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Ahmmed AU, Asif A, Winterburn S. Visual Processing Impairment in Children With Suspected Auditory Processing Disorder: A Transdisciplinary Dimensional Approach to Diagnosis. Am J Audiol 2022; 31:268-283. [PMID: 35290100 DOI: 10.1044/2021_aja-21-00168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study is to explore the utility of impairment(s) in language (LI), manual dexterity (IMD), and visual perceptual skills (IVPS) as a reference standard for diagnosing auditory processing disorder (APD). METHOD Data from 104 participants with suspected APD (males = 57, females = 47; 6-16 years) were retrospectively analyzed. Index auditory processing (AP) tests included Auditory Figure Ground 0 dB, Competing Words-Directed Ear (CW-DE), and Time-Compressed Sentences (TCS). General Communication Composite (GCC) of the Children's Communication Checklist-2, manual dexterity (MD) component of the Movement Assessment Battery for Children-Second Edition, and Test for Visual Perceptual Skills-Third Edition (TVPS-3) were used to identify LI, IMD, and IVPS, respectively. RESULTS Eighty-one (77.8%), 58 (55.8%), and 37 (35.6%) participants had LI, IVPS, and IMD, respectively. Four factors explaining 67.69% of the variance were extracted. TVPS-3 (except visual closure [VClo]) represented the first; AFG 0, VClo, and MD the second; CW-DE and GCC the third; and TCS the fourth. APD diagnosed by combining AP tests and comorbidities had better accuracy compared to AP tests alone. The combined approach had overall diagnostic accuracy of 92.2%, 88.4%, and 81.7% for the 9th, 5th, and 2nd percentile AP test cutoffs, respectively. CONCLUSIONS First-order AP tests in this study were related to language, MD, and visual perceptual skills. Given the overlap of LI, IMD, and IVPS with impaired AP, these comorbidities are an effective reference standard for APD. APD can be diagnosed following failing one AP test if one or more comorbidities exist. Ninth percentile AP test cutoff had better diagnostic accuracy compared to the currently used 2nd percentile cutoff.
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Affiliation(s)
- Ansar U. Ahmmed
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Aysha Asif
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
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Mishaal RA, Weikum WM, Brooks B, Derry K, Lanphear NE. Appraising the need for audiological assessment before autism spectrum disorder referral. Paediatr Child Health 2022; 27:176-182. [PMID: 35712033 PMCID: PMC9191924 DOI: 10.1093/pch/pxab097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/11/2021] [Indexed: 11/12/2022] Open
Abstract
Objectives Mandatory audiological testing before autism spectrum disorder (ASD) assessment is common practice. Hearing impairment (HI) in the general paediatric population is estimated at 3%; however, hearing impairment prevalence among children with ASD is poorly established. Our objective was to determine which children referred for ASD assessment require preliminary audiological assessment. Methods Retrospective chart review of children (n=4,173; 0 to 19 years) referred to British Columbia's Autism Assessment Network (2010 to 2014). We analyzed HI rate, risk factors, and timing of HI diagnosis relative to ASD referral. Results ASD was diagnosed in 53.4%. HI rates among ASD referrals was 3.3% and not significantly higher in children with ASD (ASD+; 3.5%) versus No-ASD (3.0%). No significant differences in HI severity or type were found, but more ASD+ females (5.5%) than ASD+ males (3.1%) had HI (P<0.05). Six HI risk factors were significant (problems with intellect, language, vision/eye, ear, genetic abnormalities, and prematurity) and HI was associated with more risk factors (P<0.01). Only 12 children (8.9%) were diagnosed with HI after ASD referral; all males 6 years or younger and only one had no risk factors. ASD+ children with HI were older at ASD referral than No-ASD (P<0.05). Conclusions Children with ASD have similar hearing impairment rates to those without ASD. HI may delay referral for ASD assessment. As most children were diagnosed with HI before ASD referral or had at least one risk factor, we suggest that routine testing for HI among ASD referrals should only be required for children with risk factors.
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Affiliation(s)
| | - Whitney M Weikum
- Correspondence: Whitney M. Weikum, Department of Pediatrics, The University of British Columbia and Sunny Hill Health Centre for Children, 4480 Oak Street, Vancouver, British Columbia, V6H 3N1, Canada. Telephone +1-604-875-2345 ext 458383, e-mail
| | - Beth Brooks
- Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Derry
- Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy E Lanphear
- Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Ren J, Xu T, Xiang T, Pu JM, Liu L, Xiao Y, Lai D. Prevalence of Hyperacusis in the General and Special Populations: A Scoping Review. Front Neurol 2021; 12:706555. [PMID: 34539554 PMCID: PMC8446270 DOI: 10.3389/fneur.2021.706555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: To study the prevalence of hyperacusis in the general population and the special population, and to determine the effect of population differences on hyperacusis. Methods: The two authors followed a scoping review methodology and screened nearly 30 years of English literature in Pubmed, Web of Science, OVID, and EBSCO. Then, the extracted results of each study were discussed in groups and subgroups. Results: The authors selected 42 pieces of scientific literature that met the requirements, studying a total of 34,796 subjects, including the general population (28,425 subjects), the special occupation population (2,746 subjects), and the patients with concomitant diseases (5,093 subjects). The prevalence was 0.2–17.2% in the general population, 3.8–67% in the special occupation population, and 4.7–95% in the patients with special diseases. It was found that in the general population, the high prevalence occurs in adolescents and older adults. The prevalence of hyperacusis in women is significantly higher than in men. In people with hearing disorders, the prevalence of hyperacusis is significantly higher than in people with normal hearing. Various diseases (such as Williams syndrome, tinnitus, and autism), as well as various occupations (musicians, music students, teachers, and others), have been found to be high risk factors for hyperacusis. Conclusion: The high prevalence of hyperacusis and the large differences between reported prevalence in different studies deserves our great attention. Additionally, in order to increase the comparability of the studies, a standardized set of criteria are needed to study the prevalence of hyperacusis.
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Affiliation(s)
- Jing Ren
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Tao Xu
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Tao Xiang
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jun-Mei Pu
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lu Liu
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yan Xiao
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Dan Lai
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Pflug C, Kiehn S, Koseki JC, Pinnschmidt H, Müller F, Nienstedt JC, Flügel T, Niessen A. Prognostic factors in non-organic hearing loss in children. Int J Audiol 2021; 61:400-407. [PMID: 34396881 DOI: 10.1080/14992027.2021.1922942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Exploring factors that predict a favourable clinical outcome in non-organic hearing loss (NOHL) in children. NOHL is defined as a subjective hearing loss without correlation in objective measures. DESIGN Retrospective analysis of all childrens' data with the diagnosis NOHL seen between 2005 and 2017 at a tertiary referral centre. STUDY SAMPLE Sixty-seven children (44 female, 23 male; mean age 11.26 years) were included. Statistical analyses included descriptive statistics, logistic regression, correlations, and Mann-Whitney U tests. RESULTS A quarter of the children (17/67) had been provided previously with hearing aids without objective sensorineural hearing loss. Having been provided with hearing aids before the first visit to our clinic lowered the chance of normal hearing at the final visit by 76%. The prescription of hearing aids was significantly more likely in girls. Children provided with hearing aids were significantly older than those without and the time span between the first occurrence of the NOHL and first presentation at our department was longer than in children not provided with hearing aids. CONCLUSIONS In cases of NOHL, hearing aid prescription is not indicated and significantly lowers a child's chance of full recovery and, thus, should not be prescribed unless NOHL is ruled out.
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Affiliation(s)
- Christina Pflug
- Department of Voice, Speech, and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Saskia Kiehn
- Department of Voice, Speech, and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana-C Koseki
- Department of Voice, Speech, and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Pinnschmidt
- Institute of Medical Biometry and Epidemiology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Müller
- Department of Voice, Speech, and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julie C Nienstedt
- Department of Voice, Speech, and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Flügel
- Department of Voice, Speech, and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Almut Niessen
- Department of Voice, Speech, and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ahmmed AU. Auditory Processing Disorder and Its Comorbidities: A Need for Consistency in Test Cutoff Scores. Am J Audiol 2021; 30:128-144. [PMID: 33656911 DOI: 10.1044/2020_aja-20-00103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose No gold standard criteria exist for diagnosing developmental auditory processing disorder (APD). This study aimed to identify APD criteria, which are consistent with that used for comorbidities, and how comorbidities predicted APD. Method A retrospective study of 167 participants (males = 105, females = 62; age: 6-16 years; nonverbal IQ > 80) with suspected APD is presented. Five SCAN-3 tests evaluated auditory processing (AP). Comorbidities included attention-deficit/hyperactivity disorder, language impairment, and impaired manual dexterity, which were identified using percentile ≤ 5 in the Swanson, Nolan and Pelham parental rating scale; Children's Communication Checklist-2; and Movement Assessment Battery for Children-2, respectively. Results Percentiles ≤ 9, ≤ 5, and < 2 in two or more AP tests had sensitivities (specificities) of 76% (70.6%), 59.3% (76.5%), and 26% (82.4%), respectively, in predicting comorbidities, which were present in 150 of the 167 participants. The criterion of "≤ 9 percentile in two or more AP tests" (Approach I) diagnosed APD in 119 participants, and criterion "≤ 5 percentile in two or more AP tests or ≤ 5 percentile in one AP plus one or more measures of comorbidities" (Approach II) diagnosed 123. The combination of approaches diagnosed 128 participants (76.6%) with APD, of which 114 were diagnosed by each approach (89%). Language impairment and impaired manual dexterity, but not attention-deficit/hyperactivity disorder, predicted APD. Conclusions "Percentile ≤ 9 in two or more AP tests" or "percentile ≤ 5 in one AP plus one or more measures of comorbidities" are evidence-based APD diagnostic criteria. Holistic and interprofessional practice evaluating comorbidities including motor skills is important for APD.
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Affiliation(s)
- Ansar U. Ahmmed
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
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Auditory processing, co-morbidities, and parental report of sleep disturbance in children with auditory processing disorder (APD). Int J Pediatr Otorhinolaryngol 2020; 135:110117. [PMID: 32460044 DOI: 10.1016/j.ijporl.2020.110117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/13/2020] [Accepted: 05/10/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the prevalence of sleep disturbance and its relationship with auditory processing (AP) and co-morbidities in children diagnosed with auditory processing disorder (APD). METHODS Data from 109 children (Males = 59, Females = 50) with mean non-verbal intelligence quotient (NVIQ) of 89.44 (SD:18.16), aged between 6 and 16 years (mean: 10 years 7 months; SD: 2 years 9 months) with a diagnosis of APD were analysed. Participants performed ≤1.33 SD below the mean in two or more out of five SCAN-3 diagnostic APD tests that included 'Filtered Words' (FW), 'Auditory Figure Ground 0 dB' (AFG0), 'Competing Words-Directed Ear' (CW-DE), 'Competing Sentences' (CS) and 'Time Compressed Sentences' (TCS). Concern about sleep in addition to other symptoms and medical history were documented from structured parental history sheet which forms part of the routine APD assessment. Language impairment (LI), attention-deficit-hyperactivity-disorder (ADHD) and oppositional defiant disorder (ODD), and anxiety were evaluated using the 'Children's Communication Checklist-2' (CCC-2), 'Swanson Nolan and Pelham rating scale' (SNAP-IV) and 'Anxiety Scale for Children-Autism Spectrum Disorder' (ASC-ASD) respectively. RESULTS Sixty children had sleep disturbance, a prevalence of 55% (95% CI 45.2%-64.6%). The two groups of APD children, with (n = 49) and without sleep (n = 60) disturbance, did not vary in their auditory processing abilities. The sleep disturbed group had significant issues with pragmatic language impairment, hyperactivity/impulsivity, oppositional defiant symptoms and anxiety compared to the group without sleep disturbance when they were analysed separately. After the variables were considered in step wise fashion in binary logistic regression analyses, only pragmatic language impairment and anxiety predicted sleep disturbance (p < .01). CONCLUSION In APD the prevalence of sleep disturbance is high, justifying screening within a transdisciplinary APD assessment protocol. Sleep disturbance in APD is predicted by pragmatic language impairment and anxiety, but not by ADHD symptoms or ODD.
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Ahn JH, Oh SH, Jang H, Lee JB, Chung JW. Impact of hearing loss on the performance of auditory processing measured by questionnaires in Korean adolescents. Sci Rep 2020; 10:10118. [PMID: 32572114 PMCID: PMC7308366 DOI: 10.1038/s41598-020-67033-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/02/2020] [Indexed: 11/23/2022] Open
Abstract
Increasing use of personal listening devices has been accompanied by increase in the prevalence of hearing loss (HL) among youth in Korea, as in other countries. Auditory processing disorder (APD) is one of the main factors affecting academic achievement at school. This study aimed to investigate the prevalence of HL in students attending general middle- and high schools and compare the findings with the APD survey results. From June 1 to December 31, 2016, Korean adolescents (n = 2,791) in the first years of middle- and high school underwent audiometric testing and otologic examination and completed questionnaires on APD. The survey was sponsored by the Korean Society of Otolaryngology-Head and Neck Surgery and the Korean Otology Society. The prevalence of speech-frequency hearing loss (SFHL) and high-frequency hearing loss (HFHL) in the poorer ear was 11.6% and 10.3%, respectively, among Korean adolescents. We analysed data from the Scale of Auditory Behaviors, Fisher’s Auditory Problems Checklist, and KNISE-Auditory Behavioral Checklist and compared these with the results of hearing tests. We observed positive correlations among the APD questionnaire results and mean hearing levels. This study suggested that hearing loss, especially bilateral high-frequency hearing loss, may affect central auditory processing.
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Affiliation(s)
- Joong Ho Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunsook Jang
- Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, Chuncheon, Korea
| | - Jung-Bok Lee
- Department of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Ahmmed AU. A transdisciplinary protocol evaluating auditory processing disorder (APD) in children using speech and non-speech stimuli and tools for common co-morbidities: time to re-evaluate APD diagnostic criteria. HEARING BALANCE AND COMMUNICATION 2020. [DOI: 10.1080/21695717.2020.1753416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ansar Uddin Ahmmed
- Paediatric Audiology Service, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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Ahmmed AU. Manual dexterity and outcomes in a commonly used test battery to assess auditory processing disorder (APD) in children. HEARING BALANCE AND COMMUNICATION 2019. [DOI: 10.1080/21695717.2019.1644862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ansar Uddin Ahmmed
- Fulwood Audiology Clinic, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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