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A cross-sectional study of speech- and language-abilities of children with normal hearing, mild fluctuating conductive hearing loss, or moderate to profound sensoneurinal hearing loss.

A total of 1528 pre-school children (mean age 4 years and 9 months), being identified as speech or language delayed, were evaluated with respect to micro-otoscopy, nose and throat pathology, hearing function, and speech-language abilities. Subjects were classified into groups of (I) constant normal hearing, (II) fluctuating conductive hearing loss and (III) bilateral moderate to profound sensorineural hearing loss requiring hearing aids. In groups II and III, severe speech and language pathologies were found more frequently than in group I. Additionally, auditory perception skills were less in group II, even if peripheral hearing function was normalized. Group III was affected more than group II, but not significantly. The results indicate that in children having speech or language delay for severals reasons, mild fluctuating hearing loss can additionally alter language acquisition, but less than in cases of moderate or profound sensoneurinal hearing loss. The need of early detection of sensoneurinal hearing loss appears widely accepted; this study demonstrates also the necessity of early diagnosis of mild fluctuating hearing loss, especially in children with speech-language delay.

Acoustic Impedance Tests↗

A retrospective study of hearing, speech and language function in children with clefts following palatoplasty and veloplasty procedures at 18-24 months of age.

Many cleft palate teams currently schedule palatoplasty and veloplasty within the child's first year of life. At Hannover Medical School, palatoplasty and veloplasty are performed at approximately 18-24 months of age. It was questioned which speech and language outcome was achieved and whether it may be influenced by: (1) type and extent of the clefts; (2) velopharyngeal inadequacy; and (3) hearing disorders. A retrospective evaluation of data collected from 1985 to 1993 was performed summarizing receptive and expressive speech and language skills of 370 children aged 4.5 years. Cleft types were unilateral cleft lip and palate (UCLP, 30.0%), bilateral cleft lip and palate (BCLP, 28.7%), cleft hard and soft palate (CP, 21.6%), cleft soft palate (cleft velum, CV, 10.8%), cleft lip and alveolus (CLA, 5.8%) and submucous clefts (SUB, 3.2%). n = 86 had constant normal hearing, and n = 284 had conductive hearing loss > 20 dB (500-4000 Hz). Severe developmental phonology errors were found in 30-50% of children with repaired cleft palate and in less than 8% of patients with CLA and SUB. Posterior compensatory misarticulation was below 15% in the groups UCLP, BCLP, CP, CV and SUB. Nasal resonance and air emission was nearly normal in CLA, but was increased in 27% to 38% of the other cleft types. Children with conductive hearing loss had significantly more and severely affected phonology, morphology, syntax, vocabulary, language comprehension, and auditory perception than normal hearing children. Findings indicated that speech and language function in CLP patients were predominantly related to the hearing status.

Articulation Disorders↗

Otoacoustic emissions and auditory brainstem responses after neonatal hyperbilirubinemia.

Severe hyperbilirubinemia often results in hearing loss. Behavioral audiometry, auditory-evoked brainstem responses (ABRs) and otoacoustic emissions (OAEs) were performed in three such patients in an attempt to localize the pathophysiology of this hearing loss. Behavioral audiometric findings in these patients (all male, 4, 15 and 25 years old) ranged from severe in the 4-year-old, moderate in the 15-year-old and slight in the 25-year-old. Where obtained, ABR wave V thresholds were elevated or ABR were absent. However, absolute and inter-wave latency measurements were not indicative of brainstem pathology. OAEs (transient and distortion product) could only be obtained in the high- or low-frequency ranges in these patients. Our findings suggest that at least some lesions producing hearing loss in severe hyperbilirubinemia are in the cochlea, especially at the outer hair cells. Finally, we found that only moderately elevated serum bilirubin levels (<20 mg/dl) may contribute to the development of sensorineural hearing loss.

Adolescent↗

Auditory and vestibular function in experimental hydrops.

Endolymphatic hydrops is the characteristic morphopathology observed at postmortem examination of temporal bones of Meniere's disease. Surgical induction of endolymphatic hydrops in the guinea pig provides a reproducible animal model for the investigation of some effects of endolymphatic hydrops on inner ear function. Episodic and incapacitating vertigo are classic features of Meniere's disease, although very limited vestibular dysfunction has ever been described for the animal model. On the other hand, the auditory deficits peculiar to Meniere's disease, including fluctuant sensitivity losses and a peak audiogram, are also observed at different stages in the development of experimental hydrops. In future studies the model is likely to provide a means of investigating osmoregulatory function of the inner ear.

Animals↗

Are text and tune of familiar songs separable by brain damage?

The recognition of text and tune in songs was examined in a music-agnosic patient and five matched controls. Listeners had to focus on one component of the song at a time (text or music) and had to decide whether the component was familiar or unfamiliar. Songs were either matched (i.e., an original familiar or an original unfamiliar song) or mismatched (a combination of a familiar component with an unfamiliar one). Normal listeners displayed response patterns that are congruent with those obtained previously in different experimental settings and which showed that text and tune are difficult to separate. Data collected in the patient, however, suggest some independence between text and music in songs. Moreover, the usual asymmetry in favor of text was much reduced when later verses were used. Overall, the results are interpreted as revealing strong association, not integration, between the musical and the verbal component of familiar songs.

Adult↗

Sleep arousal response to experimental thermal stimulation during sleep in human subjects free of pain and sleep problems.

Although the interaction between sleep and pain is generating considerable interest (NIH Technology Assessment Panel, 1996), it is still unknown if chronic pain is the cause or effect of poor sleep. To further this understanding, subjects free of pain and sleep problems need to be studied in order to assess their response to pain during sleep, defined as a behavioral and a physiological state in which sensory processing is altered. (For example, while auditory perception remains active, other sensory inputs are facilitated, attenuated, or suppressed (Velluti, 199746 degrees C) was statistically greater in the lighter sleep stage 2 (48.3%) than in the deeper stages 3&4 (27.9%). A nocifensive behavioral-motor response was associated with only 2.5% of the 351 heat pain stimuli. Two other markers of sleep quality-sleep stage shift and awakening-were not influenced by the thermal stimuli. None of the subjects demonstrated any burns in the morning following the thermal stimulations applied during sleep. We conclude that the processing of nociceptive inputs is attenuated across sleep stages.

Adult↗

Injury-induced reorganization in adult auditory cortex and its perceptual consequences.

Restricted cochlear lesions in adult animals result in a reorganization of auditory cortex such that the cortical region deprived of its normal input by the lesion is occupied by expanded representations of adjacent cochlear loci, and thus of the frequencies represented at those loci. Analogous injury-induced reorganization is seen in somatosensory, visual and motor cortices of adult animals after restricted peripheral lesions. The occurrence of such reorganization in a wide range of species (including simian primates), and across different sensory systems and forms of peripheral lesion, suggests that it would also occur in humans with similar lesions. Direct evidence in support of this suggestion is provided by a small body of functional imaging evidence in the somatosensory and auditory systems. Although such reorganization does not seem to have a compensatory function, such a profound change in the pattern of cortical activation produced by stimuli exciting peri-lesion parts of the receptor epithelium would be expected to have perceptual consequences. However, there is only limited psychophysical evidence for perceptual effects that might be attributable to injury-induced cortical reorganization, and very little direct evidence for the correlation between the perceptual phenomena and the occurrence of reorganization.

Animals↗

Chronic microstimulation in the feline ventral cochlear nucleus: physiologic and histologic effects.

This study was conducted to help to establish the feasibility of a multi-channel auditory prosthesis based on microstimulation within the human ventral cochlear nucleus, and to define the range of stimulus parameters that can be used safely with such a device. We chronically implanted activated iridium microelectrodes into the feline ventral cochlear nucleus and, beginning 80-250 days after implantation, they were pulsed for 7 h/day, on up to 21 successive days. The stimulus was charge-balanced pulses whose amplitude was modulated by a simulated human voice. The pulse rate (250 Hz/electrode) and the maximum pulse amplitude were selected as those that are likely to provide a patient with useful auditory percepts. The changes in neuronal responses during the multi-day stimulation regimens were partitioned into long-lasting, stimulation-induced depression of neuronal excitability (SIDNE), and short-acting neuronal refractivity (SANR). Both SIDNE and SANR were quantified from the changes in the growth functions of the evoked potentials recorded in the inferior colliculus. All of the stimulation regimens that we tested induced measurable SIDNE and SANR. The combined effect of SIDNE and the superimposed SANR is to depress the neuronal response near threshold, and thereby, to depress the population response over the entire amplitude range of the stimulus pulses. SIDNE and SANR may cause the greatest degradation of the performance of a clinical device at the low end of the amplitude range, and this may represent an inherent limitation of this type of spatially localized, high-rate neuronal stimulation. We determined sets of stimulus parameters which preserved most of the dynamic range of the neuronal response, when using either long (150 micros/phase) or short (40 micros/phase) stimulus pulses. Increasing the amplitude of the stimulus was relatively ineffective as a means of increasing the dynamic range of neuronal response, since the greater stimulus amplitude induced more SIDNE. All of the pulsed and unpulsed electrode sites were examined histologically, and no neuronal changes attributable to the stimulation were detected. There was some aggregation of glial cells immediately adjacent to some of the electrodes that were pulsed with the short-duration pulses, and at the highest current densities.

Animals↗

Masking by harmonic complexes in birds: behavioral thresholds and cochlear responses.

Thresholds for pure tones embedded in harmonic complexes were measured behaviorally and physiologically for three species of birds, and physiologically in gerbils. The harmonic maskers were generated using the Schroeder-phase algorithm, characterized by monotonically increasing or decreasing phase across frequency. Previous work has shown that these stimuli produce large differences in masking in humans but not budgerigars. In this study, we show that for two additional species of birds, the patterns of masking were similar to those shown for budgerigars, with masking differing only slightly for the two Schroeder-phase waveforms, and in the opposite direction from that demonstrated in humans. Amounts of masking among species corresponded qualitatively to differences in their critical ratios. Evoked potential measurements in birds and gerbils indicated responses that were consistent with the behaviorally measured thresholds in birds and humans. Results are interpreted in light of differences in frequency selectivity and cochlear temporal processing across species.

Acoustic Stimulation↗

The influence of external and internal noise on the detection of increments and decrements in the level of sinusoids.

This paper examines the influence of external and internal noise on the detection of increments and decrements in the level of sinusoidal pedestals. In experiment 1, the pedestals were presented either 18 dB above the masked threshold in broadband noise (condition 18-Masked) or 18 dB above the absolute threshold (condition 18-Abs). Pedestal frequencies were 250, 1000 or 4000 Hz, and increment/decrement durations ranged from 5 to 200 ms. For condition 18-Masked, thresholds decreased with increasing pedestal frequency, while for condition 18-Abs, thresholds did not change significantly with pedestal frequency. These results are consistent with the idea that, in condition 18-Masked, thresholds were influenced by the inherent fluctuations produced by the background noise at the output of the auditory filter centred at the pedestal frequency. These fluctuations would decrease in rate with decreasing centre frequency, and this might have a greater deleterious effect on performance. In contrast, the characteristics of the internal noise that presumably limited performance in condition 18-Abs do not appear to vary with pedestal frequency. In experiment 2, a 4000 Hz pedestal was used. It was presented either in quiet or in the presence of narrowband noise centred at 4000, or 7000 Hz, or both. The noise bandwidth ranged from 50 to 400 Hz. The increment/decrement duration ranged from 5 to 100 ms. The noise centred at 7000 Hz produced only a small deterioration in performance relative to that measured in quiet. The noise centred at 4000 Hz had a larger effect, and the effect increased with decreasing noise bandwidth. This is consistent with the idea that slow fluctuations at the output of the auditory filter impair increment and decrement detection more than rapid fluctuations. A model is proposed to account for the results, based on a simulated auditory filter, a compressive non-linearity, a sliding temporal integrator, a logarithmic transform and a template mechanism. Analysis using the model suggests that the effect of centre frequency observed in experiment 1, when background noise was present, cannot be explained entirely in terms of the fluctuations produced by the background noise at the output of the auditory filter centred at the pedestal frequency.

Acoustic Stimulation↗

Macaque thresholds for detecting increases in intensity: effects of formant structure.

Macaque monkeys, like humans, are more sensitive to differences in formant frequency than to differences in the frequency of pure tones (see Sinnott et al. (1987) J. Comp. Psychol. 94, 401-415; Pfingst (1993) J. Acoust. Soc. Am. 93, 2124-2129; Prosen et al. (1990) J. Acoust. Soc. Am. 88, 2152-2158; Sinnott et al. (1985) J. Acoust. Soc. Am. 78, 1977-1985; Sinnott and Kreiter (1991) J. Acoust. Soc. Am. 89, 2421-2429; for summary, see May et al. (1996) Aud. Neurosci. 3, 135-162). In the discrimination of formant frequency, it appears that the relevant cue for macaque monkeys is relative level differences of the component frequencies (Sommers et al. (1992) J. Acoust. Soc. Am. 91, 3499-3510). To further explore the result of Sommers et al., we trained macaque monkeys (Macaca fuscata) to report detection of a change in the spectral shape of multi-component harmonic complexes. Spectral shape changes were produced by the addition of intensity increments. When the amplitude spectrum of the comparison stimulus was modeled after the /ae/ vowel sound, thresholds for detecting a change from the comparison stimulus were lowest when intensity increments were added at spectral peaks. These results parallel previous data from human subjects, suggesting that both human and monkey subjects may process vowel spectra through simultaneous comparisons of component levels across the spectrum. When the subjects were asked to detect a change from a comparison stimulus with a flat amplitude spectrum, the subjects showed sensitivity that was relatively comparable to that of human subjects tested in other investigations (e.g. Zera et al. (1993) J. Acoust. Soc. Am. 93, 3431-3441). In additional experiments, neither increasing the dynamic range of the /ae/ spectrum nor dynamically varying the amplitude of the increment during the stimulus presentation reliably affected detection thresholds.

Animals↗

Onset and offset responses from inferior colliculus and auditory cortex to paired noisebursts: inner hair cell loss.

Thirteen adult chinchillas were anesthetized with ketamine/acepromazine and tungsten electrodes were placed in the right inferior colliculus (IC) and auditory cortex (AC). A reference electrode was implanted in the anterior cranium. Following a recovery period, AC and IC responses to left ear stimulation were obtained from unanesthetized animals resting in a passive restraint inside a sound-attenuating booth. After the first recording, the animals were injected with carboplatin (75 mg/kg). Four to five weeks later, a second recording was made. Stimuli were 50 ms duration (0 ms rise and fall time), 80 dB SPL noiseburst pairs. In one group of seven animals, the gap time varied from 1 to 64 ms. In a second group of six animals, the gap time ranged from 0.25 to 64 ms in order to determine gap threshold. The responses were amplified (10000x) and filtered from 10 to 3000 Hz. Each response was the average of 100 stimulus presentations. The dependent variables were the latency of the initial positive peak and the amplitude of the response from initial positive peak to the following negativity. Following the second recording, all animals were sacrificed, the cochleas harvested, and cochleograms were obtained by counting outer hair cells (OHCs) and inner hair cells (IHCs). For the onset response to the second noiseburst of each pair, response amplitudes decreased and latencies increased with decreasing gap time. For a 64 ms gap time, the IC response approached the latencies and amplitudes seen for the onset response to the single noiseburst or first noiseburst in the pair (herein called "baseline" values), while the AC response latency approached baseline values, but AC amplitude did not. Interestingly, the offset responses to the first noiseburst were not present at gaps of less than 8 ms, while the onset responses to the second noiseburst were typically present at gaps of 1-2 ms. Cochleograms revealed a normal (or near-normal) complement of OHCs, and IHC loss averaging roughly 30-40% in apical regions and increasing to 60-70% in more basal regions (compared to normative data). Following carboplatin, the latencies of IC onset responses were delayed by several tenths of a millisecond, with the greatest pre- versus post-carboplatin latency shift occurring at short noiseburst gaps. AC response latencies were largely unaffected by carboplatin. IC onset response amplitudes were reduced following carboplatin, while AC onset responses were similar to pre-carboplatin values. IC offset response latencies to the first noiseburst were increased post-carboplatin, while AC offset response latencies varied little from pre-carboplatin values. IC and AC offset response amplitudes to the first noiseburst were decreased post-carboplatin.

Acoustic Stimulation↗

The masking level difference in chinchilla auditory cortex. Effects of inner hair cell loss.

The purpose of the present study was to investigate responses from the unanesthetized chinchilla auditory cortex (AC) to conditions producing a masking level difference (MLD) in perceptual studies, both before and after inner hair cell (IHC) loss caused by carboplatin. Tungsten electrodes were chronically implanted in the right AC (active) and anterior cranium (common) in six adult chinchillas. Following a recovery period, AC responses were obtained from the unanesthetized animal placed in a passive restraint. Toneburst input/output functions were obtained. Tonebursts (500 Hz) ranged from 0 to 80 dB pSPL, in 10 dB steps, and were presented to the left ear, the right ear, binaural (in-phase) and binaural (out-of-phase). For the MLD series, responses to 70 dB pSPL, 500 Hz tonebursts and a continuous broadband noise (40-90 dB SPL, in 5 dB steps) were studied. Three MLD versus non-MLD conditions were obtained: SpiN0/S0N0, SLN0/SLNL, and SRN0/SRNR. Following baseline data collection, each animal was given 75 mg/kg carboplatin intraperitoneally. Four to five weeks later, the electrophysiology protocol was followed again. At 5 weeks post-carboplatin, the animals were sacrificed, the cochleas were harvested, and cochleograms (hair cell loss across cochlear place) were constructed. For all conditions, response latencies increased and amplitudes decreased with decreasing toneburst level and increasing level of masking noise. Masked AC response thresholds were higher (better) for the MLD conditions than their respective non-MLD conditions. AC response latencies across masking noise level did not appear to vary systematically across conditions. Under some conditions, the MLD conditions showed larger amplitudes than their respective non-MLD conditions for equivalent masker levels. Post-carboplatin, cochleograms showed moderate IHC loss (on average, approximately 40% loss in apex) with minimal outer hair cell loss. The differences in MLD versus non-MLD conditions in terms of masked threshold and response amplitude were often reduced post-carboplatin.

Acoustic Stimulation↗

Sharp low- and high-frequency limits on musical chord recognition.

This research is concerned with the recognition of major and minor triads in low- and high-frequency regions. Its specific aim is to determine the limitations on the frequency range within which musicians can recognize minor and major triads. Twelve subjects were tested in a task in which the stimuli were successions of minor and major triads centered on frequencies ranging from 39 to 8372 Hz. Subjects were asked to say, for each triad, if it had or did not have the characteristics of a minor or a major chord. Minor and major chords were presented in separate blocks. Results show that subjects failed to recognize minor and major triads when placed below approximately 120 Hz and above approximately 3000 Hz. Statistical analysis of results also demonstrates that the failure to recognize triads differed at the low- and high-frequency ends of this range--occurring much more abruptly at the low-frequency border. The failures at the borders, and some differences there in the identifiability of major and minor triads, may possibly be related to inadequate spatial resolution of components at the lower-frequency border and to frequency limitations on phase-locking at the higher.

Acoustic Stimulation↗

Detection of signals having expected and unexpected temporal structures.

Two experiments used a variant of the 'probe-signal' method [Greenberg and Larkin, J. Acoust. Soc. Am. 44 (1968) 1513-1523] to examine the effect of expectedness on the detection of signals having fixed frequencies but uncertain temporal structures. Expectedness was manipulated by presenting one signal on 75% of the trials and the other on only 25% of trials. Experiment 1 measured sensitivity (d') to 4000-Hz sinusoidal signals having durations of 10 ms and 295 ms. The results confirmed the finding by Wright and Dai [J. Acoust. Soc. Am. 95 (1994) 931-938] that sensitivity was poorer when the duration of the signal was unexpected. The second experiment used two signals having the same overall duration: six 10-ms 4000-Hz tone pulses with a 0-ms inter-pulse interval, and two 10-ms 4000-Hz pulses separated by 40 ms. Again, sensitivity was lower when the temporal structure of the signal was unexpected. It is argued that this finding is inconsistent with 'long time constant' models of temporal integration, but can be accounted for by assuming that subjects combine information from a number of short 'looks' at the signal, with the number and temporal location of these looks being influenced by its expected temporal structure.

Acoustic Stimulation↗

Stapes surgery and psychiatric complications.

Changes in auditory perception can cause disturbances in development and personality. This phenomenon has been studied in particular in children hearing loss or in progressive or sudden hearing loss in the adult. We present the case of a patient with psychobehavioural alterations after restoration of hearing following a small fenestra stapedectomy for bilateral otosclerosis with moderate-severe hearing impairment. The diagnosis, physiopathology and medicolegal implications are discussed.

Female↗

Language therapy for pure word deafness in children.--A case report.

A follow-up study has been made on a girl with pure word deafness, the onset of which was surmised to be when she was nearly four years old. In the present paper, a course of language therapy for the patient during the period from five years and three months to seven years and five months was presented and the advantage of the training program using written language as a communicaiton modality was described. The program has been employed for language training of deaf children in the authors' hospital. During the course of the training, improvement in comprehension and expression was noted as far as the cards with written words were concerned, but the patient continued to have limited ability in auditory perception even at the end of the training period and never regained usable language ability by speech. It was suggested that the language difficulty in this particular case was due to the lesions in the bilateral temporal lobes. We discuss the relation between prognosis of this disability and language therapy.

Aphasia↗

Neurocognitive development of children with congenital unilateral brain lesion and epilepsy.

The aim of this study was to specify the neuropsychological deficits characteristic of children with unilateral non-progressive brain lesion. In order to assess these specific functions, we used a comprehensive model of congenital hemiparesis with partial epilepsy and newly diagnosed partial epilepsy without hemiparesis. The neuropsychological examination was performed using the NEPSY test battery on 44 children aged from 4 to 9 years. The children were divided into three groups: 18 children suffering from congenital hemiparesis with chronic partial epilepsy, 12 children with newly diagnosed partial epilepsy prior to anti-epileptic treatment, and 14 healthy controls matched by sex, age, and socioeconomic status. Children with congenital hemiparesis and epilepsy had a more clearly expressed cognitive dysfunction, especially in language, visuo-perceptual and memory tasks, than children with newly diagnosed partial epilepsy. The profile of cognitive weakness appears to be diffuse and quite similar in both groups, and it did not demonstrate a clear effect of lateralization, according to the side of epileptic electroencephalogram discharges. Children within both groups are likely to have a high risk of developing attention, phonological, visuo-perceptual, and memory deficits in their life. Especially interesting and surprising was the fact that the newly diagnosed epilepsy group demonstrated impairment not only in attention, visuo-perceptual and short-term memory skills, but also in auditory perception, lexical function, and the comprehension of speech. Therefore, it is recommended that children with epilepsy would undergo neuropsychological examination in order to assess their cognitive abilities.

Attention Deficit Disorder with Hyperactivity↗