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Fulltext Test-Retest Reliability of Level-Specific CE-Chirp Auditory Brainstem Response in Normal-Hearing Adults

Jamal FN, Arafat Dzulkarnain AA, Shahrudin FA, Marzuki MN

J Audiol Otol, 2021 Jan;25(1):14-21.
PMID: 32575950 DOI: 10.7874/jao.2020.00073

BACKGROUND AND OBJECTIVES: There is growing interest in the use of the Level-specific (LS) CE-Chirp® stimulus in auditory brainstem response (ABR) due to its ability to produce prominent ABR waves with robust amplitudes. There are no known studies that investigate the test-retest reliability of the ABR to the LS CE-Chirp® stimulus. The present study aims to investigate the test-retest reliability of the ABR to the LS CE-Chirp® stimulus and compare its reliability with the ABR to standard click stimulus at multiple intensity levels in normal-hearing adults.
SUBJECTS AND METHODS: Eleven normal-hearing adults participated. The ABR test was repeated twice in the same clinical session and conducted again in another session. The ABR was acquired using both the click and LS CE-Chirp® stimuli at 4 presentation levels (80, 60, 40, and 20 dBnHL). Only the right ear was tested using the ipsilateral electrode montage. The reliability of the ABR findings (amplitudes and latencies) to the click and LS CE-Chirp® stimuli within the same clinical session and between the two clinical sessions was calculated using an intra-class correlation coefficient analysis (ICC).
RESULTS: The results showed a significant correlation of the ABR findings (amplitude and latencies) to both stimuli within the same session and between the clinical sessions. The ICC values ranged from moderate to excellent.
CONCLUSIONS: The ABR results from both the LS CE-Chirp® and click stimuli were consistent and reliable over the two clinical sessions suggesting that both stimuli can be used for neurological diagnoses with the same reliability.
Translation, validation and cross-cultural adaptation of the Malay emotion regulation checklist (ERC-M): A preliminary study

Jamal FN, Dzulkarnain AAA, Shahrudin FA, Musa R, Sidek SN, Yusof HM, et al.

Med J Malaysia, 2021 09;76(5):680-684.
PMID: 34508374

INTRODUCTION: Emotion Regulation Checklist (ERC) has been used globally and translated to several languages, including Brazilian Portuguese, Italian and Persian. The aim of this study is to translate and validate ERC to the Malay language and to measure the reliability and validity of the translated version of this scale among Malaysian parents.
METHODS: This study involved forward and back translation method. The translated questionnaire was then pretested and piloted among 10 parents and 50 participants, respectively. The procedure was repeated using the same questionnaire to evaluate the test-retest reliability.
RESULTS: The ERC-Malay (ERC-M) has excellent qualitative and quantitative measurements in both item-level content validation index (I-CVI) and scale-level content validation index (S-CVI). In addition, the ERC-M demonstrated good internal consistency from Cronbach's alpha and test-retest reliability based on the Intraclass Correlation Coefficient (ICC) in all domains.
CONCLUSION: ERC-M can potentially be used as a tool to evaluate emotion for the population with emotional dysregulation issue, such as autism spectrum disorder.
Fulltext Influence of Stimulus Polarity on the Auditory Brainstem Response From Level-Specific Chirp

Dzulkarnain AAA, Salamat S, Shahrudin FA, Jamal FN, Zakaria MN

J Audiol Otol, 2021 Oct;25(4):199-208.
PMID: 34425654 DOI: 10.7874/jao.2021.00248

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.
Effects of Stimulus Repetition Rates on the Auditory Brainstem Response to Level-Specific CE-Chirp in Normal-Hearing Adults

Dzulkarnain AAA, Shahrudin FA, Jamal FN, Marzuki MN, Mazlan MNS

Am J Audiol, 2020 Dec 09;29(4):838-850.
PMID: 32966099 DOI: 10.1044/2020_AJA-20-00049

Purpose The purpose of this study is to investigate the influence of stimulus repetition rates on the auditory brainstem response (ABR) to Level-Specific (LS) CE-Chirp and click stimuli at multiple intensity levels in normal-hearing adults. Method A repeated-measure study design was used on 13 normal-hearing adults. ABRs were acquired from the study participants using LS CE-Chirp and click stimuli at four stimulus repetition rates (19.1, 33.3, 61.1, and 81.1 Hz) and four intensity levels (80, 60, 40, and 20 dB nHL). The ABR test was stopped at 40-nV residual noise level. Results High-stimulus repetition rates caused the ABR latencies to be longer and have reduced amplitudes in both ABR to LS CE-Chirp and click stimuli. The ABR to LS CE-Chirp Wave I, III, and V amplitudes were larger than ABR to click in almost all the stimulus repetition rates. However, there were no differences in the number of averages required to reach the stopping criterion between ABR to LS CE-Chirp and click stimulus, and between high-stimulus repetition rates and low-stimulus repetition rates. Conclusion The LS CE-Chirp at standard low-stimulus repetition rates can be used to elicit ABR for both neurodiagnostic and threshold seeking procedure.
Fulltext Music and Sound-Based Intervention in Autism Spectrum Disorder: A Scoping Review

Shahrudin FA, Dzulkarnain AAA, Hanafi AM, Jamal FN, Basri NA, Sidek SN, et al.

Psychiatry Investig, 2022 Aug;19(8):626-636.
PMID: 36059051 DOI: 10.30773/pi.2021.0382

To map the evidence from the relevant studies regarding the use of music and sound-based intervention for autism spectrum disorder (ASD) using a scoping review study design. Scoping review was conducted according to the inclusion criteria using Google Scholar, PubMed, CINAHL, MEDLINE, and Scopus. The review was accomplished in five steps: 1) identify the inclusion criteria, 2) search for relevant studies, 3) studies selection, 4) data extraction and charting, and 5) data analysis and presentation. Four major themes emerged from 39 studies that matched the inclusion criteria as follows: 1) forms of sound therapy discussing methods of sound therapy and stimulus used, 2) duration of the intervention explain in terms of listening time and total listening sessions, 3) clinical characteristics of the intervention exploring the main interest of sound therapy study in ASD, and 4) evidence for the intervention effectiveness looking into the positive, negative, and mixed findings of previous studies. Each theme was explored to identify the knowledge gaps in sound-intervention therapy. This review demonstrated the need for further studies to address several issues including identifying the effectiveness of sound-therapy intervention for ASD according to the individual sound types, the minimum duration for ASD sound-therapy intervention and more details on the use of technology, and clinical features of the sound-therapy intervention. These elements are important to further demonstrate the effectiveness of sound therapy intervention for ASD children.
Fulltext Influence of Different Types of Contralateral Suppression Tones on Otoacoustic Emission in Children With Autism Spectrum Disorder

Jamal FN, Dzulkarnain AAA, Basri NA, Rahmat S, Shahrudin FA, Azemin MZC, et al.

J Audiol Otol, 2025 Jan;29(1):49-56.
PMID: 39916400 DOI: 10.7874/jao.2024.00353

BACKGROUND AND OBJECTIVES: Auditory sensory gating deficits are abnormalities in patients with autism spectrum disorder (ASD) that may lead to sensory processing difficulties. It is particularly difficult for children with ASD to distinguish multiple auditory stimuli, which hinders them from focusing on a single auditory stimulus and separating unnecessary sounds. Suppression of otoacoustic emission (OAE) is an approach used to identify sensory gating deficits in the general population, specifically for children with ASD. This study aimed to investigate the suppression effect of various types of sound suppressors to measure their sensory gating capacity in children with ASD. Subjects and.
METHODS: Twenty children including 10 with ASD and 10 normally developing children aged 6-12 years were recruited for this study. One accessible ear was exposed to transient-evoked OAE, whereas the other was exposed to suppressor tones. Contralateral suppressors included white noise, Quranic recitations, environmental noise, and natural sound. The magnitude of OAE suppression was determined from the difference between the OAE amplitude with and without the masker (in dB sound pressure levels) for all sound types. The sound with the highest suppression effect was determined using effect size calculation and repeated-measures analysis of variance at a 95% confidence level. A high suppression effect may suggest a high sensory gating performance, whereas low suppression may indicate low sensory gating performance.
RESULTS: Based on the analysis, the sound with the highest suppression effect was that of the waterfall. The suppression results were supported by descriptive analysis findings and effect-size calculations.
CONCLUSIONS: This study provides a better understanding of the alternative sound stimuli, besides the standard white noise tone, for the assessment of sensory gating deficits among children with ASD. Sounds with a high suppression effect have the potential to be used as sound therapy interventions for children with ASD as part of rehabilitation and therapy.