International Congress on COCHLEAR IMPLANT

International Congress on

May 9 -11, Mashhad , Iran

COCHLEARIMPLANT

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Chairman: Yahya Noroozbeigi, MD. Editor-in-Chief: Nematollah Mokhtari Amir Majdi, MD. Co-Editor: Mohsen Rajati Haghi, MD.Executive Manager: Mohamad Reza Majidi, MD.Executive Coordinator: Fereshteh Kafi, BA. Site Manager: Nahid Hosseinzadeh, Msc.License Holder: Mashhad University of Medical Sciences (MUMS).Publisher: Vice-Chancellor for Research of Mashhad University of Medical Sciences.

Certification Number: 92802 (approved by Iranian Ministry of Health and Medical Education). URL: http://ijorl.mums.ac.ir/Address: Ghaem Hospital, Ahmadabad Street, Mashhad, Iran.ISSN: Print 2251-7251, Online 2251-726XTel: +98-51-38012654, 38451128Fax: +98-51-38451128Email: [email protected] Language: English Frequency: Bimonthly

Iranian Journal of Otorhinolaryngology is indexed in Pubmed, Scopus, Embase, ISC, Index Medicus for the Eastern Mediterranean Region (IMEMR), CABI, EBSCO, Scientific Information Database (SID), DOAJ.

Iranian Journal of OtorhinolaryngologyVol 30, Supplement Issue,May 2018

Welcome MessageThe committee International FacultyThe VenueThe Scientific ProgramThe Abstract Keynote Speaker Presentations Oral Presentations Poster Presentations

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255797

Table of content

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IRAN CI 2018

Dear colleagues:

Greetings for the happy days of spring and Iranian New Year. I am pleased to declare that last year was a year of continuing activities and collaboration from our scientists and research-ers, presenting their papers in many journals including Iranian journal of otorhinolaryngology. Your support in submitting your papers in this journal helps us to continue and persuade us to improve the quality of work; in specific this means to be timely and accept better works for publication. The volume of manuscripts that we receive, while giving us the chance for better selection, shows an expanding activity of our colleagues in their scientific works. We are glad to have the 5th.Iranian international cochlear implant congress taking place in the city of Mashhad; and we are delighted to publish its abstract book. So, the colleagues who cannot attend the meeting have the chance to find and read a resume this scientific event. The 5th Iran CI is a continuum of previous ones held in Tehran and Shiraz. This event in the city of Mashhad, affords a better chance to introduce our very well established CI center with its accompanying divisions and facilities that is constructed for deaf people in eastern part of the country. It also shows the depth of the after-care services and the volume of work of cochlear implantation in Mashhad. I hope with the extensive available background we will have better achievements in future. I wish the best success for all of you in this congress and I try my best to make Iranian journal of otorhinolaryngology the journal of our ENT meetings.

Editorial

N.Mokhtari,MD.Chief Editor,

Iranian journal of otorhinolaryngologyMay 2018

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IRAN CI 2018

Dear Colleagues and Distinguished Guests,

It is a great honor to welcome all of you to the “5th International Congress on Cochlear Implant & Related Sciences” held by the Iranian Cochlear Implant Society (Khorasan branch). The conference will take place 3 days from May 9th to 11th 2018, this time in the 2nd Iargest metropolitan city of Iran, Mashhad. The Local Congress Committee has put together a scientific program in the form of scientific panel, Kwynote lectures, interactive sessions and workshops covering Cochlear Implant & Related Sciences. The entire staff of scientific and executive teams are working hard for all participants to have a wonderful time and enjoy hot discussions in the period of attendance in Mashhad. Every other year this multidisciplinary congress attracts lots of healthcare professionals and brings together and promotes an international exchange of the latest concepts, innovative techniques and develops new ideas in the main tracks of Otology, Audiology and speech pathology, offering a unique opportunity to interact with distinguished professors andresearchers.Lastly, we hope that this meeting will provide chances for networking with colleagues, friends and exhibitors and of course at the same time enjoy your stay in the historical and holly city of Mashhad.

WELCOME MESSAGE

Mohammad Mahdi Ghasemi,

M.D.Scientific Secretary

MohammadFarhadi,

M.D.President of Congress

MohsenRajati,M. D.

Executive Secretary

6

Abtahi, Hamidreza (Esfahan)Ajalloueyan, Mohammad (Tehran)Amizadeh, Maryam (Kerman)Asghari, Alimohammd (Tehran)Daneshi, Ahmad (Tehran)Eftekharian, Ali (Tehran)Farahani, Farhad (Hamedan)Farhadi, Mohammad (Tehran)Hashemi, Basir (Shiraz)Khorsandi, Mohammad Taghi (Tehran)Mohebbi, Saleh (Tehran)Mokhtari, Nematollah (Mashhad)Mokhtarinejad, Farhad (Tehran)Motassadi, Masoud (Tehran)Naderpour, Masoud (Tabriz)Nourizadeh, Navid (Mashhad)Nourooz beigi, Yahya(Mashhad)Poursadegh, Mahdi(Mashhad)Rajati, Mohsen (Mashhad)saeedi, Masoomeh (Tehran)Saki, Nader (Ahvaz)Shishegar, Mahmoud (Shiraz)

Otolaryngologists

Scientific CommitteeChairman: Mohammad Mahdi Ghasemi, M.D.

Audiologists & Speech Pathologists

Sepehrnejad, Mahsa (Esfahan)Afsharmanesh, Jila (Kerman)Akhundi, Afarin (Tabriz)Ariafar, Aida (Tabriz)Bagheripour, Hossein (Ahvaz)Emamdjomeh, Hessam. (Tehran)Ghadimi, Soheila (Hamedan)Ghorbani, Ali (Tehran)Ghayumi, Zahra (Mashhad)Haghjou, Shapour (Shiraz)Hajimohammad, Fatemeh (Kerman)Hasanzadeh, Saeid (Tehran)Jafari, Mohammad (Hamedan)Berri Dizaji, Ali (Tehran)Karimi, Majid (Ahvaz)Karimi, Marziye (esfahan)Mokari, Noosheen (Tehran) Tayarani, Hamid (Mashhad)Tale, Mohammadreza (Mashhad)Moubedshahi, Farzad (Tehran)Monabbati, Sakineh (Shiraz)Monshizadeh, Leila (Shiraz)Sadeghi, Reza (Tehran)Zarei, Kazem (Shiraz)

7

Executive CommitteeChairman: Mohsen Rajati, M.D.

Abyar, Mahdi (Mashhad)Afzalzadeh, Mohammadreza (Mashhad)Ahmadiyan, Naghmeh (Mashhad)Daroobord, Effat (Mashhad)Ghalehnavi ,Moharam Ali (Mashhad)Haghjoo, Sharife (Mashhad)Hoori, Yasaman (Mashhad)Hosseinzadeh, Nahid (Mashhad)Jajarmi, Elahe (Mashhad)Kafi, Fereshteh (Mashhad)Kashani, Reza (Mashhad)Mehrjoo, Tarlaan (Mashhad)Mirhosseini, Farnaz (Mashhad)Moammeri, Fatemeh (Mashhad)Moghiman ,Toktam (Mashhad)Movahed, Rahman (Mashhad)Nourizadeh, Navid (Mashhad)Purzaki, Mojtaba (Mashhad)Rasoulian, Bashir (Mashhad)Soleimani, Fatemeh (Mashhad)Taghizadeh, Sajedeh (Mashhad)Tale, Mohammadreza (Mashhad)Tayarani, Hamid (Mashhad)Zarin-Ghalam, Mohammad Ali (Mashhad)

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IRAN CI 2018

Nenad Arsovic

Associate Prof. M.D. Ph.D, at Clinic for ENT and MFS , Clinical Centar of Serbia

Serbia

Neil Donnelly

MBBS MSc FRCS (ORL-HNS)Consultant Otoneurological & Skull Base SurgeonCambridge University Hospitals

United Kingdom

Andy Beynon Radboud University Nijmegen, Dept . of Otorhinolaryngology, Head and Neck surgery.

Hassan Diab

ENT Surgeon at Saint Petersburg Research Institute of Ear, Russia

Russia

INTERNATIONALFACULTY

Netherland

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IRAN CI 2018

Egwin van Den Heuvel

Clinical Traning and Education manager cochlear Middle East

Belgium

Peter Franz

Head of Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Teaching Hospital, Austria

Austria

Paul Govaerts

MD, MSc, PhD, The Eargroup (director)Antwerp-Deurne & Universities of Antwerp (BE), Ghent (BE), Amsterdam (NL)

Belgium

Jitender Mohan Hans

Otorhinolaryngologist Chairman, Dept of ENT & Cochlear Implant Centre, Venkateshwar Hospital, Dwarka, New Delhi

India

Tilman Keck

MD, Professor and Head Department of Otorhinolaryngology, Elisabethinen Hospital GmbHAcademic Hospital of the Medical University of Graz

Austria

Philippe Lefebvre

Chairman and Professor of Otorhinolaryngology

Belgium

University of Liege

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IRAN CI 2018

Thomas Lenarz

Professor and chairman Department of otorhinolaryngology , Medical University of Hanover(MHH)

Germany

Eugenijus Lesinskas

MD., PhD., Head of the Center of Ear, Nose and Throat Diseases Vilnius University Hospital Santaros Clinics, Chair of the Board of Medical Faculty Vilnius University

Lithuania

Agterberg Martijn

Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Ph.D., Post-doc

Netherlands

Sunil Narayan Dutt

M.S (ENT), D.N.B (ORL), D.L.O., RCS (Eng), FRCS ED, FRCS (ORL-HNS) , Ph.D. , Clinical Fellowship ñ Otology/Neurotology Senior Consultant and Cochlear Implant Surgeon

India

Thomas P Nikolopoulos

MD, DM, PhD, FEBEORL-HNSProfessor in OtorhinolaryngologyNational and Kapodistrian University of Athens,

Greece

Levent Olgun

Director of Izmir Teaching and Research Hospital ENT ClinicDirector (and founder) of Cochlear Implant Center of Izmir Teaching and Research Hospital

Turkey

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IRAN CI 2018

Milan Profant

Otorhinolaryngologist, Secretary General of the International Federation of Otorhinolaryngological Societies (IFOS) since 2016 - University Hospital Bratislava

Felipe Santos

M.D., Department of OtolaryngologyHarvard Medical SchoolMassachusetts Eye and Ear Infirmary

United States

Mohammad Seyyedi

Otorhinolaryngologist, Medical College of Georgia, Augusta University

United States

Jiri Skrivan

MD, Ph.D. Head Department of OtorhinolaryngologyThe Second Medical FacultyCharles University of PragueMotol University HospitalCzech Republic

Robert V. Shannon

Professor of Research Otolaryngology, Head & Neck Surgery, University of Southern California

United States

Masoud Zoka Assadi

Ph.D., Research Engineer, Research Development Department, Electrodes and Surgical Unit, MED-EL Head quarters.

Austria

Slovakia

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IRAN CI 2018

Congress Venue

plan of the Congress

A.CochlearB.MedElC.Advanced Bionics

Pars Hotel Mashhad is located in the west of the city and on the edge of Vakilabad Blvd. It has easy access by car, metro and bus. It has good congress area consisting of two main conference rooms.

Address:Pars Hotel ,Blv. Vakilabad , Mashhad , IranPhone: +9851 3868 9201

Roodaki Hall(Room1)

Ferdowsi Hall

(Room2)

VOID

A

B C

D

Spea

kers

A

rea

Break Area

Elevator

Break Area

Poster

Wall

Registration D

esk

Break Area

Meeting Room

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IRAN CI 2018 Program

Program at a glance Wednesday ( May 9)

Opening Ceremony(8:00-9:15)

Keynote Lectures(9:15 - 10:30)

Break(10:30 - 11:00)



Lunch Break(13:00 - 14:00)

Satellite Symposium 1 (14:00 - 15:00)


National Cochlear Implant Summit Meeting (16:00 - 17:00)

Break(10:30 - 11:00)

Free Paper Presentation(11:00 - 12:00)

Workshop (16:00 - 17:00)

Roodaki Hall Ferdowsi HallRoom 1 Room 2

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IRAN CI 2018

Thursday (May 10)

Roodaki Hall Ferdowsi HallRoom 1 Room 2

Program at a glance

Workshop

Break(10:00 - 10:30)



Lunch Break(13:00 -14:00)


Free Paper Presentation (15:00 - 16:00)

Workshop (16:00 - 17:00)

Bakhshesh Charity Meeting

Surgery Round Table(8:00-9:00 (

ABI Panel Discussion(9:00 - 10:00)

Break(10:00 - 10:30)

Imaging Round Table(10:30 - 11:30)

Surgical Structured Panel(11:30 - 13:00)

Lunch Break(13:00 -14:00)

Implantables Round Table(15:00 - 16:00)

Workshop (16:00 - 17:00)

Program

(8:00 -10:00)

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IRAN CI 2018 Program

Keynote lecture (8:00 - 9:00)

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IRAN CI 2018

Wednesday 9 May 2018 Roodaki Hall (Room1)

(9:15 - 10:30)

Keynote Lectures 1 Chairman:Dr. Mohammadtaghi KhorsandiDr. Yahya Noroozbeigi

(11:00 - 12:00)

Coffee Break

Keynote Lectures 2 Chairman:Dr. Mahdi Poursadegh ,Dr. Aman Ghoujeghi

Keynote Lecture 3 Chairman:Dr. Mohammad Taghi Mosleh , Dr. Mohsen Jalilian

Influence of etiology on prenatal deafness in CI outcome

Pharmcological treatment of inner ear diseasePhilippe Lebfevre

(13:00 - 14:00) Lunch Break

Utility of TTEABR in CI Candidacy Sunil Narayan Dutt

Electrically- versus Acoustically-Evoked Auditory Potentials: are they so different?Andy J Beynon

New indications in cochlear implantationThomas Nikolopoulos

Cochlear implantation in the Octogenarian: Speech perception outcomes and length of device useNeil Donnelly

Who should receive a cochlear implant?Paul Govaerts The round window revisited! Details that are important for electrode insertionEgwin van Den Heuvel

How the Brain HearsRobert Shannon

Otopathologic Changes after CI surgeryMohammad Seyyedi

(14:00 - 16:00) Satellite Symposium

Satellite Symposium 1Advanced Bionics Company

(16:00 - 17:00) National Cochlear Implant Summit meeting(in the meeting room)

Satellit e Symposium 2Cochlear Company

(8:00 - 9:15) Opening Ceremony

Expanding Criteria for Cochlear Implantation in the Older Adult PopulationFelipe Santos To be determinedThomas Lenarz

Program , Wed , Room1

(10:30-11:00)

(12:00-13:00)

Milan Profant

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IRAN CI 2018

Wednesday 9 May 2018 Ferdowsi Hall (Room2)(11:00 - 12:00)

Free papers (F1)Chairman: Shapour Haghjou, Farzad Moubedshahi Aida Ariafar

(13:00 - 14:00)

(16:00 - 17:00)

Lunch Break

Workshop

Application of Neurologic Music Therapy for Improving Language and Cognition of Cochlear Implanted ChildrenRoya Jajvandian, Maryam Anvari

The development of an interventional package on "receptive vocabularyî for cochlear implanted childrenLeila Monshizadeh

Relation between Reaction Time of Electrically Stapedius Reflex Threshold (ESRT) and Auditory Perception in Cochlear Implant (CI) Children Fatemeh Arbabi Correlation between perceptual intelligibility of speech and speech acoustic parameters Saeed Mirahmadi

Phonological processes in Persian children with cochlear implantation and normal hearing in Shiraz Naeimeh Fathy

Reliability,Validity and Cross-Cultural Equivalence of the Persian Version of the Hearing Implant Sound Quality Index Hossein Bagheripour

The comparison of clinical outcomes of round window and cochleostomy approaches in cochlear implantation surgery in Shiraz ìKhalili hospitalîMasoud Janipoor

Acceptable noise level in cochlear implants and bimodal hearing usersReza sadeghi

Program , Wed , Room2

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IRAN CI 2018

Thursday 10 May 2018 Roodaki Hall (Room1) (8:00 - 10:00) Workshop

(10:00 - 10:30)

(10:30 - 11:30)

Coffee Break

Free Paper Presentation (F2) Chairman: Hessam Emamdjomeh, Majid Karimi

(11:30 - 13:00) Free Paper Presentation (F3)

Mahsa Sepehrnejad, Jila AfsharmaneshAn update of common autosomal recessive non-syndromic hearing loss genes in north west population of IranYalda Jabbarimoghaddam

Combined application of NGS and PGD in deafness: a novel OTOF mutationMohammad Amin Tabatabaiefar

Spectrum of DNA variants for non syndromic deafness in a large cohort from multiple continentsAtieh Eslahi

CI candidacy in mitochondrial syndromes, a case report of MEGDEL syndromeMohsen Samer Screening of 10 DFNB Loci causing autosomal recessive non-syndromic hearing loss in two Iranian populations Mahbobeh Koohiyan

LittlEar Questionnaire: Online evaluations for deaf childrenGuita movallali

The Study of Auditory Change Detection of Speech Stimuli Using Topographical Brain Mapping of Mismatch Negativity Responses in Children with Cochlear Implant Compared to Normal ChildrenSaeid Mahmoudian

Bilateral and bimodal implantation; the benefit of a second ëearí and the advantage of having one normal-hearing earMartijn Agterberg

Artificial Intelligence improves the outcome of CI fitting Paul Govaerts

Predictive value of caloric and video head-impulse testing of the semicircular canals Andy Beynon

Cochlear Microphonic Latency is Correlated With Hair Cell SurvivalChristofer Bester

Comparison of vestibular ocular reflexes in cochlear implanted children with two groups of children with normal hearing and severe to profound congenital sensorineural hearing loss.Sadegh Jafarzadeh Evaluation of balance function in patients with inner ear anomalies and cochlear implantation Farideh Hosseinzadeh

Setting up your EP system for pre-, intra-, postop EABRs: pitfalls, practical tips and tricksAndy J Beynon, Egwin van Den Heuvel, Hessam Emamdjomeh, Mohammadreza Tale

Program , Thur , Room1

Leila Monshizadeh

Chairman : Hamid Tayarani

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IRAN CI 2018

(13:00 - 14:00) Lunch Break

(15:00 - 16:00) Free Paper (F4)Chairman: Navid NourizadehFarhad Farahani, Mohammad Jafari

Performance of Cochlear Implants in Children with Auditory Neuropathy Spectrum DisorderMarjan Mirsalehi

CSF leakage in cochlear implant cases

Experience with the New CI532 Electrode in a Pediatric PopulationJiri Skrivan

Comparison of IQ between 4-16 year-old children after cochlear implantation in the left or right earSharifeh Haghjoo

Cochlear implantation and tinnitus suppressionSeyed Hamidreza Abtahi

Rahman Movahed

CI outcome in post-linguals Masoomeh Saeedi

(16:00 - 17:00)

(14:00 - 15:00)

Workshop

Satellite Symposium

Educational Approaches in Children with Hearing Impairment Focusing on Auditory-Verbal TherapyHamid Tayarani Niknejad, Nadia Abdulhagh

Satellite Symposium 3MedEl Company

(17:00 - 19:00) Bakhshesh Charity Meeting

(11:30 - 13:00)

Successful cochlear implantation in a deaf patient with cochlear fracture in one side and cochlear ossification after meningitis in the other sideEhsan Mazloumi

Bimodal Stimulation for CI Children in the First Year of Cochlear ImplantFatemeh Arbabi The impact of Computerized Cognitive Training in children with cochlear implantsSusan Amirsalari

The Relationship of Parent-Child Stress with Cochlear Implanted Childrenís Developmental SkillsMohammad Hossein Nilforoush The effect of rehabilitation before cochlear implant on auditory and speech performance of children after cochlear implantAtieh Ghazvini

Free Paper Presentation (F3)Chairman: Saeed HasanzadehMahsa Sepehrnejad, Jila Afsharmanesh


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IRAN CI 2018

Thursday 10 May 2018 Ferdowsi Hall (Room2) (8:00 - 9:00)

Surgery/Alternatives (Round Table)Moderator: Dr. Mohebbi

(10:00 - 10:30)

(10:30 - 11:30)

Coffee Break

Imaging (Round Table)Moderator: Dr. Dutt

(9:00 - 10:00) ABI (Panel Discussion) Moderator: Dr. Eftekharian

Robert Shannon, Neil Donnelly, Masoud Motassadi, Mohammad ajalloueyan, Alimohamad Asghari, Leila Azadeh Ranjbar

(11:30 - 13:00) Surgical Structured Panel (Ossified Cochlea, COM)Moderator: Dr. Motassadi

Surgical problems in cochlear implantMasoud Motassadi

Cochlear implantation in postmeningitic ossified cochlea Sunil Narayan Dutt

Ossified cochleaHasan Diab

Cochlear implantation in chronic otitis media

CI surgery in radical cavityTilman Keck

Surgical Challanges in Cochlear ImplantationLevent Olgun

Radiology for Cochlear ImplantationSunil Narayan Dutt

Image guided CI surgery Masoud zoka Assadi

Performing MRI scans on Cochlear Implant and Auditory Brainstem Implant recipients Neil Donnelly

Predicting round window visibility by HRCT during cochlear implantation in children

Radiology in post-CI Masoomeh Saeedi

Three Dimensional Imaging of the Human Cochlea by Scanning Laser Optical Tomography (SLOT)Saleh Mohebbi

Bone dissection studies to improve the approaches to the inner ear Hasan Diab

Endoscopic CI Sasan Dabiri

Implantation: Advantages in difficult cases with Review of 3000 casesJM Hans

Comparison of classic CI surgery with transcanal approachSeyyed Basir Hashemi


Mohsen Rajati

Transcanal Technique for Cochlear

Milan Profant

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IRAN CI 2018

(13:00 - 14:00) Lunch Break

(15:00 - 16:00) Middle Ear Implants (Round Table)Moderator: Dr. Profant

Indication and evaluation of changing pattern on middle ear implant surgery

Implantable hearing devices Mohammad Farhadi

Auditory Implants in Rehabilitation of Hearing Loss Due to Chronic Otitis Media Levent Olgun

First experience with the new ADHEAR bone conduction system Nenad Arsovic

Tenotomy of the middle ear muscles causes a dramatic reduction in vertigo attacks and improves audiological function in definite Meniere's diseasePeter Franz

(16:00 - 17:00) Workshop

Electrical Stimulation System, Features, Facilities and opportunitiesMaryam Banimostafa Arab


Milant Profant

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IRAN CI 2018

Friday11 May 2018 Roodaki Hall (Room1)(8:00 - 9:00)

(10:00 - 10:30)

(10:30 - 11:30)

Coffee Break

Special Issues (Round Table)Moderator: Dr. Asghari

(9:00 - 10:00) Workshop

Otoplan: Futue of otological surgeryMarkus Barta, Masoud zoka Assadi

(11:30 - 13:00) Free Paper Presentation (F5)Chairman: Kazem Zarei, Noosheen Mokari, Ali Berri Dizaji

Emotional Perception of Music in Children with Unilateral Cochlear ImplantsSareh Shirvani

Auditory System Reorganization following Cochlear Implant in Children with Pre-lingual DeafnessMajid Karimi

Comparison of motor, hearing and verbal functions of children with kernicterus before and after cochlear implantationMehran Beiraghi Toosi

Comparison of speech intelligibility in deaf children with cochlear implants and children using hearing aids Ehsan Mazloumi

(13:00 - 14:00) Lunch Break

(14:00 - 15:00) Closing Ceremony

Validation of Persian Version of Parentsí Views and Experiences with Pediatric Cochlear Implant QuestionnaireFatemeh Haresabadi

Comparison of intelligence quotients of first- and second-generation deaf children with cochlear implantsKourosh Amraei

Comparison of Abilities Theory of Mind and Mindfulness between Hearing Impaired People and Normal Hearing Hamid Tayarani Niknejad

The meaningful use of speech and its intelligibility following cochlear implant Atieh Ghazvini

Music perception and musical abilities of prelingualy deaf children with cochlear implantsEugenijus Lesinskas

Vestibular assessment following cochlear implantation in patient with inner ear anomalyAlimohammad Asghari

Vestibular Findings in CI childrenMasoomeh saeedi

Is vestibular function different in cochlear implant cases when the device is on or off?Moharam Ali Ghalehnavi

Electrode Impedance as A Biomarker in Cochlear Implant RecipientsChristofer Bester

Program , Fri , Room1

Adventures in Bionic HearingRobert Shannon

Keynote lecture

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IRAN CI 2018

Friday11 May 2018 Ferdowsi Hall (Room2) (8:00 - 9:00)

Special Issues (Round Table)Moderator: Dr. Keck

(9:00 - 10:00)

(10:00 - 10:30)

(10:30 - 11:30)

Genetics & Prevention (Panel Discussion)Moderator: Dr. Ajalloueyan

Coffee Break

Neuro-cognitive Rehabilitation (Panel Discussion)Moderator: Dr. Riyassi

(11:30 - 13:00) Surgical Structured Panel (Anomalies, Revision)Moderator: Dr. Diab

Anomalies of the inner earHasan Diab

Challenging cases in cochlear implantationThomas Nikolopoulos

Cochlear Implantation in Children with Inner Ear MalformationsJiri Skrivan

(13:00 - 14:00) Lunch Break

Success rate of deep insertion using long electrode arrays; reviewing our surgical routineTilman Keck

Sealing of the round and oval window niches with triamcinolone-soaked fascia as salvage surgical therapy in sudden sensorineural hearing lossPeter Franz

ABR and ASSR in preimplant evaluation of young childrenThomas Nikolopoulos

Electrocochleography during Cochlear Implantation Predicts Electrode ContactChristofer Bester

Revision Cochlear Implant Surgery: Why we need a Minimal invasive technique & a smooth electrode array for best resultsJ.M. Hans

Surgery challenges Felipe Santos

Surgery challengesMohammad Seyyedi

Program , Fri , Room2

Mohammad Amin Tabatabaiefar, Saeid Morovvati, Mohammad Keramatipour, Masoumeh Fallah, Majid Mojarrad

Peyman Hassani-Abharian, Mehdi Pourmohammad, Fatemeh Haresabadi, Toktam Maleki

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IRAN CI 2018

The AbstractKeynote Speaker PresentationsOral PresentationsPoster Presentations

255797

25

KEYNOTEPRESENTATIONS

Iranian Journal of OtorhinolaryngologyVol 30 , Supplement Issue

May 2018

IRAN CI 2018 Abstracts

26

Iranian Journal of Otorhinolaryngology, Vol 30, Supplement Issue, May 2018


27

K01Expanding criteria for cochlear implantation in the older adult populationFelipe Santos

Otology, Neurotology, Skull Base Surgery Harvard Medical School Massachusetts Eye and Ear Infirmary, USA

Keywords: Cochlear Implantation, Criteria, outcome

Introduction:To demonstrate the 1.) benefits of cochlear implantation 2.) Impact on ease of communication and 3.) effects on quality of life in a cohort of patients who are cur-rently considered above the criteria boundary for eligibility. Material and Methods:This is a prospective, repeated measure study, in a multicenter setting. Twenty sev-en patients with Cochlear, Advanced Bionics or Med El implants were included in this study. Speech perception is assessed preoperatively and at 6 and 12 months with AZ Bio sentence scores and CNC monosyllabic word lists. Subjective benefit is assessed using the Abbreviated Profile of Hearing Aid Benefit, Short Form 36 and Health Utility Index.

Results:To date all patients have shown improvement in speech perception (N=17) at 6 and 12 months (N=14).

Conclusions: Current criteria for cochlear implantation of preoperative sentence score of <40% may be too restrictive in predicting a potential benefit of cochlear implantation in older adults



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K02Cochlear implantation in the octogenarian: speech perception outcomes and length of device useNeil Donnelly1, Mira Panova1, Patrick Axon1, James Tysome1, Manohar Bance1

Cambridge University Hospitals Hearing Implant Unit

Keyword: ASSE, Cochlear Implant, Speech Perception.

Introduction:The population of England and Wales is living longer than ever before. An aging pop-ulation gives rise to concerns related to their hearing needs. Cochlear implantation is the treatment of choice for those with severe-to-profound hearing loss. This study evaluated outcomes of cochlear implantation in those over 80 years of age.

Materials and Methods:A total of 90 adults (mean age, 84± 3.3 years) with bilateral post-lingual severe-to-profound hearing loss were implanted with a unilateral cochlear implant. Data on age at implantation as well as pre- and post-implantation scores for the Auditory Speech Sound Evaluation (ASSE) test and Bench-Kowal-Bamford (BKB) sentence test in quiet and in noise were analyzed. Length of use and cumulative survival rate were calculated for deceased patients.

Results:The cochlear implant provided elderly recipients with improvement in speech under-standing and phoneme discrimination. The pre-implant average BKB test score im-proved from 13±3% to 78±15% by the 12th month of usage. The cohort included 23 deceased patients; they used their cochlear implants for 41±34 months on average. The cumulative survival rate for the cohort was 60.5%.

Conclusions: Cochlear implantation is effective in the elderly. The study demonstrated that on aver-age the elderly recipients use their implants for 3±3 years. This corresponds to the average additional life expectancy for this age group and, based on quality-adjusted life-year data, represents value for money.



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K03Influence of Etiology on Prenatal Deafness in Cochlear Implantation Outcomes Milan Profant1, Lukas Varga1, Zuzana Kabatova1

Department of Otorhinolaryngology- Head and Neck Surgery, Faculty of Medicine and Univer-sity Hospital Bratislava, Comenius University, Bratislava, Slovakia

Keywords: Cochlear implant, Etiology, Genetics, Outcome Introduction:Pathogenic gene variants represent the most prevalent cause of deafness in child-hood, but they are also an important etiological factor in bilaterally deaf adults. More than 50 genes associated with non-syndromic sensorineural hearing loss have been identified over the last decade. Several studies have indicated that genetic etiology may also have an impact on various aspects of cochlear implantation, including timing of surgery, choice of electrode, surgical difficulty or possible risk of complications, and rehabilitation outcomes. However, patients with genetic etiology in general seem to show better postoperative results than subjects with other causes of deafness.

Material and Methods:In our series, 81 of 92 prelingually deaf implanted children were tested for DFNB1 mutations. Subsequently they were divided into three etiology groups and underwent audiological evaluation in tone audiometry, speech audiometry, monosyllabic words, and categories of auditory performance (CAP), conducted 1, 3, and 5 years after implantation.

Results:The DFNB1 group outperformed the two other groups with other known and unknown deafness etiology. Statistically significant differences (p<0.05) for tone audiometry were obtained, particularly after the first and third year post implantation; whereas in speech audiometry, monosyllabic word test, and CAP, differences were achieved only after 3 and 5 years. The rate of excellent performers was also higher in the DFNB1 group, although poor performers occurred in all groups in similar proportions.

Conclusion:Hearing loss etiology may be considered as one of the important predictors of postop-erative performance, but the complex influence of other factors should also be taken into account in the counseling of every individual case.



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K04Electrically- Versus Acoustically-Evoked Auditory Potentials: Are They So Different?Andy J Beynon

Vestibular and Auditory EP Lab, ENT- Department, Radboud University Medical Centre, Ni-jmegen and Hearing & Implants, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience E-mail: [email protected]

Keywords: ABR, Auditory Neuropathy, Cochlear implant, Dyssynchrony, EABR.

Introduction: Today, objective electrophysiological measurements to assess auditory capacities in cochlear implant patients are relatively easy to perform pre-,intra-, and postoperatively.

Description: Preoperatively, auditory brainstem responses (ABR) are obtained to confirm neural synchrony at the level of the brainstem, especially in young children, including chil-dren who are suspected of Auditory Neuropathy/Dyssynchrony Spectrum Disorder (ANSD). Intratympanic Round Window Stimulation and non-invasive electrical Ear Canal Stimulation are discussed for application in the preoperative or intraoperative setting to assess specific patient groups. Intraoperatively, EABRs can also be applied to monitor optimal location of the cochlear or brainstem implant (ABI), for example. Postoperatively, evoked potentials can be used to evaluate neural processing at dif-ferent levels of the auditory pathway, including in children who show developmental problems or in adults who are suspected of central auditory processing disorders after implantation.

Conclusion: In this lecture, several clinical applications of auditory electrophysiological assess-ment at the brainstem and cortical level will be addressed with their fundamental dif-ferences and similarities between acoustical and electrical stimulation (direct versus indirect) as applied in patients with cochlear implants.



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K05Cochlear Microphonic Latency Is Correlated with Hair Cell Survival

*Christofer Bester1, Luke Campbell1, Adrian Dragovic1, Aron Collins1, Stephen O’Leary1

Department. Otolaryngology, University of Melbourne, East Melbourne, VIC, Australia. *E-mail: [email protected]

Keywords: Basilar membrane motion, Cochlear microphonic, Cochlear implant, Electrocochleog-raphy.

Introduction:The cochlear microphonic (CM) is produced by hair cells, and its latency increases from the base to the apex of the cochlea due to the traveling wave. Here we describe the absence of these latency changes at cochlear locations with substantial hearing loss, consistent with the loss of outer hair cells.

Materials and Methods:Intra-operative electrocochleography was recorded from 11 intra-cochlear electrodes basal in recipients of a cochlear slim-straight, lateral wall electrode. Patients had a range of audiometric thresholds from 20 to 120 dB HL at 0.5 and 1 kHz. Acoustic responses were recorded using 0.5- and 1-kHz pure tones of alternating polarity at 100 or 110 dB HL. The latency of the CM was measured using the difference in phase measured with a Fast Fourier Transform (FFT) at the stimulus frequency, comparing the phase at the most basal electrode with more apical electrodes.

Results:There was a significant, negative correlation between CM latency shift amplitude and HL for 1, 2, and 4 kHz when tested on electrodes 22, 14, and 10, respectively (Pear-son’s r-values of −0.7, −0.8, and −0.8). CM latency shifts were largest on apical elec-trodes (mean of 0.3 ms on electrode 22) and gradually decreased in size on more basal electrodes (means of 0.15 and 0.05 ms on electrodes 14 and 10, respectively).

Conclusion:These results demonstrate a significant relationship between the latency of the CM and the survival of hair cells in the cochlea. This finding suggests that electrocochleogra-phy can be used as a diagnostic tool to detect regions of surviving hair cells within the cochlea.



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K06Three-Dimensional Imaging of the Human Cochlea by Scanning Laser Optical Tomography (SLOT)*Saleh Mohebi1, Nadine Tinne2, Georgios C Antonopoulos3, Heiko Meyer4, Omid Majdani5, Tammo Ripken4

1. ENT and Head and Neck Research Center and Department, Iran University of Medical Sci-ence, Tehran, Iran and Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Hannover, Germany.2. Biomedical Optics Department, Laser Zentrum Hannover e.V., Hannover, Germany and Cluster of Excellence Hearing4allº, Hannover, Germany. 3. Biomedical Optics Department, Laser Zentrum Hannover e.V., Hannover, Germany. 4. Biomedical Optics Department, Laser Zentrum Hannover e.V., Hannover, Germany and Bio-fabrication for NIFE, Hannover, Germany.5. Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Hannover, Germany and 4 Cluster of Excellence Hearing4allº, Hannover, Germany,

Keywords: Imaging, Inner ear, SLOT.

Introduction:Scanning laser optical tomography (SLOT) is a technique used for visualization of anatomical structures inside the human cochlea ex vivo. SLOT is a laser-based, high-ly efficient microscopy technique which allows for tomographic imaging of the inter-nal structure of transparent specimens. Thus, in the field of otology, this technique is most convenient for an ex vivo study of the anatomy of the inner ear.

Materials and Methods:Preparation before imaging comprises decalcification, dehydration as well as optical clearing of the cochlea samples in toto.فا

Result: Here, we demonstrate results of SLOT imaging, visualizing hard and soft tissue struc-tures with an optical resolution of down to 15 μm using extinction and autofluores-cence as contrast mechanisms. Furthermore, the internal structure can be analyzed nondestructively and quantitatively in detail by sectioning of the three-dimensional datasets. An advantage of SLOT is that it uses visible light for image formation, and thus provides a variety of contrast mechanisms known from other light microscopy techniques, such as fluorescence or scattering.

Conclusion:We demonstrate that SLOT is applicable for cochleae with metallic cochlear implants that would lead to significant artifacts in μ-computed tomography imaging. The pres-ent study demonstrates the capability of SLOT for resolution visualization of cleared human cochleae ex vivo using multiple contrast mechanisms, and lays the foundation for a broad variety of additional studies.



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K07Bone Dissection Studies to Improve the Approaches to the Inner EarHasan Mohamad Ali Diab1, Nikolai Arkadievich Daykhes1, DS Kondratchikov1, OA Pashchinina1, KD Yusifov1, PU Umarov1

State Scientific Clinical Center of Otorhinolaryngology, Moscow, Russia. *Email: [email protected]

Keywords: Cochlear implant, Cadaveric temporal bone, Ossified cochlea, Second turn.

Introduction:While performing cochlear implantation in cases with more than 5-mm basal turn os-sification, the approach to the second turn tends to be the most problematic for the surgeon. We propose an approach to the second cochlea turn which was developed from a study of the temporal bone of the middle and inner ear structures syntopy, which enables the highest possible spiral ganglion cell and modiolus preservation.

Materials and Methods:We performed measurements on 10 cadaveric temporal bones. The following pro-cedures were performed: extended mastoidectomy with exposure of sigmoid sinus, dura mater and sinodural angle; extended posterior tympanotomy up to the facial nerve canal wall; removal of the incus and bony bridge. The first cochleostoma was created in the typical place. Using the cochleariform process as a landmark, the sec-ond cochleostomy was performed approximately 1 mm inward to the anterior margin of the oval window niche on the line proceeding from the pyramidal process parallel to the stapes crura. The remaining electrodes were placed in the exposed basal turn after removal of the part promontory wall separating the basal and second turn.

Results: The study shows the distance between the anterior margin of the stapes and the whole of the second turn. We also determined the safest point for drilling toward the second turn while minimizing modiolus and spiral lamina trauma. We defined the place of the approach to the second turn in cases of expanded ossification basal turn (>8 mm) inward to the anterior margin of the stapes footplate at approximately 1.2 mm. Eleven patients with bony occlusion spread to the ascending segment of the basal turn under-went cochlear implantation. Full electrode insertion was confirmed by postoperative computed tomography scan. The subjects’ audiological performance correlated with that of cochlear-implant users without cochlear ossification. No complications were re-vealed postoperatively.

Conclusion:Bone dissection studies allow us to improve the effectiveness of cochlear implantation in cases of vestibulocochlear pathologies and help us to develop new approaches to the inner ear with minimization of trauma to the inner ear structures.



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K08Endoscopic Ear Surgery and Cochlear ImplantationSasan Dabiri

Department of Otorhinolaryngology-Head and Neck Surgery, Amir Alam Hospital, Tehran Uni-versity of Medical Sciences, Tehran, Iran.

Keywords: Cochlear implantation, Endoscopic surgery, Otoendoscopy

Introduction:Otoendoscopy has opened a new window in the field of otology by allowing easier visualization of the hidden parts of the middle ear in comparison with the microscope. Through technological development and progression, endoscopy has emerged in various basic and advanced otologic surgeries. Anatomic variations can sometimes make access for cochlear implantation challenging. An endoscopic approach may be helpful in this common advanced otologic operation.

Description:The advantages and limitations of applying endoscopic surgery to cochlear implanta-tion have been analyzed, and a literature review has been performed.

Conclusion:Endoscopic cochlear implantation could be adopted as one approach, parallel to the microscopic approach.



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K09Complications of a Post-Tympanotomy and Facial Recess Approach versus a Transcanal Approach in Cochlear ImplantationSeyed Basir Hashemi1, Fatemeh Davidi1

Otolaryngology Research Center, Shiraz University of Medical Sciences.

Keywords: Cochlear implant, Transcanal, Post-tympanotomy.

Introduction:To compare complications of two techniques used for cochlear implantation; post-tym-panotomy and facial recess (conventional technique) versus transcanal technique.

Materials and Methods:In this descriptive study, 32 patients aged less than 5 years were selected randomly. Sixteen patients underwent cochlear implantation using a transcanal technique, and the conventional technique was performed in the remaining patients. According to intraoperative data, medical records and post-operative follow-up in the first and third months of surgery, complications such as tympanic membrane perforation, facial nerve injury, taste impairment, hematoma, and wound infection were compared in the two groups.

Results:The follow-up findings 1 and 3 months after surgery for both techniques showed no significant difference in the number patients who suffered from various complications (P>0.05).

Conclusion:Based on these findings and the rare complications that have sometimes been ob-served with these surgical techniques, it is necessary for surgeons to be familiar with both methods in order to be able to perform alternative implantation techniques if necessary.



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K10Auditory Implantation in Neurofibromatosis Type 2Neil Donnelly1, R Macfarlane1, Patrick Axon1, James Tysome1, R Mannion1, Manohar Bance1, D Moffat1, F Harris1, Z Vanat1

Cambridge University Skull Base Unit and Hearing Implant Unit

Keyword: ABI, Neurofibromatosis, Vestibular schwannoma.

Introduction:Neurofibromatosis type 2 (NF2) is a rare inheritable disorder characterized by multiple benign tumors. Over 80% of patients with NF2 have bilateral vestibular schwannomas and have a high incidence of bilateral hearing loss as a result of their disease or its management. The English consensus protocol sets out steps to evaluate patients for auditory brainstem implantation (ABI) or cochlear implantation.

Materials and Methods:Over the past 20 years at Cambridge University Hospitals, 27 patients have undergone surgery for ABI placement and 18 patients have undergone surgery for cochlear im-plantation.

Results:Of 27 ABI surgeries, it was not possible to place the device on three occasions due to a distorted brainstem anatomy as a result of very large tumors. Of 24 ABI activa-tions, 22 were successful. Eleven of these patients have becomes regular users, while the remaining 11 individuals include five “sleeper devices” and six non-users. Of the 18 cochlear-implantation surgeries, it was not possible to place the electrode in one patient due to intra-cochlear schwannoma. Of the 17 successfully implanted, two experienced no sound perception, while the remaining 15 became regular users. Open set speech was achieved in five cochlear-implant patients compared with two ABI users. The device was an aid to lip reading 10 cochlear-implant patients and eight ABI patients. In one ABI patient, the device provided access to environmental sound.

Conclusion: Advances and success in auditory rehabilitation in NF2 offers the opportunity to re-move larger-growing tumors early and in the rehabilitation of profound hearing loss in the presence of static tumors.



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K11Performing MRI Scans on Cochlear Implant and Auditory Brainstem Implant Recipients: 13-Year Review*Neil Donnelly1, YChuen Tam1, Ise Patterson1, Patrick Axon, James Tysome1, Manohar Bance1

Cambridge University Hospitals Hearing Implant Unit

Keyword: ABI, Cochlear Implant, MRI.

Introduction:Magnetic resonance image (MRI) scanning is regarded as the standard of care for soft-tissue imaging, particularly that of the brain and spinal cord. It is estimated that a majority of individuals will require an MRI scan at some stage during their life; it is therefore an important consideration in those undergoing auditory implantation. In neurofibromatosis type 2 (NF2), the current UK recommendation is for yearly head imaging and 3-yearly spinal imaging; these intervals are reduced in those being treat-ed with Avastin.

Materials and Methods:A total of 72 individuals (19 auditory brainstem implant, 53 cochlear implant) aged from 2 years to 86 years underwent a total of 514 MRI scans with their implant mag-nets in situ over a 13-year period; this included 2,217 sequences. A special protocol was developed to facilitate the procedure which involved placing a firm plastic card over the implant and bandaging it tightly in place. Where pain was encountered, local anesthetic was additionally used. In cases of NF2, scans were assessed to establish whether the view of the cerebellopontine angle (CPA) was adequate.

Results:Of the 514 MRI procedures, eight scans were abandoned due to pain and four pa-tients experienced dislocation of their magnet. There were no cases of device failure or demagnetization. In 85% of NF2 patients, there was an unimpeded view of the ipsilateral CPA and it was not possible to view the CPA in only 2% of cases.

Conclusion:With a careful head bandage technique, it is possible to perform 1.5T MRI scans in patients with auditory brainstem implants and cochlear implants



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K12Predicting Round Window Visibility by HRCT during Cochlear Implantation in ChildrenMohsen Rajati1, Navid Nourizadeh1, Mohammad Mehdi Ghasemi1, *Mohamad Reza Afzalzadeh2, Rahman Movahed2

1.Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 2. Otorhinolaryngology-Head & Neck Surgery Department, Faculty of Medicine, Mashhad Uni-versity of Medical Sciences, Mashhad, Iran.

Keywords: Cochlear implant, CT scan, Round window.

Introduction:To radiologically evaluate visibility of the round window during cochlear implantation by HRCT imaging of temporal bone.

Materials and Methods:In a cross-sectional, descriptive-analytic study, five radiologic measurements:1. The angle between the posterior wall of the ear canal and cochlear basal turn (EAC angle), 2. The facial recess (FR) width, 3. The location of the facial nerve (FN) relative to the cochlear basal turn (FN location), 4. The angle between the line parallel to coronal axis that passes through the middle of the round window niche (RWN) and the line that con-nects the anterior portion of the FN to the middle of the RWN (RWN angle) and 5. The vertical distance between this coronal plane and the anterior portion of the FN (modified FR distance MFRD) were evaluated on the pre-surgical HRCT of temporal bone. The measurements were then compared with the visibility of the RWN during operation as reported by surgeon.

Result: In this study we compared the above mentioned CT scan findings of cochlear implanted children in visible (n=21) and invisible (n=21) RWN during surgery, as reported by the surgeon. The analysis revealed that the MFRD (measurement 6) was significantly differ-ent between the two groups (P<0.01). The measurements also indicated that the mean RWN angle (measurement 5) is significantly different between two groups (P<0.04).

Conclusion:RWN angle and MFRD are fairly reliable predictors of round window visibility during cochlear implantation. The surgeon can use these measurements to determine the amount of visibility of the round window.



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K13Surgical Problems in Auditory ImplantsMasoud Motasaddi- Zarandy

Tehran University of Medical Sciences

Keywords: Auditory implant, Cochlear implant, Device, Problems, Surgery.

Introduction:During the course of more than two decades, numerous challenges in cochlear im-plantation have come to light. This presentation details some of the personal experi-ences gained over 25 years’ experience in cochlear implantation and other implants in the middle ear and skull. I will try to explain some of the main points which are a challenge during surgery, as well as the resulting outcomes.

Description:Cochlear implantation in a malformed cochlea is one challenge that needs very care-ful evaluation before surgery to ensure that the right surgical approach is selected, as well as the best device among all those available from different companies. Long-term use of these devices can lead to some complications, including cholesteatoma formation. In this presentation, I will try to focus on some ways and tricks to reduce the number of patients with this challenging complication. Also, by showing some images of a patient with a soft-tissue problem, I will try to expose another dark aspect of this surgery. Finally, device software failures are increasing, while the number of patients undergoing cochlear implantation is increasing. It is the responsibility of companies to reduce this complication as it wastes money and causes health problems, especially in developing countries which, as populated countries, are the main users. Resources in these countries are limited, so any failures or revision surgeries are a burden on the healthcare system.

Conclusion: With the rising number of auditory implant surgeries, teams must pay close attention to new surgical and technical challenges.



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K14 Features of Cochlear Implantation in Cases of Ossified CochleaHasan Mohamad Ali Diab 1, NA Daykhes 1, OA Pashchinina 1, DS Kondratchikov 1, PU Umarov 1, AE Mikhalevich1

State Scientific Clinical Center of Otorhinolaryngology, Moscow, Russia.

Keywords: Simultaneous bilateral cochlear implantation, Second turn, Ossified cochlea

Introduction:To evaluate the results of cochlear implantation in cases of ossified cochlea.

Materials and Methods:Twenty-five patients with cochlear ossification underwent simultaneous bilateral co-chlear implantation. Bony occlusion spread to the ascending segment of the basal turn in 11 cases (unilateral). We performed an electrode insertion through the round window after gentle drilling ossification of the inferior segment of the basal turn in 39 cases. Superior cochleostomy was performed, and the electrode was inserted though the second turn in the other 11 cases. The follow-up period varied from 6 months to 1 year.

Results:Most electrodes have an impedance in the normal range. A postoperative computed tomography scan was performed in all cases. The subjects’ audiological performance correlated with that of cochlear-implant users without cochlear ossification. No com-plications were revealed postoperatively.

Conclusion:Bilateral cochlear implantation using the described surgical tactic allows patients with ossified cochlea after meningitis to achieve high levels on audio-verbal assessment. The risk of total ossification of the cochlea and the ability to maximize the use of non-ossified cochlea areas for auditory stimulation in the early period after meningitis justifies the indication for simultaneous bilateral cochlear implantation. Applying the described approach to the second cochlear turn in patients with cochlear ossification enables maximal spiral ganglion cell and modiolus preservation and full electrode insertion, and, therefore, improves postoperative auditory performance.



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K15Cochlear Implantation in Chronic Otitis MediaMilan Profant1, Lukas Varga1, Branislava Bercikova1, Gabriela Pavlovcinova1, Zuzana Kabatova1

Department of Otorhinolaryngology- Head and Neck Surgery, Faculty of Medicine and Univer-sity Hospital Bratislava, Comenius University, Bratislava, Slovakia

Keywords:Cochlear implantation, Chronic otitis media, Petrosectomy, Obliteration

Introduction:Different options for hearing rehabilitation in chronic otitis media (COM) are available, but achieving satisfactory results can be challenging. Here we present our single-center experience with cochlear implantation in patients with COM.

Materials and Methods: In a retrospective analysis of a series of 425 cochlear implantation cases, we identi-fied seven subjects (1.65%) implanted for deafness due to COM. Five individuals pre-viously underwent modified radical surgery with open cavity, one had myringoplasty, and three had no previous surgery.

Results:Cochlear implantation was performed in nine ears; four in the radical cavity with partial obliteration, three with canal wall-up (CWU) tympanomastoidectomy, and two with sub-total petrosectomy. The complication rate was highest in the radical cavity cases with partial obliteration (75%), leading to explanation of the device followed by cochlear im-plantation in the other ear in two patients. Cholesteatoma recurrence occurred in three ears (33%). Regarding the cochlear implantation functional outcomes, five patients were assessed as good performers, whereas two cases had poor outcomes. Conclusion:Deafness and severe hearing loss after COM with cholesteatoma is an appropriate in-dication for cochlear implantation. In our experience, the method of choice is subtotal petrosectomy with cochlear implantation, offering the best results in terms of disease eradication, complications, and functional outcomes.



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K16Cochlear Implant Surgery in Radical CavityTilman Keck

ENT Clinic, Elisabethinen Hospital Graz, 14 Elisabethinergasse, 8020 Graz, Austria

Keywords: Mastoid reconstruction, Radical cavity, Reconstruction of external auditory canal, Single-stage procedure

Introduction:Cochlear implantation in patients with open mastoid cavities is a problematic topic. The surgeon has to decide either 1) to leave the mastoid cavity open and to cover the cochlear implant electrode; 2) to reconstruct the wall of the outer ear canal and the mastoid; or 3) to perform obliteration of the mastoid and to close the external auditory canal. We describe an approach to the coverage of a cochlear implant reconstructing the mastoid cavity with a rolled cartilage of the conchal cartilage.

Materials and Methods:Four patients with deafness and previous mastoidectomy and open mastoid cavities were enrolled. The median age was 37 years. One patient received a Pulsar cochlear implant, two patients a Nucleus implant, and one patient a Concerto cochlear implant. Two ears were right ears and two ears were left ears.

Results:In all patients, the rolled cartilage healed without extrusion or necrosis. The outer ear canal with the posterior wall of the external auditory canal could successfully be reconstructed in all patients. The cochlear implant electrode was not visible postop-eratively in any patient. During the follow-up time, the cochlear implant function and performance was successful in all patients, without infection or necrosis of the carti-lage surrounding the cochlear implant electrode in the reconstructed mastoid cavity.

Conclusion:Reconstruction of the mastoid cavity and the posterior wall of the external auditory canal can successfully be performed with simultaneous cochlear implantation. The advantage is that radical removal of epithelial structures with feasible risk of remain-ing epithelial tissue, can be avoided. Additionally, an open external auditory canal al-lows control of the tympanic membrane and the middle ear, especially after previous cholesteatoma surgery.



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K17Indication and Evaluation of Changing Pattern on Middle-Ear Implant SurgeryMilan Profant1, Zuzana Kabatova1, Lukas Varga1

Comenius University, Medical Faculty, Department of ORL HNS, Bratislava, Slovakia

Keywords: Bonebridge, BAHA, Middle-ear implant, Vibrant Soundbridge.

Introduction:To improve hearing is the goal of the otologist, which may be achieved through solu-tions such as tympanoplasty, hearing aids, and middle-ear implants. Advances in technology over recent years have offered new possibilities to improve hearing. Eval-uation of our experience and contemporary changes in indications for bone conduc-tion and active middle-ear implants are the subject of our presentation.

Materials and Methods:Bone conduction implants (Bone Anchored Hearing Aid [BAHA] 15x, Bonebridge 10x) and active middle-ear implants (Vibrant Soundbridge 28x) for chronic otitis, atresia, otosclerosis, sensorineural hearing loss (SNHL), and single-sided deafness were the subject of our evaluation. We evaluated a series of 53 patients using a questionnaire, pure tone audiometry, speech audiometry, and an assessment of clinical develop-ment.

Results:The results confirmed excellent audiological outcomes in the majority of patients. The only complications identified in our series were one extrusion of the abutment and one case of deafness in the Bonebridge group (simultaneous revision in a previously radicalized ear). A case report of one patient with otosclerosis in which the floating mass transducer of the Vibrant Soundbridge had been attached on the incus short process simultaneously with piston insertion is presented.

Conclusion:Audiological results and subjective evaluation found middle-ear implants to be a suit-able solution for managing SNHL, SASD, mixed and conductive hearing loss. Intro-duction of the Bonebridge device has moved the choice of implant for mixed and conductive hearing loss in favor of bone conduction implants compared with active middle-ear implants.



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K18 Implantable Hearing Devices: A Review of Advantages and OutcomesMohammad Farhadi

ENT, Head and Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

Keywords:Bone-anchored hearing devices, Implantable hearing devices, Middle-ear implants.

Introduction:The drawbacks of conventional hearing aids (such as difficulties in hearing in noisy conditions in patients with high-frequency hearing loss and uselessness in subjects with malformation of the external auditory canal) prompted studies that led to the development of implantable hearing devices. Implantable hearing treatments are di-vided into three groups: bone-anchored hearing devices, middle-ear implants, and cochlear implants. In the current study, the clinical results of patients implanted with bone-anchored devices and middle-ear implants were evaluated.

Materials and Methods:Device implantation surgery was performed in 24 patients admitted to Hazrat Rasoul Akram Hospital between 2010 and 2018. The pure-tone thresholds and speech intelli-gibility were evaluated preoperatively, and 3, 6, 12, and 24 months postoperatively, and compared to evaluate hearing gains.

Results:Device implantation was performed in 24 patients; 13 patients were implanted with bone-anchored devices (BAHA® by Cochlear Corporation or Sophono® by Medtronic) and 11 subjects with middle-ear implants (Esteem® by Envoy Medical in nine patients, and Vibrant Soundbridge by MED-EL Corporation in two patients). Concurrent disor-ders were reported in five patients implanted with bone-anchored devices (such as congenital aural atresia, chronic suppurative otitis media, hemifacial macrosomia, blind-ness, and failure of the stapedectomy). The comparison of the pre- and postoperative audiometric results of all patients demonstrated a significant improvement.

Conclusion:Bone-anchored devices and middle-ear implants are effective and safe choices for patients who are not suitable candidates for conventional hearing aids.



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K19Sealing of the round and oval window niches with triamcinolone-soaked fascia as salvage surgical therapy in sudden sensorineural hearing loss.Benjamin Loader 1, Rudolf Seemann1, Claudia Atteneder1, Elisabeth Sterrer1, Peter Franz 1, Claudia Lill2

1. Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Tertiary Hospital, Teaching Hospital of the Sigmund Freud University of Vienna. 2. Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria.

Keyword: SSHL, Round window seal, Surgical therapy.

Introduction:Triamcinolone-soaked fascia seems to show better hearing improvement when added to tympanotomy for sudden idiopathic sensorineural hearing loss (SSHL), compared to fascia round window occlusion without triamcinolone. We analyze if adding triam-cinolone to seal the round and oval window niches with fascia results in improved audiological outcome for acute SNHL.

Materials and Methods:Fifty-three patients (27m: 43 ± 12 years, 26f:45 ± 14 years) with acute SSHL ≥50dB over 3 frequencies, who failed primary therapy, underwent transcanal tympanotomy. Twenty-five patients (Group A; cortisone:14m, 11f:46 ± 9 years) received sealing of the round and oval window with fascia soaked in triamcinolone (1ml; 40mg/ml) and 28 controls (Group B;no-cortisone:13m, 15f, 42 ± 12 years) without triamcinolone. Fre-quency specific and pure tone average (PTA =500-1000-2000-3000Hz) results were compared between Group A and B pre- and postoperatively.

Results:In Group A PTA improved by ≥10dB in 21/25(83%) cases; in Group B 18/28(63%). Group A showed a statistically significantly better improvement across all frequencies, while linear regression revealed a significant decrease of posttherapeutic PTA to 94.96% of the initial PTA (P=.037). The overall PTA improved by 24dB. Group A improved from 73dB to 41dB (-32dB) PTA, Group B improved from 76dB to 56dB PTA (-20dB) (P< .05). Group A showed a significant additional decrease of 12.8dB (P< .001).

Conclusion:adding triamcinolone to seal the round and oval window niches with fascia results in improved audiological outcome for acute SNHL.



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K20Success Rate of Deep Insertion Using Long Electrode ArraysTilman Keck

ENT Clinic, Elisabethinen Hospital, Graz, Austria

Keywords: Deep electrode insertion, Long electrode array, Round window insertion.

Introduction:Flexible straight cochlear impant electrodes allow deep insertion to reach even the apical region of the cochlea. Materials and Methods:Between 2009 and 2017, 62 patients undergoing cochlear implantation were enrolled, in whom long electrodes (between 28 and 31.5 mm in length) were used. Aditionally, four patients with electric-acoustic stimulation and two patients with medium elec-trodes were enrolled. Results:The mean age of the patients was 61 years. In two of the 62 patients, only subtotal insertion was achieved, while in all other patients, deep and full insertion was suc-cessful. In all patients, a totally successful stimulation pattern could be achieved, even in the low frequencies. Conclusion:Deep electrode insertion using long electrodes in cochlear implantation shows ben-efits in perception of music and tonal languages. However, a less traumatic insertion technique is mandatory. Details of successful cochlear implantation and the round window technique will be demonstrated.



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K21Electrocochleography during Cochlear Implantation Predicts Electrode Contact*Christofer Bester1, Luke Campbell1, Aaron Collins1, Anthony W Gum-mer2, Stephen O’Leary1

1. Department. Otolaryngology, University of Melbourne, East Melbourne, VIC, Australia. E-mail: [email protected]. Section Physiological Acoustics and Communication, Department. Otolaryngology, Eber-hard-Karls-University, Tübingen, Germany

Keywords:Electrocochleography, Traumatic insertion, Cochlear implantation

Introduction:Sudden decreases in cochlear microphonic amplitude during cochlear implantation are associated with poor preservation of residual hearing post-operatively. Here we describe changes in the cochlear microphonic consistent with the electrode array contacting the basilar membrane.

Material and Methods:Intra-operative electrocochleography was recorded from the apical electrode during im-plantation in 88 recipients of a cochlear slim-straight lateral wall electrode. Patients had audiometric thresholds of between 20 and 90 dB HL and 0.5 kHz. Acoustic responses were recorded using a 0.5-kHz stimulus tone presented with alternating polarity at 100 or 110 dB HL, with interleaved common ground impedance measurements. Changes in the electrocochleographic response were associated with video recording from the operating microscope. Audiometric outcomes were collected pre-operatively and at 3-months post-operatively.

Results:During implantation, 59 patients showed a drop of cochlear microphonic amplitude, with the drop occurring during electrode insertion from 0–10 mm (eight patients), 10–20 mm (10 patients), 20 mm to full insertion (27 patients), during placement of the electrode lead (four patients), and during the placement of fascia (10 patients). Drops in cochlear microphonic amplitude were associated with significantly poorer audiometric outcomes at 3 months. During drops in cochlear microphonic amplitude, the latency of the re-sponse decreased in 17 cases, with an apparent change in the frequency of the re-sponse in 34 cases. Drops were defined as occurring rapidly (<5 s) or slowly (> 100 s).

Conclusions:Changes in the latency and frequency of the cochlear microphonic amplitude were found to be consistent with the predicted effects of damping of the basilar membrane by contact with a cochlear implant electrode array.



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K22Cochlear Implantation in Cases of Anomalies of the Inner Ear.Hasan Mohamad Ali Diab1, Daykhes NA1, Kondratchikov DS1, Pashchinina OA1, Yusifov KD1, Umarov PU1

State Scientific Clinical Center of Otorhinolaryngology, Moscow, Russia. *E-mail: [email protected]

Keywords: Mondini deformity, Common cavity, Cochlear hypoplasia, CSF leak

Introduction:To demonstrate the benefits of implantation in patients with inner ear malformations.

Materials and Methods:It has been performed 32 Cochlear Implantations (CI) on pediatric patients with Cochle-ar malformations to date. According to L. Sennaroglu, the malformations encountered included 3 common cavity (CC), 1 cochlear hypoplasia type II, 2 - type III and 2 - type IV, 3 common cavities, 3 incomplete partitions of the cochlea type I (IP-I, cystic cochlea), 10 IP-II (Mondini deformity) and 7 IP-III. In cases of round window membrane presence, the CI was performed by classical method with transmembrane electrode insertion. In cases of common cavity and one IP I case, the round window membrane was not identi-fies and the electrode was insert via cochleostomy. CSF leak occurred in all cases of IP and common cavity.

Results:The full insertion of electrodes of previously chosen length (from 11 to 27 mm) has been achieved in all 26 cases. In cases, with gushers due to the absence of bone wall between the cochlea and IAC cerebrospinal fluid leakage were successfully stop by reliable packing cohleostomy/round window niche using muscle flap and silicon stopper of electrode array. After 6 months sound processor activation, 5-7 years old children - understand words with an open choice of more than 90%. Children up to 5 years reached similar results closer to 12 months of using the systems. Speech of 5-7 years old children after 1 year using of the system was easy to understand by all. CI was less effective in cases with a CC. Children with malformed cochlea required an increasing of the adjustment session number.

Conclusion:Good visualization of round window and transmembrane insertion of active electrode into spiral canal of cochlea in patients with inner ear malformations help to minimize the trauma of the spiral organ, control liquorrhea and improve postoperative auditory performance.



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K23Cochlear Implantation in Children with Inner Ear Malformations*Skrivan Jiri1, Jurovcik Michal1, Oklusky Miroslav1, Myska Petr1

Department of Ear, Nose and Throat, Second Faculty of Medicine, University Hospital Motol, Prague, Czechia*E-mail: [email protected]

Keywords: Cochlear implantation, Inner ear, Prelingual deafness.

Introduction: Until recently, congenitally deaf children with anomalies of the inner ear were exclud-ed from cochlear implantation programs, since these malformations were considered to make implantation technically not feasible and to result in worse outcomes. Nowa-days, these children are implanted and the results in some cases are comparable with children with physiologically developed cochlea.

Materials and Methods:In the period June 2014 to December 2017, five children with inner ear malforma-tions received a cochlear implant, representing 4% of all implanted children. Out of this number, there was one reimplantation, with the rest having been primary surger-ies. The inner ear anomalies in these children included common cavity, hypoplastic cochlea, incomplete partition I, and incomplete partition II. The revision surgery was performed in a child with an electrode array dislocated into the internal auditory canal.

Results: In a preoperative workout, a detailed analysis of both computed tomography and mag-netic resonance imaging is necessary, together with a general assessment of the child’s health. The postoperative benefit may be compromised by additional handicaps (es-pecially in the central nervous system) and a greater age during surgery. Some of the implanted children are excellent users.

Conclusion:Children with anomalies of the inner ear should not be excluded from cochlear im-plantation programs.



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K24Evaluation of Music Perception Abilities in Prelingually Deaf Children with Cochlear ImplantationLesinskas Eugenijus1, Vaitkunaite Donata1

Center of the Ear, Nose and Throat Diseases Vilnius University Hospital Santaros Clinics, Vil-nius University, Lithuania

Keywords: Cochlear Implantation, Music perception.

Introduction:The goal of the present study was to evaluate music perception abilities in prelin-gually deaf children after cochlear implantation.

Materials and Methods:

We aimed to ascertain three main music perception dimensions (1): subjective music style appreciation (2), discrimination between the timbres of different musical instru-ments and (3) ability to discriminate different musical components such as rhythm, pitch, melody, volume, and harmony. In total, 47 children using unilateral or bilateral cochlear implants were investigated as well as a normal-hearing control group of 52 children matched with respect to sex and age. The selection criteria for the cochlear-implant group included ages 5 to 12 years, at least 2 years of cochlear-implant experi-ence, and development of good speech perception and expression skills.

Results:The evaluation of enjoyment of music style sections showed that normal-hearing chil-dren rank electronic and pop music as their preferred styles, while cochlear-implant users ranked rock and electronic music as their favorites. Cochlear-implant users consistently showed more diffuse error patterns than normal-hearing children in iden-tifying instrumental timbres and mistaking one instrument for another unrelated to the instrument family. Therefore, cochlear-implant subjects show great ability to identify percussive instruments. Normal-hearing controls responded with nearly 89.4% ac-curacy in the rhythmic perception task, while the results among cochlear-implant sub-jects varied from nearly perfect responses to around 74% accuracy. Evaluating pitch perception abilities, normal-hearing subjects achieved a mean performance of about 78.7% accuracy, but cochlear-implant users’ performance varied dramatically from 10% to 90%.

Conclusions:Cochlear-implant users performed slightly worse in the rhythmic perception task than normal-hearing children, but achieved perfect results in identifying music volume and harmony changes. However, compared with normal-hearing participants, cochlear-im-plant subjects varied widely in their ability to identify pitch and melody changes.



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K25Vestibular Evaluation Following Cochlear Implantation in Patients with Inner-Ear AnomalyAlimohamad Asghari1,*Farideh Hosseinzadeh1, Akram Pourbakht2, Mohammad Farhadi3, Ahmad Daneshi3, Hesam Emamjome3, Maziar Moradi-Lake4, Maryam Karimi Boroujeni2

1. Skull Base Research Center and ENT Head and Neck Research Center, Iran University of Medical Sciences, Tehran, Iran.2. Department of Audiology School of Rehabilitation Sciences, Iran University of Medical Sci-ences, Tehran, Iran.3. ENT Head and Neck Research Center and Department, Iran University of Medical Sciences, Tehran, Iran.4. Department of Community Medicine, Iran University of Medical Sciences and Health Ser-vices, Tehran, Iran.

Keywords:Cochlear implantation, Vestibular function tests, Inner ear.

Introduction: Several studies have been performed to assess the cochlear and surgical outcomes in cochle-ar-implanted children with inner-ear malformation. Auditory benefits from this intervention have been significant, but the evaluation and management of the vestibular system in these patients is a novel challenge to even the most experienced clinician. We evaluate the impact of inner-ear anomaly on the vestibular system in patients with bilateral severe-to-profound hearing loss who have undergone cochlear implantation.

Material and Methods:In this retrospective review study, 43 patients with congenital profound hearing loss who under-went unilateral cochlear implantation from 2001 to 2016 were recruited. Patients were divided into those with and without inner-ear malformations by temporal bone high-resolution computed tomography. The vestibular system was assessed using vestibular evoked myogenic potential (VEMP) and the bi-thermal caloric test. The effects of cochlear-implant surgery on vestibular function were evaluated when the contralateral ear was considered as the control. Statistical analysis was conducted using binary logistic regression with SPSS and the Fisher Exact test. The significance level was set at P<0.05.

Results: Saccular dysfunction was detected in 60.7% of abnormal ears that received cochlear implanta-tion. There were significant differences in VEMP results between groups (P=0.026), and 65% of patients with absent VEMP were inpatients with abnormal inner-ear anatomy. Patients with a history of re-implantation in both ears had bilateral VEMP abnormalities (P=0.012). Caloric no response and weakness was detected in 77.7% of patients with abnormal inner-ear anatomy, and 81.3% of patients with normal anatomy had a normal caloric test. There were no significant differences in caloric results according to implanted ear (P=0.66). Patients with a history of re-implantation in both ears had bilateral caloric abnormalities (P=0.03). Among patients with inner-ear anomalies, those with an abnormal internal auditory canal performed worse in ves-tibular function. Gender, age, duration of implantation, age of implantation, type of prosthesis, and intra-op cerebrospinal fluid leak did not lead to a significant difference in either group and did not affect clinical outcomes.

Conclusion: In patients with inner-ear anomalies, the incidence of vestibular dysfunction is predominant, especially in those with internal auditory canal narrowing. Therefore, initial early vestibular evaluation and rehabilitation may be necessary in these patients. Surgeons should be aware of possible labyrinth injury during cochlear implantation surgery, especially among those requiring re-implantation, and try to minimize the risk of injury.



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K26The Effects of Cochlear Implantation on Vestibular Function in Children Aged 1-4 YearsMohammad Ajalloueyan1, *Masoumeh Saeedi1, Mohammad Sadeghi2, Farzaneh Zamiri Abdollahi3

1.New Hearing Technologies Research Center, Baqiyatallah University of Medical Science, Tehran, Iran.2.Cochlear Implant Center of Loghman Hospital, Pejvak Auditory-Verbal Center, Tehran, Iran.3. Rehabilitation Faculty Tehran University of Medical Sciences, Tehran, Iran.

Keywords: Cochlear implant, Head-Impulse Test, Vestibular function, VEMP.

Introduction:Although cochlear implants offer an effective hearing restoration option in children with severe-to-profound hearing loss, concern continues to exist regarding the pos-sible effects of cochlear implantation on the vestibular system and balance.

Materials and Methods:In a prospective cohort study, 27 children with bilateral profound hearing loss (all candidates for cochlear implantation) were evaluated for their vestibular function be-fore and after cochlear implantation. Vestibular evaluations consisted of Vestibular Evoked Myogenic Potentials (VEMP), caloric testing, and the Head-Impulse Test.

Results:Mean age at the time of cochlear implantation was 27.19 months. Without consider-ing vestibular evaluation results, one of the ears was selected for surgery. Vestibular tests after surgery were not indicative of any statistically significant change in vestibu-lar system or balance.

Conclusion:These limited data show that cochlear implantation did not impair the vestibular sys-tem of these patients. From the results of our study, we may conclude that round window implantation does not have any disturbing impact on vestibular function in children. The generalization of this result needs further research.



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K27Is Vestibular Function Different In Cochlear-Implant Cases When The Device is on or off?Moharram Ali Ghalehnavi1, Mohammad Mahdi Ghasemi2, Mohsen Rajati2, Mohammad Reza Tale1, Eeffat Daroobord1

1. Khorasan Cochlear Implant Center, Mashhad, Iran.2. Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Keywords:Cochlear-Implant, Oculomotor test ,Vestibular Function, VNG.

Introduction:There has always been concern regarding the adverse effects of cochlear implantation on the vestibular system. In addition to the potential for vestibular injury at the time of surgery, cochlear implantation also carries the risk that the electrical current provided by the implanted array could spread beyond the auditory portion of the labyrinth and stimulate the vestibular portion. Such activation could be detrimental to vestibular func-tion. On the other hand, however, electrical stimulation of the vestibular system could theoretically provide some useful vestibular cues. In this study, we assessed the effect of electrical stimulation from cochlear-implant devices on the results of vestibular tests.

Materials and Methods:Ten unilateral cochlear-implant patients who were more than 13 years old and did not have history of trauma to the temporal bone were chosen randomly. Videonystagmog-raphy (VNG) and oculomotor tests were performed in all patients when their cochlear-implant devices were on. Then tests were then repeated after the device had been turned off for at least for 12 hours. The results were compared between cochlear-im-plant and non-cochlear-implant ears with the device on and off.

Results:Ten unilateral cochlear-implant patients including seven females and three males were tested. Subjects were aged between 13 and 60 years (average 24.4 years) and the du-ration of cochlear-implant usage was between 6 and 30 months (average 13.3). When the device was on, weakness in the non-implanted side was found in six patients and on the implanted side in two patients, while in two patients we found no lateral weakness. While, the device was off, there was weakness in the implanted side in six patients and in two patients on the non-implanted side, with no lateral weakness in the other two pa-tients. In other words, with the device on, we found better results on the implanted side; however, with the device off, four people showed better results on the non-implanted side.

Conclusion: Cochlear-implant electrical stimulation due to the device being on has a positive effect on caloric test results in comparison with when the device was off for at least for 12 hours. Vestibular function tests show better results in the device-on setting, compared with the off condition.



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K28Electrode Impedance as a Biomarker in Cochlear-Implant Recipients*Christofer Bester1, Chanan Shaul1, KV Padmavathi1, Aron Collins1, Stephen O’Leary1

Department of Otolaryngology, University of Melbourne, East Melbourne, Australia*E-mail: [email protected]

Keywords:Biomarkers, Cochlear implant, Hearing loss, Impedance. Introduction:Fluctuations in cochlear-implant impedance are associated with inner-ear pathology after implantation. Here, we correlate these fluctuations with episodes of hearing loss and/or vertigo, with a comparison between lateral wall and perimodiolar electrode ar-rays.

Materials and Methods:A total of 770 recipients of a cochlear slim-straight, lateral wall electrode (CI422) or perimodiolar (CI512) electrode were investigated for impedance fluctuations. Imped-ance fluctuations were defined as a median rise of ≥4 kΩ across all intra-cochlear electrodes from baseline measurements taken 2 weeks after switch-on. Medical re-cords were analyzed from 193 of the 770 patients.

Results:The slim-straight, lateral wall electrode was found to fluctuate in impedance at a sig-nificantly higher rate than the perimodiolar array (17% vs 12%). The perimodiolar electrode tended to fluctuate in impedance later than the slim-straight electrode. Im-pedance fluctuations were found to correlate significantly with medical events (hear-ing loss, vertigo, or tinnitus). Overall, in the “fluctuation” group, 42 out of 75 patients (56%) demonstrated a clinical event during impedance fluctuation, whereas 26 out of 118 patients (22%) in the “non-fluctuation” group had a clinical event. This significant difference existed with both implant types.

Conclusion:These results demonstrate a small but significant increase in impedance fluctua-tions in lateral wall electrodes, and support the relationship between fluctuations in cochlear-implant impedances and post-operative clinical events, including the loss of residual hearing and vertigo. Monitoring cochlear-implant impedance may be a method for the early detection, and therefore prevention, of these events in the future.



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K29Local pharmacology of the inner earPhilippe Lefebvre

Department of Otorhinolaryngology, CHU de Liège, Liège, Belgium

Keywords: Hearing loss, hair cell, inner ear, pharmacology

Introduction:Most of the deafness are of sensorineural origin and are characterized by a loss of hair cells and of spiral ganglion neurons. At the present time, hearing aids are the only treatment. However, in some diseases of the inner ear, pharmacological treatment have been proposed and used successfully. In this paper, we will review recent ani-mal studies that lead to the rationale of some treatments for the inner ear diseases.

Description: In vitro and in vivo experiments demonstrate that it is possible to manipulate the neu-rosensory structures of the inner ear and provide an effective treatment to prevent or eventually restore hearing in animals. The molecules or drugs can be administered locally to the inner ear through a direct perilymphatic perfusion or through the round window membrane. The various delivery systems available for human use will be presented as well as the bioavailibilty of the drugs after perfusion of the inner ear. Two examples will be presented: 1. we will discuss the treatment of patients suffer-ing from idiopathic sensorineural hearing loss which can be treated successfully by a perfusion through the round window membrane, improving their hearing threshold and their speech discrimination. 2. Local administration of TNF alpha blocker in an animal model of autoimmune disease prevents inflammation in the cochlea and its associated hearing loss. We will report 9 patients presenting with autoimmune sen-sory hearing loss who responded to oral steroid treatment were implanted with a Silverstein microwick local delivery system to the round window membrane for 3 to 4 weeks. Seven patients out of 9 exhibited a stabilisation of their pure tone audiometry (PTA) for a period of time ranging from 3 to 15 month. 5 of 9 patients showed an im-provement of their hearing threshold.

Conclusion: local administration of drugs to the inner ear of patients presenting a sensorineural loss allows stabilization or improvement of their hearing function in some cases, dem-onstrating the feasibility of this modality of treatment.



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ORALPRESENTATIONS



May 2018

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Iranian Journal of Otorhinolaryngology, Vol 30, Supplement Issue, May 2018 59


O01The Development of an Interventional Package on “Receptive Vocabulary” for Cochlear Implanted Children*Leila Monshizadeh1, Roshanak Vameghi2, Firoozch Sajedi3, Fariba Yadegari4,

Seyed Basir Hashemi5, Mehdi Rahimi6

1. Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Teh-ran, Iran.2. Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sci-ences, Tehran, Iran.3. Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sci-ences, Tehran, Iran.4. Speech and Language Department, University of Social Welfare and Rehabilitation Sciences, Teh-ran, Iran.5. Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz- Iran.6. Yazd University, Yazd, Iran.

Keywords: Cochlear implant, Educational package, Language disorder, Vocabulary develop-ment.

Introduction:Considering the shortage of language intervention protocols which specifically con-centrate on cochlear-implanted children, and considering the importance of timely lan-guage intervention in this group of children, the aim of the present study was to develop an interventional package on “receptive vocabulary” for cochlear-implanted children.

Materials and Methods:The first draft of the intervention protocol was prepared after reviewing the literature related to language acquisition theories in normal and language-disordered children, as well as literature on the production of intervention protocols (especially for lan-guage-impaired children), and also by considering the normal process of language and speech development in normal children. The face and content validity of the intervention protocol was then assessed by a Delphi team over three rounds, and finally approved.

Results:A language intervention protocol was developed to enhance receptive vocabulary in cochlear-implanted children aged 12–48 months, based on cognitive, behavioral and developmental theories. This protocol included five interventional stages: 1. Drilling and imitation; 2. Modeling; 3. Motor training; 4. Deliberate error correction; 5. Re-in-statement and generalization. Each stage consisted of a description of the aims of that stage, a list of techniques, tools required, a detailed step-by-step explanation of the intervention, how re-enforcement must take place, and the indicators of success which permit progress to the next stage.

Conclusion:The interventional package produced is believed to facilitate language acquisition in cochlear-implanted children, according to expert qualitative assessment and ap-proval. Experimental research is required for verification of this assumption.



O02Relationship of ESRT Reaction Time and Auditory Perception in CI Children*Fatemeh Arbabi1, Hesam Emamdjomeh1, Saeideh Mehrkian2

1. Iran Cochlear Implant Center, Tehran, Iran.2. University of Social Welfare and Rehabilitation Sciences (USWRS), Tehran, Iran. E-mail: [email protected]

Keywords: Auditory perception, Cochlear implant, ESRT.

Introduction:A common problem among cochlear-implanted children is poor progress in acquiring auditory and language skills. Although threshold and comfort levels for these patients are determined appropriately, they do not benefit from the device, as expected. This paper proposes a novel approach to overcome this problem by studying more audi-tory neural processing pathways and showing their usefulness for predicting the level of cochlear implantation value, as well as selecting an appropriate aural rehabilitation method.

Materials and Methods:An analytical-descriptive study of cochlear-implanted children aged between 3 and 7 years was designed. Children were required to have used a cochlear implant for at least 2 years and to have undergone at least 1 year of postoperative auditory verbal therapy in the cochlear implant center. Electrical Stapedial Reflex Threshold (ESRT) reaction time was measured for three electrodes (apex, middle, and base). The audi-tory perception score was determined using the Category of Auditory Performance (CAP) test.

Results:The initial results of this study show that the shorter ESRT reaction time, the higher the CAP score achieved. Final results and relevant details will be presented in the final edition of the paper.

Conclusion:There is a close correlation between ESRT reaction time and auditory perception in cochlear-implanted children as well as in all patients. Therefore, ESRT can be used as a prognosis test in a candidacy protocol for cochlear-implanted children to determine if the child will show improvement in auditory skills.



O03Correlation Between Perceptual Intelligibility of Speech and Speech Acoustic Parameters*Saeed Mirahmadi1, Negin Moradi1, Majid Soltani1, Nader Saki2, Akbar Darouie3, Amal Malehi Saki4

1.Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 2. Khuzestan Cochlear Implant Center, Ahvaz, Iran. 3. Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. 4. Department of Statistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Keywords: Acoustic parameters, Cochlear implant, Perceptual intelligibility.

Introduction:The speech intelligibility is evaluated through the perceptual and acoustic methods. In the perceptual method, the speech intelligibility is investigated using the listener’s judgment. On the other hand, in the acoustic method, the acoustic parameters related to speech are studied. This study aimed to evaluate the association between the su-prasegmental components and perceptual speech intelligibility through investigating the correlation between the Formant centralization ratio(FCR) and duration with the percentage of speech intelligibility in children with cochlear implant.

Materials and Methods:This study was conducted on 16children with cochlear implant within the age range of preschool years. The participants were asked to repeat 30 selected Persian words displayed in a video show while their voices were recorded by a microphone. The evaluation of perceptual speech intelligibility was performed using the judgment of three listeners who were unfamiliar with the speech of the hearing impaired children. Calculation of acoustic parameters has been done by 5.2.25 version of Praat soft-ware.

Results:According to the results, the mean percentage of the perceptual intelligibility is 48.96%. And Its correlation with Formant centralization ratio (P=-.064) by considering the significance level more than 0.5, is not significant, while this correlation for Dura-tion parameter (P<0.001) Is significant.

Conclusion:According to the results it may be stated that the acoustic parameters play a promi-nent role in determining speech intelligibility of children with cochlear implants at the word and one of the keys to increasing speech intelligibility of children with cochlear implants increase the duration is expressed in words. And according the fact that the FCR is vowel centralized, the less it is, the greater the intelligibility, its correlation with intelligibility speech is inverse.



O04Phonological Processes in Persian Children with Cochlear Implantation and Normal Hearing in ShirazNaimeh Fathi1, *Ali Ghorbani1, Mohammad Reza Kayhani1, Shapour Haqjoo2

1. Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. 2. Fars Cochlear Implantation Center, Shiraz, Iran.

Keywords: Cochlear implantation, Hearing children, Phonological processes.

Introduction:Natural hearing is essential for the acquisition of a phonemic system in any language. Children with hearing impairment have an inappropriate or defective phoneme sys-tem that continues to need improvement, even after resolution of the hearing loss by cochlear implantation. As phonological processes are thought to differ between Per-sian children with cochlear implantation and those with normal hearing, this study was performed to compare phonological processes between these two groups.

Materials and Methods:This cross-sectional study was performed in 28 children with cochlear implantation and 25 hearing children aged 2–8 years in Shiraz. A sample of speech was assessed by using the naming of words in 106 images and investigating each phonological process.

Results:Among phonological processes, reduplication, labialization, and glottal stopping were seen only in cochlear implantation children. The phonological processes disappeared at the age of 7 in normal-hearing children compared with after 8 years of age in cochlear implantation children. In hearing children as well as those with cochlear implantation, there was an inverse relationship between age and mean phonological process.

Conclusion: Phonological processes in children with cochlear implantation were delayed com-pared with hearing children. Disappearance and the frequency of phonological pro-cesses in cochlear-implanted children was greater than in the normal-hearing group, which indicates a delay and divergence in phonological development. Phonological processes are reduced with increasing age in both hearing children and cochlear-implanted children.



O05 Reliability, Validity and Cross-Cultural Equivalence of the Persian Version of the Hearing Implant Sound Quality Index*Hossein Bagheripour1, Majid Karimi1

Khuzestan Cochlear Implant Center,Ahvaz, Iran.

Keywords:Auditory Performance, Cochlear Implant

Introduction: HISQUI19 is a simple and comprehensive scale to assess different aspect of auditory performance after cochlear implantation (CI) and has been widely used in different countries. The aim of this study was reliability, Validity and Cross-Cultural Equiva-lence of the Persian Version of the Hearing Implant Sound Quality Index

Materials and Methods:At first the questionnaire translated to Persian. the quality of translation evaluated and necessary changes have been applied based on experts opinions. Then the back translation was done by another translator. For face validity and content validity the consensus of 10 experts were used till appropriate Content Validity Ratio (CVR) and Content Validity Index (CVI) was obtained. Construct validity was done with explor-atory factor analysis. 70 CI adults from Iran CI centers [Khuzestan, Khorasan, Fars and Tehran (Pejvak Center)] participated in the study.

Results: Based on results Face validity & Content validity was acceptable. Average of content validity was 0/96 that shows high validity of questionnaire. Cronbach’s alpha values was 0/96 and correlation coefficient in test-retest was 0/96 (P<0/001) that shows high correlation of questions and suitable repeatability.According to the results of questionnaire score 18% of persons reported poor hear-ing performance, 50% moderate, 26% good and 6% very good hearing performance.

Conclusions:Present study showed that Persian version of HISQUI19 questionnaire has a good validity and reliability to assess sound quality of CI and hearing performance of adult CI users. Results also showed that main portion of CI users get acceptable benefits from CI to improve their hearing performance.



O06Comparison of Clinical Outcomes of Round Window and Cochleostomy Approaches in Cochlear Implantation Surgery in Shiraz Khalili Hospital*Masoud Janipour1, Seyed Basir Hashemi1

Shiraz University of Medical Sciences, Shiraz ,Iran

Keywords: Cochlear implantation, Cochleostomy, Round window.Introduction:The influence of the surgical technique on postoperative complications, residual hearing, and auditory nerve stimulation is currently subject to debate. Therefore, this study was designed with the aim of comparing objective measurements on the au-ditory nerves in cochlear implantation via the round window and the cochleostomy approaches.

Materials and Methods: The present study was designed as a prospective cross-sectional study in 70 patients aged less than 5 years who underwent cochlear implantation between January 2014 and November 2015 in Khalili Hospital, Shiraz, Iran. Postoperative audiometry was performed 3 and 6 months after the implantation, in order to evaluate neural response telemetry (NRT) and impedance as the main outcomes.

Result:The mean value of impedance measurements in electrodes 1, 11, 22 was not signifi-cantly different between the two study groups 3 months after implantation (P=0.89, P=0.07, P=0.35, respectively). Moreover, similar results were also observed 6 months after implantation (E1, P=0.71; E11, P=0.64; E22, P=0.69). Therefore, it can be concluded that there was no significant difference between the two groups 3 and 6 months after implantation.

Conclusion: As both approaches provide equal stimulation of the cochlear nerve and impedance, surgeons are free to choose the procedure of their preference based on their own experience.



O07Acceptable Noise Level in Cochlear-Implant and Bimodal Hearing Users

*Reza Sadeghi1, Samin Ashjaei2, Hadi Hadipour2, Hamid Jalilvand2

1. Cochlear Implant Center of Loghman Hospital, Pejvak Auditory-Verbal Center, Tehran, Iran. 2. Auditory Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Keywords:Acceptable noise level, Bimodal hearing, Cochlear implant,

Introduction: People with cochlear implant in one ear often have sufficient hearing sensitivity to use a hearing aid in the opposite ear. This study had two aims: 1) To assess speech performance in noisy conditions in cochlear-implant users and 2) To evaluate any changes in speech performance in noisy conditions through the addition of a hearing aid to the opposite ear through its low frequency amplification.

Materials and Methods:Tests were performed at Loghman Cochlear Implant center and Pejvak Rehabilitation Clinic. Sixteen patients, with a mean age of about 16 years, were tested. Unaided and aided audiometry was performed.

Results:Mean pure tone average thresholds in the implanted ear were 110 dB HL and 5 dB HL with prosthesis. In the opposite ear, mean unaided thresholds were 90 dB HL and 45 dB HL with hearing aids. The acceptable noise level (ANL) test was then performed, once with cochlear implantation and once in the bimodal situation. Mean most com-fortable listening level (MCL) was 42.33 and 42.66 dB HL with cochlear implanta-tion and bimodal amplification, respectively. Mean tolerable background noise level (BNL) with cochlear implantation was 38.5 dB HL versus 39.22 dB HL with bimodal amplification. Mean ANL, which is the difference between BNL and MCL, was 4 with cochlear implantation and 3 in the bimodal case. There was no significant difference in ANL results between cochlear-implant users and cases with bimodal hearing.

Conclusion:Cochlear-implant users have very good speech performance in noisy conditions, with an ANL result that is within the normal range. The addition of a hearing aid to the op-posite ear does not worsen the performance, and could lead to improvement from a clinical point of view.



O08Performance of Cochlear Implants in Children with Auditory Neuropathy Spectrum DisorderAhmad Daneshi1, Mohammad Farhadi1, Hesamaldin Emamdjomeh1, *Marjan Mir-salehi1

1.ENT and Head & Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, IranE-mail: [email protected]

Keywords:Auditory neuropathy, Auditory dys-synchrony, Cochlear Implants, Speech intelligibility

Introduction: Currently, cochlear implantation is recommended in children with auditory neuropa-thy spectrum disorder (ANSD) with profound hearing loss or poor performance with conventional hearing aids. The current multicenter study evaluated the auditory per-formance and speech production results in children with ANSD. The number of par-ticipants is highest compare to previous studies evaluated the results of cochlear implantation in children with ANSD, to the best of our knowledge.

Materials and Methods:Cochlear implantation was performed in 136 children with bilateral severe to pro-found hearing loss due to ANSD at four tertiary academic centers. The auditory per-formance and speech production ability was evaluated by categories of auditory per-formance (CAP) and speech intelligibility rating (SIR) after the first and second years of cochlear implantation.

Results: The CAP scores improved in 135 (99%) patients after the first year of implantation. The CAP scores increased significantly at the first and second years after the surgery (median preoperative CAP: 1(0-1), at the first year: 4(3-4), at the second year: 7(6-7), p value <0.001). The SIR scores improved in 117 (86%) patients after the first year of implantation. The SIR scores increased significantly at the first and second years after the surgery (median preoperative SIR: 1(1-1), at the first year: 3(2-3), at the second year: 5(4-5), P <0.001).

Conclusion: The auditory performance and speech intelligibility scores improved significantly after cochlear implantation in children with ANSD.



O09 Change Detection of Speech Stimuli Using Topographical Brain Maps of Mismatch Negativity in Children with Cochlear ImplantsSaeid Mahmoudian1, Zohre Ziatabar-Ahmadi2, Hasan Ashayeri3, *Mohammad Farhadi4

1. ENT, Head and Neck Research Center and Department, Iran University of Medical Sciences, Tehran, Iran; Department of Otorhinolaryngology, Medical University of Hannover (MHH), Han-nover, Germany.2. Department of Speech and Language Pathology, School of Rehabilitation Sciences, Babol University of Medical Sciences, Babol, Iran3. Department of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.4. ENT, Head and Neck Research Center and Department, Iran University of Medical Sciences, Tehran, Iran.

Keywords:Auditory discrimination, Auditory evoked potentials, Children, Cochlear implant, Mis-match negativity response.

Introduction:This study aimed to investigate change detection of speech stimuli by means of topo-graphical maps of mismatch negativity (MMN) responses in normal and cochlear-implanted Persian-speaking children.

Materials and Methods:Twenty subjects with cochlear implant and 10 right-handed matched subjects, without visual acuity or neurological disorders, participated in the study. A new auditory para-digm by a 64-channel electroencephalogram (EEG) instrument was used with three deviant stimuli (/gam/, /jam/, and /tam/) which differed in the first consonant from a repeated standard word (/dam/).

Results:The results showed that MMN was observed in 375–395 ms in fronto-central scalps (ROIs) in all stimuli. A positive mismatch response appeared before MMN only in /tam/ stimuli in 253 ms. In good cochlear implants, a p-MMR instead of MMN was observed in /gam/ stimuli in 219 ms after the onset of stimuli. Also, the coexistence of p-MMR and MMN was acquired in 227 and 375 ms in /tam/ stimuli. In poor cochlear implants, no significant p-MMR and MMN was found in /gam/ stimuli. MMN was observed only in /jam/ stimuli. P-MMR was observed only in /tam/ in 242 ms. MMN was delayed in this group. The correlation between electrophysiological indices and behavioral tests was statistically significant.

Conclusions:MMN and p-MMR can be used as powerful electrophysiological indices for objec-tive assessment of phonological auditory discrimination. The existence of p-MMR in cochlear-implanted children shows an immature brain pattern and/or excessive neural activation to stimuli. In poor cochlear implants, MMN shows the involvement of somatosensory processing sites in the processing of complex lingual stimuli.



O10Bilateral and Bimodal Implantation: The Benefit of a Second ‘Ear’ and the Advantage of having one Normal-Hearing EarMartin Agterberg1, AJ Van Opstal1, AFM Snik1

1. Radboud University Medical Centre Nijmegen, Donders Center for Brain, Cognition and Be-haviour, Department of Otorhinolaryngology, the Netherlands.

Keywords: Bilateral, Bimodal, Cochlear implant.

Introduction: Due to new technologies, hearing preservation techniques, and because of the suc-cess of bilateral cochlear implantation in children, bilateral and bimodal implantation is also becoming available for adults.

Description: The aim of bilateral implantation is to provide access to the processing of binaural cues. However, preliminary data indicate that both bimodal and bilateral implanted patients lateralize instead of localizing sounds, and that true binaural fusion seems not be possible. However, the benefit of bilateral treatment as compared with unilat-eral treatment is significant. The clinical relevance of optimal sound localization might be limited since patients report the importance of lateralization, and in daily life most of the time both auditory and visual information is available which might explain the perceived benefit in terms of localization behaviour. The learning brain might remain plastic enough to adapt to new modes of input, optimized processing algorithms, directional microphones, and new features. However, these listening conditions still cannot compete with a normal-hearing ear. It might even be that new technologies and modes of stimulation are more effective in the absence of normal hearing (i.e. beneficial in the case of bilateral cochlear implants).

Conclusion: In order to compare the outcome in these different populations of patients, a uniform measurement is needed. A suggestion for a uniform measurement and method to evaluate the effectiveness of a certain treatment will be presented. The aim is to improve the counselling of patients and to better understand the limitations in the dif-ferent listening conditions.



O11Artificial Intelligence Improves the Outcome of Cochlear Implant FittingPaul J Govaerts1, M Artaso1, I Bermejo1, G De Ceulaer1, D Pascoal1, M Coene1

1.The Eargroup, Antwerp, Belgium

Keywords: Artificial intelligence, Cochlear implant, Fitting,

Introduction:Cochlear implant fitting is a very tedious process. It requires in-depth knowledge of the physics of sound, the electronics of cochlear implants, the electrophysiology of the cochlea and the neural substrate, and the biomedical aspects of hearing. Neither global standards nor Good Clinical Practice guidelines exist. As a result of this, there is huge variability in fitting procedures between different cochlear implant centers and audiologists.

Description: The authors have developed FOX, the first artificial intelligence (AI) application to assist the audiologist in cochlear-implant fitting. FOX reduces the fitting time and im-proves the measured results significantly. This presentation will explain the working principles of FOX. To date, the cochlear-implant fitting scheme comprises no more than three sessions in the first year after implantation, and the speech audiometry results have significantly improved since the introduction of AI in 2008.

Conclusion: FOX will be integrated in Audiqueen™ (Otoconsult, Belgium) and Custom Sound™ (Cochlear, Australia), and the combination paves the way for future remote and self-testing.



O12 Predictive Value of Caloric and Video Head-Impulse Testing of the Semicircular Canals in Cochlear Implant Andy J Beynon

Vestibular & Auditory EP Lab, ENT Department, Radboud University Medical Centre, Nijmegen and Hearing and Implants, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience , the Netherlands E-mail: [email protected]

Keywords: Cochlear implant, Calorics, Vestibular assessment, VHIT

Introduction:There have been several reports of vestibular changes following cochlear implant.

Materials and Methods: In a retrospective cohort study, 192 adult patients received pre- and postoperative vestibular testing. Subjects underwent pre-post caloric irrigational testing, video Head-Impulse Test (vHIT) and completed Dizziness Handicap Inventory (DHI). In contrast to most studies, the non-implanted side was also taken into account, and four categories were defined to assess possible deterioration.

Results: Postoperative results of the caloric tests show a significant but minimal reduction: 3.1º/s and 4.7 º/s for warm and cold irrigation, respectively. However, 37.4% of patients dropped one or more categories. vHIT analysis showed a small but significant decrease in gain of −0.057, −0.040, and −0.045 for the anterior, lateral and posterior canal, re-spectively. Further, 7.7% of patients showed a change to abnormal (impaired) gains for the anterior semicircular canal. Subjective symptoms (DHI) did not show postopera-tive changes for composite total score, or for scores on the functional and emotional subdomains. The physical subdomain score, however, showed a small but significant increase. Finally, 9.0% of patients showed a deterioration in one or two categories.

Conclusion:Although a significant postoperative vestibular deterioration (calorics, vHIT and DHI physical subdomain) was found, like in many other cochlear implant studies, our study shows that its clinical impact and predictive value is very limited and shows less impact when analyzed at the group level, compared with previous studies by us and other clinics. Nevertheless, on an individual level, vestibular deterioration after cochlear implantation can still lead to serious postoperative deterioration and subjec-tive complaints in a small group of patients, compelling clinicians to assess vestibular function pre- and postoperatively.



O13Comparison of Vestibular Ocular Reflexes in Cochlear-Implanted Children with Two Groups of Children with Normal Hearing and Severe-To-Profound Congenital Sensorineural Hearing Loss*Sadegh Jafarzadeh1, Majid Hadadi Aval1

Department of Audiology, School of Paramedical Sciences, Mashhad University of Medical Sci-ences, Mashhad, Iran E-mail: [email protected]

Keywords: Congenital sensorineural hearing loss, Cochlear implant, Vestibular system, VHIT test.

Introduction:Because of the anatomical proximity of the auditory and vestibular system in the lab-yrinth, many auditory abnormalities such as congenital sensorineural hearing loss (SNHL) affect the vestibular system. Therefore, cochlear-implant surgery may also dis-turb vestibular function. The Video Head Impulse test (VHIT) evaluates the vestibular ocular reflexes (VOR) of the semicircular canals and has high sensitivity, specificity, and repeatability. The purpose of this study was to compare the VOR gain of cochlear-implanted children with two groups of children with normal hearing and severe-to-pro-found congenital SNHL.

Materials and methods: After a comprehensive auditory assessment, the VHIT results of 26 children with a cochlear implant were compared with 54 normal-hearing children and 20 children with severe-to-profound congenital SNHL. This study was approved by the ethics commit-tee of Mashhad University of Medical Sciences.

Results:There was no significant difference in the mean age of the three groups, with most children being aged 4 to 6 years. The VHIT results of the two groups of children with cochlear implants and SNHL showed a significant difference compared with normal-hearing children (P=0.000). However, there was no significant difference in the VOR gain between these two groups.

Conclusion:This study showed no difference in VOR gain because of cochlear-implant surgery. Vestibular abnormalities in these cases may be related to congenital SNHL.



O14Evaluation of Balance Function in Patients with Inner-Ear Anomalies and Cochlear ImplantationAlimohamad Asghari1,*Farideh Hosseinzadeh1,Akram Pourbakht2, Mohammad Farhadi3,Ahmad Daneshi3,Hesam Emamjome3,Maziar Moradi-Lake4

1.Skull Base Research Center, Iran University of Medical Sciences, Tehran, Iran and ENT Head and Neck Research Center and Department, Iran University of Medical Sciences, Tehran, Iran. *Email: [email protected]. Department of Audiology School of Rehabilitation Sciences, Iran university of medical sciences, Tehran, Iran.3. ENT Head and Neck Research Center and Department, Iran University of Medical Sciences, Teh-ran, Iran.4. Department of Community Medicine, Iran University of Medical Sciences and Health Services, Tehran, Iran.

Keywords:Cochlear implantation, Ear, Inner, Vestibular function test.

Introduction:Because of the importance of vestibular function in gross motor development, otologists and audiologists should recognize and understand the high incidence of vestibular dysfunction in hearing-impaired patients and be prepared to undertake appropriate intervention. However, there have been no studies investigating the entire vestibular function in patients with inner-ear anomalies who have undergone cochlear implantation. We identify vestibular dysfunc-tion in patients with inner-ear anomalies with severe-to-profound sensorineural hearing loss (SNHL) and cochlear-implant surgery.

Material and Methods:This was a retrospective case review study of patients with unilateral cochlear implantation from 2001 to 2016. Twenty-eight patients with congenital inner-ear anomalies who under-went cochlear implantation were selected, and were compared with 16 cochlear-implanted patients with severe-to-profound hearing loss and normal inner-ear anatomy. Inner-ear anatomy was evaluated by temporal bone high-resolution computed tomography (HRCT). Vestibular function was assessed by Computerized Dynamic Posturography (CDP) and Bru-ininks–Oseretsky test (BOT-2). Binary Logistic Regression with SPSS and Fisher’s Exact test were used for data analysis.

Results:In this study, patients with inner-ear anomalies showed significantly worse performance in terms of BOT-2 scores; 13 times greater compared with the normal group (P=0.02). Data showed that as severity of abnormality increased, patients faced more vestibular dysfunc-tion. In terms of balance, posturography measurements revealed 5.91-times greater vestibu-lar dysfunction (P=0.012) in patients with inner-ear anomalies in comparison with the control group. In addition, a higher prevalence of vestibular dysfunction was found in patients with an abnormal internal auditory canal. Gender, age, duration of implantation, age of implanta-tion, re-implantation, type of prosthesis, and intra-operative cerebrospinal fluid leakage had no significant effects on vestibular function.

Conclusion: Vestibular disturbance is more prevalent in patients with inner-ear anomalies. BOT-2 and pos-turography are simple, fast, and efficient tests to screen patients with vestibular dysfunction, especially those with inner-ear anomalies. Early identification and rehabilitation and appropri-ate intervention can minimize the risk of injury in these patients.



O15An Update of Common Autosomal Recessive Non-Syndromic Hearing Loss genes in north west population of IranMasoud Naderpour1, *Yalda Jabbarimoghaddam1, Mahmoud Shekari khaniani2

1.Otolaryngology Department of Tabriz University Of medical sciences, Tabriz medical univer-sity cochlear implant center, Tabriz, IRAN2.Genetic Department of Tabriz University Of medical sciences, Tabriz, IRAN

Keywords: Consanguineous marriages, GJB2, Genetic diagnosis, NSHL.

Introduction:Autosomal-recessive genes are responsible for about 80% of the hereditary non-syndromic hearing loss(NSHL) cases. Enormous heterogeneity in the genetic pathol-ogy of hearing loss causes a major challenge in identification of responsible genes. In Iran, GJB2 is responsible for the most cases of pre-lingual and non-syndromic hearing loss (with frequency of 16.7%) which followed by other genes with lower fre-quency. new detection strategies such as NGS (Next-generation sequencing) have increased the spectrum of responsible mutations.

Materials and Methods:This study included probands from 2322 families segregating probable NSHL of dif-ferent ethnic origins selected from patients referred to our center. All samples initially underwent mutation detection for the c.35delG variant by ARMS PCR. Samples in which no mutations could be identified at that stage or were heterozygous for this variant were further analyzed by sequencing the exons 1 and 2 all novel missense mutations have been checked with ConSeq and Polyphen bioinformatic softwares.

Results: GJB2 mutations accounted for 18% of all alleles, and 16% of studied affected individ-uals. c.35delG, c.358_360delGAG, c.380G>A, IVS1+1G>A and c.71G>A mutations were the most prevalent GJB2 mutations and the frequency of c.35delG is more in north of country comparing to south.

Conclusion:By applying NGS (Next-generation sequencing) technique in Iran patients screening, the role of lots of novel related genes have been reported.



O16Combined Application of Next-Generation Sequencing and Preimplantation Genetic Diagnosis in Deafness: A Novel OTOF Mutation*Mohammad Amin Tabatabaiefar1, Mohammad Reza Pourreza2, Parisa Tahmasebi3, Nader Saki4, Morteza Hashemzadeh Chaleshtori5, Rasoul Salehi2, Javad Mohammadi-asl4

1. Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran. Email: [email protected]. Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.3. Department of Biology, Faculty of Science, Ilam University, Ilam, Iran4. Department of Otolaryngology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.5. Cellular and Molecular Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.

Keywords:Hearing loss, Iran, Next-generation sequencing, OTOF, Pathogenic variant, Preimplanta-tion genetic diagnosis

Introduction:Hearing loss is the most common sensory-neural disorder, with more than half of all cases having a genetic origin with an autosomal recessive mode of inheritance. Involvement of over 100 genes make a molecular diagnosis problematic. Next-generation sequencing (NGS) is a new strategy that can overcome this problem. Clarifying the molecular etiology of the disease is essential for genetic counseling. Here we report successful application of targeted NGS and preimplantation genetic diagnosis (PGD) in a family with multiple hear-ing loss patients, one of whom had been subjected to cochlear implantation.

Materials and Methods:A comprehensive family history was obtained in a family with multiple hearing-loss indi-viduals. Direct sequencing of GJB2 and homozygosity mapping was performed to rule out DFNB1A/B as the most common cause of the disease. Targeted NGS was applied to identify the mutation.

Results:A family with autosomal recessive non-syndromic hearing loss was enrolled. The proband suffered from profound hearing loss. However, the patient had normal hearing and speech after cochlear implantation at the age of 3 years. Molecular investigations detected no mutations in GJB2; however targeted NGS revealed two homozygous variants, c.367G>A (p.Gly123Ser) and c.1392+1G>A, in OTOF. The c.1392+1G>A variant met the criteria for being pathogenic according to the American College of Medical Genetics and Genomics (ACMG) variant interpretation guideline. PGD was successfully performed to prevent re-currence of the disease in the family.

Conclusion:We report the effectiveness of the combined application of targeted NGS and PGD in the diagnosis and prevention of hereditary hearing loss.



O17Spectrum of DNA Variants for Non-Syndromic Deafness in a Large Cohort from Multiple Continents*Atieh Eslahi

Department of Medical Genetics, Mashhad University of Medical Sciences, Mashhad, Iran.

Keywords: Hearing loss, Pathogenic variants, Targeted sequencing, Family history

Introduction:Hearing loss is the most common sensory deficit in humans with causative variants in over 140 genes. With few exceptions, however, the population-specific distribution for many of the identified variants/genes is unclear. Until recently, the extensive genetic and clinical heterogeneity of deafness precluded comprehensive genetic analysis.

Materials and Methods:we undertook a targeted sequencing of 180 genes in a multi-ethnic cohort of 342 GJB2 mutation-negative deaf probands from South Africa, Nigeria, Tunisia, Turkey, Iran, India, Guatemala, and the United States (South Florida) using a custom capture panel (MiamiOtoGenes).

Results: We detected causative DNA variants in 25 % of multiplex and 7 % of simplex families. The detection rate varied between 0 and 57 % based on ethnicity, with Guatemala and Iran at the lower and higher end of the spectrum, respectively. We detected caus-ative variants within 27 genes without predominant recurring pathogenic variants. The most commonly implicated genes include MYO15A, SLC26A4, USH2A, MYO7A, MYO6, and TRIOBP.

Conclusion:Our study highlights the importance of family history and generation of databases for multiple ethnically discrete populations to improve our ability to detect and accurately interpret genetic variants for pathogenicity.



O18CI Candidacy in Mitochondrial Syndromes: A Case Report of MEGDEL Syndrome*Samer Mohsen1, Hesamedin Emamjomeh2

1. Department of Audiology, School of Rehabilitation Sciences, the International Campus of Iran University of Medical Sciences, Tehran, Iran and Department of Otolaryngology, School of Medicine, Damascus University, Damascus, Syria. E-mail: [email protected]. ENT and Head & Neck Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran.

Keywords: Cochlear implant, Deafness, MEGDEL Syndrome, Mitochondrial syndrome,

Introduction: MEGDEL syndrome is a metabolic mitochondrial disorder related to the SARC1 mu-tation. MEGDEL syndrome refers to the association of 3-methylglutaconic aciduria, leading to deafness, Leigh-like brain lesions on magnetic resonance imaging (MRI), and progressive spasticity and dystonia.

Case Report: A 2-year-old male was admitted to our clinic with progressive bilateral hearing loss beginning 18 months previously, accompanied by developmental regression, failure to thrive (weight=7 kg), no speech, and communication through crying only. In addi-tion to dystonia, the patient exhibited dysphagia which led to feeding difficulties. The MRI revealed some Leigh-like lesions in the white mater, and the child was scheduled to participate in a cochlear implant program in another center, depending on a normal inner ear structure on computed tomography. Concerning audiologic tests, the patient had more than four auditory brainstem response (ABR) reports at 6-month intervals, beginning with normal-to-moderate results and revealing severe-to-profound hear-ing loss in the final test. The patient was admitted to undergo oto-acoustic emission (OAE) and auditory steady state response (ASSR) testing. Although no OAEs were found and the ASSR thresholds corroborated the ABR, we retained some doubts about the suitability of this child for cochlear implantation, and we arranged for anoth-er ABR with a slow rate and electrical auditory brainstem response (EABR) testing.

Conclusion: There is no general role for cochlear implantation in mitochondrial syndrome patients. Because of high variability, each case should be investigated separately and physi-cians should be aware of the normal function of the auditory nerve, central auditory system, and cognitive aspects. Therefore, we advise caution before approving the suitability of such cases for cochlear implantation.



O19Screening of 10 DFNB Loci Causing Autosomal RecessiveNon-Syndromic Hearing Loss in two Iranian PopulationsMahbobeh Koohiyan1, Morteza Hashemzadeh-Chaleshtori2, Mansoor Salehi1, Hamidreza Abtahi3, Mohammad-Reza Noori-Daloii4, *Mohammad Amin Tabatabaiefar5

1. Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medi-cal Sciences, Isfahan, Iran.2. Cellular and Molecular Research Center, Basic Health Sciences Institute, Shahrekord Univer-sity of Medical Sciences, Shahrekord, Iran.3. Department of Otolaryngology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Is-fahan, Iran.4. Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.5. Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran. Email: [email protected]

Keywords: Arnshl, Dfnb Loci, Iran.

Introduction:Autosomal recessive non-syndromic hearing loss (ARNSHL), one of the greatest global public health concerns, is marked by a high degree of genetic heterogeneity. The prevalence of GJB2, as the most common cause of ARNSHL, is only <20% in the Iranian population. Here, we aimed to determine the relative contribution of the most common loci in a cohort of ARNSHL Iranian families who were negative for GJB2 mutations.

Materials and Methods:In total, 80 Iranian ARNSHL families with three or more affected members from the Isfa-han and Hamedan provinces were enrolled. After excluding mutations in the GJB2 gene, 60 negative samples were analyzed using homozygosity mapping for 10 ARNSHL loci.

Results: In total, 634 individuals were studied, of whom 245 were patients. For 45 families, pure tone audiometry was consistent with profound hearing loss (≥80 dB), 12 families showed severe hearing loss (61–80 dB), while the remaining three families showed moderate hearing loss (41–60 dB). Fourteen families were found to be linked to five different known loci, including: DFNB4 (five families), DFNB2 (three families), DFNB7/11 (one family), DFNB9 (two families), and DFNB3 (three families).

Conclusion: Despite the high heterogeneity of ARNSHL, the genetic causes were determined in 23.5% of the studied families using homozygosity mapping. These data give an over-view of the etiology of ARNSHL in Central and Western Iran, which could be used to establish a diagnostic gene panel including the most common loci for HL diagnostics, and could lead to affordable testing and improved management of HL.



O20Littlear Questionnaire: Online Evaluations for Deaf ChildrenMaryam Yaribakht1,*Guita Movallali2

1. Psychology and Education of Exceptional Children Researcher, Azad University, Tehran, Iran. 2. Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilita-tion Sciences, Tehran, Iran. & Faranak Rehabilitation Center,Tehran, Iran.

Keywords: Children with hearing loss, Cochlear implants, Tele-intervention,

Introduction: Tele-Intervention has been improved a lot in 21th century. In this paper we will explain our online evaluation form deaf babies with LittlEar Questionnaire.

Materials and Methods: Thirty deaf children under two years of old and their parents were selected and as-signed in two groups randomly. LittlEar Questionnaire was used to evaluate their auditory skills improvement during early intervention program. Parents satisfaction from this online evaluation were measured with questionnaire.

Results: Findings show great satisfaction in parents. They indicated more easiness, acces-sibility and convenience from online evaluations in comparison to traditional evalua-tions. It is also time consuming. LittlEars questionnaire shows many aspects of audi-tory skills of deaf children who were in CI waiting lists.

Conclusion:Online practice can be done for parents who have difficulty attending sessions, par-ents in remote areas and parents with several children. Tele-practice can be done in Cochlear implant centers easily. It may be beneficial for many families who have difficulty attending routine programs .LittlEars questionnaire can be done for deaf children under two years of age.



O21Successful Cochlear Implantation in a Deaf Patient with Cochlear Fracture on One Side and Cochlear Ossification after Meningitis on the OtherElnaz Shariatpanahi1, *Farhad Farahani1, Ehsan Mazloumi1

Hearing Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran. *E-mail: [email protected]

Keywords: Cochlear implant, Case reports, Meningitis

Introduction:Although temporal bone fractures, especially otic capsule fractures, are relatively un-common, sensory-neural hearing loss and its management after these fractures is often challenging.

Case Report: This case describes a 52-year-old male with bilateral deafness due to cochlear fracture on the left side and meningitis and cochlear ossification on the right side. Cochlear im-plantation on the left side (fracture of cochlea) was performed successfully. After 1 year of follow up, auditory and speech abilities were perfect.

Conclusion:We highlight the necessity of imaging and discuss the reliability of computed tomog-raphy scanning in predicting cochlear patency in cases of temporal bone fracture. Possible management options in a case of complex cochlear implantation are also described.



O22Bimodal Stimulation for Cochlear-Implanted Children in the First Year of Cochlear Implant*Fatemeh Arbabi1, Vahid Moradi2, Farzad Mobedshahi1

1. Amir Alam Cochlear Implant Center,Tehran,Iran. Email: [email protected]. School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran

Keywords: Auditory performance, Bimodal stimulation, Cochlear implant, PEACH questionnaire.

Introduction:Many cochlear implant experts recommend use of a hearing aid in the contralateral ear (bimodal fitting) in cochlear-implanted children in order to avoid auditory depriva-tion. This approach has expanded in recent years. This article compares auditory/aural performance in bimodal and unilateral cochlear-implanted children at 1 year following implantation.

Materials and Methods:Eight children with unilateral cochlear implant and eight children with bimodal cochlear implants were selected for this study from among Amir Alam cochlear implant cases. All children were in their first year of cochlear implantation and were also benefiting from auditory verbal therapy programs. The bimodal group had used a hearing aid in the con-tralateral ear for at least 6 months. The Parents’ Evaluation of Aural/oral performance of Children (PEACH) questionnaire was used to assess auditory performance in these children.

Results:There was a significant difference in auditory performance in quiet and noisy environ-ments between the unilateral and bimodal groups.

Conclusion: For bimodal hearing, there is a potential additional advantage that arises from com-bining low-frequency information (provided via a hearing aid) with low- and high-fre-quency information (provided via a cochlear implant). This advantage provides better results, particularly in the first year of cochlear implantation.



O23Impact of Computerized Cognitive Training in Children with Cochlear Implants*Susan Amirsalari1, Mohammad Ajalloueyan1, Ali Sharifi1, Masoumeh Saeedi1

New Hearing Technologies Research Center, Baqiyatallah University of Medical Science, Teh-ran, Iran.

Keywords:Auditory perception, Cognitive Training, Children with cochlear implants, Working memory, Speech intelligibility.

Introduction:The present research was conducted to evaluate the effectiveness of computerized cognitive training based on working memory in improving auditory perception and speech intelligibility in children with cochlear implants.

Materials and Methods:Fifty-four children who had received cochlear implants at the Cochlear Implant Center, Baqiyatallah Hospital, Tehran, Iran were selected using convenience sampling. Par-ticipants were randomly assigned to the experimental or control groups. Participants in the experimental group participated in 20 50–60-minute computerized cognitive train-ing sessions based on working memory. In the control group, participants received no intervention. Before and after the intervention, both groups were evaluated according to “Categorization of Auditory Performance” (CAP) and “Speech Intelligibility Rating” (SIR) scales. Univariate analysis of covariance was employed to analyze the statistical findings.

Results:The auditory perception of children with cochlear implants who underwent the in-tervention improved significantly (P<0.05). However, participants in this condition showed no significant differences on the speech intelligibility scale compared with the control group (P>0.05).

Conclusions:The results indicate that cognitive computer training in children with cochlear implants was able to improve working memory, which was followed by improvement in audi-tory perception associated with working memory. This indicates that improved speech intelligibility probably requires a longer training time, and also a greater passage of time after completion of cognitive training in these children.



O24The Relationship of Parent-Child Stress with Developmental Skills in Cochlear-Implanted Children*Salar Faramarzi1, Alireza Mohseni-Ezhiyeh1, Seyed Hamid Reza Abtahi2, Mahsa Sepehrnejad3, Mohammad Hossein Nilforoush3

1. Department of Children with Special Needs, University of Isfahan, Isfahan. Iran.2. Medical School, Isfahan University of Medical Sciences. Isfahan. Iran.3. Communication Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail: [email protected]

Keywords: Cochlear implant, Developmental skills, Parent-child stress.

Introduction:The emotional performance and psychological problems of the main caregiver can have unfavorable effects on the developmental skills of a cochlear-implanted child. Therefore, the present study was conducted with the aim of determining the relation-ship of parent-child stress with the developmental skills of cochlear-implanted chil-dren.

Materials and Methods:The population of the study includes all children who had undergone cochlear implant surgery in Al-Zahra Hospital of Isfahan. From among this population, 57 participants were selected randomly. To evaluate the research variables, the Parenting Stress Index, Leiter International Performance Scale, Vineland Social Maturity Scale, Lan-guage Development Scale, and Cochlear Implanted Children’s Communication Per-formance Scale were used. The data were analyzed using descriptive statistics as well as correlational and regression analysis.

Results:The results of the data analysis indicated that there is a significant negative (reverse) correlation between parent-child stress and language development (−0.59), social development (−0.38), and communication development (−0.54) in children (P≤0.01). The results of regression analysis indicated that 34% of the variance of language development, 14% of the variance of social development, and 29% of the variance of communication development are explained via parent-child stress.

Conclusion:In general, the findings of this research can make experts aware of the role of par-ents, particularly of mothers, in contributing to the rehabilitation of cochlear-implanted children in Iran.



O25The Effect of Rehabilitation before Cochlear Implant on Auditory and Speech Performance in Children after Cochlear Implant*Atieh Ghazvini1, Rabeh Khalilavi1, Reza Sadeghi1, Afsane Yoysefi2

1. Cochlear Implant Center of Loghman Hospital, Pejvak Auditory-Verbal Center, Tehran, Iran. E-mail: [email protected]. University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Keywords:Auditory, Cochlear implant, Pre-implant rehabilitation, Speech

Introduction: Cochlear implant is a continuous process in hearing-impaired children, in which pre-operative rehabilitation is an important component. The purpose of this study was to evaluate the importance of preoperative rehabilitation in acquiring postoperative hearing and speech skills.

Materials and Methods:A total of 47 children were evaluated at the Cochlear Implant Center at Loghman Hos-pital. Based on the parents’ data regarding the history of rehabilitation, the children were divided into two groups; continuous (n=30) and discontinuous (n=17) rehabilita-tion. Scores were assessed using five scales (Meaningful Auditory Integration Scale [MAIS], Meaningful Use of Speech Scale [MUSS], Central Auditory Processing [CAP], Speech Intelligibility Rating [SIR], and Acceptation, Perception, Comprehension, oral Expression, speech Intelligibility [APCEI]) at device delivery, and 3, 6, and 9 months after cochlear implantation. Data were analyzed using descriptive methods, repeated measurements, and visual analysis.

Results: The scores of both groups showed upward trends with statistically significant differ-ences. Children with continuous and appropriate rehabilitation obtained higher mean scores than those with inadequate and discontinued rehabilitation. The difference between the mean scores of the two groups was not statistically significant.

Conclusion: This study shows that rehabilitation before cochlear implantation can affect the perfor-mance of children. Accordingly, factors such as the type and extent of rehabilitation, as-sessment method and age at cochlear implantation deserve further investigation. The results of this study may be effective in making decisions and drawing the attention of cochlear implant teams to the importance of both pre- and postoperative rehabilitations.



O26Outcomes of Cochlear Implantation in Post-Lingually Deaf Patients: A Report from Baqiyatallah HospitalMasoumeh Saeedi1, Susan Amirsalari2, Mahdi Zohoori3, *Mohammad Hossein Khosravi4

1.Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Baqiyatal-lah University of Medical Sciences, Tehran, Iran.2.Cochlear Implantation Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.3.Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran.4.International Otorhinolaryngology Research Association (IORA), Universal Scientific Educa-tion and Research Network (USERN), Tehran, Iran.E-mail: [email protected]

Keywords:Cochlear implantation, Complications, Efficacy, Outcome, Post-lingually deaf pa-tients.Introduction: To assess hearing improvement of post-lingually deaf patients after cochlear implan-tation.

Materials and Methods:In this cross-sectional study all the post-lingually deaf patients who had undergone cochlear implantation (CI) surgery between December 2010 and February 2016 were assessed. Patients were recalled and after explaining the study process and signing an informed consent form, an audiometry was done by a single audiologist. In addi-tion, demographic information, cause of hearing loss, age of onset, history of hearing aid use and surgical complications were recorded in a pre-designed checklist.

Results:50 patients (29 male and 21 female) with a mean age of 22.52±19.45 years underwent analysis. A majority of patients (80%) reported that their condition has progressed since childhood. Sudden sensorineural hearing loss (SSNHL) was the most prevalent (10%) known etiology of deafness followed by meningitis (6%), Trauma (2%) and oto-toxic drugs (2%) in the remaining 20% of the patients. Patients had the highest mean (37.1±12.61 dB) in 4000 Hz frequency and the lowest mean of hearing threshold level (32.6±8.37 dB) was for 1000 Hz frequency. Mean hearing threshold level was signifi-cantly lower in patients with lower ages of cochlear implantation (p=0.435). There was no significant difference between two genders for hearing improvement after cochlear implantation (P=0.927). Patients with higher ages of deafness onset showed lower degree of hearing improvement (P=0.462).

Conclusion: In conclusion, the results of our study suggest that cochlear implantation significantly improves hearing function of post-lingual patients and can be considered as a certain cure for these patients in Iran.



O27Tenotomy of the Middle Ear Muscles Causes a Dramatic Reduction in Vertigo Attacks and Improves Audiological Function in Definite Meniere’s Disease.Benjamin Loader 1, David Beicht 1, Jafar-Sasan Hamzavi 2, * Peter Franz 1

1. Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Tertiary Hospital, Teaching Hospital of the Sigmund Freud University of Vienna,Vienna, Austria.2. Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria.

Introduction:Because the presented data reveal an immediate and persistent reduction of vertigo and a clear improvement in hearing function and functional scales, we conclude te-notomy to be effective in unilateral, definite Meniere’s disease - laying the foundation for future prospective, randomized controlled trials. This study compares the unique long-term results of tenotomy of the stapedius and tensor tympani muscles in definite Meniere’s disease refractory to medical treatment and presents a hypothesis on why tenotomy seems effective.

Materials and Methods:This was an interventional cohort study. The study sample comprised 30 patients (15 males, 15 females; average age 57 ± 13.1 years) with definite Meniere’s disease (AAO-HNS criteria, 1995). Patients were evaluated pre- and postoperatively using pure tone audiometry, AAO-HNS questionnaires regarding vertigo attacks, functional level scores, and tinnitus, and were followed up for 2-9 years. Postoperative values were calculated for the patient collective as a whole and consequently divided into three equal postoperative terms of 3 years each.

Results:A statistically significant improvement of inner ear hearing levels postoperatively (P= 0.041) and a major reduction in vertigo attacks in all groups (P< 0.001) with complete absence of attacks in 26/30 patients was noted. Results remained constant up to 9 years postoperatively. Although tinnitus persisted, the intensity was lower overall (P= 0.01



O28Experience with the New CI532 Electrode in a Pediatric Population*Jiri Skrivan1, Michal Jurovcik1, Miroslav Oklusky1, Dipl Eng1, Petr Myska1

Department of Ear, Nose and Throat, the Second Faculty of Medicine, University Hospital Motol, Prague, Czechia. *E-mail: [email protected]

Keywords: Cochlear implantation; Ear, inner; Perimodiolar array

Introduction:The new cochlear electrode CI532 represents an excellent atraumatic and perimodio-lar solution for implant candidates.

Material and Methods:In the period from June 2014 to March 2018, 124 children were implanted in the Department of Ear, Nose and Throat of the Second Faculty of Medicine, University Hospital Motol in Prague. This number included 69 boys and 55 girls, with an average age at surgery of 18 months (range 9 months – 16 years). Bilateral simultaneous im-plantations represent the procedure of choice for small children with congenital deaf-ness. The cochlear device was used in 83% of implanters and, out of this number, the CI532 array was used in 53%.

Results:In the group followed, no serious complications were encountered. The new CI532 electrode array proved to be atraumatic and easy to use after training.

Conclusion:CI532 represents a first-choice array for all pediatric implantation candidates.



O29Comparison of IQ Between 4-16 Year-Old Children after Cochlear Implantation in The Left Or Right Ear

Navid Nourizadeh1, âSharifeh Haghjoo2, Mehran Beiraghi Toosi3, Mohsen Ra-jati1, Mohammad Mehdi Ghasemi1, Yalda Ravanshad4, Mohammad Reza Tale4

1.Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.2. Department Of Medical Informatics , Faculty Of Medicine , Kabul University Of Medical Sci-ences , Kabul, Afghanistan.3.Pediatric Deparment Ghaem Hospital Mashhad University of Medical Sciences, Mashhad, Iran.4.Khorasan Cochlear Implant Center, Mashhad ,Iran

Keywords: cochlear implant, dominant hand, IQ

Introduction: The dominant function of one hemisphere of the brain can lead to more activity in one half of the body, which is very important in the presence of a relationship between the intelligence and brain lateralization. Delayed language development in children undergone cochlear implantation can have deleterious effects on their growth and academic performance on the one hand and their adaptation and social interactions on the other. We attempted to determine the relationship between the dominant hand and intelligence in children aged 4-16 years after cochlear implantation in the left or right ear.

Materials and Methods:In this cross-sectional study, records of patients aged 4 to 16 years who had under-gone cochlear implantation during 2008-2011 were investigated. The subjects’ IQ was measured using Wechsler test by a neuroscience specialist. Then, IQ of the children with the right cochlea implant was compared to that of those with left cochlea implant. To analyze the data, t-test, Fisher’s exact test, Mann-Whitney U test, and Chi-square were run in SPSS.

Results:The comparison of IQ in children with cochlear implant showed no significant dif-ferences between the mean IQ score and cochlear implant in the right and left ears (P=0.54). In children undergone cochlear implantation, no significant association was noted between IQ score and right-handedness and left-handedness (P=0.17 and P=0.8, respectively).

Conclusion:According to the results of this study, there is no relationship between the dominant hand and IQ score in children with cochlear implantation.



O30Cochlear Implantation and Tinnitus Suppression*Sayed Hamidreza Abtahi1, Mahsa Sepehrnejad1, Mohammadhossein Nilfo-roush1

Department of Otolaryngology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfa-han, Iran.

Keyword: Cochlear Implantation, Tinnitus.

Introduction:The clinical observation that multichannel intra-cochlear cochlear implants have a suppressive effect on tinnitus in profoundly deaf patients is supported by many pub-lished studies. The aim of this paper was to present our personal experience of tin-nitus improvement after cochlear implantation.

Materials and Methods:Before surgery, 22 post-lingually profoundly deaf adults (single or both sided), who underwent cochlear implantation at Isfahan Cochlear Implantation Center between 2011 and 2017, completed a Tinnitus Handicap Inventory-Farsi version (THI-F) ques-tionnaire. In addition, they were asked to scale the loudness and level of annoyance of their tinnitus. Six months after surgery, patients repeated the same evaluations. Scores were analyzed statistically on the hypothesis that a cochlear implant could change the magnitude of tinnitus and/or its annoyance.

Results:In our series of patients, 25% reported total loudness suppression and another 40% reported a reduction. Annoyance scores reduced in 71% of patients. THI reduced in 68% of patients.

Conclusion:The present data are in agreement with previously published studies showing an im-provement in tinnitus following cochlear implantation for the large majority of patients with deafness. However, it seems reasonable to admit that further data are necessary before considering cochlear implantation as a treatment for tinnitus.



O31Emotional Perception of Music in Children with Unilateral Cochlear Implants*Sareh Shirvani1, Hamed Mohagheghi2, Zahra Jafari3, Shohre Jalaie4

1. Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran. E-mail: [email protected]. Department of Audiology, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.3. Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran.4. Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sci-ences, Tehran, Iran.

Keywords:Children, Cochlear Implant, Emotion, Music

Introduction: Cochlear implant improves language skills among children with hearing loss. How-ever, these children still fall short in fulfilling other needs, including musical percep-tion. This is often attributed to the biological, technological, and acoustic limitations of cochlear implants. Emotions play a key role in the understanding and enjoyment of music. The present study aimed to investigate the emotional perception of music in children with unilateral cochlear implants.

Materials and Methods: Twenty-five children with congenital severe-to-profound hearing loss and unilateral cochlear implants and 30 children with normal hearing participated in this study. The children’s emotional perceptions of music, as defined by Peretz (1998), were mea-sured. The child would indicate happy or sad feelings that the music fostered in them by pointing to pictures of faces showing these emotions.

Results: Children with cochlear implants obtained significantly lower scores than children with normal hearing, for both happy and sad items of music, as well as in overall test scores (P<0.001).

Conclusion: Hearing-impaired children with cochlear implants had a poorer emotional perception of music than their normal peers. Due to the importance of music in the development of language, cognitive, and social interaction skills, aural rehabilitation programs for children with cochlear implants should focus particularly on music. Furthermore, it is essential to enhance the quality of musical perception by improving the quality of implant prostheses.



O32The Meaningful Use of Speech and Its Intelligibility Following Cochlear Implant*Atieh Ghazvini1, Rabeh Khalilavi1, Reza Sadeghi2, Afsane Yoysefi3

1. Cochlear Implant Center of Loghman Hospital, Pejvak auditory-verbal Center, Tehran, Iran. E-mail: [email protected] Implant Center of Loghman Hospital, Pejvak Auditory-Verbal Center, Tehran, Iran.3. University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Keywords: Cochlear implant, Rehabilitation, Speech intelligibility.

Introduction:One of the most important parts of the hearing rehabilitation of children following co-chlear implant is increasing the child’s skills in using verbal communication methods based on their hearing sense and also speech intelligibility. The aim of this study was to evaluate the use of speech and its clarity after cochlear implant.

Materials and Methods:A total 50 children aged 15 to 71 months, with an average age at cochlear implant age of 40 months, were studied at the Cochlear Implant Center of Loghman Hospital. The subjects were evaluated at device delivery, and 3, 6, and 9 months after cochlear im-plantation using the Speech Intelligibility Rating (SIR) and Meaningful Use of Speech Scale (MUSS) scales. Data were analyzed using descriptive methods, visual analy-sis, and repeated measurements.

Results: Data analysis showed increased mean scores among children in the two scales dur-ing the four evaluations. The differences between the mean scores of the subjects were statistically significant at the four evaluations.

Conclusion: According to the results of this study, the children’s progress in speech use and its in-telligibility progressively increased, and the children approached the maximum of the scales in the first year after implantation. According to this study, however, acquisition of verbal skills and high levels of speech intelligibility appear to require additional time and rehabilitation.



O33Comparison of Speech Intelligibility in Deaf Children with Cochlear Implants and Children Using Hearing AidsMohammad Rezaee1,*Farhad Farahani1, Elnaz Shariatpanahi1, Ehsan Mazloumi1

Hearing Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran. *E-mail: [email protected]

Keywords: Cochlear implant, Hearing aid, Deaf, Speech intelligibility.

Introduction:The aim of this study was to evaluate and compare speech intelligibility in hearing-impaired children with cochlear implants, hearing aid users, and children with normal hearing.

Materials and Methods: The sample consisted of 45 Persian-speaking children aged 3 to 5 years. They were divided into three groups of 15, including normal children, children with cochlear im-plants and children using hearing aids in Hamadan. Participants was evaluated using the Test of Speech Intelligibility Level (TSIL).

Results:Results of an analysis of variance (ANOVA) on speech intelligibility test showed that normal hearing children had significantly better reading performance than hearing-impaired children with cochlear implants and hearing aids. A post-hoc analysis, using the Scheffe test, indicated that the mean score of speech intelligibility among normal children was higher than that in the hearing aid and cochlear groups. However, the difference was not significant between the mean value of speech intelligibility in chil-dren with hearing loss who used a cochlear implant compared with those using a hearing aid.

Conclusion:It is clear that even with remarkable advances in hearing aid technology, many hear-ing-impaired children continue to find speech production a challenge. Given that speech intelligibility is a key element in proper communication and social interaction, educational and rehabilitation programs are essential to improve speech intelligibility in children with hearing loss.



O34Comparison of Intelligence Quotients of First- and Second-Generation Deaf Children with Cochlear Implants

*Kourosh Amraei1, Susan Amirsalari2, Mohammad Ajalloueyan2

1. Department of Psychology, Faculty of Humanistic Sciences, Lorestan University, Khorramabad, Iran2. New Hearing Technologies Research Center, Baqiyatallah University of Medical Science, Tehran, Iran.

Keywords: Cochlear implant, Intelligence quotient, Sign language

Introduction:Hearing impairment is a common type of sensory loss in children. Studies indicate that children with hearing impairment are deficient in social, cognitive, and communication skills. This study compared the intelligence quotients of first- and second-generation deaf children with cochlear implants.

Materials and Methods:This research is causal-comparative. All 15 deaf children investigated had deaf parents and were selected from Baqiyatallah Cochlear Implant Center. The 15 children with cochlear im-plants were paired with similar children with hearing parents using purposive sampling. Results:The findings show that the Hotelling trace of multivariate analysis of variance was significant (P<0.01). The tests of between-subject effects for second-generation children was significantly higher than for first-generation children for all intelligence scales except knowledge.

Conclusion:It can be assumed that second-generation children joined their family in the use of sign lan-guage as the primary experience before a cochlear implant. The use of sign language before cochlear implants is recommended.



O35Comparison of Intelligence Quotients of First- and Second-Generation Deaf Children with Cochlear Implants*Kourosh Amraei1, Susan Amirsalari1, Mohammad Ajalloueyan1

New Hearing Technologies Research Center, Baqiyatallah University of Medical Science, Teh-ran, Iran.

Keywords: Cochlear implant, Intelligence quotient, Sign language

Introduction:Hearing impairment is a common type of sensory loss in children. Studies indicate that children with hearing impairment are deficient in social, cognitive, and commu-nication skills. This study compared the intelligence quotients of first- and second-generation deaf children with cochlear implants.

Materials and Methods:This research is causal-comparative. All 15 deaf children investigated had deaf par-ents and were selected from Baqiyatallah Cochlear Implant Center. The 15 children with cochlear implants were paired with similar children with hearing parents using purposive sampling.

Results:The findings show that the Hotelling trace of multivariate analysis of variance was significant (P<0.01). The tests of between-subject effects for second-generation children was significantly higher than for first-generation children for all intelligence scales except knowledge.

Conclusion:It can be assumed that second-generation children joined their family in the use of sign language as the primary experience before a cochlear implant. The use of sign language before cochlear implants is recommended.



O36Comparison of Abilities in Theory of Mind and Mindfulness between Hearing-Impaired Individuals and Those with Normal Hearing*Hamid Tayarani Niknezhad1, Malihe Khazeni2, Omid Shaban Boroon2, Moham-mad Mahdi Ghasemi3, Mohsen Rajati3, Navid Nourizade3, Mohammad Reza Tale4, Eeffat Daroobord4

1. Auditory-Verbal Rehabilitation Unit, Khorasan Cochlear Implant Center, Mashhad, Iran. *Email: [email protected] 2. Shenava Gostar Rehabilitation Institute, Mashhad, Iran.3. Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.4. Khorasan Cochlear Implant Center, Mashhad, Iran.

Keywords: Hearing impaired, Mindfulness, Theory of mind,

Introduction:The purpose of this study was to compare abilities in theory of mind and mindfulness between hearing-impaired individuals, aged 20–26 years, and their normal-hearing counterparts. Theory of mind can be defined as the ability to predict and explain be-havior by referring to the subjective state of mind, while mindfulness means present-ing in a specific way, purposeful and free from judgment.

Materials and Methods:This was a cause-comparative study. A total of 34 cases, comprising 17 hearing-loss patients (eight females and nine males) who had a high-school education and 17 nor-mal subjects (eight females and nine males) in the same age group, were selected ran-domly. The Brown and Ryan Mindfulness Test and the Theory of Mind Test (computer-ized versions of the revised tests) by Brown and Cohen were used to compare abilities in theory of mind and mindfulness between the two groups. Data were analyzed using analysis of covariance single variable.

Results:The results revealed no significant difference in hearing-loss individuals in terms of ability in theory of mind and mindfulness. In other words, people who have hearing impairment have the same ability in theory of mind and mindfulness compared with their normal counterparts.

Conclusion: It seems that in the evolution of the theory of mind, there is a constant, unchange-able growth trend, but the social environment can have a significant impact on the speed of development of this cognitive skill. If parents explain their mental state and that of others when talking with their children, the stages of the theory of mind will be acquired more rapidly.POSTER PRESENTATION



O37Comparison of motor, hearing and verbal functions of children with kernicterus before and after cochlear implantation*Mehran Beiraghi Toosi1. Efat Daroobord2

1.Pediatric ward, faculty of medicine, Mashhad university of medical sciences.2. Khorasan cochlear implant center.

Key words:cochlear implantation, kernicterus,hearing loss

Introduction: The aim of this study is to compare motor, hearing, and verbal functions in children with kernicterus before and after cochlear implantation.

Materials and Methods:Fourteen children, 8 boys (57.1%) and 6 girls (42.9%), with cochlear implantation (CI) and diagnosis of kernicterus participated in this study. They all received cochlear im-plant surgery in Mashhad University of Medical Sciences. We evaluated Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores before and after cochlear implantation. Also we studied movements (gross motor) and cogni-tion before CI.

Results: The mean age of children was 7.05 ± 3.35 years old (min 3.5 and max 17 years old) and the mean age of CI was 4.03 ± 3.70 years old (min 1.5 and max 16.5 years old). The mean SIR score before CI was 1.14 ± 0.5 and in post CI was 2.21 ± 0.8 that was statistically significant (p<0.001). Also the mean score of CAP before and after CI was 1.92 ± 0.53 and 5 ± 1.24 respectively that was statistically significant (p<0.001). The mean total bilirubin in neonate period was 33.66 ± 7.49 (min 23 and max 46). Eleven of 13 children (84%) had their blood exchanged in neonatal period. Before CI 4 (28.6%) children were ataxic, 7 (50%) couldn’t walk, 2 (14.3) couldn’t stand and 1 (7.1%) couldn’t seat, and 2 child (14.3%) had attention deficit hyper activity disorder.

Conclusion:The auditory and speech capabilities in children with kernicterus can get benefits from CI, but not as much as the normal population. The long term follow-up is required.



O38 Pediatric Auditory Brainstem Implant Surgery

Mohammad Ajalloueyan1, Saeed Farzanegan, Ali Berri, Mahdieh Hasanalifard

1.New Hearing Technologies Research Center, Baqiyatallah University of Medical Science, Tehran, Iran.

Keywords:ABI, Auditory brainstem implant, Deafness.

Introduction:American Food and Drug Administration has not yet approved indications for pe-diatric auditory brainstem implant (ABI) surgery .From 1999 we have done 21 cases of prelingual deaf children not eligible for cochlear implant. Our case series aims to determine the safety and feasibility of ABI surgery in pediatric patients <12 years old Baqiyatallah cochlear implant center in Tehran.

Materials and Methods:The inclusion criterion was prelinguistic deafness in children not eligible for cochlear implantation. Twenty one candidates were evaluated (mean ± SD: age, 3.58 ± 0.41 years).

Result: Minor complications such as CSF fistula, transient facial palsy, nonauditory stimula-tion or nonspecific meningitis occurred in 7 cases.13 subjects detected sound with environmental awareness, ten demonstrated babbling and mimicry and seven could communicate with 5 word sentences.

Conclusion:Results of ABI and complication rate in our case series are acceptable.

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P01Study of the Relationship between Auditory Development and Phonological Awareness Skills in Implanted ChildrenMasoud Naderpour1, Afarin Akhondi2, Aida Ariafar2

1. Otolaryngology Department of Tabriz University of Medical Sciences, Tabriz Medical Univer-sity Cochlear Implant Center, Tabriz, Iran.2. Tabriz cochlear Implant Center,Tabriz,Iran.

Keywords: Cochlear implant, Hearing loss, Phonological.

Introduction:The phonological process describes the process of listening to voices in oral conver-sations and using this knowledge to decode words for reading and writing purposes. As a result of cochlear implantation in deaf children, the goals of increasing hearing capability, improving of Phonological awareness skills, and excelling in writing skills become achievable.

Materials and Methods: Twenty implanted children were monitored for at least 4 years, and were divided into two groups: children up to 3 years of age and children aged more than 3 years. The two groups were assessed using the Categories of Auditory Performance (CAP) scale at 12 and 18 months after implantation. Then, at the midpoint of the first level of elementary school, children were tested in terms of phonological awareness skills in five minor further assessments: 1) Phonological segmentation; 2) Alphabetical segmentation; 3) Rhyme diagnosis; 4) The last phoneme diagnosis; 5) Naming and omitting the last phoneme.

Results:The CAP scale grade and Ph.A test both showed a substantial difference between the two groups. Comparing the results from the CAP and Ph.A tests for each subject confirms that better hearing skills lead to a better prognosis in phonological aware-ness, reading, and writing skills.

Conclusion: In this study, the need to consider the phonological learning process in children with hearing defects has been taken into account. It is proposed that the rehabilitation of these children continues until elementary school and should be included in scheduled treatment for consulting and education purposes.



P02Social Skills in Deaf Persian Children with Cochlear Implant and Hearing AidsMohammad Rezaei1, Gohar Lotfi1

Pediatric Developmental Disorder Research Center, Faculty of Rehabilitation Sciences, Hama-dan University of Medical Sciences, Hamadan, Iran

Keywords: Social skill, Communication, Cochlear implant, Hearing aid

Introduction: Children with hearing loss have been reported to experience difficulties in social skills and relationships. The aim of the present study was to compare social skills in hear-ing-impaired children with cochlear implants and hearing aids with normal-hearing children.

Materials and Methods: The sample consisted of 54 Persian-speaking children aged 5 to 7 years. They were divided into three groups, with 18 children in each group. Participants was evaluated by the social skill subtest of the Children Communication Checklist (CCC).

Results: Analysis of variance (ANOVA) showed that normal-hearing children had significantly better social skills than hearing-impaired children with cochlear implants and hearing aids. Post-hoc analysis indicated that the mean score of social skills in normal chil-dren was higher than in the cochlear implant and hearing aid groups; but the differ-ence in mean social skill score was not significant between children with hearing loss with a cochlear implant versus those using a hearing aid.

Conclusion: It is clear that even with notable advances in hearing aid technology, many hearing-impaired children have communication problems. These results are discussed in terms of previous hypotheses concerning lower social skills among deaf children and their relevance to programs integrating hearing and non-hearing children.



P03Comparison of Auditory and Speech Performance in Hearing-Impaired Children after Cochlear Implant*Atieh Ghazvini1, Rabeh Khalilavi1, Reza Sadeghi1, Afsane Yoysefi2

1. Cochlear Implant Center of Loghman Hospital, Pejvak Auditory-Verbal Center, Tehran, Iran. E-mail: [email protected]. University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Keywords: Hearing, Speech, Rehabilitation, Cochlear implant

Introduction: Rehabilitation after cochlear implant is important for the acquisition of communication skills based on hearing and speech. The aim of this study was to compare the auditory and speech performance of such children in the first year after cochlear implantation.

Materials and Methods: A total of 50 children aged 15 to 71 months, with an average age at cochlear implant of 40 months, were studied at the Cochlear Implant Center at Loghman Hospital. The subjects were evaluated at device delivery, and 3, 6, and 9 months after cochlear im-plant using five scales (Meaningful Auditory Integration Scale [MAIS], Meaningful Use of Speech Scale [MUSS], Central Auditory Processing [CAP], Speech Intelligibility Rating [SIR], and Acceptation, Perception, Comprehension, oral Expression, speech Intelligibility [APCEI]). Data were analyzed using descriptive methods, visual analysis, and repeated measurements.

Results:Data analysis showed upward trends in mean scores of children in all scales dur-ing each of the four evaluations. Significant differences were found in mean scores of subjects in each scale during the four evaluations. Visual analysis of the charts showed a higher slope on the auditory performance chart compared with the speech chart.

Conclusion: According to the results of this study, children’s auditory-verbal performance showed increasing trends, and the children approached maximum scores on each scale by the end of the first year after implant. The progression of hearing skills in the first year was faster than that of speech skills. It seems that additional time is needed to improve speech skills to higher levels of the scales.



P04Review of Handicap and Cochlear Implantation Outcomes

Parisa Zare1,*Fatemeh Fekar2

1. Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran2. Department of Speech Therapy, Faculty of Rehabilitation, Tabriz University of Medical Sci-ence, Tabriz, Iran

Key word: Cochlear implantation, Handicap, Language, Outcome, Speech.

Introduction:Hearing is one of the most precious senses, through which a human learns how to speak. Cochlear implantation is one of the most significant aids in children with severe-to-profound hearing impairment. In recent years, the number of children re-ceiving cochlear implants who have disabilities in addition to their deafness has in-creased. Approximately 30–40% of deaf children have at least one additional disabili-ty, including physical or mental, emotional or behavioral disorder. This article provides a review of studies on the outcomes of cochlear implantation in children with multiple handicaps.

Methods and Materials: The method included an online search to find to results of cochlear implants in multi-handicapped children. Published research was identified by review of scientific data-bases (Pubmed, Science Direct and Google Scholar) using relevant keywords. The present information was retrieved by reviewing articles from 1996 to 2018.

Results:The results showed that in children with multi-handicaps, cochlear implantation of-fers benefits including greater environmental sound awareness, recognition of the parents’ voice, greater social interaction, and improved speech and language percep-tion. Additional disabilities significantly affect the outcomes of cochlear implants with slower progress, less predictable outcomes, and poorer results.

Conclusion: Cochlear implantation can improve communication skills and some aspects of edu-cational achievement and quality of life in multi-handicapped children by opening the way for auditory stimulation in these children. However, the rate of growth is slower than for deaf children with no additional disabilities.



P05The Effect of the Critical Age of Cochlear Implantation on Auditory Cortex Neuroplasticity (Review Article)*Fatemeh Fekar1, Parisa Zare2

1. Department of Speech Therapy, Faculty of Rehabilitation, Tabriz University of Medical Sci-ence, Tabriz, Iran2. Faculty of medicine, Tabriz University of Medical Science, Tabriz, Iran

Key words: Cochlear implantation, Critical period, Neuroplasticity, Auditory cortex

Introduction: Cochlear implantation at an early age during the critical period increases auditory cortex neuroplasticity and acquisition of speech and language skills.

Materials and Methods: We conducted a search in PMC, Science Direct and Neuroscience, PubMed databas-es. The present information was retrieved after reviewing articles from 1996 to 2018.

Results: Neuroplasticity is a term used to describe the reorganization of the central nervous system through synaptic changes, and is present throughout a human’s lifetime. De-velopmental periods of higher neural plasticity are called the sensitive period. Co-chlear implantation is a common surgical procedure for children with profound hear-ing loss who receive minimal or no benefit from traditional hearing aids. Cochlear implantation performed before the age of 3.5 years is associated with better results in terms of acquisition of speech and language and auditory skills, implantation be-tween 3.5–7 years has a normal or abnormal outcome depending on certain factors, and implantation after 7 years causes abnormal speech, language and auditory skills due to deficits in the relationship of the primary and association auditory cortex. In normal populations, the plasticity peak of the auditory cortex is between the ages of 2 and 4 years; thus the best time to perform cochlear implantation is before the age of 3.5 years.

Conclusion: The critical time for cochlear implantation is between the ages of 3.5 and 4 years, and results are best before the second year of life when central auditory pathways show maximum plasticity to sound stimulation.



P06Review of Speech Prosody in Children with CochlearImplantation*Fatemeh Fekar1, Mahsa Zali1,Deniz Farzin1,Moghaddam Amir1,Salar Tozihi1

Faculty of Rehabilitation, Tabriz University of Medical Science, Tabriz, Iran.

Key words: Cochlear implantation, Intervention, Prosody, Perception

Introduction: To assess the effect of cochlear implantation on speech prosody and use of these features in intervention.

Materials and Methods:Published research was identified by a review of scientific databases (PMC, Science Direct and Neuroscience, PubMed) using relevant keywords. Retrieved articles from 1990 to 2018 are included.

Results:An important speech–language outcome for deaf people with cochlear implants is speech prosody which affects social functioning and communicative competence. Prosody plays an important role in the speech development of children, and children use acoustic features to prosodic structure in speech as early as 6 months of age to recover syntactic information and phrasal boundaries. Prosody development in chil-dren following cochlear implantation has different patterns compared with those with normal hearing. In general, cochlear-implanted children were less accurate in their prosody perception, pitch and melody than normal-hearing children, and cochlear-implanted children without any residual hearing had poorer voice fundamental fre-quency (F0) discrimination and showed a strong deficit in speech prosody perception and pitch processing. Prosodic perception in cochlear implantation is linked to audi-tory-working memory and auditory discrimination and music that are valuable tools in rehabilitation. Music training can lead to improvements in the perception of music and emotional speech prosody, and thus may be an effective supplementary technique for supporting auditory rehabilitation following cochlear implantation.

Conclusion: Cochlear-implanted children have deficits in facilitating prosody comprehension. Therefore, by cochlear implantation and subsequent rehabilitation, prosodic charac-teristics of cochlear-implanted children are similar to normal-hearing children, and through cochlear implantation at an early age, these limitation are somewhat com-pensated for. On the other hand, previous studies have shown that cochlear implan-tation works better in understanding segmental features of speech, although this is not true for the suprasegmental region, while the hearing aid works better in the supragmental region.



P07Auditory and Speech and Language Acquisition with Early Cochlear Implantation (Review Article)*Fatemeh Fekar1, Parisa Zare2

1. Department of Speech Therapy, Faculty of Rehabilitation, Tabriz University of Medical Sci-ence, Tabriz, Iran.2. Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran.

Keywords: Acquisition, Cochlear implantation, Perception, Speech.

Introduction: Cochlear implantation at an early age has an excellent effect in terms of increasing the acquisition of auditory, speech, and language skills.

Materials and Methods: We conducted a search in PMC, Science Direct, Neuroscience, and PubMed data-bases. The presented information was retrieved by reviewing articles from 1980 to 2018.

Results: Early diagnosis and intervention in children with congenital hearing loss provides the best opportunity for them to acquire communication skills. Infants with hearing loss who are diagnosed before the age of 6 months and who use appropriate aids have significantly higher language scores than infants who are diagnosed with hearing loss after 6 months of age. These language scores include perceptual skills, descrip-tive, and spontaneous speech. Cochlear implantation has a positive effect on speech perception and auditory awareness and the auditory acuity of individuals as there is a strong relationship between speech perception and activity in the primary and audi-tory association cortex. High levels of speech perception after implantation depend on the bilateral activity of these two regions. In general, activity in the auditory cortex before and after cochlear implantation is lower than normal.

Conclusion: Cochlear implant intervention at an early age in a congenitally deaf infant results in significantly improved auditory performance and acquisition of spoken language, especially if exposed to enriched language environments and supported by parents. The data suggest that early implantation within a brief sensitive period allows more adequate cortical maturation, resulting in the development of speech perception and the acquisition of expressive language.



P08Phonological Awareness Skills in Children with CochlearImplantation (Review Article)*Fatemeh Fekar1, Nafiseh Nehbandani1, Parisa Zare2

1. Department of Speech Therapy, Faculty of Rehabilitation, Tabriz University of Medical Sci-ence, Tabriz, Iran.2. Faculty of medicine, Tabriz University of Medical Science, Tabriz, Iran.

Keywords:Cochlear implantation,Phonological awareness,Reading, Intervention

Introduction:This review was performed to assess the effect of cochlear implantation on phono-logical awareness and the effect of intervention on acquisition of these skills and academic level.

Materials and Methods:We conducted a search in PMC, Science Direct, Neuroscience, PubMed, and Med-line databases by reviewing available articles from 1985 to 2018.

Results:The appearance of the conscious processing of speech in early childhood is known as phonological awareness. More precisely, the term phonological awareness includes sensitivity, ability to manipulate, and spelling of words, and has a special role in the assessment and treatment of hearing-impaired children. Children with problems in terms of speech sounds perception or expression, such as hearing loss, often have delayed development of phonological awareness. Phonological awareness skills are powerful predictors of a child’s likely academic achievement, and there is also a direct relationship with reading skills. Therefore, a deficit in phonological awareness may be considered a serious risk factor for the development of reading and writing skills. Hearing-impaired children perform poorly in phonological processing and phonemic manipulation tasks. In contrast, these children show better performance in word pro-cessing in relation to writing skills, but are poor in sublexical processing. Our findings show that cochlear implantation is associated with the development of oral language, auditory memory, and phonological awareness skills.

Conclusion:Very poor phonological awareness skills in hearing-impaired children lead to the main deficits in reading and writing. Studies investigating the effect of cochlear implantation on auditory, speech, and language development have shown that the earlier the age at which surgery is performed, the greater the impact on the process of teaching at the school level.



P09Syntactic Deficits in Students with Cochlear ImplantSomayeh Hasanzadeh1, *Seyyedeh Maryam Fazaeli2

1. Speech Therapy Department, Varastegan Institute for Medical Science, Mashhad, Iran. E-mail: [email protected]. Department of Linguistics, Ferdowsi University of Mashhad, Mashhad, Iran.

Keywords:Cochlear implant, Elementary school, Speech, Syntactic deficits.

Introduction:Cochlear implants are a common and important intervention for deaf children. How-ever, children with a cochlear implant have speech and language deficits when com-pared with their normal-hearing counterparts. If these deficits are not treated, they lead to irrecoverable losses in terms of language. Therefore, these deficits should first be identified, specifically during preschool and elementary school, and then they should be treated. The objective of this study was to examine syntactic deficits of language in the descriptive speech of students with cochlear implant.

Materials and Methods:Four students with cochlear implant participated in this cross-sectional study (mean age=11, SD=2.44 years). One girl and one boy were in the first-grade, and two boys were in the third and fourth grades, respectively. The subjects had no concomitant disorders such as stuttering or visual, physical, motor, mental, or neurological deficits. The data were gathered using Shafiei’s Illustrated Dictionary of Sentences (2014), in which subjects were asked to describe the pictures shown.

Results: The subjects’ syntactic deficits included deletion of the subject, deletion of the object, deletion of the objective marker “râ”, deletion of the first or second parts of verbs in compound verbs, deletion of the preposition, deletion of the genitive marker “e”, deletion of the preposition by its complement, incorrect use of verb tense (present subjunctive instead of present indicative, present subjunctive instead of past perfect), placing the verb between the noun and adjective, sole use of subject, and not com-pleting sentences.

Conclusion:Students with cochlear implant have serious syntactic deficits. Because these deficits have an adverse impact on other language levels, as well as educational and com-munication performance, speech therapists and teachers should direct their attention toward the treatment of these deficits.



P10Comparison of word Definition Skills in Third-Grade Primary-School Cochlear-Implanted Children and Their Normal-Hearing Peers*Talieh Zarifian1, Shima Hosseinabadi2, Robab Teymouri1

1. Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.2.Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Teh-ran, Iran. Cochlear Implant Center of Loghman Hospital, Pejvak Auditory-Verbal Center, Tehran, Iran.

Keywords:Cochlear implant, Lexicon, Metalinguistics, Noun, Word definition.

Introduction:Knowledge of the lexicon grows and develops throughout one’s life. Linguistic and metalinguistic knowledge are effective factors in the acquisition of definitional skills. This study investigated noun-definitional skills, both in content and in form, in cochlear-implanted children and their normal-hearing peers.

Materials and Methods:In this descriptive-analytical study, 16 third-grade primary-school children with co-chlear implants and 30 matched controls were asked to define 14 common high-fre-quency nouns. The cochlear-implant group was selected from children referred to the Loghman Cochlear Implantation Center and other rehabilitation clinics. The results were analyzed using the Shapiro-Wilk and Mann-Whitney tests.

Results:Mean total score of the word definition was 92 in the normal group compared with 49 in the group with cochlear implant. The difference between the two groups in both categories of verbs was significant (P<0.001).

Conclusion:The results of the content-related aspect of noun definition in the normal and cochle-ar-implanted groups showed that the mean scores of the normal group were approxi-mately twice as high as the cochlear-implanted group. This may result from higher levels of semantic representation in the normal group, which leads to more complete responses.



P11GJB2 Mutations Causing Autosomal Recessive Non-Syndromic Hearing Loss (ARNSHL) In Central and Western Iranian Populations: Report of Two Novel VariantsMahbobeh Koohiyan1, Mohammad Reza Pourreza1, Morteza Hashemzadeh-Chaleshtori2, Mansoor Salehi1, Hamidreza Abtahi3, Mohammad Reza Noori-Daloii4, *Mohammad Amin Tabatabaiefar5

1. Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sci-ences, Isfahan, Iran.2. Cellular and Molecular Research Center, Basic Health Research Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran.3. Department of Otolaryngology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.4.Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.5. Pediatric Inherited Diseases Research Center,Research Institute for Primordial Prevention of Noncom-municable Disease, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail; [email protected]

Keywords: ARNSHL, GJB2, Iran

Introduction:Hereditary hearing loss is a noticeable concern in medicine all over the world, and occurs in an estimated 1 in 166 births on average among Iranians, which makes it a major public health problem. Autosomal recessive non-syndromic HL (ARNSHL) is the most prevalent form of hearing loss. Although over 100 genes have been identified for ARNSHL, GJB2 mutations are the most prevalent causes of ARNSHL in many popula-tions. Previous studies have estimated the average frequency of GJB2 mutations to be 16%, but this is thought to be different among ethnic groups of Iran. This study aimed to determine the frequency and mutation profile of 70 deaf patients from two different provinces of Iran.

Materials and Methods:We enrolled 70 deaf patients with ARNSHL from the Isfahan and Hamedan provinces. After extraction of DNA, the coding region of GJB2 was directly sequenced in all pa-tients. Multiplex polymerase chain reaction was used for the detection of two deletions in the GJB6 gene.

Results: Eleven mutations were detected, nine of which were previously reported, while the other two (c.130T>G and c.178T>G) were novel. Homozygous GJB2 mutations were observed in 26.5% and 20% of all subjects from Isfahan and Hamedan provinces, respectively. The c.35delG mutation was the most frequent mutation. Screening for the two GJB6 deletions did not reveal any positive samples among GJB2 mutation-negative or heterozygous samples.

Conclusion:Our results suggest that the c.35delG mutation in the GJB2 gene is the most impor-tant cause of GJB2-related deafness in the studied population.



P12Effects of Cross-Modal Plasticity in Cochlear ImplantationMarzieh Amiri1, *Marzieh Kardooni1

Department of Audiology, Faculty of Rehabilitation, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. E-mail: [email protected]

Keywords:Auditory deprivation, Cross-modal plasticity, Cochlear implant, Neuronal plasticity.

Introduction:Congenital sensory deprivation can lead to reorganization of the deprived cortical regions by another sensory system. This phenomenon is known as cross-modal plas-ticity. The occurrence of this phenomenon has been proven during the deprivation of auditory stimulation in visual and somatosensory modalities. While this phenomenon can have beneficial effects during deprivation, there are different opinions about its effects on individual performance after cochlear implantation. This paper investigates various aspects of cross-modal plasticity on the performance of cochlear-implant re-cipients, and the latest scientific findings in this field are explored.

Materials and Methods: Scientific articles published between 1990 and 2018 in Pubmed, Google Scholar as well as Science Direct using key words “Cross-modal plasticity and Auditory”, “Cross-modal plasticity and cochlear implant” and “Neuronal plasticity” were investigated.

Results: Sixty articles were found using the above-mentioned methods. All titles and abstracts were studied thoroughly, and 52 articles with the desired concept were selected.

Conclusion: Despite the positive effects of cross-modal plasticity during deafness, this phenom-enon can have negative effects on cochlear implant users. This issue raises the im-portance of the appropriate age for cochlear implantation, such that in the event of a delay in receiving the prosthesis, the probability of occupying temporal lobes with other modalities is increased and the chance of success of surgery and improving speech understanding in the deaf person is reduced.



P13Primary Analysis of GJB2 Mutation and its Association with Cochlear Implantation OutcomeSamane Nasrniya1, Mahbobeh Koohiyan1, Hamidreza Abtahi2, Mahsa Sepehrnejad2, *Mohammad Amin Tabatabaiefar3

1. Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.2. Department of Otolaryngology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.3. Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran. Email; [email protected]

Keywords: Cochlear implantation outcome, Hearing loss, GJB2, Genetic testing.

Introduction:The prevalence of hearing loss in Iran is estimated to be 2–3 times higher than in oth-er parts of the world. Cochlear implantation is an effective treatment for children with severe-to-profound hearing impairment; however, there are significant differences in post-implantation outcomes among cochlear implant recipients. Studies conducted over the past decade have shown that the health and integrity of the spiral ganglion and auditory neurons are important factors affecting post-operative outcomes follow-ing cochlear implantation. In theory, mutations in different hearing loss genes have different pathogenic effects and might therefore affect the performance of cochlear implantation. The purpose of this study was to determine the association between GJB2 variants and cochlear implantation performance.

Materials and Methods: Children with post-lingual deafness who underwent cochlear implantation according inclusion criteria were studied.

Result: Our results demonstrate that the outcomes of cochlear implantation in patients with GJB2 mutation are good.

Conclusion:Our data are consistent with previous observations concerning cochlear implantation performance in patients with GJB2 mutations. However, further studies in larger co-horts and multiple centers are necessary to validate our observations.



P14Sound Source Localization for Bilateral Cochlear-Implant PatientsMitra Ghorbani1, Narjes Zareii1,*Somayeh Falahzade2

1. Student research committee of rehabilitation students (treata), faculty of rehabilitation sci-ences, Isfahan University of medical sciences, Isfahan, Iran.2. Communication Disorders Research Center, Rehabilitation Sciences Institute, Isfahan Univer-sity of Medical Sciences, Isfahan, Iran. E-mail: [email protected]

Keywords: Auditory processing, Bilateral cochlear implant, Cochlear implant, Localization.

Introduction:The criteria for cochlear implantation candidacy has eased in recent years, and as a result it is becoming more common for individuals with bilateral hearing loss to be fitted with two cochlear implants. The hope is that because bilateral cochlear-implant (BCI) users are receiving auditory input in both ears, they may be able to perform bin-aural tasks such as localization. Two binaural cues available to listeners with normal hearing (NH) are interaural level differences (ILDs) and interaural time differences (ITDs). The aim of this paper was to review articles that studied sound localization and magnitude of the ILDs and ITDs that remain after BCI. A major difficulty in com-paring the data from cochlear-implanted patients with NH patients is that the studies use different signals and spacing of loudspeakers and cochlear implantation proces-sors.

Materials and Methods:In this review article, sound source localization for BCI patients was considered. PubMed, Science Direct and Google Scholar searches were performed to retrieve articles from 2008 to 2018.

Results: BCI patients showed fine ILD discrimination (0.2 dB) in one study. Another study re-ported that just noticeable differences (JNDs) in ITD were about 50s; poorer than JNDs in NH listeners. However, ITD JNDs are highly variable across BCI subjects. A further study showed that the precision of neural ITD coding in acutely deafened, bilaterally implanted cats is normal.

Conclusion:Although BCI users receive input to both ears, they have relatively poor horizontal lo-calization abilities. This is probably because they have good sensitivity to ILDs, but not to ITDs. Human cochlear-implant wearers typically experience long periods of auditory deprivation before cochlear implantation. Such extended periods of deprivation, espe-cially if they include the neonatal period, may degrade neural ITD sensitivity by inducing changes in the brainstem neural circuits or preventing these circuits from developing normally.



P15A Review of Speech Perception Ability after Cochlear Implantation in People with Anomalous Inner Ear AnatomyMitra Ghorbani1, Narjes Zareii1, *Somayeh Falahzadeh 2

1. Department of Audiology, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.2.Communication Disorders Research Center, Rehabilitation Sciences Institute, Isfahan Uni-versity of Medical Sciences, Isfahan, Iran.

Keywords:Auditory prosthesis, Cochlear implant, Cochlear diseases.

Introduction:A cochlear implant is a surgically implanted electronic device that replaces the func-tion of the damaged cochlea in a person who has severe-to-profound sensorineural hearing loss. Inner ear malformations constitute about 20% of cases of congenital sensorineural hearing loss. The first classification of this malformation was devised by Jackler et al. (1987), such that 1=Michel deformity; 2 = cochlear aplasia; 3 =com-mon cavity; 4 = cochlear hypoplasia; 5 = incomplete partition. The aim of this study was to review speech perception ability following cochlear implantation in people with anomalous inner ear anatomy.

Materials and Methods:This review was conducted by retrieving relevant articles published between 2010 and 2018 from a search of the PubMed, Science Direct and Google Scholar data-bases.

Result:According to a series of tests such as Early Speech Perception (ESP), Glendonald Auditory Screening Procedure (GASP), and the Lexical Neighborhood Test (LNT), patients with eighth nerve hypoplasia, cochlear, and vestibular dysplasia showed improvements in speech perception after cochlear implantation, but poorer scores than implanted patients without these anomalies. In addition, there was evidence showing that severe cochlear dysplasia increases surgical difficulties and decreases speech perception scores. However, in another study, speech perception outcomes were similar in children with enlarged vestibular aqueducts compared with children with a normal inner ear.

Conclusion:Patients with inner ear malformations are a unique subgroup of cochlear implantation candidates. This review illustrates that speech perception scores following cochlear implantation in patients with inner ear malformation are overall below normal scores. However, the benefit of cochlear implantation in improving speech abilities in these cases is evident. Therefore, it is important that the family’s expectations be managed prior to surgery.



P16Auditory System Reorganization Following CochlearImplantation in Children with Pre-Lingual Deafness*Majid Karimi1, Arash Bayat2, Nader Saki2, Mohsen Ahadi1, Golshan Mirmomeni2, Soheila Nikakhlagh2

1. Department of Audiology, School of Rehabilitation, Iran University of Medical Sciences, Teh-ran, Iran.2. Hearing Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medi-cal Sciences, Ahvaz, Iran.

Keywords: Cochlear implantation, Cortical auditory evoked potentials, Children

Introduction:To evaluate auditory system reorganization after cochlear implantation in pre-lingually deaf children using cortical auditory evoked potentials (CAEPs).

Materials and Methods:During a longitudinal design, 20 Persian children (10 boys, 10 girls; mean age: 2.48 years) with profound pre-lingual hearing loss participated. CAEPs in response to speech stimuli (/m/, /g/, and /t/) were recorded using a HEARLab system. P1 la-tency of CAEP was calculated for each subject at “before implantation” and 3- and 6- months “after implantation” intervals.

Results:The mean P1 values decreased with increasing time of implant use during the follow-up stages. No significant differences in the group averages for P1 latency were found between the different speech stimuli.

Conclusion:The present study demonstrates that cochlear implantation has an effect on the audi-tory system, as can be seen in CAEPs.



P17Effect Of Anesthesia Techniques On Intraoperative Cochlear Implant Test EvaluationMahin Seyed Hejazi 1, Masoud Naderpour 2 , *Yalda Jabbarimoghaddam2, Aida Ariafae3, A.Rezaee3

1.Anesthesiology Department of Tabriz University of Medical sciences ,Tabriz,Iran.2.Otolaryngology Department of Tabriz University of Medical sciences Tabriz cochlear implant center,Tabriz,Iran.3.Audiologist, Tabriz cochlear implant center,Tabriz,Iran.

Keywords:Cochlear implant, Neuro-response threshold, Stapedial reflex, Anesthesia

Introduction: The aim of this study was to compare the effects of intravenous and inhaled anesthesia tech-niques on neuro-auditory thresholds (TNRT) and electrical stapedial reflex threshold (ESRT) responses.

Materials and Methods:In total, 110 children with severe or profound bilateral sensorineural hearing loss who were candidates for cochlear implant surgery were randomly divided into two groups. The effects of the total intravenous anesthesia (propofol-remifentanil) and inhalation anesthesia (sevoflurane) techniques were evaluated in terms of TNRT and ESRT responses of patients.

Results:No significant differences were found in TNRT reflex between the two groups (sevoflurane vs. propofol-remifentanil; P=0.294), but for the ESRT reflex, the difference between two groups was significant (P=0.001). In the evaluation of TNRT and ESRT responses with studied electrodes, in ESRT with electrodes 3 and 9 only, the noresponse rate was significantly higher in the sevo-flurane group (P0.05).

Conclusion:Remifentanil-propofol infusion is recommended for cochlear implant surgery.



P18Evaluation and Follow-Up of Auditory Performance and Speech Intelligibility in Cochlear Implanted Patients of Besat University Hospital, Hamadan, Western Iran from 2014–2017Farhad Farahani1,*Elnaz Shariatpanahi1, Jasem Noroozi1, Ehsan Mazloumi1

Hearing Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran. E-mail: [email protected]

Keywords:Auditory performance, Cochlear implant, Speech intelligibility, Pre-lingually deaf, Post-lingually deaf.

Introduction:The aim of this study was to evaluate auditory performance and speech perception in 100 patients, comprising congenitally deaf children and post-lingually deaf adults after implantation in Hamadan Cochlear Implant Center.

Materials and Methods:The study included 75 pre-lingually deaf children and 25 post-lingually deaf adults with cochlear implants. Auditory performance and speech intelligibility were assessed 6 months to 3 years after cochlear implantation using two scales; the Speech Intel-ligibility Rating (SIR) and the Categories of Auditory performance (CAP).

Results: The auditory performance and speech intelligibility of children increased following post-implant rehabilitation. The auditory performance of post-lingually deaf adults who had undergone cochlear implantation also increased after rehabilitation courses. The CAP and SIR results of the children and adults who had participated in more than 40 speech therapy sessions were better than who were still in their initial training after cochlear implantation.

Conclusion: Nearly all children and adults who participated in the study benefited from post-co-chlear-implant rehabilitation in terms of increased auditory performance. Speech in-telligibility was found to increase with time of cochlear implant usage and number of rehabilitation sessions. Intelligibility becomes significant by the end of the third year of cochlear implantation use and the end of the 80th session of speech therapy. Strong family support for regular speech therapy sessions was found to be important for suc-cess with cochlear implantation.



P19Comparing Language Development in Cochlear-Implanted Children and Children with Normal Hearing*Mahsa Sepehrnejad1, Alireza Mohseni-Ezhiyeh2, Seyed Hamid Reza Abtahi3, Mohammad Hossein Nilforoush1

1. Communication Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail: [email protected]. University of Isfahan. Isfahan. Iran3. Medical School. Isfahan University of Medical Sciences. Isfahan. Iran

Keywords:Cochlear-implanted children, Children with normal hearing, Language development.

Introduction:Deafness has unfavorable effects on language development in children. However, nowadays, the availability of cochlear-implant surgery provides an opportunity to de-velop language skills in deaf children. The present study aimed to investigate lan-guage development in deaf children 2 years after cochlear-implant surgery, and to compare it with the language development of naturally hearing children.

Materials and Methods:The population of cochlear-implanted children included all children who had under-gone cochlear-implant surgery at Al-Zahra University Hospital, Isfahan, Iran. From this population, 35 children (18 boys and 17 girls), in whom 2 years had passed since surgery, were selected as the sample using random sampling. In the group of children with natural hearing, the population included all children who were taught in pre-school centers and primary schools in Isfahan city. From this population, 35 children (18 boys and 17 girls) were selected using multi-stage cluster random sampling. Data were collected using the language development scale, and analyzed using correla-tion and covariance analysis.

Results:The findings of the present study indicated that although the cochlear-implanted children had high scores on the language development scale, there was a signifi-cant difference between the mean language development scores in the two groups (P≤0.001). In addition, there was a positive and significant correlation between age and language development (P≤0.01, r=0.491).

Conclusion:Regarding the findings of the present study, it can be concluded that although per-forming cochlear-implant surgery encourages language development in deaf chil-dren, it should not be expected that 2 years after surgery, cochlear-implanted children will have achieved similar language skills as naturally hearing children.



P20Parents’ Views on Changes in Their Child’s Quality of Life after Cochlear Implantation*Alireza Mohseni-Ezhiyeh1, Mahsa Sepehrnejad2, Seyed Hamid Reza Abtahi3,

Mohammad Hossein Nilforoush2

1. University of Isfahan, Isfahan, Iran. Email: [email protected]. Communication Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.3. Medical School. Isfahan University of Medical Sciences. Isfahan. Iran.

Keywords:Cochlear implant, Parent, Quality of Life.

ntroduction:Previous studies have shown that cochlear implantation achieves positive outcomes in terms of acquiring various skills among deaf children. However, one issue that has received less attention in Iran concerns the quality of life of these children after cochlear implantation. The present study was conducted to explore parents’ views on changes in their child’s quality of life after cochlear implantation.

Materials and Methods:The present study took the form of phenomenological research conducted via the semi-structured interview technique of data collection. Fifteen participants were se-lected who had undergone surgery 1 year previously. The duration of interviews was between 30 and 45 minutes. Colaizzi’s method was employed to analyze the data.

Results:Four main themes were identified, including changes in emotional, psychological, family and social-communication skills and child development in other areas as well. Moreover, fourteen subthemes were identified.

Conclusion:The results of this study show that cochlear implantation has positive outcomes in deaf children that improve the child’s quality of life. These results point to the need for greater attention to cochlear-implant surgery.



P21The Impact of Type of Auditory Prosthesis on Voice in Children with Prelingual Hearing LossFatemeh Abnavi1, *Mahsa Sepehrnejad1, Mohammad Hossein Nilforoush1, Seyed Hamid Reza Abtahi2, Karimi Marzieh3

1. Communication Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Email: [email protected]. Department of ENT Medical School, Isfahan University of Medical Sciences. Isfahan. Iran.3. Isfahan Cochlear Implant Center, Isfahan, Iran.

Keywords: Child, Hearing aids, Cochlear implant, Long-term average spectra, Voice quality.

Introduction: Normal hearing provides appropriate feedback to allow control of voice characteris-tics. It is mentioned in the literature that the voice characteristics of children with hear-ing loss differ significantly from those of normal-hearing children. Voice characteristics of children with hearing loss may be too loud or too soft or show irregular variation, and are usually described as tense, flat, breathy, or harsh, with differences in pitch and intonation. Long-term average spectra of speech (LTAS) is an appropriate acous-tic analysis tool to study voice characteristics of speech. As LTAS investigates voice quality quantitatively using connected speech, LTAS analysis enables us to examine the vibratory characteristics of the laryngeal source in an effective and reliable way.

Materials and Methods: Seven prelingual children with cochlear implants (mean age, 77 months) and 15 chil-dren with severe-to-profound hearing loss using hearing aids (mean age, 67 months) were studied. Children using a cochlear implant received a multichannel device at an average age of 3 years, and had had at least 8 months of experience with their co-chlear implant. A recording of a speech sample was made in the voice laboratory, with environmental noise under 50 dB, and analyzed using the PRAAT software program (8) with a sampling rate of 44,100 Hz (16 bit, mono-channel).

Results: The analysis showed that children with hearing aids had higher mean spectral energy (MSE) and lower spectral tilt (ST) than children with cochlear implants.

Conclusion:The levels of MSE and ST show that the voice of children with hearing aids is pro-duced with higher larynx tension and has a breathier quality compared with that in children with cochlear implants.



P22A Review of Acoustic and Electrical Hearing; Two Arrows and one Target*Mahsa Sepehrnejad1, Mohammad Hossein Nilforoush1,Mitra Ghorbani2, Seyed HamidReza Abtahi 3

1. Communication Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail: [email protected]. Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.3. Medical School, Isfahan University of Medical Sciences, Isfahan. Iran.

Keywords: Cochlear implant, Electroacoustic hearing, Hearing aid.

Introduction:Since the improvement of cochlear implants, no patients remain who are too deaf to benefit from use of a prosthetic device. A number of options are available to pa-tients with severe-to-profound hearing loss; such as hearing aids, cochlear implants, bimodal fitting (a combination of a cochlear implant in one ear and a hearing aid in the other ear), and hybrid fitting (implanting a shorter electrode array into an ear to save residual hearing). The aim of this study was to review these new types of device (bimodal fitting and hybrid fitting), including candidacy for use and the benefit offered.

Materials and Methods: This review article was performed by retrieving articles published between 2010 and 2018 in the PubMed, Science Direct, and Google Scholar databases.

Results:A great many studies show better speech intelligibility in noisy conditions and im-proved quality of life and auditory perception in quiet conditions for bimodal fitting in comparison with cochlear implantation alone. A further study reported that patients with hybrid cochlear implants demonstrated patient-reported outcome benefits.

Conclusion:Patients with ski-sloping, high-frequency hearing loss do not benefit from hearing aids or cochlear implantation. As a result, hybrid fitting can be used. Furthermore, the use of bimodal stimulation is also beneficial, offering advantages such as higher single number rating (SNR) to the hearing aid when the noise is on the cochlear implant side and the speaker is near to the hearing aid. Other advantages of this modality include use of a hearing aid microphone that receives a clearer signal than cochlear implants, or the complementary frequency range over which bimodal fitting can pro-vide information.



P23A Review of Fully Implantable Hearing Aids; FutureTechnology Which Is Not Seen but HeardMohammad Hossein Nilforoush1,*Mahsa Sepehrnejad1, Elaheh Hashemidost2, Seyed Hamid Reza Abtahi 3

1. Communication Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail: [email protected]. Faculty of rehabilitation sciences, Isfahan University of Medical Sciences, Isfahan, Iran.3. Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.

Keywords: Carina, Esteem, Full implantable hearing aids.

Introduction:Rapid progress continues to be made in the field of hearing aid technology. Hidden hearing aids have been miniaturized and digitized for improved performance. How-ever, many people are uncomfortable using hearing aids, while others do not achieve the promised benefit.

Materials and Methods: This review based on articles published from 2015 to 2018 attempted to compare fully implantable hearing aids system.

Results:Similar to semi-implantable devices, the fully implantable device consists of a sensor, a sound processor, and a driver connected to the ossicles. The sensor detects vibra-tions of the tympanic membrane and transforms the vibrations into electrical signals that are processed by a sound processor. This device uses piezoelectric transduction as opposed to the electromagnetic transduction used in semi-implantable devices. A piezoelectric transducer, the sensor, is placed at the head of the incus and converts mechanical vibrations detected from the tympanic membrane to electrical signals that are delivered to the stapes by another piezoelectric transducer, the driver.

Conclusion:The surgically implantable hearing aid is completely invisible and provides much bet-ter full-frequency audiological response.



P24Comparison of Speech and Hearing Skills in Cochlear-Implanted SubjectsMasoud Naderpour1, Aida ariafar1, Afarin akhondi1, Zare Parisa1

Tabriz cochlear Implant Center,Tabriz,Iran.

Keywords:Cochlear implant, Category of auditory performance test, Speech intelligibility rating

Introduction:The aim of the present study was to compare ratings of speech and hearing develop-ment in girls and boys with cochlear implantation.

Materials and Methods:The present study included 100 boys and 100 girls with cochlear implantation, aged between 2 and 4 years. All children were assessed 0, 3, 9, 12, and 15–18 months after surgery using a category of auditory performance test (CAP) and speech intel-ligibility rating (SIR). The CAP and SIR scores of the groups were compared.

Results:Mean CAP and SIR scores were statistically significantly different between the groups. In both groups, CAP and SIR scores increased with increasing time of implant.

Conclusion:These results indicate that implanted girls had significantly better ratings than boys in the initial assessments, although the gap between boys and girls reduced during later assessments. The findings suggest that both groups can reach speech and hearing skills appropriate for their calendar age (according to development tables).



P25Study of Entry to General Elementary Schools Based on Recorded Implantation Data in TabrizMasoud Naderpour1, Afarin Akhondi1, Aida Ariafar1, Zare Parisa1

Tabriz cochlear Implant Center,Tabriz,Iran.

Keywords: Additional disabilities, Cochlear implant, Education, General schools

Introduction:A cochlear implant is an electronic device that can provide hearing to individuals with severe-to-profound sensorineural hearing losses. Because of improvements in early identification, more children with cochlear implants will be included in elementary school general education.

Materials and Methods:Two-hundred children (100 female and 100 male) aged between 2 and 4 years with severe-to-profound sensorineural deafness with cochlear implant were studied. Of the 100 females studied, one had autism and five were mentally disabled, while of the 100 males, three were mentally disabled and one had autism.

Results:In total, 94 girls and 97 boys with cochlear implants were included in elementary school, of whom 95.5% entered general elementary school and 4.5% entered a special school.

Conclusion:These results indicate that through early identification of children with hearing loss, more children with cochlear implants will be included in elementary school general education classrooms. Thus, general education teachers should be prepared for teaching children with cochlear implants. The results also show that additional disabil-ities among children with cochlear implants may prevent entry into general schools.



P26Review of Speech Perceptual Skills in Children with Cochlear Implantation*Fatemeh Fekar1, Mahsa Mehdizadeh1, Amir Salar Tozihi1

Department of Speech Therapy, Faculty of Rehabilitation, Tabriz University of Medical Science, Tabriz, Iran.

Keywords:Auditory, Cochlear implantation, Intervention, Perception,

Introduction:The aim of this study was to assess the effect of cochlear implantation on auditory and speech perception and the effect of intervention on the acquisition of auditory and speech and language skills.

Materials and Methods:We conducted a search in PMC, Science Direct and Neuroscience, PubMed and Medline databases. The present information was retrieved from articles published from 1985 to 2018.

Results:Speech perception ability is a complex and multidimensional phenomenon that has a close relationship with hearing in humans. Speech perception tests include the recognition of stress patterns, consonants, vowels, words, and sentences. Sound awareness is a capability that develops rapidly, while speech comprehension is the final and most important ability and is required for communication. Hearing loss af-fects all aspects of a person’s life, including auditory perceptual function in particular, and may reduce general attention to speech sounds compared with normal-hearing peers. Speech perception and comprehension in deaf children is poorer than in nor-mal children, and auditory intervention is necessary to accelerate the development of auditory skills. The findings show that infants who undergo cochlear implantation are able to recognize and identify speech sounds.

Conclusion:Cochlear implantation has a beneficial effect in improving auditory perception in deaf children, and the results have been satisfactory in increasing their verbal auditory performance. When children with congenital hearing loss are fitted with implants at a younger age and the duration of rehabilitation after cochlear implantation is longer, the child’s performance is better in terms of the acquisition of language and speech skills. Therefore, according to recent studies, both factors are recommended.



P27Evaluation of Cochlear Implant in Otism ChildrenMasoud Naderpour1, Yalda Jabbarimoghaddam1, Aida Ariafar2, Afarin Akhoundi2

1.Otolaryngology Department of Tabriz University of Medical Sciences, Tabriz Medical Univer-sity Cochlear Implant center, Tabriz, Iran.2. Audiolpgist,Tabriz Medical University Cochlear Implant Center, Tabriz, Iran.

Keywords: Autism, Cochlear implant, Evaluation.

Introduction: Autism is a neurodevelopment disorder including difficulty in establishing relationships and so-cial interaction, difficulty in communication, and performing restricted and repetitive behaviors. The impaired reception and integration of sensory information especially auditory data is one of the main characteristics of children with autism. According to various studies, brainstem plays a key role in reception and integration of auditory and sensory data.

Materials and Methods:In these descriptive analytical study 12 children aged 2-8 years old on GARS questionnaire, children with autism were divided into three groups of mild, moderate and severe autism. (SIR) and (CAP) were recorded and compared after 18 months post operation.

Results:7 patients had moderate autism and 4 patients had sever otism.minimum cap was 2 and max was 5.SIR was one in 8 patients and was two in 4patients.

Conclusion:This study shows that cochlear implant results are lower in children with autism compared to normal children and dependent to autism grade.



P28Are all Children with Auditory Neuropathy Candidates for Co-chlear Implantation?*Farzaneh Zamiri Abdollahi 1, Maryam Delphi2

1. Rehabilitation Faculty of Tehran University of Medical Sciences, Tehran, Iran .Email:audiology_zamiri@ yahoo.com2. Jundishapur University of Medical Sciences ,Ahvaz, Iran

Keywords: Auditory brainstem response, Hyperbilirubinemia, Otoacoustic emissions.

Introduction:Hyperbilirubinemia in infants has been associated with neuronal damage, including in the auditory system. Some researchers have suggested that bilirubin-induced audi-tory neuronal damage may be temporary and reversible. This would have a substan-tial effect on the auditory management of the child, especially among candidates for cochlear implant.

Materials and Methods:Study participants included 60 full-term hyperbilirubinemia infants (mean age, 39.24 days) with a normal birth weight (3,200–3,700 g) admitted to hospital for hyperbiliru-binemia. All infants in the hyperbilirubinemia group had a serum bilirubin level higher than 20 mg/dl and had undergone one blood exchange transfusion. Hearing evalu-ation for each infant was conducted twice: 1) after hyperbilirubinemia treatment and before leaving the hospital and 2) 9 months later. Hearing evaluations included tran-sient evoked otoacoustic emission (TEOAE) screening and auditory brainstem re-sponse (ABR) threshold tracing.

Results:Thirty percent (18 subjects) of the children showed auditory neuropathy in their first evaluation. The degree of hearing loss in 13 out of 18 subjects was severe-to-pro-found, with the five remaining subjects showing moderate hearing loss. TEOAE re-sults in the hyperbilirubinemia group did not change significantly between the first and the second evaluation. However, the ABR results of the hyperbilirubinemia group improved significantly from the first to the second assessment (P=0.002) in eight sub-jects (normal-to-mild hearing loss).

Conclusion:It is suggested that the management of children with auditory neuropathy secondary to hyperbilirubinemia should be undertaken with caution. Patients with auditory neuropa-thy might need more frequent monitoring to preclude any incorrect management.



P29 Cochlear Implant in Children*Farzaneh Zamiri Abdollahi1,Tayebeh Ahmadi2, Mamak Joulaie2,Akbar Darouie3

1. Audiology Department, Tehran University of Medical Sciences ,Tehran, Iran.2. AVA Rehabilitation Center, Karaj, Alborz, Iran.3. University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Keywords: Cochlear implant, Music perception, Speech perception, Vestibular system

Introduction:With the introduction of the cochlear implant device, hearing sensation has been restored in many profoundly deaf children. In this article, we review new issues in cochlear implantation, including candidacy, bimodal and bilateral cochlear implant, music and speech perception, and vestibular system involvement in cochlear im-plant.

Materials and Methods:This review included 37 articles about cochlear implant identified using the follow-ing keywords: bimodal and bilateral cochlear implant, music and speech percep-tion, vestibular system involvement, cochlear implant.

Results:Children with cochlear implant show speech-in-noise perception difficulty and have a lower satisfaction with music. Bilateral cochlear implant might improve speech-in-noise perception and spatial hearing if the electrodes are implanted symmetrically. Some studies showed that cochlear implantation can have adverse effects on the vestibular system, although a recent study showed no impact.

Conclusion:Modern cochlear implants are highly developed, but there are many issues that have yet to be considered.



P30A Systematic Review of the Role of Early Surgery in Achieving Developmental Skills in Hearing-Impaired Children withCochlear Implants*Alireza Mohseni Ezhiyeh1, Khodabakhsh Heidari2

1. University of Isfahan, Isfahan, Iran *E-mail: [email protected]. Farhangian University (Pardis, Shahid Bahonar, Isfahan), Isfahan, Iran.

Keywords:Age, Cochlear-implant surgery, Developmental skills.

Introduction:A cochlear implant is a new method developed in recent years for use in hearing-impaired children. The impact of the age of the child at the time of cochlear-implant surgery in achieving developmental skills is an important consideration among spe-cialists. The aim of the present study was to conduct a systematic review of the role of age in cochlear-implant surgery.

Materials and Methods:Articles in the PubMed, ScienceDirect, and Google Scholar databases published dur-ing between 1997 and 2018 were reviewed using subject-related vocabulary. Includ-ed articles were selected according to inclusion and exclusion criteria.

Results:Findings of the study show that cochlear-implant surgery improves developmental skills in hearing-impaired children. There is also a correlation between early surgery and listening, communication, social, linguistic, spoken and cognitive skills; such that early surgery can help children acquire these skills sooner and to a greater extent.

Conclusion:The results of this study indicate that there is a positive correlation between age at cochlear-implant surgery and achievement of developmental skills. Accordingly, it is recommended that conditions for early surgery be extended for children, to allow a greater increase in children’s abilities and a reduction in costs to the family and so-ciety.



P31Scale of Parental Involvement and Self-Efficacy (SPISE) – Farsi VersionMamak Joulauie1, Akbar Darouie2, Farzaneh Zamiri-Abdollahi3, Tayebeh Ahmadi2

1. Ava Rehabilitation Center, Karaj, Iran.2. University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.3. Rehabilitation Faculty of Tehran University of Medical Sciences, Tehran, Iran.

Keywords:Cochlear implant, Hearing impairment, Involvement, Self-Efficacy.

Introduction: Expectations for rehabilitation after cochlear implantation in young children depend on the interaction between professionals and parents. The involvement and self-ef-ficacy of mothers in communicating with these children influences their performance in reaching optimal lingual input. Self-efficacy means that a person knows what she should do and has a good feeling about her duties. Parental involvement is an im-portant factor that is also essential in successfully attaining goals. Moeller (2000) first introduced a scale for evaluating the involvement of parents in early intervention in hearing impairment. DesJardin (2003) later developed an alternative scale (Scale of Parental Involvement and Self-Efficacy [SPISE]) for assessing these two factors, and studied it in children using a cochlear implant.

Materials and Methods: As the SPISE scale is the only scale to address the important issues of self-efficacy (10 questions) and involvement (11 questions), it was translated into Farsi with the permission of the author at the Ava Rehabilitation Center for hearing-impaired chil-dren and their families. The content validity was surveyed by clinicians with years of experience in working on early intervention.

Results:Limited changes were made to the SPISE scale based on the input of clinicians; therefore, determination of its reliability should be undertaken in the next step.

Conclusion:After adaptation, this scale will be available for all speech and language pathologists and audiologists as an appropriate tool for evaluating the components of a family-centered program.



P32Auditory Processing Abilities in Children with Chronic Otitis Media with EffusionBahare Khavarghazalani1, Farhad Farahani1, *Elnaz Shariatpanahi1

Hearing Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran. *Email: [email protected];

Keywords: Auditory processing disorder, Auditory temporal processing, Binaural auditory func-tion, Children, Otitis media with effusion.

Introduction:Evidence suggests that prolonged otitis media with effusion (OME) in children can result in an auditory processing disorder, presumably because hearing has been dis-rupted during an important developmental period. A lack of auditory stimulation leads to the abnormal development of the hearing pathways in the brain. The aim of the present study was to determine the effects of OME on binaural auditory function and auditory temporal processing.

Materials and Methods:In the present study, the Dichotic Digit Test (DDT) was used for binaural hearing, and the Gap in Noise (GIN) test was used to evaluate temporal hearing processing.

Results:Average GIN values differed significantly between children with a history of OME and normal controls (P<0.001). The mean values of the DDT score were significantly dif-ferent between the two groups (P=0.002).

Conclusion:The study results indicate that children with a history of OME suffer from an auditory processing disorder to some degree. The findings support the hypothesis that fluctu-ating hearing loss may affect central auditory processing during critical periods.



P33Spoken and Written Narrative in Persian Speaking Students Who Received Cochlear Implant and/Or Hearing Aid

Mohammad Rezaei1, Farhad Farahani1, *Ehsan Mazloumi1, Elnaz Shariatpanahi1

Hearing Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran. E-mail: [email protected]

Keywords: Cochlear implant, Hearing aid, Spoken narrative, Written narrative,

Introduction: To compare the narrative skills of Persian-speaking students with hearing impairments and typical hearing students, all of whom were between the 4th and 5th grades. Also, to evaluate the effects of group, gender, hearing age, and educational grade of the stu-dents on their spoken/written narrative performance.

Materials and Methods:Subjects were 174 students aged 10–13 years, of whom 54 wore cochlear implants, 60 suffered from moderate-to-severe hearing loss and wore hearing aids, and 60 had typical hearing ability. Micro- and macrostructure components of the spoken and writ-ten narrative were elicited from a pictorial story (The Playful Little Elephant), and then scored by raters. The comparisons were utilized by a four-way repeated measures analysis of variance (ANOVA) test using SPSS 17.0 for Windows.

Results:Compared with typical-hearing students, students with hearing impairments had sig-nificantly lower scores in all microstructure components of narratives. However, the findings showed no significant difference among the different groups in the macro-structure components of narratives. It was also revealed that students had an equal performance in spoken and written narrative. Finally, factor analysis showed that the group, gender, hearing age, and educational level of children might alter the outcome measures in various interactions.

Conclusion:Although cochlear implantation was more effective than use of a hearing aid on spo-ken and written narrative skills, the Persian speaking students with hearing impair-ment were seen to need additional training on the microstructure components of spo-ken/written narrative.



P34Auditory Brainstem Implantation: Our Experience*Ali Eftekharian1, Leila Azadeh Ranjbar1, K Eftekharian2

1. Hearing Disorders Research Center, Shahid Beheshti University of Medical Sciences, Teh-ran, Iran. E-mail: [email protected]. Tehran University of Medical Sciences, Tehran, Iran.

Keywords: Auditory brainstem implant, Hearing loss, Neurofibromatosis.

Introduction:The aim of this presentation is to share our experience in auditory brainstem implan-tation (ABI) and to compare it with results in the literature.

Materials and Methods:Clinical records of patients who were underwent ABI in the cochlear implant center of a tertiary hospital were evaluated, and their results were compared with those in the literature.

Results:Seventeen patients were implanted with ABI between September 2012 and Decem-ber 2017. Thirteen implantations were carried out in patients with neurofibromatosis type 2. Although all of these patients benefited from their device and used it over the course of a full day, auditory results revealed a wide spectrum, from full dependence on lip reading to an ability to talk on the telephone. Four children with bilateral pro-found hearing loss (three children with congenital anomaly and one child with post-meningitis hearing loss) were also implanted with ABI. These children also used their device over the course of the full day and were still progressing in terms of hearing and speech. Hearing and speech results for these patients were comparable with the results in the literature.

Conclusion:Although we began ABI in 2012 and are at the start of this process, our results to date are promising.



P35A Recurrent P.Arg108 Exchange In The Gene S1PR2 (DFNB68) In The Third Consanguineous Family With Hearing Loss Atieh Eslahi

Department of Medical Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad , Iran

Keywords: 3D modeling, autosomal recessive non-syndromic hearing loss, DFNB68, mixed hearing loss, S1PR2, whole exome sequencing,

Introduction :Due to genetic heterogeneity and consanguineous marriages, recessively inher-ited hearing loss in Iran is the second most common genetic disorder. To date, two pathogenic variants in the autosomal recessive hearing loss gene S1PR2 (DFNB68) have been described in Pakistani families, including one family with a c.323G>C, p.Arg108Pro pathogenic variant. Herein, we describe a segregating homozygous c.323G>A, p.Arg108Gln pathogenic variant in S1PR2 that was identified in four pro-bands from a four generation Iranian family.

Materials and Methods:Genomic DNA (gDNA) was extracted from peripheral blood leukocytes from the pro-band and her family members that included seven normal hearing and three individu-als with HL. Mutations and deletions were excluded in GJB2 and STRC, respectively. Proband gDNA was subjected to whole exome sequencing. The exome library was prepared using the Nextera Rapid Capture Enrichment kit according to manufactur-er’s instructions (Illumina, San Diego, CA, USA). Subsequently, the samples were 2x76 bp paired end sequenced on a NextSeq500 benchtop sequencer (Illumina, San Diego, CA, USA) with a v2 reagent kit and mapped to the human genome reference GRCh37 (hg19)

Results:c.323G>C, p.Arg108Pro pathogenic variant was identified through whole exome se-quencing of genomic DNA from one proband and bioinformatics analysis of 116 hear-ing loss-associated genes. Segregation analysis and 3D protein modelling validated a pathogenic prioritization of this variant and supported understanding of the p.Arg108 exchange in detail. The limited families that have been identified with S1PR2 patho-genic variants present a profound hearing loss that is also observed in the probands in our family.

Conclusion:based on the high similarity of S1PR2 and S1PR1, as well as the high conservation of the amino acids p.120Arg and p.121Glu, which are p.108Arg and p.109Glu, respec-tively, in S1PR2, we suggest that the p.108Arg position plays a key role in the ligand receptor interaction, which is disturbed by the exchange of p.108Arg to p.108Gln.



P36The effects of cochlear implant on Functional Performance of deaf children Somayeh Namaki khameneh1,Arash Bayat2,Mohammad Khayatzadeh Mahani1,Nader saki2,Majid Karimi3

1Musculoskeletal Research Center, School of Rehabilitation Sciences, Ahvaz Jundishapur Uni-versity of Medical Sciences, Ahvaz, Iran,2Hearing Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,3Khouzestan Cochlear Implant Center, Ahvaz, Iran

Keywords:Hearing impaired children;Functional performance;Pediatric Evaluation of Disability Inventory;Cochlear Implant.

Introduction:Although it has been known that a profound hearing loss in children can influence their speech, language and emotional development. its effect on functional abilities has received little attention. In this study, the effect of Cochlear Implant on functional performance of deaf children was investigated.

Methods:During a semi-experimental interventional study, a total of30children, aged from-1to7years, participated. The study population consisted of15 children with bilateral profound sensorineural hearing loss candidate for Cochlear Implant(cochlear implant group)and15age-matched children(control group). Functional performance was mea-sured using Pediatric Evaluation of Disability Inventor (PEDI), providing scaled scores of3 functional domains: self-care, mobility and social function.

Results:Based on the results of mean difference before and after Cochlear Implant in both groups in all three functional domains were significant. The results also showed that children in the cochlear implant group had more progress than the control group.Conclusion: The present findings can help us identify the needs of hearing-impaired children in daily functional activities especially the social functioning. The results could help design strategic interdisciplinary programs with a focus on improvement of social skills to prevent further communication and behavioral problems, and also to facilitate their participation at home or community.



P37Effectiveness of Group Positive Psychotherapy on Increasing the Happiness of Mothers of Children with Cochlear Implant

Sima Falakaflaki, Zahra Hosseini1, Masoumeh Alimoradi1

New hearing technologies research center, Baqiyatallah University of medical sciences, Tehran, IranCorresponding author: [email protected]

Keywords : Cochlear implant, Happiness, Positive psychotherapy Introduction: A new method for the treatment of hearing disability is cochlear implant surgery. Par-ents of children with cochlear implant, due to some problems, have some crisis and issues that endanger mental health of families and especially mothers who are spend more hours with their kids. The fact that mothers of children with disabilities in the areas of mental health, life satisfaction, depression and anxiety suffer many problems and this situation would have some significant consequences in marital relationships and parent-child relation and mental and social health of families especially mothers. The aim of the present study was to investigate the effect of positive psychotherapy in groups on increasing the happiness of mothers with cochlear implants children.

Materials and Methods: The pre-test-post-test of quasi-experimental research method with control group was used in this study. For this purpose, 20 mothers of children with cochlear implant in Baqiatallah Hospital of Tehran city were randomly assigned to two control and ex-perimental groups (10 people in the experimental group and 10 people in the control group). The experimental group received positive psychotherapy trainings during 10 sessions, 120 minutes per week and the control group received no interventions. Re-search tool was Oxford Happiness Inventory (OHI) which was carried out in two pre-test and post-test steps and data was analyzed using analysis of covariance method (ANCOVA).

Results: The results of covariance analysis showed that group positive psychotherapy was ef-fective on happiness of mothers with cochlear implant children with 99% confidence level (p˂0.01).

Conclusion: Positive psychotherapy in groups is a suitable method of treatment to increase the happiness of mothers of children with cochlear implant.



P38Speech perception in children with cochlear implants

*Amir Abbas Ebrahimi

Research Institute for Education Studies ,Tehran.Iran.

key words:cochlear implant, deaf children, speech perception

Introduction: Cochlear implants provide access to the speech signal in those profoundly deaf chil-dren who derive no benefit from acoustic hearing aids.

Description:However, despite the numerous positive results in pediatric cochlear implantation, published data still indicated a wide range of performance among implant recipient thus, a need to study the possible variables that can affect performance, could ac-count for the diversity of performance and affect speech perception is critical to both the professionals dealing with the parents and to the parents themselves.

Conclusion: A variety of factors, some of which have already been shown to influence outcome and others that warrant attention. Categorizing these determinants increases the abil-ity of clinicians to offer educated preoperative prognoses to the families and might potentially allow for manipulation of variables in an attempt to achieve the best pos-sible. This article presents an overview of these factors.



P39Study of Auditory Skills Development in Cochlear Implanted Children*1Reza sadeghi 1Atieh ghazvini 1Rabeh khalilavi:

Loghman Cochlear Implant Center, Pejvak auditory-verbal Center, Tehran, Iran [email protected].

key words: auditory skills, Cochlear Implant

Introduction: After receiving the Cochlear implant in children, the process of rehabilitation gets started in order to form auditory and speech skills. This study has been done to inves-tigate the process of auditory skills development during the first year of CI.

Materials and Methods: 50 children in Loghman CI center with the age range of 15 to 71 months with the mean age of 40 months, when implanted, participated in this study. Participants were evaluated by a test battery consisted of APCEI, MAIS, CAP II test battery when re-ceived the prosthesis and 3, 6 and 9 months after that.

Results: The data analysis showed that the mean scores in all of the 3 scales used for evalua-tion, had an ascending flow during 4 times evaluations. The difference between mean scores of participants among 4 assessments was statistically significant.

Conclusion: According to the results of this study, implanted children had a significant develop-mental rate in auditory skills during the first year after the CI and they had approached the maximum scores in these scales by a notable developmental rate. Of course some factors such as age and efficient and adequate rehabilitation should be con-sidered.



P40Comparing Feelings of Loneliness in Family Communication among Deaf Youths wıth and without Cochlear Implant:*Seyedeh Zeynab Mousavi 1, Guita Movallali2

1. Rehabilitation free researcher2. Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilita-tion Sciences, Tehran, Iran. & Faranak Rehabilitation Center, Tehran, IRAN. [email protected]

Keywords: Feeling of loneliness, cochlear implant, deaf

Introduction: Cochlear implant is the wonderful technology of recent decades that has considerably changed life of deaf people. There are many researches on various aspects of this impact, but psychological aspects and mental aspects of cochlear implant on its users are less considered. Current research was conducted aiming at comparing feelings of loneliness in family relationship among deaf youths with and without cochlear implant.

Method and Materials: This is a causal - comparative research. Statistical population included 270 ones that were members of a Telegram group called as Deaf Plentiful Youths via Faranak Center during 2016 - 2017. The sample size was selected as 60 (60 youths with co-chlear implant and 30 deaf youths without cochlear), age range of whom was 17 - 37 years. The sample was selected using convenience and purposive sampling method. Loneliness scale developed by Dehshiri (2008) was used for measuring feeling of loneliness in family communication. Collected data were analyzed using T test.

Results:Investigation of research data indicated that feeling of loneliness is significantly high-er in deaf individuals without cochlear implant than people with cochlear implant.

Conclusion:Considering higher feeling of loneliness among deaf youths without cochlear implant and youths with cochlear implant, it can be stated that cochlear implant not only in-fluences hearing, but also strongly affects other areas of the individuals. Cochlear implant may influence psychological aspects of its young users’ life. In addition, psy-chological programs should be designed and implemented for reducing feeling of loneliness and thus promoting mental health in deaf individuals.



P41Efficacy of Parent-Child Interaction Therapy on Anxiety Symp-toms in Cochlear Implanted Deaf Children*Navideh Javadi1, Rabeh Khalilavi2, Farnaz Keshavarzi Arshadi3, Saeed Hasan-zadeh4

1. Bs of Audiology, Ms of Exceptional Children Psychology, Cochlear Implant Center of Loghman Hospital Pejvak auditory-verbal Center, Tehran, Iran.2. Bs of Speech Therapy, Cochlear Implant Center of Loghman Hospital Pejvak Audi-tory-Verbal Center, Tehran, Iran.3.Phd of Clinical Psychology, Azad Slamic University. Tehran, Iran.4.Phd of Exceptional Children Psychology, Tehran university Cochlear Implant Center of Hazrate Rasul Hospital, Tehran, Iran.

Keywords:Anxiety symptoms, Cochlear implantation, Deaf children, Parent-child interaction therapy.

Introduction:The aim of this study was to investigate the effectiveness of parent-child interaction therapy on the anxiety symptoms of cochlear implanted deaf children.

Materials and Methods:This is an experimental study designed as pretest-posttest with control group in the form of random assignment to two experimental and control groups. The statistical population of the present study included deaf children aged 3 to 6 years old with cochlear implants referring to Tehran cochlear implantation centers in 2017. Among these centers, the Pejvak auditory-verbal rehabilitation center was selected by cluster sampling. The subjects were sampled among the referents with required character-istics through a targeted method. The deaf children (n= 30) with implanted cochlea were randomly divided into two experimental (n= 15) and control (n = 15) groups. The parents of these children completed the Achenbach questionnaire/parent form (CBCL) and anxiety subscale. Data were analyzed by covariance test.

Results:Comparing the mean values of the experimental and control groups showed that av-erage anxiety symptoms in the experimental group decreased significantly compared to the control group in the post-test.

Conclusion:Based on the results of this study, it can be concluded that parent-child interaction therapy has an effect on the anxiety symptoms of cochlear implanted deaf children.



P42Effect of Neurofeedback in Improving Deaf Students’ Reading after Cochlear ImplantationSakineh Soltani kouhbanani1,*Razieh Khosrorad2, Mohamad Hossein Soltani kouhbanani3,Sina Faramarziniya4

1. Assistant Professor of Ferdusi University of Mashhad. Mashhad . Iran.2. Assistant Professor, Research Center on Educational Neuroscience, Sabzevar University of Medical Sciences, Sabzevar, Iran.3.Medical student, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 4.Dentistry Student, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.

Key words:Cochlear implant, Deaf, Problems with reading, Neurofeedback.

Introduction: The aim of this study was to evaluate the effectiveness of neurofeedback in improving reading in deaf children after cochlear implantation.

Materials and Methods:This study was a statistical sample of 8 children (5 boys and 3 girls) aged 8-14 years with an IQ of 80, according to Wechsler test is listed in the student’s file. After identify-ing students with criteria and their parents participated in the Ava center in Ilam and after hearing explanations about the way they run the business themselves. Criteria: no history of seizure disorders, epilepsy and brain trauma. Since the cochlear implant at 18 months and maximum 24 months. The participants were randomly divided into experimental group and control group. Experimental group for 20 sessions of 40 min-utes each (three sessions per week) receive neurofeedback treatment. The instru-ment used in this study, a demographic questionnaire ( such as age,. grade, and IQ ), a reading disorder test Nsft et al (1380 ) and the neurofeedback devices.

Results:The ability to read the neurofeedback group showed that reading difficulties in the ex-perimental group was lower . Functional groups in addition , relocation, replacement and reverse readings improved.

Conclusion:The results suggest that neurofeedback education improves cognitive function. It seems that the neurofeedback facilitates the processing of information, because SMR reduces the voluntary control of the interaction of the motor system on cognitive information processing.



P43Effects of long term use of cochlear implant on e-Evoked Ac-tion potential

Leila Azadeh Ranjbar1, K Eftekharian2

1. Hearing Disorders Research Center, Shahid Beheshti University of Medical Sci-ences, Tehran, Iran. E-mail: [email protected]. Tehran University of Medical Sciences, Tehran, Iran.

IntroductionLong term use of cochlear implant affect the response of auditory nerve due to plas-ticity rules. The parameter of evaluation & study of νш nerve function in users of cochlear implant is e-Evoked Action potential that calls variously base on cochlear implant prothes brand such as NRT, NRI or ART.In this study we study the eEACP changes during the time.

Materials and MethodsIn this study we assessment the eECAP finding in 87 patients that was implanted 58-75 months later in 2 group of pediatric and adults. The brand of CI of this patients was in 2 groups: Advance Bionics, Cochlear

Results:The results of study indicate that:ECAP Thresholds in children: decrease of eECAP thresholds (13.82 C.L) in cochle-ar brand Decrease of eEAP threshold (12.63 CU) in AB brand ECAP Threshold in Adults: decreas of eECAP threshold (8.26 C.L) in cochlear brand decrease of eEAP thresholds (5.13 CU) ECAP Slope in children : shows steeper slope after time spend ECAP slope in Adults : shows no change of slope

Conclusion: The results of study shows that long term use of cochlear implant can affect the cur-rent field of cochlear and the relation of stimulating electrode and the tissue of nerve that is stimulating by cochlear implant.



P44The Comparative Study if Phonological Awareness in Normal and Cochlear Implant Children in Monolingual and Bilingual Family. Fatemeh Esmaeili

B.S, speech and language pathologist, M.A, general linguistics. Loghman cochlear implant center.E-mail:esmaeili_fatemeh341@yahoo

Keywords:Bilingualism, Cochlear Implant, Normal Child, Phonological Awareness,

Introduction: This study aims to compare the phonological awareness of preschool cochlear im-plant children and normal children in monolingual and bilingual families.

Materials and Methods:Method of research was descriptive and analytical one and data were gathered as field method abd is based on sub scales of tests of phonological awareness.This study was applied on 16 children in 4 groups. The children were male with age range of 5-5/11. To examine the phonological awareness skills, Dastjerdi-Soleimani phonological awareness test (1389) was used.

Results:The results indicate that phonological awareness of bilingual children in both cochlear implant and normal groups is better. In addition, cochlear implant children in mono-lingual and bilingual group show lower performance in phonological awareness skills than normal children.

Conclusion:According to importance of phonological awareness during learning of writing and reading and given to that children with cochlear implant have difficulties in learn-ing phonological awareness skills, findings of this research may help speaking and language therapists in order to improve phonological awareness. Also these findings may help therapists and parents to identify effects of bilingualism on development of meta language skills and make a true decision in using first language at home.



P45The Effectiveness of Group Teaching of Positive Thinking Skills and Playing to Reduce Anxiety in Mothers with Cochlear Implantation

Fateme khodashahi1, Azam yahyaie2, Mehri khorasani3

1. Department of Psychology, Bojnourd Branch, Islamic Azad University, Mashahd,Iran.2. Department of Psychology, Quchan Branch, Islamic Azad University Mashhad,Iran.3. Audiologist, Tehran University of Medical Sciences, Mashhad,Iran.

Keywords: Anxiety, Cochlear implant mom, Playing, Positive thinking.

Introduction:Mothers are the first people who have direct connection with the child. Feelings such as guilt, disappointment, and failure and deprivation of having abnormal child can cause the mother to be unsocial and unwilling to have relationships with others as well as losing self- esteem and feeling of sadness and depression followed by fear of tension and stress as well as lack of sanity of the mother herself. Therefore, the purpose of this study is to examine the effectiveness of group teaching of positive thinking skills and playing in reduction of anxiety in mothers of cochlear implantation children.

Materials and Methods: This study was a pre test -post test study with control group. The sample consisted of mothers of cochlear implantation referred to Butterfly rehabilitation clinic in Mash-had. Group teaching of positive thinking and playing was held in 10 sessions in 10 weeks for the test group. A questionnaire was used for Bek anxiety scale. Covariance analysis was used to analyze the data. Data were analyzed using SPSS software and descriptive statistics and paired t-test at a significant level of P <0.05.

Results: Anxiety scores decreased from 30 to 16/12 (P<0/001). In addition, the findings of this study indicated that group working of positive thinking skills and playing can reduce the anxiety of mothers with cochlear implantation children.

Conclusion:This study confirmed the effectiveness of group working of positive thinking skills and plying in reducing the anxiety level of mothers of cochlear implantation children. Finally, they showed that a positive thinking approach and play therapy can be used as a psychology intervention beside other interventions.



P46Investigating the Impacts of Cochlear Implantation on Happi-ness and Self-Esteem of Mothers of Children with Severe Hear-ing Loss

*Somayeh Moniri1, Nader Saki2, Soheyla Nikakhlagh2, Majid Karimi1, Arash Bay-at2, Ali Yadollahpour2, Hassan Abshirini 2

1. Khuzestan Cochlear Implant Center2. Hearing and Speech Research Center, Ahvaz Jundishapur University of Medical Sciences

Keywords:Mothers of children with severe hearing loss, Hearing cochlear implantation, Happi-ness Self-esteem Introduction:

Children with severe hearing loss often struggle to communicate. Mothers of children with hearing loss may also suffer psychologically in their caregiving due to this com-munication barrier. Cochlear implant surgery improves child’s hearing sense, parent and children’s psychological well-being, and communication between children and their mothers. The aim of the present study is to compare happiness and self-esteem among the mothers of children with severe hearing loss before and after cochlear implantation.

Materials and Methods: This cross sectional study was conducted with 40 mothers of children under the age of 7 with severe hearing loss, all of who were candidates for cochlear implant surgery in Imam Hospital, Ahvaz, Iran. A consecutive non-probabilistic sampling method was used. Mothers of children awaiting cochlear implantation completed the Oxford Hap-piness Questionnaire and Rosenberg Self-Esteem Inventory before and after their child’s surgery, in addition to a demographic information form. Paired t tests and Wil-coxon tests were used.

Results:A significant difference was observed between the happiness and self-esteem scores before and after surgery (P< 0.001).

Conclusions:Cochlear implantation surgery increases happiness and self-esteem in mothers of children with hearing loss. When a child with hearing loss goes through cochlear im-plant surgery, all family members will benefit from improved hearing in their child and thus, improved family communication overall.



P47The Effect of Using Composite Texts on Speech and Language Skills in cochlear implant childrenRabiei Sepideh1, Torbati Sahab2, Ajalloeian Mohammad3

1. M.Sc., Speech and language pathology, Cochlear Implant Center of Baqiatallah Hospital, Tehran, Iran.2. PhD in Arts – Psychology .Sahab Art Therapy Technology Institute, Eftetah Music school (Institute), Tehran, Iran.3. Otorhinolaryngology surgeon (ENT Surgeon), Cochlear Implant Center of Baqiatal-lah Hospital, Iran Research Center for cochlear implant auditory Technology, Tehran, Iran.

Keywords: Art therapy, Cochlear implant, Music therapy, Speech and Language Skills, Compos-ite Texts.

Introduction:One of the most important problems of hearing loss is its impact on the speech of a person, music therapy significantly improves this problem. The present study ad-dresses the impact of the use of textural texts on the speech and language skills of pediatric hearing impairment.

Materials and Methods:The research method is experimental and pre-test and post-test design. The popula-tion of this study was 40 children aged 4 to 6 years old in the cochlear implantation of the remaining observatory spiral implantation center who had been at least one year since the last operation and randomly selected and participated in the experi-ment and divided into two experimental and control groups . The statistical sample of the study consisted of texts that were collected and designed by the researchers purposefully. Then, the pre-test of Newsha’s growth assessment was performed to evaluate speech and language skills from both groups, followed by both groups in Exposed to 24 sessions of art therapy class using the lyrics (demo) and without using the lyrics (group Witness). Subsequently, both groups were subjected to post-test.

Result:The obtained data were analyzed based on descriptive statistics (mean and standard deviation) and inferential statistics (t-test, covariance analysis and Pearson correla-tion coefficient). And the results showed that the speech and language skills of pedi-atric spinal cord are enhanced by the use of musical texts.

Conclusion:Therefore, it should be noted that music therapy & art therapy can always be used as an effective tool to enhance and develop speech and language skills in cochlear implant children.



P48Hearing and Vertigo Rehabilitation after Vestibular Schwanno-mas Surgery; Using Cochlear Implants Farshid Rahimi Ghoradel1, Mitra Ghorbani1, Mojtaba Khosravi1, Mohammad Hosein Nilforush2, Mahsa Sepehrnejad

*BSc student in Audiology, Student research committee of rehabilitation students (treata), faculty of rehabilitation sciences, Isfahan university of medical sciences, Is-fahan, Iran.Communication Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Key words:Cochlear implantation, Hearing, Vestibular schwannoma, Vertigo.

Introduction:Neurofibromatosis (NF) is a group of three conditions in which tumors grow in the nervous system.One of sign of NF2 is vestibular schwannoma. Progression of tumor growth can involve intralabyrinthine, middle ear and the internal auditory canal. Ac-cording to which part of auditory canal gets involved severe to profound hearing loss, vertigo, dizziness and tinnitus can occur. Removal of vestibular schwannoma (VS) can be successful with preservation of the cochlear nerve. Protocol of cochlear im-plantation with adequate speech perception and improvement of vertigo and tinnitus, functional hearing nerve and intact inner ear anatomy is necessary.

Materials and Methods: This is reviewed type of article. PubMed, Medline and google scholar data base was used for finding articles from 2014 to 2017.

Results:All patients entering these studies should have useful hearing in the contralateral ear before surgery. Also at least profound hearing loss should be preoperatively demon-strated on the tumor side. Audiometric assessment included pure-tone thresholds (PTA); speech-recognition thresholds (SRT) and speech-discrimination score (SDS). These data in some papers demonstrated significant hearing benefits for ‘speech from deaf/implanted side, noise from the normal-hearing side’ in all patients and im-proved localization ability.

Conclusion:In some studies hearing and vertigo rehabilitation after surgery by means of CI was successful in most of patients. Speech perception with a CI is in vestibular schwan-nomas patients as promising as in patients with sensorineural hearing loss. CI seems a promising rehabilitation for hearing loss, vertigo and even tinnitus after removal of vestibular schwannoma.



P49Young cochlear implant users’ auditory development as mea-sured and monitored by the LittlEARS1 Auditory Question-naire Zahra Mortazavi1, Soheila Ghadimi1, Saideh Sadat Mortazavi1, *Ehsan Mazloumi1

Hearing Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran

Key words:LittlEARS1 Auditory Questionnaire, Cochlear implants, Children, Auditory develop-ment

Introduction:This study aims to assess the usefulness of the LittlEARS1 Auditory Questionnaire (LEAQ) in determining the audiological development of Persian children who have received a cochlear implant.

Materials and Methods:18 children received a cochlear implant before their 5rd birthday. Each child’s prog-ress was evaluated with the LittlEARS1 Auditory Questionnaire then at 3-month in-tervals for 1 years.

Results: All children showed a significant increase in LittlEARS1 Auditory Questionnaire scores over Time (P value = 0/003).

Conclusions: The LittlEARS1 Auditory Questionnaire is useful for monitoring the audiologicalde-velopment of young children with a cochlear implant. Confirmation that a cochlear implant user is achieving typical auditory milestones serves to boost parental morale during a child’s pre-verbal stage when parents may be anxious about their child’s abil-ity to talk. The questionnaire could also be useful as an early warning system. Poor scores likely indicate that something is impeding the child’s development. This should prompt professionals to try to identify the impediment, whether technical, medical, social or educational and, possibly, eliminate its effects while the child is still in his/her critical development stages.



P50Comparison of Executive Functions in Hearing Impaired Chil-dren with and without Cochlear ImplantsSara Madani ,* Movallali,G

1. M.A. in Psychology & Education of Exceptional Children, Pediatric Neurorehabili-tation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. 2.PhD in Psychology & Education of Exceptional Children, Pediatric Neurorehabili-tation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. & Faranak Rehabilitation Center ,Tehran, IRAN.

Keywords: Executive functions, Children with hearing loss, Cochlear implants

Introduction:Cochlear implants have been associated with effective outcomes in all areas of the hearing impaired child. In this study we compared executive functions in hearing impaired children with and without cochlear implants.

Materials and Methods:It was a causal-comparative research. The study population included hearing im-paired children with and without cochlear implants aged 5-8 years old in Tehran city. Subjects were selected by convenient sampling method. Sixty severe and profound children with hearing loss participated who were divided into two groups. There were 30 children in each group. The first group were selected from children with cochlear implants; and the second group were selected from children without cochlear im-plants (with hearing aids). Our tool was the “Behavioral Rating Inventory of Executive Function “(BRIEF). Data were analyzed by using multivariate analysis of variance (MANOVA).

Results:Mean scores of executive functions and the subscales of “Inhabitation, shift, emo-tional control, working memory, monitoring”, in children with cochlear implants were significantly higher than children without cochlear implants (P<0.05); but the differ-ence between mean scores of “initiate, planning and organization, and organization of material” subscales in two groups were not significant (P>0.05).

Conclusion:It seems that cochlear implants have some positive influences on the executive func-tions of hearing impaired children. So, cochlear implants can help hearing impaired children to act better in their lives and their executive functions can become better with the help of cochlear implantation. More details will be discussed in our presenta-tion.

Documents

International Congress on COCHLEAR IMPLANT