Deborah Moncrieff

Identification of binaural integration deficits in children with the Competing Words Subtest: standard score versus interaural asymmetry.

The Competing Words Subtest is a commonly used dichotic listening test for assessing binaural integration in children suspected of having an auditory processing disorder. In 124 children, standard scores from the subtest suggested a binaural integration deficit in 23% of the children tested. Because standard scores are derived from the combined scores of both ears during the test, children with normal performance in one ear and weak performance in the other ear may be overlooked. For these children, a measure of interaural asymmetry may be a more sensitive indicator of a binaural integration deficit. When an age-appropriate criterion for interaural asymmetry from the Competing Words Subtest was used, the incidence of a binaural integration deficit increased to 51% of the children tested. Four typical patterns of dichotic listening performance were identified based on results from the two scoring techniques.

The Effect of Decreased Audibility on MMSE Performance: A Measure Commonly Used for Diagnosing Dementia.

BACKGROUND Hearing loss and dementia are both prevalent in late adulthood. The most common test used to determine cognitive status in late adulthood, the Mini-Mental State Examination (MMSE), is presented face to face, usually in the context of the physicians office in the presence of background noise. Despite the problems of hearing loss and cognitive problems in late life, there is an absence of evidence linking hearing-related deficits to performance on the MMSE and dementia diagnoses. PURPOSE This study examined the effect of decreased audibility on performance on the MMSE. RESEARCH DESIGN A between-subjects design was implemented. Participants were randomly assigned to one of five degrees of simulated hearing loss conditions and were blinded to condition assignment. STUDY SAMPLE One hundred and twenty-five young normal-hearing participants were randomized into five conditions of varying degrees of simulated hearing loss. DATA COLLECTION AND ANALYSIS Performance on the MMSE was scored and cognitive status was categorized based on the scores. Analysis of variance with conditions as a between-subjects factor was conducted with post hoc multiple comparisons to determine the effect of audibility on performance. RESULTS Reduced audibility significantly affected performance on the MMSE in a sample of young adults, resulting in greater apparent cognitive deficits as audibility decreased. CONCLUSIONS Apparent cognitive deficits based on MMSE scores obtained in test conditions in which audibility is reduced could result in incorrectly identified cognitive loss if clinicians are not alert to hearing loss when patients are evaluated. Furthermore, health care providers should be cautious when using family report of cognitive impairment to diagnose dementia without accounting for hearing loss because the impression of family members may be based on misinterpretation of the effects of hearing loss.

Age- and Gender-Specific Normative Information from Children Assessed with a Dichotic Words Test.

BACKGROUND The most widely used assessment in the clinical auditory processing disorder (APD) battery is the dichotic listening test. New tests with normative information are helpful for assessment and cross-check of results for reliable diagnosis. PURPOSE The Dichotic Words Test was developed for use in the clinical test battery for diagnosis of APD. The test stimuli were common single syllable words matched for average root-mean-square amplitude and each pair was temporally aligned at both onset and offset. The study was conducted to collect performance results from typically developing children to create normative information for the test. RESEARCH DESIGN The study follows a cross-sectional design. STUDY SAMPLE Typically developing children (n = 416) between the ages of 5 and 12 yr were recruited from schools in the community. There were 217 males and 199 females in the study sample. Only children who passed a hearing screening were eligible to participate. DATA COLLECTION AND ANALYSIS Scores for each ear were recorded during administration of the first free recall version of the test. Ear advantages based on results recorded for left and right ears were used to measure prevalence of right, left, and no ear advantages. Results for each listeners dominant and non-dominant ears and the absolute difference between them were put into the data analysis. Results were analyzed for normality and because no results were normally distributed, all further analyses were done with nonparametric statistical tests. Normative data for dominant and non-dominant ear scores and ear advantages were determined at the 95% confidence interval through bootstrapping methods with 1,000 samples. RESULTS Children were divided into four age groups based on results in their dominant ears. Females generally performed better than males and the prevalence of a right-ear advantage was ∼60% across all children tested. Normative lower-bound cut-off scores were established for males and females within each age group for dominant and non-dominant ear scores. Normative upper-bound cut-off scores were established for males and females within each age group for ear advantage scores. CONCLUSIONS Normative information specific to age group and gender will be useful in clinical assessment for APD. Prevalence of left-ear advantage results in the sample may have been partly due to uncontrolled influences of voice-onset time in arranging the dichotic pairs.

A Nonsense Consonant-Vowel-Consonant Word Test to Assess Auditory Processing

BACKGROUND Dichotic listening (DL), or how the two ears work together as a team, is often used in the assessment of auditory processing disorders in both children and adults. Currently, the battery of dichotic tests includes stimuli containing words, digits, and nonsense consonant-vowel syllables. Single-syllable nonsense words are of particular use in assessing processing abilities because they can evaluate auditory processing without a listeners dependence on linguistic knowledge. Therefore, nonsense words may assess auditory processes independently of previous vocabulary knowledge. PURPOSE This study is designed to assess the clinical applicability and face validity of a nonsense word DL test in a young adult population. RESEARCH DESIGN This study included an experimental design to investigate the performance of young adult listeners on a Dichotic Nonsense Word (DNW) test spoken by a male and female speaker. The results were compared with one study that investigated young adult listeners performance on dichotic tests of English words. STUDY SAMPLE A total of 100 young adult participants were recruited from the School of Health and Rehabilitation Sciences at the University of Pittsburgh to participate in the study. The participants ranged in age from 20 to 30, with an average age of 23, and all participants had normal hearing. DATA COLLECTION AND ANALYSIS DL performance was measured in all participants using the Dichotic Words Test (DWT) and the newly developed DNW test. Kolmogorov-Smirnoff tests of normality were used to assess distribution of right- and left-ear scores. Criterion cutoff scores were determined for the percent correct scores in the nondominant ear and dominant ear and for ear advantage. RESULTS Scores were significantly different between the two tests in the right ear, Z = -8.258, p < 0.001, and in the left ear, Z = -8.471, p < 0.001. Scores within each test were higher for the right ear than for the left ear, and scores for both ears were significantly lower on the DNW test than for the DWT. Ear advantage scores from the DNW test were significantly larger than those obtained from the DWT. The low and high 95% criterion cutoff ranges for the DNW test were considerably wider than the 95% criterion cutoff ranges for the DWT. CONCLUSIONS Results indicate that the new DNW test may be a useful clinical tool within a test battery for evaluating auditory processing skills independent of vocabulary knowledge.