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Due to contradictory outcomes in the literature, the aim of this meta-analysis is to verify whether the narrowband (NB) CE-Chirp stimulus (centred at 500 Hz) would produce more robust cervical vestibular evoked myogenic potential (cVEMP) responses relative to the conventional 500 Hz tone burst. The literature search was conducted using PubMed, Scopus, and Web of Science databases and the terms used were "vestibular evoked myogenic potential" and "chirp". The cVEMP parameters to be analysed were P1 latency, N1 latency, and P1-N1 amplitude. A total of 59 potential articles were obtained from the database search. Eventually, five articles were found to be eligible for the meta-analysis (with n = 222). As found, P1 and N1 latencies of cVEMP were significantly shorter for the chirp stimulus (p < 0.001), with substantially large effect sizes. On the other hand, P1-N1 amplitude values were found to be not statistically different between the two stimuli (p = 0.189), with a small effect size. It appears that there is no indication to support the superiority of the NB CE-Chirp stimulus (centred at 500 Hz) in the cVEMP testing (relative to the conventional 500 Hz tone burst). In particular, both stimuli produce comparable P1-N1 amplitude values. Even though P1 and N1 latencies are statistically shorter for the chirp stimulus, this may not reflect that it should be the preferred stimulus for recording cVEMP responses (and the reasons for this are discussed accordingly).

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OBJECTIVE: Various studies have been conducted to search for the most optimal stimulus for eliciting cervical vestibular evoked myogenic potential (cVEMP). More recently, there is a growing interest to study the usefulness of chirp stimuli in cVEMP recording. Nevertheless, contradictory outcomes have been reported across the studies, and further research with larger samples would be beneficial to provide better insight into this matter. As such, the present study was carried out to compare cVEMP results between narrowband (NB) CE-Chirp (centered at 500 Hz) and 500 Hz tone burst stimuli. DESIGN: In this study that employed a comparative study design, 98 normally hearing adults aged between 19 and 24 years were enrolled. All of them underwent the cVEMP testing based on the recommended test protocol. The stimuli were a 500 Hz tone burst and a NB CE-Chirp (360-720 Hz) presented through insert earphones at an intensity level of 120.5 dB peSPL. RESULTS: For each stimulus, cVEMP results did not differ significantly between the ears ( p > 0.05). Relative to the 500 Hz tone burst, the NB CE-Chirp stimulus produced statistically shorter P1 and N1 latencies ( p < 0.001). On the other hand, P1-N1 amplitude was found to be comparable between the two stimuli ( p > 0.05). CONCLUSIONS: The present study did not find any supporting evidence that the NB CE-Chirp stimulus (centered at 500 Hz) outperformed the conventional 500 Hz tone burst in the cVEMP testing. Both stimuli are considered equally appropriate to record cVEMP responses in clinical settings.

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There has been a growing interest in studying the usefulness of chirp stimuli in recording cervical vestibular evoked myogenic potential (cVEMP) waveforms. Nevertheless, the study outcomes are debatable and require verification. In view of this, the aim of the present study was to compare cVEMP results when elicited by 500 Hz tone burst and narrowband (NB) CE-Chirp stimuli in adults with sensorineural hearing loss (SNHL). Fifty adults with bilateral SNHL (aged 20-65 years) underwent the cVEMP testing based on the established protocol. The 500 Hz tone burst and NB CE-Chirp (centred at 500 Hz) stimuli were presented to each ear at an intensity level of 120.5 dB peSPL. P1 latency, N1 latency, and P1-N1 amplitude values were analysed accordingly. The NB CE-Chirp stimulus produced significantly shorter P1 and N1 latencies (p < 0.001) with large effect sizes (d > 0.80). In contrast, both stimuli elicited cVEMP responses with P1-N1 amplitude values that were not statistically different from one another (p = 0.157, d = 0.15). Additionally, age and hearing level were found to be significantly correlated (r = 0.56, p < 0.001), as were age and cVEMP amplitude for each stimulus (p < 0.001). To conclude, since both stimuli were presented at an equivalent intensity level (in dB peSPL), the shorter P1 and N1 latencies of cVEMP produced by the NB CE-Chirp stimulus (centred at 500 Hz) were unlikely due to enhanced saccular stimulation. Another more sensible reason is the temporal adjustment of the chirp stimulus.

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INTRODUCTION: Dysphagia is a common disorder among stroke patients. Dysphagia can lead to consequences that can negatively impact the quality of life (QoL) in stroke patients. AIM: To investigate the impact of dysphagia on the QoL in stroke patients. METHODS: Relevant types of literature were searched from PubMed, Scopus, ProQuest, and Google Scholar databases from inception to July 2022. Peerreviewed studies that aimed to determine the impact of dysphagia on the QoL in stroke patients were included regardless of the year of publication. The National Institutes of Health tool for observational cohort and cross-sectional studies was used to assess the methodological quality of the selected studies. In addition, data analysis was conducted using qualitative methodology with narrative synthesis. RESULTS: A total of 6 studies met the inclusion criteria with a total number of 381 participants. Only one study has good methodological quality while other studies have fair methodological quality. Dysphagia negatively impacts the QoL in stroke patients, especially those with severe dysphagia. However, after treatment, changes were evident through improved QoL and decreased severity of dysphagia. Moreover, the research found that patients with a higher educational level have a better QoL. CONCLUSION: Dysphagia has a negative impact on the QoL in stroke patients, so dysphagia in stroke patients should be diagnosed and treated as soon as possible to avoid poor QoL.

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Auditory-perceptual rating of voice is one component of voice evaluation, and the CAPE-V is one of the tools for this purpose. Because of its advantages, the CAPE-V has been adapted into several languages. Accordingly, the adaptation of the CAPE-V into Malay is essential for its utility among the Malaysian population, which this study aimed to accomplish. This study involved translating the CAPE-V into Malay, termed the Malay CAPE-V, followed by establishing its validity. The translation processes (ie, forward translation and backward translation) involved four different translators ie, three speech-language therapists (SLTs), and one linguist with at least 14 years of experience. Most items were similarly translated, except for a few, which were subsequently accepted as similar, following consensus among the translators. In the examination of content validity, two raters (ie, SLTs) with at least 12 years of clinical experience reviewed and scored the tested items. Given that the scale-level content validity index average value (S-CVI/Ave) was above the acceptable level, all items were retained. The examination of construct validity and concurrent validity involved ratings of voice samples recorded from 38 participants, comprising 19 individuals with normal and disordered voices, respectively. The ratings were performed by three raters (ie, SLTs) with at least 12 years of clinical experience. For the construct validity, the Mann-Whitney U test indicated significantly higher scores of the vocal parameters of the Malay CAPE-V for the disordered voice group than for the normal voice group. Meanwhile, for the concurrent validity, the Spearman correlation indicated that all relationships between the scores of the vocal parameters of the Malay CAPE-V and GRBAS Scale were significant, with most of them achieving a very strong positive correlation. The results demonstrated that the Malay CAPE-V is a valid tool for an auditory-perceptual rating of voice among the Malaysian population.

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BACKGROUND AND OBJECTIVES: Despite few reports on the influence of ambient acoustic noise on auditory brainstem response (ABR) to click stimuli, its effects on ABR to level-specific (LS) stimuli have not been systematically investigated. This study aimed to investigate the influence of ambient acoustic noise on ABR findings using both LS chirp and click stimuli. SUBJECTS AND METHODS: Twelve normal-hearing adults participated in this repeated measure design study. The ABRs were acquired at 80, 50, and 30 dBnHL using two stimuli (LS chirp and click) under two conditions (quiet and noise). The ABRs under noise conditions were acquired using babble noise and white noise. The noise level was set at 55 dBA. Two-way repeated measure analysis was used to identify the main effects of the test conditions, stimulus types, and their interactions at a 95% confidence level. RESULTS: No significant influence of ambient acoustic noise on ABR findings was identified at all intensity levels. No significant difference was found in the number of signal averages to reach the 0.04 µV residual noise as stopping criteria among the ABRs recorded with different types of stimuli and test conditions. The ABR waves I and V amplitudes were larger with LS chirp than with click stimulus. CONCLUSIONS: Ambient acoustic noise has no significant influence on ABR findings and the ABR test time based on the 55 dBA noise level used in this study.

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Objectives: Weber test is typically conducted using tuning forks, but an audiometer can also be used for a similar purpose. Compared to the tuning fork Weber (TFW) test, performing the audiometric Weber (AW) test offers many advantages. Nevertheless, AW and TFW tests' performance compared to pure-tone audiometry (PTA) has yet to be studied. The present study aimed to determine the accuracy and agreement between the AW and TFW tests compared to PTA. Methods: In this observational cross-sectional study, 74 participants (aged 12-67 years) with unilateral conductive hearing loss (CHL) or bilateral asymmetrical CHL were enrolled. The TFW test was performed according to the established protocol at 256 and 512 Hz. For the AW test, the bone vibrator was placed in the middle of the forehead, where 250 and 500 Hz frequencies were tested. TF and AW test results were then compared with the expected lateralization from the respective PTA results. Results: At 256 Hz (or 250 Hz), the overall accuracy values of TFW and AW tests were 81.1% and 86.5%, respectively. At 512 Hz (or 500 Hz), the overall accuracy results of TFW and AW tests were 85.1% and 82.4%, respectively. In addition, the kappa statistics revealed substantial agreements between the two tests and PTA (k = .63-.72). Conclusion: Both AW and TFW tests are reasonably accurate in assessing patients with CHL. It is recommended for audiologists to perform the simple AW test to verify incomplete or questionable audiograms that are commonly encountered in clinical practice. Level of evidence: Level 3b.

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BACKGROUND: The non-invasive tympanic electrocochleography (TM-ECochG) is useful for clinical diagnoses. Nevertheless, the influence of the electrode location on tympanic membrane (TM) on ECochG results needs to be studied. OBJECTIVE: The aim of the present study was to compare the TM-ECochG results obtained when the electrode was placed on the superior region versus the inferior region of TM. MATERIALS AND METHODS: Forty healthy adults (aged 29 to 50 years) participated in this comparative study. The TM-ECochG testing was conducted with the electrode placed on the superior and inferior regions of TM. RESULTS: SP and AP amplitudes were statistically higher for the inferior region of TM (p < .05). In contrast, SP/AP ratios were comparable between the two regions of TM (p = .417). CONCLUSIONS AND SIGNIFICANCE: In TM-ECochG recording, when the electrode was placed on the inferior region of TM, SP and AP amplitudes were greater than when the electrode was placed on the superior region of TM. On the other hand, SP/AP amplitude ratio was not affected by the location of electrode on TM. The findings from the present study could be useful to guide clinicians in optimizing TM-ECochG recording when testing their respective patients.

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BACKGROUND AND OBJECTIVES: No known studies have investigated the influence of stimulus polarity on the Auditory Brainstem Response (ABR) elicited from level-specific (LS) chirp. This study is important as it provides a better understanding of the stimulus polarity selection for ABR elicited from LS chirp stimulus. We explored the influence of stimulus polarity on the ABR from LS chirp compared to the ABR from click at 80 dBnHL in normal-hearing adults. SUBJECTS AND PURPOSE: Nineteen adults with normal hearing participated. The ABRs were acquired using click and LS chirp stimuli using three stimulus polarities (rarefaction, condensation, and alternating) at 80 dBnHL. The ABRs were tested only on the right ear at a stimulus rate of 33.33 Hz. The ABR test was stopped when the recording reached the residual noise level of 0.04 µV. The ABRs amplitudes, absolute latencies, inter-peak latencies (IPLs), and the recorded number of averages were statistically compared among ABRs at different stimulus polarities and stimuli combinations. RESULTS: Rarefaction polarity had the largest ABR amplitudes and SNRs compared with other stimulus polarities in both stimuli. There were marginal differences in the absolute latencies and IPLs among stimulus polarities. No significant difference in the number of averages required to reach the stopping criteria was found. CONCLUSIONS: Stimulus polarities have a significant influence on the ABR to LS chirp. Rarefaction polarity is recommended for clinical use because of its larger ABR peak I, III, and V amplitudes than those of the other stimulus polarities.

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BACKGROUND: The graviceptive otolith function can be measured using subjective visual horizontal (SVH) testing. Nevertheless, more research efforts are required to understand the essential variables affecting SVH. OBJECTIVE: The aim of the present study was to determine the effects of type of visual image and gender on subjective visual horizontal (SVH) perception among healthy adults. MATERIALS AND METHODS: In this comparative study, 50 healthy young adults were enrolled. While in an upright body position, they were required to report their perception of horizontality for two types of visual images (solid line and arrow pattern) using a computerized SVH device. RESULTS: The arrow pattern produced significantly bigger SVH angles than the solid line (p < .001). In contrast, no significant influence of gender was found on SVH results (p = .743), Based on the statistical outcomes, the preliminary normative data for SVH were established. CONCLUSIONS AND SIGNIFICANCE: The arrow pattern (a more complex visual image) produced bigger SVH deviations than the simple solid line image. In contrast, the horizontality perception does not appear to be affected by gender. The preliminary normative SVH data gathered from the present study can be beneficial for clinical and future research applications.

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OBJECTIVE: Vestibular assessments in children are essential for the early identification of vestibular and balance dysfunctions. Vestibular evoked myogenic potentials, cervical (cVEMPs) and ocular (oVEMPs) have been reported to be feasible and effective when assessing otolith function in children. The main aim of the study was to obtain normative data for cVEMPs and oVEMPs from preschool and primary school-aged Malaysian children. METHODS: A group of 33 healthy children, aged from 5 years 9 months-12 years 4 months (mean ± SD = 8.83 ± 1.92 years), was recruited. Their otolith saccular function was assessed using 750 Hz tone burst for cVEMPs (with ER3A insert phone), while their utricular function was assessed using Brüel & Kjaer Mini-shaker Type 4810 (Naerum, Denmark) for oVEMPs. RESULTS: For cVEMPs, the mean value of P13 latency, N23 latency, P13-N23 interamplitude and asymmetry ratio were 12.62 ± 1.38 ms, 19.85 ± 1.95 ms, 92.47 ± 50.35 µV and 14.03 ± 9.75%, respectively. For oVEMPs, the mean value of N10 latency, P15 latency, N10-P15 interamplitude and asymmetry ratio were 9.23 ± 1.07 ms, 14.41 ± 1.04 ms, 10.32 ± 5.65 µV and 15.84 ± 11.49%, respectively. Two-way ANOVA analysis found that ear laterality and gender had no significant effect on all cVEMPs and oVEMPs parameters. No significant correlation was found between age and all VEMPs parameters. CONCLUSIONS: The normative data for cVEMPs and oVEMPs obtained in this study can be used as a guide by health professionals to assess saccular and utricular functions among children age from 5 to 12 years of age.

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OBJECTIVE: Language disorders can affect reading skills contributing to poor academic achievements. As such, it is vital for speech language pathologists to identify the potential language-based reading problems among children. To achieve this, specific reading assessments should be developed and studied. Thus, the present study aimed to determine the effects of gender and academic achievement on oral reading fluency (ORF) and silent reading fluency (SRF) among Year 2 Malaysian children. METHODS: In this study that employed a comparative design, fifty-nine typically developing Malaysian children (24 boys, aged from 8 years, 0 months to 8 years, 11 months) were enrolled. They were chosen from three different classrooms (consisting of high achieving, medium achieving and low achieving students, respectively) in a primary school. Their ORF and SRF skills were assessed according to the established methods. RESULTS: As revealed by two-way ANOVA results, both ORF and SRF scores were found to be comparable between boys and girls (p > 0.05). In contrast, ORF and SRF results between the three classrooms were significantly different from each other (p < 0.05). CONCLUSION: The present study provides the first report on oral and silent reading fluency skills among Year 2 Malaysian school children. While the gender effect was insignificant, low achieving students showed poorer reading fluency skills. The preliminary normative data for ORF and SRF provided by the present study are beneficial for future research applications.

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BACKGROUND AND OBJECTIVES: The cortical auditory evoked potential (CAEP) is a useful objective test for diagnosing hearing loss and auditory disorders. Prior to its clinical applications in the pediatric population, the possible influences of fundamental variables on the CAEP should be studied. The aim of the present study was to determine the effects of age and type of stimulus on the CAEP waveforms. SUBJECTS AND METHODS: Thirty-five healthy Malaysian children aged 4 to 12 years participated in this repeated-measures study. The CAEP waveforms were recorded from each child using a 1 kHz tone burst and the speech syllable /ba/. Latencies and amplitudes of P1, N1, and P2 peaks were analyzed accordingly. RESULTS: Significant negative correlations were found between age and speech-evoked CAEP latency for each peak (p< 0.05). However, no significant correlations were found between age and tone-evoked CAEP amplitudes and latencies (p>0.05). The speech syllable /ba/ produced a higher mean P1 amplitude than the 1 kHz tone burst (p=0.001). CONCLUSIONS: The CAEP latencies recorded with the speech syllable became shorter with age. While both tone-burst and speech stimuli were appropriate for recording the CAEP, significantly bigger amplitudes were found in speech-evoked CAEP. The preliminary normative CAEP data provided in the present study may be beneficial for clinical and research applications in Malaysian children.

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The present study aimed to determine the test-retest reliability of subjective visual horizontal (SVH) testing when tested with solid and dotted line images. In this repeated measures study, 36 healthy young Malaysian adults (mean age=23.3±2.3 years, 17 males and 19 females) were enrolled. All of them were healthy and had no hearing, vestibular, balance, or vision problems. The SVH angles were recorded from each participant in an upright body position using a computerized device. They were asked to report their horizontality perception for solid and dotted line images (in the presence of a static black background). After 1 week, the SVH procedure was repeated. The test-retest reliability of SVH was found to be good for both solid line [intraclass correlation (ICC)=0.80] and dotted line (ICC=0.78). As revealed by Bland-Altman plots, for each visual image, the agreements of SVH between the two sessions were within the clinically accepted criteria (±2°). The SVH testing was found to be temporally reliable, which can be clinically beneficial. Both solid and dotted lines in the SVH testing are reliable to be used among young adults.

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Abstract Introduction: Binaurally evoked auditory evoked potentials have good diagnostic values when testing subjects with central auditory deficits. The literature on speech-evoked auditory brainstem response evoked by binaural stimulation is in fact limited. Gender disparities in speech-evoked auditory brainstem response results have been consistently noted but the magnitude of gender difference has not been reported. Objective: The present study aimed to compare the magnitude of gender difference in speech-evoked auditory brainstem response results between monaural and binaural stimulations. Methods: A total of 34 healthy Asian adults aged 19-30 years participated in this comparative study. Eighteen of them were females (mean age = 23.6 ± 2.3 years) and the remaining sixteen were males (mean age = 22.0 ± 2.3 years). For each subject, speech-evoked auditory brainstem response was recorded with the synthesized syllable /da/ presented monaurally and binaurally. Results: While latencies were not affected (p > 0.05), the binaural stimulation produced statistically higher speech-evoked auditory brainstem response amplitudes than the monaural stimulation (p < 0.05). As revealed by large effect sizes (d > 0.80), substantive gender differences were noted in most of speech-evoked auditory brainstem response peaks for both stimulation modes. Conclusion: The magnitude of gender difference between the two stimulation modes revealed some distinct patterns. Based on these clinically significant results, gender-specific normative data are highly recommended when using speech-evoked auditory brainstem response for clinical and future applications. The preliminary normative data provided in the present study can serve as the reference for future studies on this test among Asian adults.

Resumo Introdução: Potenciais auditivos evocados de modo binaural apresentam bons valores diagnósticos ao testar indivíduos com déficits auditivos centrais. A literatura sobre a resposta do potencial evocado do tronco encefálico com estímulo de fala de modo binaural é, de fato, limitada. As diferenças de gênero nos resultados desse exame têm sido consistentemente observadas, mas a magnitude da diferença de gênero ainda não foi relatada. Objetivo: Comparar a magnitude da diferença de gênero nos resultados do potencial evocado do tronco encefálico com estímulo de fala entre estímulos monaural e binaural. Método: Um total de 34 adultos asiáticos saudáveis com idades entre 19 e 30 anos participaram deste estudo comparativo. Dezoito deles eram do sexo feminino (média de idade = 23,6 ± 2,3 anos) e os outros dezesseis do sexo masculino (média de idade = 22,0 ± 2,3 anos). Para cada indivíduo, o potencial evocado do tronco encefálico com estímulo de fala foi registrado com a sílaba sintetizada /da/ apresentada de forma monaural e binaural. Resultados: Embora as latências não tenham sido afetadas (p > 0,05), a estimulação binaural produziu amplitudes de potencial evocado do tronco encefálico com estímulo de fala estatisticamente maiores do que a estimulação monaural (p < 0,05). Como demonstrado pelos grandes tamanhos de efeito (d > 0,80), diferenças substanciais de gênero foram observadas na maioria dos picos de potencial evocado do tronco encefálico com estímulo de fala para ambos os modos de estímulo. Conclusão: A magnitude da diferença de gênero entre os dois modos de estímulo revelou alguns padrões distintos. Com base nesses resultados clinicamente significantes, os dados normativos específicos para o gênero são altamente recomendados quando se usa o potencial evocado do tronco encefálico com estímulo de fala para aplicações clínicas e futuras. Os dados normativos preliminares fornecidos pelo presente estudo podem servir como referência para futuros estudos sobre esse exame em asiáticos adultos.

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INTRODUCTION: Acoustic reflex (AR) is a valuable clinical test for hearing diagnosis. Parameters of AR such as its amplitude and threshold have been commonly reported in research. Acoustic reflex latency (ARL) has not been widely studied and more research is warranted to determine its basic properties and clinical usefulness. The present study aimed to determine the influences of stimulation mode and stimulus frequency on ARL. METHODS: In this study, 52 healthy young adults were enrolled (mean age = 23.2 ± 0.8 years, 61.8% were males). They underwent the standard AR testing and ARL values were computed. Both ipsilateral and contralateral recordings were made at 500, 1000, 2000 and 4000 Hz frequencies. RESULTS: The ARL values obtained are consistent with the findings from the previous studies. Two-way analysis of variance (ANOVA) revealed that the ARL values were not statistically influenced by either stimulation mode (p = 0.061) or stimulus frequency (p = 0.598). CONCLUSION: Among young adults, ARL does not appear to be influenced by stimulation mode and stimulus frequency. Further large scale research is warranted to support the present study's findings. The preliminary normative data for ARL obtained in this study can serve as the reference for future research involving this particular population.

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