RESUMEN
BACKGROUND: Pediatric central auditory processing disorder (CAPD) is frequently comorbid with other childhood disorders. However, few studies have examined the relationship between commonly used CAPD, language, and cognition tests within the same sample. PURPOSE: The present study examined the relationship between diagnostic CAPD tests and "gold standard" measures of language and cognitive ability, the Clinical Evaluation of Language Fundamentals (CELF) and the Wechsler Intelligence Scale for Children (WISC). RESEARCH DESIGN: A retrospective study. STUDY SAMPLE: Twenty-seven patients referred for CAPD testing who scored average or better on the CELF and low average or better on the WISC were initially included. Seven children who scored below the CELF and/or WISC inclusion criteria were then added to the dataset for a second analysis, yielding a sample size of 34. DATA COLLECTION AND ANALYSIS: Participants were administered a CAPD battery that included at least the following three CAPD tests: Frequency Patterns (FP), Dichotic Digits (DD), and Competing Sentences (CS). In addition, they were administered the CELF and WISC. Relationships between scores on CAPD, language (CELF), and cognition (WISC) tests were examined using correlation analysis. RESULTS: DD and FP showed significant correlations with Full Scale Intelligence Quotient, and the DD left ear and the DD interaural difference measures both showed significant correlations with working memory. However, â¼80% or more of the variance in these CAPD tests was unexplained by language and cognition measures. Language and cognition measures were more strongly correlated with each other than were the CAPD tests with any CELF or WISC scale. Additional correlations with the CAPD tests were revealed when patients who scored in the mild-moderate deficit range on the CELF and/or in the borderline low intellectual functioning range on the WISC were included in the analysis. CONCLUSIONS: While both the DD and FP tests showed significant correlations with one or more cognition measures, the majority of the variance in these CAPD measures went unexplained by cognition. Unlike DD and FP, the CS test was not correlated with cognition. Additionally, language measures were not significantly correlated with any of the CAPD tests. Our findings emphasize that the outcomes and interpretation of results vary as a function of the subject inclusion criteria that are applied for the CELF and WISC. Including participants with poorer cognition and/or language scores increased the number of significant correlations observed. For this reason, it is important that studies investigating the relationship between CAPD and other domains or disorders report the specific inclusion criteria used for all tests.
Asunto(s)
Cognición/fisiología , Trastornos del Desarrollo del Lenguaje/fisiopatología , Adolescente , Percepción Auditiva/fisiología , Niño , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/fisiopatología , Humanos , Trastornos del Desarrollo del Lenguaje/diagnóstico , Pruebas Psicológicas , Estudios RetrospectivosRESUMEN
BACKGROUND: Although central auditory processing disorder (CAPD) test battery performance has been examined in adults with neurologic lesions of the central auditory nervous system (CANS), similar data on children being referred for CAPD evaluations are sparse. PURPOSE: This study characterizes CAPD test battery performance in children using tests commonly administered to diagnose the disorder. Specifically, this study describes failure rates for various test combinations, relationships between CAPD tests used in the battery, and the influence of cognitive function on CAPD test performance and CAPD diagnosis. A comparison is also made between the performance of children with CAPD and data from patients with neurologic lesions of the CANS. RESEARCH DESIGN: A retrospective study. STUDY SAMPLE: Fifty-six pediatric patients were referred for CAPD testing. DATA COLLECTION AND ANALYSIS: Participants were administered four CAPD tests, including frequency patterns (FP), low-pass filtered speech (LPFS), dichotic digits (DD), and competing sentences (CS). In addition, they were given the Wechsler Intelligence Scale for Children (WISC). Descriptive analyses examined the failure rates of various test combinations, as well as how often children with CAPD failed certain combinations when compared with adults with CANS lesions. A principal components analysis was performed to examine interrelationships between tests. Correlations and regressions were conducted to determine the relationship between CAPD test performance and the WISC. RESULTS: Results showed that the FP and LPFS tests were most commonly failed by children with CAPD. Two-test combinations that included one or both of these two tests and excluded DD tended to be failed more often. Including the DD and CS test in a battery benefited specificity. Tests thought to measure interhemispheric transfer tended to be correlated. Compared with adult patients with neurologic lesions, children with CAPD tended to fail LPFS more frequently and DD less frequently. Both groups failed FP with relatively equal frequency. CONCLUSIONS: The two-test combination that showed the highest failure rate for children with CAPD was LPFS-FP. Comparison with adults with CANS lesions, however, suggests that the mechanisms underlying LPFS performance in children need to be better understood. The two-test combination that showed the next highest failure rates among children with CAPD and did not include LPFS was CS-FP. If it is desirable to use a dichotic measure that has a lower linguistic load than CS then DD can be substituted for CS despite the slightly lower failure rate of the DD-FP battery.
Asunto(s)
Percepción Auditiva/fisiología , Trastornos de la Percepción Auditiva/diagnóstico , Trastornos de la Percepción Auditiva/psicología , Factores de Edad , Trastornos de la Percepción Auditiva/fisiopatología , Niño , Cognición , Pruebas de Audición Dicótica , Femenino , Humanos , Masculino , Estudios Retrospectivos , Sensibilidad y Especificidad , Escalas de WechslerRESUMEN
Many individuals with central auditory nervous system (CANS) pathology/disorder report a variety of auditory symptoms with difficulty hearing in noise being one of the most common complaints (Chermak and Musiek, 1992) Interestingly, there seems to be a paucity of information in the literature on lateralized hearing loss symptoms in patients with central auditory disorders. Reported here is a case where the patient reported auditory symptoms, specifically hearing loss that was lateralized distinctly to the right ear. This ear was contralateral to a stroke that involved the left hemisphere with neural compromise limited primarily to the left Heschl's gyrus. Although the patient reported other hearing difficulties, the lateralized symptom of right-sided hearing loss seemed to be the most noticed. While the pure-tone audiogram was totally disassociated from the right ear auditory symptoms, central auditory tests revealed a marked and consistent right ear deficit, which was consistent with the site of lesion. It is rare that a relatively small lesion in Heschl's gyrus results in the perception of hearing loss so specifically localized to the right ear. It is also of interest that a patient with definite complaints of hearing loss would yield a normal, highly symmetrical pure-tone audiogram. The triad of patient symptoms, anatomy of the lesion, and central auditory test findings in this case are discussed, and theories as to possible underlying mechanisms for the patient's auditory deficits are provided.
Asunto(s)
Corteza Auditiva/patología , Enfermedades Auditivas Centrales/fisiopatología , Potenciales Evocados Auditivos del Tronco Encefálico/fisiología , Pérdida Auditiva Unilateral/fisiopatología , Accidente Cerebrovascular/complicaciones , Adulto , Afasia de Broca/etiología , Afasia de Broca/rehabilitación , Audiometría de Tonos Puros , Corteza Auditiva/fisiopatología , Enfermedades Auditivas Centrales/etiología , Enfermedades Auditivas Centrales/rehabilitación , Percepción Auditiva/fisiología , Hemorragia Cerebral/complicaciones , Pruebas de Audición Dicótica , Lateralidad Funcional , Pérdida Auditiva Unilateral/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Arteria Cerebral Media , Lóbulo Parietal , Enmascaramiento Perceptual , Reflejo Acústico/fisiología , Rehabilitación de Accidente CerebrovascularRESUMEN
Cases of central deafness are rare but they can be most informative about the function and dysfunction of the central auditory nervous system. Previous information on the anatomy, physiology, and terminology related to central deafness is reviewed and a patient with central deafness is profiled. The patient suffered bilateral cerebrovascular accidents (CVAs) compromising Heschl's gyrus and some adjacent neural tissue on both sides of the brain. At 18 months post CVAs, this patient could not understand speech presented solely through the auditory modality. Environmental sounds were perceived, but rarely recognized. Pure-tone testing revealed a severe-to-profound hearing loss bilaterally, but otoacoustic emissions, acoustic reflexes, and the auditory brainstem response were essentially within normal ranges for both ears. Middle late and late auditory potentials were compromised, yielding complex modifications of the waveforms. These findings and the compromised vascular anatomy in this case are detailed in this article.