Auditory processing and neuropsychological profiles of children with functional hearing loss.

OBJECTIVES: This paper compares structured history, auditory processing abilities and neuropsychological findings of children with functional hearing loss (FHL) to those with suspected auditory processing disorder without FHL (control). The main aim was to evaluate the value of a holistic assessment protocol for FHL used in a routine pediatric audiology clinic. The protocol incorporated a commercially available test battery for auditory processing disorder (APD), non-verbal intelligence (NVIQ) and tools to screen for common co-existing neurodevelopmental conditions such as attention deficit hyperactivity disorder (ADHD), language impairment (LI) and developmental coordination disorder (DCD). The outcome of such holistic assessment was expected to help in understanding the nature of FHL and to provide individualized support to mitigate their difficulties. METHODS: This retrospective study compared two groups, 40 children (M = 17, F = 23) in each group between seven and sixteen years of age, one group with a history of FHL and the other with suspected APD without FHL (control). The groups were matched against age, gender, hand use, diagnosis of APD or non-APD (31 with APD and 9 without APD in each group) and non-verbal intelligence. All the children were healthy English speaking children attending mainstream schools with no middle or inner ear abnormalities. Structured history was obtained from parents regarding different nonacademic and academic concerns. The SCAN-3:C and SCAN-3:A test batteries were used to assess auditory processing abilities; Lucid Ability test for NVIQ; Children's Communication Checklist-2 (CCC-2) for language ability; Swanson Nolan and Pelham-IV Rating Scale (SNAP-IV) for ADHD; and the manual dexterity components of the Movement Assessment Battery for Children-2 (MABC-2) as a screening tool for DCD. RESULTS: About 60% of children in both the groups had concerns regarding listening in noisy background. In the history, poor attention was reported in 45% of children in the FHL group compared to 82.5% in the control group (p < 0.01). Hyperacusis was present in 35% of children in the FHL group and in 62% of children in the control group (p < 0.05). Concerns about overall academic abilities were present in 59% of children in the FHL group and 75% of the controls (p > 0.05). Only 15% of children in the FHL group had concerns with numeracy skills in contrast to 41% of the controls (p < 0.05). Significantly fewer (p < 0.01) children in the FHL group (41%) received additional support at school than the controls (75%). Fewer children performed poorly in Filtered Words (FW) test of the SCAN-3 batteries, 30% in the FHL group and 17.5% in the control group, in contrast to Auditory Figure Ground 0 (AFG0), 85% in FHL and 80% in the control group. The number of children performing poorly in AFG0 was significantly higher compared to all the other SCAN-3 tests in FHL (P < 0.05), in contrast to FW and Competing Sentences (CS) only in the control group (p < 0.05). The control group had higher prevalence of atypical ear advantage (AEA) in left directed Competing Words (CW) (32.5%) and Time Compressed Sentences (TCS) (32.5%) compared to FW (7.5%). In contrast, FHL group had higher prevalence of AEA in AFG0 (48.7%) compared to CS (21%). High proportions of children in both the groups had LI (80% in FHL and 82.5% in the control group), with significantly lower (p < 0.05) levels of ADHD symptoms in the FHL group (39.5%) compared to the control group (72.5%). Impaired manual dexterity was present in 30.7% of children in FHL group and 47.5% in the controls. CONCLUSIONS: The prevalences of APD and language impairment are high compared to ADHD symptoms in children with FHL, and holistic assessment is recommended. Despite some similarities in the auditory and neuropsychological profiles between children with FHL and those with suspected APD without FHL some differences were noted. The results suggest that children with FHL have genuine difficulties that need to be identified and addressed. Future research is required to identify the neural pathways which could explain the similarities and dissimilarities between the two groups.

Evaluación y diagnóstico del deterioro cognitivo leve / Evaluation and diagnosis of mild cognitive impairment

El deterioro cognitivo leve o ligero (DCL) es la disminución mantenida de las funciones cognitivas que no es suficientemente severa como para ser considerada una demencia. Actualmente el DCL está infradiagnosticado y el reto supone detectarlo en la fase prodrómica dado que es un proceso que con frecuencia evoluciona a la enfermedad de Alzheimer (EA). Los nuevos criterios de diagnóstico del DCL incluyen biomarcadores, pero, en la práctica diaria, la historia clínica y la evaluación de diversas esferas, sobre todo la neuropsicológica, siguen siendo las herramientas más eficaces. El paciente suele acudir a consulta con quejas de memoria aunque a veces es llevado por los familiares que observan olvidos importantes. El primer paso es detectar que haya deterioro cognitivo con pruebas de cribaje entre las que se encuentran el MMSE o el Test 7 Minutos. Para confirmar la sospecha se completa la evaluación por áreas, sobre todo la memoria, o empleando baterías especiales para deterioro cognitivo y/o demencia. Es preciso evaluar las capacidades funcionales mediante escalas de valoración de las actividades de la vida diaria y explorar los síntomas neurológicos y psiquiátricos. También se realizan pruebas complementarias para descartar posibles causas de deterioro cognitivo reversible. Un diagnóstico precoz del DCL nos permitirá poner en marcha cuanto antes terapias no farmacológicas y en breve, terapias farmacológicas, así como enlentecer el desarrollo del deterioro cognitivo (AU)

Mild cognitive impairment (MCI) is a sustained decrease of cognitive functions that is insufficiently severe to warrant a diagnosis of dementia. Currently, MCI is underdiagnosed. Since MCI often progresses to Alzheimer's disease, the challenge is to identify this process in the prodromal phase. New diagnostic criteria include the use of biomarkers. However, in daily practice, clinical history and the assessment of diverse areas, mainly neuropsychological, remain the most effective tools. The patient usually attends consultations with memory complaints, but is sometimes brought by relatives who observe substantial memory failures. The first step is to detect that there is cognitive impairment with screening tests such as the Mini Mental State Examination or the Seven Minute Test. To confirm suspicion, the evaluation is completed by assessing cognitive areas, especially memory, or by using specific batteries for cognitive deterioration and/or dementia. Complex functional tasks should be evaluated through scales of activities of daily living. Neurological and psychiatric symptoms should also be assessed. Additional studies (laboratory tests) are used to exclude reversible causes of cognitive impairment. Early diagnosis of MCI allows non-pharmacological therapies and, shortly, pharmacological treatments to be started as early as possible, thus slowing the development of cognitive deterioration (AU)

Pseudohypacusis: the most frequent etiology of sudden hearing loss in children.

Sudden hearing loss is a rare pathology in children. Several factors may be responsible for it although the exact etiology remains frequently undiagnosed. Among them, pseudohypacusis has been reported. However, the extent to which this pathology contributes to sudden hearing loss in children is unknown. This study evaluates the incidence of pseudohypacusis in children presented with sudden hearing loss. The medical records of 48 children presented to our department because of sudden hearing loss from 2002 to 2007 were reviewed. Diagnostic process included both subjective and objective audiological tests while organic hearing losses were further subjected to proper evaluation and treatment. 26 cases (54%) of pseudohypacusis and 22 cases (46%) of organic sudden hearing loss were diagnosed. In the pseudohypacustic group, girls outnumbered boys (16:10) and their mean age was 10.5 years. Pseudohypacusis represents the most frequent etiology of sudden hearing loss in children. Its detection is relatively simple using conventional audiological tests though in some cases even experienced clinicians may come to incorrect diagnosis.

Sordera en el anciano / Hearing loss in the elderly

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Diminished auditory mismatch fields in dyslexic adults.

Electroencephalographic studies have demonstrated smaller auditory responses to infrequent deviances of speech and nonspeech sounds in dyslexic than normal-reading subjects. We used a whole-scalp neuromagnetometer to study selectively reactivity of the auditory cortices to sound deviances in 8 dyslexic and 11 normal-reading adults. Within a monotonous sequence of 50-millisecond 1000 Hz binaural tones, tones of 920 and 1080 Hz occurred with 7% probability each. Magnetic mismatch fields, elicited by the stimulus deviances, were diminished in the left hemisphere of the dyslexic subjects. The results indicate deficient change detection in the left auditory cortex of right-handed dyslexic adults.

Effects of otitis on hearing in dogs characterised by brainstem auditory evoked response testing.

Hearing function was measured in normal dogs and in dogs with otitis using brainstem auditory evoked response testing. Data were obtained from 86 normal ears and from 105 ears with otitis, categorised into four degrees of severity. The data were analysed to illustrate the differences between the hearing function in the normal and abnormal ears and to estimate the degree of impairment associated with differing degrees of pathology. While severe hearing loss seemed to be present in the dogs with more severe otitis, only two individuals were identified as being totally deaf in the affected ears and no dogs were identified in which the cleaning and examination processes had caused damage to hearing function. Cleaning the ear canal produced measurable improvements in hearing in several dogs, indicating the profound effect of physical obstruction of the external ear canal by debris. It is concluded that most dogs with chronic otitis externa are not totally deaf and that the hearing impairment that does occur has the characteristics of conductive hearing loss.

Evaluation and treatment of congenital facial paralysis.

An approach to the evaluation and the preferred methods of treatment of congenital facial paralysis is presented. The expected results from testing procedures and the limitations of their usefulness in acquired v developmental palsies are discussed. We recommend that the auditory brain-stem response test be included in the initial evaluation of patients with congenital facial paralysis.