intrarater reliability were moderate (0.51) and excellent (rp = 0.97, p-value <0.001), respectively. No floor/ceiling effect was seen. CONCLUSION: The Persian version of the Wexner questionnaire showed good validity and reliability in Iranian patients and can therefore be applied in clinics as well as in research for Persian-speaking countries.

The Development of a New Test for Consecutive Assessment of Narrative Skills in Iranian School-Age Children.

BACKGROUND: The assessment of narrative skills in young children is essential for early identification of potential learning and literacy-related difficulties. The present study aimed to develop a validated and reliable test for consecutive assessment of narrative skills in Iranian school-age children. METHODS: To elicit story retelling by the children, 14 pictures (each a discrete test) were developed based on which 14 stories were scripted in accordance with the Stein and Glenn model. The pictures were presented to 50 typically developing (TD) children and seven children with autism spectrum disorder (ASD) in Kerman, Iran, 2018. The recorded audio of retold stories by the children was transcribed and analyzed using the monitoring indicator of scholarly language (MISL) instrument. The SPSS software (Version: 18.0) was used to analyze the data with the significance level set at 0.05. RESULTS: A high correlation between the total MISL score of each test and each MISL item (r>0.5) confirmed the construct validity of our test. A comparison of the mean total MISL score between the TD and ASD groups showed significant differences (P<0.001) for all pictures. The internal consistency coefficient was >0.7 between all the MISL items and the intraclass correlation coefficient between the test and retest scores was >0.96 for all pictures. The repeated measures ANOVA did not indicate significant differences (P=0.15) between the total MISL scores of the pictures. CONCLUSION: The validity and reliability of the developed test were confirmed, suggesting it can be used for consecutive assessment and monitoring of the narrative skills in school-aged children.

Effect of late-onset blindness on cervical vestibular evoked myogenic potentials.

PURPOSE: Approximately 1.3 billion people worldwide have vision impairment. The aim of the present study was to investigate the influence of Late-Onset blindness on cervical vestibular evoked myogenic potentials (cVEMP) responses. Accordingly, this study was performed to investigate and compare the parameters of the cVEMP test in sighted and late-onset blind individuals. MATERIALS AND METHOD: In this cross-sectional- comparative study, cVEMP was recorded by presenting a tone burst stimulus of 500 Hz with an intensity of 95 dBnHL in 20 sighted and 20 late-onset blind individuals aged between 18 and 30 years old. RESULTS: cVEMP was observed in all the individuals (100%). The average latency of P13 and N23, amplitude, amplitude ratio, and VEMP threshold did not differ significantly between the two groups (p > 0.05). CONCLUSION: The findings of the study revealed that the formation of the neural pathway and reflex arch of cVEMP is similar between late-onset blind and sighted individuals. Thus, cVEMP can be a suitable test for assessing the vestibular function of late-onset blind people.

Statistical validity and reliability of the Persian version of the Western Ontario Meniscal Evaluation Tool (WOMET) according to the COSMIN checklist.

BACKGROUND: The Western Ontario Meniscal Evaluation Tool (WOMET) is the only questionnaire available to assess quality of life in patients with isolated meniscal injuries. The aims of this study were to prepare the Persian version of the WOMET (PWOMET) and validate it in Iranian patients with isolated meniscal tears. METHODS: In the first stage, the English version of WOMET was translated into Persian. Content validity, and qualitative and quantitative (impact score) face validity were tested by specialists and in a sample of 30 patients. In the second stage, PWOMET was assessed for the evaluation of psychometric properties in 100 patients with isolated meniscal injury and 50 healthy people based on the COSMIN checklist. Construct validity was tested based on structural validity (factor analysis) and hypothesis testing. Correlation with the total scores on the SF-36, IKDC and KOOS were used for concurrent criterion validity. Test-retest reliability and internal consistency were calculated using intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. In addition the standard error of measurement (SEM) and smallest detectable change were calculated. Interpretability was investigated as the ceiling and floor effects and minimal important difference. RESULTS: The PWOMET had acceptable qualitative face validity and content validity. The impact score (quantitative face validity) was more than 1.5 for all items. For construct validity, structural validity (factor analysis) and hypothesis testing ability were confirmed. Correlations between the PWOMET total score and IKDC, SF-36, KOOS scores were 0.61, 0.54 and 0.63, respectively (p < 0.001), thus confirming concurrent criterion validity. The intraclass correlation coefficient, Cronbach's alpha, SEM and smallest detectable change for the PWOMET were 0.73, 0.89, 9.43 and 26.13, respectively. The PWOMET had no ceiling or floor effects, and minimal important difference was 9.07. CONCLUSION: The PWOMET provides valid and reliable scores for assessment of the quality of life in patients with isolated meniscal injury.

A New Speech-in-Noise Test for Measuring Informational Masking in Speech Perception Among Elderly Listeners.

Introduction Elderly listeners have reported concerns about speech perception in noisy environments. This partly occurs because of their increased informational masking (IM). This study aimed to develop a Persian coordinate response measure (CRM) corpus and a novel speech-in-noise test for measuring IM. Material and methods A cross-sectional validation study was conducted in two parts. Part one was the determination of the validity and reliability of the Persian CRM corpus. Part two consisted of measuring the IM at five signal-to-noise ratio (SNR; -6,-3, 0, +3, and +6) in two conditions: one with the target and masker speaker of the same sex and one with the target and masker speaker of different sexes. In each condition, the IM measurements were performed at a 45° separation angle of target and maskers and as a co-location of the speakers. A group of young listeners aged 20 to 40 years and a group of elderly listeners aged 60 to 75 years were recruited (50 study participants in part one and 47 in part two). The study was conducted from July 2018 to March 2019 at the Iran University Medical Sciences audiology clinic. Content validity ratio, content validity index, impact score, Spearman's test, and Mann-Whitney's test were used for statistical analysis. Results The Persian CRM corpus showed acceptable validity and reliability in each group (p < 0.001). The results suggested that in both azimuth locations and at SNRs of 0, -3, and -6, the IM amount in the elderly group was significantly higher (p < 0.003) than in the young group at conditions of target and masker speakers of opposite-sex. However, in cases where both target and masker speakers were of the same sex, a significant difference was observed at an SNR of 0 in angular separation and SNRs of +3 and 0 at co-located situations (p < 0.001). Conclusion A validated Persian CRM corpus has been collected for use in IM measurement studies. Overall, the IM of elderly listeners was higher than younger listeners in low-cue situations such as lower SNR. Therefore, a novel speech-in-noise test for measuring IM was validated to use in speech perception studies in the elderly population.

Combining Patient Education With Dry Needling and Ischemic Compression for Treating Myofascial Trigger Points in Office Workers With Neck Pain: A Single-Blinded, Randomized Trial.

OBJECTIVE: The purpose of this study was to compare immediate and short-term effects of combining dray needling (DN) + patient education vs ischemic compression (IC) + patient education for treating myofascial trigger points (MTP) in office workers with neck pain. METHODS: This was a single-blinded, randomized trial. Thirty-two participants were randomly assigned to either DN + patient education or IC + patient education group. Both groups received 2 treatment sessions with a 48-hour time interval. Pain intensity, cervical range of motion, Neck Disability Index, and satisfaction were measured. RESULTS: Pain intensity and neck disability level decreased, whereas the cervical range of motion (side-bending and rotation) increased in both groups. Analysis of variance revealed a significant interaction of group × treatment only for pain intensity, indicating a greater reduction in the IC group. Satisfaction generally increased in the follow-up assessment in both groups. CONCLUSION: Both intervention groups had some positive immediate and short-term effects after 2 treatment sessions. However, IC + patient education was more effective than DN + patient education in the treatment of MTPs in office workers with neck pain.

Effects of aging on spatial hearing.

BACKGROUND: Aging has several effects on auditory processing with the most important effect known as speech perception impairment in noise. AIMS: The aim of the present study was to investigate the effects of aging on spatial hearing using quick speech in noise (QSIN) and binaural masking level difference (BMLD) tests and speech, spatial, and qualities of hearing scale (SSQ) questionnaire. METHODS: The study was carried out on 34 elderly people, aged 60-75 years, with normal peripheral hearing and 34 young participants, aged 18-25 years. Using SSQ questionnaire and QSIN and BMLD tests, the spatial auditory processing ability was compared between the two groups. RESULTS: Comparison of mean scores using independent t test showed that there was a significant difference in the mean scores of QSIN, BMLD tests and SSQ questionnaire between the two groups (p < 0.001). Sex was not found to have any effect on the results (p > 0.05). DISCUSSION: Structural and neurochemical changes that occur in different parts of the central nervous system by aging affect various aspects of spatial auditory processing, such as localization, the precedence effect, and speech perception in noise. CONCLUSIONS: Lower scores of older adults with normal hearing in SSQ questionnaire and behavioral tests, compared with younger participants, may be considered as their weak performance in spatial auditory processing. The results of the present study reconfirm the effects of aging on spatial auditory processing, such as localization and speech perception in noise.

A Study of Vocal Facilitating Techniques Compared to Manual Circumlaryngeal Therapy in Teachers With Muscle Tension Dysphonia.

OBJECTIVE: There are several voice therapy techniques been suggested in patients with muscle tension dysphonia (MTD), however a few studies are compared between them. The purpose of present study was to compare the effect of vocal facilitating techniques (VFTs) and manual circumlaryngeal therapy (MCT) in teachers with MTD. STUDY DESIGN: This is a randomized clinical trial study. METHODS: Sixteen teachers with MTD (female; mean age: 38.6 ± 4.6 years) participated in this study. The participants allocated to two treatment groups: the first group received VFTs (n: 8) and MCT was presented to the second one (n: 8). In each group, the voice therapy techniques were given for 10 individual sessions twice a week. The effect of both techniques was assessed using voice handicap index (VHI) and dysphonia severity index (DSI). RESULTS: Within group comparison, the VHI, DSI, and theirs components showed significantly better results after both treatment groups (P ≤ 0.05). Although, effect size was strong for all target features (η2 > 0.36); the greatest magnitude was obtained on the physical subscale of VHI following MCT and for the DSI after VFTs (η2 = 0.92 and 0.90, respectively). Moreover, the interactive effect of time and treatment groups indicated that there was significant main effect on the physical and functional subscales of VHI (P = 0.00 and 0.02, respectively) as well as I-low and DSI (P = 0.01 and 0.02, respectively). CONCLUSION: VFTs and MCT are two effective techniques in voice therapy of teachers with MTD. However, the greatest improvement obtained on the DSI following VFTs and for the physical aspect of VHI after MCT demonstrated voice therapist can use appropriate technique based on the voice complaints and results of voice assessments in MTD.

Effects of Caffeine on Auditory- and Vestibular-Evoked Potentials in Healthy Individuals: A Double-Blind Placebo-Controlled Study.

BACKGROUND AND OBJECTIVES: The blockage of adenosine receptors by caffeine changes the levels of neurotransmitters. These receptors are present in all parts of the body, including the auditory and vestibular systems. This study aimed to evaluate the effect of caffeine on evoked potentials using auditory brainstem responses (ABRs) and cervical vestibular-evoked myogenic potentials (cVEMPs) in a double-blind placebo-controlled study. SUBJECTS AND METHODS: Forty individuals (20 females and 20 males; aged 18-25 years) were randomly assigned to two groups: the test group (consuming 3 mg/kg pure caffeine powder with little sugar and dry milk in 100 mL of water), and the placebo group (consuming only sugar and dry milk in 100 mL water as placebo). The cVEMPs and ABRs were recorded before and after caffeine or placebo intake. RESULTS: A significant difference was observed in the absolute latencies of I and III (p<0.010), and V (p<0.001) and in the inter-peak latencies of III-V and I-V (p<0.001) of ABRs wave. In contrast, no significant difference was found in cVEMP parameters (P13 and N23 latency, threshold, P13-N23 amplitude, and amplitude ratio). The mean amplitudes of P13-N23 showed an increase after caffeine ingestion. However, this was not significant compared with the placebo group (p>0.050). CONCLUSIONS: It seems that the extent of caffeine's effects varies for differently evoked potentials. Latency reduction in ABRs indicates that caffeine improves transmission in the central brain auditory pathways. However, different effects of caffeine on auditory- and vestibular-evoked potentials could be attributed to the differences in sensitivities of the ABR and cVEMP tests.

Development, validity, reliability and normative data of the Persian Phonemic Synthesis Test (P-PST).

Objectives: This study was conducted to develop the Persian version of the Phonemic Synthesis Test, evaluate its psychometric properties and generate normative data.Design: Test development, including the optimisation of materials, determining content and face validities and assessing the psychometric properties.Study samples: Overall, 425 subjects participated in this study in three different stages. Ten experts participated in the content validity assessment stage. The face validity was determined by taking the views of 17 subjects, including children diagnosed with APD, normal children and experts. The psychometric properties were evaluated with 395 normal children aged 7 to 11, divided into five age groups. All the participants were retested after four weeks for evaluating the test-retest reliability.Results: The results revealed the strong content and face validity of the test. No significant differences were observed between the genders. Significant differences were observed in the quantitative and qualitative scores among the age groups. The Spearman correlation coefficient showed that the scores of the test and retest were strongly and positively correlated (r > 0.9). The findings showed many similarities with the data reported in the original American English Phonemic Synthesis Test.Conclusions: The Persian Phonemic Synthesis Test is a reliable and valid test for auditory processing assessments in Persian-speaking children.