Listening Effort in Quiet and Noisy Environments in the Daily Life of Adults With Hearing Aids: An Extended Version of the Effort Assessment Scale (EEAS)

This study was aimed at assessing listening effort (LE) in quiet and in noisy daily life situations, in 481 adults with hearing aids (HAs) and 62 adults with normal hearing, using an Extended version of the Effort Assessment Scale (EEAS). Participants were invited to self-assess their LE in daily life, on a visual analog scale graded from 0 (no effort) to 10. The EEAS's internal structure identified two separate constructs pertaining to LE in quiet and LE in noise, each with good consistency (Cronbach's α > 0.83). A three-factor model explained 12% of the variance of the EEAS scores, with HA experience the most important one, and better ear hearing threshold (averaged across 0.5-4 kHz) and ear asymmetry as the other two factors. The EEAS subscales differed in behavior, with the LE in noise being the most dependent on HA experience, whereas LE in quiet depended more on better ear hearing threshold. In a subgroup of people with 6 months to less than 24 months HA experience, a significant decrease in LE in noise was observed with increasing HA experience (0.26 points decrease per year of HA experience), whereas in a group of people with at least 24 months of HA experience, a small increase in LE in noise was observed. This effect was not mediated by age, nor hearing threshold. The extended Effort Assessment Scale is therefore offering an assessment of both LE in quiet and LE in noise, with different dependence on HA experience and hearing thresholds.

Ear Asymmetry and Contextual Influences on Speech Perception in Hearing-Impaired Patients

The left hemisphere preference for verbal stimuli is well known, with a right ear (RE) advantage obtained when competing verbal stimuli are presented simultaneously, at comfortable intensities, to both ears. Speech perception involves not only the processing of acoustic peripheral information but also top–down contextual influences, filling the gaps in the incoming information that is particularly degraded in hearing-impaired individuals. This study aimed to analyze the potential asymmetry of those contextual influences on a simple speech perception task in hearing-impaired patients in light of hemispheric asymmetry. Contextual influences on disyllabic word perception scores of 60 hearing-impaired patients were compared between left ear (LE) and RE, in a balanced design, involving two repetitions of the same task. Results showed a significantly greater contextual influence on the RE versus the LE and, for the second repetition versus the first one, without any interaction between the two. Furthermore, the difference in contextual influences between RE and LE increased significantly with the RE advantage measured by a dichotic listening test in the absence of any significant correlation with hearing threshold asymmetry. Lastly, the contextual influence asymmetry decreased significantly as age increased, which was mainly due to a greater increase, with age, of contextual influences on the LE versus the RE. Those results agree with the literature reporting a relative right-shift of hemispheric asymmetry observed with age in speech in noise perception tasks in normal hearing subjects and the clinical reports of generally better audiometric speech scores obtained in RE versus LE.

Age-related differences in bottom-up and top-down attention: Insights from EEG and MEG

Attention operates through top‐down and bottom‐up processes, and a balance between these processes is crucial for daily tasks. Imperilling such balance could explain ageing‐associated attentional problems such as exacerbated distractibility. In this study, we aimed to characterize this enhanced distractibility by investigating the impact of ageing upon event‐related components associated with top‐down and bottom‐up attentional processes. MEG and EEG data were acquired from 14 older and 14 younger healthy adults while performing a task that conjointly evaluates top‐down and bottom‐up attention. Event‐related components were analysed on sensor and source levels. In comparison with the younger group, the older mainly displayed (1) reduced target anticipation processes (reduced CMV), (2) increased early target processing (larger P50 but smaller N1) and (3) increased processing of early distracting sounds (larger N1 but reduced P3a), followed by a (4) prolonged reorientation towards the main task (larger RON). Taken together, our results suggest that the enhanced distractibility in ageing could stem from top‐down deficits, in particular from reduced inhibitory and reorientation processes.

Development of auditory cognition in 5- to 10-year-old children: Focus on musical and verbal short-term memory

Developmental aspects of auditory cognition were investigated in 5-to-10-year-old children (n = 100). Musical and verbal short-term memory (STM) were assessed by means of delayed matching-to-sample tasks (DMST) (comparison of two four-item sequences separated by a silent retention delay), with two levels of difficulty. For musical and verbal materials, children's performance increased from 5 years to about 7 years of age, then remained stable up to 10 years of age, with performance remaining inferior to performance of young adults. Children and adults performed better with verbal material than with musical material. To investigate auditory cognition beyond STM, we assessed speech-in-noise perception with a four-alternative forced-choice task with two conditions of phonological difficulty and two levels of cocktail-party noise intensity. Partial correlations, factoring out the effect of age, showed a significant link between musical STM and speech-in-noise perception in the condition with increased noise intensity. Our findings reveal that auditory STM improves over development with a critical phase around 6-7 years of age, yet these abilities appear to be still immature at 10 years. Musical and verbal STM might in particular share procedural and serial order processes. Furthermore, musical STM and the ability to perceive relevant speech signals in cocktail-party noise might rely on shared cognitive resources, possibly related to pitch encoding. To the best of our knowledge, this is the first time that auditory STM is assessed with the same paradigm for musical and verbal material during childhood, providing perspectives regarding diagnosis and remediation in developmental learning disorders.

Self-perceived attention difficulties are associated with sensory hypersensitivity in migraine

BACKGROUND

Attention is the process which enables to preferentially select salient or relevant stimuli and to attenuate the response to irrelevant incoming stimuli. Migraine is characterized by both attentional alterations and an abnormal sensory processing to external stimulations. The aim of the study was to investigate potential interactions between self-perceived attentional difficulties and sensory hypersensitivity in migraine patients.

METHODS

Forty-six episodic migraineurs without aura and 46 healthy controls filled out questionnaires on self-perceived attention difficulties and self-reported sensitivity to visual, auditory and olfactory stimulations.

RESULTS

Compared to controls, migraineurs reported significantly higher levels of attention difficulty and sensory sensitivity. Sensory hypersensitivity correlated significantly with self-perceived attentional difficulties in migraineurs (P=0.002), but not with migraine disability or levels of anxiety or depression. Ictal and interictal sensory sensitivities were significantly correlated in migraineurs within visual (P<0.001), auditory (P<0.001) and olfactory (P=0.001) modalities.

CONCLUSION

This study shows for the first time an association between self-reported attentional difficulties and multimodal sensory hypersensitivity. Studies combining behavioral and physiological measures of sensory processing and attention processes are necessary to further understand the peculiar vulnerability of migraineurs to sensory stimuli.

Correction to: A case of verbal and emotional prosody processing dissociation after a right temporal venous infarct

The above article was published online with missing authors.

Orbital exenteration and conjunctival melanoma: a 14-year study at the Jules Gonin Eye Hospital

Purpose

To report our 14-year experience with orbital exenteration and assess risk factors for poor prognosis by focusing on conjunctival melanoma.

Patients and method

A retrospective study was conducted in our tertiary care centre (Jules Gonin Eye Hospital, Lausanne, Switzerland) between 2003 and 2017. Inclusion criteria were patients aged  ≥18 years with a follow-up >12 months, without metastatic spread at the time of surgery. Data recorded were age, gender, tumour histology, surgical technique, postoperative complications, surgical margin status, local recurrence, postoperative radiation beam therapy and metastatic status.

Results

Twenty-five patients with a mean age of 63.2 years (38–92) were included. Conjunctival melanoma was the most frequently identified tumour (n = 14, 56%) followed by conjunctival squamous cell carcinoma (n = 4, 16%), sebaceous carcinoma (n = 3, 12%), choroidal melanoma (n = 2, 8%) and basal cell carcinoma (n = 2, 8%). Eighteen tumours (72%) originated from the conjunctival tissue. Clear surgical margins were achieved in 21 (84%) patients. Fourteen (56%) patients experienced distant metastases and died from metastatic spread after a mean follow-up of 52.3 months (6–120). The 1-, 3- and 5-year overall survival (OS) was 96%, 72% and 60%, respectively. In the univariate analysis, positive surgical margins, local recurrence and metachronous metastases were associated with a decreased OS (p = 0.002, p = 0.005 and p = 0.007, respectively). In the multivariate analysis, positive surgical margins and metachronous metastases were also associated with a decreased OS (p = 0.02 and p = 0.042, respectively). Conjunctival melanoma was not associated with a poorer prognosis (p = 0.280).

Conclusion

Free surgical margins are needed to increase OS. To achieve clearer surgical margins, neoadjuvant targeted therapies/immunotherapies may be considered.

[Clinical, radiological, pathological features, treatment and follow-up of periocular and/or orbital amyloidosis: Report of 6 cases and literature review]

PURPOSE

To assess demographic, clinical, radiological, pathological features, treatment and follow-up of periocular or/and orbital amyloidosis.

PATIENTS AND METHODS

We conducted an observational retrospective monocentric study from January 2004 to April 2017 in patients diagnosed with histologically proven periocular or/and orbital amyloidosis.

RESULTS

Six patients were included (2 females, 4 males). Mean age was 76.8 years (range 66-88 years). Mean time between first ophthalmological symptoms and diagnosis was 27 months (range 11-36 months). The main symptoms were subconjunctival infiltration (6 patients; 100%), periocular pain or discomfort (4 patients; 66.6%) and subconjunctival hemorrhage (1 patient; 16.6%). Clinical findings included ptosis (4 patients; 66.6%), keratitis (3 patients; 50%) leading to corneal perforation in one patient, and proptosis (3 patients; 50%). One-half of the patients showed bilateral involvement. AL amyloidosis was identified on immunohistochemistry in 5 patients (83.3%). One case of B cell marginal zone orbital lymphoma was diagnosed. Systemic work-up was negative for all patients. Treatment consisted of simple monitoring (1 patient; 16.6%), surgical debulking (3 patients; 50%), ptosis surgery (1 patient; 16.6%), eyelid or eyelash malposition surgery (2 patients; 33.3%) and orbital radiation beam therapy (2 patients; 33.3%). Mean follow-up was 14.6 months (range 6-36 months), and no progression nor recurrence were noted.

CONCLUSION

Periocular or/and orbital amyloidosis is rarely encountered. Diagnosis is based on pathological examination, and immunohistochemistry analysis should always be performed to guide systemic work-up. Orbital lymphoma and multiple myeloma should be ruled out if AL amyloidosis is diagnosed. Progression is slow, and surgery is the mainstay of treatment in symptomatic patients. Long-term multidisciplinary follow-up is advocated.

Lexical Influences on Spoken Spondaic Word Recognition in Hearing-Impaired Patients

Top-down contextual influences play a major part in speech understanding, especially in hearing-impaired patients with deteriorated auditory input. Those influences are most obvious in difficult listening situations, such as listening to sentences in noise but can also be observed at the word level under more favorable conditions, as in one of the most commonly used tasks in audiology, i.e., repeating isolated words in silence. This study aimed to explore the role of top-down contextual influences and their dependence on lexical factors and patient-specific factors using standard clinical linguistic material. Spondaic word perception was tested in 160 hearing-impaired patients aged 23-88 years with a four-frequency average pure-tone threshold ranging from 21 to 88 dB HL. Sixty spondaic words were randomly presented at a level adjusted to correspond to a speech perception score ranging between 40 and 70% of the performance intensity function obtained using monosyllabic words. Phoneme and whole-word recognition scores were used to calculate two context-influence indices (the j factor and the ratio of word scores to phonemic scores) and were correlated with linguistic factors, such as the phonological neighborhood density and several indices of word occurrence frequencies. Contextual influence was greater for spondaic words than in similar studies using monosyllabic words, with an overall j factor of 2.07 (SD = 0.5). For both indices, context use decreased with increasing hearing loss once the average hearing loss exceeded 55 dB HL. In right-handed patients, significantly greater context influence was observed for words presented in the right ears than for words presented in the left, especially in patients with many years of education. The correlations between raw word scores (and context influence indices) and word occurrence frequencies showed a significant age-dependent effect, with a stronger correlation between perception scores and word occurrence frequencies when the occurrence frequencies were based on the years corresponding to the patients' youth, showing a "historic" word frequency effect. This effect was still observed for patients with few years of formal education, but recent occurrence frequencies based on current word exposure had a stronger influence for those patients, especially for younger ones.

Triazole GHS-R1a antagonists JMV4208 and JMV3002 attenuate food intake, body weight, and adipose tissue mass in mice

The only peripherally released orexigenic hormone, ghrelin, plays a key role in food intake and body weight regulation. Antagonizing the ghrelin receptor, GHS-R1a, represents a promising approach for anti-obesity therapy. In our study, two novel GHS-R1a antagonists JMV4208 and JMV3002, which are trisubstituted 1,2,4-triazoles, decreased food intake in fasted lean mice in a dose-dependent manner, with ED50 values of 5.25 and 2.05 mg/kg, respectively. Both compounds were stable in mouse blood, with half-lives of 90 min (JMV4208) and 60 min (JMV3002), and disappeared from the blood 8h after administration. Fourteen days of treatment with the ghrelin antagonists (20 mg/kg twice a day) decreased food intake, body weight and adipose tissue mass in mice with diet-induced obesity (DIO). These results are likely attributable to an impact on food intake reduction and an attenuated expression of the lipogenesis-promoting enzymes (acetyl-CoA carboxylase 1 in subcutaneous fat and fatty acid synthase in subcutaneous and intraperitoneal fat). The decrease in fat mass negatively impacted circulating leptin levels. These data suggest that JMV4208 and JMV3002 could be useful therapeutic agents for the treatment of obesity.

A Computerized Closed-Response Speech Test in the ENT Clinic

Objective: 1) To assess the feasibility of a computer-based closed-response speech test (CRST) in the ENT clinic. 2) To compare a closed response speech test to standard speech audiometry.

Method: Thirty patients underwent otoscopy, tympanometry, pure-tone audiometry, speech audiometry and a closed-response speech test (CRST). For the CRST, patients were asked to choose, on a tactile computer screen, the words that were presented to their ear, amongst a choice of 4 words. Fifteen sets of 4 words were used.

Results: The CRST was well accepted by all patients, whatever their computer literacy, but took significantly longer (10 to 15 minutes per ear) than speech audiometry did. Pure transmission hearing losses showed a translation of the performance intensity function toward greater intensities, without change in slope, as in standard speech audiometry. Correlations between auditory thresholds and speech recognition thresholds were greater for the CRST ( r = 0.70, P < .01) than for speech audiometry ( r = 0.46, P < .05). Several cases of patients showing very similar speech audiometry performance intensity functions, but different CRST scores were identified.

Conclusion: Although the closed-set computerized test took substantially longer than speech audiometry, it was well accepted by patients. It was more sensitive to minor alterations of hearing than speech audiometry and shows promise as a longitudinal assessment tool of speech perception.

Aging and Linguistic Factors Influence on Speech Audiometry

Objective: 1) Assess the influence of word familiarity, phonological neighborhood, and acoustic patterns on speech audiometry variability. 2) Evaluate the interaction between those factors and patients’ age and years of education.

Method: Patients (n = 160) underwent otoscopy, tympanometry, pure-tone, and speech audiometry. At an intensity level corresponding to a speech score between 40% and 60%, patients were presented 6 lists of 10 spondees, taken from a standard material used in France. Linguistic characteristics of the spondees and spectral acoustic patterns were characterized. PLS regression analysis was used to determine the factors influencing the percent score recognition for each word (PC).

Results: PC varied from 18% to 92%. PC rose significantly with word familiarity ( r = 0.38, P = .005) and 1 kHz frequency band amplitude of each word’s acoustic spectrum ( r = 0.60, P = .001). The percentage variability due to linguistic factors decreased significantly with age (from 30% below 50 years old to less than 10% above 60 years old), and with number of educational years (NEY; from 40% for NEY under 10 down to 18% for NEY above 10, for patients less than 50 years old). PC was significantly lower for spondees with large phonological neighborhood ( F(1, 51) = 12, P = .002), word familiarity being equal) for patients with NEY above 10.

Conclusion: When taken independently from hearing loss, variability in PC was explained mostly by linguistic factors, combined with age and years of education, hence the need of carefully considering those factors when conceiving speech audiometry material.