Abstract
The present study aimed to assess the central auditory processing abilities and working memory in children with non-syndromic cleft lip and palate (NSCLP) and to compare with the developed normative and craniofacially normal peers. Sixteen NSCLP children aged 7 to 12 years and fifteen craniofacially normal peers were recruited in this study. Speech perception in noise Kannada (SPIN-K), gap detection threshold (GDT), dichotic consonant-vowel (DCV), and masking level difference (MLD) tests were administered to assess various central auditory processing abilities. Working memory abilities were assessed by using forward-digit span and backward-digit span tests. The results showed significant differences in SPIN-K, dichotic CV, GDT, forward digit, and backward digit span scores between children with NSCLP and craniofacially normal peers. Thus, it can be concluded from the present study that children with NSCLP have a risk of developing auditory processing deficits. To conclude, assessment of central auditory processing abilities in children with NSCLP is recommended.
Keywords: Non-syndromic cleft lip and palate, Auditory processing deficit, Working memory
Introduction
Cleft lip and palate (CLP) is a congenital anomaly of the craniofacial structure. CLP prevalence is around 1 in 500 to 2500 births globally [1]. There are three different categories in the oro-facial cleft, which are cleft lip only (CL), cleft lip and palate (CLP), and cleft palate only (CP). Cleft palate poses a severe problem in affected children among these three categories [1]. A condition in which cleft disorder is isolated from other abnormal phenotypes is called non-syndromic cleft and palate (NSCLP), and 70% of cleft lip and palate are identified as NSCLP [2].
Peripheral hearing loss is commonly seen in children with NSCLP due to middle ear infections, and the hearing loss is majorly bilateral with mild to moderate degrees [3]. Poor academic achievement was reported in children with NSCLP due to impaired auditory skills [4,5,6]. Another potential contributing cause to learning and language delay is auditory processing disorder (APD), which has recently been flagged as an additional hearing deficit in children with NSCLP.
Several studies report that children with NSCLP had a history of conductive hearing impairment [3, 7, 8]. There is a higher prevalence of auditory tube dysfunction and glue ear in children with NSCLP [9]. Interference in the normal binaural hearing pathway and sound conduction due to the middle ear infection might impair the auditory processing abilities in children with NSCLP [10]. Also, the middle ear infection induces neural changes in the auditory system [11]. Children with middle ear infections are also associated with hyperacusis, which may impair the development of normal listening. Because of the altered peripheral auditory system, there will be a problem in decoding the messages adequately directed to the child [12]. Even mild hearing loss caused by otitis media may have long-term functional and structural changes in the synaptic connections of the central auditory nervous system [1]. Thus, there is a higher risk of developing auditory processing deficits in children with NSCLP.
Numerous studies have shown that children with NSCLP have difficulty in speech perception in noise [6], difficulty in dichotic listening [12, 13], and difficulty in temporal resolution abilities [1]. Studies have investigated some auditory processing skills in individuals with NSCLP. Also, studies have yet to assess working memory abilities in children with NSCLP, which is also a part of auditory processing. As per the author’s knowledge, there are no studies on the effect of NSCLP on auditory processing abilities in the Indian context. Thus, the present study aims to assess central auditory processing abilities in children with NSCLP. It will provide evidence to the audiologist, help them in early diagnosis and management, and improve the quality of life of these children.
Methods
Between subject experimental research design was used to fulfill the aim of the study. Sixteen non-syndromic cleft lip and palate children between the ages of 7 to 12 years (Mean age: 9.78 years) were recruited in this study. Fifteen craniofacially normal peers were included as a control group to compare the working memory abilities and temporal resolution abilities among children with NSCLP. Congenital non-syndromic cleft lip and palate with normal hearing sensitivity with no active middle ear infection and normal cognitive ability were included in this study. Craniofacially normal children with normal hearing sensitivity and no active middle ear infection were included as the control group. The participants in the control group passed the ‘Screening Checklist for Auditory Processing (SCAP) [14]. Table 1 shows the age, gender, and type of cleft of children with NSCLP.
Table 1.
Age, gender, and type of cleft of children with NSCLP
| Subject No | Age (years) | Gender | Cleft type |
|---|---|---|---|
| 1 | 7.1 | M | Bilateral RCLP |
| 2 | 7.6 | M | Bilateral RCP |
| 3 | 7.2 | F | RCP (soft palate) |
| 4 | 8.1 | F | Bilateral RCP |
| 5 | 8.7 | F | Bilateral RCP |
| 6 | 8.9 | M | Unilateral RCLP |
| 7 | 9.7 | M | Bilateral RCP |
| 8 | 9.3 | M | Bilateral RCLP |
| 9 | 10.4 | F | Unilateral RCLP |
| 10 | 10.3 | F | Unilateral RCLP |
| 11 | 10.3 | M | RCP (soft palate) |
| 12 | 11.4 | F | Bilateral RCLP |
| 13 | 11.3 | M | RCP (soft palate) |
| 14 | 11.9 | F | Bilateral RCP |
| 15 | 12 | M | Unilateral RCLP |
| 16 | 11.8 | M | Unilateral RCLP |
Procedure
All testing was conducted in an acoustically treated soundproof room within the permissible noise limit [15]. A basic audiological evaluation, including pure tone audiometry, acoustic immittance, and otoacoustic emissions, was done to rule out hearing loss and middle ear dysfunction. Central auditory processing (CAP) skills were assessed on participants with normal hearing sensitivity and no middle ear infections. All the CAP tests were conducted at 60 dBHL routed through the audiometer. The following tests were done to assess CAP skills.
Speech Perception in Noise Test
Speech perception in noise test in Kannada (SPIN-K) [16] was done to assess auditory closure. The phonemically balanced words were used as a test stimulus [17] and presented with speech noise at 0 dB SNR. The word list consists of 25 words, and two different wordlists were used. The participants were instructed to repeat the words. A score of one was given for the correctly repeated words and zero for incorrect responses.
Gap Detection Test
Temporal resolution abilities were measured using a gap detection test. A Hewlett-Packard computer with Intel i7 and 16GB RAM running Windows 10 version 20H2 installed with MATLAB was used to conduct gap detection test. In this test, the subjects were given a stimulus with a gap; the minimum gap which the participant can perceive is called the gap detection threshold. The GDT was estimated using MATLAB’s maximum likelihood procedure (MLP) function. Three alternate force choice method was used, and the standard stimulus was 500 ms broadband noise. At the beginning and end of the gap, a noise with 0.5ms cosine ramps was given to estimate the gap detection threshold. The participants were asked to identify the stimulus with a gap among the three stimuli.The gap detection corresponding to 79.4% of the psychometric function was calculated using MLP.
Binaural Processing
Binaural integration was evaluated through the dichotic consonant-vowel (DCV) test [18]. The six different syllables /pa/, /ta/, /ka/, /ba/, /da/, and/ga/ were presented in a random order five times simultaneously to each ear with 0ms lag. The participants were instructed to repeat the words that they heard. A score of ‘one’ was given for every correct response; a score of ‘zero’ was given for an incorrect response. Additionally, responses were scored as single correct and double correct scores. A single correct score was given when the subject correctly repeated the syllable presented in one ear. Double correct scores were given when the participants correctly repeated the syllable presented in both ears.
The masking level difference (MLD) was done to assess the binaural interaction. A dual-channel calibrated audiometer (Inventis - Piano, Italy) with TDH-39 headphones was utilized to assess MLD. Masked thresholds were obtained for homo phasic (S0N0) and antiphasic(SπN0) signal and noise conditions for 500 Hz test stimuli. The difference between the homophasic and antiphasic masked threshold was calculated to obtain MLD.
Working Memory
An auditory digit span test assessed the auditory working memory using the ‘Auditory cognitive module’ of Smrithi Shravan software [19]. Digits from one to nine except seven were given in a random order, and the number of digits presented increased from a minimum of two digits to a maximum of ten digits to increase the difficulty of the test with 250 ms of inter-stimulus interval. The participants were asked to repeat the digits in the same order for the forward digit span test and in the reverse order for the backward digit span test. The scoring was based on the number of correct digits the participants reported in the required sequence. The midpoint of the forward and backward digit span test was taken for analysis.
Statistical Analyses
The data from the present study was subjected to statistical analysis by utilizing the subjective package for social science (SPSS) version 26.0 (IBM Corp). A descriptive statistical analysis determined each parameter’s means and standard deviations. Shapiro Wilks normality test was done to analyze the normality distribution of this study data. A One-sample Wilcoxon signed rank test was administered to compare the auditory closure, binaural integration, and binaural interaction abilities between children with NSCLP and the developed normative. Mann-Whitney U test was conducted to compare the temporal resolution abilities between NSCLP and craniofacially normal groups. An independent t-test was done to compare the working memory abilities of children with NSCLP and craniofacially normal peers.
Results
The present study aimed to compare the central auditory processing abilities and working memory of children with NSCLP with the developed normative. Table 2 shows the mean, median, range, and standard deviation (SD) for all the central auditory processing tests in children with NSCLP. The Shapiro-Wilk test showed that the data did not fulfill the assumptions of normality (p<0.05) for all the central processing tests. Hence, non-parametric statistics were used to evaluate the significance of the difference of various tests. However, for working memory tests, the data fulfilled the assumptions of normality (p>0.05). Hence, parametric tests assessed the significant difference in working memory between children with NSCLP and craniofacially normal peers.
Table 2.
Mean, median, range, and SD of various auditory processing tests for children with NSCLP
| Auditory processing test | Mean | Median | Range | SD | |
|---|---|---|---|---|---|
| Minimum | Maximum | ||||
|
SPIN R (No. of words repeated) |
12.38 | 12.50 | 5 | 16 | 2.87 |
|
SPIN L (No. of words repeated) |
12.06 | 12.50 | 7 | 16 | 2.86 |
| GDT R (ms) | 10.31 | 9.14 | 3.15 | 20.20 | 6.25 |
| GDT L (ms) | 10.42 | 8.60 | 3.12 | 21.30 | 6.54 |
|
DSC R (No. of syllables repeated) |
12.87 | 13.00 | 8 | 16 | 1.96 |
|
DSC L (No. of syllables repeated) |
12.00 | 13.00 | 7 | 15 | 3.29 |
|
DDC (No. of syllables repeated) |
4.69 | 5.00 | 2 | 7 | 1.99 |
| MLD (dB) | 12.91 | 10.00 | 10 | 15 | 2.56 |
| Forward digit span | 2.79 | 3.00 | 1.0 | 4.4 | 1.06 |
| Backward digit span | 1.91 | 2.05 | 0 | 3.1 | 0.92 |
SPIN R = Speech perception in noise scores of the right ear
SPIN L = Speech perception in noise scores for left ear
GDT R = Gap detection thresholds for right ear
GDT L = Gap detection thresholds for left ear
DSC R = Dichotic single correct score for right ear
DSC L = Dichotic single correct score for left ear
DDC = Dichotic double correct scores
MLD = Masking level difference
Auditory Closure Abilities
Table 2 shows the mean and SD of SPIN-K scores of NSCLP participnats for the right and left ears. For comparison, normative data were taken from the study by Nigam and Jain (2020). Table 3 shows the mean SPIN scores for the current study and the developed norms.
Table 3.
Mean and SD of established norms for SPIN-K (Nigam & Jain, 2020) and NSCLP group
| Auditory processing test | Normative | NSCLP | ||
|---|---|---|---|---|
| Mean | SD | Mean | SD | |
|
SPIN R (No. of words repeated) |
18.53 | 1.73 | 12.38 | 2.87 |
|
SPIN L (No. of words repeated) |
18.33 | 1.91 | 12.50 | 2.86 |
Table 3 shows that the SPIN scores derived from the present study were less than developed normative. Further, a One-sample Wilcoxon signed-rank test was used to compare the SPIN-K scores between NSCLP children and established norms. The results showed that there was a significant difference in SPIN scores between NSCLP children and established norms for the right ear (Z= -3.526; p = < 0.001) and left ear (Z= -3.529; p = < 0.001). It was also noted that SPIN R was affected in 93% (cut-off = 16.8; mean-1SD) of the NSCLP children, and SPIN L was affected in 87% (cut-off = 16.4; mean-1SD) of the NSCLP children.
Temporal Processing Abilities
Table 4 displays the mean and SD of the GDT thresholds for both groups, and it can be noted that GDT thresholds are higher in children with NSCLP than in the control group. Further, the Mann-Whitney U test was administered to find the significant difference in GDT thresholds between the two groups. The results showed a significant difference in GDT thresholds among children with NSCLP and the control group for the right ear (Z= -2.753; p = 0.006) and left ear (Z= -2.375; p = 0.018). It was also noted that GDT for the right ear was affected in 81% (cut-off = 3.12; mean-1SD) of NSCLP children, and GDT for the left ear was affected in 93% (cut-off = 2.88; mean-1SD) of NSCLP children.
Table 4.
Mean and SD of GDT in children with NSCLP and control group
| Auditory processing test | Control group | NSCLP | ||
|---|---|---|---|---|
| Mean | SD | Mean | SD | |
| GDT R (ms) | 4.28 | 1.16 | 10.31 | 6.25 |
| GDT L (ms) | 4.31 | 1.43 | 10.42 | 6.54 |
Binaural Integration Abilities
Table 5 represents the mean and SD of right single correct, left single correct and double correct scores of dichotic CV. For statistical comparison purposes, normative data of dichotic CV was used [18]. Table 5 shows that the dichotic CV scores obtained from the present study were lesser than the established normative. A One-sampleWilcoxon signed rank test showed a significant difference in dichotic CV scores among the children with NSCLP with the developed normative for right single correct (Z= -3.535; p = < 0.001), left single correct (Z= -3.526; p = < 0.001), and double correct scores (Z= -3.533; p = < 0.001). It was also noted that 100% of children with NSCLP had affected dichotic CV single correct and double correct scores.
Table 5.
Mean and SD of established norms for Dichotic CV (Gowri &Yathiraj, 2001) and NSCLP group
| Auditory processing test | Normative | NSCLP | ||
|---|---|---|---|---|
| Mean | SD | Mean | SD | |
|
DSC R (No. of syllables repeated) |
21.68 | 3.41 | 12.87 | 1.96 |
|
DSC L (No. of syllables repeated) |
20.44 | 3.52 | 12.00 | 3.29 |
|
DDC (No. of syllables repeated) |
14.24 | 5.35 | 4.69 | 1.99 |
| Right ear advantage (DSCR-DSCL) | 1.24 | 0.87 | ||
Binaural Interaction Abilities
Table 6 demonstrates the mean and SD of MLD thresholds for children with NSCLP. The normative developed by Lavanya and Jain (2019) was used for statistical comparison. A One-sample Wilcoxon signed-rank test showed no significant difference in MLD thresholds (Z= -0.108; p = 0.914) between the children with NSCLP and the developed norms.
Table 6.
Mean and SD of developed norms (Lavanya & Jain, 2019) and NSCLP group
| Auditory processing test | Normative | NSCLP | ||
|---|---|---|---|---|
| Mean | SD | Mean | SD | |
| MLD (dB) | 13.45 | 2.21 | 13.43 | 2.56 |
Working Memory Abilities
Table 7 shows the mean and SD of forward and backward-digit tests in children with NSCLP and ontrol group and it can be noted that the forward-digit and backward-digit scores of NSCLP children were lesser than those of children in cotrol group. As the working memory data was normally distributed based on the Shapiro-Wilk test (p > 0.05), an independent t-test was done to compare the forward-digit and backward-digit scores between NSCLP children and craniofacially normal children. The results revealed that there was a significant difference in both forward digit (t = 3.928; p = < 0.001) and backward digit span test (t = 2.722; p = 0.011) between children with NSCLP and . Further, it was noted that, in the forward digit span test, 50% (cut-off = 3.25; mean-1SD) of children with NSCLP were affected and 56% (cut-off = 1.96; mean-1SD) of the NSCLP children had affected backward digit span scores.
Table 7.
Mean and SD of forward digit and backward digit test in NSCLP children and control group
| Auditory processing test | Control group | NSCLP | ||
|---|---|---|---|---|
| Mean | SD | Mean | SD | |
| Forward digit | 4.26 | 1.01 | 2.79 | 1.06 |
| Backward digit | 2.77 | 0.81 | 1.91 | 0.92 |
Discussion
Auditory processing deficits are commonly linked in children with NSCLP. Studies have assessed various central auditory processing abilities in NSCLP children [1, 6, 20, 21] Results from these studies suggest that children with NSCLP are at risk of developing central auditory processing deficits. Because of their malformed palate, children with NSCLP have a higher risk of recurrent middle ear infections. Recurrent otitis media in children can lead to auditory processing disorder due to interrupting auditory information during critical periods [22]. Several brain imaging studies show that individuals with NSCLP have radiologically abnormal cortical regions and noticeable variations in the left temporal lobe [23, 24]. The anterior cerebrum was larger in children with NSCLP than the posterior cerebrum, leading to various processing deficits [25].
Results of the current study showed affected SPIN-K in children with NSCLP. Studies also suggest that speech intelligibility in the presence of noise is impaired in children and adults with NSCLP [1, 6, 26]. Normal cortical structure and function are required to perceive speech in a noisy environment [10]. Structural malformation in the superior temporal plane may cause higher auditory processing deficits in children with NSCLP [27]. So, a cortical deficit in children with NSCLP may have a negative effect on auditory closure abilities [24].
The results showed that children with NSCLP had larger GDT than craniofacially normal peers. Similar findings have been reported in the literature [1, 6, 21, 28]. The findings of these mentioned studies show that children with NSCLP have problems perceiving the rapid changes in the stimulus and have the risk of developing temporal resolution disability. The presence of recurrent middle ear infections in children with NSCLP can disrupt normal auditory processing and may have a negative impact on temporal processing [1]. Middle ear infection can lead to a longer period of sensory deprivation in children with NSCLP, which may affect their temporal processing ability [13]. Temporal processing ability is also sensitive to cortical and interhemispheric lesions [29]. Studies have reported abnormal cortical regions in children with NSCLP compared to craniofacially normal peers, which also can lead to temporal processing deficits [23, 24].
Results to compare binaural integration abilities showed a significant difference in dichotic CV single correct and double correct scores between children with NSCLP and established normative. Similar reports have been reported in the literature [12, 13, 30]. Studies have shown that children with NSCLP had significantly reduced dichotic scores compared to craniofacially normal peers [12, 13, 30]. Higher right ear advantage (REA) has also been seen in children with NSCLP compared to craniofacially normal peers [1]. On the contrary, few authors noticed no significant difference in dichotic digit scores between children with NSCLP and craniofacially normal peers [6, 26]. The difference in findings can be attributed to the different stimuli used for assessing binaural integration abilities in these studies [31]. Binaural integration requires a normal and integrated auditory system. A deficit in dichotic tests could result from maturational delay or poor neural connectivity [32]. Fluctuations in the binaural hearing caused by recurrent otitis media may have a negative effect on the development of binaural integration ability [13].
Results to compare binaural interaction showed that MLD thresholds are normal in children with NSCLP. Similar results have been reported in the literature [13, 30]. Studies have shown normal binaural interaction abilities in children with NSCLP. It can be concluded from the results of the present study that the lower brain stem structures are not affected in children with NSCLP. However, few studies have been done to examine binaural interaction abilities in children with NSCLP, and further studies are needed to assess binaural interaction abilities in children with NSCLP.
The present study showed that children with NSCLP had significantly poorer forward and backward digit scores than craniofacially normal peers. Previous research has reported similar findings [7, 33, 34]. Abnormal brain structures in children with NSCLP can cause working memory deficits and reduced cognitive function [24, 35]. Temporal lobe enlargement in children with NSCLP is directly associated with lower cognitive functions and reduces working memory [7].
Conclusion
The present study’s findings support the previous literature confirming the important role of central auditory processing assessment in children with NSCLP. Thus, assessing the central auditory processing abilities in children with NSCLP is recommended. There is a need to identify the problem in the initial stages to provide suitable rehabilitation.
Acknowledgements
The authors acknowledge the Director of All India Institute of Speech and Hearing for allowing to carry out this study. The authors acknowledge the participant for their cooperation. The study is a part of the dissertation submitted to the University of Mysore.
Authors Contribution
Dhivagar B was involved in concept development, study design, questionnaire preparation, analysis of the results, interpretation, and manuscript writing; Chandni Jain was involved in concept development and study design, questionnaire preparation, and manuscript writing.
Funding
The study does not involve any funds.
Declarations
Competing Interest
There is no conflict of interest to disclose.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Zarei M, Hosseini Dastgerdi Z, Momeni A, Nouri NS (2021) Assessment of auditory processing in children with non-syndromic cleft lip and/or palate. https://doi.org/101080/2169571720211933317. [cited 2023 Jan 18];20(1):32–8. https://www.tandfonline.com/doi/abs/10.1080/21695717.2021.1933317
- 2.Stanier P, Moore GE (2004) Genetics of cleft lip and palate: syndromic genes contribute to the incidence of non-syndromic clefts. Hum Mol Genet. Apr 1 [cited 2023 Jan 18];13(suppl_1):R73–81. https://academic.oup.com/hmg/article/13/suppl_1/R73/617511 [DOI] [PubMed]
- 3.Yang FF, McPherson B (2007) Assessment and Management of hearing loss in children with cleft lip and/or palate: a review. Asian J Oral Maxillofacial Surg 19(2):77–88 [Google Scholar]
- 4.Conrad AL, McCoy TE, DeVolder I, Richman LC, Nopoulos P Reading in subjects with an oral cleft: speech, hearing and neuropsychological skills. Neuropsychology. 2014 May 1 [cited 2023 Jan 20];28(3):415–22. https://pubmed.ncbi.nlm.nih.gov/24188114/ [DOI] [PMC free article] [PubMed]
- 5.Persson M, Becker M, Svensson H (2012) Academic achievement in individuals with cleft: a population-based register study. Cleft Palate Craniofac J. [cited 2023 Jan 20];49(2):153–9. https://pubmed.ncbi.nlm.nih.gov/21214320/ [DOI] [PubMed]
- 6.Feng Y, Lu Z Auditory processing impairments under background noise in children with non-syndromic cleft lip and/or palate. Proceedings of the Annual Conference of the International Speech Communication Association, INTERSPEECH. 2016 [cited 2023 Jan 18];08-12-September-2016:257–61. https://www.researchgate.net/publication/307889137_Auditory_Processing_Impairments_Under_Background_Noise_in_Children_with_Non-Syndromic_Cleft_Lip_andor_Palate
- 7.Conrad AL, Richman L, Nopoulos P, Dailey S Neuropsychological functioning in children with non-syndromic cleft of the lip and/or palate. Child Neuropsychology. 2009 Sep [cited 2023 Aug 13];15(5):471–84. https://www.researchgate.net/publication/23966538_Neuropsychological_Functioning_in_Children_with_Non-Syndromic_Cleft_of_the_Lip_andor_Palate [DOI] [PMC free article] [PubMed]
- 8.Jocelyn MAPHLRode LJ (1996) Cognition, communication, and hearing in young children with cleft lip and palate and in control children: a longitudinal study - PubMed. [cited 2023 Jan 18]. https://pubmed.ncbi.nlm.nih.gov/8632941/ [PubMed]
- 9.Doyle WJ, Cantekin EI, Bluestone CD Eustachian Tube Function in Cleft Palate Children. https://doi.org/101177/00034894800890S311. 2016 Dec 4 [cited 2023 Jan 18];89(3 II Suppl. 68):34–40. Available from: https://journals.sagepub.com/doi/abs/10.1177/00034894800890S311 [DOI] [PubMed]
- 10.Ma X, McPherson B, Ma L Behavioral Signs of (Central) Auditory Processing Disorder in Children WithNonsyndromic Cleft Lip and/or Palate: A Parental Questionnaire Approach. Cleft Palate Craniofac J. 2016 Mar 1 [cited 2023 Jan 18];53(2):147–56. https://pubmed.ncbi.nlm.nih.gov/25647518/ [DOI] [PubMed]
- 11.Roberts J, Hunter L, Gravel J, Rosenfield R, Berman S, Haggard M et al Otitis media, hearing loss, and language learning: controversies and current research. J Dev BehavPediatr. 2004 Apr [cited 2023 Jan 20];25(2):110–22. https://pubmed.ncbi.nlm.nih.gov/15083134/ [DOI] [PubMed]
- 12.Cristina I, Lemos C, Monteiro CZ, Camargo RA, Cristina A, Rissato S et al Dichotic Listening Test (directed attention mode) in children with cleft lip and palate Summary. Braz J Otorhinolaryngol. 2008 [cited 2023 Apr 27];74(5):662–7. http://www.rborl.org.br/http://www.rborl.org.br/ [DOI] [PMC free article] [PubMed]
- 13.Boscariol M, André KD, Feniman MR (2009) Cleft palate children: performance in auditory processing tests. Braz J Otorhinolaryngol. [cited 2023 Jan 18];75(2):213–20. https://pubmed.ncbi.nlm.nih.gov/19575106/ [DOI] [PMC free article] [PubMed]
- 14.Yathiraj AMK (2002) The Screening Checklist for Auditory Processing (SCAP). All India Institute of Speech and Hearing
- 15.Frank T, Durrant JD, Lovrinic JM Maximum Permissible Ambient Noise Levels for Audiometric Test Rooms. Am J Audiol. 1993 Mar [cited 2023 Jul 10];2(1):33–7. 10.1044/1059-0889.0201.33 [DOI] [PubMed]
- 16.Vaidyanath RYA (2012) Speech Perception in noise test in Kannada. All India Institute of Speech and Hearing
- 17.YathirajA, Vijayalakshmi CS (2005) Phonemically balanced word identification test in Kannada. All India Institute of Speech and Hearing Mysore
- 18.Gowri K (2001) YA. Dichotic CV Test–Revised: normative data on children. Unpublished master’s independent project]. All India Institute of Speech and Hearing
- 19.Kumar AUSM (2013) Auditory cognitive training module. All India Institute of Speech and Hearing
- 20.Cayres Minardi CG, Fernandes Souza AC, Paranhos Netto M, Ulhôa FM, Ribeiro Feniman M, Ferreira Campos C et al [Auditory abilities in children with cleft lip and/or palate according to Fisher’s]. Acta Otorrinolaringol Esp. 2004 Apr 1 [cited 2023 Jul 24];55(4):160–4. https://pubmed.ncbi.nlm.nih.gov/15359661/ [DOI] [PubMed]
- 21.Ma X, McPherson B, Ma L Behavioral assessment of auditory processing disorder in children with non-syndromic cleft lip and/or palate. Int J PediatrOtorhinolaryngol. 2015 Mar 1 [cited 2023 Apr 25];79(3):349–55. https://pubmed.ncbi.nlm.nih.gov/25583086/ [DOI] [PubMed]
- 22.Khavarghazalani B, Farahani F, Emadi M, HosseniDastgerdi Z Auditory processing abilities in children with chronic otitis media with effusion. Acta Otolaryngol. 2016 May 3 [cited 2023 Jul 24];136(5):456–9. https://www.researchgate.net/publication/294921250_Auditory_processing_abilities_in_children_with_chronic_otitis_media_with_effusion [DOI] [PubMed]
- 23.Chollet MB, DeLeon VB, Conrad AL, Nopoulos P Morphometric analysis of brain shape in children with nonsyndromic cleft lip and/or palate. J Child Neurol. 2014 Dec 1 [cited 2023 Jul 24];29(12):1616–25. https://pubmed.ncbi.nlm.nih.gov/24381208/ [DOI] [PMC free article] [PubMed]
- 24.Nopoulos P, Langbehn DR, Canady J, Magnotta V, Richman L Abnormal brain structure in children with isolated clefts of the lip or palate. Arch PediatrAdolesc Med. 2007 Aug [cited 2023 May 21];161(8):753–8. https://pubmed.ncbi.nlm.nih.gov/17679656/ [DOI] [PubMed]
- 25.Nopoulos P, Berg S, Canady J, Richman L, Van Demark D, Andreasen NC Structural brain abnormalities in adult males with clefts of the lip and/or palate. Genetics in Medicine. 2002 Jan 1 [cited 2023 Jan 18];4(1):1–9. http://www.gimjournal.org/article/S1098360021029476/fulltext [DOI] [PubMed]
- 26.Hofer-Martini S, Hofer M, Hemprich A, Berger T, Fuchs M, Meuret S [Auditory processing in children and adolescents with cleft palate]. Laryngorhinootologie. 2021 Jan 1 [cited 2023 Apr 25];100(1):30–7. https://pubmed.ncbi.nlm.nih.gov/33022738/ [DOI] [PubMed]
- 27.Shriver AS, Canady J, Richman L, Andreasen NC, Nopoulos P Structure and function of the superior temporal plane in adult males with cleft lip and palate: pathologic enlargement with no relationship to childhood hearing deficits. J Child Psychol Psychiatry. 2006 Nov [cited 2023 Aug 6];47(10):994–1002. https://pubmed.ncbi.nlm.nih.gov/17073978/ [DOI] [PubMed]
- 28.Maximino LP, Marcelino FC, Cavalheiro MG, Abramides DVM, Caldana M, de de L, Corrêa C (2022) Auditory and language skills in children with cleft lip and palate. Acta Otorrinolaringologica (English Edition) 73(3):157–163 [DOI] [PubMed] [Google Scholar]
- 29.Bellis TJ Assessment and management of central auditory processing disorders in the educational setting: from science to practice. [cited 2023 Aug 6]; https://books.google.com/books/about/Assessment_and_Management_of_Central_Aud.html?id=UdHuBwAAQBAJ
- 30.Do Amaral MIR, Martins JE, Dos Santos MFC A study on the hearing of children with non-syndromic cleft palate/lip. Braz J Otorhinolaryngol. 2010 [cited 2023 Jan 18];76(2):164–71. http://www.scielo.br/j/bjorl/a/mwhLYVX3TPFtBLLHtFSLS3F/citation/?lang=en [DOI] [PMC free article] [PubMed]
- 31.Jäncke L, Steinmetz H, Volkmann J (1992) Dichotic listening: what does it measure? Neuropsychologia. [cited 2023 Aug 24];30(11):941–50. https://pubmed.ncbi.nlm.nih.gov/1470338/ [DOI] [PubMed]
- 32.Borges LR, Paschoa JR, Colella-Santos MF (2013) (Central) Auditory Processing: the impact of otitis media. Clinics 68(7):954–959 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Bodoni PSB, Leoni RF, do Vale AB, da Silva PHR, Meira Junior SG, Richieri Costa A et al Neuropsychological functioning and its relationship with brain anatomical measures of children and adolescents with non-syndromic cleft lip and palate. https://doi.org/101080/0929704920201776240. 2020 [cited 2023 Aug 19];27(1):2–16. https://www.tandfonline.com/doi/abs/10.1080/09297049.2020.1776240 [DOI] [PubMed]
- 34.Richman LC, Ryan SM Do the reading disabilities of children with cleft fit into current models of developmental dyslexia? Cleft Palate Craniofac J. 2003 Mar [cited 2023 Aug 13];40(2):154–7. https://pubmed.ncbi.nlm.nih.gov/12605520/ [DOI] [PubMed]
- 35.Devolder I, Richman L, Conrad AL, Magnotta V, Nopoulos P Abnormal cerebellar structure is dependent on phenotype of isolated cleft of the lip and/or palate. Cerebellum. 2013 Apr [cited 2023 May 21];12(2):236–44. https://pubmed.ncbi.nlm.nih.gov/23055082/ [DOI] [PMC free article] [PubMed]