Prognostic Value of Electrophysiological and MRI Findings for Pediatric Cochlear Implant Outcomes: A Systematic Review.

PURPOSE: Magnetic resonance imaging (MRI), electric compound action potential (eCAP), and electric auditory brainstem response (eABR) are among the routine assessments performed before and/or after cochlear implantation. The objective of this review was to systematically summarize and critically appraise existing evidence of the prognostic value of eCAP, eABR, and MRI for predicting post-cochlear implant (CI) speech perception outcomes in children, with a particular focus on the lesion site. METHOD: The present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Three electronic databases (ProQuest, PubMed, and Scopus) were searched with no restrictions on language, publication status, or year of publication. Studies on children identified with sensorineural hearing loss, auditory neuropathy spectrum disorder, cochlear nerve deficiency, or cochleovestibular nerve abnormalities reporting the relevance of eCAP, eABR, and/or MRI results to CI speech perception outcomes were included. The literature search yielded 1,887 publications. Methodological quality and strength of evidence were assessed by the Crowe Critical Appraisal Tool and the Grading of Recommendations Assessment, Development, and Evaluation tool, respectively. RESULTS: Of the 25 included studies, the relevance of eCAP, eABR, and/or MRI findings to post-CI speech perception outcomes was reported in 10, 11, and 11 studies, respectively. The studies were strongly in support of the prognostic value of eABR and MRI for CI outcomes. However, the relevance of eCAP findings to speech perception outcomes was uncertain. CONCLUSION: Despite the promising findings, caution is warranted in interpreting them due to the observational and retrospective design of the included studies, as well as the heterogeneity of the population and the limited control of confounding factors within these studies. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26169859.

Exploring the Differences Between an Immature and a Mature Human Auditory System Through Auditory Late Responses in Quiet and in Noise.

Children are disadvantaged compared to adults when they perceive speech in a noisy environment. Noise reduces their ability to extract and understand auditory information. Auditory-Evoked Late Responses (ALRs) offer insight into how the auditory system can process information in noise. This study investigated how noise, signal-to-noise ratio (SNR), and stimulus type affect ALRs in children and adults. Fifteen participants from each group with normal hearing were studied under various conditions. The findings revealed that both groups experienced delayed latencies and reduced amplitudes in noise but that children had fewer identifiable waves than adults. Babble noise had a significant impact on both groups, limiting the analysis to one condition: the /da/ stimulus at +10 dB SNR for the P1 wave. P1 amplitude was greater in quiet for children compared to adults, with no stimulus effect. Children generally exhibited longer latencies. N1 latency was longer in noise, with larger amplitudes in white noise compared to quiet for both groups. P2 latency was shorter with the verbal stimulus in quiet, with larger amplitudes in children than adults. N2 latency was shorter in quiet, with no amplitude differences between the groups. Overall, noise prolonged latencies and reduced amplitudes. Different noise types had varying impacts, with the eight-talker babble noise causing more disruption. Children's auditory system responded similarly to adults but may be more susceptible to noise. This research emphasizes the need to understand noise's impact on children's auditory development, given their exposure to noisy environments, requiring further exploration of noise parameters in children.

Predictors of cochlear implant outcomes in pediatric auditory neuropathy: A matched case-control study.

OBJECTIVES: Current evidence supports the benefits of cochlear implants (CIs) in children with hearing loss, including those with auditory neuropathy spectrum disorder (ANSD). However, there is limited evidence regarding factors that hold predictive value for intervention outcomes. DESIGN: This retrospective case-control study consisted of 66 children with CIs, including 22 with ANSD and 44 with sensorineural hearing loss (SNHL) matched on sex, age, age at CI activation, and the length of follow-up with CIs (1:2 ratio). The case and control groups were compared in the results of five open-set speech perception tests, and a Forward Linear Regression Model was used to identify factors that can predict the post-CI outcomes. RESULTS: There was no significant difference in average scores between the two groups across five outcome measures, ranging from 88.40% to 95.65%. The correlation matrix revealed that younger ages at hearing aid fitting and CI activation positively influenced improvements in speech perception test scores. Furthermore, among the variables incorporated in the regression model, the duration of follow-up with CIs, age at CI activation, and the utilization of two CIs demonstrated prognostic significance for improved post-CI speech perception outcomes. CONCLUSIONS: Children with ANSD can achieve similar open-set speech perception outcomes as children with SNHL. A longer CI follow-up, a lower age at CI activation, and the use of two CIs are predictive for optimal CI outcome.

Assessing Auditory Processing in Children with Listening Difficulties: A Pilot Study.

BACKGROUND: Auditory processing disorders (APD) may be one of the problems experienced by children with listening difficulties (LiD). The combination of auditory behavioural and electrophysiological tests could help to provide a better understanding of the abilities/disabilities of children with LiD. The current study aimed to quantify the auditory processing abilities and function in children with LiD. METHODS: Twenty children, ten with LiD (age = 8.46; SD = 1.39) and ten typically developing (TD) (age = 9.45; SD = 1.57) participated in this study. All children were evaluated with auditory processing tests as well as with attention and phonemic synthesis tasks. Electrophysiological measures were also conducted with click and speech auditory brainstem responses (ABR). RESULTS: Children with LiD performed significantly worse than TD children for most behavioural tasks, indicating shortcomings in functional auditory processing. Moreover, the click-ABR wave I amplitude was smaller, and the speech-ABR waves D and E latencies were longer for the LiD children compared to the results of TD children. No significant difference was found when evaluating neural correlates between groups. CONCLUSIONS: Combining behavioural testing with click-ABR and speech-ABR can highlight functional and neurophysiological deficiencies in children with learning and listening issues, especially at the brainstem level.

An Umbrella Review of Cochlear Implant Outcomes in Children With Auditory Neuropathy.

PURPOSE: The objective of this overview of systematic reviews (SRs; umbrella review) was to systematically summarize and critically appraise current evidence of cochlear implant (CI) outcomes in children with auditory neuropathy spectrum disorder (ANSD). METHOD: This study was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. The methodological quality and the risk of bias in the included SRs were assessed using A MeaSurement Tool to Assess systematic Reviews 2 checklist and the Risk of Bias in Systematic Reviews tool, respectively. RESULTS: According to eight included SRs, children with ANSD achieve CI outcomes (speech perception performance) similar to their peers with sensorineural hearing loss. In children with postsynaptic ANSD (cochlear nerve deficiency), cochlear nerve hypoplasia is associated with better speech recognition outcomes compared with cochlear nerve aplasia, especially in the absence of additional disabilities. Except for one study, the overall quality of the included SRs was critically low, and except for three studies, evidence of a high risk of bias was identified in other included SRs. CONCLUSIONS: Current evidence supports CI benefits for children with ANSD. To improve the quality of evidence, well-designed, prospective studies with appropriate sample sizes, using valid outcome measures, clarifying matching criteria, and taking into account the role of confounding factors are essential.

Can auditory evoked responses elicited to click and/or verbal sound identify children with or at risk of central auditory processing disorder: A scoping review.

BACKGROUND: (Central) auditory processing disorders, (C)APDs are clinically identified using behavioral tests. However, changes in attention and motivation may easily affect true identification. Although auditory electrophysiological tests, such as Auditory Brainstem Responses (ABR), are independent of most confounding cognitive factors, there is no consensus that click and/or speech-evoked ABR can be used to identify children with or at-risk of (C)APDs due to heterogeneity among studies. AIMS: This study aimed to review the possibility of using ABR evoked by click and/or speech stimuli to identify children with or at risk of (C)APDs. METHODS: The online databases of PubMed, Web of Science, Medline, Embase, and CINAHL were explored using combined keywords for all English and French articles published until April 2021. Additional gray literature was also included such as conference abstracts, dissertations, and editorials in ProQuest Dissertations. MAIN CONTRIBUTION: Thirteen papers met the eligibility criteria and were included in the scoping review. Fourteen papers were cross-sectional and two were interventional studies. Eleven papers used click stimuli to assess children with/at risk of (C)APDs, and speech stimuli were utilized in the remaining studies. Despite the diversity of the results, especially in click ABR assessments, most studies indicated increases in the wave latencies and/or decreases in the wave amplitudes of click ABR in children with/at risk of (C)APDs. The results of speech ABR assessments were more consistent, as prolongation of the transient components of speech ABR was observed in these children, while sustained components remained almost unchanged. CONCLUSIONS: Although both click and speech-evoked ABRs could be used to assess children with (C)APDs, it appears that speech-evoked ABR assessments yield more reliable findings. These findings, however, should be interpreted with caution given the heterogeneity among studies. Well-designed studies on children with confirmed (C)APDs using standard diagnostic and assessment protocols are recommended.

Long Latency Auditory Evoked Responses in the Identification of Children With Central Auditory Processing Disorders: A Scoping Review.

PURPOSE: The long latency auditory evoked responses (LLAERs), originating in the auditory cortex, are often considered a biomarker for maturity in the central auditory system and may therefore be useful in the evaluation of children with central auditory processing disorder (CAPD). However, the characteristics of the LLAERs elicited in this population have not been widely described, and clinical applications remain unclear. The goal of this scoping review was to investigate if LLAERs can be used to identify children with CAPD. METHOD: A systematic search strategy was used to identify studies that analyzed the latencies and amplitudes of P1, N1, P2, and N2 waveforms of the LLAERs. The online databases, including Embase, Web of Science, MEDLINE, PubMed, ProQuest, and CINAHL, as well as the gray literature were searched for papers published in English and French between January 1980 and May 2021. RESULTS: Seventeen papers met the eligibility criteria and were included in the study. Four papers had pre- and posttraining study designs, and the remaining studies were cross-sectional. Several studies reported significant differences in LLAERs between children with CAPD and their normal-hearing peers, and the results tended toward longer latencies and smaller amplitudes regardless of LLAER waves considered. N1 and/or N2 results were most likely to reveal significant differences between children with CAPD and normal-hearing controls and could potentially be considered a biomarker for CAPD. CONCLUSIONS: It seems that LLAER assessments, especially waves N1 and N2, might assist in better identification of CAPD children. However, considering heterogeneity in the methodology among the included studies, the results should be interpreted with caution. Well-designed studies on children with confirmed CAPD using standard diagnostic and assessment protocols are suggested.

The development of auditory functions.

Typical development and maturation of the auditory system, at both the peripheral and central levels, is essential for the acquisition of speech, language, and auditory skills. The peripheral system generally encodes three basic parameters associated with auditory stimuli-time, frequency, and intensity. These acoustic cues are subsequently processed by the central auditory structures to reach and be perceived by the cerebral cortex. Observations of the human fetal and neonatal ear indicate that the peripheral auditory system is structurally and functionally adult-like at birth. In contrast, the central auditory system exhibits progressive anatomical and physiologic changes until early adulthood. Enriched experience with sound is fundamental and critical to auditory development. The absence of early and prolonged acoustic stimulation delays neuronal maturation, affecting the central auditory nervous system, in particular, and leading to atypical development. The present chapter reviews the various stages of development of the auditory system structures, especially the embryology of the human ear, before briefly presenting the trajectories of typical development of auditory abilities from infants to school-aged children.

Event-related potentials following gaps in noise: The effects of the intensity of preceding noise.

Auditory temporal resolution is critical for the perception of speech. It is often studied using gap detection methods in which a silent period (or "gap") is inserted in a long duration auditory stimulus. When the gap is inserted in a frequently occurring standard stimulus, it elicits a negative-going event-related potential, called the deviant-related negativity (DRN). A time-efficient multi-deviant paradigm was employed in which a standard 200 ms noise burst was presented on 50% of trials and a deviant stimulus, containing a gap, on the remaining 50% of trials. Seven different deviants were constructed by inserting a gap in the centre of the standard. The duration of the seven gaps ranged from 2 to 40 ms. In different conditions, the intensity of the noise burst was either 60 or 80 dB SPL. Ten adults watched a silent video while ignoring the auditory sequence. As expected, the amplitude of the DRN increased as gap duration became longer, regardless of the intensity of the noise in which the gap occurred. The intensity of the noise burst also affected the DRN measured peak-to-peak (DRN-to-following positivity). This was reduced when the gap occurred in the lower intensity noise burst. The time efficient multi-deviant paradigm can thus be employed to determine the effects of factors known to affect gap detection: the duration of the gap, and the intensity of the sound in which the gap is inserted.

A time-efficient multi-deviant paradigm to determine the effects of gap duration on the mismatch negativity.

The insertion of a silent period (or gap) in a frequently occurring standard stimulus elicits a negative-going event-related potential (ERP), called the Deviant-Related Negativity (DRN). This is often studied using a single-deviant paradigm. To study the effects of gaps with multiple durations, a different sequence would be required for each gap. A more time-efficient multi-deviant paradigm has been developed in which stimuli of various gap widths are included in a single sequence. In the present study, 14 young adults watched a silent video while ignoring an auditory sequence. A single run of a multi-deviant sequence was presented in which 6 different rare deviants alternated with a standard stimulus. The standard was a 200-ms white noise burst. The deviants were constructed by inserting a gap in the standard. The duration of the 6 gaps ranged from 2 to 40 ms. Participants were also presented with multiple runs of single-deviant sequences. Each of the 3 deviants was run in a separate sequence. The amplitude of the DRN elicited by the deviant increased as gap duration became longer, although it did plateau for the longer duration gaps. The amplitudes of the DRNs were larger in the single-deviant paradigm than in the multi-deviant paradigm. However, the difference was only significant when the mastoid reference was used. Behavioural data showed a mean d' of 2.1 for the 5-ms gap. None of the participants were able to detect the 2-ms gap. There was no correlation between d' and the DRN amplitude. Still, the effects of gap duration on the amplitude of the DRN were similar between the single and multi-deviant sequences. This makes the multi-deviant paradigm a possible time-saving alternative to the single-deviant paradigm.

Abnormalities in cortical auditory responses in children with central auditory processing disorder.

The main objective of the present study was to identify markers of neural deficits in children with central auditory processing disorder (CAPD) by measuring latency and amplitude of the auditory cortical responses and mismatch negativity (MMN) responses. Passive oddball paradigms were used with nonverbal and verbal stimuli to record cortical auditory-evoked potentials and MMN. Twenty-three children aged 9-12 participated in the study: 10 with normal hearing acuity as well as CAPD and 13 with normal hearing without CAPD. No significant group differences were observed for P1 latency and amplitude. Children with CAPD were observed to have significant N2 latency prolongation and amplitude reduction with nonverbal and verbal stimuli compared to children without CAPD. No significant group differences were observed for the MMN conditions. Moreover, electrode position affected the results in the same manner for both groups of children. The findings of the present study suggest that the N2 response could be a marker of neural deficits in children with CAPD. N2 results suggest that maturational factors or a different mechanism could be involved in processing auditory information at the central level for these children.

Speech-evoked auditory brainstem responses in children with hearing loss.

OBJECTIVE: The main objective of the present study was to investigate subcortical auditory processing in children with sensorineural hearing loss. METHODS: Auditory Brainstem Responses (ABRs) were recorded using click and speech/da/stimuli. Twenty-five children, aged 6-14 years old, participated in the study: 13 with normal hearing acuity and 12 with sensorineural hearing loss. RESULTS: No significant differences were observed for the click-evoked ABRs between normal hearing and hearing-impaired groups. For the speech-evoked ABRs, no significant differences were found for the latencies of the following responses between the two groups: onset (V and A), transition (C), one of the steady-state wave (F), and offset (O). However, the latency of the steady-state waves (D and E) was significantly longer for the hearing-impaired compared to the normal hearing group. Furthermore, the amplitude of the offset wave O and of the envelope frequency response (EFR) of the speech-evoked ABRs was significantly larger for the hearing-impaired compared to the normal hearing group. CONCLUSIONS: Results obtained from the speech-evoked ABRs suggest that children with a mild to moderately-severe sensorineural hearing loss have a specific pattern of subcortical auditory processing. Our results show differences for the speech-evoked ABRs in normal hearing children compared to hearing-impaired children. These results add to the body of the literature on how children with hearing loss process speech at the brainstem level.

Auditory Brainstem Responses in Tinnitus: A Review of Who, How, and What?

The auditory brainstem response (ABR) in tinnitus subjects has been extensively investigated over the last decade with the hopes of finding possible abnormalities related to the pathology. Despite this effort, the use of the ABR for tinnitus diagnosis or as an outcome measure is under debate. The present study reviewed published literature on ABR and tinnitus. The authors searched PubMed, MedLine, Embase, PsycINFO, and CINAHL, and identified additional records through manually searching reference lists and gray literature. There were 4,566 articles identified through database searching and 151 additional studies through the manual search (4,717 total): 2,128 articles were removed as duplicates, and 2,567 records did not meet eligibility criteria. From the final 22 articles that were included, ABR results from 1,240 tinnitus subjects and 664 control subjects were compiled and summarized with a focus on three main areas: the participant characteristics, the methodology used, and the outcome measures of amplitude and/or latency of waves I, III, and V. The results indicate a high level of heterogeneity between the studies for all the assessed areas. Amplitude and latency differences between tinnitus and controls were not consistent between studies. Nevertheless, the longer latency and reduced amplitude of wave I for the tinnitus group with normal hearing compared to matched controls was the most consistent finding across studies. These results support the need for greater stratification of the tinnitus population and the importance of a standardized ABR method to make comparisons between studies possible.

Auditory temporal-organization abilities in school-age children with peripheral hearing loss.

PURPOSE: The objective was to assess auditory sequential organization (ASO) ability in children with and without hearing loss. METHOD: Forty children 9 to 12 years old participated in the study: 12 with sensory hearing loss (HL), 12 with central auditory processing disorder (CAPD), and 16 with normal hearing. They performed an ASO task in which they were asked to recall 2, 3, and 5 verbal and nonverbal stimuli with an interstimulus interval (ISI) of 425 ms as well as sequences of 2 elements with an ISI of 20 or 1,000 ms. RESULTS: No significant difference was found between the group of children with HL and the 2 other groups on nonverbal stimuli in all testing conditions. Regardless of ISI duration or number of elements in the sequence, children with HL had significantly fewer correct responses than children with normal hearing and children with CAPD for the verbal stimuli /ba/-/da/. Children with HL had significantly better performance than children with CAPD for the verbal a/-/da/ when the number of elements in the sequence varied. CONCLUSIONS: Children with sensory HL showed impaired ASO ability when recalling verbal /ba/-/da/. Results suggest that hearing loss can induce a specific signature when processing these verbal stimuli.

Auditory event related potentials in children with peripheral hearing loss.

OBJECTIVE: The aim of the study was to investigate the neurophysiological responses in children with hearing loss. METHODS: Cortical auditory evoked potentials and Mismatch Negativity (MMN) Responses were recorded in 40 children, 9-12 years old: 12 with hearing loss, 12 with central auditory processing disorder (CAPD) and 16 with normal hearing. Passive oddball paradigms were used with nonverbal and verbal stimuli. RESULTS: For P1, no significant group differences were observed. A significant reduction in N2 amplitude with all stimuli was observed in the group of children with hearing loss compared to the results of those with normal hearing. N2 results did not reveal any significant differences between the group of children with hearing loss and the children with CAPD. MMN amplitude indicated a trend toward larger MMN amplitude among the group of children with hearing loss compared to the value of those of children with CAPD. CONCLUSIONS: Abnormal N2 characteristics could be a manifestation of a specific signature in children with hearing loss. This cortical response could be considered as a neurophysiologic marker of central auditory processing deficits in these children. SIGNIFICANCE: Results suggest maturational delays and/or deficits in central auditory processing in children with hearing loss.

Cortical auditory evoked potentials in children with a hearing loss: a pilot study.

Objective. This study examined the patterns of neural activity in the central auditory system in children with hearing loss. Methods. Cortical potentials and mismatch responses (MMRs) were recorded from ten children aged between 9 and 10 years: five with hearing loss and five with normal hearing in passive oddball paradigms using verbal and nonverbal stimuli. Results. Results indicate a trend toward larger P1 amplitude, a significant reduction in amplitude, and latency of N2 in children with hearing loss compared to control. No significant group differences were observed for the majority of the MMRs conditions. Conclusions. Data suggest that the reduced auditory input affects the pattern of cortical-auditory-evoked potentials in children with a mild to moderately severe hearing loss. Results suggest maturational delays and/or deficits in central auditory processing in children with hearing loss, as indicated by the neurophysiological markers P1 and N2. In contrast, negative MMR data suggest that the amplification provided by the hearing aids could have allowed children with hearing loss to develop adequate discriminative abilities.

Peripheral hearing loss and auditory temporal ordering ability in children.

OBJECTIVE: The main objective of this study was to assess the influence of peripheral hearing loss (abnormal encoding of the auditory system) on auditory information processing. We examine the ability of children with and without hearing loss to correctly reproduce sequence blocks of acoustic stimuli that vary in type, number, and temporal ordering. METHODS: Twenty-six children between 8 and 12 years old, 13 with hearing loss and 13 without hearing loss, participated in the study. They performed an auditory temporal ordering task (auditory sequential organization task) by recalling two, three, and five verbal (/ba/-/da/and/a/-/da/) and nonverbal stimuli (acoustic transformation of /ba/-/da/) with a fixed interstimulus interval (ISI) of 425 ms. They also reproduced sequences of two elements with variables ISI, 20, and 1000 ms. RESULTS: Children with hearing loss had significantly lower correct responses than children with normal hearing for sequences of two, three, and five verbal stimuli with similar and complex acoustic features (/ba/-/da/), for an ISI of 425 ms. There was no significant difference in performance between children with hearing loss and their peers with normal hearing on nonverbal sequences or verbal sequences with different and complex acoustic features (/a/-/da/) when ISI was 425 ms. Furthermore, children with hearing loss performed significantly lower than their peers on the three groups of stimuli when ISI was 20 ms between two stimuli. CONCLUSION: Peripheral hearing loss can influence auditory information processing in the central auditory system.