Fulya Yalçınkaya

Transient evoked otoacoustic emissions and contralateral suppressions in children with auditory listening problems.

OBJECTIVES Transient evoked otoacoustic emissions (TEOAEs) are reflections of cochlear energy produced during the processing of sound. The suppression effect identified as the decrease with the additional tone stimulator of the otoacoustic emission amplitude is use for assessing efferent auditory system function. The aim of this study is to investigate the contralateral suppression effect (CSE) of transient evoked otoacoustic emissions (TEOAEs) in children with auditory listening problems (ALPs) compared to normal hearing children. METHOD The study group (Group 1) was consisted of 12 ALP children (8 males and 4 females), aged 5-10 years, and associated with receptive and expressive language delay. The control group was consisted of (Group 2) 12 children with normal hearing levels, matched according to gender and age of TEOAEs and CSE of TEOAEs were investigated at 1.0-4.0 kHz in both groups. RESULTS For right ear, at 1.0 and 3.0 kHz, TEOAE amplitudes of the ALP group were significantly lower than the control group. At 2.0, 4.0 and 5.0 kHz of the right ear and at 1.0-5.0 kHz of the left ear, TEOAE amplitudes were found as not different between ALP and control groups. Suppression values of the ALP group were significantly lower than the control group at 1.0-2.0 kHz of the right ear and at 2.0 kHz of the left ear. At the other frequencies, there was no significant difference between the suppression values of the ALP and control groups. CONCLUSION Lower suppression values in ALP group at all frequencies (significant at 1.0-2.0 and 2.0 kHz in the right and left ears, respectively) showed that cochlear and cranial maturation of the ALP group may lower than the control group. Since the age profile in both group is similar, we thought that ages effect on this results is not important. Our results showed that children with ALP have auditory processing difficulties in noisy environment. For understanding the efferent auditory system, patients with auditory processing disorders may be evaluated by the help of background noise.

Random Gap Detection Test and Random Gap Detection Test-Expanded results in children with auditory neuropathy

OBJECTIVES In auditory neuropathy (AN) children with hearing aids (HAs) or cochlear implant (CI), the speech perception improvement may not be in a significant degree. These children may perform speech perception after a few repeats. This condition may show that these children had difficulties in receiving and processing speech sounds. If the children with AN cannot distinguish the heard tones one or two in Random Gap Detection Test (RGDT), their benefit performances between hearing aids or CI may not be significant. It is thought that the answer of this question is closely related with unique auditory processing performance of each child. The aim of the study is to investigate the RGDT and RGDT-Expanded (RGDT-EXP) performance of five children with AN. METHODS In this study, RGDT was applied to five children with auditory neuropathy between ages of 7 and 13 years (study group) (3 male, 2 female). As a control group, RGDT was applied to 10 normal hearing children who had not auditory processing problem between ages of 7 and 16 years (5 male, 5 female). In the first test, all children were applied to RGDT and RGDT-EXP. Each child responded whether he/she heard one or two tones. Their responses were taken as verbally and/or hold up one finger or two fingers. In the second test, they were applied speech discrimination test in quiet environment and in noise. Gap detection thresholds (GDTs) were detected at 500-4000 Hz; and composite GDTs (CGDTs) were found for the study and control groups. GDT/CGDT>20 ms was considered as abnormal for temporal processing disorder. RESULTS Any of the children with AN who has no HAs; with HAs; and CI, could not be able to perform RGDT. Therefore the RGDT-EXP was applied in this group. In the study group, GDTs was all over 50 ms at 500-4000 Hz; and CGDTs were all over 50 ms for all children included into the study group with AN. In control group, except child 9 (GDTs were 25 ms at 3000 and 4000Hz); and child 10 (GDT was 25 ms at 500 Hz); GDTs were all in normal limits for 500-4000 Hz for all children included into the study as control group. CGDTs were all in normal limits for the control group, except child 9 (CGDTs were 22.50, slightly higher than normal limits). In the study group with AN, mean of the GDTs was all over the normal limits; and in control group, mean of GDTs were all in normal limits. The difference between the mean GDTs of the study group was significantly higher than the control groups at all frequencies of 500-4000. In AN group, CGDT (97.5+/-9.57 ms) was significantly higher than that of the control group (10.35+/-0.65 ms). CONCLUSION We concluded that these results may only not be explained by auditory processing performance or temporal aspects of audition of each child. Their gap detection was much worse for short duration stimuli than for longer duration stimuli. The present study showed that temporal processing, auditory timing and gap detection skills of the children with AN were found as delayed in advanced degree. These findings may indicate that the AN children cannot perform temporal asynchrony. Our results may help to understand why the children with AN cannot manage the speech perception; and why they understand the speech after a few repeats.

Effects of listening ability on speaking, writing and reading skills of children who were suspected of auditory processing difficulty

OBJECTIVES The aim of this study was to investigate the effects of listening ability on speaking, writing and reading skills of children who was suspected of auditory processing difficulty (APD). METHOD This research was conducted with 67 children in 1st or 2nd grade of primary school. The first group (Group I-control) was comprised of 41 children without APD. The second group (Group II-study group) was comprised of 26 children with APD. Listening, speaking, reading and writing skills were evaluated by Observational Rating Scale (ORS) and analyzed in both groups. RESULTS Listening value of ORS in APD group was significantly lower; and, speaking, reading and writing values of ORS in APD group were significantly higher than control group (p=0.000). It was also found that, the main effect of listening skills was on speaking in normal childs, and on writing ability in children with APD. CONCLUSION It was concluded that, for school-aged children, APD can lead to or is associated with difficulties in written language.

Random gap detection test and random gap detection test-expanded: Results in children with previous language delay in early childhood

OBJECTIVES The children with difficulty in receiving sounds presented at rapid rates in speech sounds and language learning period, may have delay in speech sounds and language development due to hearing speech sounds not clearly. Auditory temporal processing (ATP) is the ability to perceive auditory signals of brief duration accurately when presented at rapid rates. ATP can be evaluated by the random gap detection test (RGDT), which detects a brief gap between two stimuli. In this study, we investigated performance of children with previous language delay (PLD), currently having disorders in more than one speech sounds, on random gap detection test (RGDT) and RGDT-expanded (RGDT-EXP) tests. METHODS 12 children (8 male, 4 female) with previous language delay (PLD) and complaint of expressing speech sounds distorted, were included into the study. They had applied language training for at least one-year period in the past and in the current time, their language development is normal. They expressed one or more speech sounds as distorted. The control group consisted of 10 normal hearing children with normal phonological development and language matched for age; and who had not PLD (5 male, 5 female). Children language levels were evaluated by Preschool Language Scale-4 test; or Clinical evaluation of language fundamentals, fourth edition (CELF-4) according to childs age. Speech sounds development was assessed by Speech Sound Development Test (SSDT). They were applied RGDT and/if necessary, RGDT-EXP. Each child responded whether he/she heard one or two tones. Their responses were taken as verbally and/or hold up one finger or two fingers. In the second test, they were applied speech discrimination test in quiet environment and in noise. Gap detection thresholds (GDTs) were detected at 500-4000 Hz; and Composite GDTs (CGDTs) were found for the study and control groups. GDT/CGDT > 20 ms was considered as abnormal for temporal processing disorder. RESULTS In the study group with PLD, mean of the GDTs were all over the normal limits; and in control group, mean of GDTs were all in normal limits. The difference between the mean GDTs of the study group were significantly higher than the control groups at all frequencies of 500-4000 Hz. In PLD group, CGDT (103.53 ± 11.63 ms) was significantly higher than that of the control group, (10.35 ± 0.65 ms) (p=0.021). CONCLUSION The children with PLD have difficulties in perception of speech sounds at a certain rate, even they have not language learning difficulties. Therefore, difficulty in distinguishing of speech sounds may cause especially receptive language development delay. We believe that perception of the speech sounds and language in a certain speed; and temporally degraded speech programmes should be incorporated into the training programme and may help to prevent delays.