Using auditory-visual speech to probe the basis of noise-impaired consonant-vowel perception in dyslexia and auditory neuropathy

Children with developmental dyslexia have equivalent audiovisual speech perception performance but their perceptual weights differ

As reading is inherently a multisensory, audiovisual (AV) process where visual symbols (i.e., letters) are connected to speech sounds, the question has been raised whether individuals with reading difficulties, like children with developmental dyslexia (DD), have broader impairments in multisensory processing. This question has been posed before, yet it remains unanswered due to (a) the complexity and contentious etiology of DD along with (b) lack of consensus on developmentally appropriate AV processing tasks. We created an ecologically valid task for measuring multisensory AV processing by leveraging the natural phenomenon that speech perception improves when listeners are provided visual information from mouth movements (particularly when the auditory signal is degraded). We designed this AV processing task with low cognitive and linguistic demands such that children with and without DD would have equal unimodal (auditory and visual) performance. We then collected data in a group of 135 children (age 6.5-15) with an AV speech perception task to answer the following questions: (1) How do AV speech perception benefits manifest in children, with and without DD? (2) Do children all use the same perceptual weights to create AV speech perception benefits, and (3) what is the role of phonological processing in AV speech perception? We show that children with and without DD have equal AV speech perception benefits on this task, but that children with DD rely less on auditory processing in more difficult listening situations to create these benefits and weigh both incoming information streams differently. Lastly, any reported differences in speech perception in children with DD might be better explained by differences in phonological processing than differences in reading skills. RESEARCH HIGHLIGHTS: Children with versus without developmental dyslexia have equal audiovisual speech perception benefits, regardless of their phonological awareness or reading skills. Children with developmental dyslexia rely less on auditory performance to create audiovisual speech perception benefits. Individual differences in speech perception in children might be better explained by differences in phonological processing than differences in reading skills.

Audiovisual multisensory integration in individuals with reading and language impairments: A systematic review and meta-analysis

Differences in sensory function have been documented for a number of neurodevelopmental conditions, including reading and language impairments. Prior studies have measured audiovisual multisensory integration (i.e., the ability to combine inputs from the auditory and visual modalities) in these populations. The present study sought to systematically review and quantitatively synthesize the extant literature on audiovisual multisensory integration in individuals with reading and language impairments. A comprehensive search strategy yielded 56 reports, of which 38 were used to extract 109 group difference and 68 correlational effect sizes. There was an overall difference between individuals with reading and language impairments and comparisons on audiovisual integration. There was a nonsignificant trend towards moderation according to sample type (i.e., reading versus language) and publication/small study bias for this model. Overall, there was a small but non-significant correlation between metrics of audiovisual integration and reading or language ability; this model was not moderated by sample or study characteristics, nor was there evidence of publication/small study bias. Limitations and future directions for primary and meta-analytic research are discussed.

Is Working Memory Compromised in Individuals with Sensorineural Hearing Loss with Auditory Neural Origin?

The study aimed to investigate the working memory and speech recognition in noise from individuals with Sensori Neural Hearing Loss (SNHL) with and without auditory neuropathy spectrum disorder (ANSD). The purpose of assessing working memory recommends for a potential intervention program to perceive speech. Twenty participants in the age range of 16-44 years, diagnosed as having mild to moderate SNHL were recruited for the study. The participants were divided into two groups based on the presence and absence of ANSD (10 in each group). The visual working memory was assessed in all the participants using the Operation Span Test, Reading Span Test and Visual Backward Test. Speech perception ability was assessed using the SNR 50 test. There was no significant difference between the scores of Operation Span, Reading Span, and Visual Backward Span for individuals with SNHL with and without ANSD. There was a significant difference between the scores of SNR 50 for individuals with SNHL with and without ANSD. The visual working memory in individuals with and without ANSD is similar. Speech perception in noise is significantly affected in ANSD than SNHL without ANSD. Thus, it is recommended to use speech reading, which utilizes visual working memory to interpret the message, as previous studies have reported that individuals with ANSD show limited benefit in auditory mode of rehabilitation alone.

Facial speech processing in children with and without dyslexia

What role does the presence of facial speech play for children with dyslexia? Current literature proposes two distinctive claims. One claim states that children with dyslexia make less use of visual information from the mouth during speech processing due to a deficit in recruitment of audiovisual areas. An opposing claim suggests that children with dyslexia are in fact reliant on such information in order to compensate for auditory/phonological impairments. The current paper aims at directly testing these contrasting hypotheses (here referred to as "mouth insensitivity" versus "mouth reliance") in school-age children with and without dyslexia, matched on age and listening comprehension. Using eye tracking, in Study 1, we examined how children look at the mouth across conditions varying in speech processing demands. The results did not indicate significant group differences in looking at the mouth. However, correlation analyses suggest potentially important distinctions within the dyslexia group: those children with dyslexia who are better readers attended more to the mouth while presented with a person's face in a phonologically demanding condition. In Study 2, we examined whether the presence of facial speech cues is functionally beneficial when a child is encoding written words. The results indicated lack of overall group differences on the task, although those with less severe reading problems in the dyslexia group were more accurate when reading words that were presented with articulatory facial speech cues. Collectively, our results suggest that children with dyslexia differ in their "mouth reliance" versus "mouth insensitivity," a profile that seems to be related to the severity of their reading problems.

Cortical tracking of speech in noise accounts for reading strategies in children

Humans' propensity to acquire literacy relates to several factors, including the ability to understand speech in noise (SiN). Still, the nature of the relation between reading and SiN perception abilities remains poorly understood. Here, we dissect the interplay between (1) reading abilities, (2) classical behavioral predictors of reading (phonological awareness, phonological memory, and rapid automatized naming), and (3) electrophysiological markers of SiN perception in 99 elementary school children (26 with dyslexia). We demonstrate that, in typical readers, cortical representation of the phrasal content of SiN relates to the degree of development of the lexical (but not sublexical) reading strategy. In contrast, classical behavioral predictors of reading abilities and the ability to benefit from visual speech to represent the syllabic content of SiN account for global reading performance (i.e., speed and accuracy of lexical and sublexical reading). In individuals with dyslexia, we found preserved integration of visual speech information to optimize processing of syntactic information but not to sustain acoustic/phonemic processing. Finally, within children with dyslexia, measures of cortical representation of the phrasal content of SiN were negatively related to reading speed and positively related to the compromise between reading precision and reading speed, potentially owing to compensatory attentional mechanisms. These results clarify the nature of the relation between SiN perception and reading abilities in typical child readers and children with dyslexia and identify novel electrophysiological markers of emergent literacy.

Dynamics of Speech Perception in the Auditory-Visual Mode: An Empirical Evidence for the Management of Auditory Neuropathy Spectrum Disorders

BACKGROUND AND OBJECTIVES

The present study probed into the relative and combined contribution of auditory and visual modalities in the speech perception of individuals with auditory neuropathy spectrum disorders (ANSD). Specifically, the identification scores of consonantvowel (CV) syllables, visual enhancement (VE), and auditory enhancement in different signal to noise ratios (SNRs) were compared with that of the control group. Subjects and.

METHODS

The study used a repeated measure standard group comparison research design. Two groups of individuals in the age range of 16 to 35 years participated in the study. The clinical group included 35 participants diagnosed as ANSD, while the control group had 35 age and gender matched individuals with typical auditory abilities. The participants were assessed for CV syllable identification in auditory only (A), visual only (V), and auditory-visual (AV) modalities. The syllables were presented in quiet and at 0 dB SNR.

RESULTS

The speech identification score was maximum in AV condition followed by A-condition and least in V condition. This was true in both the groups. The individuals with ANSD were able to make better use of visual cues than the control group, as evident in the VE score.

CONCLUSIONS

The dynamics of speech perception in the AV mode is different between ANSD and control. There is definite benefit of auditory as well as visual cues to individuals with ANSD, suggesting the need to facilitate both the modalities as part of the audiological rehabilitation. Future studies can focus on independently facilitating the two modalities and testing the benefits in the AV mode of speech perception in individuals with ANSD.

A Selective Deficit in Phonetic Recalibration by Text in Developmental Dyslexia

Upon hearing an ambiguous speech sound, listeners may adjust their perceptual interpretation of the speech input in accordance with contextual information, like accompanying text or lipread speech (i.e., phonetic recalibration; Bertelson et al., 2003). As developmental dyslexia (DD) has been associated with reduced integration of text and speech sounds, we investigated whether this deficit becomes manifest when text is used to induce this type of audiovisual learning. Adults with DD and normal readers were exposed to ambiguous consonants halfway between /aba/ and /ada/ together with text or lipread speech. After this audiovisual exposure phase, they categorized auditory-only ambiguous test sounds. Results showed that individuals with DD, unlike normal readers, did not use text to recalibrate their phoneme categories, whereas their recalibration by lipread speech was spared. Individuals with DD demonstrated similar deficits when ambiguous vowels (halfway between /wIt/ and /wet/) were recalibrated by text. These findings indicate that DD is related to a specific letter-speech sound association deficit that extends over phoneme classes (vowels and consonants), but – as lipreading was spared – does not extend to a more general audio–visual integration deficit. In particular, these results highlight diminished reading-related audiovisual learning in addition to the commonly reported phonological problems in developmental dyslexia.

Lipreading Ability and Its Cognitive Correlates in Typically Developing Children and Children With Specific Language Impairment

PURPOSE

Lipreading and its cognitive correlates were studied in school-age children with typical language development and delayed language development due to specific language impairment (SLI).

METHOD

Forty-two children with typical language development and 20 children with SLI were tested by using a word-level lipreading test and an extensive battery of standardized cognitive and linguistic tests.

RESULTS

Children with SLI were poorer lipreaders than their typically developing peers. Good phonological skills were associated with skilled lipreading in both typically developing children and in children with SLI. Lipreading was also found to correlate with several cognitive skills, for example, short-term memory capacity and verbal motor skills.

CONCLUSIONS

Speech processing deficits in SLI extend also to the perception of visual speech. Lipreading performance was associated with phonological skills. Poor lipreading in children with SLI may be, thus, related to problems in phonological processing.

A General Audiovisual Temporal Processing Deficit in Adult Readers With Dyslexia

PURPOSE

Because reading is an audiovisual process, reading impairment may reflect an audiovisual processing deficit. The aim of the present study was to test the existence and scope of such a deficit in adult readers with dyslexia.

METHOD

We tested 39 typical readers and 51 adult readers with dyslexia on their sensitivity to the simultaneity of audiovisual speech and nonspeech stimuli, their time window of audiovisual integration for speech (using incongruent /aCa/ syllables), and their audiovisual perception of phonetic categories.

RESULTS

Adult readers with dyslexia showed less sensitivity to audiovisual simultaneity than typical readers for both speech and nonspeech events. We found no differences between readers with dyslexia and typical readers in the temporal window of integration for audiovisual speech or in the audiovisual perception of phonetic categories.

CONCLUSIONS

The results suggest an audiovisual temporal deficit in dyslexia that is not specific to speech-related events. But the differences found for audiovisual temporal sensitivity did not translate into a deficit in audiovisual speech perception. Hence, there seems to be a hiatus between simultaneity judgment and perception, suggesting a multisensory system that uses different mechanisms across tasks. Alternatively, it is possible that the audiovisual deficit in dyslexia is only observable when explicit judgments about audiovisual simultaneity are required.

Visual Speech Perception in Children With Language Learning Impairments

PURPOSE

The purpose of the study was to assess the ability of children with developmental language learning impairments (LLIs) to use visual speech cues from the talking face.

METHOD

In this cross-sectional study, 41 typically developing children (mean age: 8 years 0 months, range: 4 years 5 months to 11 years 10 months) and 27 children with diagnosed LLI (mean age: 8 years 10 months, range: 5 years 2 months to 11 years 6 months) completed a silent speechreading task and a speech-in-noise task with and without visual support from the talking face. The speech-in-noise task involved the identification of a target word in a carrier sentence with a single competing speaker as a masker.

RESULTS

Children in the LLI group showed a deficit in speechreading when compared with their typically developing peers. Beyond the single-word level, this deficit became more apparent in older children. On the speech-in-noise task, a substantial benefit of visual cues was found regardless of age or group membership, although the LLI group showed an overall developmental delay in speech perception.

CONCLUSION

Although children with LLI were less accurate than their peers on the speechreading and speech-in noise-tasks, both groups were able to make equivalent use of visual cues to boost performance accuracy when listening in noise.

Impairments of multisensory integration and cross-sensory learning as pathways to dyslexia

Two sensory systems are intrinsic to learning to read. Written words enter the brain through the visual system and associated sounds through the auditory system. The task before the beginning reader is quite basic. She must learn correspondences between orthographic tokens and phonemic utterances, and she must do this to the point that there is seamless automatic 'connection' between these sensorially distinct units of language. It is self-evident then that learning to read requires formation of cross-sensory associations to the point that deeply encoded multisensory representations are attained. While the majority of individuals manage this task to a high degree of expertise, some struggle to attain even rudimentary capabilities. Why do dyslexic individuals, who learn well in myriad other domains, fail at this particular task? Here, we examine the literature as it pertains to multisensory processing in dyslexia. We find substantial support for multisensory deficits in dyslexia, and make the case that to fully understand its neurological basis, it will be necessary to thoroughly probe the integrity of auditory-visual integration mechanisms.

Atypical audio-visual speech perception and McGurk effects in children with specific language impairment

Audiovisual speech perception of children with specific language impairment (SLI) and children with typical language development (TLD) was compared in two experiments using /aCa/ syllables presented in the context of a masking release paradigm. Children had to repeat syllables presented in auditory alone, visual alone (speechreading), audiovisual congruent and incongruent (McGurk) conditions. Stimuli were masked by either stationary (ST) or amplitude modulated (AM) noise. Although children with SLI were less accurate in auditory and audiovisual speech perception, they showed similar auditory masking release effect than children with TLD. Children with SLI also had less correct responses in speechreading than children with TLD, indicating impairment in phonemic processing of visual speech information. In response to McGurk stimuli, children with TLD showed more fusions in AM noise than in ST noise, a consequence of the auditory masking release effect and of the influence of visual information. Children with SLI did not show this effect systematically, suggesting they were less influenced by visual speech. However, when the visual cues were easily identified, the profile of responses to McGurk stimuli was similar in both groups, suggesting that children with SLI do not suffer from an impairment of audiovisual integration. An analysis of percent of information transmitted revealed a deficit in the children with SLI, particularly for the place of articulation feature. Taken together, the data support the hypothesis of an intact peripheral processing of auditory speech information, coupled with a supra modal deficit of phonemic categorization in children with SLI. Clinical implications are discussed.

Emergent literacy in kindergartners with cochlear implants

OBJECTIVE

A key ingredient to academic success is being able to read. Deaf individuals have historically failed to develop literacy skills comparable with those of their normal-hearing (NH) peers, but early identification and cochlear implants (CIs) have improved prospects such that these children can learn to read at the levels of their peers. The goal of this study was to examine early, or emergent, literacy in these children.

METHOD

Twenty-seven deaf children with CIs, who had just completed kindergarten were tested on emergent literacy, and on cognitive and linguistic skills that support emergent literacy, specifically ones involving phonological awareness, executive functioning, and oral language. Seventeen kindergartners with NH and eight with hearing loss, but who used hearing aids served as controls. Outcomes were compared for these three groups of children, regression analyses were performed to see whether predictor variables for emergent literacy differed for children with NH and those with CIs, and factors related to the early treatment of hearing loss and prosthesis configuration were examined for children with CIs.

RESULTS

The performance of children with CIs was roughly 1 SD or more below the mean performance of children with NH on all tasks, except for syllable counting, reading fluency, and rapid serial naming. Oral language skills explained more variance in emergent literacy for children with CIs than for children with NH. Age of first implant explained moderate amounts of variance for several measures. Having one or two CIs had no effect, but children who had some amount of bimodal experience outperformed children who had none on several measures.

CONCLUSIONS

Even deaf children who have benefitted from early identification, intervention, and implantation are still at risk for problems with emergent literacy that could affect their academic success. This finding means that intensive language support needs to continue through at least the early elementary grades. Also, a period of bimodal stimulation during the preschool years can help boost emergent literacy skills to some extent.

Audiovisual perception of noise vocoded speech in dyslexic and non-dyslexic adults: the role of low-frequency visual modulations

Visual speech inputs can enhance auditory speech information, particularly in noisy or degraded conditions. The natural statistics of audiovisual speech highlight the temporal correspondence between visual and auditory prosody, with lip, jaw, cheek and head movements conveying information about the speech envelope. Low-frequency spatial and temporal modulations in the 2-7 Hz range are of particular importance. Dyslexic individuals have specific problems in perceiving speech envelope cues. In the current study, we used an audiovisual noise-vocoded speech task to investigate the contribution of low-frequency visual information to intelligibility of 4-channel and 16-channel noise vocoded speech in participants with and without dyslexia. For the 4-channel speech, noise vocoding preserves amplitude information that is entirely congruent with dynamic visual information. All participants were significantly more accurate with 4-channel speech when visual information was present, even when this information was purely spatio-temporal (pixelated stimuli changing in luminance). Possible underlying mechanisms are discussed.

Reduced sensitivity to slow-rate dynamic auditory information in children with dyslexia

The etiology of developmental dyslexia remains widely debated. An appealing theory postulates that the reading and spelling problems in individuals with dyslexia originate from reduced sensitivity to slow-rate dynamic auditory cues. This low-level auditory deficit is thought to provoke a cascade of effects, including inaccurate speech perception and eventually unspecified phoneme representations. The present study investigated sensitivity to frequency modulation and amplitude rise time, speech-in-noise perception and phonological awareness in 11-year-old children with dyslexia and a matched normal-reading control children. Group comparisons demonstrated that children with dyslexia were less sensitive than normal-reading children to slow-rate dynamic auditory processing, speech-in-noise perception, phonological awareness and literacy abilities. Correlations were found between slow-rate dynamic auditory processing and phonological awareness, and speech-in-noise perception and reading. Yet, no significant correlation between slow-rate dynamic auditory processing and speech-in-noise perception was obtained. Together, these results indicate that children with dyslexia have difficulties with slow-rate dynamic auditory processing and speech-in-noise perception and that these problems persist until sixth grade.

Discrete neural substrates underlie complementary audiovisual speech integration processes

The ability to combine information from multiple sensory modalities into a single, unified percept is a key element in an organism's ability to interact with the external world. This process of perceptual fusion, the binding of multiple sensory inputs into a perceptual gestalt, is highly dependent on the temporal synchrony of the sensory inputs. Using fMRI, we identified two anatomically distinct brain regions in the superior temporal cortex, one involved with processing temporal-synchrony, and one with processing perceptual fusion of audiovisual speech. This dissociation suggests that the superior temporal cortex should be considered a "neuronal hub" composed of multiple discrete subregions that underlie an array of complementary low- and high-level multisensory integration processes. In this role, abnormalities in the structure and function of superior temporal cortex provide a possible common etiology for temporal-processing and perceptual-fusion deficits seen in a number of clinical populations, including individuals with autism spectrum disorder, dyslexia, and schizophrenia.

Speech perception abilities of adults with dyslexia: is there any evidence for a true deficit?

PURPOSE

This study investigated whether adults with dyslexia show evidence of a consistent speech perception deficit by testing phoneme categorization and word perception in noise.

METHOD

Seventeen adults with dyslexia and 20 average readers underwent a test battery including standardized reading, language and phonological awareness tests, and tests of speech perception. Categorization of a pea/bee voicing contrast was evaluated using adaptive identification and discrimination tasks, presented in quiet and in noise, and a fixed-step discrimination task. Two further tests of word perception in noise were presented.

RESULTS

There were no significant group differences for categorization in quiet or noise, across- and within-category discrimination as measured adaptively, or word perception, but average readers showed better across- and within-category discrimination in the fixed-step discrimination task. Individuals did not show consistent poor performance across related tasks.

CONCLUSIONS

The small number of group differences, and lack of consistent poor individual performance, suggests weak support for a speech perception deficit in dyslexia. It seems likely that at least some poor performances are attributable to nonsensory factors like attention. It may also be that some individuals with dyslexia have speech perceptual acuity that is at the lower end of the normal range and exacerbated by nonsensory factors.

The nicotinic receptor of cochlear hair cells: a possible pharmacotherapeutic target?

Mechanosensory hair cells of the organ of Corti transmit information regarding sound to the central nervous system by way of peripheral afferent neurons. In return, the central nervous system provides feedback and modulates the afferent stream of information through efferent neurons. The medial olivocochlear efferent system makes direct synaptic contacts with outer hair cells and inhibits amplification brought about by the active mechanical process inherent to these cells. This feedback system offers the potential to improve the detection of signals in background noise, to selectively attend to particular signals, and to protect the periphery from damage caused by overly loud sounds. Acetylcholine released at the synapse between efferent terminals and outer hair cells activates a peculiar nicotinic cholinergic receptor subtype, the alpha9alpha10 receptor. At present no pharmacotherapeutic approaches have been designed that target this cholinergic receptor to treat pathologies of the auditory system. The potential use of alpha9alpha10 selective drugs in conditions such as noise-induced hearing loss, tinnitus and auditory processing disorders is discussed.

Hyperbilirubinemia and language delay in premature infants

OBJECTIVE

Our goal was to evaluate whether language delay at 3 years in premature infants is associated with previous exposure to hyperbilirubinemia during the first 2 weeks after birth.

PATIENTS AND METHODS

We performed a retrospective case-control study of infants admitted to the NICU between January and October 2003. Inclusion criteria included a birth weight of < or =1500 g and follow-up to age 3 years. Exclusion criteria included genetic disorders and hearing loss or recurrent ear infections. Peak total serum bilirubin levels during the first 2 weeks and duration of hyperbilirubinemia (days with total serum bilirubin level at >8 mg/dL) were determined. Infants with language delay and who were receiving speech therapy by 3 years were identified through developmental clinic charts and a tracking program and compared with infants who had normal language development.

RESULTS

A total of 125 infants with birth weight of < or =1500 g were admitted to the NICU between January and October 2003. Fifteen infants died, and 110 were discharged from the hospital. A total of 102 (93%) of 110 infants had follow-up to the age of 3 years. Four infants were excluded (1 genetic disorder, 3 delayed hearing loss or recurrent ear infections). Twenty-four infants had a language delay and received speech therapy, whereas 74 infants had normal language development. There was no significant difference in peak total serum bilirubin level and duration of hyperbilirubinemia between the 2 groups. On logistic regression, only bronchopulmonary dysplasia was associated with language delay.

CONCLUSIONS

Hyperbilirubinemia, defined as peak total serum bilirubin level or duration of elevated bilirubin in days, is not associated with language delay in premature infants. However, this issue deserves investigation, because other measures of bilirubin, such as unbound bilirubin, may be associated with language delay.

Developmental shifts in children's sensitivity to visual speech: a new multimodal picture-word task

This research developed a multimodal picture-word task for assessing the influence of visual speech on phonological processing by 100 children between 4 and 14 years of age. We assessed how manipulation of seemingly to-be-ignored auditory (A) and audiovisual (AV) phonological distractors affected picture naming without participants consciously trying to respond to the manipulation. Results varied in complex ways as a function of age and type and modality of distractors. Results for congruent AV distractors yielded an inverted U-shaped function with a significant influence of visual speech in 4-year-olds and 10- to 14-year-olds but not in 5- to 9-year-olds. In concert with dynamic systems theory, we proposed that the temporary loss of sensitivity to visual speech was reflecting reorganization of relevant knowledge and processing subsystems, particularly phonology. We speculated that reorganization may be associated with (a) formal literacy instruction and (b) developmental changes in multimodal processing and auditory perceptual, linguistic, and cognitive skills.

Speech perception ability in individuals with Friedreich ataxia

The aim of this study was to investigate auditory pathway function and speech perception ability in individuals with Friedreich ataxia (FRDA). Ten subjects confirmed by genetic testing as being homozygous for a GAA expansion in intron 1 of the FXN gene were included. While each of the subjects demonstrated normal, or near normal sound detection, 3 of the 10 showed electrophysiological evidence of auditory pathway disorder [presenting with the auditory neuropathy/dyssynchrony (AN/AD) result pattern], and 9 of the 10 showed abnormal speech understanding when tested with levels of background noise typical of everyday listening conditions. Information transmission analyses of the speech perception findings for the three FRDA subjects with AN/AD type hearing loss when compared with those of a cohort of individuals with peripheral [sensorineural (SN)] hearing loss, showed a distinct pattern of perceptual disruption. Where the listeners with SN loss confused sounds on the basis of frequency (pitch) differences, the FRDA subjects with AN/AD made errors that reflected an inability to perceive temporal (timing) cues in the speech sounds.

Speech Perception in Noise for Children with Auditory Neuropathy/Dys-Synchrony Type Hearing Loss

OBJECTIVE

To evaluate the effect of background noise on speech perception in children with auditory neuropathy/dys-synchrony (AN/AD) type hearing loss.

DESIGN

Open and closed-set speech perception abilities were assessed in 12 school-age children who had been diagnosed with AN/AD in infancy. Data were also obtained from a cohort of subjects with sensorineural (SN) hearing loss and from a group of normal-hearing children.

RESULTS

Closed-set speech understanding was more affected by the presence of a competing signal in the hearing impaired than in the normal-hearing subjects. The mean S/N ratio required to identify a spondee in noise was -11.5 +/- 2.0 dB for the normal group, whereas the ratio required for the SN group was -5.4 +/- 5.1 dB and for the AN/AD group was -2.5 +/- 4.7 dB. Closed-set perception in noise was not significantly different for the AN/AD children and their SN counterparts although there was a trend toward poorer performance in the AN/AD group. The effect of background noise on open-set speech perception was also similar across hearing-impaired subjects although again, the AN/AD cohort tended to show greater difficulties in noise than their SN peers.

CONCLUSIONS

Listening in background noise was more difficult for our group of children with AN/AD-type hearing loss than for their normal-hearing peers. However, the noise effects were not consistent across subjects and some children demonstrated reasonable perceptual ability at low signal-to-noise ratios. The ways in which speech understanding is affected by competing signals may be different for different types of hearing deficit, but the results of this investigation indicate that significant perceptual disruption occurs both in children with auditory neuropathy/dys-synchrony and sensorineural type hearing loss.

A dominantly inherited progressive deafness affecting distal auditory nerve and hair cells

We have studied 72 members belonging to a large kindred with a hearing disorder inherited in an autosomal dominant pattern. We used audiological, physiological, and psychoacoustic measures to characterize the hearing disorders. The initial phenotypic features of the hearing loss are of an auditory neuropathy (AN) with abnormal auditory nerve and brainstem responses (ABRs) and normal outer hair cell functions [otoacoustic emissions (OAEs) and cochlear microphonics (CMs)]. Psychoacoustic studies revealed profound abnormalities of auditory temporal processes (gap detection, amplitude modulation detection, speech discrimination) and frequency processes (difference limens) beyond that seen in hearing impairment accompanying cochlear sensory disorders. The hearing loss progresses over 10-20 years to also involve outer hair cells, producing a profound sensorineural hearing loss with absent ABRs and OAEs. Affected family members do not have evidence of other cranial or peripheral neuropathies. There was a marked improvement of auditory functions in three affected family members studied after cochlear implantation with return of electrically evoked auditory brainstem responses (EABRs), auditory temporal processes, and speech recognition. These findings are compatible with a distal auditory nerve disorder affecting one or all of the components in the auditory periphery including terminal auditory nerve dendrites, inner hair cells, and the synapses between inner hair cells and auditory nerve. There is relative sparing of auditory ganglion cells and their axons.