Abstract
Background: Vestibular evoked myogenic potentials (VEMPs) are reflex myogenic potentials of the neck muscles elicited by
stimulating the vestibular system with a click or tone burst sound stimulus. VEMP responses depend on good energy transfer
of sound from the middle ear to the inner ear and are presumed absent in the presence of a conductive hearing loss (CHL) of
more than 20 dB air-bone gap (ABG). The aim of this study was to evaluate VEMPs in patients with chronic suppurative otitis
media (CSOM) before and after surgery.
Material and methods: The study was conducted on 20 patients with CSOM preoperatively and postoperatively and on 20
controls. Their ages ranged from 20 to 50 years. Each subject underwent history taking, otologic examination, basic audiological
evaluation, and air- and bone-conducted VEMP testing.
Results: All perforated ears showed a lost air conduction VEMP response pre-operatively without any post-operative improvement.
This can be attributed to the absence of any statistically significant differences between the pre-operative and post-operative
ABGs at all tested frequencies. Bone conduction VEMP was preserved in all CSOM cases pre-operatively and post-operatively.
There were no statistically significant differences between the air conduction and bone conduction VEMP parameters
in the controls except for a significantly smaller P13–N23 amplitude of bone conduction VEMP compared to air conduction
VEMP. There was no statistically significant differences between the pre-operative perforated ears of CSOM cases and their
controls regarding bone conduction P13, N23 latencies, or P13–N23 amplitude. There was a significantly delayed P13 latency
and greater P13–N23 amplitude of bone conduction VEMP post-operatively compared to pre-operatively. But there was
no statistically significant difference between pre-operative and post-operative bone conduction N23 VEMP latency or interaural
amplitude difference. Bone conduction VEMP results were pre-operatively affected by the ABG and bone conduction,
but not post-operatively.
Conclusions: Air conduction VEMP in patients with CSOM showed a zero-percent response rate pre-operatively that did not
change post-operatively, whereas bone conduction VEMP showed a 100% response rate pre- and post-operatively. We therefore
recommend using bone rather than air conduction VEMP for assessment of the sacculo-collic reflex in patients with
CSOM who complain of balance problems.
Keywords: hearing loss • conductive • otitis media • suppurative • vestibular evoked myogenic potentials

Background
Cortical auditory evoked potentials (CAEPs) are noninvasive measures used to
quantify central auditory system function in humans. More specifically, the P1–N1–P2
cortical auditory evoked potential has a unique role in identifying the central auditory
system that has benefited from amplification or implantation. P1 reflects the maturation
of the auditory system in general as it has developed over time.
Objective
The aims of this study were to assess the CAEP in children with cochlear implants
compared with age-matched controls, to study the different variables affecting the
results, and to compare the pattern of P1 CAEP in cochlear implant patients compared
with that in those with hearing aids.
Methodology
Thirty-five hearing-impaired children (using cochlear implants) were compared with
20 age-matched and sex-matched children with normal hearing. In both groups,
P1 CAEP latency and waveform morphology were recorded using free-field auditory
stimulation with tone bursts at 500 and 2000 Hz at 100 dB sound pressure level in two
sessions that were 6 months apart.
Results
Children using cochlear implants exhibited prolongation of P1 latencies, indicating an
overall delay in maturation when compared with that in children who could hear
normally. P1 CAEP latency and amplitude improved significantly after 6 months of
device use.
Conclusion
Standardized age-appropriate normative data on P1 CAEPs in the pediatric Egyptian
population could be used to determine implantation or amplification results.
Keywords:
children, cochlear implant, cortical auditory evoked potentials, free field, P1
Egypt J Otolaryngol 29:263–268
& 2013 The Egyptian Oto - Rhino - Laryngological Society

Abstract
Objectives : Hyperacusis appears to be a subjective phenomenon, which is not easily defi ned or quantifi ed by objective
measurements. The primary aim of this work was to evaluate the Arabic version of the Khalfa questionnaire for hyperacusis
on a sample of normal hearing Egyptians complaining of hyperacusis. The secondary aim was to compare the audiological
criteria of this group of hyperacusis patients (with or without tinnitus) with a control group of similar age and
gender. Study design : The study group comprised 60 adult patients (age range 19 – 45 years) having normal hearing and
complaining of hyperacusis with or without tinnitus. The control group comprised 20 normal hearing age and gendermatched
individuals. All patients were subjected to full history-taking, otological examination, pure tone audiometry,
immittance audiometry, uncomfortable loudness levels (ULLs) assessment, a transient evoked otoacoustic emissions
(TEOAEs) test and, in addition, to the Arabic version of the Khalfa hyperacusis questionnaire. Results: The uncomfortable
loudness levels indicated a markedly contracted dynamic range in the hyperacusis group, with the majority of individuals
showing ULLs less than 90dB HL. Hyperacusis patients with tinnitus showed signifi cantly lower TEOAEs amplitudes, with
overall echo level and reproducibility percent lower than for hyperacusis patients without tinnitus or for the control group.
Hyperacusis patients had higher means of total, attentional, social, and emotional scores on the Khalfa questionnaire compared
to the control group. The emotional parameter of the questionnaire had the highest score for the hyperacusis patients.
Both the emotional and attentional dimension scores were higher in females, while attentional scores were higher for males.
The total and social dimensions were affected by age. Conclusions: The emotional impact of noise exposure was more severe
than the attentional and social impact in hyperacusis patients. There was a gender difference evident in the results of the
Khalfa questionnaire in hyperacusis patients. The Arabic version of the Khalfa hyperacusis questionnaire seems to be a
fairly effective tool for the assessment of hyperacusis patients.
Key words: hypersensitivity to sound , hyperacusis , questionnaire , noise exposure , hearing loss , tinnitus

Introduction
Studies using clinical tests have reported abnormal postural balance in children with
autism generally but it was only clinically significant when somatosensory input was
disrupted alone or in combination with other sensory challenges.
Objective
To assess the postural control system in autistic children and correlate their age and
Child Autism Rating Scale (CARS) score with their postural control.
Methods
Computerized dynamic posturography was performed in 20 autistic children with
(IQ470) between the ages of 5 and 15 years and 15 age-matched healthy children.
Results
There was a statistically significant positive correlation between age in both the study
and the control groups and the Sensory Organization Test (SOT) results in all SOT
conditions. As regards the degree of autism, this study included 20 autistic children
diagnosed by CARS and their CARS values ranged from 30 to 46, with a mean
(33.7 ± 3.22). In our study, we found that there was a statistically significant negative
correlation between the CARS score in the study group and SOT results in all
conditions, except in SOT condition 1.
Conclusion
The evidence from this study suggests the more general involvement of neural circuitry
beyond the neural systems for social behavior, communication, and reasoning, all of
which share a high demand on neural integration of information.
Keywords:
autism, autism spectrum disorder, children, development, postural control, sensory
analysis, sensory organization test
Egypt J Otolaryngol 28:44–48
& 2012 The Egyptian Oto - Rhino - Laryngological Society

Introduction
Hearing rehabilitation using nonlinear hearing aid (HA) fitting formulae provides
hearing-impaired individuals with the audibility, comfort, and speech intelligibility
for a better life.
Objective
To compare three nonlinear HA fitting formulae in adults in a Channel Free artificial
intelligence parallel processing HA.
Materials and methods
The study included 19 adults with bilateral moderate to severe sensorineural hearing
loss, monaurally fitted with nonlinear HA. Comparisons were made on the basis of
aided speech intelligibility in quiet and in noise, aided sound field thresholds, and
functional performance in real life using APHAB, COSI, and GHABP questionnaires.
Results
The three formulae have significantly improved speech discrimination in adults, with no
significant difference among the formulae for speech intelligibility in quiet or in noise,
with no sex or HA experience differences. The three formulae have significantly
improved functional performance in real-life speech communication, with the NAL-NL1-
based formula showing the greatest degree of benefit and improvement in listening
needs, followed by NAL-NL1 and then DSL [I/O]. However, amplification with the three
formulae increased aversiveness to environmental sounds. Participants reported
significant benefits using NAL and NAL-NL1-based formulae. Experienced HA users,
using the NAL-NL1-based formula, showed significantly less difficulty in listening
quality in large spaces and greater capacity to recognize speech within competitive
noise and better tolerance to environmental sounds than nonexperienced users.
The SPIN test correlated well with real-life speech communication.
Conclusion
The three fitting rationales have equally improved intelligibility, with variable degrees
of improvement in real-life speech communication with preferences for NAL-NL1 and
the manufacture-specific NAL-NL1-based formula

Summary
Objective: Congenital aural atresia prevents sound conduction to the inner ear, so the
child may suffer learning problems. Transmastoid approach is a safe method to create
functional pathway by which sound can reach the cochlear fluids but it leaves mastoid
cavity which may be problematic. The purpose of this study is to assess the feasibility
of improving hearing in those patients on the expense of mastoid cavity.
Methods: Forty children with congenital aural atresia were included in this study. All
had functioning cochlea on evoked response audiometry and normal cochlear morphology
with pneumatized mastoid on CT scan. Transmastoid approach was used for
reconstruction of the external auditory canal with covering of the newly created canal
using split thickness skin graft. Reconstruction of the tympanic membrane was carried
out by temporalis fascia graft. Follow-up of the patients for 3 years was carried out.
Results: Surgical success is considered on restoration of hearing and maintenance of a
patent, infection-free ear canal. This study showed a successful hearing result in 85%
of patients at 3 months postoperatively, this result diminished to 65% after 3 years.
The incidence of canal restenosis was 17.5%; the narrowing was in the outer
cartilaginous part. No cases developed facial nerve paralysis or sensorineural hearing
loss postoperatively.
Conclusions: Congenital aural atresia is one of the most difficult and challenging
surgeries for the otologic surgeon. However, in the hands of experienced otologists,
repair of this deformity can be performed safely and with predictable results using
transmastoid approach.
# 2008 Elsevier Ireland Ltd. All rights reserved

Abstract
Objective: Sensorineural hearing loss (SNHL) results in reduced sensitivity, abnormal growth of loudness, reduced frequency
selectivity and reduced temporal resolution (1). Our aim was to study frequency discrimination abilities in children with
SNHL using the psychophysical Pitch Pattern Sequence Test (PPST) and an electrophysiological measure, the Mismatch
Negativity Test (MMN). Methods: This is a cross-sectional study that included 90 children, ages ranging from 6 - 12 years,
divided into a study group of 60 children with mild to moderate SNHL and a control group of 30 normal hearing children.
Both groups were subdivided into 3 subgroups according to age. Results: Subgroups of children with SNHL showed statistically
signifi cant poorer scores on the PPST than their well-matched controls. Although MMN can be elicited in children
with mild to moderate degree of SNHL, its latency was prolonged. The older control subgroups did not show any statistically
signifi cant better scores on the PPST; MMN latencies were longer with increased duration of hearing loss. Degree of
hearing loss, gender and side had no effect on PPST or MMN. There was no statistically signifi cant correlation between
the results of the PPST and MMN. Conclusion: SNHL affects frequency discrimination abilities demonstrated in poor
scores on the PPST and prolonged MMN latency.
Key words: mismatch negativity, pitch pattern test, frequency discrimination , sensorineural hearing loss

. Introduction
Fast psychophysical tuning curve (fPTC) test is a fast computer-based method that aims to assess the frequency selectivity of the cochlea and to detect the dead regions. It can quickly identify tip frequency and Q10 of psychophysical tuning curves (PTCs) derived by using a band of noise that changes in center frequency and a Békésy method to adjust the masker level required for threshold of the noise. We applied this method in normal hearing individuals in the presence of threshold equalizing noises at three signal levels. The sharpness of the PTCs (Q10) and the typical shift of tips of the PTCs for 16 normal hearing individuals, when the tip frequency is estimated for the average of a forward and reverse sweep, were obtained. The results were used to determine the mean, SD, and 95% confidence interval of the shifts in normal hearing individuals.
ii-Objective
The purpose of this experiment was to estimate the typical shift of tips of the PTCs for normal hearing individuals. The results were used to determine the mean, SD, and 95% confidence interval of the shifts. The sharpness of the PTCs change with signal level under conditions where off-frequency listening is restricted, using a background noise, was also assessed. This was performed to allow a comparison with the results of hearing-impaired patients tested at
the same level (but without background noise).
Study design
Sixteen adults of both sexes (eight male individuals and eight female individuals) were
randomly selected to establish normative data for the fPTC test. They were selected with age ranging from 18 to 45 years. All individuals had normal middle ear function as indicated by tympanometry and acoustic reflex measurement and by hearing threshold equal to or better than 20 dB at octave frequencies in the frequency range (250–8000 Hz) (as defined by ANSI S3.6-2004).

Conclusion
This experiment aimed to gather baseline data for normal hearing individuals for comparison with data obtained from hearing-impaired patients. The typical shift of tips of the PTCs for normal hearing individuals, when the tip frequency is estimated for the average of a forward and reverse sweep, was estimated and the results will be used to determine the mean, SD, and 95% confidence interval of the shifts. This information is to be used to determine when the PTC for a hearing-impaired patient has a shifted tip (when the shift falls outside the 95% confidence interval for normal hearing individuals).

Introduction
Fast psychophysical tuning curve (fPTC) test is a fast computer-based method that aims to assess
the frequency selectivity of the cochlea and to detect the dead regions. It can quickly identify tip
frequency and Q10 of psychophysical tuning curves (PTCs) derived by using a band of noise
that changes in center frequency and a Békésy method to adjust the masker level required for
threshold of the noise. We applied this method in normal hearing individuals in the presence of
threshold equalizing noises at three signal levels. The sharpness of the PTCs (Q10) and the typical
shift of tips of the PTCs for 16 normal hearing individuals, when the tip frequency is estimated for
the average of a forward and reverse sweep, were obtained. The results were used to determine
the mean, SD, and 95% confidence interval of the shifts in normal hearing individuals.
Objective
The purpose of this experiment was to estimate the typical shift of tips of the PTCs for normal
hearing individuals. The results were used to determine the mean, SD, and 95% confidence
interval of the shifts. The sharpness of the PTCs change with signal level under conditions
where off-frequency listening is restricted, using a background noise, was also assessed. This
was performed to allow a comparison with the results of hearing-impaired patients tested at
the same level (but without background noise).
Study design
Sixteen adults of both sexes (eight male individuals and eight female individuals) were
randomly selected to establish normative data for the fPTC test. They were selected with
age ranging from 18 to 45 years. All individuals had normal middle ear function as indicated
by tympanometry and acoustic reflex measurement and by hearing threshold equal to or
better than 20 dB at octave frequencies in the frequency range (250–8000 Hz) (as defined
by ANSI S3.6-2004).
Keywords:
fast psychophysical tuning curves, Q10, tip frequency

Abstract
Objective: To study the effect of dual therapy with interferon and ribavirin on hearing in chronic HCV patients treated with
these medications. Study design: This was a cross-sectional study in which assessment of hearing and cochlear function was
carried out using pure tone audiometry and transient otoacoustic emissions (TEOAEs). Thirty young-aged adult patients
with chronic active hepatitis C virus (HCV) received dual treatment with interferon and ribavirin for at least three months.
They were compared to 30 chronic HCV patients for whom treatment was not applicable. Results: HCV patients under
treatment exhibited a mild high-frequency sensorineural hearing loss (SNHL) in 63.3% of subjects (unilateral in 36.7%
and bilateral in 26.7% of subjects). HCV patients not receiving treatment showed SNHL, which was unilateral in 13.3%
of subjects. In HCV patients under treatment 33% of subjects had a bilateral TEOAE pass and 30% of subjects had a
unilateral pass (unilateral partial pass). The remaining 37% of subjects had a bilateral partial pass, compared to a bilateral
pass in 96.67% of subjects not receiving treatment. There was a statistically signifi cant difference between the two groups
with regard to the hearing threshold at different frequencies and TEOAE overall wave reproducibility in both ears. Normal
hearing ears of those with a unilateral SNHL showed a lower pass rate (27.3%) than those of the bilateral normal hearing
group (54.5%), which suggests subtle changes in their cochleae. Conclusion: Dual interferon and ribavirin therapy for HCV
patients could damage the cochlear outer or inner hair cells.
Key words: audiometry , hepatitis , interferon , ribavirin , transient evoked otoacoustic emissions