Temporal resolution and pitch discrimination in music education: novel data in children.

BACKGROUND: Rehabilitation of hearing and listening difficulties through neuroplasticity of the auditory nervous system is a promising technique. Evidence of enhanced auditory processing in adult musicians is often not based on clinical auditory processing tests and is lacking in children with musical education. PURPOSE: The aim of this study is to investigate the temporal resolution and frequency discrimination elements of auditory processing both in adults and children with musical education and to compare them with those without any musical education. METHODS: Participants consisted of ten children without musical training and ten children with musical training with mean age 11.3 years and range 8-15 years as well as ten adults without musical education and ten adults with musical education with mean age 38.1 years and range 30-45 years. All participants were tested with two temporal resolution tests (GIN:Gaps-In-Noise and RGDT:Random Gap Detection Test), a temporal ordering frequency test (FPT:Frequency Pattern Test), and a frequency discrimination test (DLF: Different Limen for Frequency). RESULTS: All test results revealed better performance in both children and adults with musical training for both ears. CONCLUSION: A positive effect of formal music education for specific auditory processing elements in both children and adults is documented. Larger samples, longitudinal studies, as well as groups with impaired hearing and/or auditory processing are needed to further substantiate the effect shown.

A systematic review and metanalysis of questionnaires used for auditory processing screening and evaluation.

The recognition of Auditory Processing Disorder (APD) as a distinct clinical condition that impacts hearing capacity and mental health has gained attention. Although pure tone audiometry is the gold standard for assessing hearing, it inadequately reflects everyday hearing abilities, especially in challenging acoustic environments. Deficits in speech perception in noise, a key aspect of APD, have been linked to an increased risk of dementia. The World Health Organization emphasizes the need for evaluating central auditory function in cases of mild hearing loss and normal audiometry results. Specific questionnaires play a crucial role in documenting and quantifying the difficulties faced by individuals with APD. Validated questionnaires such as the Children's Auditory Processing Performance Scale, the Fisher's Auditory Problems Checklist, and the Auditory Processing Domains Questionnaire are available for children, while questionnaires for adults include items related to auditory functions associated with APD. This systematic review and meta-analysis identified six questionnaires used for screening and evaluating APD with a total of 783 participants across 12 studies. The questionnaires exhibited differences in domains evaluated, scoring methods, and evaluation of listening in quiet and noise. Meta-analysis results demonstrated that individuals with APD consistently exhibited worse scores compared to healthy controls across all questionnaires. Additionally, comparisons with clinical control groups showed varying results. The study highlights (i) the importance of standardized questionnaires in identifying and assessing APD, aiding in its diagnosis and management, and (ii) the need to use sub-scores as well as overall scores of questionnaires to elaborate on specific hearing and listening situations. There is a need to develop more APD specific questionnaires for the adult population as well as for more focused research on APD diagnosed individuals to further establish the validity and reliability of these questionnaires.

Auditory Processing in Musicians, a Cross-Sectional Study, as a Basis for Auditory Training Optimization.

Μusicians are reported to have enhanced auditory processing. This study aimed to assess auditory perception in Greek musicians with respect to their musical specialization and to compare their auditory processing with that of non-musicians. Auditory processing elements evaluated were speech recognition in babble, rhythmic advantage in speech recognition, short-term working memory, temporal resolution, and frequency discrimination threshold detection. All groups were of 12 participants. Three distinct experimental groups tested included western classical musicians, Byzantine chanters, and percussionists. The control group consisted of 12 non-musicians. The results revealed: (i) a rhythmic advantage for word recognition in noise for classical musicians (M = 12.42) compared to Byzantine musicians (M = 9.83), as well as for musicians compared to non-musicians (U = 120.50, p = 0.019), (ii) better frequency discrimination threshold of Byzantine musicians (M = 3.17, p = 0.002) compared to the other two musicians' group for the 2000 Hz region, (iii) statistically significant better working memory for musicians (U = 123.00, p = 0.025) compared to non-musicians. Musical training enhances elements of auditory processing and may be used as an additional rehabilitation approach during auditory training, focusing on specific types of music for specific auditory processing deficits.

Sensitivity Analysis in Economic Evaluations of Immuno-Oncology Drugs: A Systematic Literature Review.

OBJECTIVES: This study aimed to review, assess, and report the characteristics and strategies of sensitivity analyses (SAs) that were performed in the context of published economic evaluations of immuno-oncology drugs. METHODS: The systematic literature search was conducted in Scopus and MEDLINE for articles published from 2005 to 2021. Study selection, based on a predefined set of criteria, was performed by 2 reviewers independently. We included economic evaluations of Food and Drug Administration-approved immuno-oncology drugs that were published in English and assessed the accompanying SAs on a set of items, including the range justification of the baseline parameters within the deterministic SA, the provisions for the correlation/overlay between parameters, and the justification of the chosen parameter distribution for the probabilistic SA, among others. RESULTS: A total of 98 of 295 publications met the inclusion criteria. A total of 90 studies included a one-way and probabilistic SA and 16 of 98 studies had one-way and scenario analysis, alone or together with probabilistic analysis. Most studies provide explicit references as to the choice of parameters and values; nevertheless, there is a lack of a reference of correlation/overlay between parameters in most of the evaluations. In 26 of 98 studies, the most influential parameter for the incremental cost-effectiveness ratio was the under-evaluation drug cost. CONCLUSIONS: Most of included articles contained an SA that was implemented according to commonly accepted published guidance. The under-evaluation drug cost, the estimates of progression-free survival, the hazard ratio for overall survival, and the time horizon of the analysis seem to play an important part in the robustness of the outcomes.

Early Prediction of Planning Adaptation Requirement Indication Due to Volumetric Alterations in Head and Neck Cancer Radiotherapy: A Machine Learning Approach.

BACKGROUND: During RT cycles, the tumor response pattern could affect tumor coverage and may lead to organs at risk of overdose. As such, early prediction of significant volumetric changes could therefore reduce potential radiation-related adverse effects. Nevertheless, effective machine learning approaches based on the radiomic features of the clinically used CBCT images to determine the tumor volume variations due to RT not having been implemented so far. METHODS: CBCT images from 40 HN cancer patients were collected weekly during RT treatment. From the obtained images, the Clinical Target Volume (CTV) and Parotid Glands (PG) regions of interest were utilized to calculate 104 delta-radiomics features. These features were fed on a feature selection and classification procedure for the early prediction of significant volumetric alterations. RESULTS: The proposed framework was able to achieve 0.90 classification performance accuracy while detecting a small subset of discriminative characteristics from the 1st week of RT. The selected features were further analyzed regarding their effects on temporal changes in anatomy and tumor response modeling. CONCLUSION: The use of machine learning algorithms offers promising perspectives for fast and reliable early prediction of large volumetric deviations as a result of RT treatment, exploiting hidden patterns in the overall anatomical characteristics.

On the Difference of Scoring in Speech in Babble Tests.

Hearing is a complex ability that extends beyond the peripheral auditory system. A speech in noise/competition test is a valuable measure to include in the test battery when attempting to assess an individual's "hearing". The present study compared syllable vs. word scoring of the Greek Speech-in-Babble (SinB) test with 22 native Greek speaking children (6-12-year-olds) diagnosed with auditory processing disorder (APD) and 33 native Greek speaking typically developing children (6-12-year-olds). A three-factor analysis of variance revealed greater discriminative ability for syllable scoring than word scoring, with significant interactions between group and scoring. Two-way analysis of variance revealed SinB word-based measures (SNR50%) were larger (poorer performance) than syllable-based measures for both groups of children. Cohen's d values were larger for syllable-based mean scores compared to word-based mean scores between groups for both ears. These findings indicate that the type of scoring affects the SinB's resolution capacity and that syllable scoring might better differentiate typically developing children and children with APD.

Implications for Early Diagnosis and Treatment in Schizophrenia Due to Correlation between Auditory Perceptual Deficits and Cognitive Impairment.

It is indicated that auditory perception deficits are present in schizophrenia and related to formal thought disorder. The purpose of the present study was to investigate the association of auditory deficits with cognitive impairment in schizophrenia. An experimental group of 50 schizophrenia patients completed a battery of auditory processing evaluation and a neuropsychological battery of tests. Correlations between neuropsychological battery scores and auditory processing scores were examined. Cognitive impairment was correlated with auditory processing deficits in schizophrenia patients. All neuropsychological test scores were significantly correlated with at least one auditory processing test score. Our findings support the coexistence of auditory processing disorder, severe cognitive impairment, and formal thought disorder in a subgroup of schizophrenia patients. This may have important implications in schizophrenia research, as well as in early diagnosis and nonpharmacological treatment of the disorder.

Deformable image registration to assist clinical decision for radiotherapy treatment adaptation for head and neck cancer patients.

Head and neck (H&N) cancer patients often present anatomical and geometrical changes in tumors and organs at risk (OARs) during radiotherapy treatment. These changes may result in the need to adapt the existing treatment planning, using an expert's subjective opinion, for offline adaptive radiotherapy and a new treatment planning before each treatment, for online adaptive radiotherapy. In the present study, a fast methodology is proposed to assist in planning adaptation clinical decision using tumor and parotid glands percentage volume changes during treatment. The proposed approach was applied to 40 Η&Ν cases, with one planning Computed Tomography (pCT) image and CBCT scans for 6 weeks of treatment per case. Deformable registration was used for each patient's pCT image alignment to its weekly CBCT. The calculated transformations were used to align each patient's anatomical structures to the weekly anatomy. Clinical target volume (CTV) and parotid gland volume percentage changes were calculated in each case. The accuracy of the achieved image alignment was validated qualitatively and quantitatively. Furthermore, statistical analysis was performed to test if there is a statistically significant correlation between CTV and parotid glands volume percentage changes. Average MDA for CTV and parotid glands between corresponding structures defined by an expert in CBCTs and automatically calculated through registration was 1.4 ± 0.1 mm and 1.5 ± 0.1 mm, respectively. The mean registration time of the first CBCT image registration for 40 cases was lower than 3.4 min. Five patients show more than 20% tumor volume change. Six patients show more than 30% parotid glands volume change. Ten out of 40 patients proposed for planning adaptation. All the statistical tests performed showed no correlation between CTV/parotid glands percentage volume changes. The aim to assist in clinical decision making on a fast and automatic way was achieved using the proposed methodology, thereby reducing workload in clinical practice.

Remote Microphone Hearing Aid Use Improves Classroom Listening, Without Adverse Effects on Spatial Listening and Attention Skills, in Children With Auditory Processing Disorder: A Randomised Controlled Trial.

BACKGROUND: Children with Auditory Processing Disorder (APD) often have poor auditory processing skills in the presence of normal peripheral hearing. These children have worse listening-in-noise skills compared to typically developing peers, while other commonly reported symptoms include poor attention and distractibility. One of the management strategies for children with APD is the use of Remote Microphone Hearing Aids (RMHAs), which can help improve the signal-to-noise ratio in the child's ears. The aim of this randomised controlled trial was to examine whether RMHAs improved classroom listening in children with APD, and to further test their effects on children's listening-in-noise and attention skills following a 6-month intervention. METHODS: Twenty-six children diagnosed with APD, aged 7-12, in primary mainstream education, were randomised into the intervention (N = 13) and control group (N = 13). The primary outcome measure was the Listening Inventory for Education - Revised questionnaire, completed by children to assess their listening using RMHAs under several acoustically challenging situations in the classroom. Secondary outcome measures included the Listening in Spatialised Noise - Sentences test, assessing speech-in-noise perception and spatial listening, and the Test of Everyday Attention for Children, assessing different types of attention skills. Tests were conducted in unaided conditions. Mixed analysis of variance was used to analyse the data. The clinical trial was registered at clinicaltrials.gov (unique identifier: NCT02353091). RESULTS: The questionnaire scores of self-reported listening skills in the classroom significantly improved in the intervention group after 3, MD = 7.31, SE = 2.113, p = 0.014, and after 6 months, M = 5.00, SE = 1.468, p = 0.016. The behavioural measures of listening-in-noise and attention did not significantly change. CONCLUSION: Use of RMHAs improves classroom listening, evidenced by the results of the questionnaire analysis, while a 6-month use did not have adverse effects on unaided spatial listening or attention skills.

Absence of Rhythm Benefit on Speech in Noise Recognition in Children Diagnosed With Auditory Processing Disorder.

Auditory processing disorder (APD) is a specific deficit in the processing of auditory information along the central auditory nervous system. It is characterized mainly by deficits in speech in noise recognition. APD children may also present with deficits in processing of auditory rhythm. Rhythmic neural entrainment is commonly present in perception of both speech and music, while auditory rhythmic priming of speech in noise has been known to enhance recognition in typical children. Here, we test the hypothesis that the effect of rhythmic priming is compromised in APD children, and further assessed for correlations with verbal and non-verbal auditory processing and cognition. Forty APD children and 33 neurotypical ones were assessed through (a) WRRC, a test measuring the effects of rhythmic priming on speech in noise recognition, (b) a battery of auditory processing tests, commonly used in APD diagnosis, and (c) two cognitive tests, assessing working memory and auditory attention respectively. Findings revealed that (a) the effect of rhythmic priming on speech in noise recognition is absent in APD children, (b) it is linked to non-verbal auditory processing, and (c) it is only weakly dependent on cognition. We discuss these findings in light of Dynamic Attention Theory, neural entrainment and neural oscillations and suggest that these functions may be compromised in APD children. Further research is needed (a) to explore the nature of the mechanics of rhythmic priming on speech in noise perception and why the effect is absent in APD children, (b) which other mechanisms related to both rhythm and language are also affected in this population, and (c) whether music/rhythm training can restore deficits in rhythm effects.

Auditory processing disorder may be present in schizophrenia and it is highly correlated with formal thought disorder.

The present study investigates the presence of Auditory Processing Disorder (APD) in schizophrenia and its association with symptomatology, especially Formal Thought Disorder (FTD). 50 patients with schizophrenia and 25 matched healthy controls completed a battery of three auditory processing tests. Positive and Negative Syndrome Scale (PANSS) and Thought, Language and Communication (TLC) scale were used to assess clinical symptoms. The patient group was divided into two subgroups, according to FTD severity. Auditory processing performance of the control group and the patient group was evaluated. Correlations between auditory processing scores and TLC scores, as well as auditory processing scores and PANSS scores were examined. Most of the patients, especially those with FTD, had auditory deficits that can be classified as APD. Patients showed impaired performance compared to controls in all tests. Total severity and specific factors of FTD, as well as other clinical symptoms and symptom categories were correlated with auditory processing performance. We provided evidence that APD may be present in schizophrenia and that FTD, as well as other clinical symptoms are associated with auditory processing deficits. There are important clinical implications for non-pharmacological interventions and early diagnosis of schizophrenia.

Test-retest reliability of the Greek Speech-in-babble test (SinB) as a potential screening tool for auditory processing disorder.

INTRODUCTION: There seems to exist a specific group of people considered to be at higher risk of having Auditory Processing Disorders (APD). These patients are frequently initially referred to, or managed by various professionals such as Otolaryngologists, Speech Therapists, and Occupational Therapists. It is, therefore, essential to retain a low threshold of when to refer such individuals for a formal APD diagnostic evaluation. Under these circumstances, there might be a role for the Greek Speech-in-Babble (SinB) recognition test as a screening tool for abnormal auditory processing competency. OBJECTIVE: To explore the test-retest reliability of a diagnostically validated speech-in-babble test, the Greek SinB, as a potential screening tool. METHODS: Ten health professionals coming from various disciplines administered the SinB test twice, under conditions similar to those encountered when using it as a screening tool, and test-retest reliability was assessed. 93 Greek-speaking individuals, of whom 27 adults and 66 children or young adolescents aged five years old or more, served as our study sample. RESULTS: For the right ear, the Intraclass Correlation Coefficient (ICC) was 0.858 with a 95% confidence interval (CI) = 0.786-0.906. Slightly better conditions apply for the left ear, as the ICC was 0.873 with 95% CI = 0.809-0.916. These 95% CIs indicate a 'good' to 'excellent' level of reliability for both ears. Spearman's rho was 0.86 and 0.71 for the right and left ear, respectively. CONCLUSION: Our results suggest that the test possesses the required reliability to evaluate a subject's hearing abilities under screening conditions. On these terms, it could be used to screen populations considered as being at risk for Auditory Processing Disorders. Forthcoming research should focus on establishing its efficiency by comparing the results of the screening test with that of diagnostic tests and on fine-tuning SinB as a screening tool.

Clinical Expertise Is Core to an Evidence-Based Approach to Auditory Processing Disorder: A Reply to Neijenhuis et al. 2019.

The opinion article "An Evidence-based Perspective on Misconceptions Regarding Pediatric Auditory Processing Disorder" by Neijenhuis et al. (1) presents a distorted view of the evidence-based approach used in medicine. The authors focus on the amorphous non-diagnostic entity "listening difficulties" not auditory processing disorder (APD) and create confusion that could jeopardize clinical services to individuals with APD. In our perspective article, we rebut Neijenhuis et al. (1), and more importantly, we present a rationale for evidence-based practice founded on the premise that research on APD is only clinically applicable when conducted on clinical populations diagnosed with APD.

Deficits in Auditory Rhythm Perception in Children With Auditory Processing Disorder Are Unrelated to Attention.

Auditory processing disorder (APD) is defined as a specific deficit in the processing of auditory information along the central auditory nervous system, including bottom-up and top-down neural connectivity. Even though music comprises a big part of audition, testing music perception in APD population has not yet gained wide attention in research. This work tests the hypothesis that deficits in rhythm perception occur in a group of subjects with APD. The primary focus of this study is to measure perception of a simple auditory rhythm, i.e., short isochronous sequences of beats, in APD children and to compare their performance to age-matched normal controls. The secondary question is to study the relationship between cognition and auditory processing of rhythm perception. We tested 39 APD children and 25 control children aged between 6 and 12 years via (a) clinical APD tests, including a monaural speech in noise test, (b) isochrony task, a test measuring the detection of small deviations from perfect isochrony in a isochronous beats sequence, and (c) two cognitive tests (auditory memory and auditory attention). APD children scored worse in isochrony task compared to the age-matched control group. In the APD group, neither measure of cognition (attention nor memory) correlated with performance in isochrony task. Left (but not right) speech in noise performance correlated with performance in isochrony task. In the control group a large correlation (r = -0.701, p = 0.001) was observed between isochrony task and attention, but not with memory. The results demonstrate a deficit in the perception of regularly timed sequences in APD that is relevant to the perception of speech in noise, a ubiquitous complaint in this condition. Our results suggest (a) the existence of a non-attention related rhythm perception deficit in APD children and (b) differential effects of attention on task performance in normal vs. APD children. The potential beneficial use of music/rhythm training for rehabilitation purposes in APD children would need to be explored.

Behavioral assessment of auditory processing deficits in schizophrenia: Literature review and suggestions for future research.

During the last decades, a considerable number of studies about auditory processing deficits in schizophrenia have been published, some of them using the term of Auditory Processing Disorder (APD). Due to heterogeneous methodology and inconsistent results concrete conclusions may not be straightforward. We focused on studies that used at least one behavioral test for the assessment of auditory processing in schizophrenia, in order to identify new evidence on auditory processing deficits in schizophrenia, and to consider fields for future research. 28 studies met inclusion criteria and are presented in this review. The articles were divided into three groups, those that implemented a test battery approach, those that used only Dichotic Listening (DL), those that used DL along with imaging or electrophysiology techniques. Most of the studies that implemented a test battery showed significant performance differences between patients and controls. This indicates APD presence. Due to the limited number of studies implementing a test battery, this is not conclusive. The majority of all studies that used a DL task showed that patients' performance or laterality was significantly lower than that of controls. Age, duration of illness, total and specific positive symptoms seem to affect significantly DL performance and auditory laterality. The results support the existence of various schizophrenia subgroups that differ in their auditory processing performance, and also have structural and functional specificities. Further research in the field is needed, especially studies that implement a test battery, and studies that examine possible correlations between clinical variables and auditory processing deficits.