<p>Preventing ototoxicity and its effects</p>

The term ototoxicity is used to refer to temporary or permanent damage to the audiovestibular system as a result of medicines or chemicals. The ototoxic substances may target: - The vestibular system, which is important for balance - The cochlea, which is the organ of hearing - The auditory pathways, which convey signals from these structures to the auditory cortex/vestibular cortex - A combination of these. Although studies from many countries have shown that ototoxicity is not a major cause of hearing loss or balance problems, it is important as it is potentially preventable. It is more prevalent in low- and middle-income countries (LMICs) due to a lack of understanding amongst health workers and insufficient resources to identify improper use of medicines and chemicals. Health workers may not have come across ototoxicity in their training. Laboratories in hospitals may lack the facilities to monitor the blood levels of ototoxic drugs and industrial use of ototoxic chemicals may not be recognised as a cause for concern by those responsible for the care of the workers exposed

A European perspective on auditory processing disorder-current knowledge and future research focus

Current notions of \u201chearing impairment,\u201d as reflected in clinical audiological practice, do not acknowledge the needs of individuals who have normal hearing pure tone sensitivity but who experience auditory processing difficulties in everyday life that are indexed by reduced performance in other more sophisticated audiometric tests such as speech audiometry in noise or complex non-speech sound perception. This disorder, defined as \u201cAuditory Processing Disorder\u201d (APD) or \u201cCentral Auditory Processing Disorder\u201d is classified in the current tenth version of the International Classification of diseases as H93.25 and in the forthcoming beta eleventh version. APDs may have detrimental effects on the affected individual, with low esteem, anxiety, and depression, and symptoms may remain into adulthood. These disorders may interfere with learning per se and with communication, social, emotional, and academic-work aspects of life. The objective of the present paper is to define a baseline European APD consensus formulated by experienced clinicians and researchers in this specific field of human auditory science. A secondary aim is to identify issues that future research needs to address in order to further clarify the nature of APD and thus assist in optimumdiagnosis and evidence-based management. This European consensus presents the main symptoms, conditions, and specific medical history elements that should lead to auditory processing evaluation. Consensus on definition of the disorder, optimum diagnostic pathway, and appropriate management are highlighted alongside a perspective on future research focus

Inventory of current EU paediatric vision and hearing screening programmes

Background: We examined the diversity in paediatric vision and hearing screening programmes in Europe. Methods: Themes relevant for comparison of screening programmes were derived from literature and used to compile three questionnaires on vision, hearing and public-health screening. Tests used, professions involved, age and frequency of testing seem to influence sensitivity, specificity and costs most. Questionnaires were sent to ophthalmologists, orthoptists, otolaryngologists and audiologists involved in paediatric screening in all EU fullmember, candidate and associate states. Answers were cross-checked. Results: Thirty-nine countries participated; 35 have a vision screening programme, 33 a nation-wide neonatal hearing screening programme. Visual acuity (VA) is measured in 35 countries, in 71% more than once. First measurement of VA varies from three to seven years of age, but is usually before the age of five. At age three and four picture charts, including Lea Hyvarinen are used most, in children over four Tumbling-E and Snellen. As first hearing screening test otoacoustic emission (OAE) is used most in healthy neonates, and auditory brainstem response (ABR) in premature newborns. The majority of hearing testing programmes are staged; children are referred after one to four abnormal tests. Vision screening is performed mostly by paediatricians, ophthalmologists or nurses. Funding is mostly by health insurance or state. Coverage was reported as >95% in half of countries, but reporting was often not first-hand. Conclusion: Largest differences were found in VA charts used (12), professions involved in vision screening (10), number of hearing screening tests before referral (1-4) and funding sources (8)

Management of auditory processing disorders

Hearing is one of the cornerstones of human communication. The term ‘Auditory Processing Disorder (APD)’ refers to a hearing disorder resulting from impaired brain function. Diagnosis and management of APD requires a multidisciplinary approach, given the potential impact of APD on listening, communication and academic outcomes, and considering the frequent comorbidity of APD with related language and learning difficulties. Intervention strategies can be divided into five main categories, namely environmental modifications, signal enhancement strategies, teacher/speaker based adaptations, formal and informal auditory training, and compensatory strategies. While outcome studies – other than single case studies – are lacking for informal auditory training and compensatory strategies, these are low-cost procedures that have been long employed in children's education. There is some recent evidence to suggest that formal auditory training by means of computerized games leads to improvements in phonological awareness and educational performance in these children. However, further research is needed to understand how and why intervention works and which is the most cost-effective intervention for individual case

CAPD Is Classified in ICD-10 as H93.25 and Hearing Evaluation—Not Screening—Should Be Implemented in Children With Verified Communication and/or Listening Deficits

PURPOSE: The article "It Is Time to Rethink Central Auditory Processing Disorder Protocols for School-Aged Children" (DeBonis, 2015) appeared in the American Journal of Audiology as a tutorial. The author used the argument made by Cowan, Rosen, and Moore (2009), referring to central auditory processing disorder (CAPD), that "such impairments have not been shown to uniquely contribute to a clearly defined condition that would warrant its inclusion in any of the major disease classification systems" (emphasis added; p. 129). However, CAPD is included in the U.S. version of the International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) under the code H93.25; this was not mentioned in the article by DeBonis. We would like to point out some additional omissions of this tutorial that may bias its conclusions

Evolving concepts of developmental auditory processing disorder (APD): a British Society of Audiology APD Special Interest Group 'white paper'

Children with listening difficulties, but normal audiometry, may be diagnosed with APD. The diagnosis is typically based on poor performance on tests of perception of both non-speech and speech stimuli. However, non-speech test results correlate only weakly with evaluations of speech-in-noise processing, cognitive skills, and caregiver evaluations of listening ability. The interpretation of speech test results is confounded by the involvement of language processing mechanisms. Overall, listening ability is associated more with higher-level, cognitive and analytic processing than with lower-level sensory processing. Current diagnosis of a child with APD, rather than another problem (e.g. language impairment, LI), is determined more by the referral route than by the symptoms. Co-occurrence with other learning problems suggests that APD may be a symptom of a more varied neurodevelopmental disorder. Alternately, APD has been proposed as a cause of language-based disorders, but there is no one-to-one mapping between listening and language among individuals. Screening for APD may be most appropriately based on a well-validated, caregiver questionnaire that captures the fundamental problem of listening difficulties and identifies areas for further assessment and management. This approach has proved successful for LI, and may in future serve as a metric to help assess other, objective testing methods<br/

Auditory Processing after Early Left Hemisphere Injury: A Case Report

Few studies have addressed the long-term outcomes of early brain injury, especially after hemorrhagic stroke. This is the first study to report a case of acquired auditory processing disorder in a 10-year-old child who had a severe left hemorrhagic cerebral infarction at 13 months of age, compromising nearly all of the left temporal lobe. This case, therefore, is an excellent and rare opportunity to investigate the presence of neural plasticity of central auditory system in a developing brain followed severe brain damage. After assuring normal functioning of the peripheral auditory system, a series of behavioral auditory processing tests was applied in dichotic and monaural listening conditions and with verbal and non-verbal stimuli. For all verbal dichotic tasks (dichotic digits, competing words, and sentences tests), good performance on the left ear, especially for Dichotic digits test (100%), and zero performance on the right ear were observed. For monaural low-redundancy tests, the patient also exhibited good performance for auditory figure-ground and time-compressed sentences tests in the left ear. In the right ear, a very poor performance was observed, but slightly better than the same in Dichotic tasks. Impaired performance was also observed in the LiSN test in terms of spatial advantage and, for the Pitch Pattern Sequence test, the only non-verbal test applied, the patient had performance within the normal range in both ears. These results are interpreted taking into consideration the anatomical location of stroke lesion and also the influence of hemispheric specialization for language on auditory processing performance

The Relationship between Types of Attention and Auditory Processing Skills: Reconsidering Auditory Processing Disorder Diagnosis

Measures of attention have been found to correlate with specific auditory processing tests in samples of children suspected of Auditory Processing Disorder (APD), but these relationships have not been adequately investigated. Despite evidence linking auditory attention and deficits/symptoms of APD, measures of attention are not routinely used in APD diagnostic protocols. The aim of the study was to examine the relationship between auditory and visual attention tests and auditory processing tests in children with APD and to assess whether a proposed diagnostic protocol for APD, including measures of attention, could provide useful information for APD management. A pilot study including 27 children, aged 7–11 years, referred for APD assessment was conducted. The validated test of everyday attention for children, with visual and auditory attention tasks, the listening in spatialized noise sentences test, the children's communication checklist questionnaire and tests from a standard APD diagnostic test battery were administered. Pearson's partial correlation analysis examining the relationship between these tests and Cochrane's Q test analysis comparing proportions of diagnosis under each proposed battery were conducted. Divided auditory and divided auditory-visual attention strongly correlated with the dichotic digits test, r = 0.68, p &lt; 0.05, and r = 0.76, p = 0.01, respectively, in a sample of 20 children with APD diagnosis. The standard APD battery identified a larger proportion of participants as having APD, than an attention battery identified as having Attention Deficits (ADs). The proposed APD battery excluding AD cases did not have a significantly different diagnosis proportion than the standard APD battery. Finally, the newly proposed diagnostic battery, identifying an inattentive subtype of APD, identified five children who would have otherwise been considered not having ADs. The findings show that a subgroup of children with APD demonstrates underlying sustained and divided attention deficits. Attention deficits in children with APD appear to be centred around the auditory modality but further examination of types of attention in both modalities is required. Revising diagnostic criteria to incorporate attention tests and the inattentive type of APD in the test battery, provides additional useful data to clinicians to ensure careful interpretation of APD assessments