Caregiver's Quality of Life Among Children with Cerebral Palsy in the Kingdom of Saudi Arabia, and Various Influencing Factors: A Single Cohort Study.

Purpose: Quality of life (QOL) among disabled children and their caregivers is an important concern in healthcare. We aim to evaluate the quality of life among caregivers of children with cerebral palsy and to observe the effects of various demographic factors and affected child-related factors on caregivers' quality of life. Patients and Methods: After ethical approval and written consent was obtained from the participants. One hundred six caregivers of children with cerebral palsy from the Asir region were recruited for the study. Caregivers provided details, including their demographic characteristics, social factors, and information regarding their affected children regarding age, gender, mobility levels, etc. They also completed the Arabic version of the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire for assessing their QOL. Results: All the caregivers were women; their mean age was 40.38 years and SD7.09, and the overall QOL mean and standard deviations were 66.38 ± 12.88. There was a moderately significant correlation between total QOL in comparison with caregivers' educational level and mobility capacity, with R values of 0.54 (p<0.001) and 0.62 (p<0.001), respectively. Conclusion: All the subdomains of WHOQOL-BREF were found to be very closely related to the total scores for QOL. The caregivers of children with cerebral palsy had better QOL scores than the cutoff scores proposed in the WHOQOL-BREF scale. Factors such as increased mobility and education of the affected child contributed to better total QOL scores.

The effect of recreational noise exposure on amplitude-modulation detection, hearing sensitivity at frequencies above 8 kHz, and perception of speech in noise.

Psychoacoustic and speech perception measures were compared for a group who were exposed to noise regularly through listening to music via personal music players (PMP) and a control group without such exposure. Lifetime noise exposure, quantified using the NESI questionnaire, averaged ten times higher for the exposed group than for the control group. Audiometric thresholds were similar for the two groups over the conventional frequency range up to 8 kHz, but for higher frequencies, the exposed group had higher thresholds than the control group. Amplitude modulation detection (AMD) thresholds were measured using a 4000-Hz sinusoidal carrier presented in threshold-equalizing noise at 30, 60, and 90 dB sound pressure level (SPL) for modulation frequencies of 8, 16, 32, and 64 Hz. At 90 dB SPL but not at the lower levels, AMD thresholds were significantly higher (worse) for the exposed than for the control group, especially for low modulation frequencies. The exposed group required significantly higher signal-to-noise ratios than the control group to understand sentences in noise. Otoacoustic emissions did not differ for the two groups. It is concluded that listening to music via PMP can have subtle deleterious effects on speech perception, AM detection, and hearing sensitivity over the extended high-frequency range.

The effect of age and hearing sensitivity at frequencies above 8 kHz on auditory stream segregation and speech perception.

The effects of age and mild hearing loss over the extended high-frequency (EHF) range from 9000 to 16 000 Hz on speech perception and auditory stream segregation were assessed using four groups: (1) young with normal hearing threshold levels (HTLs) over both the conventional and EHF range; (2) older with audiograms matched to those for group 1; (3) young with normal HTLs over the conventional frequency range and elevated HTLs over the EHF range; (4) older with audiograms matched to those for group 3. For speech in quiet, speech recognition thresholds and speech identification scores did not differ significantly across groups. For monosyllables in noise, both greater age and hearing loss over the EHF range adversely affected performance, but the effect of age was much larger than the effect of hearing status. Stream segregation was assessed using a rapid sequence of vowel stimuli differing in fundamental frequency (F0). Larger differences in F0 were required for stream segregation for the two groups with impaired hearing in the EHF range, but there was no significant effect of age. It is argued that impaired hearing in the EHF range is associated with impaired auditory function at lower frequencies, despite normal audiometric thresholds at those frequencies.

Long-Term Average Speech Spectra and Dynamic Ranges of 17 Indian Languages.

PURPOSE: In this work, we have determined the long-term average speech spectra (LTASS) and dynamic ranges (DR) of 17 Indian languages. This work is important because LTASS and DR are language-dependent functions used to fit hearing aids, calculate the Speech Intelligibility Index, and recognize speech automatically. Currently, LTASS and DR functions for English are used to fit hearing aids in India. Our work may help improve the performance of hearing aids in the Indian context. METHOD: Speech samples from native talkers were used as stimuli in this study. Each speech sample was initially cleaned for extraneous sounds and excessively long pauses. Next, LTASS and DR functions for each language were calculated for different frequency bands. Similar analysis was also performed for English for reference purposes. Two-way analysis of variance was also conducted to understand the effects of important parameters on LTASS and DR. Finally, a one-sample t test was conducted to assess the significance of important statistical attributes of our data. RESULTS: We showed that LTASS and DR for Indian languages are 5-10 dB and 11 dB less than those for English. These differences may be due to lesser use rate of high-frequency dominant phonemes and preponderance of vowel-ending words in Indian languages. We also showed that LTASS and DR do not differ significantly across Indian languages. Hence, we propose a common LTASS and DR for Indian languages. CONCLUSIONS: We showed that differences in LTASS and DR for Indian languages vis-à-vis English are large and significant. Such differences may be attributed to phonetic and linguistic characteristics of Indian languages.

Influence of Alignment Strategies and Consonant Acoustic Features on Laterality Index in Dichotic Testing in Indian Languages.

BACKGROUND: The right ear advantage (REA) observed for dichotic CV (DCV) testing in Indian languages is seen to be smaller compared with the observations in several studies in English and other languages. PURPOSE: The present study aims to explore whether the differences in the temporal alignment of consonant-vowel (CV) stimuli used for the dichotic task is a contributing factor that can explain the smaller REAs observed in Indian languages. RESEARCH DESIGN: The study compared the laterality index (LI) values between DCV test results obtained using CV stimuli that were temporally aligned at the acoustic onset versus the burst onset, with 0 milliseconds lag between the right and left ears. STUDY SAMPLE: A total of 50 right-handed individuals (native speakers of Kannada language) in the age range of 17 to 30 years with normal hearing sensitivity participated in the study. DATA COLLECTION AND ANALYSIS: The participants' responses to the two sets of DCV stimuli were recorded and compared. LI was calculated for the overall scores as well as for specific voiced and unvoiced segment combinations. To test the reliability of the findings, 10 of the participants were re-tested using the same stimuli and the data were checked for reliability. RESULTS: The overall LI was 15.1% for the stimuli temporally aligned at the burst onset, whereas it was 5.7% for the stimuli temporally aligned at the acoustic onset. The difference in LI was not significant between the alignment conditions for unvoiced-unvoiced and voiced-voiced CV combinations, but this difference was significant for the unvoiced-voiced and voiced-unvoiced CV combinations. Comparing test and re-test scores showed good reliability. CONCLUSION: The results support our hypothesis that smaller REA observed in DCV task in Indian languages was due to the temporal alignment of CV stimuli. In the acoustic-onset-aligned condition, presenting pairs contrasting in the voicing feature tends to cancel out a relative ear advantage.

The Relationship Between Tinnitus Pitch, Audiogram Edge Frequency, and Auditory Stream Segregation Abilities in Individuals With Tinnitus.

Purpose Around 80%-93% of the individuals with tinnitus have hearing loss. Researchers have found that tinnitus pitch was related to the frequencies of hearing loss, but unclear about the relationship between tinnitus pitch and audiometry edge frequency. The comorbidity of tinnitus and speech perception in noise problems had also been reported, but the relationship between tinnitus pitch and speech perception in noise had seldom been investigated. This study was designed to estimate the relationship between tinnitus pitch, audiogram edge frequency, and speech perception in noise. The speech perception in noise was measured using auditory stream segregation paradigm. Method Thirteen individuals with bilateral mild-to-severe tonal tinnitus and minimal-to-mild cochlear hearing loss were selected. Thirteen individuals with hearing loss without tinnitus were also selected. The audiogram of each participant with tinnitus was matched with that of the participant without tinnitus. Tinnitus pitch of the participants with tinnitus was measured and compared with audiogram edge frequency. The stream segregation thresholds were calculated at the participants' admitted tinnitus pitch and one octave below the tinnitus pitch. The stream segregation thresholds were estimated at fission and fusion boundary using pure-tone stimuli in ABA paradigm. Results High correlation between tinnitus pitch and audiogram edge frequency was noted. Overall stream segregation thresholds were higher for individuals with tinnitus. Higher thresholds indicated poorer stream segregation abilities. Within tinnitus participants, the thresholds were significantly lesser at frequency corresponding to admitted tinnitus pitch than at one octave below the tinnitus pitch. Conclusions The information from this study may be helpful in educating the patients about the relationship between hearing loss and tinnitus. The findings may also account for speech-perception-in-noise difficulties often reported by the individuals with tinnitus.

Narrow-band ripple glide direction discrimination and its relationship to frequency selectivity estimated using psychophysical tuning curves.

The highest spectral ripple density at which the discrimination of ripple glide direction was possible (STRtdir task) was assessed for one-octave wide (narrowband) stimuli with center frequencies of 500, 1000, 2000, and 4000 Hz and for a broadband stimulus. A pink noise lowpass filtered at the lower edge frequency of the rippled-noise stimuli was used to mask possible combination ripples. The relationship between thresholds measured using the STRtdir task and estimates of the sharpness of tuning (Q10) derived from fast psychophysical tuning curves was assessed for subjects with normal hearing (NH) and cochlear hearing loss (CHL). The STRtdir thresholds for the narrowband stimuli were highly correlated with Q10 values for the same center frequency, supporting the idea that STRtdir thresholds for the narrowband stimuli provide a good measure of frequency resolution. Both the STRtdir thresholds and the Q10 values were lower (worse) for the subjects with CHL than for the subjects with NH. For both the NH and CHL subjects, mean STRtdir thresholds for the broadband stimulus were not significantly higher (better) than for the narrowband stimuli, suggesting little or no ability to combine information across center frequencies.

Effect of ripple repetition rate on discrimination of ripple glide direction and the detection of brief tones in spectro-temporal ripple noise.

The effect of temporal repetition rate R on the discrimination and internal representation of stimuli with spectro-temporal ripples was examined. Experiment 1 measured the highest ripple density D at which upward- and downward-gliding ripples could be discriminated. Thresholds varied only slightly for R from 2 to 8 Hz, with a median threshold just above 5 ripples/oct. The threshold decreased (worsened) when R was increased to 16 and 32 Hz, suggesting that the limited temporal resolution of the auditory system plays a role for these higher values of R. Experiment 2 explored the internal representation of stimuli with static and downward-gliding spectral ripples by measuring the detection threshold for a brief tone presented at a peak or a valley in the stimulus spectrum. Thresholds were generally higher when the signal was at a peak than when it was at a valley. The peak-valley difference tended to decrease with increasing D, and the variation of thresholds with D was greater for low R than for high R. The results suggest that the discrimination of spectro-temporal ripples is limited mainly by frequency resolution for lower ripple rates (up to 4-8 Hz) but temporal resolution plays a major role for higher rates.

Development of equally intelligible Telugu sentence-lists to test speech recognition in noise.

OBJECTIVE: To develop sentence lists in the Telugu language for the assessment of speech recognition threshold (SRT) in the presence of background noise through identification of the mean signal-to-noise ratio required to attain a 50% sentence recognition score (SRTn). DESIGN: This study was conducted in three phases. The first phase involved the selection and recording of Telugu sentences. In the second phase, 20 lists, each consisting of 10 sentences with equal intelligibility, were formulated using a numerical optimisation procedure. In the third phase, the SRTn of the developed lists was estimated using adaptive procedures on individuals with normal hearing. STUDY SAMPLE: A total of 68 native Telugu speakers with normal hearing participated in the study. Of these, 18 (including the speakers) performed on various subjective measures in first phase, 20 performed on sentence/word recognition in noise for second phase and 30 participated in the list equivalency procedures in third phase. RESULTS: In all, 15 lists of comparable difficulty were formulated as test material. The mean SRTn across these lists corresponded to -2.74 (SD = 0.21). CONCLUSIONS: The developed sentence lists provided a valid and reliable tool to measure SRTn in Telugu native speakers.

Gender Differences in Audiological Findings and Hearing Aid Benefit in 255 Individuals with Auditory Neuropathy Spectrum Disorder: A Retrospective Study.

BACKGROUND: There are many studies reported in the literature that have summarized audiological findings and possible rehabilitation in individuals with auditory neuropathy spectrum disorder (ANSD). However, there are very few studies that have attempted to delineate the gender differences in audiological characteristics and hearing aid benefit in individuals with ANSD. PURPOSE: The study aimed to explore the differences between males and females in terms of demographic details, audiogram, speech identification scores, otoacoustic emissions, acoustic reflexes, long latency responses, and hearing aid benefit. RESEARCH DESIGN: A retrospective study. STUDY SAMPLE: A total of 255 individuals diagnosed with ANSD were selected for the study. The study included 137 females and 88 males. DATA COLLECTION AND ANALYSIS: The demographic details, results of diagnostic audiological testing, and hearing aid benefit were analyzed retrospectively. The differences in findings across gender were compared. RESULTS: The study shows that females have a relatively higher degree of hearing loss and that the majority of females show a rising type of audiometric configuration. The study shows that females have poorer speech perception abilities and experience limited benefits from hearing aids compared to males. CONCLUSIONS: The results of the study show that there are gender differences in audiological findings and hearing aid benefits in individuals with ANSD. However, well-controlled prospective studies are essential to confirm the results obtained and to identify the possible mechanisms underlying the gender differences.

Erratum: The Effect of Short-Term Auditory Training on Speech in Noise Perception and Cortical Auditory Evoked Potentials in Adults with Cochlear Implants.

[This corrects the article DOI: 10.1055/s-0035-1570335.].

Effects of spectral smearing on performance of the spectral ripple and spectro-temporal ripple tests.

The main aim of this study was to use spectral smearing to evaluate the efficacy of a spectral ripple test (SRt) using stationary sounds and a recent variant with gliding ripples called the spectro-temporal ripple test (STRt) in measuring reduced spectral resolution. In experiment 1 the highest detectable ripple density was measured using four amounts of spectral smearing (unsmeared, mild, moderate, and severe). The thresholds worsened with increasing smearing and were similar for the SRt and the STRt across the three conditions with smearing. For unsmeared stimuli, thresholds were significantly higher (better) for the STRt than for the SRt. An amplitude fluctuation at the outputs of simulated (gammatone) auditory filters centered above 6400 Hz was identified as providing a potential detection cue for the STRt stimuli. Experiment 2 used notched noise with energy below and above the passband of the SRt and STRt stimuli to reduce confounding cues in the STRt. Thresholds were almost identical for the STRt and SRt for both unsmeared and smeared stimuli, indicating that the confounding cue for the STRt was eliminated by the notched noise. Thresholds obtained with notched noise present could be predicted reasonably accurately using an excitation-pattern model.

Assessing spectral and temporal processing in children and adults using temporal modulation transfer function (TMTF), Iterated Ripple Noise (IRN) perception, and spectral ripple discrimination (SRD).

BACKGROUND: There are many clinically available tests for the assessment of auditory processing skills in children and adults. However, there is limited data available on the maturational effects on the performance on these tests. PURPOSE: The current study investigated maturational effects on auditory processing abilities using three psychophysical measures: temporal modulation transfer function (TMTF), iterated ripple noise (IRN) perception, and spectral ripple discrimination (SRD). RESEARCH DESIGN: A cross-sectional study. Three groups of subjects were tested: 10 adults (18-30 yr), 10 older children (12-18 yr), and 10 young children (8-11 yr) DATA COLLECTION AND ANALYSIS: Temporal envelope processing was measured by obtaining thresholds for amplitude modulation detection as a function of modulation frequency (TMTF; 4, 8, 16, 32, 64, and 128 Hz). Temporal fine structure processing was measured using IRN, and spectral processing was measured using SRD. RESULTS: The results showed that young children had significantly higher modulation thresholds at 4 Hz (TMTF) compared to the other two groups and poorer SRD scores compared to adults. The results on IRN did not differ across groups. CONCLUSIONS: The results suggest that different aspects of auditory processing mature at different age periods and these maturational effects need to be considered while assessing auditory processing in children.

Time-frequency analysis of transient evoked-otoacoustic emissions in individuals with auditory neuropathy spectrum disorder.

The aim of the study was to describe and quantify the cochlear active mechanisms in individuals with Auditory Neuropathy Spectrum Disorders (ANSD). Transient Evoked Otoacoustic Emissions (TEOAEs) were recorded in 15 individuals with ANSD and 22 individuals with normal hearing. TEOAEs were analyzed by Wavelet transform method to describe and quantify the characteristics of TEOAEs in narrow-band frequency regions. It was noted that the amplitude of TEOAEs was higher and latency slightly shorter in individuals with ANSD compared to normal hearing individuals at low and mid frequencies. The increased amplitude and reduced latencies of TEOAEs in ANSD group could be attributed to the efferent system damage, especially at low and mid frequencies seen in individuals with ANSD. Thus, wavelet analysis of TEOAEs proves to be another important tool to understand the patho-physiology in individuals with ANSD.

Effect of companding on speech recognition in quiet and noise for listeners with ANSD.

OBJECTIVE: The present study assesses the effect of companding on speech perception in quiet and noise for listeners with auditory neuropathy spectrum disorder (ANSD). DESIGN: Speech perception was assessed using speech reception threshold in noise (SRTn) for sentences and consonant identification in quiet and at different signal-to-noise ratios (15, 10, 5, and 0 dB SNR). STUDY SAMPLE: Ten ANSD listeners and normal-hearing listeners participated in the study. RESULTS: ANSD listeners required significantly higher SRTn when compared to the normal-hearing listeners. Companding reduced SRTn more significantly in listeners with ANSD, but for normal-hearing listeners there was only a marginal reduction. In the consonant identification task, ANSD listeners performed poorer than normal-hearing listeners in quiet and noise. Companding improved consonant identification in quiet and at 15 dB SNR for listeners with ANSD, whereas no improvement was observed in normal-hearing listeners. CONCLUSION: Results of the present study demonstrate that companding improved speech perception in quiet and noise for ANSD listeners. The amount of improvement is higher at higher SNRs. In normal-hearing listeners, companding showed marginal improvement in both quiet and noise. The findings are discussed for rehabilitation of ANSD listeners by hearing aids which incorporate the companding strategy.

Temporal processing and speech perception in noise by listeners with auditory neuropathy.

AIM: The present study evaluated the relation between speech perception in the presence of background noise and temporal processing ability in listeners with Auditory Neuropathy (AN). METHOD: The study included two experiments. In the first experiment, temporal resolution of listeners with normal hearing and those with AN was evaluated using measures of temporal modulation transfer function and frequency modulation detection at modulation rates of 2 and 10 Hz. In the second experiment, speech perception in quiet and noise was evaluated at three signal to noise ratios (SNR) (0, 5, and 10 dB). RESULTS: Results demonstrated that listeners with AN performed significantly poorer than normal hearing listeners in both amplitude modulation and frequency modulation detection, indicating significant impairment in extracting envelope as well as fine structure cues from the signal. Furthermore, there was significant correlation seen between measures of temporal resolution and speech perception in noise. CONCLUSION: Results suggested that an impaired ability to efficiently process envelope and fine structure cues of the speech signal may be the cause of the extreme difficulties faced during speech perception in noise by listeners with AN.

Perception of speech with envelope enhancement in individuals with auditory neuropathy and simulated loss of temporal modulation processing.

Individuals with auditory neuropathy (AN) often suffer from temporal processing deficits causing speech perception difficulties. In the present study an envelope enhancement scheme that incorporated envelope expansion was used to reduce the effects of temporal deficits. The study involved two experiments. In the first experiment, to simulate the effects of reduced temporal resolution, temporally smeared speech stimuli were presented to listeners with normal hearing. The results revealed that temporal smearing of the speech signal reduced identification scores. With the envelope enhancement of the speech signal prior to being temporally smeared, identification scores improved significantly compared to temporally smeared condition. The second experiment assessed speech perception in twelve individuals with AN, using unprocessed and envelope-enhanced speech signals. The results revealed improvement in speech identification scores for the majority of individuals with AN when the envelope of the speech signal was enhanced. However, envelope enhancement was not able to improve speech identification scores for individuals with AN who had very poor unprocessed speech scores. Overall, the results of the present study suggest that applying envelope enhancement strategies in hearing aids might provide some benefits to many individuals with AN.

Perception of envelope-enhanced speech in the presence of noise by individuals with auditory neuropathy.

OBJECTIVE: To investigate the effect of background noise on perception of unprocessed and envelope-enhanced speech in individuals with auditory neuropathy (AN). DESIGN: Open-set speech identification abilities were assessed for unprocessed and envelope-enhanced speech in quiet and at three signal to noise ratios (10, 5, and 0 dB signal to noise ratio) in 15 individuals with AN. RESULTS: Results revealed that speech identification ability was affected more in the presence of noise than in quiet. The participants were classified into two groups, Good Performers and Poor Performers, based on their speech identification scores in quiet. It was observed that the reduction in mean speech identification scores in noise was less for Good Performers when compared with that of Poor Performers. Envelope enhancement of the signal improved speech identification scores in both the groups. The analysis of results also showed that Good Performers showed a significant improvement in all the conditions, whereas Poor Performers showed improvement only in quiet and +10 dB signal to noise ratio. CONCLUSIONS: For individuals with AN, listening in background noise is more difficult than in quiet condition. Envelope enhancement of speech signal improves speech identification scores in quiet and in background noise for individuals with AN. However, the benefit obtained varies depending on the speech identification ability in quiet.

Speech identification and cortical potentials in individuals with auditory neuropathy.

BACKGROUND: Present study investigated the relationship between speech identification scores in quiet and parameters of cortical potentials (latency of P1, N1, and P2; and amplitude of N1/P2) in individuals with auditory neuropathy. METHODS: Ten individuals with auditory neuropathy (five males and five females) and ten individuals with normal hearing in the age range of 12 to 39 yr participated in the study. Speech identification ability was assessed for bi-syllabic words and cortical potentials were recorded for click stimuli. RESULTS: Results revealed that in individuals with auditory neuropathy, speech identification scores were significantly poorer than that of individuals with normal hearing. Individuals with auditory neuropathy were further classified into two groups, Good Performers and Poor Performers based on their speech identification scores. It was observed that the mean amplitude of N1/P2 of Poor Performers was significantly lower than that of Good Performers and those with normal hearing. There was no significant effect of group on the latency of the peaks. Speech identification scores showed a good correlation with the amplitude of cortical potentials (N1/P2 complex) but did not show a significant correlation with the latency of cortical potentials. CONCLUSION: Results of the present study suggests that measuring the cortical potentials may offer a means for predicting perceptual skills in individuals with auditory neuropathy.