1
|
Kamerer AM, Harris SE, Wichman CS, Rasetshwane DM, Neely ST. The relationship and interdependence of auditory thresholds, proposed behavioural measures of hidden hearing loss, and physiological measures of auditory function. Int J Audiol 2024:1-14. [PMID: 39180321 DOI: 10.1080/14992027.2024.2391986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/12/2024] [Accepted: 08/07/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVES Standard diagnostic measures focus on threshold elevation but hearing concerns may occur independently of threshold elevation - referred to as "hidden hearing loss" (HHL). A deeper understanding of HHL requires measurements that locate dysfunction along the auditory pathway. This study aimed to describe the relationship and interdependence between certain behavioural and physiological measures of auditory function that are thought to be indicative of HHL. DESIGN Data were collected on a battery of behavioural and physiological measures of hearing. Threshold-dependent variance was removed from each measure prior to generating a multiple regression model of the behavioural measures using the physiological measures. STUDY SAMPLE 224 adults in the United States with audiometric thresholds ≤65 dB HL. RESULTS Thresholds accounted for between 21 and 60% of the variance in our behavioural measures and 5-51% in our physiological measures of hearing. There was no evidence that the behavioural measures of hearing could be predicted by the selected physiological measures. CONCLUSIONS Several proposed behavioural measures for HHL: thresholds-in-noise, frequency-modulation detection, and speech recognition in difficult listening conditions, are influenced by hearing sensitivity and are not predicted by outer hair cell or auditory nerve physiology. Therefore, these measures may not be able to assess threshold-independent hearing disorders.
Collapse
Affiliation(s)
| | - Sara E Harris
- Boys Town National Research Hospital, Omaha, NE, USA
| | | | | | | |
Collapse
|
2
|
Brice S, Zakis J, Almond H. Changing Knowledge, Principles, and Technology in Contemporary Clinical Audiological Practice: A Narrative Review. J Clin Med 2024; 13:4538. [PMID: 39124804 PMCID: PMC11313557 DOI: 10.3390/jcm13154538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
The field of audiology as a collection of auditory science knowledge, research, and clinical methods, technologies, and practices has seen great changes. A deeper understanding of psychological, cognitive, and behavioural interactions has led to a growing range of variables of interest to measure and track in diagnostic and rehabilitative processes. Technology-led changes to clinical practices, including teleaudiology, have heralded a call to action in order to recognise the role and impact of autonomy and agency on clinical practice, engagement, and outcomes. Advances in and new information on loudness models, tinnitus, psychoacoustics, deep neural networks, machine learning, predictive and adaptive algorithms, and PREMs/PROMs have enabled innovations in technology to revolutionise clinical principles and practices for the following: (i) assessment, (ii) fitting and programming of hearing devices, and (iii) rehabilitation. This narrative review will consider how the rise of teleaudiology as a growing and increasingly fundamental element of contemporary adult audiological practice has affected the principles and practices of audiology based on a new era of knowledge and capability. What areas of knowledge have grown? How has new knowledge shifted the priorities in clinical audiology? What technological innovations have been combined with these to change clinical practices? Above all, where is hearing loss now consequently positioned in its journey as a field of health and medicine?
Collapse
Affiliation(s)
- Sophie Brice
- Australian Institute of Health Service Management, COBE, University of Tasmania, Sandy Bay, Hobart, TAS 7001, Australia
- Institute of Health Management, 185-187 Boundary Road, North Melbourne, VIC 3051, Australia
| | - Justin Zakis
- National Acoustic Laboratories, Level 4, 16 University Avenue, Macquarie University, NSW 2109, Australia
| | - Helen Almond
- Institute of Health Management, 185-187 Boundary Road, North Melbourne, VIC 3051, Australia
| |
Collapse
|
3
|
Andéol G, Paraouty N, Giraudet F, Wallaert N, Isnard V, Moulin A, Suied C. Predictors of Speech-in-Noise Understanding in a Population of Occupationally Noise-Exposed Individuals. BIOLOGY 2024; 13:416. [PMID: 38927296 PMCID: PMC11200776 DOI: 10.3390/biology13060416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
Understanding speech in noise is particularly difficult for individuals occupationally exposed to noise due to a mix of noise-induced auditory lesions and the energetic masking of speech signals. For years, the monitoring of conventional audiometric thresholds has been the usual method to check and preserve auditory function. Recently, suprathreshold deficits, notably, difficulties in understanding speech in noise, has pointed out the need for new monitoring tools. The present study aims to identify the most important variables that predict speech in noise understanding in order to suggest a new method of hearing status monitoring. Physiological (distortion products of otoacoustic emissions, electrocochleography) and behavioral (amplitude and frequency modulation detection thresholds, conventional and extended high-frequency audiometric thresholds) variables were collected in a population of individuals presenting a relatively homogeneous occupational noise exposure. Those variables were used as predictors in a statistical model (random forest) to predict the scores of three different speech-in-noise tests and a self-report of speech-in-noise ability. The extended high-frequency threshold appears to be the best predictor and therefore an interesting candidate for a new way of monitoring noise-exposed professionals.
Collapse
Affiliation(s)
- Guillaume Andéol
- Institut de Recherche Biomédicale des Armées, 1 Place Valérie André, 91220 Brétigny sur Orge, France; (V.I.); (C.S.)
| | - Nihaad Paraouty
- iAudiogram—My Medical Assistant SAS, 51100 Reims, France; (N.P.); (N.W.)
| | - Fabrice Giraudet
- Department of Neurosensory Biophysics, INSERM U1107 NEURO-DOL, School of Medecine, Université Clermont Auvergne, 63000 Clermont-Ferrand, France;
| | - Nicolas Wallaert
- iAudiogram—My Medical Assistant SAS, 51100 Reims, France; (N.P.); (N.W.)
- Laboratoire des Systèmes Perceptifs, UMR CNRS 8248, Département d’Etudes Cognitives, Ecole Normale Supérieure, Université Paris Sciences et Lettres (PSL), 75005 Paris, France
- Department of Otorhinolaryngology-Head and Neck Surgery, Rennes University Hospital, 35000 Rennes, France
| | - Vincent Isnard
- Institut de Recherche Biomédicale des Armées, 1 Place Valérie André, 91220 Brétigny sur Orge, France; (V.I.); (C.S.)
| | - Annie Moulin
- Centre de Recherche en Neurosciences de Lyon, CRNL Inserm U1028—CNRS UMR5292—UCBLyon1, Perception Attention Memory Team, Bâtiment 452 B, 95 Bd Pinel, 69675 Bron Cedex, France;
| | - Clara Suied
- Institut de Recherche Biomédicale des Armées, 1 Place Valérie André, 91220 Brétigny sur Orge, France; (V.I.); (C.S.)
| |
Collapse
|
4
|
Dias JW, McClaskey CM, Alvey AP, Lawson A, Matthews LJ, Dubno JR, Harris KC. Effects of age and noise exposure history on auditory nerve response amplitudes: A systematic review, study, and meta-analysis. Hear Res 2024; 447:109010. [PMID: 38744019 PMCID: PMC11135078 DOI: 10.1016/j.heares.2024.109010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
Auditory nerve (AN) function has been hypothesized to deteriorate with age and noise exposure. Here, we perform a systematic review of published studies and find that the evidence for age-related deficits in AN function is largely consistent across the literature, but there are inconsistent findings among studies of noise exposure history. Further, evidence from animal studies suggests that the greatest deficits in AN response amplitudes are found in noise-exposed aged mice, but a test of the interaction between effects of age and noise exposure on AN function has not been conducted in humans. We report a study of our own examining differences in the response amplitude of the compound action potential N1 (CAP N1) between younger and older adults with and without a self-reported history of noise exposure in a large sample of human participants (63 younger adults 18-30 years of age, 103 older adults 50-86 years of age). CAP N1 response amplitudes were smaller in older than younger adults. Noise exposure history did not appear to predict CAP N1 response amplitudes, nor did the effect of noise exposure history interact with age. We then incorporated our results into two meta-analyses of published studies of age and noise exposure history effects on AN response amplitudes in neurotypical human samples. The meta-analyses found that age effects across studies are robust (r = -0.407), but noise exposure effects are weak (r = -0.152). We conclude that noise exposure effects may be highly variable depending on sample characteristics, study design, and statistical approach, and researchers should be cautious when interpreting results. The underlying pathology of age-related and noise-induced changes in AN function are difficult to determine in living humans, creating a need for longitudinal studies of changes in AN function across the lifespan and histological examination of the AN from temporal bones collected post-mortem.
Collapse
Affiliation(s)
- James W Dias
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425-5500, United States.
| | - Carolyn M McClaskey
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425-5500, United States
| | - April P Alvey
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425-5500, United States
| | - Abigail Lawson
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425-5500, United States
| | - Lois J Matthews
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425-5500, United States
| | - Judy R Dubno
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425-5500, United States
| | - Kelly C Harris
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425-5500, United States
| |
Collapse
|
5
|
Takahashi S, Zhou Y, Cheatham MA, Homma K. The frequency dependence of prestin-mediated fast electromotility for mammalian cochlear amplification. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.22.595389. [PMID: 38826260 PMCID: PMC11142200 DOI: 10.1101/2024.05.22.595389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Prestin's voltage-driven motor activity confers sound-elicited somatic electromotility in auditory outer hair cells (OHCs) and is essential for the exquisite sensitivity and frequency selectivity of mammalian hearing. Lack of prestin results in hearing threshold shifts across frequency, supporting the causal association of variants in the prestin-coding gene, SLC26A5 , with human hearing loss, DFNB61. However, cochlear function can tolerate reductions in prestin-mediated OHC electromotility. We found that two deafness-associated prestin variants, p.A100T and p.P119S, do not deprive prestin of its fast motor function but significantly reduce membrane expression, leading to large reductions in OHC electromotility that were only ∼30% of wildtype (WT). Mice harboring these missense variants suffered congenital hearing loss that was worse at high frequencies; however, they retained WT-like auditory brainstem response thresholds at 8 kHz, which is processed at the apex of the mouse cochlea. This observation suggests the increasing importance of prestin-driven cochlear amplification at higher frequencies relevant to mammalian hearing. The observation also suggests the promising clinical possibility that small enhancements of OHC electromotility could significantly ameliorate DFNB61 hearing loss in human patients. SIGNIFICANCE Prestin is abundantly expressed in the auditory outer hair cells and is essential for normal cochlear operation. Hence, reduction of prestin expression is often taken as indicative of reduced cochlear function in diseased or aged ears. However, this assumption overlooks the fact that cochlear function can tolerate large reductions in prestin motor activity. DFNB61 mouse models generated and characterized in this study provide an opportunity to gauge the amount of prestin motor activity needed to sustain normal hearing sensitivity. This knowledge is crucial not only for understanding the pathogenic roles of deafness-associated variants that impair OHC electromotility but also for unraveling how prestin contributes to cochlear amplification.
Collapse
|
6
|
Dias JW, McClaskey CM, Alvey AP, Lawson A, Matthews LJ, Dubno JR, Harris KC. Effects of Age and Noise Exposure History on Auditory Nerve Response Amplitudes: A Systematic Review, Study, and Meta-Analysis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.20.585882. [PMID: 38585917 PMCID: PMC10996537 DOI: 10.1101/2024.03.20.585882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Auditory nerve (AN) function has been hypothesized to deteriorate with age and noise exposure. Here, we perform a systematic review of published studies and find that the evidence for age-related deficits in AN function is largely consistent across the literature, but there are inconsistent findings among studies of noise exposure history. Further, evidence from animal studies suggests that the greatest deficits in AN response amplitudes are found in noise-exposed aged mice, but a test of the interaction between effects of age and noise exposure on AN function has not been conducted in humans. We report a study of our own examining differences in the response amplitude of the compound action potential N1 (CAP N1) between younger and older adults with and without a self-reported history of noise exposure in a large sample of human participants (63 younger adults 18-30 years of age, 103 older adults 50-86 years of age). CAP N1 response amplitudes were smaller in older than younger adults. Noise exposure history did not appear to predict CAP N1 response amplitudes, nor did the effect of noise exposure history interact with age. We then incorporated our results into two meta-analyses of published studies of age and noise exposure history effects on AN response amplitudes in neurotypical human samples. The meta-analyses found that age effects across studies are robust (r=-0.407), but noise-exposure effects are weak (r=-0.152). We conclude that noise-exposure effects may be highly variable depending on sample characteristics, study design, and statistical approach, and researchers should be cautious when interpreting results. The underlying pathology of age-related and noise-induced changes in AN function are difficult to determine in living humans, creating a need for longitudinal studies of changes in AN function across the lifespan and histological examination of the AN from temporal bones collected post-mortem.
Collapse
Affiliation(s)
- James W Dias
- Medical University of South Carolina Department of Otolaryngology - Head and Neck Surgery
| | - Carolyn M McClaskey
- Medical University of South Carolina Department of Otolaryngology - Head and Neck Surgery
| | - April P Alvey
- Medical University of South Carolina Department of Otolaryngology - Head and Neck Surgery
| | - Abigail Lawson
- Medical University of South Carolina Department of Otolaryngology - Head and Neck Surgery
| | - Lois J Matthews
- Medical University of South Carolina Department of Otolaryngology - Head and Neck Surgery
| | - Judy R Dubno
- Medical University of South Carolina Department of Otolaryngology - Head and Neck Surgery
| | - Kelly C Harris
- Medical University of South Carolina Department of Otolaryngology - Head and Neck Surgery
| |
Collapse
|
7
|
Bramhall NF, McMillan GP. Perceptual Consequences of Cochlear Deafferentation in Humans. Trends Hear 2024; 28:23312165241239541. [PMID: 38738337 DOI: 10.1177/23312165241239541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Cochlear synaptopathy, a form of cochlear deafferentation, has been demonstrated in a number of animal species, including non-human primates. Both age and noise exposure contribute to synaptopathy in animal models, indicating that it may be a common type of auditory dysfunction in humans. Temporal bone and auditory physiological data suggest that age and occupational/military noise exposure also lead to synaptopathy in humans. The predicted perceptual consequences of synaptopathy include tinnitus, hyperacusis, and difficulty with speech-in-noise perception. However, confirming the perceptual impacts of this form of cochlear deafferentation presents a particular challenge because synaptopathy can only be confirmed through post-mortem temporal bone analysis and auditory perception is difficult to evaluate in animals. Animal data suggest that deafferentation leads to increased central gain, signs of tinnitus and abnormal loudness perception, and deficits in temporal processing and signal-in-noise detection. If equivalent changes occur in humans following deafferentation, this would be expected to increase the likelihood of developing tinnitus, hyperacusis, and difficulty with speech-in-noise perception. Physiological data from humans is consistent with the hypothesis that deafferentation is associated with increased central gain and a greater likelihood of tinnitus perception, while human data on the relationship between deafferentation and hyperacusis is extremely limited. Many human studies have investigated the relationship between physiological correlates of deafferentation and difficulty with speech-in-noise perception, with mixed findings. A non-linear relationship between deafferentation and speech perception may have contributed to the mixed results. When differences in sample characteristics and study measurements are considered, the findings may be more consistent.
Collapse
Affiliation(s)
- Naomi F Bramhall
- VA National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Garnett P McMillan
- VA National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, OR, USA
| |
Collapse
|
8
|
Colla MDF, Lunardelo PP, Dias FAM. Cochlear synaptopathy and hidden hearing loss: a scoping review. Codas 2023; 36:e20230032. [PMID: 37991055 DOI: 10.1590/2317-1782/20232023032pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/10/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE To identify the pathophysiological definitions adopted by studies investigating "cochlear synaptopathy" (CS) and "hidden hearing loss" (HHL). RESEARCH STRATEGIES The combination of keywords "Auditory Synaptopathy" or "Neuronal Synaptopathy" or "Hidden Hearing Loss" with "etiology" or "causality" or "diagnosis" was used in the databases EMBASE, Pubmed (MEDLINE), CINAHL (EBSCO), and Web of Science. SELECTION CRITERIA Studies that investigated CS or HHL in humans using behavioral and/or electrophysiological procedures were included. DATA ANALYSIS Data analysis and extraction were performed with regard to terminology, definitions, and population. RESULTS 49 articles were included. Of these, 61.2% used the CS terminology, 34.7% used both terms, and 4.1% used HHL. The most-studied conditions were exposure to noise and tinnitus. CONCLUSION CS terminology was used in most studies, referring to the pathophysiological process of deafferentiation between the cochlear nerve fibers and inner hair cells.
Collapse
Affiliation(s)
- Marina de Figueiredo Colla
- Departamento de Fonoaudiologia, Pontifícia Universidade Católica de Minas Gerais - PUC MG - Belo Horizonte (MG), Brasil
| | - Pamela Papile Lunardelo
- Programa de Pós-graduação em Psicobiologia, Universidade de São Paulo de Ribeirão Preto - USP RP - Ribeirão Preto (SP), Brasil
| | - Fernanda Abalen Martins Dias
- Departamento de Fonoaudiologia, Pontifícia Universidade Católica de Minas Gerais - PUC MG - Belo Horizonte (MG), Brasil
| |
Collapse
|
9
|
Le Prell CG, Clavier OH, Bao J. Noise-induced hearing disorders: Clinical and investigational tools. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 153:711. [PMID: 36732240 PMCID: PMC9889121 DOI: 10.1121/10.0017002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 06/18/2023]
Abstract
A series of articles discussing advanced diagnostics that can be used to assess noise injury and associated noise-induced hearing disorders (NIHD) was developed under the umbrella of the United States Department of Defense Hearing Center of Excellence Pharmaceutical Interventions for Hearing Loss working group. The overarching goals of the current series were to provide insight into (1) well-established and more recently developed metrics that are sensitive for detection of cochlear pathology or diagnosis of NIHD, and (2) the tools that are available for characterizing individual noise hazard as personal exposure will vary based on distance to the sound source and placement of hearing protection devices. In addition to discussing the utility of advanced diagnostics in patient care settings, the current articles discuss the selection of outcomes and end points that can be considered for use in clinical trials investigating hearing loss prevention and hearing rehabilitation.
Collapse
Affiliation(s)
- Colleen G Le Prell
- Department of Speech, Language, and Hearing Science, University of Texas at Dallas, Richardson, Texas 75080, USA
| | | | - Jianxin Bao
- Gateway Biotechnology Inc., St. Louis, Missouri 63132, USA
| |
Collapse
|
10
|
Grinn SK, Le Prell CG. Evaluation of hidden hearing loss in normal-hearing firearm users. Front Neurosci 2022; 16:1005148. [PMID: 36389238 PMCID: PMC9644938 DOI: 10.3389/fnins.2022.1005148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/07/2022] [Indexed: 04/05/2024] Open
Abstract
Some noise exposures resulting in temporary threshold shift (TTS) result in cochlear synaptopathy. The purpose of this retrospective study was to evaluate a human population that might be at risk for noise-induced cochlear synaptopathy (i.e., "hidden hearing loss"). Participants were firearm users who were (1) at-risk for prior audiometric noise-induced threshold shifts, given their history of firearm use, (2) likely to have experienced complete threshold recovery if any prior TTS had occurred, based on this study's normal-hearing inclusion criteria, and (3) not at-risk for significant age-related synaptopathic loss, based on this study's young-adult inclusion criteria. 70 participants (age 18-25 yr) were enrolled, including 33 firearm users experimental (EXP), and 37 non-firearm users control (CNTRL). All participants were required to exhibit audiometric thresholds ≤20 dB HL bilaterally, from 0.25 to 8 kHz. The study was designed to test the hypothesis that EXP participants would exhibit a reduced cochlear nerve response compared to CNTRL participants, despite normal-hearing sensitivity in both groups. No statistically significant group differences in auditory performance were detected between the CNTRL and EXP participants on standard audiom to etry, extended high-frequency audiometry, Words-in-Noise performance, distortion product otoacoustic emission, middle ear muscle reflex, or auditory brainstem response. Importantly, 91% of EXP participants reported that they wore hearing protection either "all the time" or "almost all the time" while using firearms. The data suggest that consistent use of hearing protection during firearm use can effectively protect cochlear and neural measures of auditory function, including suprathreshold responses. The current results do not exclude the possibility that neural pathology may be evident in firearm users with less consistent hearing protection use. However, firearm users with less consistent hearing protection use are also more likely to exhibit threshold elevation, among other cochlear deficits, thereby confounding the isolation of any potentially selective neural deficits. Taken together, it seems most likely that firearm users who consistently and correctly use hearing protection will exhibit preserved measures of cochlear and neural function, while firearm users who inconsistently and incorrectly use hearing protection are most likely to exhibit cochlear injury, rather than evidence of selective neural injury in the absence of cochlear injury.
Collapse
Affiliation(s)
- Sarah K. Grinn
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant, MI, United States
| | - Colleen G. Le Prell
- Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, TX, United States
| |
Collapse
|
11
|
Le Prell CG. Prevention of Noise-Induced Hearing Loss Using Investigational Medicines for the Inner Ear: Previous Trial Outcomes Should Inform Future Trial Design. Antioxid Redox Signal 2022; 36:1171-1202. [PMID: 34346254 PMCID: PMC9221155 DOI: 10.1089/ars.2021.0166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/13/2022]
Abstract
Significance: Noise-induced hearing loss (NIHL) is an important public health issue resulting in decreased quality of life for affected individuals, and significant costs to employers and governmental agencies. Recent Advances: Advances in the mechanistic understanding of NIHL have prompted a growing number of proposed, in-progress, and completed clinical trials for possible protections against NIHL via antioxidants and other drug agents. Thirty-one clinical trials evaluating prevention of either temporary or permanent NIHL were identified and are reviewed. Critical Issues: This review revealed little consistency in the noise-exposed populations in which drugs are evaluated or the primary outcomes used to measure NIHL prevention. Changes in pure-tone thresholds were the most common primary outcomes; specific threshold metrics included both average hearing loss and incidence of significant hearing loss. Changes in otoacoustic emission (OAE) amplitude were relatively common secondary outcomes. Extended high-frequency (EHF) hearing and speech-in-noise perception are commonly adversely affected by noise exposure but are not consistently included in clinical trials assessing prevention of NIHL. Future Directions: Multiple criteria are available for monitoring NIHL, but the specific criterion to be used to define clinically significant otoprotection remains a topic of discussion. Audiogram-based primary outcome measures can be combined with secondary outcomes, including OAE amplitude, EHF hearing, speech-in-noise testing, tinnitus surveys, and patient-reported outcomes. Standardization of test protocols for the above primary and secondary outcomes, and associated reporting criterion for each, would facilitate clinical trial design and comparison of results across investigational drug agents. Antioxid. Redox Signal. 36, 1171-1202.
Collapse
Affiliation(s)
- Colleen G. Le Prell
- Department of Speech, Language, and Hearing Science, University of Texas at Dallas, Richardson, Texas, USA
| |
Collapse
|
12
|
Ripley S, Xia L, Zhang Z, Aiken SJ, Wang J. Animal-to-Human Translation Difficulties and Problems With Proposed Coding-in-Noise Deficits in Noise-Induced Synaptopathy and Hidden Hearing Loss. Front Neurosci 2022; 16:893542. [PMID: 35720689 PMCID: PMC9199355 DOI: 10.3389/fnins.2022.893542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/22/2022] [Indexed: 12/26/2022] Open
Abstract
Noise induced synaptopathy (NIS) and hidden hearing loss (NIHHL) have been hot topic in hearing research since a massive synaptic loss was identified in CBA mice after a brief noise exposure that did not cause permanent threshold shift (PTS) in 2009. Based upon the amount of synaptic loss and the bias of it to synapses with a group of auditory nerve fibers (ANFs) with low spontaneous rate (LSR), coding-in-noise deficit (CIND) has been speculated as the major difficult of hearing in subjects with NIS and NIHHL. This speculation is based upon the idea that the coding of sound at high level against background noise relies mainly on the LSR ANFs. However, the translation from animal data to humans for NIS remains to be justified due to the difference in noise exposure between laboratory animals and human subjects in real life, the lack of morphological data and reliable functional methods to quantify or estimate the loss of the afferent synapses by noise. Moreover, there is no clear, robust data revealing the CIND even in animals with the synaptic loss but no PTS. In humans, both positive and negative reports are available. The difficulty in verifying CINDs has led a re-examination of the hypothesis that CIND is the major deficit associated with NIS and NIHHL, and the theoretical basis of this idea on the role of LSR ANFs. This review summarized the current status of research in NIS and NIHHL, with focus on the translational difficulty from animal data to human clinicals, the technical difficulties in quantifying NIS in humans, and the problems with the SR theory on signal coding. Temporal fluctuation profile model was discussed as a potential alternative for signal coding at high sound level against background noise, in association with the mechanisms of efferent control on the cochlea gain.
Collapse
Affiliation(s)
- Sara Ripley
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, NS, Canada
| | - Li Xia
- Department of Otolaryngology-Head and Neck Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Zhen Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Steve J. Aiken
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, NS, Canada
| | - Jian Wang
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, NS, Canada
- Department of Otolaryngology-Head and Neck Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| |
Collapse
|
13
|
Sonstrom Malowski K, Gollihugh LH, Malyuk H, Le Prell CG. Auditory changes following firearm noise exposure, a review. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 151:1769. [PMID: 35364940 DOI: 10.1121/10.0009675] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
Firearms produce peak sound pressure levels (peak SPL) between ∼130 and 175 dB peak SPL, creating significant risk of noise-induced hearing loss (NIHL) in those exposed to firearm noise during occupational, recreational, and/or military operations. Noise-induced tinnitus and hearing loss are common in military service members, public safety officers, and hunters/shooters. Given the significant risk of NIHL due to firearm and other noise sources, there is an interest in, and demand for, interventions to prevent and/or treat NIHL in high-risk populations. However, research and clinical trial designs assessing NIHL prevention have varied due to inconsistent data from the literature, specifically with end point definitions, study protocols, and assessment methodologies. This article presents a scoping review of the literature pertaining to auditory changes following firearm noise exposure. Meta-analysis was not possible due to heterogeneity of the study designs. Recommendations regarding audiologic test approach and monitoring of populations at risk for NIHL are presented based on critical review of the existing literature.
Collapse
Affiliation(s)
| | - Lindsay H Gollihugh
- School of Speech-Language Pathology and Audiology, The University of Akron, Akron, Ohio 44325, USA
| | - Heather Malyuk
- School of Speech-Language Pathology and Audiology, The University of Akron, Akron, Ohio 44325, USA
| | - Colleen G Le Prell
- Department of Speech, Language, and Hearing, The University of Texas at Dallas, Richardson, Texas 75080, USA
| |
Collapse
|
14
|
Le Prell CG. Investigational Medicinal Products for the Inner Ear: Review of Clinical Trial Characteristics in ClinicalTrials.gov. J Am Acad Audiol 2021; 32:670-694. [PMID: 35609594 PMCID: PMC9129919 DOI: 10.1055/s-0041-1735522] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/21/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The previous 30 years have provided information on the mechanisms of cell death in the inner ear after noise exposure, ototoxic drug injury, and during aging, and clinical trials have emerged for all of these acquired forms of hearing loss. Sudden hearing loss is less well understood, but restoration of hearing after sudden hearing loss is also a long-standing drug target, typically using steroids as an intervention but with other agents of interest as well. PURPOSE The purpose of this review was to describe the state of the science regarding clinical testing of investigational medicinal products for the inner ear with respect to treatment or prevention of acquired hearing loss. DATA COLLECTION AND ANALYSIS Comprehensive search and summary of clinical trials listed in the National Library of Medicine (www. CLINICALTRIALS gov) database identified 61 clinical trials. RESULTS Study phase, status, intervention, and primary, secondary, and other outcomes are summarized for studies assessing prevention of noise-induced hearing loss, prevention of drug-induced hearing loss, treatment of stable sensorineural hearing loss, and treatment of sudden sensorineural hearing loss. CONCLUSION This review provides a comprehensive summary of the state of the science with respect to investigational medicinal products for the inner ear evaluated in human clinical trials, and the current challenges for the field.
Collapse
MESH Headings
- Cell Death/drug effects
- Cell Death/physiology
- Deafness/chemically induced
- Deafness/drug therapy
- Deafness/prevention & control
- Ear, Inner/pathology
- Hearing Loss, Noise-Induced/drug therapy
- Hearing Loss, Noise-Induced/pathology
- Hearing Loss, Noise-Induced/prevention & control
- Hearing Loss, Sensorineural/chemically induced
- Hearing Loss, Sensorineural/drug therapy
- Hearing Loss, Sensorineural/pathology
- Hearing Loss, Sensorineural/prevention & control
- Hearing Loss, Sudden/chemically induced
- Hearing Loss, Sudden/drug therapy
- Hearing Loss, Sudden/pathology
- Hearing Loss, Sudden/prevention & control
- Humans
- United States
Collapse
Affiliation(s)
- Colleen G. Le Prell
- Department of Speech, Language, and Hearing, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas
| |
Collapse
|