Utility of a Questionnaire Short Form for Adolescents with Listening Difficulties in Japan.

BACKGROUND: A short and easy questionnaire is needed to identify symptoms of listening difficulties (LiD) at an early stage. This study aimed to evaluate the utility of such a questionnaire for adolescents with and without LiD. METHODS: We included adolescents with and without LiD and adults without LiD in this study. We utilized a questionnaire designed for individuals with LiD, which combined the Speech, Spatial, and Quality of Hearing scales (SSQ)-12 and four additional psychological items. From this, we selected three items that exhibited the largest differences between adolescents with and without LiD. We subsequently examined the relationship between the total scores of all items and the three selected items to develop the short questionnaire. RESULTS: The responses of adolescents to the questionnaire were consistent with those of adults. The total scores from the three selected items exhibited a strong correlation with the overall questionnaire score for adolescents both with and without LiD, indicating their potential for identifying LiD symptoms. CONCLUSIONS: The wide implementation of the short questionnaire developed in this study could lead to the early detection of potential LiD symptoms and timely intervention.

Traits of Developmental Disorders in Adults With Listening Difficulties Without Diagnosis of Autism Spectrum Disorder And/or Attention-Deficit/Hyperactivity Disorder.

Background: Some individuals have a normal audiogram but have listening difficulties (LiD). As many studies have investigated the relationship between listening and developmental disorders, the traits of developmental disorders might explain the symptoms of LiD. In this study, we examined the traits of developmental disorders of adults with LiD to help clarify the cause of LiD symptoms. Methods: In total, 60 adults with LiD and 57 adults without LiD were included. Participants completed a questionnaire for the autism spectrum quotient (AQ) test, the Adult Attention-Deficit Hyperactivity Disorder Self-Rating Scale (A-ADHD), the Adolescent/Adult Sensory Profile (SP), and the severity of subjective LiD in daily life. Results: Before analysis, we excluded participants with LiD who were already diagnosed or met the criteria for autism spectrum disorder (ASD) or ADHD, and the results of the remaining 30 participants (50.0%) with LiD were analyzed. Adults with LiD showed higher scores than those without LiD in the AQ. Attention switching in the AQ and attention ability in the A-ADHD scale were correlated with the severity of LiD symptoms in everyday life. The AQ scores were also significantly correlated with subscales of the SP. Conclusions: Adults with LiD showed greater autistic traits than those without LiD; therefore, LiD symptoms are possibly related to autistic symptoms. Furthermore, adults with LiD might have attention disorder traits of both ASD and ADHD and sensory processing problems. These findings suggest that the attention problems in adults with LiD noted in previous studies might be related to these traits of developmental disorders.

Masking Effects Caused by Contralateral Distractors in Participants With Versus Without Listening Difficulties.

OBJECTIVES: To examine the effects of distractor sounds presented to the contralateral ear on speech intelligibility in patients with listening difficulties without apparent peripheral pathology and in control participants. DESIGN: This study examined and analyzed 15 control participants (age range, 22 to 30 years) without any complaints of listening difficulties and 15 patients (age range, 15 to 33 years) diagnosed as having listening difficulties without apparent peripheral pathology in the outpatient clinic of the Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital. Speech intelligibility for 50 Japanese monosyllables presented to the right ear was examined under the following three different conditions: "without contralateral sound," "with continuous white noise in the contralateral ear," and "with music stimuli in the contralateral ear." RESULTS: The results indicated the following: (1) speech intelligibility was significantly worse in the patient group with contralateral music stimuli and noise stimuli; (2) speech intelligibility was significantly worse with contralateral music stimuli than with contralateral noise stimuli in the patient group; (3) there was no significant difference in speech intelligibility among three contralateral masking conditions (without contra-stimuli, with contra-noise, and with contra-music) in the control group, although average and median values of speech intelligibility tended to be worse with contralateral music stimuli than without contralateral stimuli. CONCLUSIONS: Significantly larger masking effects due to a contralateral distractor sound observed in patients with listening difficulties without apparent peripheral pathology may suggest the possible involvement of masking mechanisms other than the energetic masking mechanism occurring in the periphery in these patients. In addition, it was also shown that the masking effect is more pronounced with real environmental sounds, that is, music with lyrics, than with continuous steady noise, which is often used as a masker for speech-in-noise testing in clinical trials. In other words, it should be noted that a speech-in-noise test using such steady noise may underestimate the degree of listening problems of patients with listening difficulties in their daily lives, and a speech-in-noise test using a masker such as music and/or speech sounds could make listening problems more obvious in patients with listening difficulties.

Effect of background noise and memory load on listening effort of young adults with and without hearing loss.

OBJECTIVE: People with hearing loss often encounter difficulties in hearing under adverse conditions, such as listening in the presence of noise. Listening effort is an indicator used to assess listening difficulties in daily life. Although many studies on listening effort have been conducted in recent years, there is a notable gap in the exploration of how task load influences listening effort in young adults. This study compared the effects of background noise and memory load on task performance and subjective listening effort in young adults with and without hearing loss. METHODS: The study included a group of 8 adults with hearing loss (mean age: 24.1 ± 6.0 years) and a group of 16 individuals with normal hearing (mean age: 27.9 ± 4.9 years). A number memorizing task was conducted, involving two types of auditory digits (either three or seven digits) presented under multi-talker babble noise conditions of signal-to-noise ratio of -5 dB [SN -5 dB] or SN +5 dB. Participants determined whether the number presented in the encoding interval matched the one presented in the retrieval interval. Subsequently, they were asked to complete a questionnaire using a Visual Analog Scale (VAS) to assess their subjective listening effort. Percentage of correct responses, reaction times, and VAS ratings were compared between adults with and without hearing loss. RESULTS: Our results showed significant differences between the two groups in the percentage of correct responses and the reaction time under the SN -5 dB conditions, regardless of the memory load. Under the SN +5 dB conditions, a significant difference was found only in the percentage of correct responses for seven digits. In the normal hearing group, the percentage of correct responses and VAS ratings tended to decrease as the memory load increased, even under the same noise condition. Conversely, in the hearing loss group, a consistent trend could not be identified in the effects of noise and memory load on the percentage of correct responses and VAS ratings. CONCLUSION: These results suggest that in conditions of high noise load, young adults with hearing loss show a higher tendency for listening effort to be affected by other loads. We confirmed that for some participants with hearing loss, the task exceeded a certain level of difficulty in the SN -5 dB and seven digits condition, leading to a change in their motivation and strategy used. Future research should examine ways to control for participants' motivations.

Survey of students and guardians for assessing the early detection of auditory processing disorder and listening difficulties in school-age students.

OBJECTIVE: Auditory processing disorders (APD) and listening difficulties (LiD) are becoming increasingly prevalent in young adults. Our study surveyed students and their guardians to assess the early detection of APD and LiDs in students aged 6-18 years. We estimated the percentage of students with LiDs and assessed their guardians' perceptions during different school years. METHODS: This prospective study enrolled students from schools affiliated with Osaka Kyoiku University and their guardians. Both students and their guardians completed a basic assessment on demographics, and a questionnaire assessing LiD (completed by both students and guardians) and developmental problems (completed only by guardians). LiD was assessed in the following four domains: (i) auditory attention, (ii) auditory memory, (iii) auditory discrimination, and (iv) auditory restoration. The relationship between the school-year group and the total score for LiD and the differences between the students' and guardians' perceptions of the association between the school-year group and LiD domains were examined. RESULTS: Respondents comprised 743 students from 120 classes at three schools and 743 guardians. Hearing loss was reported by 26.5% of students and 26.1% of their guardians, with the majority indicating slight hearing loss. Compared with the students, their guardians more commonly indicated a normal response to all the questions related to LiD. The LiD scores reported by students increased with increasing school years and significantly deviated from those reported by their guardians. The students' scores in the auditory attention and auditory memory domains demonstrated significant increase with increasing school years, with the greatest increase in the auditory attention category. CONCLUSIONS: Students reported increasing severity of LiD with increasing school years, whereas their guardians underreported such symptoms, most significantly in the later school years. Therefore, screening for symptoms related to auditory attention could aid in the early detection of APD and LiD in school-age children.

Auditory Attention Ability under Dichotic Dual-Task Situation in Adults with Listening Difficulties.

INTRODUCTION: Recent studies have reported poor cognition, such as attention and working memory, in adults with listening difficulties (LiD). However, they do not adequately describe the actual state of poor attention ability in adults with LiD. We examined the state of auditory attention in adults with and without LiD in tasks requiring multiple attention controls. METHODS: Twenty-one adults who had normal hearing but complained about LiD encountered during everyday life and 22 healthy controls were included. We presented a target detection task using an odd-ball format for one ear and a sentence repetition task for the other ear. In the target detection task, participants listened to the 1,000-Hz tone served as the standard stimulus, while they had to accept a 2,000-Hz tone presented as the deviant stimulus. In the sentence repetition task, short sentences were presented. The stimuli presented to them were played on a personal computer at the most comfortable level. The participants heard these stimuli through headphones. They were required to press a key for standard stimuli in the target detection task and repeat what they heard immediately in the repetition task. We compared the response accuracy for each ear task between adults with and without LiD. RESULTS: Our results showed that there were significant differences between the participant groups in the auditory dual-task under the dichotic listening situation. When examined individually, four adults with LiD had decreased scores in both the sentence repetition and target detection task, while the other nine participants showed a bias toward either task. Furthermore, the analysis of reaction time for pressing button revealed that the standard deviation of reaction time was extended in participants who scored poorly in either of the ear tasks. On the other hand, all adults without LiD were able to conduct the auditory dual-task exactly and promptly. CONCLUSION: The results suggest that adults with LiD have difficulties in appropriately allocating various cognitive abilities required for each task. We concluded that auditory attention is an important ability to conduct the auditory dual-task, and this is applicable for adults with LiD. Therefore, we believe that it is necessary to use auditory tests that require complex attentional abilities in listening, such as those required in daily life, to assess adults with LiD.

Temporal and Directional Cue Effects on the Cocktail Party Problem for Patients With Listening Difficulties Without Clinical Hearing Loss.

OBJECTIVES: To evaluate the listening difficulty in a cocktail party environment in the sound field in order to better demonstrate patients' difficulties listening in noise, and to examine temporal and directional cue effects on the speech intelligibility in patients with listening difficulties in noise in comparison with control subjects. DESIGN: This study examined and analyzed 16 control subjects without any complaints of listening difficulties and 16 patients who had visited the outpatient clinic of the Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, with complaints of listening difficulties, especially in background crowded conditions, despite having relatively good hearing on routine audiograms and speech audiometry. Using five loudspeakers located in front of the subject and at 30° and 60° to the left and right from the front, word intelligibility for the target voice (female talker) presented from one of the loudspeakers in random order with four distractor voices (male talker) was assessed under the following cue conditions: (1) "no additional temporal/directional cue (only talker sex as a cue)"; (2) "fixed temporal cue without directional cue" (white noise bursts [cue sounds] were presented from the five loudspeakers just before word presentation at 500-ms intervals); (3) "directional + variable temporal cues" [cue sounds were presented from the loudspeaker where the next target word would be presented with a variable inter-stimulus interval [ISI] of 500, 1000, 1500, or 2000 ms between the cue sound and word presentation); and (4) "directional + fixed temporal cues" (cue sounds were presented from the loudspeaker where the next target word would be presented with a fixed ISI of 500 ms). RESULTS: The results indicated the following: (1) word intelligibility under distractors was significantly deteriorated in patients with listening difficulties compared with control subjects, although the clinical speech in noise test using the headphone system did not show any significant differences between the two groups; (2) word intelligibility under distractors for patients with listening difficulties was significantly improved with directional cues presented in advance; and (3) under most cue conditions, individual differences in word intelligibility among patients with listening difficulties were significantly correlated with their dichotic listening ability, which is one of the indicators used to assess auditory selective attention ability. CONCLUSIONS: The results of this study indicate the usefulness of the presentation of directional cues for speech comprehension in the cocktail party situation in patients with listening difficulties, as well as the importance of evaluating the degree of listening difficulties spatially in the cocktail party situation.

Neurophysiological Evaluation of Right-Ear Advantage During Dichotic Listening.

Right-ear advantage refers to the observation that when two different speech stimuli are simultaneously presented to both ears, listeners report stimuli more correctly from the right ear than the left. It is assumed to result from prominent projection along the auditory pathways to the contralateral hemisphere and the dominance of the left auditory cortex for the perception of speech elements. Our study aimed to investigate the role of attention in the right-ear advantage. We recorded magnetoencephalography data while participants listened to pairs of Japanese two-syllable words (namely, "/ta/ /ko/" or "/i/ /ka/"). The amplitudes of the stimuli were modulated at 35 Hz in one ear and 45 Hz in the other. Such frequency-tagging allowed the selective quantification of left and right auditory cortex responses to left and right ear stimuli. Behavioral tests confirmed the right-ear advantage, with higher accuracy for stimuli presented to the right ear than to the left. The amplitude of the auditory steady-state response was larger when attending to the stimuli compared to passive listening. We detected a correlation between the attention-related increase in the amplitude of the auditory steady-state response and the laterality index of behavioral accuracy. The right-ear advantage in the free-response dichotic listening was also found in neural activities in the left auditory cortex, suggesting that it was related to the allocation of attention to both ears.

Clinical feasibility of auditory processing tests in Japanese older adults: a pilot study.

Background: Difficulty in listening comprehension is a major audiological complaint of older adults. Behavioural auditory processing tests (APTs) may evaluate it. Aims/Objectives: The aim was to assess the feasibility of administering Japanese APTs to older adults at otolaryngology clinics. Material and Methods: Using computer programs interfaced with an audiometer, APTs (dichotic listening test; fast speech test, FST; gap detection test, GDT; speech in noise test; rapidly alternating speech perception test) were administered to 20 older adults (65-84 years old; mean 75.3 years) and 20 young adults at the 40 dB sensation level. Monosyllable speech perception (MSP) and the Mini-Mental State Examination (MMSE) were evaluated. Results: APT results except for GDT were significantly correlated with MSP. The performance on each APT was worse in older adults than in young adults (p < .01). The older adults with good MSP ≥ 80% (n = 13) or excellent cognitive function (MMSE ≥ 28; n = 11) also did worse on APTs (p < .05). A ceiling effect was noted in the APT data, with FST showing a minimum ceiling effect and reflecting interindividual variations of data. Conclusions and Significance: It is feasible to administer APTs to older adults who visit otolaryngology clinics. Among our Japanese APTs, FST may be suitable for further large-scale clinical studies.

Auditory symptoms and psychological characteristics in adults with auditory processing disorders.

Most adults with auditory processing disorder (APD) often have trouble at work. It is possible that these listening problems in adults with APD influence their mental health. Thus, we have to take the subject's personality and mental status into consideration when supporting subjects with APD. However, studies on APD in adults are comparatively rare. In this study, we aimed to evaluate the relationships between the results of auditory tests, APD symptoms, and psychological status in subjects with APD. This study included 22 adults who complained of listening problems in everyday life, and they underwent auditory processing tests and were questioned regarding their psychological characteristics. From the results of the auditory processing tests, all subjects showed low scores on at least one test; therefore, they were suspected of having APD. Especially, the scores were low on the auditory memory test. Furthermore, subjects with APD show relatively similar psychological characteristics to each other. However, there was no significant relationship between the results of the auditory processing tests and psychological characteristics. We have to take notice of a subject's psychological state when they perceive their listening difficulties as a large-scale problem and feel anxious as a result. For this purpose, we should take psychological characteristics into consideration at the time of the medical examination interview before audio-psychological testing.

A novel frameshift mutation in KCNQ4 in a family with autosomal recessive non-syndromic hearing loss.

Mutation of KCNQ4 has been reported to cause autosomal dominant non-syndromic hearing loss (DFNA2A) that usually presents as progressive hearing loss starting from mild to moderate hearing loss during childhood. Here, we identified a novel KCNQ4 mutation, c.1044_1051del8, in a family with autosomal recessive non-syndromic hearing loss. The proband was homozygous for the mutation and was born to consanguineous parents; she showed severe hearing loss that was either congenital or of early childhood onset. The proband had a sister who was heterozygous for the mutation but showed normal hearing. The mutation caused a frameshift that eliminated most of the cytoplasmic C-terminus, including the A-domain, which has an important role for protein tetramerization, and the B-segment, which is a binding site for calmodulin (CaM) that regulates channel function via Ca ions. The fact that the heterozygote had normal hearing indicates that sufficient tetramerization and CaM binding sites were present to preserve a normal phenotype even when only half the proteins contained an A-domain and B-segment. On the other hand, the severe hearing loss in the homozygote suggests that complete loss of the A-domain and B-segment in the protein caused loss of function due to the failure of tetramer formation and CaM binding. This family suggests that some KCNQ4 mutations can cause autosomal recessive hearing loss with more severe phenotype in addition to autosomal dominant hearing loss with milder phenotype. This genotype-phenotype correlation is analogous to that in KCNQ1 which causes autosomal dominant hereditary long QT syndrome 1 with milder phenotype and the autosomal recessive Jervell and Lange-Nielsen syndrome 1 with more severe phenotype due to deletion of the cytoplasmic C-terminus of the potassium channel.

Binaural integration abilities in bilateral cochlear implant user.

Bilateral Cochlear implants (CIs) improved speech intelligibility, speech perception in background noise, and sound localization in quiet and noisy situations. However, it is unclear whether these advantages essentially result in binaural integration of acoustic stimuli from each ear. In this study, we investigated the effectiveness of binaural integration by bilateral CIs placement using binaural hearing tests and subjective auditory perceptual assessment. A 61-year-old bilateral CIs subject underwent the following four tests: the Japanese Hearing in Noise Test (HINT-J), the dichotic listening test (DLT), the Rapidly Alternating Speech Perception (RASP) test, and subjective auditory perceptual assessment. The HINT-J score was significantly higher for bilateral CIs than for a unilateral CI. However, DLT and the RASP test revealed contradictory results. Subjective auditory perceptual assessment revealed active and bright impressions for bilateral hearing, which were also noisy and strong compared with those for unilateral hearing. The results of this study revealed that bilateral CIs improved speech perception in background noise and an improved auditory impression, although the bilateral integration abilities were not improved. This was probably because the patient was required to combine information from the two ears into a single perception in DLT and the RASP test. More longitudinal data should be collected and analyzed in future studies to evaluate the long-term effects of bilateral CIs.

Auditory Evoked Potentials under Active and Passive Hearing Conditions in Adult Cochlear Implant Users.

OBJECTIVES: Speech perception abilities, which vary widely among cochlear implant (CI) users, are considered to be associated with the integrity of the central auditory pathways from the auditory nerve to the cortex. Therefore, auditory evoked potentials (AEPs) are used to evaluate central auditory processing, which is thought to contribute to speech perception in CI subjects. In AEPs, the P300 component reflects the cognitive ability of subjects to detect and respond to stimuli and has most frequently been used and investigated in CI subjects. Other studies have used mismatched negativity (MMN) to examine central auditory processing. It is important to compare MMN and P300 and examine the auditory processing mechanisms involved in these components. Our study therefore aimed to investigate the relationship between P300 and MMN using both active and passive hearing paradigms in CI and normal hearing (NH) subjects. METHODS: Our subjects consisted of 3 CI subjects and 3 NH subjects. An oddball paradigm was used to deliver the stimuli on both components. The frequent stimuli were 1,000-Hz tone bursts, whereas the rare stimuli were 1,500, 2,000, and 4,000-Hz. RESULTS: As the frequency contrasts increased, the P3 latencies increased in the CI subjects. However, the latency in NH subjects did not change significantly across the frequency contrast conditions. MMNs were identified for both the CI and NH subjects; the latencies in the CI subjects were longer than those in the NH subjects. However, there were no differences in the latencies of either the CI or NH subjects in the 3 frequency contrast tasks. CONCLUSION: Our results indicated that different auditory processing pathways are involved in the active and passive hearing conditions based on the P300 and MMN data and that a combination of both responses plays an important role in the comprehension of auditory processing mechanisms in CI subjects.