Auditory Training for Central Auditory Processing Disorder

Hearing rehabilitation of adults with auditory processing disorder: a systematic review and meta-analysis of current evidence-based interventions

Background

For adults with auditory processing disorder (APD), listening and communicating can be difficult, potentially leading to social isolation, depression, employment difficulties and certainly reducing the quality of life. Despite existing practice guidelines suggesting treatments, the efficacy of these interventions remains uncertain due to a lack of comprehensive reviews. This systematic review and meta-analysis aim to establish current evidence on the effectiveness of interventions for APD in adults, addressing the urgent need for clarity in the field.

Methods

Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search across MEDLINE (Ovid), Embase (Ovid), Web of Science and Scopus, focusing on intervention studies involving adults with APD. Studies that met the inclusion criteria were grouped according to intervention with a meta-analysis only conducted where intervention, study design and outcome measure were comparable.

Results

Out of 1,618 screened records, 13 studies were included, covering auditory training (AT), low-gain hearing aids (LGHA), and personal remote microphone systems (PRMS). Our analysis revealed: AT, Mixed results with some improvements in speech intelligibility and listening ability, indicating potential benefits but highlighting the need for standardized protocols; LGHA, The included studies demonstrated significant improvements in monaural low redundancy speech testing (p < 0.05), suggesting LGHA could enhance speech perception in noisy environments. However, limitations include small sample sizes and potential biases in study design. PRMS, Demonstrated the most consistent evidence of benefit, significantly improving speech testing results, with no additional benefit from combining PRMS with other interventions.

Discussion

PRMS presents the most evidence-supported intervention for adults with APD, although further high-quality research is crucial for all intervention types. The establishment and implementation of standardized intervention protocols alongside rigorously validated outcome measures will enable a more evidence-based approach to managing APD in adults.

Interventions for School-Aged Children with Auditory Processing Disorder: A Scoping Review

(1) Background: Auditory processing (AP) disorder is associated with learning difficulties and poses challenges to school-aged children in their daily activities. This scoping review identifies interventions and provides audiologists with protocol insights and outcome measures. (2) Methods: A systematic search of both peer-reviewed and grey literature (January 2006 to August 2023) covered ten databases. Studies included had the following characteristics: (i) published in French or English; (ii) participants were school-aged, and had a normal audiogram, AP difficulties or disorder, and no cognitive, developmental, congenital or neurological disorder (with the exception of learning, attention, and language disabilities); (iii) were intervention studies or systematic reviews. (3) Results: Forty-two studies were included, and they predominantly featured auditory training (AT), addressing spatial processing, dichotic listening, temporal processing and listening to speech in noise. Some interventions included cognitive or language training, assistive devices or hearing aids. Outcome measures listed included electrophysiological, AP, cognitive and language measures and questionnaires addressed to parents, teachers or the participants. (4) Conclusions: Most interventions focused on bottom-up approaches, particularly AT. A limited number of top-down approaches were observed. The compiled tools underscore the need for research on metric responsiveness and point to the inadequate consideration given to understanding how children perceive change.

Central auditory processing and self-perception questionnaire after acoustically controlled auditory training in individuals with mild traumatic brain injury

PURPOSE

To correlate behavioral assessment results of central auditory processing and the self-perception questionnaire after acoustically controlled auditory training.

METHODS

The study assessed 10 individuals with a mean age of 44.5 years who had suffered mild traumatic brain injury. They underwent behavioral assessment of central auditory processing and answered the Formal Auditory Training self-perception questionnaire after the therapeutic intervention - whose questions address auditory perception, understanding orders, request to repeat statements, occurrence of misunderstandings, attention span, auditory performance in noisy environments, telephone communication, and self-esteem. Patients were asked to indicate the frequency with which the listed behaviors occurred.

RESULTS

Figure-ground, sequential memory for sounds, and temporal processing correlated with improvement in following instructions, fewer requests to repeat statements, increased attention span, improved communication, and understanding on the phone and when watching TV.

CONCLUSION

Auditory closure, figure-ground, and temporal processing had improved in the assessment after the acoustically controlled auditory training, and there were fewer auditory behavior complaints.

Early auditory processing abnormalities alter individual learning trajectories and sensitivity to computerized cognitive training in schizophrenia

BACKGROUND

Auditory system plasticity is a promising target for neuromodulation, cognitive rehabilitation and therapeutic development in schizophrenia (SZ). Auditory-based targeted cognitive training (TCT) is a 'bottom up' intervention designed to enhance the speed and accuracy of auditory information processing, which has been shown to improve neurocognition in certain SZ patients. However, the dynamics of TCT learning as a function of training exercises and their impact on neurocognitive functioning and therapeutic outcomes are unknown.

METHODS

Forty subjects (SZ, n = 21; healthy subjects (HS), n = 19) underwent comprehensive clinical, cognitive, and auditory assessments, including measurements of auditory processing speed (APS) at baseline and after 1-h of TCT. SZ patients additionally completed 30-hours of TCT and repeated assessments ~10-12 weeks later.

RESULTS

SZ patients were deficient in APS at baseline (d = 0.96, p < 0.005) relative to HS. After 1-h of TCT, analyses revealed significant main effects of diagnosis (d = 1.75, p = 0.002) and time (d = 1.04, p < 0.001), and a diagnosis × time interaction (d = 0.85, p = 0.02) on APS. APS learning effects were robust after 1-h in SZ patients (d = 1.47, p < 0.001) and persisted throughout the 30-h of training. Baseline APS was associated with verbal learning gains after 30-h of TCT (r = 0.51, p = 0.02) in SZ.

CONCLUSIONS

TCT learning metrics may have prognostic utility and aid in the prospective identification of individuals likely to benefit from TCT. Future experimental medicine studies may advance predictive algorithms that enhance TCT-related clinical, cognitive and functional outcomes.

Impact of Otitis Media With Effusion in Early Age on Auditory Processing Abilities in Children: A Systematic Review and Meta-Analysis

Objective: Early-onset otitis media with effusion (OME) can affect the development of the auditory nervous system and thus lead to auditory processing abnormalities. This study aims to review the effect of childhood OME on auditory processing abilities in children. Methods: A systematic review of the literature, restricted to the English language from 1990 to 2022 was conducted using search engines like PubMed, Embase, and Google Scholar. After selecting the articles following predefined inclusion and exclusion criteria, the data were extracted and meta-analysis was performed. Results: A total of 10 articles met the inclusion criteria. Children with a history of OME had poorer performance in most behavioral and electrophysiological tests. Pooled analysis of various tests such as the gap in noise test, frequency pattern test (verbal and nonverbal), and latencies of auditory brainstem response-I, V, I to III, and I to V showed a difference between the 2 groups. Conclusion: Childhood OME can significantly affect auditory processing abilities in children.

Investigation of the relationship between hyperacusis and auditory processing difficulties in individuals with normal hearing

PURPOSE

This study aimed to investigate the prevalence of hyperacusis and auditory processing (listening) difficulties (APDiff) in normal-hearing young adults and to explore the relationship between these two conditions.

METHODS

A total of 333 participants aged 18-24 underwent pure-tone audiometry tests and completed the Khalfa Hyperacusis Questionnaire (KHQ) and the University of Cincinnati Auditory Processing Inventory (UCAPI) online.

RESULTS

Hyperacusis was identified in 26.43% of participants, and APDiff in 36.04%. A strong, positive correlation was found between KHQ and UCAPI scores (r = 0.603, p < 0.001). Logistic regression models indicated that hyperacusis significantly increased the likelihood of having APDiff (OR 7.688, p < 0.001).

CONCLUSION

Despite the high prevalence of hyperacusis and APDiff in young adults, few seek help from audiology clinics. Our findings highlight a significant link between hyperacusis and APDiff, emphasizing the need for screening protocols for auditory processing skills in young adults due to these conditions' potential social and academic impacts.

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.

Central Auditory Processing Dysfunction in Service Members and Veterans: Treatment Considerations and Strategies

PURPOSE

Military risk factors such as blast exposure, noise exposure, head trauma, and neurotoxin exposure place Service members and Veterans at risk for deficits associated with auditory processing dysfunction. However, there is no clinical guidance specific to the treatment of auditory processing deficits in this unique population. We provide an overview of available treatments and their limited supporting evidence for use in adults, emphasizing the need for multidisciplinary case management and interdisciplinary research to support evidence-based solutions.

METHOD

We explored relevant literature to inform the treatment of auditory processing dysfunction in adults, with emphasis on findings involving active or former military personnel. We were able to identify a limited number of studies, pertaining primarily to the treatment of auditory processing deficits through the use of assistive technologies and training strategies. We assessed the current state of the science for knowledge gaps that warrant additional study.

CONCLUSIONS

Auditory processing deficits often co-occur with other military injuries and may pose significant risk in military operational and occupational settings. Research is needed to advance clinical diagnostic and rehabilitative capabilities, guide treatment planning, support effective multidisciplinary management, and inform fitness-for-duty standards. We emphasize the need for an inclusive approach to the assessment and treatment of auditory processing concerns in Service members and Veterans and for evidence-based solutions to address complex military risk factors and injuries.

Functional Hearing Difficulties in Veterans: Retrospective Chart Review of Auditory Processing Assessments in the VA Health Care System

PURPOSE

Approximately 23 million Americans might have functional hearing difficulties (FHDs) that are not well explained by their audiometric thresholds. Clinical management of patients with FHDs is the subject of considerable debate, with few evidence-based guidelines to direct patient care. A better understanding of the characteristics of patients who seek help for FHDs, as well as current audiological management practices, is needed to direct research efforts to the areas greatest opportunity for advancement of clinical care.

METHOD

A retrospective chart review was conducted examining the medical records of a random sample of 100 Veterans who underwent auditory processing assessments across the VA Health Care System between 2008 and 2020.

RESULTS

Patients were young to middle-age, often with previous traumatic brain injury or blast exposure. Mental health, sleep, and pain disorders were common. No consistent relationships emerged between specific patient factors and domains of auditory processing deficits. Low-gain hearing aids were provided to 35 patients, 69% of whom continued wearing their hearing aids for at least 2 years.

CONCLUSION

Future research should address the potential overlap in symptoms and treatment for comorbid health conditions and FHDs, as well as the conditions underlying successful hearing aid use in this patient population.

Efficacy of training with the Arabic "differential processing training program "on temporal processing skills in dyslexic children with auditory processing disorder: A randomized clinical trial

BACKGROUND

There is a lot of debate regarding auditory processing disorders, especially treatment, as there is no gold standard to date. Learning and literacy challenges can result from impaired auditory processing abilities, specifically temporal processing skills, compromising a child's academic and social accomplishment.

OBJECTIVE

To determine the effect of auditory processing training using the adapted translated version of the "Differential Processing Training Program" on auditory and cognitive functions in Egyptian Arabic-speaking dyslexic children with auditory processing disorder in comparison to training with the established Arabic computer-based auditory training program.

METHODS

A randomized controlled trial was conducted on 52 dyslexic children with an auditory processing disorder. Using block randomization, the children were divided into two groups: a case group called the DPTP group and a control group called the CBAT group. Objective assessments were used to assess both groups' auditory skills. The DPTP group received training using the "Differential Processing Training Program," while CBAT received training in a computer-based auditory training program. Both groups were re-evaluated post-therapy using the same protocol.

RESULTS

All assessed parameters demonstrated statistical improvement in both groups when pre-therapy and post-therapy scores were compared. Furthermore, the DPTP group exhibited superior performance in the AFTR when percent change was compared between the studied groups.

CONCLUSIONS

Temporal processing skills showed a favorable response to therapy. Comparable results of the Arabic version of the "Differential Processing Training Program" and the Arabic computer-based training program Hence, the Arabic version of the "Differential Processing Training Program" is a reliable and valid training program for the tested population.

Training Programs for Improving Speech Perception in Noise: A Review

Understanding speech in the presence of noise is difficult and challenging, even for people with normal hearing. Accurate pitch perception, coding and decoding of temporal and intensity cues, and cognitive factors are involved in speech perception in noise (SPIN); disruption in any of these can be a barrier to SPIN. Because the physiological representations of sounds can be corrected by exercises, training methods for any impairment can be used to improve speech perception. This study describes the various types of bottom-up training methods: pitch training based on fundamental frequency (F0) and harmonics; spatial, temporal, and phoneme training; and top-down training methods, such as cognitive training of functional memory. This study also discusses music training that affects both bottom-up and top-down components and speech training in noise. Given the effectiveness of all these training methods, we recommend identifying the defects underlying SPIN disorders and selecting the best training approach.

Effect of an Auditory Temporal Training Program on Speech Fluency of Children with Developmental Stuttering

Objectives

The present study aims to investigate the effect of a temporal processing-based auditory training program on alleviating stuttering severity in children diagnosed with auditory temporal processing disorders.

Materials & Methods

Thirty-one children with stuttering diagnosed with auditory temporal processing disorders participated in this study (intervention group: 17 participants between seven to 12 years old; control group: 14 participants between eight to 12 years old). The auditory temporal processing test and Stuttering Severity Instrument-3 (SSI-3) were examined before/after 12 sessions (nearly 540 minutes) of training and three months following the conclusion of the intervention.

Results

According to the results, auditory temporal processing improved significantly in the intervention group after temporal processing-based auditory training. Besides, the differences between the intervention and control groups were significant (P<0.05). The improvement of auditory temporal processing skills remained stable in the post-training evaluation after three months (P>0.05). Although the SSI-3 score was somewhat improved in the intervention group, no significant difference was found between the two groups (P=0.984).

Conclusion

The findings revealed that auditory temporal processing training acted as a complementary therapy alleviating the stuttering severity of children who stutter with auditory temporal processing disorders to some extent.

Central Auditory Functions of Alzheimer's Disease and Its Preclinical Stages: A Systematic Review and Meta-Analysis

In 2020, 55 million people worldwide were living with dementia, and this number is projected to reach 139 million in 2050. However, approximately 75% of people living with dementia have not received a formal diagnosis. Hence, they do not have access to treatment and care. Without effective treatment in the foreseeable future, it is essential to focus on modifiable risk factors and early intervention. Central auditory processing is impaired in people diagnosed with Alzheimer's disease (AD) and its preclinical stages and may manifest many years before clinical diagnosis. This study systematically reviewed central auditory processing function in AD and its preclinical stages using behavioural central auditory processing tests. Eleven studies met the full inclusion criteria, and seven were included in the meta-analyses. The results revealed that those with mild cognitive impairment perform significantly worse than healthy controls within channel adaptive tests of temporal response (ATTR), time-compressed speech test (TCS), Dichotic Digits Test (DDT), Dichotic Sentence Identification (DSI), Speech in Noise (SPIN), and Synthetic Sentence Identification-Ipsilateral Competing Message (SSI-ICM) central auditory processing tests. In addition, this analysis indicates that participants with AD performed significantly worse than healthy controls in DDT, DSI, and SSI-ICM tasks. Clinical implications are discussed in detail.

Auditory Processing Intervention Program for school-aged children - development and content validation

PURPOSE

The study aimed at the development and content validation of an Auditory Processing Intervention Program for school-aged European Portuguese speaking children with Auditory Processing Disorder.

METHODS

The first step was the program's development and its instructions manual, which includes objectives, activities, procedures, materials, reinforcement, instructions, and verbal stimuli used, for the following auditory skills: auditory discrimination, auditory attention; auditory memory; auditory closure; figure-ground; auditory separation; auditory integration; binaural fusion; content validation was performed next, with two expert panels analyzing the program, through the use of a questionnaire. Content validity was calculated using the content validity index.

RESULTS

Program evaluation shows an excellent content validity. Some items were modified after analyzing the experts' comments and suggestions (e.g. instructions, intensity differences, main character).

CONCLUSION

This work allowed the development and content validation of an auditory processing intervention program, with verbal stimuli, selected according to strict linguistic criteria. In the future, the acceptability and efficacy of this program with the target population should be analyzed.

Central auditory processing deficits in schizophrenia: Effects of auditory-based cognitive training

BACKGROUND

Sensory processing abnormalities are common in schizophrenia (SZ) and impact everyday functions, such as speech perception in noisy environments. Auditory-based targeted cognitive training (TCT) is a "bottom up" cognitive remediation intervention designed to enhance the speed and accuracy of low-level auditory information processing. However, the effects of TCT on behavioral measures of central auditory processing (CAP) and the role of CAP function on verbal learning outcomes in SZ are unknown.

METHODS

SZ (n = 42) and healthy subjects (CTL; n = 18) underwent comprehensive clinical, neurocognitive, and auditory assessments, including tests of hearing sensitivity and speech recognition (Words-in-Noise (WIN), Quick Speech-in-Noise (SIN)). SZ patients were randomized to receive either treatment-as-usual (TAU); or 30-h of TCT + TAU using a stratified, parallel design. SZ patients repeated assessments ~10-12 weeks later.

RESULTS

Patients exhibited deficits in both WIN (p < 0.05, d = 0.50) and SIN (p < 0.01, d = 0.63). A treatment × time interaction on WIN (p < 0.05, d = 0.74), but not SIN discriminability, was seen in the TCT group relative to TAU. Specific enhancements in the 4-dB over background range drove gains in WIN performance. Moreover, SZ patients with greater CAP deficits experienced robust gains in verbal learning after 30-h of TCT relative to SZ patients without CAP impairment (p < 0.01, d = 1.28).

CONCLUSION

Findings demonstrate that intensive auditory training enhances the fidelity of auditory processing and perception, such that specific CAP deficits were 'normalized' and were predictive of gains in verbal learning after TCT. It is conceivable that patients with deficiencies in CAP measures may benefit most from TCT and other interventions targeting auditory dysfunction in SZ.

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

Understanding speech in the presence of acoustical competition is a major complaint of those with hearing difficulties. Here, a novel perceptual learning game was tested for its effectiveness in reducing difficulties with hearing speech in competition. The game was designed to train a mixture of auditory processing skills thought to underlie speech in competition, such as spectral-temporal processing, sound localization, and auditory working memory. Training on these skills occurred both in quiet and in competition with noise. Thirty college-aged participants without any known hearing difficulties were assigned either to this mixed-training condition or an active control consisting of frequency discrimination training within the same gamified setting. To assess training effectiveness, tests of speech in competition (primary outcome), as well as basic supra-threshold auditory processing and cognitive processing abilities (secondary outcomes) were administered before and after training. Results suggest modest improvements on speech in competition tests in the mixed-training compared to the frequency-discrimination control condition (Cohen’s d = 0.68). While the sample is small, and in normally hearing individuals, these data suggest promise of future study in populations with hearing difficulties.

Electrophysiological Screening for Children With Suspected Auditory Processing Disorder: A Systematic Review

Objective: This research aimed to provide evidence for the early identification and intervention of children at risk for auditory processing disorder (APD). Electrophysiological studies on children with suspected APDs were systematically reviewed to understand the different electrophysiological characteristics of children with suspected APDs. Methods: Computerized databases such as PubMed, Cochrane, MEDLINE, Web of Science, and EMBASE were searched for retrieval of articles since the establishment of the database through May 18, 2020. Cohort, case-control, and cross-sectional studies that evaluated the literature for the electrophysiological assessment of children with suspected APD were independently reviewed by two researchers for literature screening, literature quality assessment, and data extraction. The Newcastle-Ottawa Scale and 11 entries recommended by the Agency for Healthcare Research and Quality were used to evaluate the quality of the literature. Results: In accordance with the inclusion criteria, 14 articles were included. These articles involved 7 electrophysiological testing techniques: click-evoked auditory brainstem responses, frequency-following responses, the binaural interaction component of the auditory brainstem responses, the middle-latency response, cortical auditory evoked potential, mismatch negativity, and P300. The literature quality was considered moderate. Conclusions: Auditory electrophysiological testing can be used for the characteristic identification of children with suspected APD; however, the value of various electrophysiological testing methods for screening children with suspected APD requires further study.

Effect of a Dichotic Interaural Time Difference Program on Dichotic Listening Deficit of Children with Learning Difficulty

BACKGROUND

 Dichotic listening deficit (DLD) is a common sign in children showing learning problem and is identified during auditory processing assessment. A dichotic listening training program was developed in which the weak ear lags behind the strong ear in time and has certain practices for switching attention between the ears and auditory memory.

PURPOSE

 The aim of the present study was to evaluate the effectiveness of this treatment program on dichotic performance of primary school children showing DLD.

RESEARCH DESIGN

 A pre/post clinical trial without control study.

STUDY SAMPLE

 Twenty-five primary school children, aged 7 to 12 years (mean = 9.3 years), showing DLD.

DATA COLLECTION AND ANALYSIS

 Several primary schools referred the children with learning difficulty to us. We defined learning difficulty as a score of 2 and lower on a five-point scale in at least two primary school courses in the current semester. The children with DLD participated in listening practices three times a week for 10 weeks, each session lasting for 30 minutes. The practices started with one pair of dichotic digits and ended in practice with sentences. The weak ear lag varied from 100 to 1,000 milliseconds. In the last stage of the practices, the precued and postcued directed response aimed at strengthening auditory memory and switching attention between the ears. The results obtained by the tests of dichotic digits, competing words, and competing sentences before and after the intervention were compared using paired t-test. Hedges's g was calculated as the effect size.

RESULTS

 Comparison of the results of pretraining and those of posttraining revealed that the average dominant ear (DE) and nondominant ear (NDE) scores in dichotic listening tests improved significantly with medium-to-large effect sizes. It was also found that the mean change in the NDE score of the children was significantly greater than that of the DE score for all the tests.

CONCLUSIONS

 Dichotic interaural time difference training that employed dichotic lag phenomenon followed by directed response practices significantly improved the DE and the NDE scores of the schoolchildren with DLD.

The Influence of the Type of Background Noise on Perceptual Learning of Speech in Noise

OBJECTIVES

Auditory perceptual learning studies tend to focus on the nature of the target stimuli. However, features of the background noise can also have a significant impact on the amount of benefit that participants obtain from training. This study explores whether perceptual learning of speech in background babble noise generalizes to other, real-life environmental background noises (car and rain), and if the benefits are sustained over time.

DESIGN

Normal-hearing native English speakers were randomly assigned to a training (n = 12) or control group (n = 12). Both groups completed a pre- and post-test session in which they identified Bamford-Kowal-Bench (BKB) target words in babble, car, or rain noise. The training group completed speech-in-babble noise training on three consecutive days between the pre- and post-tests. A follow up session was conducted between 8 and 18 weeks after the post-test session (training group: n = 9; control group: n = 7).

RESULTS

Participants who received training had significantly higher post-test word identification accuracy than control participants for all three types of noise, although benefits were greatest for the babble noise condition and weaker for the car- and rain-noise conditions. Both training and control groups maintained their pre- to post-test improvement over a period of several weeks for speech in babble noise, but returned to pre-test accuracy for speech in car and rain noise.

CONCLUSION

The findings show that training benefits can show some generalization from speech-in-babble noise to speech in other types of environmental noise. Both groups sustained their learning over a period of several weeks for speech-in-babble noise. As the control group received equal exposure to all three noise types, the sustained learning with babble noise, but not other noises, implies that a structural feature of babble noise was conducive to the sustained improvement. These findings emphasize the importance of considering the background noise as well as the target stimuli in auditory perceptual learning studies.

Central Auditory Tests to Track Cognitive Function in People With HIV: Longitudinal Cohort Study

Background

The development of neurocognitive deficits in people infected with HIV is a significant public health problem. Previous cross-sectional studies have shown that performance on central auditory tests (CATs) correlates with cognitive test results in those with HIV, but no longitudinal data exist for confirmation. We have been performing longitudinal assessments of central auditory and cognitive function on a cohort of HIV-positive and HIV-negative individuals in Dar es Salaam, Tanzania to understand how the central auditory system could be used to study and track the progress of central nervous system dysfunction.

Objective

The goal of the project was to determine if CATs can track the trajectory of cognitive function over time in people diagnosed with HIV.

Methods

Tests of peripheral and central auditory function as well as cognitive performance were performed on 382 individuals over the course of 3.5 years. Visits were scheduled every 6 months. CATs included tests of auditory temporal processing (gap detection) and speech perception in noise (Hearing in Noise Test and Triple Digit Test). Cognitive tests included the Montreal Cognitive Assessment (MoCA), Test of Variables of Attention (TOVA), and subtests from the Cogstate battery. HIV-positive subjects were divided into groups based on their CAT results at their final visit (bottom 20%, top 20%, middle 60%). Primary analyses focused on the comparison between HIV-positive individuals that performed worse on CATs (bottom 20%) and the overall HIV-positive group (middle 60%). Data were analyzed using linear mixed-effect models with time as the main fixed effect.

Results

The group with the worst (bottom 20%) CAT performance showed a difference in trajectory for the MoCA (P=.003), TOVA (P<.048), and Cogstate (P<.046) over the course of the study period compared to the overall HIV-positive group. A battery of three CATs showed a significant difference in cognitive trajectory over a relatively short study period of 3.5 years independent of age (bottom 20% vs HIV-positive group).

Conclusions

The results of this study support the ability for CATs to track cognitive function over time, suggesting that central auditory processing can provide a window into central nervous system performance. CATs can be simple to perform, and are relatively insensitive to education and socioeconomic status because they only require repeating sentences, numbers, or detecting gaps in noise. These tests could potentially provide a time-efficient, low-cost method to screen for and monitor cognitive decline in patients with HIV, making them a useful surveillance tool for this major public health problem.

Araújo FC, Costa KM, da Silva Filho M. A Digital Filter-Based Method for Diagnosing Speech Comprehension Deficits

Objective

To improve the diagnostic efficiency of current tests for auditory processing disorders (APDs) by creating new test signals using digital filtering methods.

Methods

We conducted a prospective study from August 1, 2014, to August 31, 2019, using 3 low speech redundancy tests with novel test signals that we created with specially designed digital filters: the binaural resynthesis test and the low pass and high pass filtered speech tests. We validated and optimized these new tests, then applied them to healthy individuals across different age groups to examine how age affected performance and to children with APD before and after acoustically controlled auditory training (ACAT) to assess clinical improvement after treatment.

Results

We found a progressive increase in performance accuracy with less restrictive filters (P<.001) and with increasing age for all tests (P<.001). Our results suggest that binaural resynthesis and auditory closure mature at similar rates. We also demonstrate that the new tests can be used for the diagnosis of APD and for the monitoring of ACAT effects. Interestingly, we found that patients having the most severe deficits also benefited the most from ACAT (P<.001).

Conclusion

We introduce a method that substantially improves current diagnostic tools for APD. In addition, we provide information on auditory processing maturation in normal development and validate that our method can detect APD-related deficits and ACAT-induced improvements in auditory processing.

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.

Music Listening Habits and Music Perception Abilities of Prelingually Deafened Adolescent Cochlear Implant Recipients

BACKGROUND

Music is a very important art form that can evoke strong emotions and involvement with it can have a considerable impact on cochlear implant (CI) recipients' quality of life. It is well known that music perception is limited in CI with fully electric hearing and CI recipients have significantly poorer music-appraisal ability when compared with normal hearing subjects. Considering the importance of music on the life of an adolescent and negative impact of hearing loss on mental health, understanding and improving music listening habits and perception abilities can have a positive impact on the mental health of CI user adolescents.

PURPOSE

This study aims to evaluate music listening habits and music perception abilities of prelingually deafened adolescent CI users to reveal the relationship between self-reported assessment and psychophysical measurement.

RESEARCH DESIGN

The psychophysical measures of music perception and self-reported music listening habits of adolescent CI users were obtained.

STUDY SAMPLE

Twenty-nine prelingually deafened adolescent CI users were evaluated in this study.

DATA COLLECTION AND ANALYSIS

The Turkish Clinical Assessment of Music Perception (T-CAMP) test was used to evaluate music perception abilities. These abilities were evaluated with a three-item questionnaire assessing enjoyment of music, listening habits, and comprehension of lyrics. Pearson's correlation coefficients were calculated to assess the relationship between the T-CAMP subtests and questionnaire items.

RESULTS

Statistically significant correlations were observed between the melody-recognition subtest of T-CAMP and all three questionnaire items. The correlation between the enjoyment and rate items on the questionnaire was also statistically significant.

CONCLUSION

The present study shows that adolescent CI users also enjoy and listen to music in ways similar to postlingually deafened adult CI users. It also demonstrates that melody-recognition abilities have a significant relationship with music enjoyment and listening habits in prelingually deafened adolescent CI users.

Validity of the Multiple Auditory Processing Assessment-2: A Test of Auditory Processing Disorder

Purpose A normative study using the Multiple Auditory Processing Assessment-2 (MAPA-2; Schow et al., 2018) was recently completed. With access to these data, the authors extend that work and support a definite construct for auditory processing disorder (APD). The goal here is to examine MAPA-2 reliability and validity (construct, content, and concurrent). Evidence for the APD construct is further buttressed by measures of sensitivity and specificity. Results of MAPA-2 testing on children diagnosed with learning disability (LD), attention-deficit/hyperactivity disorder (ADHD), and specific language impairment (SLI) are included. Method Normative data (previously published as the MAPA-2) allowing derivation of these findings included a representative sample of 748 children (53% girls) ages 7-14 years tested by 54 speech-language pathologists and audiologists in 27 U.S. states. The authors examined diagnostic accuracy based on the American Speech-Language-Hearing Association (2005) criteria (index test) for confirmed cases of APD. The index was also used to identify listening problems for three other diagnostic categories (LD, ADHD, and SLI). Validated questionnaire responses from parents and school personnel allowed incorporation of functional measures widely supported in APD diagnosis but unavailable with other normative and sensitivity/specificity studies. Results Reliability and validity were both satisfactory, and diagnostic accuracy for an APD group of 18 (28% female) compared to the remaining typical group of 625 yielded 89% sensitivity and 82% specificity. The remaining three groups (LD, ADHD, and SLI), where comorbidity was expected to be about 50%, had APD-type listening problems with a prevalence ranging from 52% to 65%. Conclusions Current results provide important evidence for the construct of APD. The MAPA-2 can be administered by an audiologist or speech-language pathologist. A similar diagnostic protocol in Australia yielded positive therapeutic gains. Further study is encouraged to determine if the present positive findings will be found in future research.

Clinical Expertise Is Core to an Evidence-Based Approach to Auditory Processing Disorder: A Reply to Neijenhuis et al. 2019

The opinion article "An Evidence-based Perspective on Misconceptions Regarding Pediatric Auditory Processing Disorder" by Neijenhuis et al. (1) presents a distorted view of the evidence-based approach used in medicine. The authors focus on the amorphous non-diagnostic entity "listening difficulties" not auditory processing disorder (APD) and create confusion that could jeopardize clinical services to individuals with APD. In our perspective article, we rebut Neijenhuis et al. (1), and more importantly, we present a rationale for evidence-based practice founded on the premise that research on APD is only clinically applicable when conducted on clinical populations diagnosed with APD.

Head and neck surgical reconstruction in Operation Iraqi Freedom and Operation Enduring Freedom-Afghanistan: A systematic review

Historically, head and neck injuries constituted 16 to 20% of all nonfatal combat injuries. However, advances in body and vehicle armor in the context of the use of ambushes and improvised explosive devices by enemy combatants have resulted in fewer fatalities from head and neck wounds, and thus the incidence of nonfatal head and neck injuries has risen to as high as 52%. Despite this increase, data regarding specific injury distributions, surgical cases, and approaches to repair are lacking in the current literature. We conducted a study to systematically review the current literature regarding head and neck injuries and reconstructions during Operation Iraqi Freedom and Operation Enduring Freedom-Afghanistan. We found 44 articles that met our inclusion criteria. These articles covered 17,461 head and neck wounds sustained by 12,105 patients. Superficial soft-tissue facial injuries were most common wounds (31.7% of cases), followed by wounds to the neck (25.2%) and midface (17.9%). The 44 articles listed 5,122 discrete surgical reports covering 5,758 procedures. Of these procedures, simple facial laceration repairs (25.2%) and ophthalmologic surgeries (12.1%) were the most common soft-tissue repairs, and mandibular reconstructions (11.3%) were the most common type of bony reconstruction. Major flap reconstructions for coverage were required in only 0.4% of procedures. This information will be valuable for educating those involved in otolaryngology training programs, as well as civilian otolaryngologists regarding the types of injury patterns they should expect to see and treat in the returning veteran population.

Hearing complaints among veterans following traumatic brain injury

It has been shown that there is an increased risk for impaired auditory function following traumatic brain injury (TBI) in Veterans. Evidence is strongest in the area of self-report, but behavioural and electro-physiological data have been obtained that are consistent with these complaints. Peripheral and central dysfunction have both been observed. Historically, studies have focused on penetrating head injuries where central injury is more easily documented than in mild closed head injuries, but several recent reports have expanded the literature to include closed head injuries as well. The lack of imaging technology that can identify which closed head injuries are likely to impact auditory function is a significant barrier to accurate diagnosis and rehabilitation. Current behavioural and electrophysiological measures are effective in substantiating the auditory complaints of these patients but leave many questions unanswered. One significant limitation of current approaches is the lack of clear data regarding the potential influence of those mental health comorbidities that are very likely to be present in the Veteran population. In the area of rehabilitation, there are indications that hearing aids and other assistive listening devices may provide benefit, as can auditory training programmes, yet more research needs to be done.

Multiple sclerosis: Left advantage for auditory laterality in dichotic tests of central auditory processing and relationship of psychoacoustic tests with the Multiple Sclerosis Disability Scale-EDSS

OBJECTIVE

To evaluate the central auditory processing disorders in patients with multiple sclerosis, emphasizing auditory laterality by applying psychoacoustic tests and to identify their relationship with the Multiple Sclerosis Disability Scale (EDSS) functions.

METHOD

Depression scales (HADS), EDSS, and 9 psychoacoustic tests to study CAPD were applied to 26 individuals with multiple sclerosis and 26 controls. Correlation tests were performed between the EDSS and psychoacoustic tests.

RESULTS

Seven out of 9 psychoacoustic tests were significantly different (P<.05); right or left (14/19 explorations) with respect to control. In dichotic digits there was a left-ear advantage compared to the usual predominance of RDD. There was significant correlation in five psychoacoustic tests and the specific functions of EDSS.

CONCLUSION

The left-ear advantage detected and interpreted as an expression of deficient influences of the corpus callosum and attention in multiple sclerosis should be investigated. There was a correlation between psychoacoustic tests and specific EDSS functions.

Effectiveness of working memory training among children with dyscalculia: evidence for transfer effects on mathematical achievement-a pilot study

We examined whether the working memory (WM) capacity of developmentally dyscalculic children can be improved by a WM training program and whether outcomes relate to mathematical performance. The experimental design comprised two groups with developmental dyscalculia with grade 4 schooling: an experimental group (n = 14; mean age = 115.29 months) and a control group (n = 14; mean age = 116.07 months). All participants were assessed on measures of WM, mathematic attainment, and nonverbal mental ability (Raven test) before and after training. The WM training program focused on manipulating and maintaining arithmetic information. The results show that both WM and mathematical performances improved significantly after intervention, indicating a strong relationship between these two constructs. The control group improved slightly in Raven's progressive matrices and a reading number task. These findings are discussed in terms of near and far transfer toward trained and untrained skills and stress the positive impact of WM training on learning mathematics in children with dyscalculia.

Practical guidelines to minimise language and cognitive confounds in the diagnosis of CAPD: a brief tutorial

OBJECTIVE

To provide audiologists with strategies to minimise confounding cognitive and language processing variables and accurately diagnose central auditory processing disorder (CAPD).

DESIGN

Tutorial.

STUDY SAMPLE

None.

RESULTS

Strategies are reviewed to minimise confounding cognitive and language processing variables and accurately diagnose CAPD.

CONCLUSIONS

Differential diagnosis is exceedingly important and can be quite challenging. Distinguishing between two or more conditions presenting with similar symptoms or attributes requires multidisciplinary, comprehensive assessment. To ensure appropriate interventions, the audiologist is a member of the multidisciplinary team responsible for determining whether there is an auditory component to other presenting deficits or whether one condition is responsible for the symptoms seen in another. Choice of tests should be guided both by the symptoms of the affected individual, as established in an in-depth interview and case history, the individual's age and primary language, and by the specific deficits reported to be associated with specific clinical presentations. Knowing which tests are available, their strengths and limitations, the processes assessed, task and response requirements, and the areas of the central auditory nervous system (CANS) to which each test is most sensitive provides the audiologist with critical information to assist in the differential diagnostic process.