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.

The Magnitude of Contralateral Suppression of Otoacoustic Emissions Is Ear- and Age-Dependent.

The maturation of the uncrossed medial olivocochlear (UMOC) efferent remains poorly documented to date. The UMOC efferent system allows listeners to not only detect but also to process, recognize, and discriminate auditory stimuli. Its fibers can be explored non-invasively by recording the effect of contralateral acoustic stimulation (CAS), resulting in a decrease in the amplitude of transient evoked otoacoustic emissions (TEOAE). The objective of the present cross-sectional study was to investigate how the effectiveness of this system varies with age in healthy subjects aged 8 years to adulthood. For this purpose, 120 right-handed native French-speaking subjects (57 females and 63 males) were divided into five age groups of 24 subjects each: 8y-10y, 10y-11y6m, 11y6m-13y, 13y-17y, and ≥18y. TEOAE amplitudes with and without CAS were recorded. The equivalent attenuation (EA) was calculated, corresponding to the change in TEOAE amplitude equivalent to the effect generated by CAS. General linear models were performed to control for the effect of ear, sex, and age on EA. No sex effect was found. A stronger EA was consistently found regardless of age group in the right ear compared to the left. In contrast to the right ear, for which, on average, EA remained constant across age groups, an increasingly weaker TEOAE suppression effect with age was found in the left ear, reinforcing the asymmetrical functioning of the UMOC efferent system in favor of the right ear in adulthood. Further studies are needed to investigate the lateralization of the UMOC efferent system and its changes over time in cases of atypical or reversed cortical asymmetries, especially in subjects with specific learning disorders.

Age-Related Dichotic Listening Skills in Impaired and Non-Impaired Readers: A Comparative Study.

Dichotic listening is the high-level auditory process which enables the perception of different verbal stimuli delivered simultaneously to the right and left ears (binaural integration), as well as the perception of a verbal stimulus presented to one ear while ignoring a different stimulus in the other ear (binaural separation). Deficits in central auditory processing have been reported in children with learning disabilities. The present study aimed to compare dichotic listening performances in right-handed impaired readers (IR) and non-impaired readers (non-IR) according to age. For this, a cross-sectional study was conducted in 120 IR (56 males and 64 females) divided into five age groups and 120 non-IR (63 male and 57 female) matched on chronological age (8 to 9 years; 9 to 10 years; 10 to 12 years; 12 to 18 years; adult). They were tested for binaural integration and binaural separation, allowing for the calculation of dichotic aptitude (DA), ear prevalence (EP), and attentional shift index (ASI). A series of ANOVAs showed an effect of age and of the reading group for all the dichotic-related measures, except for EP. Binaural separation scores were lower in IR who also showed more intrusive responses compared to non-IR. These intrusive responses, which were more frequent on the right ear for IR, decreased with age in both groups. Overall, these results suggest that dichotic listening scores improve with age as the central auditory pathways mature. However, whatever the age, performances are lower in IR than in non-IR. This might be explained by an incomplete maturation of the auditory pathways in IR; an early start for long-term follow-up and auditory training is suggested.

Online digital audiometry vs. conventional audiometry: a multi-centre comparative clinical study.

OBJECTIVE: The primary objective of the current study was the validation of a cloud-centralized audiometry system for clinical practice. DESIGN: A cross-sectional study design was used. STUDY SAMPLE: A convenience sample of patients (>10 years old) booked for follow-up appointments were invited to participate. Participants completed both conventional and online digital audiometry in a standard sound treated clinic space during a single clinic visit; tests were completed in random order. Data for both ears were included. Patients were from one of three audiological practices. RESULTS: A total of 41 participants completed both audiometric tests. Validation study results showed that the mean difference between the two audiometric test results remained within 5 dB HL for both air and bone conduction thresholds at all tested frequencies. CONCLUSIONS: Online digital audiometry has been demonstrated as a clinically accurate method for hearing assessment.

Effect of Serious Gaming on Speech-in-Noise Intelligibility in Adult Cochlear Implantees: A Randomized Controlled Study.

Listening in noise remains challenging for adults with cochlear implants (CI) even after prolonged experience. Personalized auditory training (AT) programs can be proposed to improve specific auditory skills in adults with CI. The objective of this study was to assess serious gaming as a rehabilitation tool to improve speech-in-noise intelligibility in adult CI users. Thirty subjects with bilateral profound hearing loss and at least 9 months of CI experience were randomized to participate in a 5-week serious game-based AT program (n = 15) or a control group (n = 15). All participants were tested at enrolment and at 5 weeks using the sentence recognition-in-noise matrix test to measure the signal-to-noise ratio (SNR) allowing 70% of speech-in-noise understanding (70% speech reception threshold, SRT70). Thirteen subjects completed the AT program and nine of them were re-tested 5 weeks later. The mean SRT70 improved from 15.5 dB to 11.5 dB SNR after 5 weeks of AT (p < 0.001). No significant change in SRT70 was observed in the control group. In the study group, the magnitude of SRT70 improvement was not correlated to the total number of AT hours. A large inter-patient variability was observed for speech-in-noise intelligibility measured once the AT program was completed and at re-test. The results suggest that serious game-based AT may improve speech-in-noise intelligibility in adult CI users. Potential sources of inter-patient variability are discussed. Serious gaming may be considered as a complementary training approach for improving CI outcomes in adults.

Speech-in-Noise Audiometry in Adults: A Review of the Available Tests for French Speakers.

BACKGROUND: Difficulty understanding speech in background noise is the reason of consultation for most people who seek help for their hearing. With the increased use of speech-in-noise (SpIN) testing, audiologists and otologists are expected to evidence disabilities in a greater number of patients with sensorineural hearing loss. The purpose of this study is to list validated available SpIN tests for the French-speaking population. SUMMARY: A review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and Scopus databases were searched. Search strategies used a combination of 4 keywords: speech, audiometry, noise, and French. There were 10 validated SpIN tests dedicated to the Francophone adult population at the time of the review. Some tests use digits triplets as speech stimuli and were originally designed for hearing screening. The others were given a broader range of indications covering diagnostic or research purposes, determination of functional capacities and fitness for duty, as well as assessment of hearing amplification benefit. KEY MESSAGES: As there is a SpIN test for almost any type of clinical or rehabilitation needs, both the accuracy and duration should be considered for choosing one or the other. In an effort to meet the needs of a rapidly aging population, fast adaptive procedures can be favored to screen large groups in order to limit the risk of ignoring the early signs of forthcoming presbycusis and to provide appropriate audiological counseling.

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.

A New Method to Test the Efficiency of Cochlear Implant Artifacts Removal From Auditory Evoked Potentials.

Auditory evoked potentials are of great interest to objectively evaluate the audition in cochlear implant (CI) recipients. However, these measures are impeded by CI stimulation electrical artifacts present in the EEG. In the first part, this paper investigates the use of a hybrid model approximating CI patient data. This model gives access to both uncontaminated and denoised data, thus allowing for the evaluation of CI artifact removal methods. Here the efficiency of independent component analysis (ICA) is evaluated in the context of auditory steady-state responses (ASSRs). A dedicated experimental setup was developed to simultaneously record EEG data from a normal hearing (NH) participant and CI artifact data from a phantom equipped with a CI. Hybrid data were obtained as a linear mixture of both sources. Amplitude-modulated continuous tones were used as stimuli to elicit ASSRs. After denoising, the comparison of denoised hybrid data and original NH data showed high correlations between the two datasets, demonstrating the efficiency of ICA. In the second part, the ICA was applied to real clinical CI ASSR data. Results support the usefulness of the methodology as regards the performance evaluation of signal processing methods applied to CI patient data prior to clinical application.

Auditory steady state responses and cochlear implants: Modeling the artifact-response mixture in the perspective of denoising.

Auditory steady state responses (ASSRs) in cochlear implant (CI) patients are contaminated by the spread of a continuous CI electrical stimulation artifact. The aim of this work was to model the electrophysiological mixture of the CI artifact and the corresponding evoked potentials on scalp electrodes in order to evaluate the performance of denoising algorithms in eliminating the CI artifact in a controlled environment. The basis of the proposed computational framework is a neural mass model representing the nodes of the auditory pathways. Six main contributors to auditory evoked potentials from the cochlear level and up to the auditory cortex were taken into consideration. The simulated dynamics were then projected into a 3-layer realistic head model. 32-channel scalp recordings of the CI artifact-response were then generated by solving the electromagnetic forward problem. As an application, the framework's simulated 32-channel datasets were used to compare the performance of 4 commonly used Independent Component Analysis (ICA) algorithms: infomax, extended infomax, jade and fastICA in eliminating the CI artifact. As expected, two major components were detectable in the simulated datasets, a low frequency component at the modulation frequency and a pulsatile high frequency component related to the stimulation frequency. The first can be attributed to the phase-locked ASSR and the second to the stimulation artifact. Among the ICA algorithms tested, simulations showed that infomax was the most efficient and reliable in denoising the CI artifact-response mixture. Denoising algorithms can induce undesirable deformation of the signal of interest in real CI patient recordings. The proposed framework is a valuable tool for evaluating these algorithms in a controllable environment ahead of experimental or clinical applications.

Speech Auditory Brainstem Response through hearing aid stimulation.

Millions of people across the world are hearing impaired, and rely on hearing aids to improve their everyday life. Objective audiometry could optimize hearing aid fitting, and is of particular interest for non-communicative patients. Speech Auditory Brainstem Response (speech ABR), a fine electrophysiological marker of speech encoding, is presently seen as a promising candidate for implementing objective audiometry; yet, unlike lower-frequency auditory-evoked potentials (AEPs) such as cortical AEPs or auditory steady-state responses (ASSRs), aided-speech ABRs (i.e., speech ABRs through hearing aid stimulation) have almost never been recorded. This may be due to their high-frequency components requesting a high temporal precision of the stimulation. We assess here a new approach to record high-quality and artifact-free speech ABR while stimulating directly through hearing aids. In 4 normal-hearing adults, we recorded speech ABR evoked by a /ba/ syllable binaurally delivered through insert earphones for quality control or through hearing aids. To assess the presence of a potential stimulus artifact, recordings were also done in mute conditions with the exact same potential sources of stimulus artifacts as in the main runs. Hearing aid stimulation led to artifact-free speech ABR in each participant, with the same quality as when using insert earphones, as shown with signal-to-noise (SNR) measurements. Our new approach consisting in directly transmitting speech stimuli through hearing aids allowed for a perfect temporal precision mandatory in speech ABR recordings, and could thus constitute a decisive step in hearing impairment investigation and in hearing aid fitting improvement.

Relationship between age of hearing-loss onset, hearing-loss duration, and speech recognition in individuals with severe-to-profound high-frequency hearing loss.

The factors responsible for interindividual differences in speech-understanding ability among hearing-impaired listeners are not well understood. Although audibility has been found to account for some of this variability, other factors may play a role. This study sought to examine whether part of the large interindividual variability of speech-recognition performance in individuals with severe-to-profound high-frequency hearing loss could be accounted for by differences in hearing-loss onset type (early, progressive, or sudden), age at hearing-loss onset, or hearing-loss duration. Other potential factors including age, hearing thresholds, speech-presentation levels, and speech audibility were controlled. Percent-correct (PC) scores for syllables in dissyllabic words, which were either unprocessed or lowpass filtered at cutoff frequencies ranging from 250 to 2,000 Hz, were measured in 20 subjects (40 ears) with severe-to-profound hearing losses above 1 kHz. For comparison purposes, 20 normal-hearing subjects (20 ears) were also tested using the same filtering conditions and a range of speech levels (10-80 dB SPL). Significantly higher asymptotic PCs were observed in the early (<=4 years) hearing-loss onset group than in both the progressive- and sudden-onset groups, even though the three groups did not differ significantly with respect to age, hearing thresholds, or speech audibility. In addition, significant negative correlations between PC and hearing-loss onset age, and positive correlations between PC and hearing-loss duration were observed. These variables accounted for a greater proportion of the variance in speech-intelligibility scores than, and were not significantly correlated with, speech audibility, as quantified using a variant of the articulation index. Although the lack of statistical independence between hearing-loss onset type, hearing-loss onset age, hearing-loss duration, and age complicate and limit the interpretation of the results, these findings indicate that other variables than audibility can influence speech intelligibility in listeners with severe-to-profound high-frequency hearing loss.

Plasticity of tonotopic maps in humans: influence of hearing loss, hearing aids and cochlear implants.

CONCLUSION: This paper reviews psychoacoustical and electrophysiological evidence for reorganization of the human central auditory system in case of auditory deprivation and rehabilitation. OBJECTIVE: To investigate the plasticity of cortical tonotopic maps in cochlear-damaged subjects. METHODS: Frequency discrimination scores were analysed in subjects with high frequency hearing loss to test for potential perceptual correlates of auditory deprivation- and rehabilitation-induced plasticity. In cochlear implant patients, electrically evoked auditory cortical responses were obtained using EEG to study scalp potential maps. RESULTS: Perceptual changes in frequency discrimination were observed at the lesion-edge frequency of steeply sloping hearing loss. Although these results are not direct proof of cortical plasticity, no peripheral phenomenon has been found to explain them. The reversal of such auditory deprivation-induced plasticity, a phenomenon that may be termed rehabilitation plasticity, can be studied in hearing-impaired subjects fitted with a hearing aid. Cochlear implant subjects provide another interesting model for studying rehabilitation plasticity in that even profound to total deafness is made partially reversible by cochlear implantation. We found that the auditory cortex of deaf subjects with at least 3 months of cochlear implant experience is organized in a way similar to the tonotopy described in normal-hearing subjects.

The effect of long-term unilateral deafness on the activation pattern in the auditory cortices of French-native speakers: influence of deafness side.

BACKGROUND: In normal-hearing subjects, monaural stimulation produces a normal pattern of asynchrony and asymmetry over the auditory cortices in favour of the contralateral temporal lobe. While late onset unilateral deafness has been reported to change this pattern, the exact influence of the side of deafness on central auditory plasticity still remains unclear. The present study aimed at assessing whether left-sided and right-sided deafness had differential effects on the characteristics of neurophysiological responses over auditory areas. Eighteen unilaterally deaf and 16 normal hearing right-handed subjects participated. All unilaterally deaf subjects had post-lingual deafness. Long latency auditory evoked potentials (late-AEPs) were elicited by two types of stimuli, non-speech (1 kHz tone-burst) and speech-sounds (voiceless syllable/pa/) delivered to the intact ear at 50 dB SL. The latencies and amplitudes of the early exogenous components (N100 and P150) were measured using temporal scalp electrodes. RESULTS: Subjects with left-sided deafness showed major neurophysiological changes, in the form of a more symmetrical activation pattern over auditory areas in response to non-speech sound and even a significant reversal of the activation pattern in favour of the cortex ipsilateral to the stimulation in response to speech sound. This was observed not only for AEP amplitudes but also for AEP time course. In contrast, no significant changes were reported for late-AEP responses in subjects with right-sided deafness. CONCLUSION: The results show that cortical reorganization induced by unilateral deafness mainly occurs in subjects with left-sided deafness. This suggests that anatomical and functional plastic changes are more likely to occur in the right than in the left auditory cortex. The possible perceptual correlates of such neurophysiological changes are discussed.

Speech restoration: an interactive process.

PURPOSE: This study investigates the ability to understand degraded speech signals and explores the correlation between this capacity and the functional characteristics of the peripheral auditory system. METHOD: The authors evaluated the capability of 50 normal-hearing native French speakers to restore time-reversed speech. The task required them to transcribe two-syllable items containing temporal reversions of variable sizes, ranging from no reversion to complete reversion, increasing by half-syllable steps. In parallel, the functionality of each participant's auditory efferent system was evaluated using contralateral suppression of click-evoked otoacoustic emissions. RESULTS: Perceptual accuracy for time-reversed speech diminished when the size of the applied temporal distortion increased. A lexical benefit was evident, and an important interindividual variability in performance was observed. Functional exploration of the auditory system revealed that speech restoration performances correlated with the suppression strength of the participant's auditory efferent system. CONCLUSIONS: These results suggest a clear relation between the functional asymmetry of the auditory efferent pathway (the right-side activity is greater than the left-side activity in right-handed participants) and the comprehension of acoustically distorted speech in normal-hearing participants. Further experiments are needed to better specify how the functionality of the medial olivocochlear bundle can cause phonological activation to be more efficient.

Speech auditory brainstem response (speech ABR) characteristics depending on recording conditions, and hearing status: an experimental parametric study.

Speech elicited auditory brainstem responses (Speech ABR) have been shown to be an objective measurement of speech processing in the brainstem. Given the simultaneous stimulation and recording, and the similarities between the recording and the speech stimulus envelope, there is a great risk of artefactual recordings. This study sought to systematically investigate the source of artefactual contamination in Speech ABR response. In a first part, we measured the sound level thresholds over which artefactual responses were obtained, for different types of transducers and experimental setup parameters. A watermelon model was used to model the human head susceptibility to electromagnetic artefact. It was found that impedances between the electrodes had a great effect on electromagnetic susceptibility and that the most prominent artefact is due to the transducer's electromagnetic leakage. The only artefact-free condition was obtained with insert-earphones shielded in a Faraday cage linked to common ground. In a second part of the study, using the previously defined artefact-free condition, we recorded speech ABR in unilateral deaf subjects and bilateral normal hearing subjects. In an additional control condition, Speech ABR was recorded with the insert-earphones used to deliver the stimulation, unplugged from the ears, so that the subjects did not perceive the stimulus. No responses were obtained from the deaf ear of unilaterally hearing impaired subjects, nor in the insert-out-of-the-ear condition in all the subjects, showing that Speech ABR reflects the functioning of the auditory pathways.

Auditory processing disorder in children with reading disabilities: effect of audiovisual training.

Reading disability is associated with phonological problems which might originate in auditory processing disorders. The aim of the present study was 2-fold: first, the perceptual skills of average-reading children and children with dyslexia were compared in a categorical perception task assessing the processing of a phonemic contrast based on voice onset time (VOT). The medial olivocochlear (MOC) system, an inhibitory pathway functioning under central control, was also explored. Secondly, we investigated whether audiovisual training focusing on voicing contrast could modify VOT sensitivity and, in parallel, induce MOC system plasticity. The results showed an altered voicing sensitivity in some children with dyslexia, and that the most severely impaired children presented the most severe reading difficulties. These deficits in VOT perception were sometimes accompanied by MOC function abnormalities, in particular a reduction in or even absence of the asymmetry in favour of the right ear found in average-reading children. Audiovisual training significantly improved reading and shifted the categorical perception curve of certain children with dyslexia towards the average-reading children's pattern of voicing sensitivity. Likewise, in certain children MOC functioning showed increased asymmetry in favour of the right ear following audiovisual training. The training-related improvements in reading score were greatest in children presenting the greatest changes in MOC lateralization. Taken together, these results confirm the notion that some auditory system processing mechanisms are impaired in children with dyslexia and that audiovisual training can diminish these deficits.

Enhanced frequency discrimination in hearing-impaired individuals: a review of perceptual correlates of central neural plasticity induced by cochlear damage.

Cochlear damages have been shown to induce changes in tonotopic maps in the central auditory system of animals; neurons deprived from peripheral inputs start to respond to stimuli with frequencies close to the cutoff frequency (Fc) or "edge" of the hearing loss, which then become over-represented at the neural level. Here, we review findings, which reveal a possible psychophysical correlate of such central over-representation in human listeners with sensorineural hearing loss. These findings concur to demonstrate a local improvement in difference limens for frequency (DLFs) at or near Fc. This effect has now been observed in several studies and subjects with varied audiometric characteristics, including high- and low-frequency, and symmetric and asymmetric hearing losses. The presence of cochlear dead region or a steeply sloping hearing loss appear as a necessary condition for its occurrence. The effect cannot be explained simply by more prominent loudness cues or spontaneous otoacoustic emissions (SOAEs) near the audiogram edge. Overall, the data are consistent with local changes in pitch discrimination performance near the hearing-loss cutoff frequency being a result of the neural over-representation of that frequency region in the central auditory system. Further work is needed to confirm this hypothesis, and investigate other possible perceptual correlates of injury-related cortical plasticity in both humans and animals.

Increased perception of loudness in autism.

Clinical reports on autism describe abnormal responses to auditory stimuli such as intolerance to sounds. The present study assessed subjective perception of loudness in subjects with autism compared to healthy controls, using two psychoacoustic tests. First, the auditory dynamic range was evaluated at six different tone frequencies. Secondly, loudness growth as a function of the intensity level of a 1 kHz tone was estimated. Verbal responses from a group of 11 children and adolescents with autism were compared to responses of 11 age- and gender- matched healthy controls. Smaller auditory dynamic ranges were found in the autistic group than in the control group, as well as increased perception of loudness, indicating hyperacusis in subjects with autism.