Contentious issues related to auditory processing disorder

A number of children undergo audiometric evaluation due to suspected hearing difficulties. Yet for some, their hearing sensitivity is found to be normal (Iliadou et al., 2017; Sharma, Purdy, & Kelly, 2009). Often, these children are described by parents and teachers as having difficulties to follow several instructions or attend to a conversation, and getting distracted when background noise is present (Iliadou et al., 2017; Witton, 2010). There are also reports of these children either misunderstanding or taking longer to understand simple verbal directions, and demonstrating selective hearing (Johnson, Benson, & Seaton, 1997). These weaknesses often cause educational, vocational and social challenges (American Speech-Language-Hearing Association (ASHA), 2005; British Society of Audiology (BSA, 2007). Children exhibiting these problems could be diagnosed with Auditory Processing Disorder (APD) (American Academy of Audiology (AAA), 2010; ASHA, 2005; BSA, 2007; Iliadou et al., 2017).peer-reviewe

The impact of socioeconomic status on auditory processing skills in Maltese children

Auditory processing skills (APS) may affect the development of language. Understanding the impact that socioeconomic status (SES) has on APS can help to identify individuals at risk of poor auditory processing skills and in turn develop more focused intervention strategies to target these skills before serious repercussions emerge. This study explored the impact of SES on the auditory processing skills of 41 Maltese children aged between 7 and 9 years. A self-devised questionnaire was used to gather information relating to the SES of the children, using maternal education and occupation to categorise SES. Such information was compared with the children’s performance on an auditory processing test battery in order to analyse its effect. Results demonstrated a significant correlation between SES groups and performance on the Duration Patterns Test (DPT), an auditory processing subtest which presents tones of varying duration as a stimulus. In addition, overall higher mean scores on almost all the tests were observed for the mid and high-mid socioeconomic groups. This study provides the first preliminary indications that lower SES could be associated with poorer APS in Maltese children.peer-reviewe

The Impact of Hearing Loss and Hearing Aid Usage on the Visuospatial Abilities of Older Adults in a Cohort of Combined Hearing and Cognitive Impairment

Introduction: It has been proposed that hearing loss may result in improved visuospatial abilities. The evidence for this assertion is inconsistent, and limited to studies in congenitally deaf children, despite older adults with age-related hearing loss constituting the vast majority of the hearing impaired population. We assessed visuospatial (visuoconstruction and visuospatial memory) ability in older adult hearing aid users with and without clinically significant cognitive impairment. The primary aim of the study was to determine the effect of hearing loss on visuospatial abilities. Method: Seventy-five adult hearing aid users (HA) aged over 65 were recruited, out of whom 30 had normal cognition (NC-HA), 30 had mild cognitive impairment (MCI-HA), and 15 had dementia (D-HA). The Rey Osterrieth Complex figure test (ROCFT) copy, 3 min recall and 30 min recall tests were performed to evaluate the visuoconstructional and visuospatial memory abilities of the participants. Results: There were significant differences between the ROCFT copy, 3 min recall, and 30 min recall among the three cohorts (p < 0.005). Compared with previously published normative data, the NC-HA performed significantly better in the ROCFT copy (p < 0.001), immediate recall (p < 0.001), and delay recall (p = 0.001), while the MCI-HA performed similarly to the expected norms derived from population (p = 0.426, p = 0.611, p = 0.697, respectively), and the D-HA performed below this norm. Conclusion: Though visuospatial abilities tend to decline when the global cognitive functioning declines, we found suggestive evidence for positive effects of age-related hearing loss on visuospatial cognitive ability. Participants with mild cognitive impairment and hearing loss, who would have been expected to perform worse than normative data, were in fact performing as well as cognitively healthy subjects without hearing loss. Visuospatial ability could be targeted when providing rehabilitation for the older adults with hearing loss

Long-term use benefits of personal frequency-modulated systems for speech in noise perception in patients with stroke with auditory processing deficits: a non-randomised controlled trial study.

OBJECTIVES: Approximately one in five stroke survivors suffer from difficulties with speech reception in noise, despite normal audiometry. These deficits are treatable with personal frequency-modulated systems (FMs). This study aimed to evaluate long-term benefits in speech reception in noise, after daily 10-week use of personal FMs, in non-aphasic patients with stroke with auditory processing deficits. DESIGN: This was a prospective non-randomised controlled trial study. Patients were allocated to an intervention care group or standard care subjects group according to their willingness to use the intervention or not. SETTING: Tertiary care setting. PARTICIPANTS: Nine non-aphasic subjects with ischaemic stroke, normal/near-normal audiometry and auditory processing deficits and with reported difficulties understanding speech in background noise were recruited in the subacute stroke stage (3-12 months after stroke). INTERVENTIONS: Four patients (intervention care subjects) used the FMs in their daily life over 10 weeks. Five patients (standard care subjects) received standard care. PRIMARY OUTCOME MEASURES: All subjects were tested at baseline (visit 1) and 10 weeks later (visit 2) on a sentences in noise test with the FMs (aided) and without the FMs (unaided). RESULTS: Speech reception thresholds showed clinically and statistically significant improvements in intervention but not in standard care subjects at 10 weeks in aided and unaided conditions. CONCLUSIONS: 10-week use of FMs by adult patients with stroke may lead to benefits in unaided speech in noise perception. Our findings may indicate auditory plasticity type changes and require further investigation. TRIAL REGISTRATION NUMBER: Pre-results; NCT02889107

Long-term use benefits of personal frequency-modulated systems for speech in noise perception in patients with stroke with auditory processing deficits: a non-randomised controlled trial study.

OBJECTIVES: Approximately one in five stroke survivors suffer from difficulties with speech reception in noise, despite normal audiometry. These deficits are treatable with personal frequency-modulated systems (FMs). This study aimed to evaluate long-term benefits in speech reception in noise, after daily 10-week use of personal FMs, in non-aphasic patients with stroke with auditory processing deficits. DESIGN: This was a prospective non-randomised controlled trial study. Patients were allocated to an intervention care group or standard care subjects group according to their willingness to use the intervention or not. SETTING: Tertiary care setting. PARTICIPANTS: Nine non-aphasic subjects with ischaemic stroke, normal/near-normal audiometry and auditory processing deficits and with reported difficulties understanding speech in background noise were recruited in the subacute stroke stage (3-12 months after stroke). INTERVENTIONS: Four patients (intervention care subjects) used the FMs in their daily life over 10 weeks. Five patients (standard care subjects) received standard care. PRIMARY OUTCOME MEASURES: All subjects were tested at baseline (visit 1) and 10 weeks later (visit 2) on a sentences in noise test with the FMs (aided) and without the FMs (unaided). RESULTS: Speech reception thresholds showed clinically and statistically significant improvements in intervention but not in standard care subjects at 10 weeks in aided and unaided conditions. CONCLUSIONS: 10-week use of FMs by adult patients with stroke may lead to benefits in unaided speech in noise perception. Our findings may indicate auditory plasticity type changes and require further investigation. TRIAL REGISTRATION NUMBER: Pre-results; NCT02889107

The role of motivation factors in exergame interventions for fall prevention in older adults: A systematic review and meta-analysis

Balance disorders and falls are common in the elderly population. Regular balance exercises are an evidence-based physical intervention to prevent falls in older adults, while patient motivation and adherence are important factors for intervention outcome. Exergames are a relatively new, alternative intervention for physical rehabilitation as they improve balance and strength in older adults. The aims of this systematic review and meta-analysis were to assess the (1) effect of motivation factors as per the Capability, Opportunity and Motivation model of Behavior change (COM-B) on the effectiveness of exergame interventions in healthy older adults, (2) effectiveness of exergames to improve balance in older healthy adults and, (3) impact of exergames on cognitive outcomes. Results show that motivation and capability components influence the general outcome of the exergame training. Motivational factors should thus be considered when setting-up an exergame intervention. Furthermore, exergame intervention appears to be a promising training method in comparison to traditional exercise training. However, exergame training in itself might not be sufficient to improve fall risk and cognitive performance

Health-Related Quality of Life in Adults With Classical Infratentorial Superficial Siderosis: A Cross-sectional Study

BACKGROUND AND OBJECTIVES: Infratentorial superficial siderosis (iSS) is a rare but disabling neurological condition characterised by progressive hearing loss, balance and mobility problems. The functional decline in these neurological domains with iSS progression is likely to adversely impact health-related quality of life (HRQoL). We studied HRQoL of adults with iSS using two common generic HRQoL measures (Health Utilities Index Mark III (HUI3) and EuroQoL EQ5D (5 Level) to determine the most impacted domains and evaluate the association between HRQoL scores and disease duration. METHODS: This observational study was an anonymous online survey. Following institutional Research Ethics Committee approval, we contacted dedicated international organisations, charities and patient-groups identified through online searches, social media and collaborative networks, to distribute the study information and study link, inviting their members diagnosed with iSS to participate. Participation required access to a digital device connected to the internet, confirmation of eligibility (aged ≥18 years and previously diagnosed with iSS) and informed consent to participate in the survey, which included study-specific questions (demographics, iSS, hearing) and HRQoL questionnaires. Survey responses were captured by the Research Electronic Data Capture (REDCap) survey software and analysed using the SPSS statistical package. Linear regression analysis was performed to investigate the association between HRQoL scores and disease duration. RESULTS: Of fifty participants,60% were male; the median (interquartile range, IQR) age was 60 (15) years. The median (IQR) multi-attribute scores for HUI3 and EQ5D were 0.36 (0.53) and 0.64 (0.33), respectively. The most frequently affected domains (moderate or worse category) were hearing (64%), and pain (48%) for HUI3, and mobility (54%) and pain (50%) for EQ5D. There was a weak association between disease duration and multi-attribute scores for HUI3 (R=0.353; adjusted R2=0.096; b=-0.008; p=0.047) but not EQ5D. DISCUSSION: Our findings demonstrate low HRQoL scores which capture low functional status in several domains typically affected in iSS, suggesting that iSS has a major adverse impact on quality of life in multiple functional domains. Measures of HRQoL in iSS should be included in clinical and research settings, including treatment trials

The interplay between cognition, functional and dual-task gait in persons with a vestibular disorder versus healthy controls

Close links exist between vestibular function and cognition. Dual-task (DT) tests may have ecological validity to assess the impact of daily life cognitive-motor demands in people with vestibular dysfunction (PwVD), functional gait and falls risk. The present paper aimed at building predictive models for functional gait under DT conditions, while clarifying the impact of vestibular dysfunction, individual characteristics, varying task types and motor-cognitive demands. Case-controlled observational study with 39 PwVD and 62 healthy participants. The Functional Gait Assessment (FGA), with and without an additional motor, numeracy, or literacy task, was completed. Multiple linear regression was used to fit models to predict FGA under single and DT performance. Dual task cost (DTC, %) was calculated to assess DT interference on FGA performance using the equation: 100*(single task score-dual task score)/single-task score. Following Bonferroni corrections for multiple comparisons (corrected alpha level of 0.003), PwVD had poorer performance than controls for all FGA conditions (p < 0.001), motor (- 3.94%; p = 0.002) and numeracy (- 22.77%; p = 0.001) DTCs and spatial working memory (p = 0.002). The literacy DTC was marginally significant (- 19.39% p = 0.005). FGA single and DT motor, numeracy, and literacy models explained 76%, 76%, 66% and 67% of the variance respectively for PwVD. Sustained attention, visual memory and sex contributed to all models; short-term visual recognition memory, balance confidence, and migraine contributed to some models. Cognitive performance is impaired in PwVD. Motor, numeracy and literacy tasks impair functional gait performance. Cognitive assessment and FGA with a numeracy or literacy cognitive component should be included within assessment protocols and considered in the provision of targeted interventions for PwVD

Auditory and language processing skills in Maltese children : a comparative study

Auditory processing disorder is described as a mixture of unrefined listening skills which, despite normal hearing, causes poor speech perception. These difficulties have also been reported in children with a diagnosis of language impairment (LI), literacy difficulties (LD)1, and attention-deficit/hyperactivity disorder (ADHD). The purpose of this study is to describe and compare the listening performance of typically developing (TD) children with those diagnosed with LI, LD, and ADHD on an assessment battery of auditory processing (AP) and language processing (LP). One hundred and one TD children and 53 children with a clinical diagnosis were assessed using four subtests of AP presenting linguistic stimuli, three AP subtests with non-linguistic stimuli and an assessment of LP. Parents of all children were required to fill in a questionnaire related to their listening difficulties. Parental report for the TD group on average yielded the lowest score, indicating fewer difficulties with listening skills in the TD group. The listening difficulties exhibited in the Maltese participants diagnosed with LI, LD and ADHD were mainly specific to the AP subtests using linguistic stimuli. The LI and LD groups generally performed significantly worse than the TD group on all AP subtests using linguistic stimuli, while the ADHD group performed significantly worse than the TD group on some of these tests. The same pattern did not emerge for the subtests using non-linguistic stimuli. Few significant effects between groups were evident. The LI groups were found to perform the weakest in all tests of language processing.peer-reviewe

A Hearing Screening Protocol for Stroke Patients: An Exploratory Study.

Background: Auditory impairment post stroke is common and may be due to both peripheral hearing loss and or central auditory processing disorder (CAPD). When auditory impairment remains untreated, it may impact on patient communication and rehabilitation after stroke. Offering a comprehensive audiological assessment to all stroke patients would be both costly and time-consuming. A brief hearing screening is thus required. Objective: The aim of this study was to determine whether a two-tiered hearing screening approach, with use of a handheld hearing screener and two validated hearing questionnaires could be used as a hearing screening for peripheral hearing loss and CAPD in stroke survivors. The sensitivity and specificity of the screening method was analyzed. Methods: This was a prospective study conducted in a tertiary neurology hospital. Forty-two consecutive stroke patients were recruited and tested within 3-12 months post-onset of their stroke. Three screening tools for the identification of hearing impairment were evaluated in this study: A handheld hearing screener for determination of peripheral audiometric hearing loss and two validated questionnaires (The Amsterdam Inventory Auditory for Disability (AIAD) and the Hearing Handicap Inventory for Elderly (HHIE) questionnaires) for determination of peripheral hearing loss and/or CAPD. Results: The hearing screener had a sensitivity of 92. 59% detecting a hearing loss and specificity of 100%. The greatest test accuracy in identifying a central auditory processing type hearing impairment in stroke patients was found when the handheld hearing screener and the AIAD questionnaire were combined. Conclusion: This study is a first step toward addressing the complex auditory needs of stroke survivors in a systematic manner, with the ultimate aim to support their communication needs and long-term recovery and wellbeing. Registration: Project Identification number 11/0469 and REC ref 11/LO/1675