Idiopathic auditory dysfunction in children: nature and mechanisms

 描述(由申请者提供)：听觉处理障碍是一种定义不明确、理解不清的听力障碍，在美国每年约有50,000名儿童被诊断为听力障碍。本研究的主要目的是增加对听力障碍儿童的认识，为听力障碍儿童提供更合理的诊断和更好的处理。动作障碍有两种主要的理论，一种是中枢听觉神经系统(CAN)对声音的“自下而上”处理的问题，另一种是“自上而下”的问题，即更普遍的认知障碍，导致注意力、工作记忆和执行功能受损。这项拟议的研究将在辛辛那提儿童医院诊所的6-12岁儿童中详细检验这些理论，因为他们怀疑有听力困难(LID)，但 临床听力正常。儿童将使用一种新颖的、经过良好验证的照顾者问卷(ECLIPS)进行筛查，该问卷专门设计用于识别日常生活中的盖子。具体的假设是：(I)目前诊断apd的临床方法没有区分自下而上和自上而下的障碍，(Ii)LID儿童由于耳朵或罐子产生的自下而上听觉功能受损，在噪音中言语和空间处理能力受损，以及(Iii)LID儿童听觉认知受损，反映在听觉注意力、工作记忆和执行功能及其在大脑皮层的生物相关性。这项研究将是新颖的，因为它使用了各种敏感的、尖端的行为和生理方法，专门解决了这些假设。基线数据将从三个人口统计学匹配的组(每组n=50)的6-9岁儿童中收集，这些儿童通常正在发展中(TD)，或者有LID(AP)或没有(AP-)临床诊断的APD。将使用纵向设计中的数据的定量建模来建立每个群体和其中的个体的成熟轨迹。据预测，大多数 患有LID的儿童会有各种各样的罐头和认知功能障碍，但会出现一些不同的特征。根据我们之前的研究和临床报告，我们预计大多数LID儿童都会有一种普遍的认知缺陷，这种缺陷是各种基于语言的学习困难的共同特征。然而，我们也希望发现一些患有可识别疾病(例如，内毛细胞传入突触、脑干传导速度或皮质白质完整性)的儿童，他们的耳朵、CANS或皮质产生、整合或传输超阈值、时间敏感信号的能力受到损害。我们的方法将使我们能够定位这些疾病的来源。从这项研究中获得的数据将对雪崩的诊断产生立竿见影的影响，并对区别治疗产生影响，这取决于所发现的问题的具体性质。它们还将提供有关人类听觉系统正常、完整的功能和发育的新信息，并对其他感觉运动系统、人类发育、学习和学习障碍产生影响。

 DESCRIPTION (provided by applicant): Auditory processing disorder (APD), a poorly defined and understood listening difficulty, is diagnosed in about 50,000 children in the US annually. The primary goal of this research is to increase understanding of APD and to provide more rational diagnosis and better management of children with listening difficulties. There are two major theories of APD, that it is a problem with `bottom-up' processing of sounds by the central auditory nervous system (CANS) or, alternately, that it is due to `top-down', more general cognitive difficulties resulting in impaired attention, working memory and executive function. The proposed research will examine these theories in detail in children aged 6-12 years attending clinics at Cincinnati Children's Hospital because of suspected listening difficulty (LiD), but with clinically normal hearing thresholds. Children will be screened using a novel, well-validated, caregiver questionnaire (the ECLiPS) specifically designed to identify LiD in everyday life. Specific hypotheses are that, (i) current clinical methods to diagnose APD do not distinguish between bottom-up and top-down impairments, (ii) children with LiD have impaired speech-in-noise and spatial processing due to impaired, bottom-up auditory function deriving from the ear or the CANS, and (iii) children with LiD have impaired auditory cognition, reflected in auditory attention, working memory and executive function and their biological correlates in the cerebral cortex. The study will be novel through its use of a wide variety of sensitive, cutting-edge behavioral and physiological approaches that specifically address these hypotheses. Baseline data will be collected from 6-9 year olds in three demographically matched groups (each n=50) who are typically developing (TD), or who have LiD with (AP+) or without (AP-) a clinical diagnosis of APD. Quantitative modeling of data in a longitudinal design will be used to establish maturational trajectories for each group and the individuals within them. It is predicted that most children with LiD will have a variety of both CANS and cognitive dysfunction, but that some distinct profiles will emerge. Based on our previous research and on clinical reports, we expect that most children with LiD will have a generalized cognitive deficit that is common to a variety of language-based learning difficulties. However, we also expect to find some children who have identifiable disorders (e.g. of the inner hair cell afferent synapse, brainstem conduction speed, or cortical white matter integrity) underlying impaired ability of the ear, CANS or cortex to generate, integrate or transmit supra-threshold, time-sensitive signals. Our methods will enable us to localize the source of those disorders. The data obtained from this study will have immediate impact on the diagnosis of APD, with implications for differential management, dependent on the specific nature of the problems identified. They will also provide novel information on the normal, integrated function and development of the human auditory system, with implications for other sensorimotor systems, human development, learning and learning disorders.