Can speech-evoked Auditory Brainstem Response become a useful tool in clinical practice?

Auditory Processing Disorder: Protocols and Controversy

PURPOSE

This study examined current auditory processing disorder (APD) protocols and audiologists' perspectives on the active debate seen in the literature regarding the status of APD as a unique disorder.

METHOD

This study used a cross-sectional, nonexperimental survey design. The participants were 134 U.S. audiologists, representing diversity across experience level and work setting.

RESULTS

Popular APD tests from prior surveys remain popular, and a few new tests have emerged. Most audiologists use diverse strategies to identify potential comorbid disorders as part of their APD protocol, including multidisciplinary assessment and referral to other specialists. Most participants disagreed with the assertion that APD is not a unique disorder; however, many also pointed out that patients' struggles with listening need to be the primary focus of APD assessment and management, regardless of the label of the disorder. Qualitative analysis of participant comments on the controversy yielded six themes: Clinical Experience, Comorbidity, Listening Skills, Literature Support, Overdiagnosis, and More Information Needed.

CONCLUSION

Most participants consider APD to be a unique disorder, citing clinical experience and the literature for support; however, many also indicated APD is complicated by comorbidity and APD may be overdiagnosed.

Speech auditory brainstem response in audiological practice: a systematic review

BACKGROUND

Speech-ABR is an auditory brainstem response that evaluates the integrity of the temporal and spectral coding of speech in the upper levels of the brainstem. It reflects the acoustic properties of the stimulus used and consists of seven major waves. Waves V and A represent the onset of the response; wave C transition region; D, E, and F waves periodic region (frequency following response); and wave O reflects the offset of the response.

PURPOSE

The aim of this study is to evaluate the clinical availability of the speech-ABR procedure through a literature review.

METHODS

Literature search was conducted in Pubmed, Google Scholar, Scopus and Science Direct databases. Clinical studies of the last 15 years have been included in this review and 60 articles have been reviewed.

RESULTS

As a result of the articles reviewed, it was seen that most of the studies on speech ABR were conducted with children and young people and generally focused on latency analysis measurements. Most used stimulus is the /da/ syllable.

CONCLUSIONS

Speech ABR can objectively measure the auditory cues important for speech recognition and has many clinical applications. It can be used as a biomarker for auditory processing disorders, learning disorders, dyslexia, otitis media, hearing loss, language disorders and phonological disorders. S-ABR is an effective procedure that can be used in speech and language evaluations in people with hearing aids or cochlear implant. It may also be of benefit to the aging auditory system's ability to encode temporal cues.

The development, validity, reliability, and norm of a preschool auditory processing assessment scale in China

BACKGROUND

Children with auditory processing deficits may face problems with language, learning, and social communication.

AIMS

To develop a Chinese auditory processing assessment scale for preschool children and establish the norms of the scale.

METHODS AND PROCEDURES

The predictive version of the scale was formed by a literature review, qualitative interviews, expert consultation, and a pre-test with a small sample. Nine kindergartens in Nanjing were selected by a stratified cluster sampling plan. First, 734 children from two kindergartens were selected for the large sample pre-test of the scale. Then, 1526 children from four kindergartens and 1151 children from three kindergartens were selected for the reliability and validity analysis and confirmatory factor analysis, respectively. The standardized norm data of the scale were established based on the 3411 points of scale data of the nine kindergartens. Finally, the clinical usefulness of the scale was analyzed by comparing the results of objective auditory processing tests in children with normal and abnormal auditory processing prompted by the score on the scale.

OUTCOMES AND RESULTS

The preschool auditory processing assessment scale includes 5 dimensions and 30 items. The Cronbach's alpha value of the scale is greater than 0.9. The confirmatory factor analysis results verify that the scale structure is reasonable. The percentile norm of the scale was established. The results of electrophysiological tests of the normal and abnormal auditory processing groups were statistically different (P < 0.05).

CONCLUSIONS AND IMPLICATIONS

The developed preschool auditory processing assessment scale has good reliability and validity. The scale is suitable for clinical application.

Frequency-Following Response (FFR) in cochlear implant users: a systematic review of acquisition parameters, analysis, and outcomes

PURPOSE

To characterize the acquisition parameters, analysis, and results of the frequency-following response (FFR) in cochlear implant users.

RESEARCH STRATEGIES

The search was conducted in Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), Ovid Technologies, PubMed, SciELO, ScienceDirect, Scopus, Web of Science, and gray literature.

SELECTION CRITERIA

Studies on FFR in cochlear implant users or that compared them with normal-hearing people, with no restriction of age, were included. Secondary and experimental studies were excluded. There was no restriction of language or year of publication.

DATA ANALYSIS

The data were analyzed and reported according to the stages in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 2020. The methodological quality was analyzed with the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Divergences were solved by a third researcher.

RESULTS

Six studies met the inclusion criteria. Only one study was comparative, whose control group comprised normal-hearing people. The variations in acquisition parameters were common and the analysis predominantly approached the time domain. Cochlear implant users had different FFR results from those of normal-hearing people, considering the existing literature. Most articles had low methodological quality.

CONCLUSION

There is no standardized FFR acquisition and analysis protocol for cochlear implant users. The results have a high risk of bias.

Frequency-Following Response (FFR) in Military Pilots

Introduction  Good hearing in pilots, including central auditory skills, is critical for flight safety and the prevention of aircraft accidents. Pure tone audiometry alone may not be enough to assess hearing in the members of this population who, in addition to high noise levels, routinely face speech recognition tasks in non-ideal conditions. Objective  To characterize the frequency-following response (FFR) of a group of military pilots compared with a control group. Methods  Twenty military pilots in the Study Group and 20 non-pilot military personnel, not exposed to noise in their work, in the Control Group, all with normal hearing, aged between 30 and 40 years old, completed a questionnaire to assess their hearing habits, and their FFRs were measured with a /da/ syllable (duration 40 milliseconds, speed 10.9/s), at 80 dB NA in the right ear. All procedures were approved by the ethical committee of the institution. Statistical analysis was performed using the t-Student or Mann-Whitney tests for quantitative variables, and the Fisher or chi-squared tests for qualitative variables, and a value of p  < 0.05 was considered to be statistically significant. Results  There was no significant difference between the groups regarding auditory habits. In the FFR, wave amplitudes A ( p  = 0.01) and C ( p  = 0.04) were significantly lower in the Study Group. Conclusion  Working as a military pilot can be a crucial factor in determining an individual's typical FFR pattern, demonstrated in the present study by statistically significant reductions in the amplitudes of the A and C waves.

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.

Frequency Following Responses in childhood apraxia of speech

OBJECTIVE

to compare the Frequency Following Responses of children with childhood apraxia of speech with typical development children.

METHOD

this is an observational cross-sectional analytical study approved by Human Research Ethics Committee. Thirty normal hearing children have participated in the study.

THEY WERE DIVIDED INTO TWO GROUPS

1) study group - composed by 15 children diagnosed with childhood apraxia of speech (between the chronological ages of 3 and 11 years, mean age of 5,7 years); and 2) control group: composed by 15 children with typical development, paired by age and gender with study group. Frequency Following Response were recorded using the/da/syllable presentation rate at 10.9 ms.

RESULTS

there was a significant delay in latencies of waves V, A and C of children with apraxia of speech, suggesting difficulties in the ability to process sounds.

CONCLUSION

The delay on Frequency Following Response's latencies (waves V, A and C) in children with apraxia of speech maybe related to atypical neural coding of speech sounds, suggesting that apraxia of speech must not be purely considered as a motor speech disorder.

Study of the brainstem auditory evoked potential with speech stimulus in the pediatric population with and without oral language disorders: a systematic review

INTRODUCTION

The brainstem auditory evoked potential with speech stimulus, BAEP-speech, has been applied to observe how speech sounds are manifested in the brainstem. This tool can be used in children to assess central auditory processing, allowing preventive and early interventions.

OBJECTIVE

To assess the results found in the brainstem auditory evoked potential with speech stimulus in the pediatric population with and without oral language disorders, through a systematic literature review.

METHOD

The search was carried out in the scientific databases Portal BVS, Pubmed, Lilacs, Medline, Scielo and Web of Science, OpenGrey.eu, DissOnline, OpenDoar, OAIster and The New York Academy of Medicine. A systematic literature review was performed using the descriptors: auditory evoked potentials, children and their synonyms, combined by the Boolean operators AND and OR. The search filter "age: child" was used. The studies were independently read by peers and, in case of disagreement regarding the inclusion of studies, a third researcher was consulted. Original case-control articles that performed BAEP-speech without competitive noise, carried out in the pediatric population without and with oral language disorders, were included.

RESULT

14 articles published between 2008 and 2019 were included in this review. Methodological variability was observed in the exam, with the syllable / da / being the most frequently used as the stimulus. When performing the average of the groups, it was observed that the population with specific language disorders showed greater latency delays in the sustained portion, lower amplitude values and VA complex slope. The group with phonological disorders had higher values in the transient portion of the responses.

CONCLUSION

Children with language disorders of different etiologies have different patterns of BAEP-speech responses when compared to children with typical development.

Masking Level Difference and Electrophysiological Evaluation in Adults with Normal Hearing

Introduction  The auditory structures of the brainstem are involved in binaural interaction, which contributes to sound location and auditory figure-background perception. Objective  To investigate the performance of young adults in the masking level difference (MLD) test, brainstem auditory-evoked potentials (BAEPs) with click stimulus, and frequency-following response (FFR), as well as to verify the correlation between the findings, considering the topographic origin of the components of these procedures. Methods  A total of 20 female subjects between 18 and 30 years of age, with normal hearing and no complaints concerning central auditory processing underwent a basic audiological evaluation, as well as the MLD test, BAEP and FFR. Results  The mean result on the MLD test was of 10.70 dB. There was a statistically significant difference in the absolute latencies of waves I, III and V in the BAEPs of the ears. A change in the FFR characterized by the absence of the C, E and F waves was noticed. There was a statistically significant difference in the positive correlation of wave V in the BAEPs with the MLD. There was a statistically significant difference in the positive correlation of the mean MLD and the V, A and F components of the FFR. Conclusion  The mean MLD was adequate. In the BAEPs, we observed that the click stimulus transmission occurred faster in the right ear. The FFR showed absence of some components. The mean MLD correlated positively with the BAEPs and FFR.

Assessing Auditory Processing Deficits in Tinnitus and Hearing Impaired Patients with the Auditory Behavior Questionnaire

Background and Purpose: Auditory processing disorders (APD), tinnitus and hearing loss (HL) are typical issues reported by patients in audiologic clinics. These auditory impairments can be concomitant or mutually excluding. APD are not necessarily accompanied by significant HL, whereas many adults exhibit peripheral HL and typical cognitive deficits often associated with APD. Since HL, tinnitus and APD affects to several parts of the ascending auditory pathway from the periphery to the auditory cortex, there could be some interrelationship between them. For instance, tinnitus has been reported to degrade the auditory localization capacity. Tinnitus is believed to be triggered by deafferentation of normal peripheral input to the central auditory system. This peripheral deficit can be accompanied by HL or not, since a type of permanent cochlear damage (thus deafferentation) without an elevation of hearing thresholds might persist. Therefore, a combined study of APD, tinnitus and HL on the same cohort of patients can be audiologically relevant and worthy. Methods: Statistical analysis is applied to a cohort of 305 patients attending an audiology clinic in Madrid (Spain). This group of patients is first categorized in four subgroups, namely, HLTG (with tinnitus and HL), NHLTG (with tinnitus and without HL), HLNTG (with HL but no tinnitus), and NHLNTG (neither tinnitus nor HL). The statistical variables include Age, Average Auditory Threshold (ATT), for assessing HL, Tinnitus Handicap Inventory (THI), for measuring tinnitus, and a new 25-item Auditory Behavior Questionnaire (ABQ), for scoring APD. Factor analysis is applied to arrange these items into 4 subscales. The internal consistency reliability of this ABQ is confirmed by calculating Cronbach's coefficients α. The test-retest reliability is assessed by the intraclass correlation coefficients, ICC. Statistical techniques applied to the data set include descriptive analysis of variables and Spearman rank correlations (ρ) between them. Results: Overall reliability of ABQ is confirmed by an α value of 0.89 and by an ICC of 0.91. Regarding the internal consistency reliability, the four subscales prove a fairly good consistency with α coefficients above 0.7. Average values of statistical variables show significantly lower age of patients with tinnitus and no HL, which can provide a cue of noise overexposure of this segment of population. These younger patients show also decreased ABQ and similar THI in comparison with patients in the other subgroups. A strong correlation (ρ = 0.63) was found between AAT and Age for the HLNTG subgroup. For the HLTG subgroup, a moderate correlation (ρ = 0.44) was found between ABQ and THI. Conclusion: The utilized questionnaire (ABQ), together with AAT and THI, can help to study comorbid hearing impairments in patients regularly attending an audiological clinic.