Are there auditory processing and perception disorders in children with dyslexia?

BACKGROUND: In this paper the dichotic tests and the CERA (Cortical Evoked Response Audiometry) of children with dyslexia had been examined, in order to find out if there are auditory processing and perception disorders. PATIENTS AND METHODS: 33 children with dyslexia had been compared with 28 children without problems of writing and reading. The mean age of the children was 9 years. All of the children had been examined by the following audiometric measurements: tympanometry, pure-tone-audiometry, speech-audiometry, dichotic Tests by Uttenweiler and Feldmann and the Cortical Evoked Response Audiometry (CERA) rated according to Esser. RESULTS: The intelligence quotients were in the group of dyslexic children significantly lower. The Uttenweiler and Feldmann tests were in dyslexic children significantly lower in the control group as well. The late cortical responses ware normal or near normal in both groups. CONCLUSION: Dichotic speech tests indicate central auditory processing and perception deficits in dyslexia. These tests are confounded, however, by attention and memory deficits. The CERA rated according to Esser does not point out to these auditory disorders in dyslexia.     

The Hebrew and the Arabic version of the LittlEARS® auditory questionnaire for the assessment of auditory development: results in normal hearing children and children with cochlear implants

Objective

With more children receiving cochlear implants at an early age, there is a need for evaluation and assessment of early auditory behavior. We present the translation of the LittlEARS^® Auditory Questionnaire into Hebrew and into Arabic. First the validation of the LittlEARS^® Auditory Questionnaire in normal hearing children was evaluated. Second, the auditory behavior and the progress in hearing skills of a group of children with cochlear implants were assessed.

Methods

A “back-translation” method was used to translate and adapt the LittlEARS^® Auditory Questionnaire into Hebrew and into Arabic. Normal hearing participants included 70 Hebrew speaking and 97 Arabic speaking parents of children from 1 to 24 months of age with normal hearing. An additional group of 42 parents of children with cochlear implants with a hearing age of up to 24 months completed the LittlEARS^® Auditory Questionnaire. 27 of them completed the questionnaire more than once at intervals, so that change and development could be recorded. Scores on the LittlEARS^® Auditory Questionnaire were compared to results of SIR and CAP scales and other available auditory data.

Results

The results of the first study show that the curves found for the Hebrew and the Arabic translations of the LittlEARS^® Auditory Questionnaire are essentially similar to those previously found for other languages. These curves reflect the age dependency of auditory skills. Furthermore, in the group with cochlear implants the developmental pattern was different than that of the normal hearing group, with an initial steep increase and a later slower improvement. This trend appeared both in curves of groups and in curves of individuals (individuals whose parents completed the questionnaire at several points in time). There was a high correlation between scores on the LittlEARS^® Auditory Questionnaire and results of other audiologic tests, showing validity of results with the LittlEARS^® Auditory Questionnaire.

Conclusion

Both the Hebrew and Arabic versions of the LittlEARS^® Auditory Questionnaire were found to be reliable and valid tools for assessment of the development of auditory behavior in children up to the age of 24 months. Furthermore, the LittlEARS^® Auditory Questionnaire in both languages is useful in monitoring the progress of children with cochlear implant.     

Short-term study of the effect of speech coding strategy on the auditory performance of pre- and post-lingually deafened adults implanted with the Clarion CII®

Objective The auditory performance of cochlear implantees is linked to numerous variables, such as audiological characteristics, age and type of speech coding strategy. In recent years, many different ways of processing sounds have been developed, with possible implications for auditory performance. The purpose of this study was to evaluate the intra-individual differences of patients for speech perception tasks in quiet and in noise as a result of switching from a standard strategy [Continuous Interleaved Sampling (CIS)/Simultaneous Analog Strategy (SAS)] to Hi-Resolution (HiRes).

Material and Methods A total of 14 post-lingual adults implanted with the Clarion CII® were selected for trials. At switch-on, six patients chose a CIS strategy and eight an SAS strategy. After an average period of 9.3 months, all patients were switched over to HiRes. All patients were tested (open-set mode) with bisyllabic words and sentences, in both quiet and noise [speech/noise ratio (SNR)=+10]. Testing was carried out after an initial period with the CIS/SAS strategy and 3 months after switching over to HiRes.

Results After switch-over a significant improvement was seen for both speech in quiet (words +25.2%, sentences +10.8%) and speech in noise (words 44.8%, sentences 45.4%).

Conclusion Despite individual differences, all patients improved their performance with HiRes use, the greatest improvements being seen under unfavourable listening conditions (SNR=+10). Subjective improvements in speech discrimination and overall sound quality perception were reported even after the first week of HiRes use.     

The relationship between cortical auditory evoked potentials (CAEPs) and speech perception in children with Nurotron® cochlear implants during four years of follow-up

ObjectiveThe purpose of the current study was to evaluate the relationship between the presence or absence of cortical auditory evoked potentials (CAEPs) to speech stimuli and the performance of speech perception in Chinese pediatric recipients of the Nurotron^® cochlear implant (CI).We also wanted to determine how the CAEPs might be used as an indicator for predicting early speech perception and could provide objective evidence for clinical applications of CAEPs.Methods23 pediatric unilateral CI recipients participated in this study. 15 males 8 females, and their ages at implantation ranged from 13 to 68 months, with a mean age of 36 months. CAEPs and Mandarin Early Speech Perception (MESP) tests were used to evaluate the audibility and speech perception of these CI users. The tests were administered at the first, second, third, and fourth year after the CI surgery.ResultsAll the subjects demonstrated improvements in detection of speech sounds with CI. The percentages of participants who could detect all three stimuli were 26% (6/23) at first year, to 100% (23/23) at the fourth year post-implantation. The percentages of participants who passed the Category 6 of MESP were from 9% (2/23) at first year, to 91% (21/23) at the fourth year post-implantation. Significant correlations (p < 0.05) were found between CAEP scores and MESP at the first, second, third year after the CI surgery. The multiple regression equation for prediction of MESP categories from CAEP scores and hearing ages was MESP = 1.088 + (0.504 × CAEP score) + (0.964 × hearing ages) (F = 72.919, p < 0.001, R² = 0.621).ConclusionThe results of this study suggested that aided cortical assessment was a useful tool to evaluate the outcomes of cochlear implantation. Cortical outcomes had a significant positive relationship with the MESP, which predicted the early speech perception of CI recipients.     

Combined electric and acoustic hearing performance with Zebra® speech processor: Speech reception,place, and temporal coding evaluation

Abstract

Objective

To assess the auditory performance of Digisonic^® cochlear implant users with electric stimulation (ES) and electro-acoustic stimulation (EAS) with special attention to the processing of low-frequency temporal fine structure.

Method

Six patients implanted with a Digisonic^® SP implant and showing low-frequency residual hearing were fitted with the Zebra^® speech processor providing both electric and acoustic stimulation. Assessment consisted of monosyllabic speech identification tests in quiet and in noise at different presentation levels, and a pitch discrimination task using harmonic and disharmonic intonating complex sounds ( ). These tests investigate place and time coding through pitch discrimination. All tasks were performed with ES only and with EAS.

Results

Speech results in noise showed significant improvement with EAS when compared to ES. Whereas EAS did not yield better results in the harmonic intonation test, the improvements in the disharmonic intonation test were remarkable, suggesting better coding of pitch cues requiring phase locking.

Discussion

These results suggest that patients with residual hearing in the low-frequency range still have good phase-locking capacities, allowing them to process fine temporal information. ES relies mainly on place coding but provides poor low-frequency temporal coding, whereas EAS also provides temporal coding in the low-frequency range. Patients with residual phase-locking capacities can make use of these cues.     

Speech characteristics after articulation therapy in children with cleft palate and velopharyngeal dysfunction – A single case experimental design

ObjectiveThe aim of this study was to investigate the impact of an intensive 10-week course of articulation therapy on articulation errors in cleft lip and palate patients who have Velopharyngeal Insufficiency (VPI), non-oral and passive cleft speech characteristics.MethodsFive children with cleft palate (+/-cleft lip) with VPI and non-oral and passive cleft speech characteristics underwent 40 intensive articulation therapies over 10 weeks in a single case experimental design. The percentage of non-oral CSCs (NCSCs), passive CSCs (PCSCs), stimulable consonants (SC), correct consonants in word imitation (CCI), and correct consonants in picture naming (CCN) were captured at baseline, during intervention and in follow up phases. Visual analysis and two effect size indexes of Percentage of Nonoverlapping Data and Percentage of Improvement Rate Difference were analyzed.ResultsArticulation therapy resulted in visible decrease in NCSCs for all 5 participants across the intervention phases. Intervention was effective in changing percentage of passive CSCs in two different ways; it reduced the PCSCs in three cases and resulted in an increase in PCSCs in the other two cases. This was interpreted as intervention having changed the non-oral CSCs to consonants produced within the oral cavity but with passive characteristics affecting manner of production including weakness, nasalized plosives and nasal realizations of plosives and fricatives. Percent SC increased throughout the intervention period in all five patients. All participants demonstrated an increase in percentage of CCI and CCN suggesting an increase in the consonant inventory. Follow-up data showed that all the subjects were able to maintain their ability to articulate learned phonemes correctly even after a 4-week break from intervention.ConclusionThis single case experimental study supports the hypothesis that speech intervention in patients with VPI can result in an improvement in oral placements and passive CSCs.     

AMTAS®: Automated method for testing auditory sensitivity: II. Air conduction audiograms in children and adults

Abstract

Objective: This study was designed to evaluate an automated pure-tone audiometric procedure (AMTAS^®) for 4–8 year-old children, and a quality assessment method (QUALIND^®) that predicts the accuracy of the test. Design: Children were tested with AMTAS and conventional manual air-conduction audiometry. A group of adults was tested for comparison. Study sample: Eighty-one 4–8 year-old children and 15 adults. Most had normal hearing. Results: For most subjects (93% of adults and 91% of children) differences between AMTAS and manual thresholds were similar to differences that occur when two experienced audiologists test the same subjects. QUALIND detected the inaccurate audiograms with a sensitivity of 71% and a specificity of 91%. When inaccurate audiograms identified by QUALIND are excluded, the accuracy of AMTAS is similar to the accuracy of manual audiometry. Conclusions: AMTAS produces accurate air-conduction audiograms in a high proportion of 4–8 year-old children and adults. QUALIND successfully identified most inaccurate AMTAS audiograms. The method can decrease the cost and increase efficiency and accessibility of hearing testing.

Sumario

Objetivo: Este estudio fue diseñado para evaluar un procedimiento automatizado de evaluación audiométrica de tonos puros (AMTAS^®) para niños de 4-8 años y un método de evaluación de calidad (QUALIND?) que predice la exactitud de la prueba. Diseño: Los niños fueron evaluados con el AMTAS y con audiometría convencional manual de conducción aérea. Un grupo de adultos fue evaluado como comparación. Muestra de estudio: Ochenta y un niños de 4–8 años de edad y 15 adultos. La mayoría tenían audición normal. (“la mayoría”: COMO PUEDEN DECIR ESTO, ASI, EN UN ESTUDIO CIENTÍFICO?) Resultados: En la mayoría de los sujetos (93% de los adultos y 91% de los niños) la diferencia entre el AMTAS y los umbrales manuales fue similar a las diferencias que ocurren cuando dos audiólogos de experiencia evalúan al mismo sujeto. QUALIND detectó los audiogramas inexactos con una sensibilidad del 71% y una especificidad del 91%. Cuando se excluyen los audiogramas inexactos identificados por QUALIND, la exactitud de AMTAS es similar a la exactitud de la audiometría manual. Conclusiones: AMTAS produce audiogramas de conducción aérea exactos en una alta proporción de niños de 4–8 años de edad y en adultos. QUALIND identifica con éxito las mayor parte de los audiogramas inexactos obtenidos por AMTAS. El método puede disminuir el costo y aumentar la eficiencia y la accesibilidad para pruebas auditivas.     

Normative data of the A§E® discrimination and identification tests in preverbal children

Abstract

The A§E® is a set of suprathreshold tests for the auditory evaluation of the hearing impaired. A particular population of interest is the hearing-impaired preverbal child. This paper reports on normative data of the A§E® discrimination test in children aged 10 months and of the A§E® identification tests in children aged 2 to 4 years. Normally hearing children of these ages were tested and pass criteria were defined in such a way that 95% of the hearing infants would pass the tests. With these criteria, the A§E® discrimination test is feasible at 10 months of age and the A§E® identification test from 30 months of age. Copyright © 2006 John Wiley & Sons, Ltd.     

Complications associated with Dermabond® during head and neck surgery: MAUDE and literature review

IntroductionDermabond® is a liquid surgical sealant containing 2-octyl-cyanoacrylate that has been widely used during head and neck surgeries. This study aims to provide a summary of adverse events related to Dermabond® in head and neck procedures as reported in the MAUDE database, and to report a complete overview of all documented adverse events related to Dermabond® use in current literature.MethodsThe US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database was queried for reports of adverse events related to Dermabond® use from January 1, 2010, to February 1, 2020. Data were extracted from reports pertaining to head and neck procedures. In addition, literature review was performed from January 1970 to January 2021. Various adverse events related to Dermabond® were included in the study.ResultsWe identified 32 adverse events, from which 29 (90.6%) were patient-related events and 3 (9.4%) were operator-related events. Of the patient-related events, contact dermatitis (CD) (20 [69.0%]) was the most common, followed by wound dehiscence (4 [13.8%]). All of the operator-related events were from inadvertent cut injury (3 [100%]). Following the literature review, adverse events of Dermabond® were categorized into CD, wound dehiscence, infection, and cut injury.ConclusionDermabond® demonstrated utility in various surgical procedures including head and neck surgeries but are associated with risks. This study identified adverse events associated with Dermabond®. Further studies are needed to establish the causation of contact dermatitis in certain populations.     

Adenotonsillar hypertrophy: Does it correlate with obstructive symptoms in children?

Objective

The goal of this study is to determine the correlation of clinical symptoms of UAO (upper airway obstruction) with radiographic evaluation of adenoidal obstruction and tonsil size in children with adenotonsillar hypertrophy and to evaluate the usefullness of lateral neck radiography.

Study design

Prospective study.

Setting

Haydarpa?a Numune Research and Education Hospital, Istanbul, Turkey.

Subjects and methods

This study analyses 95 children with one or more of the symptoms of UAO. Clinical symptoms were assessed by a standardized questionnaire evaluating the severity of symptoms. All patients underwent otolaryngologic examination and their tonsil sizes were graded. 74 of 95 patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to four different methods.

Results

We did not find statistically siginificant correlation between symptom scores and radiologic measurements according to Johanneson (r = 0.072, p = 0.544, p > 0.05) and Crepeau (r = 0.034, p = 0.773, p > 0.05). The correlations between OSA score and Cohen and Konak's method and AN ratio were weak and not statistically siginificant (p = 0.133, r = 0.176; p = 0.290, r = 0.125 respectively; p > 0.05). But, we found a statistically siginificant correlation between the tonsil grade and symptom scores (r = 0.216, p = 0.036, p < 0.05).

Conclusion

Our results have demonstrated that radiologic measurements of the nasopharyngeal obstruction do not correlate with clinical symptoms of UAO, but clinical assessment of tonsil size does.     

Airway obstruction in children with cerebral palsy: Need for tracheostomy?

Objective

To examine the progress of the airway obstruction over time in children with cerebral palsy (CP) and the timing of any interventions.

Methods

The medical notes of patients with CP younger than 16 years admitted with airway obstruction to a tertiary referral Pediatric Otolaryngology Center from 2006 to 2012 were retrospectively reviewed. The gender, age of referral, co-morbidities, type of surgical intervention and age this was performed and the time interval between sequential surgeries were documented.

Results

Fifteen children with CP and airway obstruction were admitted, eight boys and seven girls with an average age of referral 8 years (range 3–13.3 years). Adenotonsillectomy was performed in 11/15 patients at a mean age of 9.1 years (range 4.5–14 years). Tracheostomy was performed in 8/15 children at an average age of 11.6 years (range 7.5–15 years). Seven out of 11 patients having undergone adenotonsillectomy, required tracheostomy after an average time interval of 1.9 years (range 0.5–3.5 years). Tracheostomy was performed in 80% of referred patients with CP older than 10 years, while surgical intervention was uncommon in children younger than 5 years. There was a statistically significant correlation between the age of the children and the performance of a tracheostomy (Pearson's correlation coefficient 0.68, p = 0.005).

Conclusions

The severity of the airway obstruction in children with CP tends to increase with age. We postulate that this increase results from worsening hypotonia of pharyngeal musculature. Children with CP and severe upper airway obstruction are likely to require tracheostomy as they grow older.     

Cochlear implantation in children with Jervell and Lange-Nielsen syndrome – a cautionary tale

Abstract

Objective and importance

Jervell and Lange-Nielsen (JLN) syndrome is a rare cause of congenital profound hearing loss associated with a prolonged QT interval on the electrocardiogram. Children presenting for cochlear implantation with this condition may be asymptomatic but are at risk of sudden death. Screening and subsequent careful management is therefore required to ensure a successful outcome. We present our experience of cochlear implantation in children with JLN syndrome, including two who died unexpectedly, and suggest a protocol for management of such cases.

Clinical presentation

Four cases of cochlear implantation in JLN syndrome are described. None had any previous cardiological family history. Two were diagnosed pre-operatively but, despite appropriate management under a cardiologist, died from cardiac arrest; the first in the perioperative period following reimplantation for infection, and the second unrelated to his cochlear implant surgery. The other two patients were diagnosed only subsequent to their implantation and continue to use their implants successfully.

Conclusion

These cases highlight the variation in presentation of JLN syndrome, and the spectrum of disease severity that exists. Our protocol stresses the importance of careful assessment and counselling of parents by an experienced implant team.     

Speech, vocabulary, and the education of children using cochlear implants: oral or total communication?

This study examines the relationship between the teaching method, oral or total communication, used at children's schools and children's consonant-production accuracy and vocabulary development over time. Children who participated in the study (N = 147) demonstrated profound sensorineural hearing loss and had used cochlear implants for between 6 months and 10 years. Educational programs that used an oral communication (OC) approach focused on the development of spoken language, whereas educational programs that used a total communication (TC) approach focused on the development of language using both signed and spoken language. Using Hierarchical Linear Modeling (HLM) we compared the consonant-production accuracy, receptive spoken vocabulary, and expressive spoken and/or signed vocabulary skills, over time, of children who were enrolled in schools that used either OC or TC approaches, while controlling for a number of variables. These variables included age at implantation, preoperative aided speech detection thresholds, type of cochlear implant device used, and whether a complete or incomplete active electrode array was implanted. The results of this study indicated that as they used their implants the children demonstrated improved consonant-production accuracy and expressive and receptive vocabulary over time, regardless of whether their school employed a TC or OC teaching method. Furthermore, there appeared to be a complex relationship among children's performance with the cochlear implant, age at implantation, and communication/teaching strategy employed by the school. Controlling for all variables, children in OC programs demonstrated, on average, superior consonant-production accuracy, with significantly greater rates of improvement in consonant-production accuracy scores over time compared to children in TC programs. However, there was no significant difference between OC and TC groups in performance or rate of growth in consonant-production accuracy when children received their implants before the age of 5 years. There was no significant difference between the OC and TC groups in receptive spoken vocabulary scores or in rate of improvement over time. However, children in the TC group achieved significantly higher receptive spoken vocabulary scores than children in the OC group if they received their implant before the age of 5 years. The TC group demonstrated superior scores and rates of growth on the expressive vocabulary measure (spoken and/or signed) when compared to the OC group if they received their implants during their preschool or early elementary school years. There was no significant difference if the children received their implants during middle elementary school. Regardless of whether children were in the OC or TC group, children who received their implants during preschool demonstrated stronger performance, on average, on all measures over time than children who received their implants during their elementary school years. The results of this study suggest that children may benefit from using cochlear implants regardless of the communication strategy/teaching approach employed by their school program and that other considerations, such as the age at which children receive implants, are more important. Implications and future research needs are discussed.