Hearing rehabilitation of adults with auditory processing disorder: a systematic review and meta-analysis of current evidence-based interventions.

Background: For adults with auditory processing disorder (APD), listening and communicating can be difficult, potentially leading to social isolation, depression, employment difficulties and certainly reducing the quality of life. Despite existing practice guidelines suggesting treatments, the efficacy of these interventions remains uncertain due to a lack of comprehensive reviews. This systematic review and meta-analysis aim to establish current evidence on the effectiveness of interventions for APD in adults, addressing the urgent need for clarity in the field. Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search across MEDLINE (Ovid), Embase (Ovid), Web of Science and Scopus, focusing on intervention studies involving adults with APD. Studies that met the inclusion criteria were grouped according to intervention with a meta-analysis only conducted where intervention, study design and outcome measure were comparable. Results: Out of 1,618 screened records, 13 studies were included, covering auditory training (AT), low-gain hearing aids (LGHA), and personal remote microphone systems (PRMS). Our analysis revealed: AT, Mixed results with some improvements in speech intelligibility and listening ability, indicating potential benefits but highlighting the need for standardized protocols; LGHA, The included studies demonstrated significant improvements in monaural low redundancy speech testing (p < 0.05), suggesting LGHA could enhance speech perception in noisy environments. However, limitations include small sample sizes and potential biases in study design. PRMS, Demonstrated the most consistent evidence of benefit, significantly improving speech testing results, with no additional benefit from combining PRMS with other interventions. Discussion: PRMS presents the most evidence-supported intervention for adults with APD, although further high-quality research is crucial for all intervention types. The establishment and implementation of standardized intervention protocols alongside rigorously validated outcome measures will enable a more evidence-based approach to managing APD in adults.

Hearing Loss and Cognitive Decline in the Aging Population: Emerging Perspectives in Audiology.

In this perspective article, the author explores the connections between hearing loss, central auditory processing, and cognitive decline, offering insights into the complex dynamics at play. Drawing upon a range of studies, the relationship between age-related central auditory processing disorders and Alzheimer's disease is discussed, with the aim of enhancing our understanding of these interconnected conditions. Highlighting the evolving significance of audiologists in the dual management of cognitive health and hearing impairments, the author focuses on their role in identifying early signs of cognitive impairment and evaluates various cognitive screening tools used in this context. The discussion extends to adaptations of hearing assessments for older adults, especially those diagnosed with dementia, and highlights the significance of objective auditory electrophysiological tests. These tests are presented as vital in assessing the influence of aging and Alzheimer's disease on auditory processing capabilities and to signal cognitive dysfunction. The article underscores the critical role of audiologists in addressing the challenges faced by the aging population. The perspective calls for further research to improve diagnostic and therapeutic strategies in audiology, and emphasizes the need for a multidisciplinary approach in tackling the nexus of hearing loss, auditory processing, and cognitive decline.

Interventions for School-Aged Children with Auditory Processing Disorder: A Scoping Review.

(1) Background: Auditory processing (AP) disorder is associated with learning difficulties and poses challenges to school-aged children in their daily activities. This scoping review identifies interventions and provides audiologists with protocol insights and outcome measures. (2) Methods: A systematic search of both peer-reviewed and grey literature (January 2006 to August 2023) covered ten databases. Studies included had the following characteristics: (i) published in French or English; (ii) participants were school-aged, and had a normal audiogram, AP difficulties or disorder, and no cognitive, developmental, congenital or neurological disorder (with the exception of learning, attention, and language disabilities); (iii) were intervention studies or systematic reviews. (3) Results: Forty-two studies were included, and they predominantly featured auditory training (AT), addressing spatial processing, dichotic listening, temporal processing and listening to speech in noise. Some interventions included cognitive or language training, assistive devices or hearing aids. Outcome measures listed included electrophysiological, AP, cognitive and language measures and questionnaires addressed to parents, teachers or the participants. (4) Conclusions: Most interventions focused on bottom-up approaches, particularly AT. A limited number of top-down approaches were observed. The compiled tools underscore the need for research on metric responsiveness and point to the inadequate consideration given to understanding how children perceive change.

Exploring the effects of a repair strategies training program among children with auditory processing disorder: A pilot study.

OBJECTIVES: Children with hearing loss, as well as those with auditory processing disorder (APD), experience more communication difficulties than their normal-hearing peers. Receiving training on communication strategies has been shown to be beneficial for children with hearing loss, but little is known on the effect of such training on children with APD. The main purpose of this pilot study was to assess the effects of a repair strategies training program among children with APD. METHODS: Ten school-aged children with APD participated in a ten 60-min weekly repair strategies training program (experimental group) and ten did not receive any training (control group). In pre- and post-intervention, children were filmed while taking part in short scripted conversation situations in which communication breakdowns were introduced. Additionally, questionnaires on communication difficulties and repair skills, on life habits related to communication and education as well as on emotional well-being were filled by the children and their parents. RESULTS: In post-compared to in pre-intervention, children in the experimental group used significantly more of the repair strategies taught right after a communication breakdown occurred, used a greater variety of repair strategies, and overcame more communication breakdowns. The number of strategies needed to overcome a breakdown was not significantly different after the training compared to before. The level of difficulty to accomplish education-related life habits was generally lower, although not significantly, after entering the program than before. The individualized data showed that the studied training was more suited for children aged 9 years and older. The results of the children in the control group were not significantly different between the two measured times on all outcomes. CONCLUSION: Learning how to recognize and overcome communication breakdowns through a training program was beneficial for children with APD. The program enabled them to use a wider variety of repair strategies and to be more proactive in situations where communication is difficult. Studies are needed to further examine these findings in a larger sample of children with APD and in real-life settings.

Normative values for tests of central auditory processing disorder in children aged from 6 to 12 years old.

INTRODUCTION: Central auditory processing disorders (CAPD) can significantly affect the daily functioning of a child, and the first step in determining whether rehabilitation procedures are required is a proper diagnosis. Different guidelines for making diagnoses have been published in the literature, and in various centers normative values for psychoacoustic tests of CAPD have been used internally. The material presented in this paper is based on more than 1000 children and is the largest collection so far published. The aim of this study is to present normative values for tests assessing CAPD in children aged 6 to 12 years, divided by age at last birthday. METHOD: We tested 1037 children aged 6 to 12 years who were attending primary schools and kindergartens. The criteria for inclusion were a normal audiogram, intellectually normal, no developmental problems, and no difficulties in auditory processing. To evaluate auditory processing all children were given three tests on the Senses Examination Platform: the Frequency Pattern Test (FPT), Duration Pattern Test (DPT), and Dichotic Digit Test (DDT). RESULTS: The results from 1,037 children allowed us to determine normative values for FPT, DPT, and DDT in seven different age groups (6 through to 12 years). We developed a newapproach, based on quantile-based norms, to determine normative values in each group. Three categories - average, below-average, and above-average - allow for a broader but more realistic interpretation than those used previously. We compare our results with published standards. CONCLUSIONS: Our study is the largest normative database published to date for CAPD testing, setting a standard for each child by age in years. We used the Senses Examination Platform, a universal tool, to unify standards for the classification of CAPD. Our study can serve as a basis for the development of a Polish model for the diagnosis of CAPD.

Impact of Otitis Media With Effusion in Early Age on Auditory Processing Abilities in Children: A Systematic Review and Meta-Analysis.

Objective: Early-onset otitis media with effusion (OME) can affect the development of the auditory nervous system and thus lead to auditory processing abnormalities. This study aims to review the effect of childhood OME on auditory processing abilities in children. Methods: A systematic review of the literature, restricted to the English language from 1990 to 2022 was conducted using search engines like PubMed, Embase, and Google Scholar. After selecting the articles following predefined inclusion and exclusion criteria, the data were extracted and meta-analysis was performed. Results: A total of 10 articles met the inclusion criteria. Children with a history of OME had poorer performance in most behavioral and electrophysiological tests. Pooled analysis of various tests such as the gap in noise test, frequency pattern test (verbal and nonverbal), and latencies of auditory brainstem response-I, V, I to III, and I to V showed a difference between the 2 groups. Conclusion: Childhood OME can significantly affect auditory processing abilities in children.

Auditory processing disorder: an online survey of hearing healthcare professionals' knowledge and practices.

OBJECTIVE: To investigate (1) the current level of awareness and knowledge on Auditory Processing Disorder (APD) among Audiologists and other hearing healthcare professionals; (2) current practices in screening, diagnosis, and management of APD in children and adults across the UK; (3) professional's acceptance of APD assessment and diagnosis. DESIGN: An online survey was disseminated through the British Academy of Audiology and ENT UK. STUDY SAMPLE: A total of 191 hearing healthcare professionals responded to the survey. RESULTS: Overall, while 63% of the respondents considered themselves to be adequately informed about APD, only 4% viewed themselves as very informed on the topic. Fewer than half of the respondents report screening (31%), diagnosing (14%), or managing (36%) cases of APD. For screening APD, professionals most commonly use auditory processing tests in adults and take case histories in children, whereas routine audiological procedures are the primary method for diagnosing APD in both adults and children. Although modifying the listening environment is a widely recommended management strategy for APD, half of the respondents indicated that a diagnosis of APD has no implications for patient management. CONCLUSIONS: There is a critical need to promote APD-related training to ensure they can provide appropriate referrals and management.

A Survey on Screening and Diagnostic Criteria of Auditory Processing Disorders in India.

The current study aimed to determine the criteria used for screening and diagnosing cases with central auditory processing disorders (CAPD) in India. A cross-sectional questionnaire-based survey design was used in the present study. A questionnaire was developed to determine the criteria used for screening and diagnosing CAPD across clinics in India. Responses were obtained from 83 participants from all over India. Results indicated that 78% of respondents were currently doing CAPD evaluation. In that, the majority of respondents (63%) had a predetermined minimum battery that was relatively adaptable depending on the case history and age of the patient. In screening, most respondents used a screening questionnaire (SCAP, 75%) and a screening test (STAP, 60%). In the diagnostic protocol, the most used tests by the respondents were masking level difference (MLD), repetition of words (RW), gap detection test (GDT), pitch pattern test (PPT), speech perception in noise (SPIN), digit span test (DST), dichotic digit test (DDT), binaural fusion test (BFT), auditory brainstem response (ABR), dichotic CV test (DCVT), and duration pattern test (DPT). The current study's result will help professionals choose the minimum test battery for diagnosing CAPD.

The Prevalence of Central Auditory Processing Disorder in Elementary School Students of Kerman, Iran.

Objectives: This study aimed to determine the prevalence of central auditory processing disorder (CAPD) in elementary school students in Kerman, Iran, during 2018-2019. Materials & Methods: This cross-sectional study was conducted on 1369 elementary school students in Kerman. These students were selected by cluster sampling from different areas of Kerman and then screened using the Buffalo Model Questionnaire (BMQ). Based on the data obtained from the questionnaire, normal children were excluded from the study. Then, children with suspected central auditory processing disorder (CAPD) underwent ear exams and were excluded from the study in case of abnormal results in the tympanic membrane examination (rapture-effusion). The remaining subjects underwent peripheral audiometry evaluation, and children with abnormal audiometry were excluded from the study. Finally, the remaining children with suspicious screening results, a normal examination, and normal audiometry underwent a specific test to detect Central auditory processing disorder. Data analysis was carried out using SPSS software. Results: One thousand three hundred sixty-nine primary school students with a mean age of 9.15 ±2.63 years enrolled in this study. 52%% of students were male. 8.03% of them had CAPD. A statistically significant relationship was found between the prevalence of CAPD and gender (P<0.001), place of residence (P<0.001), history of middle ear inflammation (P<0.001) and history of head injury. Conclusion: The quality of life of these students with CAPD can be improved via timely recognition of CAPD and the provision of appropriate preventive and therapeutic facilities.

Changes in Auditory Evoked Potentials Increase the Chances of Adults Having Central Auditory Processing Disorder.

Introduction Auditory evoked potentials are widely used in clinical practice to complement the assessment of central auditory processing. However, it is necessary to understand whether these potentials are highly accurate, to assist in the diagnosis of auditory processing disorder. Objective To measure the accuracy of middle and long latency auditory evoked potentials in the diagnosis of auditory processing disorder in adults. Methods This is a case-control study, formed by a control group of 30 individuals with normal auditory processing assessment, and a case group composed of 43 individuals with altered auditory processing assessment. Their sensitivities, specificities, accuracies, positive and negative predictive values for the diagnosis of alterations were measured and compared between the potentials. Results The accuracies of the middle and long latency potentials were 51% and 67%, respectively. The P1-N1-P2 and N2-P300 complexes had an accuracy of 57.5% and 58.9%, respectively. The cognitive potential P300 showed an accuracy of 55%. There was no significant result for the middle-latency potential (OR = 1.8; 95% CI: 0.6-5.4, p > 0.42) and for P300 (OR = 2.63, 95% CI: 0.85-8.43, p > 0.11). However, the result was significant for the long-latency potential (OR = 6.3; 95% CI: 2-19.6, p < 0.01). There was a significant result for the P1-N1-P2 complexes (OR = 6.76, 95% CI:1.4-32.5, p = < 0.010) and N2-P300 (OR = 3.60; 95% CI: 10.16-11.20, p < 0.039). Conclusion Individuals with altered long-latency auditory evoked potential are more likely to have auditory processing disorder and, as such, this test can be used as a complementary tool to confirm the diagnosis.

A comment on the order of report in two-pair dichotic digit testing in children assessed for auditory processing.

OBJECTIVE: This clinical note aimed to 1) describe the order-of-report (OoR) strategies used by a large sample of children who completed 2pDD testing in the free-recall condition as part of an audiological assessment of auditory processing (AP), and 2) determine if use of OoR correlated with 2pDD test performance. DESIGN: A retrospective (case-review), single observation design. STUDY SAMPLE: A convenient sample of 77 children (50 males and 27 females aged 7.0 to 17.4 years [median = 8.8 years]) referred to audiology for an AP assessment. RESULTS: The participating children used temporal more than ear or sequential OoR and showed decreased test scores with increased use of ear OoR. CONCLUSIONS: These findings suggest children referred for an AP assessment could favour a temporal OoR when completing 2pDD testing for its opportunity to rehearse the first digit pair (possibly strengthening its memory trace) prior to processing the second digit pair, while their use of an ear OoR could come at the cost detrimental ear dominance effects that reduce their test performance. Future research could consider if similar results are observed in other child populations and if preferred dichotic processing strategy could inform auditory training for children with dichotic listening deficits.

Incidence of Otolaryngological Manifestations in Individuals with Autism Spectrum Disorder: A Special Focus on Auditory Disorders.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by stereotyped and repetitive behavior patterns. In addition to neurological and behavioral problems, individuals with ASD commonly experience otolaryngological comorbidities. Individuals with ASD often have auditory disorders including hearing loss and auditory processing disorders such as central auditory processing disorder (CAPD), as well as both chronic and recurrent otitis media. These challenges negatively impact a person's ability to effectively communicate and may further impact their neurological functioning, particularly when not appropriately treated. Individuals diagnosed with ASD also have difficulty sleeping which contributes to increased irritability and may further aggravate the core behavioral symptoms of autism. The individuals with ASD also have a higher rate of sinusitis which contributes to the worsening of the autism behavior phenotype. The high prevalence of otolaryngological comorbidities in individuals with ASD warrants a better collaboration between their various healthcare providers and otolaryngologists with expertise in auditory, sleep, and sinus disorders in pursuit of improving the quality of life of affected individuals and their families/caregivers.

Survey of students and guardians for assessing the early detection of auditory processing disorder and listening difficulties in school-age students.

OBJECTIVE: Auditory processing disorders (APD) and listening difficulties (LiD) are becoming increasingly prevalent in young adults. Our study surveyed students and their guardians to assess the early detection of APD and LiDs in students aged 6-18 years. We estimated the percentage of students with LiDs and assessed their guardians' perceptions during different school years. METHODS: This prospective study enrolled students from schools affiliated with Osaka Kyoiku University and their guardians. Both students and their guardians completed a basic assessment on demographics, and a questionnaire assessing LiD (completed by both students and guardians) and developmental problems (completed only by guardians). LiD was assessed in the following four domains: (i) auditory attention, (ii) auditory memory, (iii) auditory discrimination, and (iv) auditory restoration. The relationship between the school-year group and the total score for LiD and the differences between the students' and guardians' perceptions of the association between the school-year group and LiD domains were examined. RESULTS: Respondents comprised 743 students from 120 classes at three schools and 743 guardians. Hearing loss was reported by 26.5% of students and 26.1% of their guardians, with the majority indicating slight hearing loss. Compared with the students, their guardians more commonly indicated a normal response to all the questions related to LiD. The LiD scores reported by students increased with increasing school years and significantly deviated from those reported by their guardians. The students' scores in the auditory attention and auditory memory domains demonstrated significant increase with increasing school years, with the greatest increase in the auditory attention category. CONCLUSIONS: Students reported increasing severity of LiD with increasing school years, whereas their guardians underreported such symptoms, most significantly in the later school years. Therefore, screening for symptoms related to auditory attention could aid in the early detection of APD and LiD in school-age children.

Changes in Auditory Evoked Potentials Increase the Chances of Adults Having Central Auditory Processing Disorder

Abstract Introduction Auditory evoked potentials are widely used in clinical practice to complement the assessment of central auditory processing. However, it is necessary to understand whether these potentials are highly accurate, to assist in the diagnosis of auditory processing disorder. Objective To measure the accuracy of middle and long latency auditory evoked potentials in the diagnosis of auditory processing disorder in adults. Methods This is a case-control study, formed by a control group of 30 individuals with normal auditory processing assessment, and a case group composed of 43 individuals with altered auditory processing assessment. Their sensitivities, specificities, accuracies, positive and negative predictive values for the diagnosis of alterations were measured and compared between the potentials. Results The accuracies of the middle and long latency potentials were 51% and 67%, respectively. The P1-N1-P2 and N2-P300 complexes had an accuracy of 57.5% and 58.9%, respectively. The cognitive potential P300 showed an accuracy of 55%. There was no significant result for the middle-latency potential (OR = 1.8; 95% CI: 0.6-5.4, p > 0.42) and for P300 (OR = 2.63, 95% CI: 0.85-8.43, p > 0.11). However, the result was significant for the long-latency potential (OR = 6.3; 95% CI: 2-19.6, p < 0.01). There was a significant result for the P1-N1-P2 complexes (OR = 6.76, 95% Cl:1.4-32.5, p = < 0.010) and N2-P300 (OR = 3.60; 95% CI: 10.16-11.20, p < 0.039). Conclusion Individuals with altered long-latency auditory evoked potential are more likely to have auditory processing disorder and, as such, this test can be used as a complementary tool to confirm the diagnosis.

[Speech intelligibility in adults after the new coronavirus infection (COVID-19)]. / Razborchivost' rechi u vzroslykh patsientov posle novoi koronavirusnoi infektsii (COVID-19).

OBJECTIVE: The research was aimed to assess speech intelligibility in adults after the new coronavirus infection (COVID-19), state of peripheral and central parts of auditory system and cognitive functions. MATERIAL AND METHODS: 26 people complaining about hearing loss, poor speech intelligibility and/or tinnitus after COVID-19 were examined. All the patients underwent the basic audiological assessment before COVID-19. Extended testing in patients after COVID-19 included: pure tone audiometry, impedancemetry, speech audiometry in quiet and noise (evaluation of monosyllabic words intelligibility and the Russian matrix sentence test RuMatrix), the alternating binaural speech test, the dichotic digits test and the Montreal Cognitive Assessment (MoCA). RESULTS: The most significant deviations from the normative values were obtained in the RuMatrix test and the dichotic digits test that may be due to both central auditory processing disorder and memory impairment. Low MoCA scores were obtained in 62% of patients. CONCLUSION: Deterioration of speech intelligibility after COVID-19 was revealed, both in patients with hearing loss and with normal hearing that corresponded to their complaints. It may be caused by central auditory disorder, memory impairment or cognitive status lesion. The correlation found between the results of the RuMatrix test in noise and the severity of the COVID-19 may indicate the impact of the virus on the auditory cortex.

Understanding Auditory Processing Disorder: A Narrative Review.

Auditory processing disorder (APD) is defined as difficulty in listening despite possessing hearing thresholds within the normal limit. Understanding rapid speech, following complex instructions, and listening in the existence of background noise are some of the difficulties in APD. APD has been observed in diverse clinical populations with suspected or diagnosed disorders, such as attention deficit-hyperactivity disorder, dyslexia, aphasia, and Alzheimer's disease; however, it should be differentiated from these disorders. Despite the research on APD, its awareness is limited, resulting in it often being undiagnosed. Therefore, improving the awareness and understanding of APD is important. The current paper aims to review the literature on APD with a focus on school-age children. The prevalence, etiology, screening, and diagnosis of APD are discussed along with correlated disorders, interpretation of tests, and management strategies.

Study of the Effect of Minimal Sensorineural Hearing Loss on the Central Auditory Processing in Children: A Pilot Study.

Hearing loss is a main cause of poor auditory, academic, and social performance especially in children. This study aimed to find out the relationship between minimal hearing loss (sensorineural or conductive) and the central auditory processing disorders in children. A cross-sectional study was conducted to compare the probability of having central auditory processing disorder in 159 children diagnosed with minimal sensorineural hearing loss and hearing loss caused by otitis media with effusion aged (6-7 years old) in 4 primary schools in Damascus Syria, and 155 children with normal hearing of the same age group using the children's auditory performance scale (C.H.A.P.S). A remarkable statistical difference was found between the two groups with higher scores of C.H.A.P.S scale in the minimal hearing loss group (P value = 0.000 < 0.05). The difference involved all the sub-scales of the C.H.A.P.S scale, which indicates that minimal hearing loss in children can be considered as one important predisposing factor for central auditory processing disorders.

Cochlear Implantation in Children with Auditory Neuropathy: Meta-Analysis.

BACKGROUND: Auditory neuropathy (AN) is a nosological entity of unknown etiology, which is associated with fluctuations in rates of speech discrimination. Its diagnosis is based on presence of otoacoustic emissions and lack of, or abnormal, brainstem auditory evoked potential. With respect to treatment, we have variable results in the literature about development of speech perception and skills, in children with AN and cochlear implant (CI) rehabilitation. OBJECTIVES: Comparatively assessing results recorded for the development of auditory and speech skills in children with auditory neuropathy spectrum disorder (ANSD), who were subjected to cochlear implantation, in comparison to results recorded for children with sensorineural hearing loss associated with other causes was the objective of this study. METHOD: A systematic literature review with meta-analysis was performed, with studies published from 1975 to 2023. RESULTS: Nineteen studies were included in the systematic review, and eight were selected for the meta-analysis, which showed there was no evidence allowing the conclusion that the two groups were different from each other about results in speech performance after 1 year of CI placement. CONCLUSION: Therefore, this study shows that CI provides the comparable benefit to children with ANSD in comparison to children with neurosensory hearing loss associated with other causes in their speech development.

Central Auditory Processing Skills in Individuals with Takayasu Syndrome.

The current study was done to assess the central auditory processing in individuals with Takayasu's Syndrome. The Takayasu Syndrome is a rare disease, hence a case series was conducted with consecutive sampling. In this study, five patients diagnosed with Takayasu's syndrome were evaluated on the central auditory processing tests. The tests were administered using standard operating protocols. It was observed that the score on the dichotic digit test was drastically reduced suggesting difficulty in auditory integration skills in all the participants. There was an observed difficulty in speech perception in noise for all the participants indicating abnormal auditory closure ability. It was concluded that the reduced blood supply to the cortex would have caused a reduction in auditory skills. The current attempts to document the central processing disorder in a rare syndrome. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03733-1.