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.

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.

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.

Otoacoustic emission suppression in children diagnosed with central auditory processing disorder and speech in noise perception deficits.

OBJECTIVE: The present study was designed to test the hypothesis that medial olivocochlear system functionality is associated with speech recognition in babble performance in children diagnosed with central auditory processing disorder. METHOD: Children diagnosed with central auditory processing disorder who specifically demonstrated speech in noise deficits were compared to children diagnosed with central auditory processing disorder without these deficits. Suppression effects were examined across 15 time intervals to examine variability. Analysis of right and left ear suppression was performed separately to evaluate laterality. STUDY SAMPLE: 52 children diagnosed with central auditory processing disorder, aged 6-14 years were divided into normal or abnormal groups based on SinB performance in each ear. Cut-off value was set at SNR = 1.33 dB. Transient otoacoustic emissions suppression was measured. RESULTS: The abnormal Speech in Babble Right Ear group showed significant negative correlations with suppression levels for 7 of the 15 time intervals measured. No significant correlations with SinBR performance were observed for the remaining time intervals, as was the case for the typically evaluated R8-18 time interval and the Speech in Babble Left Ear. CONCLUSIONS: Results indicate that suppression is influenced by the time window analysed, and ear tested, and is associated with speech recognition in babble performance in children with central auditory processing disorder.

A European Perspective on Auditory Processing Disorder-Current Knowledge and Future Research Focus.

Current notions of "hearing impairment," as reflected in clinical audiological practice, do not acknowledge the needs of individuals who have normal hearing pure tone sensitivity but who experience auditory processing difficulties in everyday life that are indexed by reduced performance in other more sophisticated audiometric tests such as speech audiometry in noise or complex non-speech sound perception. This disorder, defined as "Auditory Processing Disorder" (APD) or "Central Auditory Processing Disorder" is classified in the current tenth version of the International Classification of diseases as H93.25 and in the forthcoming beta eleventh version. APDs may have detrimental effects on the affected individual, with low esteem, anxiety, and depression, and symptoms may remain into adulthood. These disorders may interfere with learning per se and with communication, social, emotional, and academic-work aspects of life. The objective of the present paper is to define a baseline European APD consensus formulated by experienced clinicians and researchers in this specific field of human auditory science. A secondary aim is to identify issues that future research needs to address in order to further clarify the nature of APD and thus assist in optimum diagnosis and evidence-based management. This European consensus presents the main symptoms, conditions, and specific medical history elements that should lead to auditory processing evaluation. Consensus on definition of the disorder, optimum diagnostic pathway, and appropriate management are highlighted alongside a perspective on future research focus.

The Use of the Gaps-In-Noise Test as an Index of the Enhanced Left Temporal Cortical Thinning Associated with the Transition between Mild Cognitive Impairment and Alzheimer's Disease.

BACKGROUND: The known link between auditory perception and cognition is often overlooked when testing for cognition. PURPOSE: To evaluate auditory perception in a group of older adults diagnosed with mild cognitive impairment (MCI). RESEARCH DESIGN: A cross-sectional study of auditory perception. STUDY SAMPLE: Adults with MCI and adults with no documented cognitive issues and matched hearing sensitivity and age. DATA COLLECTION: Auditory perception was evaluated in both groups, assessing for hearing sensitivity, speech in babble (SinB), and temporal resolution. RESULTS: Mann-Whitney test revealed significantly poorer scores for SinB and temporal resolution abilities of MCIs versus normal controls for both ears. The right-ear gap detection thresholds on the Gaps-In-Noise (GIN) Test clearly differentiated between the two groups (p < 0.001), with no overlap of values. The left ear results also differentiated the two groups (p < 0.01); however, there was a small degree of overlap ∼8-msec threshold values. With the exception of the left-ear inattentiveness index, which showed a similar distribution between groups, both impulsivity and inattentiveness indexes were higher for the MCIs compared to the control group. CONCLUSIONS: The results support central auditory processing evaluation in the elderly population as a promising tool to achieve earlier diagnosis of dementia, while identifying central auditory processing deficits that can contribute to communication deficits in the MCI patient population. A measure of temporal resolution (GIN) may offer an early, albeit indirect, measure reflecting left temporal cortical thinning associated with the transition between MCI and Alzheimer's disease.

Auditory Processing Disorder as the Sole Manifestation of a Cerebellopontine and Internal Auditory Canal Lesion.

BACKGROUND: Clinical importance of auditory processing disorder (APD) testing is often overlooked and regarded with skepticism given the challenging interpretation of results and the current growing debate of its nature and clinical entity. PURPOSE: Presentation of this case is highly educational as APD is the single clinical manifestation of a large cerebellopontine and internal auditory canal lesion. RESEARCH DESIGN: A case report. DATA COLLECTION AND ANALYSIS: The patient underwent a standard audiological evaluation with normal results. She was referred for APD evaluation. The APD test battery consisted of speech in babble (SinB), dichotic digits (DD), frequency and duration of pattern sequence testing, Random Gap Detection Test, and gaps in noise. These were followed by otoacoustic emissions testing, auditory brainstem responses (ABR) and magnetic resonance imaging (MRI). RESULTS: Her auditory processing results showed deficits in SinB and DD limited to the right ear as well as deficits in temporal processing. Both verbal and nonverbal tests exhibited deficits strictly limited to the right ear, which was in accordance with what she was experiencing as reduced loudness for the incoming sounds on the right ear. This less costly evaluation revealed that there was good reason to assess electrophysiologically the auditory system. ABR showed an abnormal waveform with either missing or severely prolongated wave V (depending on stimulus polarity). Otoacoustic emissions were normal. MRI was then implemented revealing a large cerebellopontine and internal auditory canal lesion. CONCLUSIONS: This clinical case stresses the importance of testing for APD with a psychoacoustical test battery despite current debate of lack of a gold standard diagnostic approach to APD. In this case, APD diagnosis led to a cerebellopontine lesion identification with extension to the right internal auditory canal. This rare cause of APD demonstrates the efficiency of the current diagnostic test battery in revealing lesional causes of central APD.

CAPD Is Classified in ICD-10 as H93.25 and Hearing Evaluation-Not Screening-Should Be Implemented in Children With Verified Communication and/or Listening Deficits.

Purpose: The article "It Is Time to Rethink Central Auditory Processing Disorder Protocols for School-Aged Children" (DeBonis, 2015) appeared in the American Journal of Audiology as a tutorial. The author used the argument made by Cowan, Rosen, and Moore (2009), referring to central auditory processing disorder (CAPD), that "such impairments have not been shown to uniquely contribute to a clearly defined condition that would warrant its inclusion in any of the major disease classification systems" (emphasis added; p. 129). However, CAPD is included in the U.S. version of the International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) under the code H93.25; this was not mentioned in the article by DeBonis. We would like to point out some additional omissions of this tutorial that may bias its conclusions.

Assessment of Functional Hearing in Greek-Speaking Children Diagnosed with Central Auditory Processing Disorder.

BACKGROUND: Including speech recognition in noise testing in audiological evaluations may reveal functional hearing deficits that may otherwise remain undetected. PURPOSE: The current study explored the potential utility of the Speech-in-Babble (SinB) test in the assessment of central auditory processing disorder (CAPD) in young children for whom diagnosis is challenging. RESEARCH DESIGN: A cross-sectional analysis. STUDY SAMPLE: Forty-one Greek children 4-13 yr of age diagnosed with CAPD and exhibiting listening and academic problems (clinical group) and 20 age-matched controls with no listening or academic problems participated in the study. DATA COLLECTION AND ANALYSIS: All participants' auditory processing was assessed using the same tests and instrumentation in a sound-treated room. Two equivalent lists of the SinB test, developed at the Psychoacoustic Laboratory of the Aristotle University of Thessaloniki, were administered monaurally in a counterbalanced order. SinB consists of lists of 50 phonetically balanced disyllabic words presented in background multitalker babble. Five signal-to-noise ratios (SNRs) were used in a fixed order. The children were instructed to repeat the word after each presentation. The SNR at which the child achieved 50% correct word identification served as the dependent variable or outcome measure, with higher SinB scores (measured in SNR dB) corresponding to poorer performance. RESULTS: SinB performance was better (lower SNR) for the normal control group versus the clinical group [F(1,35) = 43.03, p < 0.0001]. SinB inversely correlated with age for both CAPD and control groups (r = -0.648, p << 0.001 and r = -0.658, p < 0.005, respectively). Regression analysis revealed that linear models better explained the variance in the data than a quadratic model for both the control and CAPD groups. The slope (beta value of the linear model) was steeper for the clinical group compared to the control group (beta = -0.306 versus beta = -0.130, respectively). An analysis of covariance run with age as the covariate to assess the potential effect of comorbidity on SinB performance in children with CAPD with and without comorbid conditions revealed no significant differences between groups [F(1,38) = 0.149, p > 0.05]. CONCLUSIONS: This study offers the first detailed presentation of the performance of Greek children on a Greek language SinB test. The main finding is that SinB scores improved as a function of age in a constant manner as represented by the slope of the linear regression line for both CAPD and control groups. Results suggest that this speech recognition in competition test holds promise for differentiating typically developing Greek children from those children with CAPD across the age range studied here (4-13 yr). The SinB seemed rather immune to the presence of comorbid conditions presented by some of the children in this study, suggesting its potential utility as a valid measure of central auditory processing. While there are many speech-in-noise or competition tests in English, there are fewer in other languages. Tests like the SinB should be developed in other languages to ensure that children demonstrating "listening" problems can be properly evaluated.

What Can We Learn about Auditory Processing from Adult Hearing Questionnaires?

BACKGROUND: Questionnaires addressing auditory disability may identify and quantify specific symptoms in adult patients with listening difficulties. PURPOSE: (1) To assess validity of the Speech, Spatial, and Qualities of Hearing Scale (SSQ), the (Modified) Amsterdam Inventory for Auditory Disability (mAIAD), and the Hyperacusis Questionnaire (HYP) in adult patients experiencing listening difficulties in the presence of a normal audiogram. (2) To examine which individual questionnaire items give the worse scores in clinical participants with an auditory processing disorder (APD). RESEARCH DESIGN: A prospective correlational analysis study. STUDY SAMPLE: Clinical participants (N = 58) referred for assessment because of listening difficulties in the presence of normal audiometric thresholds to audiology/ear, nose, and throat or audiovestibular medicine clinics. Normal control participants (N = 30). DATA COLLECTION AND ANALYSIS: The mAIAD, HYP, and the SSQ were administered to a clinical population of nonneurological adults who were referred for auditory processing (AP) assessment because of hearing complaints, in the presence of normal audiogram and cochlear function, and to a sample of age-matched normal-hearing controls, before the AP testing. Clinical participants with abnormal results in at least one ear and in at least two tests of AP (and at least one of these tests to be nonspeech) were classified as clinical APD (N = 39), and the remaining (16 of whom had a single test abnormality) as clinical non-APD (N = 19). RESULTS: The SSQ correlated strongly with the mAIAD and the HYP, and correlation was similar within the clinical group and the normal controls. All questionnaire total scores and subscores (except sound distinction of mAIAD) were significantly worse in the clinical APD versus the normal group, while questionnaire total scores and most subscores indicated greater listening difficulties for the clinical non-APD versus the normal subgroups. Overall, the clinical non-APD group tended to give better scores than the APD in all questionnaires administered. Correlation was strong for the worse-ear gaps-in-noise threshold with the SSQ, mAIAD, and HYP; strong to moderate for the speech in babble and left-ear dichotic digit test scores (at p < 0.01); and weak to moderate for the remaining AP tests except the frequency pattern test that did not correlate. The worse-scored items in all three questionnaires concerned speech-in-noise questions. This is similar to worse-scored items by hearing-impaired participants as reported in the literature. Worse-scored items of the clinical group also included quality aspects of listening questions from the SSQ, which most likely pertain to cognitive aspects of listening, such as ability to ignore other sounds and listening effort. CONCLUSIONS: Hearing questionnaires may help assess symptoms of adults with APD. The listening difficulties and needs of adults with APD to some extent overlap with those of hearing-impaired listeners, but there are significant differences. The correlation of the gaps-in-noise and duration pattern (but not frequency pattern) tests with the questionnaire scores indicates that temporal processing deficits may play an important role in clinical presentation.

Differential Diagnosis of Speech Sound Disorder (Phonological Disorder): Audiological Assessment beyond the Pure-tone Audiogram.

BACKGROUND: According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosis of speech sound disorder (SSD) requires a determination that it is not the result of other congenital or acquired conditions, including hearing loss or neurological conditions that may present with similar symptomatology. PURPOSE: To examine peripheral and central auditory function for the purpose of determining whether a peripheral or central auditory disorder was an underlying factor or contributed to the child's SSD. RESEARCH DESIGN: Central auditory processing disorder clinic pediatric case reports. STUDY SAMPLE: Three clinical cases are reviewed of children with diagnosed SSD who were referred for audiological evaluation by their speech-language pathologists as a result of slower than expected progress in therapy. RESULTS: Audiological testing revealed auditory deficits involving peripheral auditory function or the central auditory nervous system. These cases demonstrate the importance of increasing awareness among professionals of the need to fully evaluate the auditory system to identify auditory deficits that could contribute to a patient's speech sound (phonological) disorder. CONCLUSIONS: Audiological assessment in cases of suspected SSD should not be limited to pure-tone audiometry given its limitations in revealing the full range of peripheral and central auditory deficits, deficits which can compromise treatment of SSD.

Comparison of two tests of auditory temporal resolution in children with central auditory processing disorder, adults with psychosis, and adult professional musicians.

OBJECTIVE: Evaluate auditory temporal resolution threshold outcomes across three different populations. DESIGN: Two commercially available tests of auditory gap detection (Random gap detection (RGDT) test, and Gaps-in-noise (GIN) test) were administered to all participants. STUDY SAMPLE: Adult professional musicians (APM) (N = 11, age range 28-61 years); children with central auditory processing disorder (CAPD) (N = 22, age range 7.5-17 years); and first episode psychosis patients (FEP) (N = 17, age range 18-48 years). RESULTS: It was not possible to calculate a threshold for the RGDT for 13 of 22 children with CAPD and for 7 of 17 adults with FEP due to response inconsistency. Analysis of variance (ANOVA) excluding cases that produced inconsistent RGDT results showed that only RGDT thresholds differed across groups (F = 8.73, p = 0.001). Three t-tests comparing test means within group revealed statistically significant differences between the gap detection thresholds obtained with the RGDT vs. the GIN for each group. No significant correlations were seen between RGDT and GIN. CONCLUSION: Lower/better gap detection thresholds and smaller standard deviations were obtained using the GIN in all three groups. Lack of correlation between the two tests suggests that they may measure different processes.

Is central auditory processing disorder present in psychosis?

PURPOSE: The scope of this study was to trace central auditory processing issues in patients with first-episode psychosis using a psychoacoustic test battery approach. METHOD: Patients (n = 17) and volunteer control subjects (n = 17) with no personal or family history of schizophrenia were included in the study on the basis of normal hearing sensitivity. The authors implemented a central auditory processing battery consisting of monaural and binaural tests with verbal and nonverbal stimuli. RESULTS: Perceptual deficits in both nonverbal and verbal auditory stimuli are reported in this study, with temporal central auditory processing deficits and a mean left-ear advantage documented in the patient group. CONCLUSION: This study points to the possibility of the existence of central auditory processing deficits in first-episode psychosis leading to schizophrenia. Audiologists should be aware of the psychiatric research pointing to enhanced verbal memory as a result of auditory training, linking bottom-up remediation with top-down improvement.