- EROM can produce, what I refer to as, ‘The Otitis Media Dialect (OMD)’. What is the OMD?
- The OMD is noted in those who have had (significant) histories of EROM (whether they knew it or not). You can often hear it in their phonemic errors and in their speaking-voice.
- I’m glad you asked for phonemes first. In 1983 Shriberg and Smith ran an amazing study at 2 separate universities. Each one demonstrated the same thing. Those with a significant history of O.M. showed a significant tendency to insert an /h/ at the beginnings of words (replacing the first sound or inserting /h/ in front of a vowel (“hand” for “tan” and “hose” for owes” on the W-22s in noise). They also noted an Epenthetic Stop, I believe we see it when a person puts a stop-consonant at the beginnings of words (like on the W-22s they say “bahm” or something like it for “farm”.
- A very important phonemic error involves the /l/ and to a lesser extent /w/. We studied chinchillas, many years ago, and found that with middle ear fluid (similar to O.M.) that the middle formant of /l/ disappeared. That is, a ramp from slightly higher to lower frequency vanished. When there was fluid in the ear, even when we amplified the response to make up for the conductive loss, on the spectrogram, that ramp was gone! That made the remaining 2 formants look exactly like the vowel. Because of this and/or other reasons there are a lot of vowel confusions and/or vowel plus /l/ confusions in those we have seen with EROM.
- Oh yes, that’s not all. In addition, there were other phonemic problems. Because fluid, especially thick fluid, greatly reduces the weak high frequency sounds like /p/ and /t/. You may have heard of “H and Friends” and “Just the Friends”. They are therapies for /h/ /p/ /t/ and /k/ in the initial position with HaF and JtF for the 3 plosives in the final position.
- The other OMD characteristic that we have noticed are poor low-pitched voices, spoken from the back of the throat. In fact, if you ask the person to say /l/, you may hear a mumble from the back of the throat that sounds like a noisy short-u plus a weak noisy /l/.
- Why? On the spectrogram you will see the high frequency sounds faded-out and lots of noise that may, or may not, be associated with the speech. When you speak with the words aimed at the side of the mouth, you get a kind of a noisy speech. Unfortunately, when we speak from the back of our throats, we also minimize H-and-Friends sounds and other frontal sounds, so their speech is not clear.
- Another thing I found is that the phonemic errors that are associated with EROM take longer to correct. That is how HaF came about. I was curious what speech-in-noise errors were left at the end of WINT therapy. The 4 HaF sounds on WINT represented 30% of the errors. HaF and JtF have been most helpful.
- Itch Cards and Focus that we use in the Buffalo Model are also very helpful for stubborn speech sound confusions, like those above. I’ve added words to Itch Cards for the vowel+/l/ problems and also for Focus cards just the vowels+/l/. My new Itch words to represent the /l/ errors are “old, pool, full, ultra, whittle” (the underline shows the /l/ confusion. You may know that in some cases /l/ sounds like “ittl” to them.
About Buffalo Model Assessment and Intervention
About 35 years ago one of our graduate students checked to see how many SSW references he could find. He found more than 60. Now, I have also been working on a history of the SSW over the past 60 years. I reference 60+ SSW studies (the majority more recent than 35 years.
So just the ones he and I mentioned would be over 100 SSW reference for 50+ years. They include studies in various languages and with many disorders, dealing with site of lesion and APD.
SSW is so powerful, uses multidimensional scoring (so you get lots of details about the disorder). It is reliable and sensitive. It enables people with hearing loss to be tested effectively. It was initially based on an NIH grant with more than 100 subjects with well localized lesions. They were studied by audiologists, neurologists and a neurosurgeon as well as ENTs. This was the basis for the Buffalo Model because those results enabled us to identify 4 major types of APD.
The SSW does not stand alone. There are 3 tests that provide 40 indicators of APD. No APD test or battery has survived so many decades. In the U.S. the SSW has been reported to be the most used central test (by an independent audiology group).
The field of APD has had a history of many people saying that there is no such thing as APD (which has caused countless children and adults to suffer and under achieve in life). Some interested in APD say that short-term auditory memory is not auditory processing. Why do we do this to ourselves?
In the Buffalo Model we work to make our test and test battery as beneficial to our patients as we can. The parents of the children have been our biggest advocates. They see what the benefits have been to their children and would like to see others benefit too.
At 87 years I get such joy seeing my patients improve their lives and seeing their joy.
Be well and keep doing this wonderful work!
Professional Discussion about the significance of Auditory-Speech-Language Processing and Intervention
I was very disheartened to have a seasoned SLP tell me that “auditory therapy doesn’t really work” because so many parents that come to her have had an evaluation for APD and completed all therapy recommended with little to no results. She claimed that “what they really need is an SLP to work on language” to see real results.
So, please help!! If you can recall a specific study or article that comprehensively explains the need for many to have a full audiological evaluation for APD and treatment before and/or simultaneously with speech-language services or something similar, I would be so grateful.
Hi, I don’t have a study, but can suggest a short argument, and an entertainingly-documented case study
If the child has a language problem caused by anything other than some type of APD, language intervention is necessary and auditory training is useless.
If the child has a language problem caused by some type of APD, then auditory training to overcome the APD is necessary. Once the APD remediated, the child may or may not need language intervention to catch up. Without addressing the APD, the child may go through life continually having to exert more effort than his or her peers, just to understand what is being said. That is fatiguing and leaves fewer cognitive resources available to learn, participate etc.
Because language problems, and doubtless causes of language problems, are so multifaceted, as are APDs, a study like you are after would be very hard to do. Perhaps a professionally filmed case study of a child’s academic ability being changed by an auditory training program, delivered to address one specific type of APD, might help. If so, please pass on this link to a TV Science show on this topic. It goes for about 7 minutes and is easy to watch.
Good explanation HD
Except for one sentence where you say APD therapy is useless
In my experience i have found even those kids need help with extracting the key information and formulating responses based on what they heard
Teaching them listening skills to help language development is important and APD therapy does foster that.
I don’t think we can separate auditory-speech -and language processing with such distinct parameters
In my experience they all spill into each other and we as professionals have to know where and when to support the specific deficits regardless of whether you are doing APD therapy or Speech and Language therapy
I agree with the intermingling of skills you refer to. I think that any type of training probably has direct and indirect spill-over effects on things that the training is not actually designed to do. Two examples:
Direct spill-over: Children who were trained on spatial processing also significantly increased their scores on measures of attention and memory. I think this was a consequence of doing challenging auditory training for 15 minutes a day, 5 days a week, for 12 weeks (Cameron & Dillon, 2011, attached). These changes would probably have occurred no matter what type of training was undertaken. (But the much bigger changes in spatial hearing ability could only be achieved by spatial training.) I think you refer to a similar spill-over where some types of auditory training might directly help language development.
Indirect spill-over: Good language ability helps with understanding in acoustically challenging situations, and good auditory processing ability helps develop good language. So if auditory training improves auditory processing, it should eventually improve language, and hence even more improve listening ability in challenging situations.
That is why I cringe when professionals try to compartmentalize the -auditory speech language processing conglomerate-like they are independent functions in the brain