Amblyaudia

Amblyaudia (amblyos- blunt; audia-hearing) is a term coined by Dr. Deborah Moncrieff from the University of Pittsburgh to characterize a specific pattern of performance from dichotic listening tests. Dichotic listening tests are widely used to assess individuals for binaural integration, a type of auditory processing skill. During the tests, individuals are asked to identify different words presented simultaneously to the two ears. Normal listeners can identify the words fairly well and show a small difference between the two ears with one ear slightly dominant over the other. For the majority of listeners, this small difference is referred to as a "right-ear advantage" because their right ear performs slightly better than their left ear. But some normal individuals produce a "left-ear advantage" during dichotic tests and others perform at equal levels in the two ears. Amblyaudia is diagnosed when the scores from the two ears are significantly different with the individual's dominant ear score much higher than the score in the non-dominant ear [1] Researchers interested in understanding the neurophysiological underpinnings of amblyaudia consider it to be a brain based hearing disorder that may be inherited or that may result from auditory deprivation during critical periods of brain development.[2] Individuals with amblyaudia have normal hearing sensitivity (in other words they hear soft sounds) but have difficulty hearing in noisy environments like restaurants or classrooms. Even in quiet environments, individuals with amblyaudia may fail to understand what they are hearing, especially if the information is new or complicated. Amblyaudia can be conceptualized as the auditory analog of the better known central visual disorder amblyopia. The term “lazy ear” has been used to describe amblyaudia although it is currently not known whether it stems from deficits in the auditory periphery (middle ear or cochlea) or from other parts of the auditory system in the brain, or both. A characteristic of amblyaudia is suppression of activity in the non-dominant auditory pathway by activity in the dominant pathway which may be genetically determined[3] and which could also be exacerbated by conditions throughout early development.

Physiology

Amblyaudia is a deficit in binaural integration of environmental information entering the auditory system. It is a disorder related to brain organization and function rather than what is typically considered a “hearing loss” (damage to the cochlea). It may be genetic or developmentally acquired or both. When animals are temporarily deprived of hearing from an early age, profound changes occur in the brain. Specifically, cell sizes in brainstem nuclei are reduced,[4][5][6][7] the configuration of brainstem dendrites are altered[8][9][10] and neurons respond in different ways to sounds presented to both the deprived and non-deprived ears[11][12][13][14] (in cases of asymmetric deprivation). This last point is particularly important for listening tasks that require inputs from two ears to perform well. There are multiple auditory functions that rely on the computation of well calibrated inputs from the two ears. Chief among these is the ability to localize sound sources and separate what we want to hear from a background of noise. In the brainstem, the auditory system compares the timing and levels of sounds between the two ears to encode the location of sound sources (sounds that originate from our right as opposed to left side are louder and arrive earlier in our right ear). This ability to separate sound sources not only helps us locate the trajectories of moving objects, but also to separate different sound sources in noisy environments.

An electrophysiologic study demonstrated that children with amblyaudia (referred to then as a "left-ear deficit") were less able to process information from their non-dominant ears when competing information is arriving at their dominant ears. The N400-P800 complex[15] showed a strong and highly correlated response from the dominant and non-dominant ears among normal children while the response from children with amblyaudia was uncorrelated and indicated an inability to separate information arriving at the non-dominant ear from the information arriving at the dominant ear. The same children also produced weaker fMRI responses from their non-dominant left ears[16] when processing dichotic material in the scanner.

Symptoms

Children with amblyaudia experience difficulties in speech perception,[17] particularly in noisy environments, sound localization,[18] and binaural unmasking[19][20][21][22][23] (using interaural cues to hear better in noise) despite having normal hearing sensitivity (as indexed through pure tone audiometry). These symptoms may lead to difficulty attending to auditory information causing many to speculate that language acquisition and academic achievement may be deleteriously affected in children with amblyaudia. A significant deficit in a child's ability to use and comprehend expressive language may be seen in children who lacked auditory stimulation throughout the critical periods of auditory system development. A child suffering from amblyaudia may have trouble in appropriate vocabulary comprehension and production and the use of past, present and future tenses. Amblyaudia has been diagnosed in many children with reported difficulties understanding and learning from listening[24][25][26] and adjudicated adolescents are at a significantly high risk for amblyaudia (Moncrieff, et al., 2013, Seminars in Hearing).

Clinical Diagnosis

A clinical diagnosis of amblyaudia is made following dichotic listening testing as part of an auditory processing evaluation. Clinicians are advised to use newly developed dichotic listening tests that provide normative cut-off scores for the listener's dominant and non-dominant ears. These are the Randomized Dichotic Digits Test [27] and the Dichotic Words Test.[28] Older dichotic listening tests that provide normative information for the right and left ears can be used to supplement these two tests for support of the diagnosis ([29]). If performance across two or more dichotic listening tests is normal in the dominant ear and significantly below normal in the non-dominant ear, a diagnosis of amblyaudia can be made.[30] The diagnosis can also be made if performance in both ears is below normal but performance in the non-dominant ear is significantly poorer, thereby resulting in an abnormally large asymmetry between the two ears. Amblyaudia is emerging as a distinct subtype of auditory processing disorder (APD).

Risk Factors

Families report the presence of amblyaudia in several individuals, suggesting that it may be genetic in nature. It is possible that abnormal auditory input during the first two years of life may increase a child’s risk for amblyaudia, although the precise relationship between deprivation timing and development of amblyaudia is still unclear. Recurrent ear infections (otitis media) are the leading cause of temporary auditory deprivation in young children.[31][32][33] During ear infection bouts, the quality of the signal that reaches the auditory regions of the brains of a subset of children with OM is degraded in both timing and magnitude.[34][35] When this degradation is asymmetric (worse in one ear than the other) the binaural cues associated with sound localization can also be degraded. Aural atresia (a closed external auditory canal) also causes temporary auditory deprivation in young children. Hearing can be restored to children with ear infections and aural atresia through surgical intervention (although ear infections will also resolve spontaneously). Nevertheless, children with histories of auditory deprivation secondary to these diseases can experience amblyaudia for years after their hearing has been restored.[19][36]

Treatments

A number of computer-based auditory training programs exist for children with generalized Auditory Processing Disorders (APD). In the visual system, it has been proven that adults with amblyopia can improve their visual acuity with targeted brain training programs (perceptual learning).[37] A focused perceptual training protocol for children with amblyaudia called Auditory Rehabilitation for Interaural Asymmetry (ARIA) was developed in 2001[38] which has been found to improve dichotic listening performance in the non-dominant ear and enhance general listening skills. ARIA is now available in a number of clinical sites in the U.S., Canada, Australia and New Zealand. It is also undergoing clinical research trials involving electrophysiologic measures and activation patterns acquired through functional magnetic resonance imaging (fMRI) techniques to further establish its efficacy to remediate amblyaudia.

See also

References

  1. ↑ Moncrieff, Keith, Abramson, & Swann (2016) Diagnosis of amblyaudia in children referred for auditory processing assessment. International journal of audiology, 55(6), 333-345.
  2. ↑ Whitton JP, Polley DB (October 2011). "Evaluating the perceptual and pathophysiological consequences of auditory deprivation in early postnatal life: a comparison of basic and clinical studies". J. Assoc. Res. Otolaryngol. 12 (5): 535–47. PMC 3173557 Freely accessible. PMID 21607783. doi:10.1007/s10162-011-0271-6.
  3. ↑ Morell RJ, Brewer CC, Ge D, et al. (August 2007). "A twin study of auditory processing indicates that dichotic listening ability is a strongly heritable trait". Hum. Genet. 122 (1): 103–11. PMID 17533509. doi:10.1007/s00439-007-0384-5.
  4. ↑ Webster DB, Webster M (July 1977). "Neonatal sound deprivation affects brain stem auditory nuclei". Arch Otolaryngol. 103 (7): 392–6. PMID 880104. doi:10.1001/archotol.1977.00780240050006.
  5. ↑ Webster DB, Webster M (1979). "Effects of neonatal conductive hearing loss on brain stem auditory nuclei". Ann. Otol. Rhinol. Laryngol. 88 (5 Pt 1): 684–8. PMID 496200.
  6. ↑ Coleman JR, O'Connor P (June 1979). "Effects of monaural and binaural sound deprivation on cell development in the anteroventral cochlear nucleus of rats". Exp. Neurol. 64 (3): 553–66. PMID 467549. doi:10.1016/0014-4886(79)90231-0.
  7. ↑ Conlee, John W.; Parks, Thomas N. (1981). "Age- and position-dependent effects of monaural acoustic deprivation in nucleus magnocellularis of the chicken". The Journal of Comparative Neurology. 202 (3): 373–384. PMID 7298905. doi:10.1002/cne.902020307.
  8. ↑ Conlee JW, Parks TN (June 1983). "Late appearance and deprivation-sensitive growth of permanent dendrites in the avian cochlear nucleus (nuc. magnocellularis)". J. Comp. Neurol. 217 (2): 216–26. PMID 6886053. doi:10.1002/cne.902170208.
  9. ↑ Gray L, Smith Z, Rubel EW (July 1982). "Developmental and experimental changes in dendritic symmetry in n. laminaris of the chick". Brain Res. 244 (2): 360–4. PMID 7116181. doi:10.1016/0006-8993(82)90098-1.
  10. ↑ Smith ZD, Gray L, Rubel EW (October 1983). "Afferent influences on brainstem auditory nuclei of the chicken: n. laminaris dendritic length following monaural conductive hearing loss". J. Comp. Neurol. 220 (2): 199–205. PMID 6315783. doi:10.1002/cne.902200207.
  11. ↑ Silverman MS, Clopton BM (November 1977). "Plasticity of binaural interaction. I. Effect of early auditory deprivation". J. Neurophysiol. 40 (6): 1266–74. PMID 925728.
  12. ↑ Clopton BM, Silverman MS (November 1977). "Plasticity of binaural interaction. II. Critical period and changes in midline response". J. Neurophysiol. 40 (6): 1275–80. PMID 925729.
  13. ↑ Moore DR, Irvine DR (March 1981). "Plasticity of binaural interaction in the cat inferior colliculus". Brain Res. 208 (1): 198–202. PMID 7470922. doi:10.1016/0006-8993(81)90632-6.
  14. ↑ Popescu MV, Polley DB (March 2010). "Monaural deprivation disrupts development of binaural selectivity in auditory midbrain and cortex". Neuron. 65 (5): 718–31. PMC 2849994 Freely accessible. PMID 20223206. doi:10.1016/j.neuron.2010.02.019.
  15. ↑ Moncrieff, DW (Jul 2004). "ERP evidence of a dichotic left-ear deficit in some dyslexic children". J Am Acad Audiol. 15: 518–34. PMID 15484601. doi:10.3766/jaaa.15.7.6.
  16. ↑ Moncrieff, D (Jan 2008). "Hemodynamic differences in children with dichotic listening deficits: preliminary results from an fMRI study during a cued listening task.". J Am Acad Audiol. 19: 33–45. PMID 18637408. doi:10.3766/jaaa.19.1.4.
  17. ↑ Miccio AW, Gallagher E, Grossman CB, Yont KM, Vernon-Feagans L (2001). "Influence of chronic otitis media on phonological acquisition". Clin Linguist Phon. 15 (1-2): 47–51. PMID 21269097. doi:10.3109/02699200109167629.
  18. ↑ Besing JM, Koehnke J (April 1995). "A test of virtual auditory localization". Ear Hear. 16 (2): 220–9. PMID 7789673. doi:10.1097/00003446-199504000-00009.
  19. 1 2 Hall JW, Grose JH, Pillsbury HC (August 1995). "Long-term effects of chronic otitis media on binaural hearing in children". Arch. Otolaryngol. Head Neck Surg. 121 (8): 847–52. PMID 7619408. doi:10.1001/archotol.1995.01890080017003.
  20. ↑ Moore DR, Hutchings ME, Meyer SE (1991). "Binaural masking level differences in children with a history of otitis media". Audiology. 30 (2): 91–101. PMID 1877902. doi:10.3109/00206099109072874.
  21. ↑ Gravel JS, Wallace IF, Ruben RJ (March 1996). "Auditory consequences of early mild hearing loss associated with otitis media". Acta Otolaryngol. 116 (2): 219–21. PMID 8725518. doi:10.3109/00016489609137827.
  22. ↑ Pillsbury HC, Grose JH, Hall JW (July 1991). "Otitis media with effusion in children. Binaural hearing before and after corrective surgery". Arch. Otolaryngol. Head Neck Surg. 117 (7): 718–23. PMID 1863436. doi:10.1001/archotol.1991.01870190030008.
  23. ↑ Hogan SC, Moore DR (June 2003). "Impaired binaural hearing in children produced by a threshold level of middle ear disease". J. Assoc. Res. Otolaryngol. 4 (2): 123–9. PMC 3202709 Freely accessible. PMID 12943367. doi:10.1007/s10162-002-3007-9.
  24. ↑ Moncrieff, DW (Sep 2002). "Interaural asymmetries revealed by dichotic listening tests in normal and dyslexic children.". J Am Acad Audiol. 13: 428–37. PMID 12371660.
  25. ↑ Moncrieff, DW (Sep 2006). "Identification of binaural integration deficits in children with the Competing Words Subtest: standard score versus interaural asymmetry.". Int J Audiol. 45: 546–54; discussion 554–8. PMID 17005498. doi:10.1080/14992020601003196.
  26. ↑ Moncrieff, DW (Feb 2008). "Dichotic listening deficits in children with dyslexia". Dyslexia. 14: 54–75. PMID 17647215. doi:10.1002/dys.344.
  27. ↑ Moncrieff, DW (Jan 2009). "Recognition of randomly presented one-, two-, and three-pair dichotic digits by children and young adults.". J Am Acad Audiol. 20: 58–70. PMID 19927683. doi:10.3766/jaaa.20.1.6.
  28. ↑ Moncrieff, D (Jul 2015). "Age- and Gender-Specific Normative Information from Children Assessed with a Dichotic Words Test.". J Am Acad Audiol. 26: 632–44. PMID 26218052. doi:10.3766/jaaa.14096.
  29. ↑ Moncrieff, Keith, Abramson, & Swann, 2016. Diagnosis of amblyaudia in children referred for auditory processing assessment. International journal of audiology, 55(6), 333-345.
  30. ↑ Moncrieff DW (July 2011). "Dichotic listening in children: age-related changes in direction and magnitude of ear advantage". Brain Cogn. 76 (2): 316–22. PMID 21530051. doi:10.1016/j.bandc.2011.03.013.
  31. ↑ Pennie RA (September 1998). "Prospective study of antibiotic prescribing for children". Can Fam Physician. 44: 1850–6. PMC 2277846 Freely accessible. PMID 9789665.
  32. ↑ Teele DW, Klein JO, Rosner B (July 1989). "Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study". J. Infect. Dis. 160 (1): 83–94. PMID 2732519. doi:10.1093/infdis/160.1.83.
  33. ↑ Freid VM, Makuc DM, Rooks RN (May 1998). "Ambulatory health care visits by children: principal diagnosis and place of visit" (PDF). Vital Health Stat 13 (137): 1–23. PMID 9631643.
  34. ↑ Owen MJ, Norcross-Nechay K, Howie VM (January 1993). "Brainstem auditory evoked potentials in young children before and after tympanostomy tube placement". Int. J. Pediatr. Otorhinolaryngol. 25 (1-3): 105–17. PMID 8436453. doi:10.1016/0165-5876(93)90014-T.
  35. ↑ Eric Lupo J, Koka K, Thornton JL, Tollin DJ (February 2011). "The effects of experimentally induced conductive hearing loss on spectral and temporal aspects of sound transmission through the ear". Hear. Res. 272 (1-2): 30–41. PMC 3073683 Freely accessible. PMID 21073935. doi:10.1016/j.heares.2010.11.003.
  36. ↑ Wilmington D, Gray L, Jahrsdoerfer R (April 1994). "Binaural processing after corrected congenital unilateral conductive hearing loss". Hear. Res. 74 (1-2): 99–114. PMID 8040103. doi:10.1016/0378-5955(94)90179-1.
  37. ↑ Levi DM, Li RW (October 2009). "Perceptual learning as a potential treatment for amblyopia: a mini-review". Vision Res. 49 (21): 2535–49. PMC 2764839 Freely accessible. PMID 19250947. doi:10.1016/j.visres.2009.02.010.
  38. ↑ Moncrieff DW, Wertz D (February 2008). "Auditory rehabilitation for interaural asymmetry: preliminary evidence of improved dichotic listening performance following intensive training". Int J Audiol. 47 (2): 84–97. PMID 18236240. doi:10.1080/14992020701770835.
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