Diagnostic Accuracy of Established Central Auditory Processing Test Batteries in Patients with Documented Brain Lesions
The sensitivity, specificity, and efficiency of commonly used behavioral central auditory processing tests and test batteries were determined for 20 individuals with known lesions of the central auditory nervous system (CANS) and related auditory symptoms.
Twenty-nine individuals with no known neurological involvement served as the control group. Both groups were administered dichotic digits (DD), competing sentences (CS), frequency patterns (FP), and low-pass filtered speech (FS) tests.
Diagnostic indices for individual tests and test batteries comprised of two, three, or four tests were calculated both using a lax criterion in which failure on only one test in a battery led to a positive diagnosis and using a strict criterion in which failure on all tests in the battery was necessary to trigger a positive diagnosis.
The test battery providing the best balance between sensitivity and specificity varied as a function of criterion. The two-test DD-FP battery using a strict criterion demonstrated the best balance.
Limitations of particular tests, the advantages of larger test batteries to more broadly examine multiple auditory processes, the degree to which the present results can be generalized clinically to populations without known brain lesions, and other clinical considerations are discussed.
Available from: Caroline Nunes Rocha-Muniz
- "" Thus, simply incorporating speech-evoked ABR into a battery is insufficient to ensure diagnostic efficiency. Furthermore, Musiek et al. (2011) also affirm that the diagnostic test should comprise tests with demonstrated reliability, validity, sensitivity, specificity and efficiency. "
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ABSTRACT: We determined the sensitivity, specificity and efficiency of speech-evoked Auditory Brainstem Response (ABR) as a diagnostic support for Auditory Processing Disorder (APD) and specific language impairment (SLI). Speech-evoked ABRs were elicited using the five-formant syllable/da/. The waveforms V, A, C, D, E, F, and O of all groups were analyzed. The sensitivity and specificity were calculated, and receiver operating characteristic analyses were performed to determine the optimum cut-off. Seventy-five children who were native speakers of Brazilian-Portuguese participated. The participants included 25 children with APD, 25 children with SLI and 25 with typical development. Statistical analysis demonstrated a cut-off for latency values of 6.48, 7.51, 17.82, 22.33, 30.79, 39.54 and 48.00 for V, A, C, D, E, F, and O waves, respectively. The A wave exhibited superior balance for the APD group. For the SLI group, the A, D and O waves exhibited the best balance. Furthermore, when analyzing the APD and SLI groups separately, better sensitivity values were observed for the SLI group than the APD group. Speech-evoked ABR is a useful test to identify auditory processing disorders and language impairment. Furthermore, this study represented an important step forward in establishing the clinical utility of speech-evoked ABR in Brazilian Portuguese-speaking children.
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ABSTRACT: Background: Tests of auditory perception, such as those used in the assessment of central auditory processing disorders ([C]APDs), represent a domain in audiological assessment where measurement of this theoretical construct is often confounded by nonauditory abilities due to methodological shortcomings. These confounds include the effects of cognitive variables such as memory and attention and suboptimal testing paradigms, including the use of verbal reproduction as a form of response selection. We argue that these factors need to be controlled more carefully and/or modified so that their impact on tests of auditory and visual perception is only minimal. Purpose: To advocate for a stronger theoretical framework than currently exists and to suggest better methodological strategies to improve assessment of auditory processing disorders (APDs). Emphasis is placed on adaptive forced-choice psychophysical methods and the use of matched tasks in multiple sensory modalities to achieve these goals. Together, this approach has potential to improve the construct validity of the diagnosis, enhance and develop theory, and evolve into a preferred method of testing. Research Design: Examination of methods commonly used in studies of APDs. Where possible, currently used methodology is compared to contemporary psychophysical methods that emphasize computer-controlled forced-choice paradigms. Results: In many cases, the procedures used in studies of APD introduce confounding factors that could be minimized if computer-controlled forced-choice psychophysical methods were utilized. Conclusions: Ambiguities of interpretation, indeterminate diagnoses, and unwanted confounds can be avoided by minimizing memory and attentional demands on the input end and precluding the use of response-selection strategies that use complex motor processes on the output end. Advocated are the use of computer-controlled forced-choice psychophysical paradigms in combination with matched tasks in multiple sensory modalities to enhance the prospect of obtaining a valid diagnosis.
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ABSTRACT: Background: The role of the right temporal lobe in processing speech is not well understood. Although the left temporal lobe has long been recognized as critical for speech perception, there is growing evidence for right hemisphere involvement. To investigate whether the right temporal lobe is critical for auditory speech processing, we studied prospectively a normal-hearing patient who underwent consecutive right temporal lobe resections for treatment of medically intractable seizures. Purpose: To test the hypothesis that the right temporal lobe is critical for auditory speech processing. Research Design: We used a prospective, repeated-measure, single-case design. Auditory processing was evaluated using behavioral tests of speech recognition (words, sentences) under multiple listening conditions (e.g., quiet, background noise, etc.). Auditory processing of nonspeech sounds was measured by pitch pattern sequencing and environmental sound recognition tasks. Data Collection: Repeat behavioral testing was performed at four time points over a 2 yr period: before and after consecutive right temporal lobe resection surgeries. Results: Before surgery, the patient demonstrated normal speech recognition in quiet and under real-world listening conditions (background noise, filtered speech). After the initial right anterior temporal resection, speech recognition scores declined under adverse listening conditions, especially for the left ear, but remained largely within normal limits. Following resection of the right superior temporal gyrus 1 yr later, speech recognition in quiet and nonspeech sound processing (pitch patterns, environmental sounds) remained intact. However, speech recognition under adverse listening conditions was severely impaired. Conclusions: The right superior temporal gyrus appears to be critical for auditory processing of speech under real-world listening conditions.
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