processing disorders Luciana Macedo de Resende PhD Auditory processing disorders Despite normal h earing thresholds there are auditory difficulties such as understanding ID: 914997
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Slide1
Behavioral and electrophysiological results in auditory processing disorders
Luciana Macedo de Resende PhD
Slide2Auditory processing disorders
Despite
normal hearing thresholds, there are
auditory difficulties, such as understanding speech in
noisy
environments, sound discrimination, following verbal tasks ...Present in different stages in life Diagnosis – after 8 years oldMay be related to language developmental disorders, ADHD, learning disorders, autism, ...
Slide3Auditory processing disorders
In
Brazil:Lack of epidemiological
data concerning APDRecommendation on Diagnostic
procedures
advise inclusion of behavioral and electrophysyologic audiological measures
Slide4Auditory processing assessment
Behavioral tests
Slide5Auditory processing assessment
Electrophysiological tests
Slide6Auditory processing assessment
Electrophysiological
tests
Relation to auditory development
Add
objectivity to the diagnostic processHelp defining true auditory deficits:deficits with auditory ‘origin’Measure intervention results
Slide7Auditory processing assessment
Auditory
development
Slide8Auditory processing assessmentAuditory development
Slide9Behavioral and electrophysiological results in auditory processing
disordersPurpose: describe the carachteristics
and performance of patients referenced to auditory processing assessment and associate findings to complaints and also correlate behavioral and electrophysiological findings. Context:University Hospital (Hospital das Clínicas /UFMG)Secondary and tertiary health care facilityAprox. 200
patients referred for auditory processing assessment during the study period
Slide10Behavioral and electrophysiological results in auditory processing
disordersMethods
Study design: Cross-sectional descriptive study. UFMG Ethical aproval no. 668376. Patients referenced to the audiology service for auditory processing assessment were invited to participate in the study. All patients and/or parent´s patients signed an informed consent allowing assessment results to be included in the study.
Slide11Behavioral and electrophysiological results in auditory processing
disordersMethods
Procedures: - tonal audiometry, - tympanometry and acoustic reflexes, - behavioral and electrophysiological measures. Selected behavioral procedures included dichotic tests, monaural low redundancy tests, temporal processing tests and binaural interactions tests.
Auditory brainstem response (ABR), middle latency responses (MLR) and P300 were the electrophysiological measures.
Slide12Behavioral and electrophysiological results in auditory processing
disordersMethods
Statistical analisys: - Chi square and Fisher’s exact test were used at statistical analysis to associate categorical variables, followed by Kappa’s to observe the degree of associations. T test and Mann-Whitney were also used. Variables distribution was assessed with Kolmogorov-Smirnov and a p-value of 5% was adopted
Slide13Results and discussion
Descriptive analysis: - number of patients: 159 (
43.4% female and 56.6% male) - mean age: 15,3 years old - source of referral: neurologists, speech therapists, otolaryngologists
Slide14Results and discussion
Audiometry and Immitance
results:100% with hearing thresholds within normal
limits100% with type A tympanometry 89% contra lateral acoustic
reflexes
present
11% contra lateral acoustic reflexes absent or increased
Slide15Results and discussion
Behavioral tests performance
Slide16Results and discussion
Electrophysiological tests performance
Slide17Results and discussion
Behavioral and Electrophysiological tests performanceXMain complaints
No association was found relating auditory processing assessment results and complaintsEach case presents it´s particularity, each patient has a history and background that determines varied patterns of response
Slide18Results and discussion
P300
LatencyP300 AmplitudeAuditory closure0,4520,701
Temporal ordering0,8650,006*Temporal resolution
0,94
0,805
Dichotic listening0,4450,009*Binaural interaction0,1940,074teste T (valor p ≤ 0,005)Subjects with impaired dichotic listening and temporal ordering presentedsmaller mean P300 amplitudes.
Slide19Results and discussion
teste T (valor p ≤ 0,005)
Kappa correlation: medium strength correlation between P300, MLR and temporal
ordering.Variables
RE
reflexLE reflexABRRE MLRLE MLREar effect LEar effect RElectrode effect LElectrode effect RMLRP300Auditory
closure
0,515
0,555
0,154
0,019*
0,036
*
_
_
_
_
0,003*
0,64
Temporal
ordering
0,154
0,414
0,204
0,183
0,51
0,063
0,201
0,563
0,025*
0,155
0,016*
Temporal
resolution
0,64
0,605
0,591
0,573
0,668
0,434
0,182
0,427
0,593
0,464
0,508
Dicothic
listening
0,666
0,904
0,229
0,571
0,327
0,137
0,632
0,707
0,0980,4030,016*Binaural interaction0,019*0,013*0,5240,450,3250,5350,0640,3420,4650,4380,22
*p<0,05,
Fisher´s
exact
test
or
Chi-
square
.
Slide20Results and discussion
Correlation among
behavioral and electrophysiological tests, when assessing auditory processing, adds
objectivity in intervention definition and diagnostic confirmation.Auditory processing
may
be the cause of learning and language disabilities or may be a manifestation of other conditions such as ADHD, SLI. A detailed auditory processing assessment is crucial for a successful intervention plan.
Slide21Behavioral and electrophysiological results in auditory processing
disordersConclusion
Patient´s main complaint was learning disability and behavioral results indicated most disorders in auditory temporal processing aspects and dichotic listening. Correlation was observed between behavioral and electrophysiological measures, particularly auditory closure and MLRs, temporal ordering and MLR and P300, dichotic listening and P300, binaural interaction and acoustic reflexes.Individuals with learning disabilities may present maturational delay in cortical structures related to auditory abilities assessed with behavioral and electrophysiological measures. Both measures are relevant in diagnosing auditory processing disorders and directing auditory intervention plans.
Slide22Thank you!lucianamr@medicina.ufmg.br