Brainstem Auditory Physiology in Children with Listening Difficulties

Abstract

Children who have listening difficulties (LiD) despite having normal audiometry are often diagnosed as having an auditory processing disorder (APD). A lack of evidence regarding involvement of specific auditory mechanisms has limited development of effective treatments for these children. Here, we examined brainstem pathway mechanisms in children with and without defined LiD. We undertook a prospective controlled study of 132 children aged 6-14 years with normal pure tone audiometry, grouped into LiD (n=63) or Typically Developing (TD; n=69) based on scores on the Evaluation of Childrens Listening and Processing Skills (ECLiPS), a validated caregiver report. The groups were matched on age at test, sex, race, and ethnicity. Neither group had diagnoses of major neurologic disorder, intellectual disability, or brain injuries. Both groups received a test battery designed to measure receptive speech perception against distractor speech, Listening in Spatialized Noise - Sentences (LiSN-S), along with multiple neurophysiologic measures that tap afferent and efferent auditory subcortical pathways. Group analysis showed that participants with LiD performed significantly more poorly on all subtests of the LiSN-S. The LiD group had significantly steeper wideband middle ear muscle reflex (MEMR) growth functions and shorter Wave III, Wave V, and I-V interpeak latencies in their auditory brainstem responses (ABR). Across individual participants, shorter latency ABR Wave V correlated significantly with poorer parent report of LiD (ECLiPS composite). Steeper MEMR growth functions also correlated with poorer ECLiPS scores and reduced LiSN-S talker advantage. The LiD and TD groups had equivalent summating potentials, compound action potentials, envelope-following responses (EFR), and binaurally activated medial olivocochlear reflexes (MOCR). In conclusion, there was no evidence for auditory synaptopathy or lower brainstem dysfunction for LiD. Evidence for higher brainstem differences between groups showed that the LiD group had increased efferent control or central gain, with shorter ABR Wave III and V latencies and steeper MEMR growth curves. These differences were related to poorer parent report and speech perception ability.

Speech cortical activation and connectivity in typically developing children and those with listening difficulties

“…All participants had clinically normal audiometry (≤20 dB HL, bilaterally; 0.25 – 8 kHz, Fig. 1 B), tympanometry ( Hunter et al, 2021 ) and afferent auditory brainstem function ( Hunter et al, 2022 ). Participants who scored at or below the bottom 10th percentile on the total score of a caregiver checklist of everyday listening skills, the ECLiPS ( Barry et al, 2015 , Barry and Moore, 2021 , Roebuck and Barry, 2018 ), were classified as having LiD ( Fig.…”

“…In this paper we focus on the fMRI and its relationship with behavioural responses from the baseline of our longitudinal ‘SICLiD’ study examining correlates of LiD in children. Extensive analysis of ear function and behavioural responses of these children is reported elsewhere ( Hunter et al, 2021 , Hunter et al, 2022 , Petley et al, 2021 ).…”

Speech cortical activation and connectivity in typically developing children and those with listening difficulties

“…In this paper we focus on the fMRI and its relationship with behavioural responses from the baseline of our longitudinal 'SICLID' study examining correlates of LiD in children. Extensive analysis of ear function and behavioural responses of these children is reported elsewhere (Hunter et al, 2021(Hunter et al, , 2022Petley et al, 2021).…”

“…In this report we present data from the first wave of a longitudinal study investigating the audiological and cognitive abilities of children (6-13 years old; Table 1) with LiD and their typically developing peers (6-13 years old; Table 1; Petley et al, 2021). All participants had clinically normal audiometry (≤ 20 dB HL, bilaterally; 0.25 – 8 kHz, Figure 1B), tympanometry (Hunter et al, 2021) and afferent auditory brainstem function (Hunter et al, 2022). Participants who scored at or below the bottom 10 th percentile on the total score of a caregiver checklist of everyday listening skills, the ECLiPS (Barry et al, 2015; Barry & Moore, 2021; Roebuck & Barry, 2018), were classified as having LiD (Figure 1C).…”