Association between language development and auditory processing disorders1

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www.bjorl.org

Brazilian Journal of

OTORHINOLARYNGOLOGY

http://dx.doi.org/10.1016/j.bjorl.2014.01.002

ORIGINAL ARTICLE

Association between language development and auditory

processing disorders

Caroline Nunes Rocha-Muniz

a,

**_{*, Elaine Cristina Zachi}**

b

_,

Rosani Aparecida Antunes Teixeira

b

_{, Dora Fix Ventura}

b

_{'HERUD0DULD%HÀ/RSHV}

a

_,

Eliane Schochat

a

a_{Medicine School, Universidade de São Paulo (USP), São Paulo, SP, Brazil} b_{Psychology Institute, Universidade de São Paulo (USP), São Paulo, SP, Brazil}

Received 9 September 2013; accepted 24 January 2014

KEYWORDS Auditory perception; Speech perception; Language development disorders Abstract

Introduction: It is crucial to understand the complex processing of acoustic stimuli along the au-ditory pathway ;comprehension of this complex processing can facilitate our understanding of the processes that underlie normal and altered human communication.

Aim: To investigate the performance and lateralization effects on auditory processing assessment

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Material and methods:3URVSHFWLYHVWXG\6HYHQW\ÀYHFKLOGUHQDJHG\HDUVZHUHVHSDUDWHGLQ WKUHHJURXSVFKLOGUHQZLWK6/,FKLOGUHQZLWK$3'DQGFKLOGUHQZLWK7'$OOZHQWWKURXJK WKHIROORZLQJWHVWVVSHHFKLQQRLVHWHVW'LFKRWLF'LJLWWHVWDQG3LWFK3DWWHUQ6HTXHQFLQJWHVW

Results:7KH HIIHFWV RI ODWHUDOL]DWLRQ ZHUH REVHUYHG RQO\ LQ WKH 6/, JURXS ZLWK WKH OHIW HDU

presenting much lower scores than those presented to the right ear. The inter-group analysis has

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Conclusion:7KLVVWXG\KDVVKRZQLQFKLOGUHQZLWK6/,DQLQHIÀFLHQWSURFHVVLQJRIHVVHQWLDOVRXQG FRPSRQHQWVDQGDQHIIHFWRIODWHUDOL]DWLRQ7KHVHÀQGLQJVPD\LQGLFDWHWKDWQHXUDOSURFHVVHVUH

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3$/$95$6&+$9( Percepção auditiva; Percepção da fala; Transtornos do desenvolvimento da linguagem

Associação entre transtornos no desenvolvimento de linguagem e processamento auditivo Resumo

Introdução: Entender como os estímulos acústicos são processados ao longo da via auditiva é

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Objetivo: Investigar o desempenho e efeitos de lateralidade na avaliação do processamento

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* Corresponding author.

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Introduction

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children have language alteration in the absence of

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-WRU GHYHORSPHQW LPSDLUPHQW SHUYDVLYH GHYHORSPHQWDO GLVRUGHUVDQGDFTXLUHGVHQVRULQHXUDOFKDQJHVDQGV\QGUR -mes and in neurological lesions._{This type of language}

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not reached a consensus on the physiological basis of causation of this disorder involving language development yet.

One possible theory suggests that one of the reasons for

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changes in abilities to process sounds and to abnormalities

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The basic idea is as follows: the perception of those

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-lated to the ability to perceive and process rapid changes of

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can be said that the auditory perception is the result of the auditory signal processing. When a change occurs in this

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This instability of the representation of speech sounds can

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-FDOV\QWDFWLFDQGVHPDQWLFHOHPHQWVRIODQJXDJH Although the presence of alterations in auditory

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the etiological causes of disorders in language development remains controversial.

From the previously established relationships between

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the auditory processing and possible effects of laterality in

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We hope this study will provide new information on the

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better understanding of this disorder and more appropriate and effective therapeutic interventions.

Material and method

This study was approved by the Ethics Committee under Protocol 1049/07. The children’s parents or guardians were instructed about the procedures of the study and signed a term of free and informed consent.

Cases

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-ted. All subjects evaluated had auditory pure tone

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and referred to specialized service.

The subjects were divided into three groups:

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through interviews with these children’s parents or

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Material e método:(VWXGR3URVSHFWLYRFULDQoDVDQRVGLYLGLGDVHPWUrVJUXSRV FULDQoDVFRP'(/FULDQoDVFRP73$HFULDQoDVHP'7IRUDPVXEPHWLGDVDRVVHJXLQWHV WHVWHV7HVWHGH)LJXUDFRP5XtGR7HVWH'LFyWLFRGH'tJLWRVH7HVWHGH3DGUmRGH)UHTXrQFLD Resultado2VHIHLWRVGHODWHUDOLGDGHIRUDPREVHUYDGRVDSHQDVQRJUXSR'(/VHQGRRGHVHPSH -QKRQDRUHOKDHVTXHUGDLQIHULRUDRDSUHVHQWDGRQDRUHOKDGLUHLWD1DFRPSDUDomRLQWHUJUXSRV RGHVHPSHQKRGRVJUXSRV73$H'(/IRLVLJQLÀFDWLYDPHQWHLQIHULRUDRREVHUYDGRQRJUXSR'7 SDUDWRGRVRVWHVWHV$OpPGLVVRREVHUYDPRVQDVFULDQoDVGRJUXSR'(/XPGHVHPSHQKRLQIHULRU jVGRJUXSR73$ Conclusão:(VWHHVWXGRFRQVWDWRXRSURFHVVDPHQWRLQHÀFLHQWHGHFRPSRQHQWHVFUXFLDLVGHVRQV HRHIHLWRGHODWHUDOLGDGHHPFULDQoDVFRP'(/(VVHVDFKDGRVHYLGHQFLDPTXHRVSURFHVVRV QHXUDLVTXHVXEMD]HPDRSURFHVVDPHQWRDXGLWLYRVmRGLIHUHQWHVHQWUHDOWHUDo}HVGHSURFHVVD -PHQWRDXGLWLYRHDOWHUDo}HVGHIDOD

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FDQ6SHHFK/DQJXDJH+HDULQJ$VVRFLDWLRQ$6+$LHSHU -formance below normal for their age on at least two tests

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assessment battery applied in this group was composed of temporal processing and monotic and dichotic hearing tests.

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providing at least an average intellectual level in an intel-lectual assessment using the Raven Coloured Progressive

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Procedures

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central auditory processing were performed.11_D0RQRWLF

test – Speech-in-noise test – used to assess the ability of auditory closure. This test consists of a list of 10

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the speech test. The signal/noise ratio used was + 20 dB

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-ponding to the words that were heard. This procedure was

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and binaural integration for linguistic sounds. Two numbers

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the child was instructed to repeat both pairs immediately

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speech test. The number of digits correctly repeated was

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instructed to listen carefully to three stimuli and to res-pond orally to the order in which the sounds came. If the

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The Speech-in-noise test and “dichotic digit” tests were

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and left ears were evaluated separately. The “pattern of

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Statistical analysis

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-mum. To compare the means of the tests in the three

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Results

The subjects’ age had a similar distribution among the three

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Table 1 shows the descriptive statistics of data obtained

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mean percentage of hits in the left ear was smaller than the

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only for SLI group.

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three groups. It should be noted that the percentages pre-sented are the result of the use of the test in binaural form. In Table 2 the descriptive statistics of data obtained by

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Comparing the mean percentages of correct answers for

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Table 1'HVFULSWLYHVWDWLVWLFVIRUWKHSHUFHQWDJHRIFRUUHFWDQVZHUVRQWKHÀJXUHZLWKQRLVHWHVWDQGRQGLFKRWLFGLJLWWHVWLQ WKHWKUHHJURXSVE\HDU

$129$

0HDQ 6' 0LQLP 0HGLDQ 0D[LPXP F P value

Figure with noise test

7' RE 98.40 3.74 90 100.00 100 1.00 0.36 LE 98.80 3.31 90 100.00 100 $3' RE 92.00 9.12 70 90.00 100 1.50 0.23 LE 90.00 10.00 60 90.00 100 SLI RE 87.20 11.00 70 90.00 100 6.33 0.01** LE 81.40 15.78 50 90.00 100 'LFKRWLFGLJLWWHVW 7' RE 95.90 6.49 77.50 100.00 100.00 0.92 0.34 LE 95.20 6.76 70.00 95.00 100.00 $3' RE 81.60 16.95 30.00 87.50 100.00 2.82 0.10 LE 77.21 15.86 42.50 80.00 97.50 SLI RE 77.60 16.64 25.00 80.00 97.50 15.79 0.001** LE 66.31 20.90 10.00 70.00 92.50 S Table 2'HVFULSWLYHVWDWLVWLFVRIWKHSHUFHQWDJHRIFRUUHFW DQVZHUVWRSDWWHUQRIIUHTXHQF\WHVWLQWKHWKUHHJURXSV PFT 0HDQ 6' 0LQLPXP 0HGLDQ 0D[LPXP 7' 89.60 9.28 65.00 90.00 100.00 $3' 63.00 26.65 0.00 65.00 100.00 SLI 50.20 20.38 15.00 50.00 80.00

Table 3 P values for comparison among the three groups in

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p value

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Pattern of

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test

< 0.001*** < 0.001*** 0.06

*** p < 0.001.

_{Trend towards significance.}

Discussion

7KHUHVXOWVRIWKHEHKDYLRUDOHYDOXDWLRQRIWKHFHQWUDODX -ditory processing showed that the performance obtained by

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compromise the integrity of speech processing and production.

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or receptive language.

In that the temporal processing is involved in each test

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in compromises in the perception of phonemes and of other

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phonemic representation.

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-creasing the controversy about the aetiology of SLI. Some

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and speech perception tests8_{showed children with language} GLIÀFXOWLHVKDGDGHTXDWHSHUIRUPDQFHRQWDVNVRIGLVFULPL

-nation and temporal processing of auditory stimuli. The second hypothesis suggests the presence of oth-er disabilities in children with SLI in addition to those responsible for the auditory processing. According to

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act synergistically. This would explain the fact that some children show changes in auditory processing and normal language development.

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the results of Ferguson et al.14_{DQG 0LOOHU DQG :DJVWDII}15 7KHVH UHVHDUFKHUV IRXQG QR GLIIHUHQFHV EHWZHHQ$3' DQG 6/,JURXSVIRUPHDVXUHVRIODQJXDJHFRPPXQLFDWLRQFRJ

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Another feature found only by the SLI group in our re-search was a poorer performance of the left ear compared

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through the actions of the contralateral pathways. When

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This asymmetry between ears would be expected to

de-FUHDVHZLWKLQFUHDVLQJDJHWKLVLVDOLNHO\PDUNHURIPDWXUL -ty and of hearing process improvement.19

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transmission of auditory information from the non-dom-inant ear toward the domnon-dom-inant hemisphere for speech

SURFHVVLQJYLDFRUSXVFDOORVXP20 possibly due to a

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or to impairments in the auditory system.21_{According to} 0RQFULHII19WKHÀQGLQJVRQWKHGLIIHUHQFHVEHWZHHQULJKW

and left ears represent an important aspect related to the immaturity in dichotic hearing ability.

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the left ear compared to the right ear rather than exhibit a right ear advantage.22

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temporal auditory processing manifested in the pattern of

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impairment of the inter-hemispheric function of auditory

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the cerebral hemispheres.23

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the left ear in the dichotic test – plus the abnormal

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-house and Bishop28_{found some evidence that children with} 6/,PLJKWKDYHWKHIXQFWLRQRIODQJXDJHODWHUDOL]HGWR5+28 7KDW LV RXU ÀQGLQJV FRXOG FRUURERUDWH WKH LPSRUWDQW ODQ -JXDJHGHÀFLWGLVSOD\HGE\WKHVHFKLOGUHQ

,Q IDFH RI WKH K\SRWKHVHV SUHVHQWHG ZH FDQ FRQVLGHU WKDWWKHSRVVLEOHFDXVHVRIDV\PPHWU\EHWZHHQHDUVIRXQG RQO\LQFKLOGUHQZLWK6/,PD\EHUHODWHGHLWKHUWRDPDWX -rational delay – especially in regard to the interhemispheric

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underlie auditory processing disorders may differ between auditory and language processing change.

Conclusion

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-mance on the auditory processing abilities compared to

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with language processing found in these children are

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and/or in auditory processing in the right hemisphere.

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speech processing changes.

Funding

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Estado de São Paulo – FAPESP.

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(6)

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children with development dysphasia. Nature. 1973; 241:468-9.

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5. Tallal P. The science of literancy: From the laboratory to the classroom. Proc Natl Acad Sci USA. 2000; 97:2402-4.

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cues predicts later language impairment. Behav Brain Res. 2002;136:31-49.

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Res. 1999; 42:1295-310.

8. Sussman J. Perception of formant transition cues to place of articulation in children with language impairment. J Speech

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1995;38:387-92.

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3HUHLUD/'6FKRFKDW(3URFHVVDPHQWR$XGLWLYR&HQWUDO²PDQX -al de av-aliação. São Paulo. Pro-Fono; 2011.

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2011;54:211-27.

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-poral grain of sound representation in the primary auditory

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stimuli. Canadian Journal of Psychology. 1961;15:166-71.

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-ges in direction and magnitude of ear advantage. Brain Cogn. 2011;76:316-22.

0RUWRQ//,QWHUKHPLVSKHULFEDODQFHSDWWHUQVGHWHFWHGE\VH -lective phonemic dichotic laterality measures in four clinical subtypes of reading disabled children. J Clin Exp Neuroychol. 1994;16:556-67.

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0DFKDGR$Neuroanatomia Funcional ; Editora Atheneu. 2004. 24. Sinha SO. The role of the temporal lobe in hearing. Thesis:

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0RUDOHV*DUFLD&3RROH-20DVNHGVSHHFKDXGLRPHWU\LQFHQ -tral deafness. Acta Otolaryngol. 1972;74:307-16.

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temporal lobe dysfunction. Neurology. 1973;23:384-6.

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