Testing a Possible Cause of Reduced Ability of Children to Process Speech in Noise
Testing a Possible Cause of Reduced Ability of Children to Process Speech in Noise
This study aims to increase our understanding of the difficulty people have recognizing the
 spoken word, especially in noisy situations.

 Subjects must be between 12 and 18 years old with no history of voice disorder, autism,
 stuttering, aphasia, multiple sclerosis, traumatic brain injury, severe language disorders,
 and psychiatric disorders. Group A subjects must show reduced speech-in-noise scores and
 Group B subjects must demonstrate speech-in-noise scores within normal limits.

 The child will perform a series of hearing tasks that will take from 1.5 to 2 hours, with a
 break halfway through. A routine hearing test will be given. The child will sit in a
 sound-treated room wearing earphones and will depress a button in response to sound or to
 repeat words. The words may be in quiet or mixed with noise. In a test called "immitance,"
 air pressure change and tones will be sent through a miniature probe in the ear for about 1
 minute. TEOAE (transient-evoked otoacoustic emission) testing will test the inner ear with
 clicking sounds. At times, noise will be presented through a probe in the opposite ear.

 The child will listen to a series of recordings of speech in quiet and in noise and will be
 asked to repeat what is heard. These recordings will include monosyllabic words with some
 part of the sounds cut out; words presented with several voices speaking together; two words
 presented at the same time, one to each ear (child must repeat both words); and two sentences
 presented at the same time, one to each ear (child must repeat sentence presented to chosen
 ear).

 The only risk in this study is tiredness from listening.
Five to ten percent of school-age children in the United States are identified as having
 learning disability and 10 to 20% have attention deficit hyperactivity disorder (ADHD). Many
 of these children have difficulty with tasks that challenge the auditory system. It is
 estimated that 3 to 7 percent of children have difficulty with auditory processing as a major
 factor interfering with education (Chermak and Musiek, 1997). Pinpointing physiological
 causes of auditory processing difficulty has been elusive. Intervention is hampered by the
 lack of knowledge of possible physical causes and therefore intervention addresses systems
 rather than causes of auditory processing difficulty. Indeed, whether the problem has a
 peripheral or central origin is unclear. Identification of physiological differences in
 children with auditory processing disorders may lead to electrophysiologic identification of
 potential auditory processing disorders. Thus the possibility of early intervention might
 reduce the educational impact of this problem.

 The aim of this study is to investigate the relationship of the efferent auditory neural
 system to the ability to process speech in noise. The study measures suppression of
 otoacoustic emissions in a population of adolescents with auditory processing difficulty as
 demonstrated by reduced ability to process speech in noise (Group A). These subjects will be
 compared to an age and sex matched group of adolescents with speech-in-noise test scores
 within normal limits (Group B). The study population will include 100 children between the
 ages of 12 and 18 years. All subjects must demonstrate normal puretone thresholds, speech
 recognition scores in quiet and middle ear function measured by acoustic immittance tests.
 Furthermore, the subjects' otoacoustic emissions must have reproducibility percentages within
 normal limits in the 2000, 3000, 4000 and 5000 Hz frequency bands. Subjects will complete an
 auditory speech recognition test battery (Scan-A and NU6 in multi-talker noise) and
 otoacoustic emission suppression tests. The auditory recognition tests each measure the
 subjects' ability to recognize speech in the presence of various types of noise and/or
 filtering. A group design will be used. Outcome parameters are the amount of suppression in
 dB for a group of subjects with normal speech understanding in noise and a group with reduced
 speech scores in noise and the relationship between speech measures and the degree of
 suppression.
INCLUSION CRITERIA:

 Subjects selected will be between the ages of 12 and 18 years.

 All subjects must score within normal limits on measures of threshold sensitivity, speech
 recognition in quiet, middle ear function and TEOAEs to be included in the study.

 Group A subjects must be identified as having learning or attention problems in school and
 show show reduced scores on speech-in-noise tasks.

 Group B subjects must demonstrate speech-in-noise scores within normal limits.

 Groups will be matched for sex, age and handedness.

 EXCLUSION CRITERIA:

 Subjects will be excluded for history of voice disorders, autism, stuttering, aphasia,
 multiple sclerosis, traumatic brain injury, severe language disorders and psychiatric
 disorders.

 Children who are being treated for hyperactivity disorder will be excluded.

 Children who are taking medication prescribed for hyperactivity, anxiety or depression may
 be excluded.

 Children younger than 12 will be excluded.