Toward Sound Localization Testing in Virtual Reality to Aid in the Screening of Auditory Processing Disorders

Sound localization testing is key for comprehensive hearing evaluations, particularly in cases of suspected auditory processing disorders. However, sound localization is not commonly assessed in clinical practice, likely due to the complexity and size of conventional measurement systems, which require semicircular loudspeaker arrays in large and acoustically treated rooms. To address this issue, we investigated the feasibility of testing sound localization in virtual reality (VR). Previous research has shown that virtualization can lead to an increase in localization blur. To measure these effects, we conducted a study with a group of normal-hearing adults, comparing sound localization performance in different augmented reality and VR scenarios. We started with a conventional loudspeaker-based measurement setup and gradually moved to a virtual audiovisual environment, testing sound localization in each scenario using a within-participant design. The loudspeaker-based experiment yielded results comparable to those reported in the literature, and the results of the virtual localization test provided new insights into localization performance in state-of-the-art VR environments. By comparing localization performance between the loudspeaker-based and virtual conditions, we were able to estimate the increase in localization blur induced by virtualization relative to a conventional test setup. Notably, our study provides the first proxy normative cutoff values for sound localization testing in VR. As an outlook, we discuss the potential of a VR-based sound localization test as a suitable, accessible, and portable alternative to conventional setups and how it could serve as a time- and resource-saving prescreening tool to avoid unnecessarily extensive and complex laboratory testing.

Development and experience-dependence of multisensory spatial processing

Multisensory spatial processes are fundamental for efficient interaction with the world. They include not only the integration of spatial cues across sensory modalities, but also the adjustment or recalibration of spatial representations to changing cue reliabilities, crossmodal correspondences, and causal structures. Yet how multisensory spatial functions emerge during ontogeny is poorly understood. New results suggest that temporal synchrony and enhanced multisensory associative learning capabilities first guide causal inference and initiate early coarse multisensory integration capabilities. These multisensory percepts are crucial for the alignment of spatial maps across sensory systems, and are used to derive more stable biases for adult crossmodal recalibration. The refinement of multisensory spatial integration with increasing age is further promoted by the inclusion of higher-order knowledge.

Test-Retest Reliability of Virtual Acoustic Space Identification Test in School-Going Children

PURPOSE

The virtual acoustic space identification (VASI) test was designed to assess spatial-hearing acuity by simulating sound location perception in a closed field (under headphones). The utility of this tool in children can be asserted only if the test results are consistent across measurement sessions, which is evaluated in this study using test-retest reliability assessments.

METHOD

The VASI test assessed the spatial abilities of 40 typically developing school-aged children aged 7-13 years (M age = 10.47 ± 1.83 years, 22 boys, 18 girls). The test consisted of eight virtual location percepts (with 45° separation) produced under headphones (Sennheiser HD 569). Each spatial percept was presented randomly 7 times at 65 dB SPL. Each participant completed the assessment in three measurement sessions (baseline, intrasession, and intersession). The accuracy scores at each location and overall accuracy scores were compared across the sessions.

RESULTS

The Shapiro-Wilk test indicated that the VASI data were not normally distributed. Intraclass correlation coefficient analysis revealed excellent test-retest reliability of the overall accuracy scores and moderate-to-high reliability of location-specific scores. This was complimented by the low response variability of the overall and location-specific accuracy scores. The Bland-Altman analysis also indicated minimal bias in VASI accuracy scores across the three sessions.

CONCLUSIONS

It can be concluded from the results that VASI is a reliable tool for assessing spatial-hearing acuity in school-aged children. The high test-retest reliability and ease of portability make the test highly relevant for classroom setups where early diagnosis and intervention of spatial deficits can play a critical role in determining the academic success of school-going children.

Age differences in binaural and working memory abilities in school-going children

OBJECTIVES

Binaural hearing is the interplay of acoustic cues (interaural time differences: ITD, interaural level differences: ILD, and spectral cues) and cognitive abilities (e.g., working memory, attention). The current study investigated the effect of developmental age on auditory binaural resolution and working memory and the association between them (if any) in school-going children.

METHODS

Fifty-seven normal-hearing school-going children aged 6-15 y were recruited for the study. The participants were divided into three groups: Group 1 (n=17, M_age = 7.1y ± 0.72 y), Group 2 (n = 23; M_age = 10.2y ± 0.8 y), Group 3 (n = 17; M_age: 14.1 y ±1.3 y). Group 4, with normal hearing young adults (n = 20; M_age = 21.1 y± 3.2 y), was included for comparing the maturational changes in former groups with adult values. Tests of binaural resolution (ITD and ILD thresholds) and auditory working memory (forward and backward digit span and 2n-back digit) were administered to all the participants.

RESULTS

Results indicated a main effect of age on spatial resolution and working memory, with the median of lower age groups (Group 1 & Group 2) being significantly poorer (p < 0.01) than the higher age groups (Group 3 & Group 4). Groups 2, 3, and 4 performed significantly better than Group 1 (p < 0.001) on the forward span and ILD task. Groups 3 and 4 had significantly better ITD (p = 0.04), backward span (p = 0.02), and 2n-back scores than Group 2. A significant correlation between scores on working memory tasks and spatial resolution thresholds was also found. On discriminant function analysis, backward span and ITD emerged as sensitive measures for segregating older groups (Group 3 & Group 4) from younger groups (Group 1 & Group 2).

CONCLUSIONS

The present study showed that the ILD thresholds and forward digit span mature by nine years. However, the backward digit span score continued to mature beyond 15 y. This finding can be attributed to the influence of auditory attention (a working memory process) on the binaural resolution, which is reported to mature till late adolescence.

Design of Audio-Augmented-Reality-Based O&M Orientation Training for Visually Impaired Children

Orientation and Mobility training (O&M) is a specific program that teaches people with vision loss to orient themselves and travel safely within certain contexts. State-of-the-art research reveals that people with vision loss expect high-quality O&M training, especially at early ages, but the conventional O&M training methods involve tedious programs and require a high participation of professional trainers. However, there is an insufficient number of excellent trainers. In this work, we first interpret and discuss the relevant research in recent years. Then, we discuss the questionnaires and interviews we conducted with visually impaired people. On the basis of field investigation and related research, we propose the design of a training solution for children to operate and maintain direction based on audio augmented reality. We discuss how, within the perceptible scene created by EasyAR's map-aware framework, we created an AR audio source tracing training that simulates a social scene to strengthen the audiometric identification of the subjects, and then to verify the efficiency and feasibility of this scheme, we implemented the application prototype with the required hardware and software and conducted the subsequential experiments with blindfolded children. We confirm the high usability of the designed approach by analyzing the results of the pilot study. Compared with other orientation training studies, the method we propose makes the whole training process flexible and entertaining. At the same time, this training process does not involve excessive economic costs or require professional skills training, allowing users to undergo training at home or on the sports ground rather than having to go to rehabilitation sites or specified schools. Furthermore, according to the feedback from the experiments, the approach is promising in regard to gamification.

Instant improvement in monaural spatial hearing abilities through cognitive feedback

Several studies report that sound localization performance of acute and chronic monauralized normal-hearing listeners can improve through training. Typically, training sessions are administered daily for several days or weeks. While this intensive training is effective, it may also be that monaural localization abilities improve instantly after providing explicit top-down information about the direction dependent change in timbre and level. The aim of the present study was to investigate whether cognitive feedback (i.e., top-down information) could instantly improve sound localization in naive acutely monauralized listeners. Forty-three normal-hearing listeners (experimental group), divided over five different centers, were tested. Two control groups, consisting of, respectively, nine and eleven normal-hearing listeners, were tested in one center. Broadband sounds (0.5-20 kHz) were presented from visible loudspeakers, positioned in azimuth (- 90° to 90°). Participants in the experimental group received explicit information about the noticeable difference in timbre and the poor localization in the monauralized listening condition, resulting in an instant improvement in sound localization abilities. With subsequent roving of stimulus level (20 dB), sound localization performance deteriorated immediately. The reported improvement is related to the context of the localization test. The results provide important implications for studies investigating sound localization in a clinical setting, especially during closed-set testing, and indicate the importance of top-down information.

The Development of Sound Localization Latency in Infants and Young Children with Normal Hearing

With the advances in eye tracking, saccadic reflexes towards auditory stimuli have become an easily accessible behavioral response. The present study investigated the development of horizontal sound localization latency quantified by saccadic reflexes in infants and young children with normal hearing (0.55 to 5.6 years, n = 22). The subject was seated in front of an array of 12 loudspeaker/display-pairs arranged equidistantly in an arc from -55 to + 55° azimuth. An ongoing auditory-visual stimulus was presented at 63 dB SPL and shifted to another randomly selected pair at 24 occasions. At each shift, the visual part of the stimulus was blanked for 1.6 s providing auditory-only localization cues. A sigmoid model was fitted to the gaze samples following the azimuthal sound shifts. The overall sound localization latency (SLL) for a subject was defined as the mean of the latencies for all trials included by objective criteria. The SLL was assessed in 21 of 22 children with a mean of 6.1 valid trials. The SLL ranged 400 to 1400 ms (mean = 860 ms). An inverse model demonstrated a significant relationship between SLL and age (R² = 0.79, p < 0.001), reflecting a distinct reduction of latency with increasing age. No partial correlation between SLL and sound localization accuracy was found when controlling for age (p = 0.5), suggesting that localization latency may provide diagnostic value beyond accuracy.

Unilateral Conductive Hearing Loss Disrupts the Developmental Refinement of Binaural Processing in the Rat Primary Auditory Cortex

Binaural hearing is critically important for the perception of sound spatial locations. The primary auditory cortex (AI) has been demonstrated to be necessary for sound localization. However, after hearing onset, how the processing of binaural cues by AI neurons develops, and how the binaural processing of AI neurons is affected by reversible unilateral conductive hearing loss (RUCHL), are not fully elucidated. Here, we determined the binaural processing of AI neurons in four groups of rats: postnatal day (P) 14–18 rats, P19–30 rats, P57–70 adult rats, and RUCHL rats (P57–70) with RUCHL during P14–30. We recorded the responses of AI neurons to both monaural and binaural stimuli with variations in interaural level differences (ILDs) and average binaural levels. We found that the monaural response types, the binaural interaction types, and the distributions of the best ILDs of AI neurons in P14–18 rats are already adult-like. However, after hearing onset, there exist developmental refinements in the binaural processing of AI neurons, which are exhibited by the increase in the degree of binaural interaction, and the increase in the sensitivity and selectivity to ILDs. RUCHL during early hearing development affects monaural response types, decreases the degree of binaural interactions, and decreases both the selectivity and sensitivity to ILDs of AI neurons in adulthood. These new evidences help us to understand the refinements and plasticity in the binaural processing of AI neurons during hearing development, and might enhance our understanding in the neuronal mechanism of developmental changes in auditory spatial perception.

Sound Localization in Single-Sided Deaf Participants Provided With a Cochlear Implant

Spatial hearing is crucial in real life but deteriorates in participants with severe sensorineural hearing loss or single-sided deafness. This ability can potentially be improved with a unilateral cochlear implant (CI). The present study investigated measures of sound localization in participants with single-sided deafness provided with a CI. Sound localization was measured separately at eight loudspeaker positions (4°, 30°, 60°, and 90°) on the CI side and on the normal-hearing side. Low- and high-frequency noise bursts were used in the tests to investigate possible differences in the processing of interaural time and level differences. Data were compared to normal-hearing adults aged between 20 and 83. In addition, the benefit of the CI in speech understanding in noise was compared to the localization ability. Fifteen out of 18 participants were able to localize signals on the CI side and on the normal-hearing side, although performance was highly variable across participants. Three participants always pointed to the normal-hearing side, irrespective of the location of the signal. The comparison with control data showed that participants had particular difficulties localizing sounds at frontal locations and on the CI side. In contrast to most previous results, participants were able to localize low-frequency signals, although they localized high-frequency signals more accurately. Speech understanding in noise was better with the CI compared to testing without CI, but only at a position where the CI also improved sound localization. Our data suggest that a CI can, to a large extent, restore localization in participants with single-sided deafness. Difficulties may remain at frontal locations and on the CI side. However, speech understanding in noise improves when wearing the CI. The treatment with a CI in these participants might provide real-world benefits, such as improved orientation in traffic and speech understanding in difficult listening situations.

The development of allocentric spatial frame in the auditory system

The ability to encode space is a crucial aspect of interacting with the external world. Therefore, this ability appears to be fundamental for the correct development of the capacity to integrate different spatial reference frames. The spatial reference frame seems to be present in all the sensory modalities. However, it has been demonstrated that different sensory modalities follow various developmental courses. Nevertheless, to date these courses have been investigated only in people with sensory impairments, where there is a possible bias due to compensatory strategies and it is complicated to assess the exact age when these skills emerge. For these reasons, we investigated the development of the allocentric frame in the auditory domain in a group of typically developing children aged 6-10 years. To do so, we used an auditory Simon task, a paradigm that involves implicit spatial processing, and we asked children to perform the task in both the uncrossed and crossed hands postures. We demonstrated that the crossed hands posture affected the performance only in younger children (6-7 years), whereas at 10 years of age children performed as adults and were not affected by such posture. Moreover, we found that this task's performance correlated with age and developmental differences in spatial abilities. Our results support the hypothesis that auditory spatial cognition's developmental course is similar to the visual modality development as reported in the literature.

Spatial Hearing Difficulties in Reaching Space in Bilateral Cochlear Implant Children Improve With Head Movements

Supplemental Digital Content is available in the text.

The aim of this study was to assess three-dimensional (3D) spatial hearing abilities in reaching space of children and adolescents fitted with bilateral cochlear implants (BCI). The study also investigated the impact of spontaneous head movements on sound localization abilities.

Contribution of a method of assessing minimum audible angle in headphones

OBJECTIVES

The main objective of this study was to test the feasibility of measuring minimum audible angle in headphones with different reference positions in the horizontal plane, and comparing different types of pre-recorded head-related transfer functions. The secondary objective was to assess spatial discrimination performance in simulated unilateral hearing loss by measuring the minimum audible angle under monaural conditions using headphones.

MATERIALS AND METHODS

Minimum audible angle was assessed in 27 normal-hearing subjects, to test their spatial discrimination abilities, using 4 datasets of pre-recorded head-related transfer functions: 2 recorded on mannequins (KU100, KEMAR), and 2 individualized head-related transfer function datasets (TBM, PBM). Performance was evaluated at 3 reference positions (0°, 50° and 180°) in 1 binaural and 2 monaural conditions.

RESULTS

KU100 generated minimum audible angle values smaller than KEMAR in frontal and lateral position P<0.005), with a suggestive difference (P<0.05) compared to TBM and PBM in the frontal and lateral planes. Comparison between binaural and monaural conditions showed significant differences in frontal position for MON-c (contralateral) and MON-i (ipsilateral) (P<0.001), in lateral position for MON-c only (P<0.001) and in posterior position for MON-c and MON-i (P<0.001).

CONCLUSION

This study suggests that evaluation of spatial discrimination capacity using minimum audible angle with the KU100 head-related transfer dataset was reliable and robust.

Spatial Soundscapes and Virtual Worlds: Challenges and Opportunities

There is increasing effort to characterize the soundscapes around us so that we can design more compelling and immersive experiences. This review paper focuses on the challenges and opportunities around sound perception, with a particular focus on spatial sound perception in a virtual reality (VR) cityscape. We review how research on temporal aspects has recently been extended to evaluating spatial factors when designing soundscapes. In particular, we discuss key findings on the human capability of localizing and distinguishing spatial sound cues for different technical setups. We highlight studies carried out in both real-world and virtual reality settings to evaluate spatial sound perception. We conclude this review by highlighting the opportunities offered by VR technology and the remaining open questions for virtual soundscape designers, especially with the advances in spatial sound stimulation.

[Auditory localisation in hearing impaired schoolchildren with and without hearing aids]

OBJECTIVE

Auditory localisation is part of central auditory processing. The study examined the impact of hearing aids on the auditory localisation ability of non-linguistic stimuli in hearing impaired schoolchildren.

PATIENTS AND METHODS

Above threshold acoustic signals were presented to 20 children (7-17 years) in a free field condition with 45 loudspeakers placed on a semicircular array. All participants had a bilaterally symmetric moderate sensorineural hearing loss (WHO grade 2) and used behind the ear style (BTE) hearing aids with conventional earmolds. The children had to indicate the position of the signal by a laser pointer. Both high- and low-frequency noise bursts were employed in the tests to separately address spatial auditory processing based on interaural time differences and interaural intensity differences. The examination was performed with and without BTE hearing aids.

RESULTS

There was no significant difference between results in the aided and the unaided condition: neither for the different frequency bands nor for the signal positions. The auditory localisation of the hearing impaired children was reduced by 3°-4° for frontal and 5°-11° for lateral positions compared to normal-hearing children. There was no age-relation.

CONCLUSIONS

In our experimental setting, BTE hearing aids could not compensate the impaired auditory localisation ability of children with sensorineural hearing loss.

The development of perceptual averaging: Efficiency metrics in children and adults using a multiple-observation sound-localization task

This study examined the ability of older children to integrate spatial information across sequential observations of bandpass noise. In experiment I, twelve adults and twelve 8-14 yr olds localized 1-5 sounds, all presented at the same location along a 34° speaker array. Rate of gain in response precision (as a function of N observations) was used to measure integration efficiency. Children were no worse at localizing a single sound than adults, and-unexpectedly-were no less efficient at integrating information across observations. Experiment II repeated the task using a Reverse Correlation paradigm. The number of observations was fixed (N = 5), and the location of each sound was independently randomly jittered. Relative weights were computed for each observation interval. Distance from the ideal weight-vector was used to index integration efficiency. The data showed that children were significantly less efficient integrators than adults: only reaching adult-like performance by around 11 yrs. The developmental effect was small, however, relative to the amount of individual variability, with some younger children exhibiting greater efficiency than some adults. This work indicates that sensory integration continues to mature into late childhood, but that this development is relatively gradual.

Localization and Spatial Discrimination in Children and Adolescents with Moderate Sensorineural Hearing Loss Tested without Their Hearing Aids

The present study investigated two measures of spatial acoustic perception in children and adolescents with sensorineural hearing loss (SNHL) tested without their hearing aids and compared it to age-matched controls. Auditory localization was quantified by means of a sound source identification task and auditory spatial discrimination acuity by measuring minimum audible angles (MAA). Both low- and high-frequency noise bursts were employed in the tests to separately address spatial auditory processing based on interaural time and intensity differences. In SNHL children, localization (hit accuracy) was significantly reduced compared to normal-hearing children and intraindividual variability (dispersion) considerably increased. Given the respective impairments, the performance based on interaural time differences (low frequencies) was still better than that based on intensity differences (high frequencies). For MAA, age-matched comparisons yielded not only increased MAA values in SNHL children, but also no decrease with increasing age compared to normal-hearing children. Deficits in MAA were most apparent in the frontal azimuth. Thus, children with SNHL do not seem to benefit from frontal positions of the sound sources as do normal-hearing children. The results give an indication that the processing of spatial cues in SNHL children is restricted, which could also imply problems regarding speech understanding in challenging hearing situations.

Auditory Spatial Discrimination and the Mismatch Negativity Response in Hearing-Impaired Individuals

The aims of the present study were to investigate the ability of hearing-impaired (HI) individuals with different binaural hearing conditions to discriminate spatial auditory-sources at the midline and lateral positions, and to explore the possible central processing mechanisms by measuring the minimal audible angle (MAA) and mismatch negativity (MMN) response. To measure MAA at the left/right 0°, 45° and 90° positions, 12 normal-hearing (NH) participants and 36 patients with sensorineural hearing loss, which included 12 patients with symmetrical hearing loss (SHL) and 24 patients with asymmetrical hearing loss (AHL) [12 with unilateral hearing loss on the left (UHLL) and 12 with unilateral hearing loss on the right (UHLR)] were recruited. In addition, 128-electrode electroencephalography was used to record the MMN response in a separate group of 60 patients (20 UHLL, 20 UHLR and 20 SHL patients) and 20 NH participants. The results showed MAA thresholds of the NH participants to be significantly lower than the HI participants. Also, a significantly smaller MAA threshold was obtained at the midline position than at the lateral position in both NH and SHL groups. However, in the AHL group, MAA threshold for the 90° position on the affected side was significantly smaller than the MMA thresholds obtained at other positions. Significantly reduced amplitudes and prolonged latencies of the MMN were found in the HI groups compared to the NH group. In addition, contralateral activation was found in the UHL group for sounds emanating from the 90° position on the affected side and in the NH group. These findings suggest that the abilities of spatial discrimination at the midline and lateral positions vary significantly in different hearing conditions. A reduced MMN amplitude and prolonged latency together with bilaterally symmetrical cortical activations over the auditory hemispheres indicate possible cortical compensatory changes associated with poor behavioral spatial discrimination in individuals with HI.

Age-related changes in sound localisation ability

Auditory spatial processing is an important ability in everyday life and allows the processing of omnidirectional information. In this review, we report and compare data from psychoacoustic and electrophysiological experiments on sound localisation accuracy and auditory spatial discrimination in infants, children, and young and older adults. The ability to process auditory spatial information changes over lifetime: the perception of the acoustic space develops from an initially imprecise representation in infants and young children to a concise representation of spatial positions in young adults and the respective performance declines again in older adults. Localisation accuracy shows a strong deterioration in older adults, presumably due to declined processing of binaural temporal and monaural spectro-temporal cues. When compared to young adults, the thresholds for spatial discrimination were strongly elevated both in young children and older adults. Despite the consistency of the measured values the underlying causes for the impaired performance might be different: (1) the effect is due to reduced cognitive processing ability and is thus task-related; (2) the effect is due to reduced information about the auditory space and caused by declined processing in auditory brain stem circuits; and (3) the auditory space processing regime in young children is still undergoing developmental changes and the interrelation with spatial visual processing is not yet established. In conclusion, we argue that for studying auditory space processing over the life course, it is beneficial to investigate spatial discrimination ability instead of localisation accuracy because it more reliably indicates changes in the processing ability.

A Neuropsychological Approach to Auditory Verbal Hallucinations and Thought Insertion - Grounded in Normal Voice Perception

A neuropsychological perspective on auditory verbal hallucinations (AVH) links key phenomenological features of the experience, such as voice location and identity, to functionally separable pathways in normal human audition. Although this auditory processing stream (APS) framework has proven valuable for integrating research on phenomenology with cognitive and neural accounts of hallucinatory experiences, it has not yet been applied to other symptoms presumed to be closely related to AVH – such as thought insertion (TI). In this paper, I propose that an APS framework offers a useful way of thinking about the experience of TI as well as AVH, providing a common conceptual framework for both. I argue that previous self-monitoring theories struggle to account for both the differences and similarities in the characteristic features of AVH and TI, which can be readily accommodated within an APS framework. Furthermore, the APS framework can be integrated with predictive processing accounts of psychotic symptoms; makes predictions about potential sites of prediction error signals; and may offer a template for understanding a range of other symptoms beyond AVH and TI.

Auditory and visual localization accuracy in young children and adults

OBJECTIVE

This study aimed to measure and compare sound and light source localization ability in young children and adults who have normal hearing and normal/corrected vision in order to determine the extent to which age, type of stimuli, and stimulus order affects sound localization accuracy.

METHODS

Two experiments were conducted. The first involved a group of adults only. The second involved a group of 30 children aged 3 to 5 years. Testing occurred in a sound-treated booth containing a semi-circular array of 15 loudspeakers set at 10° intervals from -70° to 70° azimuth. Each loudspeaker had a tiny light bulb and a small picture fastened underneath. Seven of the loudspeakers were used to randomly test sound and light source identification. The sound stimulus was the word "baseball". The light stimulus was a flashing of a light bulb triggered by the digital signal of the word "baseball". Each participant was asked to face 0° azimuth, and identify the location of the test stimulus upon presentation. Adults used a computer mouse to click on an icon; children responded by verbally naming or walking toward the picture underneath the corresponding loudspeaker or light. A mixed experimental design using repeated measures was used to determine the effect of age and stimulus type on localization accuracy in children and adults. A mixed experimental design was used to compare the effect of stimulus order (light first/last) and varying or fixed intensity sound on localization accuracy in children and adults.

RESULTS

Localization accuracy was significantly better for light stimuli than sound stimuli for children and adults. Children, compared to adults, showed significantly greater localization errors for audition. Three-year-old children had significantly greater sound localization errors compared to 4- and 5-year olds. Adults performed better on the sound localization task when the light localization task occurred first.

CONCLUSIONS

Young children can understand and attend to localization tasks, but show poorer localization accuracy than adults in sound localization. This may be a reflection of differences in sensory modality development and/or central processes in young children, compared to adults.

Auditory processing disorders with and without central auditory discrimination deficits

Auditory processing disorder (APD) is defined as a processing deficit in the auditory modality and spans multiple processes. To date, APD diagnosis is mostly based on the utilization of speech material. Adequate nonspeech tests that allow differentiation between an actual central hearing disorder and related disorders such as specific language impairments are still not adequately available. In the present study, 84 children between 6 and 17 years of age (clinical group), referred to three audiological centers for APD diagnosis, were evaluated with standard audiological tests and additional auditory discrimination tests. Latter tests assessed the processing of basic acoustic features at two different stages of the ascending central auditory system: (1) auditory brainstem processing was evaluated by quantifying interaural frequency, level, and signal duration discrimination (interaural tests). (2) Diencephalic/telencephalic processing was assessed by varying the same acoustic parameters (plus signals with sinusoidal amplitude modulation), but presenting the test signals in conjunction with noise pulses to the contralateral ear (dichotic(signal/noise) tests). Data of children in the clinical group were referenced to normative data obtained from more than 300 normally developing healthy school children. The results in the audiological and the discrimination tests diverged widely. Of the 39 children that were diagnosed with APD in the audiological clinic, 30 had deficits in auditory performance. Even more alarming was the fact that of the 45 children with a negative APD diagnosis, 32 showed clear signs of a central hearing deficit. Based on these results, we suggest revising current diagnostic procedure to evaluate APD in order to more clearly differentiate between central auditory processing deficits and higher-order (cognitive and/or language) processing deficits.

Auditory localization and precedence effect: an exploratory study in infants and toddlers with visual impairment and normal vision

The precedence effect is a spatial hearing phenomenon implicated in sound localization on reverberant environments. It occurs when a pair of sounds, with a brief delay between them, is presented from different directions; listeners give greater perceptual weight to localization cues coming from the first-arriving sound, called lead, and suppress localization cues from the later-arriving reflection, called lag. Developmental studies with sighted infants show that the first responses to precedence effect stimuli are observed at 4-5 months of life. In this exploratory study, we use the minimum audible angle (MAA) paradigm in conjunction with the observer-based psychophysical procedure to test the ability of infants and toddlers, with visual impairment and normal vision, to discriminate changes in the azimuthal position of sounds configured under precedence effect conditions. The results indicated that similar and, in some conditions, higher performances were obtained by blind toddlers when compared to sighted children of similar age, and revealed that the observer-based psychophysical procedure is a valuable method to measure auditory localization acuity in infants and toddlers with visual impairment. The video records showed auditory orienting behaviors specific of the blind children group.