Expressive amusia and aphasia: the story of Maurice Ravel.

The French composer, Maurice Ravel, at the peak of his career, showed signs of a progressive disorder that affected his ability to function with verbal and musical language, as noted by the neurologist Théophile Alajouanine. The worsening of the disease led to a craniotomy, performed in 1937, which failed to reveal the cause of his illness, and he died shortly thereafter. A lack of post-mortem neuropathological evidence precluded a definitive diagnosis of the illness, which remained enigmatic. Speculations about the precise diagnosis of Ravel's neurological disease have been largely based on Alajouanine's observations, which included aphasia and amusia, mostly expressive, and ideomotor apraxia, while musical judgement, taste, and memory remained relatively intact, implying different neuroanatomical substrates. A possible subform of frontotemporal lobar degeneration complex was the diagnostic suggestion of many authors. His untimely death deprived the world of this remarkable musician, and the music that remained trapped in his mind.

O compositor francês Maurice Ravel, no ápice de sua carreira, mostrou sinais de uma desordem progressiva que afetou sua capacidade de funcionar com linguagem verbal e musical, como notado pelo neurologista Théophile Alajouanine. O agravamento de sua condição levou a uma craniotomia, efetuada em 1937, que deixou de revelar a causa de sua doença, tendo ele falecido pouco depois. A ausência de evidência neuropatológica pós-morte impediu o diagnóstico definitivo da doença, que permaneceu enigmático. Especulações sobre o diagnóstico preciso da doença neurológica de Ravel foram baseadas sobretudo nas observações de Alajouanine, que compreendiam afasia e amusia, predominantemente expressiva, e também apraxia, enquanto o julgamento, gosto e memória musicais permaneceram relativamente intactos, implicando diferentes substratos neuroanatômicos. A possibilidade de uma subforma do complexo da degenearação lobar frontotemporal foi a sugestão diagnóstica de muitos autores. A sua morte prematura privou o mundo desse notável músico e da música que permaneceu presa em sua mente.

Temporal Ordering and Auditory Resolution in Individuals with Sensorineural Hearing Loss.

Introduction Peripheral hearing loss, besides causing inadequate auditory input, can lead to distortions in the tonotopic auditory map and reorganization of neural networks. Therefore, the processing of temporal aspects of a sound stimulus and, consequently, the effectiveness of human communication can be negatively impacted. Objective To test the temporal ordering and auditory resolution of people with mild and moderate sensorineural hearing loss and to compare them with the those of people with normal hearing. Methods A total of 19 right-handed individuals aged 16 to 59 years with mild to moderate postlingually acquired symmetric bilateral sensorineural hearing loss participated in the study. They were submitted to frequency and duration pattern tests and a random gap detection test. Results The mean correct response rate in the frequency pattern test was of 66.3%, and, in the duration pattern test, 71.7%. The mean threshold in the random gap detection test was of 14.1 ms. A comparison with the criteria established for normal subjects without peripheral hearing loss revealed that more than half the subjects had abnormal results in the temporal ordering test, while a smaller fraction had reduced temporal resolution. Conclusions The performance of the subjects with acquired sensorineural hearing loss was poorer than that of the participants without peripheral hearing loss. Their results on the temporal ordering test were also poorer than in the temporal resolution test, demonstrating the importance of analyzing both these auditory skills in people with peripheral hearing loss.

Does a patient with acquired arbovirus infection have a hearing impairment? A scoping review of hearing changes in an adult with Dengue, Chikungunya, and Zika.

OBJECTIVES: To identify and understand the evidence regarding hearing changes related to acquired Dengue, Chikungunya, and Zika virus infection in adult individuals. METHODS: A scoping review was performed according to the recommendations of The Joanna Briggs Institute and guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews in the Embase, PubMed/Medline, ScienceDirect, Scopus, and Web of Science databases without restriction on language and year of publication. Case studies, observational studies, and clinical trials reporting hearing loss in adult subjects (>18-60 years of age) of both sexes with DENV, CHIKV, or ZIKV diagnosed by positive molecular/serological examination by RT-PCR or IgM/IgG by ELISA method were included. RESULTS: Thirteen studies met the inclusion criteria and were selected for review. The occurrence of auditory symptoms caused by arboviroses and the presence of permanent or transient sensorineural hearing loss was variable in adults. CONCLUSIONS: Dengue, Chikungunya, and Zika infections in adults are associated with a variety of auditory symptoms. The frequency of permanent or transient sensorineural hearing loss is low but not negligible.

Does a patient with acquired arbovirus infection have a hearing impairment? A scoping review of hearing changes in an adult with Dengue, Chikungunya, and Zika

Abstract Objectives To identify and understand the evidence regarding hearing changes related to acquired Dengue, Chikungunya, and Zika virus infection in adult individuals. Methods A scoping review was performed according to the recommendations of The Joanna Briggs Institute and guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews in the Embase, PubMed/Medline, ScienceDirect, Scopus, and Web of Science databases without restriction on language and year of publication. Case studies, observational studies, and clinical trials reporting hearing loss in adult subjects (>18-60 years of age) of both sexes with DENV, CHIKV, or ZIKV diagnosed by positive molecular/serological examination by RT-PCR or IgM/IgG by ELISA method were included. Results Thirteen studies met the inclusion criteria and were selected for review. The occurrence of auditory symptoms caused by arboviroses and the presence of permanent or transient sensorineural hearing loss was variable in adults. Conclusions Dengue, Chikungunya, and Zika infections in adults are associated with a variety of auditory symptoms. The frequency of permanent or transient sensorineural hearing loss is low but not negligible.

Temporal Ordering and Auditory Resolution in Individuals with Sensorineural Hearing Loss

Abstract Introduction Peripheral hearing loss, besides causing inadequate auditory input, can lead to distortions in the tonotopic auditory map and reorganization of neural networks. Therefore, the processing of temporal aspects of a sound stimulus and, consequently, the effectiveness of human communication can be negatively impacted. Objective To test the temporal ordering and auditory resolution of people with mild and moderate sensorineural hearing loss and to compare them with the those of people with normal hearing. Methods A total of 19 right-handed individuals aged 16 to 59 years with mild to moderate postlingually acquired symmetric bilateral sensorineural hearing loss participated in the study. They were submitted to frequency and duration pattern tests and a random gap detection test. Results The mean correct response rate in the frequency pattern test was of 66.3%, and, in the duration pattern test, 71.7%. The mean threshold in the random gap detection test was of 14.1 ms. A comparison with the criteria established for normal subjects without peripheral hearing loss revealed that more than half the subjects had abnormal results in the temporal ordering test, while a smaller fraction had reduced temporal resolution. Conclusions The performance of the subjects with acquired sensorineural hearing loss was poorer than that of the participants without peripheral hearing loss. Their results on the temporal ordering test were also poorer than in the temporal resolution test, demonstrating the importance of analyzing both these auditory skills in people with peripheral hearing loss.

Benefits of intervention in the Central Auditory Nervous System in individuals with Neurofibromatosis Type 1.

OBJECTIVE: To verify the effectiveness of acoustically controlled auditory training in individuals with Neurofibromatosis Type 1. METHODS: The sample consisted of individuals with Neurofibromatosis Type 1, randomly distributed into two groups, making up the intervention group: individuals undergoing formal auditory training; and the comparison group: individuals who were not submitted to the intervention. Behavioral assessment of central auditory processing and electrophysiological evaluation, composed by Brainstem Auditory Evoked Potential and Long Latency-P300 Auditory Evoked Potential, were evaluated in three moments of evaluations: initial evaluation, reevaluation and after four months of reevaluation and comparing the performance between the groups. RESULTS: Better performances in central auditory processing were observed after the formal auditory training in the intervention group with significant differences between the evaluations and performance maintenance four months after the end of the training. Significant differences were observed between the groups in the evaluations after the intervention. The electrophysiological evaluation shows unsystematic variation in the short latency potentials and changes in the long latency potentials with the appearance of the P3 wave after the intervention. The behavioral and electrophysiological evaluation in group that was not submitted to the intervention demonstrated that there is no improvement without the intervention, with deterioration of performance. Significant differences were observed in the behavioral and electrophysiological evaluations, in favor of the group submitted to formal auditory training. CONCLUSIONS: Formal auditory training is effective in rehabilitation in individuals with Neurofibromatosis Type 1. DESCRIPTORS/KEYWORDS: Neurofibromatosis 1; Hearing Disorders; Auditory Perceptual Disorders; Acoustic Stimulation; Evoked Potentials, Auditory.

Evaluation of Subtle Auditory Impairments with Multiple Audiological Assessments in Normal Hearing Workers Exposed to Occupational Noise.

Recent studies involving guinea pigs have shown that noise can damage the synapses between the inner hair cells and spiral ganglion neurons, even with normal hearing thresholds-which makes it important to investigate this kind of impairment in humans. The aim was to investigate, with multiple audiological assessments, the auditory function of normal hearing workers exposed to occupational noise. Altogether, 60 workers were assessed (30 in the noise-exposure group [NEG], who were exposed to occupational noise, and 30 in the control group [CG], who were not exposed to occupational noise); the workers were matched according to age. The following procedures were used: complete audiological assessment; speech recognition threshold in noise (SRTN); speech in noise (SN) in an acoustic field; gaps-in-noise (GIN); transient evoked otoacoustic emissions (TEOAE) and inhibitory effect of the efferent auditory pathway; auditory brainstem response (ABR); and long-latency auditory evoked potentials (LLAEP). No significant difference was found between the groups in SRTN. In SN, the NEG performed worse than the CG in signal-to-noise ratio (SNR) 0 (p-value 0.023). In GIN, the NEG had a significantly lower percentage of correct answers (p-value 0.042). In TEOAE, the NEG had smaller amplitude values bilaterally (RE p-value 0.048; LE p-value 0.045) and a smaller inhibitory effect of the efferent pathway (p-value 0.009). In ABR, the NEG had greater latencies of wave V (p-value 0.017) and interpeak intervals III-V and I-V in the LE (respective p-values: 0.005 and 0.04). In LLAEP, the NEG had a smaller P3 amplitude bilaterally (RE p-value 0.001; LE p-value 0.002). The NEG performed worse than the CG in most of the assessments, suggesting that the auditory function in individuals exposed to occupational noise is impaired, even with normal audiometric thresholds.

Precisión diagnóstica de una versión abreviada de las pruebas de patrones de frecuencia y patrones de duración para la evaluación del ordenamiento auditivo temporal / Diagnostic accuracy of an abbreviated version of the frequency pattern and duration pattern tests for the evaluation of auditory temporal ordering

Introducción: Las pruebas de patrones de frecuencia y patrones de duración son consideradas los gold standard de evaluación del ordenamiento auditivo temporal. A pesar de su amplia difusión, la extensión y duración de estas pruebas dificultan su utilización dentro de baterías de evaluación del procesamiento auditivo. Sin embargo, dadas sus características estructurales, pareciera ser posible reducirlas sin perder su precisión diagnóstica. Objetivo: Determinar las propiedades diagnósticas de versiones abreviadas de las pruebas de patrones de frecuencia y patrones de duración. Material y Método: Se realizó un estudio transversal de diseño observacional analítico. Se evaluaron 166 oídos de 88 sujetos con edades entre 18 y 33 años, los cuales fueron clasificados con normalidad o alteración del ordenamiento auditivo temporal. Se utilizaron las pruebas originales de Auditec de 30 ítems por oído como referencia y los primeros 10 ítems de cada oído como versión abreviada. Resultados: La versión abreviada de la prueba de patrones de frecuencia obtuvo una sensibilidad de un 94,33%, una especificidad del 94,29% y un área bajo la curva ROC de 0,980. La versión abreviada de la prueba de patrones de duración obtuvo una sensibilidad de un 89,58%, especificidad del 71,88% y un área bajo la curva ROC de 0,916. Ambas versiones tuvieron un índice de concordancia adecuado. Conclusiones: Las versiones abreviadas de la prueba de patrones de frecuencia y patrones de duración cuentan con excelentes propiedades diagnósticas para la evaluación del ordenamiento auditivo temporal y pueden ser utilizadas de manera intercambiable con las versiones originales.

Introduction: The frequency and duration pattern tests are considered the gold standard for assessing auditory temporal ordering. Despite their wide dissemination, the length and duration of these tests make it difficult to use them within auditory processing assessment batteries. However, given their structural characteristics, reducing them without losing their diagnostic accuracy seems possible. Aim: Determine the diagnostic properties of abbreviated versions of the Frequency Patterns and Duration Patterns tests. Material and Method: A cross-sectional study with an analytical observational design was carried out. 166 ears of 88 subjects aged between 18 and 33 years were evaluated, classified as normal or altered in temporal auditory order. The original Auditec tests of 30 items per ear were used as a reference, and the first 10 items of each ear as an abbreviated version. Results: The abbreviated version of the frequency patterns test obtained a sensitivity of 94.33%, a specificity of 94.29%, and an area under the ROC curve of 0.980. The abbreviated version of the duration pattern test obtained a sensitivity of 89.58%, a specificity of 71.88%, and an area under the ROC curve of 0.916. Both versions had an adequate concordance index. Conclusion: The abbreviated versions of the frequency patterns and duration patterns test have excellent diagnostic properties for assessing auditory temporal ordering and can be used interchangeably with the original versions.

Central auditory processing in children after traumatic brain injury.

INTRODUCTION: Traumatic brain injury can impair the central auditory pathways and auditory cortex. Hence, individuals who suffered a traumatic brain injury may be at risk of central auditory processing disorders, which can be identified with behavioral tests that assess central auditory function. OBJECTIVE: To characterize and compare the performance of children and adolescents with and without a history of traumatic brain injury in behavioral tests that assess central auditory processing. METHOD: The sample comprised 8- to 18-year-old individuals of both sexes who suffered moderate or severe closed traumatic brain injury 3 to 24 months before their participation in the study and whose hearing thresholds were normal. These individuals were matched for sex and age with other subjects without a history of traumatic brain injury and submitted to behavioral assessment of the central auditory processing with special tests to assess hearing skills (namely, auditory closure, figure-ground, and temporal processing), selected according to their chronological age and response-ability. RESULTS: The study group performed statistically worse than the comparison group in auditory closure, figure-ground in verbal dichotic listening, and temporal ordering. The central auditory processing tests with abnormal results in the comparison group were different from those in the study group. CONCLUSION: Central auditory processing disorders were identified in all subjects of the study group, especially involving auditory closure and temporal processing skills, in comparison with subjects without a history of traumatic brain injury.

Relación entre hiperacusia y desorden del procesamiento auditivo central: Una revisión de la literatura / Relationship between hyperacusis and auditory processing disorder: a literature review

Resumen La hiperacusia corresponde a la excesiva sensibilidad auditiva o intolerancia a ciertos sonidos cotidianos que para la mayoría de las personas parecerían habituales. Considerando los mecanismos fisiológicos involucrados en el origen de la hiperacusia, es lógico pensar que su presencia podría afectar algunas habilidades del procesamiento auditivo central, sin embargo, la evidencia en torno al tema es escasa y no existe actualmente una revisión de la literatura que agrupe las investigaciones sobre esta temática. Por ello, el presente estudio pretende identificar y analizar la evidencia científica disponible sobre la relación entre hiperacusia y desorden del procesamiento auditivo central. Se realizó una revisión de la literatura guiada por protocolo PRISMA en las bases de datos Proquest, Ebsco, Pubmed, ScienceDirect, Cochrane Library y Scielo de acuerdo con términos claves. Fueron incluidos artículos originales de investigación, revisiones sistemáticas y metaanálisis, publicados desde el año 2010, realizados en animales y humanos, escritos en idiomas inglés, español y portugués. Se encontraron 323 estudios relacionados con los términos claves utilizados, de los cuales 13 cumplieron con los criterios de inclusión y fueron analizados. Se puede concluir que la evidencia científica en torno al tema es escasa e incipiente. Estructuras de la vía auditiva central como núcleos cocleares, lemnisco lateral, colículos inferiores, cuerpo geniculado medial y corteza auditiva primaria estarían relacionadas con la hiperacusia, así como también habilidades de procesamiento auditivo de figura/fondo, ordenación temporal y transferencia interhemisférica se verían afectadas.

Abstract Hyperacusis has been defined as the excessive auditory sensitivity or intolerance to certain everyday sounds that seem common for most people. Considering the underlying physiological mechanisms of hyperacusis, it is reasonable to think that it could affect some abilities involved in the central auditory processing. However, there is lack of evidence about this topic, and there is no literature review that gathers all the existing research. Therefore, the current study intends to identify and analyze the available scientific evidence regarding the relationship between hyperacusis and central auditory processing disorder. The review of the literature followed the PRISMA protocol, using key words in Proquest, Ebsco, Pubmed, ScienceDirect, Cochrane Library and Scielo databases. Original research articles, systematic reviews and meta-analyses of studies made with human and animals that have been published since 2010 in English, Spanish and Portuguese were included. Among them, 323 studies were related to the key terms, out of which 13 met the inclusion criteria and were analyzed. It is possible to conclude that there is little and incipient scientific evidence on the topic. Structures of the central auditory pathway such as cochlear nuclei, lateral lemniscus, inferior colliculi, medial geniculate body and primary auditory cortex seem to be related to hyperacusis; auditory processing skills such as figure/ground discrimination, temporal ordering and interhemispheric transfer appear to be affected as well.

Central auditory processing in children after traumatic brain injury

Abstract Introduction: Traumatic brain injury can impair the central auditory pathways and auditory cortex. Hence, individuals who suffered a traumatic brain injury may be at risk of central auditory processing disorders, which can be identified with behavioral tests that assess central auditory function. Objective: To characterize and compare the performance of children and adolescents with and without a history of traumatic brain injury in behavioral tests that assess central auditory processing. Method: The sample comprised 8- to 18-year-old individuals of both sexes who suffered moderate or severe closed traumatic brain injury 3 to 24 months before their participation in the study and whose hearing thresholds were normal. These individuals were matched for sex and age with other subjects without a history of traumatic brain injury and submitted to behavioral assessment of the central auditory processing with special tests to assess hearing skills (namely, auditory closure, figure-ground, and temporal processing), selected according to their chronological age and response-ability. Results: The study group performed statistically worse than the comparison group in auditory closure, figure-ground in verbal dichotic listening, and temporal ordering. The central auditory processing tests with abnormal results in the comparison group were different from those in the study group. Conclusion: Central auditory processing disorders were identified in all subjects of the study group, especially involving auditory closure and temporal processing skills, in comparison with subjects without a history of traumatic brain injury.

Masking Level Difference: avaliação da confiabilidade teste-reteste em estudantes universitárias normo-ouvintes / Masking Level Difference: test-retest reliability assessment in normal hearing female university students

RESUMO Objetivo Verificar a confiabilidade teste-reteste do Masking Level Difference em estudantes universitárias normo-ouvintes. Método Estudo prospectivo descritivo com 78 adultos jovens do gênero feminino sem queixas auditivas, submetidas à versão, em compact disc, do Masking Level Difference da Auditec of Saint Louis. O Masking Level Difference foi determinado por meio da diferença entre as relações sinal-ruído nos limiares auditivos encontrados nas condições antifásica e homofásica. O teste foi aplicado pelo mesmo examinador em dois momentos (teste e reteste) com intervalo de sete a 14 dias entre eles. A análise estatística inferencial incluiu comparação das situações teste e reteste por meio do teste t de Student para amostras pareadas, cálculo do coeficiente de correlação intraclasse e dos intervalos de confiança de 95% para as relações sinal/ruído nos limiares auditivos nas condições antifásica e homofásica e para o cálculo do Masking Level Difference. Resultados A média da relação sinal-ruído no limiar auditivo na condição homofásica foi -12,59 dB e -12,46 dB nas situações teste e reteste, respectivamente, e -21,54 dB e -21,08 dB na condição antifásica. A média do Masking Level Difference foi 8,95 dB no teste e 8,74 dB no reteste. Os coeficientes de correlação intraclasse obtidos foram 0,436, 0,625 e 0,577 para as condições homofásica, antifásica e Masking Level Difference, respectivamente. Conclusão O teste Masking Level Difference mostrou grau moderado de confiabilidade teste-reteste em estudantes universitárias normo-ouvintes.

ABSTRACT Purpose To verify the test-retest reliability of the Masking Level Difference in normal hearing female university students. Methods Prospective descriptive study with 78 young female adults without hearing complaints, submitted to the compact disc version of the Masking Level Difference by Auditec of Saint Louis. The threshold was determined by the difference between signal-to-noise ratios at hearing thresholds found in the antiphasic and homophasic conditions. The test was applied by the same examiner in two moments (test and retest) with an interval of seven to 14 days between them. Inferential statistical analysis included comparison of test and retest situations using Student's t test for paired samples, calculation of the intraclass correlation coefficient and calculation of 95% confidence intervals for signal-to-noise ratios at hearing thresholds found in the antiphasic and homophasic conditions and for masking level difference. Results The average signal-to-noise ratio at hearing threshold ​​in the homophasic condition was -12.59 dB and -12.46 dB in the Test and Retest situations, respectively, and -21.54 dB and -21.08 dB in the antiphasic condition. The average value ​​in the final Masking Level Difference result was 8.95 dB in the Test and 8.74 dB in the Retest. Intraclass correlation coefficient values ​​obtained were 0.436, 0.625 and 0.577 for homophasic, antiphasic and Masking Level Difference conditions, respectively. Conclusion The Masking Level Difference showed moderate test-retest reliability in normal hearing adults female university students.

Frequency-Following Response (FFR) em usuários de implante coclear: uma revisão sistemática dos parâmetros de aquisição, análise e resultados / Frequency-Following Response (FFR) in cochlear implant users: a systematic review of acquisition parameters, analysis, and outcomes

RESUMO Objetivo Caracterizar os parâmetros de aquisição, análise e resultados do exame Frequency Following Response (FFR) em usuários de implante coclear. Estratégia de pesquisa As buscas foram realizadas nas bases Cochrane Library, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Ovid Technologies, PubMed, SciELO, ScienceDirect, Scopus, Web of Science e na literatura cinzenta. Critérios de seleção Foram incluídos estudos sobre o FFR em usuários de implante coclear ou que os comparassem à indivíduos com audição normal, sem restrição de idade. Foram excluídos estudos secundários e experimentais. Não houve restrição de idioma e ano de publicação. Análise dos dados Os dados foram analisados e redigidos de acordo com as etapas do Preferred Reporting Items for Systematic Reviews and Meta-Analyse (PRISMA) 2020. Para análise da qualidade metodológica foi utilizado o instrumento Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies. As divergências foram resolvidas por um terceiro pesquisador. Resultados Seis estudos atenderam aos critérios de inclusão. Apenas um estudo foi do tipo comparativo com grupo controle de indivíduos com audição normal. As variações nos parâmetros de aquisição foram comuns e as análises predominaram no domínio do tempo. Usuários de implante coclear apresentaram diferenças nos resultados do FFR quando comparados a indivíduos com audição normal, considerando a literatura existente. A maioria dos artigos teve baixa qualidade metodológica. Conclusão Não existe padronização de um protocolo de aquisição e análise para o FFR em usuários de implante coclear. Os resultados são de alto risco de viés.

ABSTRACT Purpose To characterize the acquisition parameters, analysis, and results of the frequency-following response (FFR) in cochlear implant users. Research strategies The search was conducted in Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), Ovid Technologies, PubMed, SciELO, ScienceDirect, Scopus, Web of Science, and gray literature. Selection criteria Studies on FFR in cochlear implant users or that compared them with normal-hearing people, with no restriction of age, were included. Secondary and experimental studies were excluded. There was no restriction of language or year of publication. Data analysis The data were analyzed and reported according to the stages in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 2020. The methodological quality was analyzed with the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Divergences were solved by a third researcher. Results Six studies met the inclusion criteria. Only one study was comparative, whose control group comprised normal-hearing people. The variations in acquisition parameters were common and the analysis predominantly approached the time domain. Cochlear implant users had different FFR results from those of normal-hearing people, considering the existing literature. Most articles had low methodological quality. Conclusion There is no standardized FFR acquisition and analysis protocol for cochlear implant users. The results have a high risk of bias.

Percepção dos pais sobre hipersensibilidade auditiva de crianças com sinais clínicos de risco para o Transtorno do Espectro do Autismo / Parents' perception of auditory hypersensitivity in children with clinical signs of risk for Autism Spectrum Disorder

Resumo Objetivo Averiguar a ocorrência e o tipo de hipersensibilidade auditiva em crianças com sinais clínicos de Transtorno do Espectro do Autismo por meio do relato dos pais no contexto da pandemia da COVID-19. Método Trata-se de um estudo transversal e descritivo, composto por pais de 11 crianças com sinais clínicos de risco para Transtorno do Espectro do Autismo. As crianças eram de ambos os sexos, com média de 44,8 meses de idade. Os pais responderam, por meio de contato telefônico, a um questionário, previamente validado, sobre comportamentos de hipersensibilidade auditiva de seus filhos. Foi considerado como sinalizador de hipersensibilidade a pontuação igual ou superior a oito pontos no escore geral. Resultados 63,6% das crianças apresentaram resultado indicativo de hipersensibilidade e 54,5% obtiveram pontuação máxima nas questões relacionadas à irritabilidade a sons específicos. Os sons citados como geradores de irritabilidade foram: palmas, fogos, gritos, ferramentas de construção, canto e toque de celular. Conclusão Constatou-se ocorrência de hipersensibilidade auditiva, especialmente relacionada à irritabilidade, o que sugere relação com o sistema límbico e, portanto, pode remeter à misofonia. Assim, torna-se importante a equipe multidisciplinar atentar-se à ocorrência e a características de hipersensibilidade dessa população, a fim de maximizar condições favoráveis à reabilitação.

Abstract Objective To investigate the occurrence and type of auditory hypersensitivity in children with clinical signs of Autism Spectrum Disorder through parents' reports in the context of the COVID-19 pandemic. Method This is a cross-sectional and descriptive study, composed of parents of 11 children with clinical signs of risk for Autism Spectrum Disorder. The children were of both sexes, with a mean age of 44.8 months. Parents answered a previously validated questionnaire about their children's auditory hypersensitivity behaviors by telephone. A score equal to or greater than eight points in the general score was considered as a sign of hypersensitivity. Results 63.6% of the children presented results indicative of hypersensitivity and 54.5% obtained maximum scores on questions related to irritability to specific sounds. The sounds cited as generating irritability were: clapping, fireworks, shouting, construction tools, singing and cell phone ringtones. Conclusion Auditory hypersensitivity was observed, especially related to irritability, which suggests a relationship with the limbic system and, therefore, may refer to misophonia. Thus, it is important for the multidisciplinary team to pay attention to the occurrence and characteristics of hypersensitivity in this population, in order to maximize favorable conditions for rehabilitation.

Association between autism spectrum disorder and changes in the central auditory processing in children

SUMMARY OBJECTIVE: To verify the scientific evidence on the association between Autistic Spectrum Disorder and Central Auditory Processing Disorder in children, aiming to answer the following research question: What is the association between Autistic Spectrum and Alteration of Auditory Processing in Children? METHODS: Studies were chosen through the combination based on the Medical Subject Heading Terms (MeSH): [(auditory processing) and (children) and (autism) and (neurological disorders)]. The MEDLINE (PubMed), LILACS, and SciELO databases were used. The analyzed papers covered a ten-year period, from 2010 to 2020. We selected descriptive, cross-sectional, cohort, and case studies. We evaluated the quality of the papers, which had a minimum score of six in the modified scale of the literature. RESULTS: 126 papers were retrieved after the exclusion phase, and 17 of them followed the inclusion criteria. Only two papers answered the guiding question with audiological results. CONCLUSIONS: Patients diagnosed with autistic spectrum disorder may have disturbance central auditory processing, considering that changes were found both in absolute and interpeak latencies in the brainstem evoked response audiometry, as well as in latency and laterality of the N1c wave amplitude. In addition, there were changes in the assessment behavioral auditory processing. Thus, disturbance central auditory processing is common in children with autistic spectrum disorder.

Central auditory processing: behavioral and electrophysiological assessment of children and adolescents diagnosed with stroke.

INTRODUCTION: Central auditory processing refers to the efficiency and effectiveness with which the central nervous system uses auditory information: it may be altered in neurological disorders and brain injuries, such as strokes. However, despite evidence of probable alterations in the pediatric population, functional abilities and post-stroke limitations are still not well documented in the literature. OBJECTIVE: To analyze the findings of the electrophysiological and behavioral evaluations of central auditory processing of children and adolescents diagnosed with stroke from a reference outpatient clinic, as well as to investigate possible associations with the variables: type and location of the stroke and age group. METHODS: The present study is characterized as comparative cross-sectional. The sample, for convenience, included individuals aged 7-18 years divided into two groups: study group, composed of individuals with a diagnosis of stroke, and control group, composed of individuals with typical development. The evaluation consisted of the following procedures: anamnesis, basic audiological evaluation, behavioral evaluation of the auditory processing disorder (dichotic digit test, dichotic consonant-vowel, synthetic sentence identification/pediatric speech intelligibility, gaps in noise, pitch pattern sequence, masking level difference), and electrophysiological evaluation (P300 and mismatch negativity). RESULTS: Nineteen children and adolescents were included in the study group. The control group was composed of 19 children and adolescents with typical development. In the comparison between the groups, a worse performance is observed for the study group in all the evaluated tests, behavioral and electrophysiological. In the behavioral evaluation of central auditory processing, there was a statistical difference for all tests, except for masking level difference and dichotic digit test, binaural separation step on the left. In the electrophysiological evaluation, there was a statistical difference in the latency of mismatch negativity and P300. No associations were found between the behavioral and electrophysiological findings and the location of the stroke and age group variables. CONCLUSION: Children and adolescents diagnosed with stroke present a worse performance in the electrophysiological and behavioral evaluations of central auditory processing when compared to a control group.

Acoustically controlled binaural auditory training with vocal duets: assessment and effectiveness

OBJECTIVES: We aimed to evaluate the effectiveness of a binaural auditory training program with vocal duets by comparing skills through outcomes from behavioral and electrophysiological assessment instruments at three moments: before the intervention, moment one (M1); immediately after training, moment two (M2); and 3 months after, moment three (M3). METHODS: This interventional, longitudinal, prospective, and uncontrolled study was approved by our Research Ethics Committee. Binaural auditory training with vocal duets (ATVD) was applied in 10 adults with normal audiometric thresholds and auditory processing disorders. ATVD used four different vocals of a public domain song sung in a cappella as stimuli. Participants were asked to register any perceived difference in frequency for each syllable of the song during 30-minute sessions twice a week. The number of sessions required ranged from 12 (6 hours) to 20 (10 hours). RESULTS: Regarding behavioral tests, the dichotic consonant-vowel test showed significant evidence of an improved advantage in the left ear (LE) in the non-forced condition and a significant reduction in the number of errors at M2 and M3 in the forced left condition. The speech-in-noise test and frequency pattern test showed a significant reduction in impaired results at M2 and M3. Electrophysiological results showed a significant increase in the LE amplitude in the P3 long-latency auditory evoked potentials test, as well as a decrease in the auditory brainstem response test (III-V and I-V inter-peak latencies in the right ear and wave I and I-III inter-peak latencies in LE). CONCLUSION: The effectiveness of ATVD was evidenced, and the results were maintained after 3 months.

Accuracy of screening instruments in identifying central auditory processing disorders: an integrative literature review

ABSTRACT Purpose: to assess the literature about the accuracy of screening instruments for identifying the Central Auditory Processing Disorders (CAPD). Methods: search strategies were performed in the following databases: CINAHL, LILACS, PubMed /MEDLINE, Scopus, Speechbite and Web of Science. A search was also carried out in the grey literature. Four independent reviewers selected the included articles using a two-phase process based on the eligibility criteria. Two reviewers independently collected the required information from the included articles. The diagnostic methods were minimal batteries of behavioral tests to assess auditory processing skills. Results: from 1,366 articles found on all databases, after analysis of title and abstract, 36 were selected for the next phase, when 5 articles were finally included. It was found that the studies included were related to five instruments applied in children. The specificity was higher than 70%, but just the Mottier test and Screening Test for Auditory Processing (STAP), and Screening Checklist for Auditory Processing (SCAP) showed sensibility higher than 70%. Conclusion: Mottier was the most accurate CAPD screening test. There was no homogeneity in the presentation of the pass/fail criterion, or in the gold reference test used to establish the presence of CAPD.

Teste de dígitos no ruído baseado em software para português brasileiro em crianças com transtorno do processamento auditivo central / Software-based digits-in-noise test for Brazilian Portuguese in children0ith central auditory processing disorder / Prueba de dígitos en ruido basado en software para portugués brasileño en niños con trastorno del central procesamiento auditivo

Introdução: Nas situações da vida diária, frequentemente, é necessário reconhecer a fala em ambientes com ruído competitivo, sendo que dificuldades neste reconhecimento é uma queixa comum de pessoas com transtornos do processamento auditivo central (TPAC). O Teste de Dígitos no Ruído (TDR), desenvolvido para triagem de perdas auditivas em adultos e idosos, apresenta vantagens que o tornam promissor para triagem em crianças com TPAC. Objetivo: Verificar o desempenho de crianças com TPAC no TDR baseado em software para o Português brasileiro. Método: A amostra de conveniência foi constituída por 31 crianças (8-12 anos), sendo 23 com TPAC, alocadas no G1, e oito sem o transtorno, que compuseram o G2. Todas realizaram avaliação audiológica básica, timpanometria, reconhecimento numérico visual e aleatório, aplicação do TDR e avaliação comportamental do processamento auditivo central (PAC) para determinar presença ou não do TPAC. Na análise foi utilizado Teste de Mann-Whitney no comparativo entre G1 e G2 e correlação de Sperman entre os testes de PAC e a média da relação S/R (RSR) do TDR. Resultados: G1 e G2 apresentaram desempenhos significativamente diferentes nos testes fala filtrada (orelha direita), dicótico de dígitos (orelha esquerda), fusão binaural e gaps-in-noise de ambas as orelhas e no teste de padrões de frequência. A média da relação sinal/ruído (RSR) do TDR foi de -7,29 dB (dp ± 4,76) nos sujeitos do G1 e de -8,42 dB (dp ± 2,93) no G2. Não houve diferença estatisticamente significante entre G1 e G2 no comparativo das médias de RSR final (p = 0,227). Não foi evidenciada correlação na maior parte dos testes de PAC e o TDR, exceto correlação negativa no FBOE e DDIOD. Conclusão: O desempenho das crianças com TPAC é similar ao de crianças sem TPAC no teste de dígitos no ruído em Português Brasileiro.

Speech recognition on noise is an auditory processing skill, important for children in contexts with competitive noise and reverberation and can test their functional capacity. The Digits-in-Noise (DIN) Test, developed for hearing screening in adults and the elderly, has advantages that make it promising for screening children with central auditory processing disorders (CAPD). Objective: Verify the performance of children with central auditory processing disorder in a software-based DIN Test for Brazilian Portuguese. Methods: The convenience sample comprised 31 children (8 to 12 years), 23 with CAPD placed in G1, and eight without the disorder that composed G2. All children underwent basic audiological assessment and tympanometry, visual and random numerical recognition, use of DIN and auditory processing behavioral assessment to determine the presence or absence of APD. We used the Mann-Whitney test to compare G1 and G2. Results: G1 and G2 presented different performances in the filtered speech (right ear), dichotic digits (left ear), binaural fusion and gaps-in-noise tests of both ears and in the frequency pattern test. We observed that the average DIN signal-to-noise ratio (SNR) was -7.29 dB (SD ± 4.76) in G1 subjects, and -8.42 dB (SD ± 2.93) in G2 subjects. There was no statistically significant difference between G1 and G2 in comparison of average final SNR (p = 0.227). Conclusion: Considering the average values of the final SNR, we found that the children's performance in the DIN test was similar between both groups.

Introducción: Reconocimiento de habla en ruido es una habilidad del procesamiento auditivo, importante para chicos en contextos con ruido competitivo y reverberación, y puede ser evaluada para determinar su capacidad funcional. La Prueba de Dígitos en Ruido (PDR), desarrollada para detectar pérdida de audición en adultos y ancianos, presentado ventajas que lo hacen prometedor para detección en niños con trastorno del procesamiento auditivo central (TPAC). Objetivo: Verificar el rendimiento de niños conTPAC en PDR basado en software en portugués brasileño. Metodos: La muestra de conveniencia consistió en 31 niños entre 8-12 año, 23 chicos con TPAC, asignado en G1, y ocho sin trastorno, que componen G2. Todos realizaron evaluación audiológica básica, timpanometría, reconocimiento numérico visual y aleatorio, aplicación del PDR y evaluación comportamental del procesamiento auditivo, aplicación del PDR e del comportamiento del procesamiento auditivo para determinar la presencia o ausencia de TPAC. Se utilizó la prueba de Mann-Whitney para análisis entre G1 y G2. Resultados: G1 y G2 presentaron diferentes rendimientos en pruebas de habla filtrada (oído derecho), dígitos dicóticos (oído izquierdo), fusión binaural y gaps-in-noise en ambos oídos y en la prueba del patrón de frecuencia. La Relación Señal/Ruido (S/R) del PDR fue -7.29 dB (sd ± 4.76) en chicos del G1 y -8.42 dB (sd ± 2.93) en G2. No hubo diferencias estadísticamente significativas entre G1 y G2 al comparar las medias finales de RSR (p = 0.227). Conclusión: Teniendo en cuenta valores de la media S/R final, hubo similitud de rendimiento en PDR en ambos grupos.

Individuals With Autism Have No Detectable Deficit in Neural Markers of Prediction Error When Presented With Auditory Rhythms of Varied Temporal Complexity.

The brain's ability to encode temporal patterns and predict upcoming events is critical for speech perception and other aspects of social communication. Deficits in predictive coding may contribute to difficulties with social communication and overreliance on repetitive predictable environments in individuals with autism spectrum disorder (ASD). Using a mismatch negativity (MMN) task involving rhythmic tone sequences of varying complexity, we tested the hypotheses that (1) individuals with ASD have reduced MMN response to auditory stimuli that deviate in presentation timing from expected patterns, particularly as pattern complexity increases and (2) amplitude of MMN signal is inversely correlated with level of impairment in social communication and repetitive behaviors. Electroencephalography was acquired as individuals (age 6-21 years) listened to repeated five-rhythm tones that varied in the Shannon entropy of the rhythm across three conditions (zero, medium-1 bit, and high-2 bit entropy). The majority of the tones conformed to the established rhythm (standard tones); occasionally the fourth tone was temporally shifted relative to its expected time of occurrence (deviant tones). Social communication and repetitive behaviors were measured using the Social Responsiveness Scale and Repetitive Behavior Scale-Revised. Both neurotypical controls (n = 19) and individuals with ASD (n = 21) show stepwise decreases in MMN as a function of increasing entropy. Contrary to the result forecasted by a predictive coding hypothesis, individuals with ASD do not differ from controls in these neural mechanisms of prediction error to auditory rhythms of varied temporal complexity, and there is no relationship between these signals and social communication or repetitive behavior measures. LAY SUMMARY: We tested the idea that the brain's ability to use previous experience to influence processing of sounds is weaker in individuals with autism spectrum disorder (ASD) than in neurotypical individuals. We found no difference between individuals with ASD and neurotypical controls in brain wave responses to sounds that occurred earlier than expected in either simple or complex rhythms. There was also no relationship between these brain waves and social communication or repetitive behavior scores.