Training with an auditory perceptual learning game transfers to speech in competition

Multidisciplinary assessment and interventions for childhood auditory processing disorder (APD) and listening difficulties (LiD)

Purpose

Auditory processing disorder (APD) has been studied in both research and clinic settings, but the relation between the two has not been addressed. In a longitudinal research study (SICLiD), we found that children with clinically normal audiometry who had caregiver-reported listening difficulties (LiD), with or without clinically assessed APD, performed poorly on both listening and cognitive tests. Specific questions asked here were, for the children with LiD, what other neurodevelopmental clinical conditions were identified, what interventions were used by different clinical providers, and how clinical practice was predicted by research results.

Methods

Study setting was a large, research-led, tertiary pediatric hospital. Electronic medical records of 74 children aged 6-13 years, recruited into SICLiD and assigned to an LiD group based on a validated and reliable caregiver report (ECLiPS), were independently reviewed. Focus was on clinical assessments and interventions following appointments provided in the Hospital Divisions of Audiology, Occupational Therapy, Psychology (Developmental and Behavioral Pediatrics), and Speech-Language Pathology (SLP), prior to participation in SICLiD. Descriptive statistics on clinical encounters, identified conditions, and interventions were compared with quantitative, standardized performance on SICLiD assessments of listening and cognitive function. SICLiD z-scores were compared for participants with and without each clinical condition using univariate and logistic prediction analyses.

Results

Most (86%) of the children with LiD had been evaluated by at least one clinical service. Overall, 24 assessment categories related to LiD, including APD, were identified. Most common conditions were attention (32%), language (28%), hearing (18%), anxiety (16%), and autism spectrum (6%) disorders. Performance on SICLiD measures varied significantly between providers, conditions, and interventions. Significant relationships between SICLiD and clinical conditions were mostly caregiver-reported items from the ECLiPS or the Children's Communication Checklist (CCC-2). Other significant correlations were scarce, but included the SCAN composite score, which predicted clinical language and attention, but not other auditory abilities or APD. SICLiD data combined with caregiver reports provided reliable predictions of all clinical conditions except APD.

Conclusions

The variety of disciplines, assessments, conditions and interventions revealed here supports previous studies showing that LiD and APD are multifaceted problems of neurodevelopment. Comparisons between clinical- and research-based assessments suggest a diagnostic path that prioritizes caregiver reports and selected psychometric tests for screening and diagnostic purposes.

A Step Toward Precision Audiology: Individual Differences and Characteristic Profiles From Auditory Perceptual and Cognitive Abilities

Older adults with normal hearing or with age-related hearing loss face challenges when listening to speech in noisy environments. To better serve individuals with communication difficulties, precision diagnostics are needed to characterize individuals' auditory perceptual and cognitive abilities beyond pure tone thresholds. These abilities can be heterogenous across individuals within the same population. The goal of the present study is to consider the suprathreshold variability and develop characteristic profiles for older adults with normal hearing (ONH) and with hearing loss (OHL). Auditory perceptual and cognitive abilities were tested on ONH (n = 20) and OHL (n = 20) on an abbreviated test battery using portable automated rapid testing. Using cluster analyses, three main profiles were revealed for each group, showing differences in auditory perceptual and cognitive abilities despite similar audiometric thresholds. Analysis of variance showed that ONH profiles differed in spatial release from masking, speech-in-babble testing, cognition, tone-in-noise, and binaural temporal processing abilities. The OHL profiles differed in spatial release from masking, speech-in-babble testing, cognition, and tolerance to background noise performance. Correlation analyses showed significant relationships between auditory and cognitive abilities in both groups. This study showed that auditory perceptual and cognitive deficits can be present to varying degrees in the presence of audiometrically normal hearing and among listeners with similar degrees of hearing loss. The results of this study inform the need for taking individual differences into consideration and developing targeted intervention options beyond pure tone thresholds and speech testing.

Relating Suprathreshold Auditory Processing Abilities to Speech Understanding in Competition

(1) Background: Difficulty hearing in noise is exacerbated in older adults. Older adults are more likely to have audiometric hearing loss, although some individuals with normal pure-tone audiograms also have difficulty perceiving speech in noise. Additional variables also likely account for speech understanding in noise. It has been suggested that one important class of variables is the ability to process auditory information once it has been detected. Here, we tested a set of these “suprathreshold” auditory processing abilities and related them to performance on a two-part test of speech understanding in competition with and without spatial separation of the target and masking speech. Testing was administered in the Portable Automated Rapid Testing (PART) application developed by our team; PART facilitates psychoacoustic assessments of auditory processing. (2) Methods: Forty-one individuals (average age 51 years), completed assessments of sensitivity to temporal fine structure (TFS) and spectrotemporal modulation (STM) detection via an iPad running the PART application. Statistical models were used to evaluate the strength of associations between performance on the auditory processing tasks and speech understanding in competition. Age and pure-tone-average (PTA) were also included as potential predictors. (3) Results: The model providing the best fit also included age and a measure of diotic frequency modulation (FM) detection but none of the other potential predictors. However, even the best fitting models accounted for 31% or less of the variance, supporting work suggesting that other variables (e.g., cognitive processing abilities) also contribute significantly to speech understanding in noise. (4) Conclusions: The results of the current study do not provide strong support for previous suggestions that suprathreshold processing abilities alone can be used to explain difficulties in speech understanding in competition among older adults. This discrepancy could be due to the speech tests used, the listeners tested, or the suprathreshold tests chosen. Future work with larger numbers of participants is warranted, including a range of cognitive tests and additional assessments of suprathreshold auditory processing abilities.

Auditory Perceptual Exercises in Adults Adapting to the Use of Hearing Aids

Older adults with age-related hearing loss often use hearing aids (HAs) to compensate. However, certain challenges in speech perception, especially in noise still exist, despite today's HA technology. The current study presents an evaluation of a home-based auditory exercises program that can be used during the adaptation process for HA use. The home-based program was developed at a time when telemedicine became prominent in part due to the COVID-19 pandemic. The study included 53 older adults with age-related symmetrical sensorineural hearing loss. They were divided into three groups depending on their experience using HAs. Group 1: Experienced users (participants who used bilateral HAs for at least 2 years). Group 2: New users (participants who were fitted with bilateral HAs for the first time). Group 3: Non-users. These three groups underwent auditory exercises for 3 weeks. The auditory tasks included auditory detection, auditory discrimination, and auditory identification, as well as comprehension with basic (syllables) and more complex (sentences) stimuli, presented in quiet and in noisy listening conditions. All participants completed self-assessment questionnaires before and after the auditory exercises program and underwent a cognitive test at the end. Self-assessed improvements in hearing ability were observed across the HA users groups, with significant changes described by new users. Overall, speech perception in noise was poorer than in quiet. Speech perception accuracy was poorer in the non-users group compared to the users in all tasks. In sessions where stimuli were presented in quiet, similar performance was observed among new and experienced uses. New users performed significantly better than non-users in all speech in noise tasks; however, compared to the experienced users, performance differences depended on task difficulty. The findings indicate that HA users, even new users, had better perceptual performance than their peers who did not receive hearing aids.