Pure word deafness with auditory object agnosia after bilateral lesion of the superior temporal sulcus

Situating word deafness within aphasia recovery: A case report

Word deafness is a rare neurological disorder often observed following bilateral damage to superior temporal cortex and canonically defined as an auditory modality-specific deficit in word comprehension. The extent to which word deafness is dissociable from aphasia remains unclear given its heterogeneous presentation, and some have consequently posited that word deafness instead represents a stage in recovery from aphasia, where auditory and linguistic processing are affected to varying degrees and improve at differing rates. Here, we report a case of an individual (Mr. C) with bilateral temporal lobe lesions whose presentation evolved from a severe aphasia to an atypical form of word deafness, where auditory linguistic processing was impaired at the sentence level and beyond. We first reconstructed in detail Mr. C's stroke recovery through medical record review and supplemental interviewing. Then, using behavioral testing and multimodal neuroimaging, we documented a predominant auditory linguistic deficit in sentence and narrative comprehension-with markedly reduced behavioral performance and absent brain activation in the language network in the spoken modality exclusively. In contrast, Mr. C displayed near-unimpaired behavioral performance and robust brain activations in the language network for the linguistic processing of words, irrespective of modality. We argue that these findings not only support the view of word deafness as a stage in aphasia recovery but also further instantiate the important role of left superior temporal cortex in auditory linguistic processing.

The neuroanatomical hallmarks of chronic tinnitus in comorbidity with pure-tone hearing loss

Tinnitus is one of the main hearing impairments often associated with pure-tone hearing loss, and typically manifested in the perception of phantom sounds. Nevertheless, tinnitus has traditionally been studied in isolation without necessarily considering auditory ghosting and hearing loss as part of the same syndrome. Hence, in the present neuroanatomical study, we attempted to pave the way toward a better understanding of the tinnitus syndrome, and compared two groups of almost perfectly matched individuals with (TIHL) and without (NTHL) pure-tone tinnitus, but both characterized by pure-tone hearing loss. The two groups were homogenized in terms of sample size, age, gender, handedness, education, and hearing loss. Furthermore, since the assessment of pure-tone hearing thresholds alone is not sufficient to describe the full spectrum of hearing abilities, the two groups were also harmonized for supra-threshold hearing estimates which were collected using temporal compression, frequency selectivity und speech-in-noise tasks. Regions-of-interest (ROI) analyses based on key brain structures identified in previous neuroimaging studies showed that the TIHL group exhibited increased cortical volume (CV) and surface area (CSA) of the right supramarginal gyrus and posterior planum temporale (PT) as well as CSA of the left middle-anterior part of the superior temporal sulcus (STS). The TIHL group also demonstrated larger volumes of the left amygdala and of the left head and body of the hippocampus. Notably, vertex-wise multiple linear regression analyses additionally brought to light that CSA of a specific cluster, which was located in the left middle-anterior part of the STS and overlapped with the one found to be significant in the between-group analyses, was positively associated with tinnitus distress level. Furthermore, distress also positively correlated with CSA of gray matter vertices in the right dorsal prefrontal cortex and the right posterior STS, whereas tinnitus duration was positively associated with CSA and CV of the right angular gyrus (AG) and posterior part of the STS. These results provide new insights into the critical gray matter architecture of the tinnitus syndrome matrix responsible for the emergence, maintenance and distress of auditory phantom sensations.

Auditory agnosia with anosognosia

A 66-year-old right-handed female medical doctor suffered two consecutive cardioembolic strokes, initially affecting the right frontal lobe and the right insula, followed by a lesion in the left temporal lobe. The patient presented with distinctive phenomenology of general auditory agnosia with anosognosia for the deficit. She did not understand verbal requests and her answers to oral questions were fluent but unrelated to the topic. However, she was able to correctly answer written questions, name objects, and fluently describe their purpose, which is characteristic for verbal auditory agnosia. She was also unable to recognise environmental sounds or to recognise and repeat any melody. These inabilities represent environmental sound agnosia and amusia, respectively. Surprisingly, she was not aware of the problem, not asking any questions regarding her symptoms, and avoiding discussing her inability to understand spoken language, which is indicative of anosognosia. The deficits in our patient followed a distinct pattern of recovery. The verbal auditory agnosia was the first to resolve, followed by environmental sound agnosia. Amusia persisted the longest. The patient was clinically assessed from the first day of symptom onset and the evolution of symptoms was video documented. We give a detailed account of the patient's behaviour and provide results of audiological and neuropsychological evaluations. We discuss the anatomy of auditory agnosia and anosognosia relevant to the case. This case study may serve to better understand auditory agnosia in clinical settings. It is important to distinguish auditory agnosia from Wernicke's aphasia, because use of written language may enable normal communication.

Pure word deafness in a patient with bilateral ischemic stroke in the superior temporal gyrus (STG)

INTRODUCTION

Pure word deafness is a rare neurological disorder linked with an inability to comprehend speech. The precise localization of damage is still unclear.

CASE PRESENTATION

A 72-year-old woman presented with acute verbal contact disturbances, disorientation, and anxiety. In the neurological examination a slight right hemiparesis was found, together with a pure word deafness (PWD) in neuropsychological tests. Neuroimages confirmed bilateral ischemic lesions in the superior temporal gyrus (STG) acute in the left hemisphere.

CONCLUSIONS

Our case suggested that bilateral, symmetric lesions in the region of STG could cause pure world deafness. The diversity and severity of symptoms confirm the necessity of pure world deafness classification for subtypes.

Adult normative data for the speech in babble (SiB) test

Objective: The Speech in Babble (SiB) test assesses the perception of speech in noise in UK adults. Here, we define the normal range of SiB scores to enable the use of the test in clinic.Design: In each test, 25 monosyllabic words were played in background multi-talker babble. Listeners had to repeat the word they heard. An adaptive procedure was used to determine the signal-to-noise ratio needed to reach 50% correct responses (i.e. the Speech Reception Threshold). Eight distinct equivalent lists were available.Study sample: Sixty-nine normal-hearing adults (aged 20-57 years) with no reported listening difficulties participated in the study and completed the SiB test twice in both ears.Results: Normative SiB scores varied from -0.8 dB to 3.7 dB suggesting that patients outside these limits should be considered as having abnormal scores. No statistically significant difference between ears and no effect of age or sex was found. There was "fair" test-retest reliability.Conclusion: The SiB test is a short, valid and reliable test that can be used in UK clinics, e.g. as part of a standard APD battery or evaluating the performance of hearing impaired patients.

A roadmap for the study of conscious audition and its neural basis

How and which aspects of neural activity give rise to subjective perceptual experience-i.e. conscious perception-is a fundamental question of neuroscience. To date, the vast majority of work concerning this question has come from vision, raising the issue of generalizability of prominent resulting theories. However, recent work has begun to shed light on the neural processes subserving conscious perception in other modalities, particularly audition. Here, we outline a roadmap for the future study of conscious auditory perception and its neural basis, paying particular attention to how conscious perception emerges (and of which elements or groups of elements) in complex auditory scenes. We begin by discussing the functional role of the auditory system, particularly as it pertains to conscious perception. Next, we ask: what are the phenomena that need to be explained by a theory of conscious auditory perception? After surveying the available literature for candidate neural correlates, we end by considering the implications that such results have for a general theory of conscious perception as well as prominent outstanding questions and what approaches/techniques can best be used to address them.This article is part of the themed issue 'Auditory and visual scene analysis'.

From Mimicry to Language: A Neuroanatomically Based Evolutionary Model of the Emergence of Vocal Language

The auditory cortex communicates with the frontal lobe via the middle temporal gyrus (auditory ventral stream; AVS) or the inferior parietal lobule (auditory dorsal stream; ADS). Whereas the AVS is ascribed only with sound recognition, the ADS is ascribed with sound localization, voice detection, prosodic perception/production, lip-speech integration, phoneme discrimination, articulation, repetition, phonological long-term memory and working memory. Previously, I interpreted the juxtaposition of sound localization, voice detection, audio-visual integration and prosodic analysis, as evidence that the behavioral precursor to human speech is the exchange of contact calls in non-human primates. Herein, I interpret the remaining ADS functions as evidence of additional stages in language evolution. According to this model, the role of the ADS in vocal control enabled early Homo (Hominans) to name objects using monosyllabic calls, and allowed children to learn their parents' calls by imitating their lip movements. Initially, the calls were forgotten quickly but gradually were remembered for longer periods. Once the representations of the calls became permanent, mimicry was limited to infancy, and older individuals encoded in the ADS a lexicon for the names of objects (phonological lexicon). Consequently, sound recognition in the AVS was sufficient for activating the phonological representations in the ADS and mimicry became independent of lip-reading. Later, by developing inhibitory connections between acoustic-syllabic representations in the AVS and phonological representations of subsequent syllables in the ADS, Hominans became capable of concatenating the monosyllabic calls for repeating polysyllabic words (i.e., developed working memory). Finally, due to strengthening of connections between phonological representations in the ADS, Hominans became capable of encoding several syllables as a single representation (chunking). Consequently, Hominans began vocalizing and mimicking/rehearsing lists of words (sentences).