Auditory processing and perception disorders

from Wikipedia, the free encyclopedia
Classification according to ICD-10
F80.20 Auditory processing and perception disorders (AVWS)
ICD-10 online (WHO version 2019)

The term auditory processing and perception disorders (AVWS) is used to describe hearing impairments that do not result in a reduction in peripheral hearing, i.e. H. of the hearing organ itself. The term auditory processing and perception disorders (AVWS) was introduced in 2000 in a consensus statement by the German Society for Phoniatry and Pediatric Audiology (DGPP) . It is based on the Anglo-Saxon terminology of the Auditory Processing Disorder (APD) or Central Auditory Processing Disorder [(C) APD]. The auditory processing and perception of sound signalstakes place following the sound recording by the hearing organ. The term AVWS encompasses the preconscious processes of processing ( brain stem level ) as well as the perception (higher auditory functions including cognitive functions) of these neural impulses. In the current consensus paper of the DGPP, AVWS are defined as follows: “An auditory processing and / or perception disorder (AVWS) is present if central hearing processes are disturbed in a normal tone audiogram . Central processes of hearing enable u. a. the preconscious and conscious analysis, differentiation and identification of time, frequency and intensity changes of acoustic or auditory language signals as well as processes of binaural ('two-eared') interaction (e.g. for noise localization, lateralization, noise removal, summation) and dichotic processing. "

Definition of terms

The auditory processing and perception of sound stimuli includes various auditory partial services that can be affected in different combinations and to different degrees in AVWS. In order to be able to diagnose an AVWS, at least two auditory sub-performance areas must be clearly affected (with significant deviations from the norm).

  1. Sound localization: The sound localization takes place through the cooperation of both ears by evaluating time and level differences between the two ears in the auditory path . If sound hits the head from the side rather than the frontal one, it absorbs part of the sound energy so that the ear facing away from it receives the sound with a minimal difference in time and volume. This enables the localization of a sound event and prepares the understanding in noise situations or in conversations with several people (pre-processing).
  2. Auditory selection: The filtering of speech signals from competing noises and in conversations with several people is understood as a complex service of the central auditory system. This performance is often referred to as the “ cocktail party effect ”.
  3. Auditory separation ( dichotic hearing ): The auditory separation makes it possible to process different sound signals arriving in both ears at the same time in the auditory path independently of one another, e.g. B. two different words. This function is also seen as a complex performance of the auditory system and the corpus callosum (the bar) is supposed to convey this performance.
  4. Auditory differentiation: This is understood to mean the ability to differentiate between similar sounding sound events (e.g. differences in pitch or level). The term Phonemdifferenzierung (syn. Auditory discrimination, sound discrimination) means the corresponding ability related to different speech sounds such. B. the sounds / d / and / t /. The degree of difficulty of the task is determined by the position of the sound pairings in the so-called contrast hierarchy. In children with AVWS, limitations in the differentiation of very similar sounding speech sounds are most often found, e.g. B. / d / and / t / (a ​​voiced-unvoiced contrast). The person with normal hearing distinguishes the consonant - vowel combinations / da / and / ta / only by perceiving the voice-onset-time, i.e. H. the presence of an acoustic space (English gap ) between the plosive and the vowel. The auditory pathway must therefore be able to evaluate such sound events that are only around 5–20 milliseconds long. Usually acoustic gaps of less than 10 milliseconds can be perceived. From this point of view, speech-free auditory differentiation, identification and time order are seen as essential auditory requirements for the exact recognition of speech sounds. This is also known as auditory time resolution, which enables the ability to correctly recognize spoken language quickly.
  5. Auditory identification: Auditory identification is understood to mean the ability to recognize sound events, i.e. H. assign a specific sound its meaning. Phoneme identification (syn. Phonematic identification, sound identification) describes the ability to hear speech sounds, e.g. B. to recognize the sound / d / as such. If this auditory function is disturbed, the person affected may have difficulties in correctly and reliably assigning speech sounds to the characters (letters).
  6. Auditory analysis and synthesis: These functions are understood to mean the ability to hear individual sounds from words, e.g. B. to form the sound / l / from the word owl or the correct word from individually specified sounds (e.g. from the sounds / r / - / a / - / b / - / e / the word raven )
  7. Auditory short-term memory: The short-term memorization of heard information is of considerable importance for conscious processing. Disorders of the auditory short-term memory occur more frequently in "circumscribed language development disorders (USES)" and in reading-spelling disorders. Here the model of the phonological loop of the working memory is viewed as an instance, the limitation of which leads to difficulties in both speech reception and production and the further consequences.

Symptoms of the AVWS

Patients affected by such a disorder may e.g. B. complain about

  • Impairment of auditory alertness
  • Problems with understanding auditory (heard) information
  • Misunderstandings with verbal (spoken) requests
  • slowed processing of verbal (spoken) information
  • delayed response to auditory or verbal stimuli
  • impaired auditory memory (e.g. hearing span)
  • impaired recognition and differentiation of sound stimuli
  • Problems of sound source localization ("directional hearing")
  • Difficulties in understanding speech and hearing in background noise (e.g. King Kopetzky syndrome )
  • Problems with understanding changed speech signals (e.g. incomplete speech signals or speech signals with reduced redundancy , for example with a poor telephone connection)

Many of these abnormalities also occur as secondary disorders in a peripheral (i.e. caused by the outer , middle or inner ear ) hearing loss, including even “minor” or “minimal” peripheral hearing disorders, regardless of whether they are caused by disorders of the external, middle or Inner ear related symptoms can lead to symptoms similar to those of AVWS.

The DGPP has issued a questionnaire on the anamnesis of AVWS. This questionnaire was developed for structured anamnesis and follow-up and can be filled out by parents, teachers, day care staff; it was not developed as a diagnostic tool and therefore cannot replace diagnostics.

Diagnosis

Prior to a special diagnosis of AVWS, the exclusion of a peripheral hearing impairment is mandatory. H. an impairment of the hearing function due to a disorder of the outer, middle or inner ear must be definitely excluded. This also applies in particular to minor or minimal hearing impairments. In addition, disorders that are much more common than AVWS and that can be associated with similar symptoms must be ruled out in advance. H. Learning disabilities or attention / hyperactivity syndromes and especially receptive language development disorders (language comprehension disorders ) and expressive language development disorders ( dyslalia , dysgrammatism, etc.). If the preliminary diagnosis does not provide a sufficient explanation for the symptoms described, a comprehensive pedaudiological examination of the various auditory functions is recommended. The examination of the auditory processing and perception is carried out by specialists in phoniatrics and pediatric audiology (syn. Doctors for speech, voice and children's hearing disorders) in phoniatric-pedaudiological clinics, hospital departments, phoniatric-pedaudiological practices or by pedaudio-trained ENT specialists. Diagnosis by the above-mentioned specialists is a standard benefit of the health insurance companies; it is not about individual health services (IGeL). Since AVWS are often associated with other impairments such as language development disorders , reading and spelling disorders , attention deficit / hyperactivity disorders and other disorders, special differential diagnostic aspects must be clarified on an interdisciplinary basis, e.g. B. by child and adolescent psychiatrists, child and adolescent psychologists and psychotherapists as well as neuropediatricians (child neurologists).

treatment

The treatment of AVWS in children is carried out through practicing procedures, through the promotion of compensations for the impaired functions as well as through the improvement of the acoustic signal quality. The therapy of AVWS should basically consider all three areas. With clear comorbidities, i. H. Additional abnormalities (e.g. reading and spelling disorders, language development disorders, attention-hyperactivity syndromes) must be weighed up on the need for therapy in the auditory area, taking into account the severity of the AVWS, the symptoms it causes in everyday life and at school, and the interdisciplinary findings. The procedures practiced at AVWS include, on the one hand, function-specific, language-bound auditory forms of treatment, which include exercises on phoneme differentiation, phoneme identification, phoneme analysis in words, phoneme synthesis and phonological awareness. In addition, training methods for speech-free auditory functions (e.g. training threshold training, training of auditory low-level functions) or with modified speech signals (e.g. Fast-ForWord, lateral training, high-tone training) are offered. With regard to the effectiveness of the different therapeutic approaches, the research results so far speak clearly in favor of the language-bound, partial-function-specific treatment methods as the therapy of choice for AVWS (overview in Nikisch). The decisive question for the benefit of a therapy for the patient is whether the treatment can have a positive influence on the development of language or the development of written language. With regard to linguistic-auditory training, transfer effects on reading-spelling performance have been proven in many studies. This applies not only to children who are inconspicuous in the area of ​​auditory perception, but also especially to children with poor performance in the language-bound auditory perception areas. In addition, effects in objective procedures (e.g. functional magnetic resonance imaging, fMRI, and late acoustic evoked potentials , SAEP) were also reported after linguistic and auditory training .

In contrast, most of the controlled studies have so far not proven any clear transfer effects of training basic auditory functions on speech or reading-spelling performance. Overall, the implementation of training forms of basic auditory functions is often justified with the observations of the working group around Tallal. For the auditory training (Fast ForWord) developed in the USA on the basis of these studies, improvements in both speech and reading-spelling disorders were documented in children with reading-spelling disorders and were also confirmed in fMRI, however these effects could not be proven in a number of other studies. Furthermore, a Cochrane Review from 2011 showed no evidence of therapeutic effects for sound therapies, including Tomatis Therapy.

In addition to the practicing procedures, the therapy of AVWS should include the development of compensation strategies (via the visual sensory modality, e.g. phoneme-specific manual system) as well as metacognitive strategies. Another aim of the therapy is that the patient can independently assess the respective auditory situation and actively counteract any hearing difficulties. Finally, the signal quality can be improved by e.g. For example, noise sources are reduced in the school classroom, the seating position in the school class is changed or soundproofing measures are taken in the classroom. An FM system can also be profitable in school lessons. The prerequisite for this is a specialist phoniatric-pedaudiological diagnosis of AVWS as well as impairment of hearing in the background noise.

Individual evidence

  1. ^ M. Ptok, R. Berger, C. von Deuster, M. Gross, A. Lamprecht-Dinnesen, A. Nickisch, HJ Radü, V. Uttenweiler: Auditory processing and perception disorders. Consensus statement of the German Society for Phoniatrics and Pediatric Audiology. In: ENT. 2000, 48, 5, pp. 357-360.
  2. ^ Position Statement Auditory Processing Disorder (APD) . (PDF) Draft document. British Society of Audiology, 2010; accessed November 23, 2013.
  3. a b A. Nickisch, M. Gross, R. Schönweiler, V. Uttenweiler, A. am Zehnhoff-Dinnesen, R. Berger, HJ Radü, M. Ptok: Auditory processing and perception disorders. Consensus statement of the German Society for Phoniatrics and Pediatric Audiology. In: ENT. 2007, 55, pp. 61-72.
  4. M. Ptok, A. am Zehnhoff-Dinnesen, A. Nickisch: Auditory processing and perception disorders - definition. Guidelines of the German Society for Phoniatry and Pedaudiology. In: ENT. 2010, 58, pp. 617-620.
  5. Diagnosis of language development disorders (SES) with special consideration of circumscribed language development disorders (USES) . ( Memento of March 4, 2016 in the Internet Archive ) (PDF) Interdisciplinary S2k guideline. AWMF, accessed January 10, 2014
  6. ^ A. Nickisch, R. von Kries: Short-term Memory (STM) Constraints in Children with Specific Language Impairments (SLI) - Are There Differences Between Receptive and Expressive SLI? In: Journal of Speech, Language, and Hearing Research. 2009, 52, pp. 578-595.
  7. ^ AD Baddeley: Working memory . University Press, Oxford 1986.
  8. Anamnesis sheet for recording auditory processing and perception disorders (AVWS) . (PDF)
  9. A. Nickisch, C. Kiese-Himmel, R. Schönweiler, M. Gross, HJ Radü: Relationships between the "Anamnestic survey and observation sheet for auditory processing and perception disorders (AVWS)" of the DGPP and the "Heidelberger Lautdifferenzierungstest" ( HLAD). In: Laryngo-Rhino-Otology. (2005); 84, pp. 487-492.
  10. a b c R. Schönweiler, A. Nickisch, A. am Zehnhoff-Dinnesen: Auditory processing and perception disorders - proposal for treatment and management in AVWS. Guidelines of the German Society for Phoniatry and Pedaudiology. In: ENT. , 2012, 60, pp. 359-368.
  11. ^ A. Nickisch: Treatment methods for auditory processing and perception disorders: evaluation criteria. In: Pediatric Practice. 2005, 76, pp. 216-223.
  12. ^ I. Lundberg: Reading difficulties can be predicted and prevented. In: C. Hulme, M. Snowling (Eds.): Reading development and dyslexia. Whurr, London 1994, pp. 180-199.
  13. ^ P. Hatcher, C. Hulme, A. Ellis: Ameliorating early reading failure by integrating the teaching of reading and phonological skills. In: Child Developm. , 1994, 65, pp. 41-57.
  14. JK Torgesen, RK Wagner, CA Rashotte, E. Rose, P. Lindamood, T. Conway: Preventing Reading: Failure in Young Children with Phonological Processing Disabilities: Group and Individual Responses to Instruction. In: Journal of Educational Psychology. 1999, 91, 4, pp. 579-593.
  15. ^ W. Schneider, M. Ennemoser, E. Roth, P. Küspert: Kindergarten prevention of dyslexia: Does training in phonological awareness work for everybody? In: J Learn Dis. , 1999, 32, pp. 429-436,
  16. ^ W. Schneider, E. Roth, M. Ennemoser: Training Phonological Skills and Letter Knowledge in Children at Risk for Dyslexia: A Comparison of Three Kindergarten Intervention Programs. In: J Educat Psychol. , 2000, 92, pp. 284-295.
  17. PJ Hatcher, C. Hulme, MJ Snowling: Explicit phoneme training combined with phonic reading instructions helps young children at risk of reading failure. In: J Child Psychol Psychiat. , 2004, 45, pp. 338-358.
  18. BA Shaywitz et al .: Development of left occipitotemporal systems for skilled reading in children after a phonologically-based intervention. In: Biol Psychiat. , 2004, 55, pp. 926-933, 56.
  19. ^ AG Bus, MH Ijzendoorn: Phonological awareness and early reading: a meta-analysis of experimental training studies. In: J Educat Psychol. , 1999, 91, pp. 404-414.
  20. K. Tremblay, N. Kraus, TD Carrell, T. McGee: Central auditory system plasticity: Generalization to novel stimuli following listening training. In: J Acoust Soc Am. 1997, 102.6, pp. 3762-3773.
  21. K. Tremblay, N. Kraus, T. McGee, C. Ponton, B. Otis: Central Auditory Plasticity: Changes in the N1-P2 Complex after Speech-Sound Training. In: Ear & Hearing. 2001, 22, 2, pp. 79-90.
  22. PG Simos, JM Flechter, E. Bergmann, JI Breier, BR Foorman, EM Castillo, RN Davis, M. Fitzgerald, AC Papanicolaou: Dyslexia-specific brain activation profile becomes normal following successful remedial training. In: Neurology. 2002, 58, pp. 1203-1213.
  23. ^ EA Hayes, CM Warrier, TG Nicol, SG Zecker, N. Kraus: Neural plasticity following auditory training in children with learning problems. In: Clinical Neurophysiology. 2003, 114, pp. 673-684.
  24. ^ DP Hurford, RE Sanders: Assessment and remediation of a phonemic discrimination deficit in reading disabled second and fourth graders. In: J Exp Child Psychol. , 1990, 50, pp. 396-415.
  25. C. Klicpera, B. Gasteiger-Klicpera: Effects of training the central hearing ability according to edu-kinesiological concepts on children with reading and spelling difficulties. In: Heilpäd research. 1996, 12, 2, pp. 57-64.
  26. H. Kühn-Inacker, S. Weinmann: Training of the Ordnungsschwelle - An Approach to Promoting Speech Perception in Children with a Central Auditory Processing Disorder? In: language, voice, hearing. 2000, 24, pp. 119-125.
  27. J. Bischof, V. Gratzka, U. Strehlow, J. Haffner, P. Parzer, F. Resch: Reliability, trainability and stability of auditory discriminative performance in two computer-aided measurement and training processes. In: Child and Youth Psychiatrist. 2002; 30, 4, pp. 261-270.
  28. D. Berwanger: Ordnungsschwellenraining. In: Suchodoletz v W (Hrsg.): Therapy of reading and writing disorders. Kohlhammer, Stuttgart 2003, pp. 129-160.
  29. W. von Suchodoletz: Treatment of auditory perception disorders: methods and their effectiveness. In: Forum Speech Therapy. 2003, 17, pp. 6-11, 58.
  30. P. Tallal, SL Miller, G. Bedi, G. Býma, X. Wang, SS Nagarajan, C. Schreiner, WM Jenkins, MM Merzenich: Language comprehension in language-learning impaired children improved with acoustically modified speech. In: Science , 1996, 271, pp. 81-84.
  31. MM Merzenich, WM Jenkins, P. Johnson, C. Schreiner, SL Miller, P. Tallal: Temporal processing deficits of language-learing impaired children ameliorated by training. In: Science , 1996, 271, pp. 77-81.
  32. ^ E. Temple, GK Deutsch, RA Poldrack, SL Miller, P. Tallal, MM Merzenich, JDE Gabrieli: Neural deficits in children with dyslexia ameliorated by behavioral remediation: Evidence from functional MRI. In: Proc Natl Acad Sci USA. 2003, 100, 5, pp. 2860-2865.
  33. AR Bradlow, N. Kraus, TG Nicol, TJ McGee, J. Cunningham, SG Zecker, TD Carrell: Effects of lengthened formant transition duration on discrimination and neural representation of synthetic CV syllables by normal and learning-disabled children. In: J Acoust Soc Am. 1999 Oct, 106 (4 Pt 1), 1999, pp. 2086-2096.
  34. ^ W. Cohen, A. Hodson, A. O'Hare, J. Boyle, T. Durrani, E. McCartney, M. Mattey, L. Naftalin, J. Watson: Effects of computer-based intervention through acoustically modified speech ( FastforWord) in severe mixed receptive-expressive language impaiment: Outcomes from a randomized controlled trial. In: J Speech Lang Hear Res. , 2005, 48, pp. 715-729.
  35. D. Valentine, MS Hedrick, LA Swanson: Effect of an auditory training program on reading, phoneme awareness, and language. In: Percept Mot Skills. 2006; 103, pp. 183-196.
  36. Y. Sinha, N. Silove, A. Hayen, K. Williams (2011): Auditory Integration Training and other sound therapies for autism spectrum, disorders (ASD). In: Cochrane Database Syst Rev. CD003681, PMID 22161380 .
  37. a b GD Chermak, FE Musiek: Central auditory processing disorders - new perspectives. In: Singular, San Diego. 1997
  38. A. Nickisch, J. Burger-Gartner, D. Heber: Auditory processing and perception disorders in school age. 4th edition. Modern learning publishing house, Dortmund 2010.
  39. a b TJ Bellis: Assessment and Management of Central Auditory Processing Disorders. 2nd Edition. Thomson Delmar Learning, New York 2003.