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  1. Chahed N, Dzulkarnain AAA, Jamaluddin SA
    Malays J Med Sci, 2024 Apr;31(2):62-71.
    PMID: 38694577 DOI: 10.21315/mjms2024.31.2.7
    BACKGROUND: Auditory brainstem response (ABR) to the level-specific (LS) CE-Chirp has been reported to provide optimum neural synchrony along cochlear partitions, theoretically improving ABR waveform resolution. Despite this promising finding, limited studies have been conducted to contrast the results between LS CE-Chirp and Click stimuli. The current study aimed to compare the results of ABR between the two stimuli (Click and LS CE-Chirp).

    METHOD: Sixty-seven normal-hearing infants, both with and without risk factors, aged less than 7 months old, participated in this study. The ABR test was conducted at 70 dBnHL using 33.3 stimulus repetition rates with both Click and LS CE-Chirp stimuli. The signal averaging was stopped at a maximum fixed signal average of 2,500 sweeps. Data were statistically compared between the two stimuli using the Wilcoxon signed-rank test.

    RESULTS: The waves I and V ABRs elicited by LS CE-Chirp exhibited significantly larger amplitudes than the Click stimulus. However, the amplitude of wave III and absolute latencies were similar in both stimuli at a supra-threshold level.

    CONCLUSION: LS CE-Chirp has the advantage of larger amplitudes than the ABR from Click at the supra-threshold level (70 dBnHL) in normal-hearing infants.

  2. Dzulkarnain AAA, Azizi AK, Sulaiman NH
    J Taibah Univ Med Sci, 2020 Dec;15(6):495-501.
    PMID: 33318741 DOI: 10.1016/j.jtumed.2020.08.007
    Objective: This study aims to investigate the auditory sensory gating capacity in Huffaz using an auditory brainstem response (ABR) test with and without psychological tasks.

    Methods: Twenty-three participants were recruited for this study. The participants were comprised of 11 Huffaz who memorized 30 chapters of the Islamic Scripture (from the Quran) and 12 non-Huffaz as the control group. All participants had normal hearing perception and underwent an ABR test with and without psychological tasks. The ABR was elicited at 70 dB nHL using a 3000 Hz tone burst stimulus with a 2-0-2 cycle at a stimulus repetition rate of 40 Hz. The ABR wave V amplitude and latencies were measured and statistically compared. A forward digit span test was also conducted to determine participants' working memory capacity.

    Results: There were no significant differences in the ABR wave V amplitudes and latencies between Huffaz and non-Huffaz in ABR with and without psychological tasks. There were also no significant differences in the ABR wave V amplitudes and latencies in both groups of ABR with and without psychological tasks. In addition, no significant differences were identified in the digit span working memory score between both groups.

    Conclusions: In this study, based on the ABR findings, Huffaz showed the same auditory sensory gating capacity as the non-Huffaz group. The ABR result was consistent with the digit span working memory test score. This finding implies that both groups have similar working memory performance. However, the conclusion is limited to the specific assessment method that we used in this study.

  3. Dzulkarnain AAA, Sani MKA, Rahmat S, Jusoh M
    J Audiol Otol, 2019 Jul;23(3):121-128.
    PMID: 30857383 DOI: 10.7874/jao.2018.00381
    BACKGROUND AND OBJECTIVES: There is a scant evidence on the use of simulations in audiology (especially in Malaysia) for case-history taking, although this technique is widely used for training medical and nursing students. Feedback is one of the important components in simulations training; however, it is unknown if feedback by instructors could influence the simulated patient (SP) training outcome for case-history taking among audiology students. Aim of the present study is to determine whether the SP training with feedback in addition to the standard role-play and seminar training is an effective learning tool for audiology case-history taking.

    SUBJECTS AND METHODS: Twenty-six second-year undergraduate audiology students participated. A cross-over study design was used. All students initially attended two hours of seminar and role-play sessions. They were then divided into three types of training, 1) SP training (Group A), 2) SP with feedback (Group B), and 3) a non-additional training group (Group C). After two training sessions, the students changed their types of training to, 1) Group A and C: SP training with feedback, and 2) Group B: non-additional training. All the groups were assessed at three points: 1) pre-test, 2) intermediate, and 3) post-test. The normalized median score differences between and within the respective groups were analysed using non-parametric tests at 95% confidence intervals.

    RESULTS: Groups with additional SP trainings (with and without feedback) showed a significantly higher normalized gain score than no training group (p<0.05).

    CONCLUSIONS: The SP training (with/ without feedback) is a beneficial learning tool for history taking to students in audiology major.

  4. Rahmat S, Rahman SA, Tukiran NH, Musa R, Othman NA, Dzulkarnain AAA
    Med J Malaysia, 2021 03;76(2):205-211.
    PMID: 33742629
    OBJECTIVE: This study is a preliminary work to develop a Malay version questionnaire named 'Inventori Persepsi bagi Muslim yang Memiliki Masalah Pendengaran (IPM3P)' to assess the perception on Islamic understanding and practice among Muslim adults with hearing impairment.

    METHODS: The scale development involved three phases: i) generation of domains based on the literature, ii) generation of sub-domains based on literature review and Islamic panel survey, and iii) generation of items.

    RESULTS: Preliminary version of IPM3P consists of 59 items was produced, representing three domains: Obligation (18 items), Practice (21 items), and Difficulty (20 items), and seven sub-domains ('Ibadah', 'Aqidah', 'Muamalat', 'Tasawwuf', 'Akhlak','Da'wah', and 'Sirah').

    CONCLUSION: The preliminary version of IPM3P needs to be psychometrically tested. This pioneering study may become an impetus towards more research pertaining to understanding the effect of hearing loss towards religious life in the future in Malaysia.

  5. Zam Zam TZHBT, Dzulkarnain AAA, Rahmat S, Jusoh M
    J Audiol Otol, 2019 Jul;23(3):129-134.
    PMID: 30727717 DOI: 10.7874/jao.2018.00395
    BACKGROUND AND OBJECTIVES: Sine a self-reported questionnaire for hearing-impaired listeners is not available by Malay language yet, it is important to develop or translate any available existing questionnaires. The aim of this study was to translate, adapt and validate the Hearing Handicap Inventory for Adult (HHIA) to be used by the audiologist among the hearing-impaired population in Malaysia.

    SUBJECTS AND METHODS: The HHIAs was translated to Malay language using forward-backward translation techniques by four-panellists (two for each level). The translated HHIA was then reconciled and harmonized for cultural aspects and content of the questionnaire by the researchers and two expert panels before being pilot-tested among 10 hearing-impaired patients. Questionnaire validation was conducted among 80 adults with a hearing loss to calculate for Cronbach's α (internal reliability), Spearman's correlation (inter-item correlation) and factor analysis.

    RESULTS: None of the translated items were removed from the scale. The overall Cronbach's α was 0.964; 0.927 and 0.934 for both social and emotional subscales, respectively. The factor analysis (force-concept inventory) demonstrated a two-structure with a strong correlation between all items in either component 1 or 2, that resembled the original scale. The Mann-Whitney test revealed significantly higher scores for those adults with a hearing loss than those adults with normal hearing.

    CONCLUSIONS: The Malay HHIA has been successfully translated and validated for the purpose of determining the psychosocial aspects of adults with hearing loss in the local population.

  6. Dzulkarnain AAA, Rahmat S, Ismail AW, Musa R, Badzis M, Tengku Zam Zam TZH
    Med J Malaysia, 2019 04;74(2):168-173.
    PMID: 31079129
    INTRODUCTION: This paper describes the development and the evaluation of a new Two-dimensional (2D) computer-based (CB) Simulated Learning Environment (SLE) software for routine audiology tests that comes with learning assistance for audiology students. The aim of the study was to serve as preliminary evaluation on the effectiveness of the new 2D CB SLE audiology software among audiology students.

    MATERIALS AND METHODS: The development process of the new 2D CB SLE includes, (i) the identification of common errors made by students in the audiology clinic, (ii) the development of five case simulations that include four routine audiology tests incorporating learning assistance derived from the errors commonly made by audiology students and, (iii) the development of 2D CB SLE from a technical perspective. A preliminary evaluation of the use of the 2D CB SLE software was conducted among twenty-six second-year undergraduate audiology students.

    RESULTS: The pre-analysis evaluation of the new 2D CB SLE showed that the majority of the students perceived the new 2D CB SLE software as realistic and helpful for them in achieving the course learning outcomes and in improving their clinical skills. The mean overall scores among the twenty-six students using the self-reported questionnaire were significantly higher when using the 2D CB SLE software than with the existing software typically used in their SLE training.

    CONCLUSIONS: This new 2D CB SLE software has the potential for use by audiology students for enhancing their learning.

  7. Jusoh M, Dzulkarnain AAA, Rahmat S, Musa R, Che Azemin MZ
    Asia Pac Psychiatry, 2021 Jun;13(2):e12414.
    PMID: 32815284 DOI: 10.1111/appy.12414
    The aim of this study is to evaluate the psychometric properties of the Malay version of the Swanson, Nolan, and Pelham Parent Rating Scale of attention deficit hyperactivity disorders (ADHD) symptoms (M-SNAP-IV). For this purpose, the SNAP-IV scale was translated into the Malay language and was pilot-tested on 91 parents of children aged 8 to 11 years (ADHD [n = 36] and non-ADHD children [n = 55]). The findings depicted that the M-SNAP-IV has excellent content validity, internal consistency, and test-retest reliability. The M-SNAP-IV is a valid and reliable screening tool to detect ADHD symptoms in children and has the advantages to assess the specific presentation of ADHD.
  8. 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.

  9. Rahmat S, Yati IES, Musa R, A Rahman S, Ahmad NS, Dzulkarnain AAA
    Med J Malaysia, 2021 09;76(5):672-679.
    PMID: 34508373
    OBJECTIVE: The aims of this study are to measure the psychometric properties of the newly developed preliminary version of hearing impairment inventory for religious duties for Muslim adults, i.e., the Inventori Persepsi Bagi Muslim Yang Memiliki Masalah Pendengaran (IPM3P), and to produce a final version of IPM3P.

    METHODS: The preliminary version of IPM3P that is used to investigate the perception of Muslim adults with hearing impairment towards Islamic understanding and practice has been tested in this study. The preliminary version of IPM3P consists of three domains (obligation, practice, and difficulty) with 59 items in total. Four phases of validity and reliability testing involved were: i) Content validation, ii) Pretesting, face validity and proofreading, iii) Pilot study, and iv) Psychometric evaluation.

    RESULTS: The final version of IPM3P consists of 36 items. The findings from the present study suggest that the final version of IPM3P has excellent psychometric properties manifested by: i) good content validity, ii) excellently pretested, iii) good face validity, iv) good construct validity shown by principal component analysis and convergent validity, and v) good discriminant validity showed by divergent validity.

    CONCLUSION: IPM3P shows good potential to be used as a tool in investigating perception of Muslim adults towards Islamic understanding and practice.

  10. 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.

  11. 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.
  12. Amirullah NA, Rahmat S, Dzulkarnain AAA, Maamor N, Jamaludin MKA, Che Azemin MZ
    Med J Malaysia, 2022 Jan;77(1):12-19.
    PMID: 35086989
    INTRODUCTION: Sound therapy is one of the complementary or alternative interventions for various populations. The intensity of the sounds for sound therapy needs to be properly calibrated to ensure their accuracy and effectiveness. This paper aims to provide a general guideline for calibrating sound files using free software, specifically Audacity®.

    MATERIALS AND METHODS: Six sounds (broadband noise, rain, ocean, waterfall, Quranic chapters Al-Fatihah, and Yasin recitations) were calibrated at the intensity levels of 45, 50, 55, 60, 65, 70, 75, and 80dBA. The sounds were delivered through a pair of Sennheiser HD 280 Pro headphones connected to the Sound Blaster X-Fi Surround 5.1 Pro sound card. The long-term average of the sound pressure level over the time of recording (LAseq) was recorded using the 3M SoundPro Class 1 1/3 Octave RTA sound level meter (SLM). The desired intensity levels were obtained by making adjustments to the sound files via the Audacity® software.

    RESULTS: All sound files were calibrated at the targeted levels as verified by the value of LAseq.

    CONCLUSIONS: Calibration of audio files can be done using a free/open-source software, as all six sound files were successfully calibrated at the targeted levels of 45, 50, 55, 60, 65, 70, 75, and 80dBA. The calibration steps provided in this paper can be easily applied by other researchers for similar purposes, with precautions when calibrating at low levels.

  13. Dzulkarnain AAA, Noor Ibrahim SHM, Anuar NFA, Abdullah SA, Tengku Zam Zam TZH, Rahmat S, et al.
    Int J Audiol, 2017 Oct;56(10):723-732.
    PMID: 28415891 DOI: 10.1080/14992027.2017.1313462
    OBJECTIVE: To investigate the influence of two different electrode montages (ipsilateral: reference to mastoid and vertical: reference to nape of neck) to the ABR results recorded using a level-specific (LS)-CE-Chirp® in normally hearing subjects at multiple intensities levels.

    DESIGN: Quasi-experimental and repeated measure study designs were applied in this study. Two different stopping criteria were used, (1) a fixed-signal averaging 4000 sweeps and, (2) a minimum quality indicator of Fmp = 3.1 with a minimum of 800 sweeps.

    STUDY SAMPLE: Twenty-nine normally hearing adults (18 females, 11 male) participated.

    RESULTS: Wave V amplitudes were significantly larger in the LS CE-Chirp® recorded from the vertical montage than the ipsilateral montage. Waves I and III amplitudes were significantly larger from the ipsilateral LS CE-Chirp® than from the other montages and stimulus combinations. The differences in the quality of the ABR recording between the vertical and ipsilateral montages were marginal.

    CONCLUSIONS: Overall, the result suggested that the vertical LS CE-Chirp® ABR had a high potential for a threshold-seeking application, because it produced a higher wave V amplitude. The Ipsilateral LS CE-Chirp® ABR, on the other hand, might also have a high potential for the site of lesion application, because it produced larger waves I and III amplitudes.

  14. Dzulkarnain AAA, Abdullah SA, Ruzai MAM, Ibrahim SHMN, Anuar NFA, Rahim 'EA
    Am J Audiol, 2018 Sep 12;27(3):294-305.
    PMID: 30054628 DOI: 10.1044/2018_AJA-17-0087
    Purpose: The purpose of this study was to investigate the influence of 2 different electrode montages (ipsilateral and vertical) on the auditory brainstem response (ABR) findings elicited from narrow band (NB) level-specific (LS) CE-Chirp and tone-burst in subjects with normal hearing at several intensity levels and frequency combinations.

    Method: Quasi-experimental and repeated-measures study designs were used in this study. Twenty-six adults with normal hearing (17 females, 9 males) participated. ABRs were acquired from the study participants at 3 intensity levels (80, 60, and 40 dB nHL), 3 frequencies (500, 1000, and 2000 Hz), 2 electrode montages (ipsilateral and vertical), and 2 stimuli (NB LS CE-Chirp and tone-burst) using 2 stopping criteria (fixed averages at 4,000 sweeps and F test at multiple points = 3.1).

    Results: Wave V amplitudes were only 19%-26% larger for the vertical recordings than the ipsilateral recordings in both the ABRs obtained from the NB LS CE-Chirp and tone-burst stimuli. The mean differences in the F test at multiple points values and the residual noise levels between the ABRs obtained from the vertical and ipsilateral montages were statistically not significant. In addition, the ABR elicited from the NB LS CE-Chirp was significantly larger (up to 69%) than those from the tone-burst, except at the lower intensity level.

    Conclusion: Both the ipsilateral and vertical montages can be used to record ABR to the NB LS CE-Chirp because of the small enhancement in the wave V amplitude provided by the vertical montage.

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