Central nervous system plasticity during hair cell loss and regeneration

Nondeterministic nature of sensorineural outcomes following noise trauma

Over 1.1 billion individuals are at risk for noise induced hearing loss yet there is no accepted therapy. A long history of research has demonstrated that excessive noise exposure will kill outer hair cells (OHCs). Such observations have fueled the notion that dead OHCs underlie hearing loss. Therefore, previous and current therapeutic approaches are based on preventing the loss of OHCs. However, the relationship between OHC loss and hearing loss is at best a modest correlation. This suggests that in addition to the death of OHCs, other mechanisms may regulate the type and degree of hearing loss. In the current study, we tested the hypothesis that permanent noise-induced-hearing loss is consequent to additional mechanisms beyond the noise dose and the death of OHCs. Hooded male rats were randomly divided into noise and control groups. Morphological and physiological assessments were conducted on both groups. The combined results suggest that beyond OHC loss, the surviving cochlear elements shape sensorineural outcomes, which can be nondeterministic. These findings provide the basis for individualized ototherapeutics that manipulate surviving cellular elements in order to bias cochlear function towards normal hearing even in the presence of dead OHCs.

Summary: The current findings provide the basis for individualized ototherapeutics that manipulate surviving cellular elements in order to bias cochlear function towards normal hearing even in the presence of dead cells.

Music perception and training for pediatric cochlear implant users

INTRODUCTION

Cochlear implants (CIs) are biomedical devices that restore sound perception for people with severe-to-profound sensorineural hearing loss. Most postlingually deafened CI users are able to achieve excellent speech recognition in quiet environments. However, current CI sound processors remain limited in their ability to deliver fine spectrotemporal information, making it difficult for CI users to perceive complex sounds. Limited access to complex acoustic cues such as music, environmental sounds, lexical tones, and voice emotion may have significant ramifications on quality of life, social development, and community interactions.

AREAS COVERED

The purpose of this review article is to summarize the literature on CIs and music perception, with an emphasis on music training in pediatric CI recipients. The findings have implications on our understanding of noninvasive, accessible methods for improving auditory processing and may help advance our ability to improve sound quality and performance for implantees.

EXPERT OPINION

Music training, particularly in the pediatric population, may be able to continue to enhance auditory processing even after performance plateaus. The effects of these training programs appear generalizable to non-trained musical tasks, speech prosody and, emotion perception. Future studies should employ rigorous control groups involving a non-musical acoustic intervention, standardized auditory stimuli, and the provision of feedback.

Impedance and electrically evoked compound action potential (ECAP) drop within 24 hours after cochlear implantation

Previous animal study revealed that post-implantation electrical detection levels significantly declined within days. The impact of cochlear implant (CI) insertion on human auditory pathway in terms of impedance and electrically evoked compound action potential (ECAP) variation within hours after surgery remains unclear, since at this time frequency mapping can only commence weeks after implantation due to factors associated with wound conditions. The study presented our experiences with regards to initial switch-on within 24 hours, and thus the findings about the milieus inside cochlea within the first few hours after cochlear implantation in terms of impedance/ECAP fluctuations. The charts of fifty-four subjects with profound hearing impairment were studied. A minimal invasive approach was used for cochlear implantation, characterized by a small skin incision (≈ 2.5 cm) and soft techniques for cochleostomy. Impedance/ECAP was measured intro-operatively and within 24 hours post-operatively. Initial mapping within 24 hours post-operatively was performed in all patients without major complications. Impedance/ECAP became significantly lower measured within 24 hours post-operatively as compared with intra-operatively (p<0.001). There were no differences between pre-operative and post-operative threshold for air-conduction hearing. A significant drop of impedance/ECAP in one day after cochlear implantation was revealed for the first time in human beings. Mechanisms could be related to the restoration of neuronal sensitivity to the electrical stimulation, and/or the interaction between the matrix enveloping the electrodes and the electrical stimulation of the initial switch-on. Less wound pain/swelling and soft techniques both contributed to the success of immediate initial mapping, which implied a stable micro-environment inside the cochlea despite electrodes insertion. Our research invites further studies to correlate initial impedance/ECAP changes with long-term hearing/speech performance.

Return of function after hair cell regeneration

The ultimate goal of hair cell regeneration is to restore functional hearing. Because birds begin perceiving and producing song early in life, they provide a propitious model for studying not only whether regeneration of lost hair cells can return auditory sensitivity but also whether this regenerated periphery can restore complex auditory perception and production. They are the only animal where hair cell regeneration occurs naturally after hair cell loss and where the ability to correctly perceive and produce complex acoustic signals is critical to procreation and survival. The purpose of this review article is to survey the most recent literature on behavioral measures of auditory functional return in adult birds after hair cell regeneration. The first portion of the review summarizes the effect of ototoxic drug induced hair cell loss and regeneration on hearing loss and recovery for pure tones. The second portion reviews studies of complex, species-specific vocalization discrimination and recognition after hair cell regeneration. Finally, we discuss the relevance of temporary hearing loss and recovery through hair cell regeneration on complex call and song production. Hearing sensitivity is restored, except for the highest frequencies, after hair cell regeneration in birds, but there are enduring changes to complex auditory perception. These changes do not appear to provide any obstacle to future auditory or vocal learning. This article is part of a Special Issue entitled "Inner Ear Development and Regeneration".

Neuromagnetic index of hemispheric asymmetry predicting long-term outcome in sudden hearing loss

The neuromagnetic index of hemispheric asymmetry in terms of ipsilateral/contralateral ratio at acute stage was previously revealed to prognosticate the 1-month hearing outcome of acute unilateral idiopathic sudden sensorineural hearing loss (ISSNHL), showing a dynamic relationship between top- and down-levels of auditory pathway. However, the prognostic effect of reorganization pattern for the long-term results remained elusive. This study aimed to probe the prognosticating relevance of hemispheric asymmetry to the hearing at chronic stage of ISSNHL. Using magnetoencephalography (MEG), inter-hemispheric differences in peak dipole of N100m responses to monaural tones were evaluated in 21 controls and 21 ISSNHL patients at initial and final (12 months later) stages. Predictive value of hemispheric asymmetry was assessed by correlating hearing level and ipsilateral/contralateral ratio (I/C) of N100m latency and amplitude. Healthy-side dominance of N100m was observed in ISSNHL initially, and remained in three final prognostic subgroups (complete, partial, and no recovery) of ISSNHL. The initial I/C(amplitude) on affected-ear stimulation strongly correlated with the hearing level of final stage in ISSNHL. However, there was no prognostic effect of hemispheric asymmetry pattern for the 12-month hearing improvement. The heterogeneity between neuromagnetic index and hearing levels possibly echoed different pathogeneses of ISSNHL. Since a restored hearing status did not necessarily lead toward a normal functional organization, the dynamics of hemispheric asymmetry could actually index a central resilient reorganization in the brain for sound processing in ISSNHL. Our finding showed not only a clinically relevant measure to predict final hearing of ISSNHL, but also a linkage between central plasticity and cochlear lesion. This finding suggests a new perspective, and perhaps new interventions, to diagnose and treat unilateral ISSNHL.

Neuromagnetic index of hemispheric asymmetry prognosticating the outcome of sudden hearing loss

The longitudinal relationship between central plastic changes and clinical presentations of peripheral hearing impairment remains unknown. Previously, we reported a unique plastic pattern of “healthy-side dominance” in acute unilateral idiopathic sudden sensorineural hearing loss (ISSNHL). This study aimed to explore whether such hemispheric asymmetry bears any prognostic relevance to ISSNHL along the disease course. Using magnetoencephalography (MEG), inter-hemispheric differences in peak dipole amplitude and latency of N100m to monaural tones were evaluated in 21 controls and 21 ISSNHL patients at two stages: initial and fixed stage (1 month later). Dynamics/Prognostication of hemispheric asymmetry were assessed by the interplay between hearing level/hearing gain and ipsilateral/contralateral ratio (I/C) of N100m latency and amplitude. Healthy-side dominance of N100m amplitude was observed in ISSNHL initially. The pattern changed with disease process. There is a strong correlation between the hearing level at the fixed stage and initial I/C_amplitude on affected-ear stimulation in ISSNHL. The optimal cut-off value with the best prognostication effect for the hearing improvement at the fixed stage was an initial I/C_latency on affected-ear stimulation of 1.34 (between subgroups of complete and partial recovery) and an initial I/C_latency on healthy-ear stimulation of 0.76 (between subgroups of partial and no recovery), respectively. This study suggested that a dynamic process of central auditory plasticity can be induced by peripheral lesions. The hemispheric asymmetry at the initial stage bears an excellent prognostic potential for the treatment outcomes and hearing level at the fixed stage in ISSNHL. Our study demonstrated that such brain signature of central auditory plasticity in terms of both N100m latency and amplitude at defined time can serve as a prognostication predictor for ISSNHL. Further studies are needed to explore the long-term temporal scenario of auditory hemispheric asymmetry and to get better psychoacoustic correlates of pathological hemispheric asymmetry in ISSNHL.

[Molecular biological aspects of neuroplasticity: approaches for treating tinnitus and hearing disorders]

Peripheral and central structures are involved in the onset of tinnitus. Neuronal plasticity is of special importance for the occurrence of central tinnitus and its persistent form. Neuronal plasticity is the ability of the brain to adapt its own structure (synapses, nerve cells, or even whole areas of the brain) and its organization to modified biological requirements. Neuroplasticity is an ongoing dynamic process. Generally speaking, there are two types of plasticity: synaptic and cortical. Cortical plasticity involves activity-dependent changes in size, connectivity, or in the activation pattern of cortical networks. Synaptic plasticity refers to the activity-dependent change in the strength of synaptic transmission and can affect both the morphology and physiology of the synapse. The stimulation of afferent fibers leads to long-lasting changes in synaptic transmission. This phenomenon is called long-term potentiation (LTP) or long-term depression (LTD). From the perspective of molecular biology, synaptic plasticity is of particular importance for the development of tinnitus and its persistence. Ultimately, the damage to the hair cells, auditory nerve, and excitotoxicity results in an imbalance between LTP and LTD and thus in changes of synaptic plasticity. After excessive acoustic stimulation, LTP can be induced by the increase of afferent inputs, whereas decreased afferent inputs generate LTD. The imbalance between LTP and LTD leads to changes in gene expression and involves changes in neurotransmission, in the expression of the receptors, ion channels, regulatory enzymes, and in direct changes on the synapses. This causes an increase of activity on the cellular level. As a result, the imbalance can lead to hyperactivity in the dorsal cochlear nucleus, inferior colliculus, and in the auditory cortex and, later on, to changes in cortical plasticity leading to tinnitus.

Music training improves pitch perception in prelingually deafened children with cochlear implants

OBJECTIVE

The comparatively poor music appreciation in patients with cochlear implants might be ascribed to an inadequate exposure to music; however, the effect of training on music perception in prelingually deafened children with cochlear implants remains unknown. This study aimed to investigate whether previous musical education improves pitch perception ability in these children.

METHODS

Twenty-seven children with congenital/prelingual deafness of profound degree were studied. Test stimuli consisted of 2 sequential piano tones, ranging from C (256 Hz) to B (495 Hz). Children were asked to identify the pitch relationship between the 2 tones (same, higher, or lower). Effects of musical training duration, pitch-interval size, current age, age of implantation, gender, and type of cochlear implant on accuracy of pitch perception were evaluated.

RESULTS

The duration of musical training positively correlated with the correct rate of pitch perception. Pitch perception performance was better in children who had a cochlear implant and were older than 6 years than in those who were aged < or =6 years (ie, preschool). Effect of pitch-interval size was insignificant on pitch perception, and there was no correlation between pitch perception and the age of implantation, gender, or type of cochlear implant.

CONCLUSIONS

Musical training seems to improve pitch perception ability in prelingually deafened children with a cochlear implant. Auditory plasticity might play an important role in such enhancement. This suggests that incorporation of a structured training program on music perception early in life and as part of the postoperative rehabilitation program for prelingually deafened children with cochlear implants would be beneficial. A longitudinal study is needed to show whether improvement of music performance in these children is measurable by use of auditory evoked potentials.

Rebuilding lost hearing using cell transplantation

OBJECTIVE

The peripheral auditory nervous system (cochlea and auditory nerve) has a complex anatomy, and it has traditionally been thought that once the sensorineural structures are damaged, restoration of hearing is impossible. In the past decade, however, the potential to restore lost hearing has been intensively investigated using molecular and cell biological techniques, and we can now part with such a pessimistic view. In this review, we examine an important field in hearing restoration research: cell transplantation.

METHODS

Most efforts in this field have been directed to the replacement of hair cells by transplantation to the cochlea. Here, we focus on transplantation to the auditory nerve, from the side of the cerebellopontine angle rather than the cochlea.

RESULTS

Delivery of cells to the cochlea is potentially damaging, and nerve cells transplanted distally to the Schwann-glial transitional zone (cochlear side) may become inhibited when they reach the transitional zone. The auditory nerve is probably the most suitable route for cell transplantation.

CONCLUSION

The auditory nerve occupies an important position not only in neurosurgery but also in various diseases in other disciplines, and several lines of recent evidence indicate that it is a key target for hearing restoration. It is familiar to most neurosurgeons, and the recent advances in the molecular and cell biology of inner-ear development are of direct importance to neurorestorative medicine. In this article, we review the anatomy, development, and molecular biology of the auditory nerve and cochlea, with emphasis on the advances in cell transplantation.

Healthy-side dominance of middle- and long-latency neuromagnetic fields in idiopathic sudden sensorineural hearing loss

Any lesion along the neural axis may induce a subsequent functional reorganization at the level above. The present study used magnetoencephalography to investigate auditory-evoked magnetic fields [a component of the middle-latency auditory evoked fields peaking at approximately 50 ms (P50m) and a component of the long-latency auditory evoked fields peaking at approximately 100 ms (N100m)] on stimulation of both healthy and affected ears in patients with acute unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) of moderate degree in order to elucidate the functional plasticity of the auditory system. Sixteen right-handed, previously untreated adult patients with acute unilateral left (n = 8) or right (n = 8) ISSNHL of moderate degree were studied. Sixteen right-handed healthy volunteers with normal hearing served as control. Auditory neuromagnetic responses, measured by a whole-head 306-channel neuromagnetometer, were detected by monaural tone stimulation applied to affected and healthy ears, respectively, in different sessions. Intragroup and intergroup interhemispheric differences of peak dipole strengths and latencies of P50m and N100m, respectively, to monaural tones were evaluated. Healthy-side amplitude dominance of both P50m and N100m was found in ISSNHL, i.e. contralateral dominance was preserved on affected-ear stimulation but ipsilateral dominance was seen on healthy-ear stimulation. The phenomena could be attributed to the combined contralateral attenuation and ipsilateral enhancement of P50m and N100m activity in response to healthy-ear stimulation. Our findings confirmed that functional modulation can occur within the first few tens of milliseconds of evoked response at the auditory cortex in ISSNHL. The mechanisms of healthy-side dominance might be ascribed to a functional retune of auditory pathways, i.e. conjoined contralateral inhibition and ipsilateral excitation of the auditory pathway in response to healthy-ear stimulation. The effect could be registered in cortical responses.

Effect of monoenergetic neutron irradiation on the postnatal development of the cochlea in C3H/HeN mice

To investigate the toxic effect of neutrons at energies of approximately 1MeV on the ear, we exposed 7-day-old mice to 1.0 Gy of monoenergetic neutrons (1.026 MeV) or (137)Cs gamma rays, and assessed subsequent morphological changes in the inner ear by light and scanning electron microscopy. Monoenergetic neutrons, but not gamma rays, caused acute changes in the ear. The epithelium of the greater epithelial ridge in the organ of Corti had disappeared by 72 hr post-irradiation, as a result of epithelial apoptosis observed 6 hr post-irradiation. Radiation could induce apoptotic cell death of the epithelium of the greater epithelial ridge at 3 or 4 days of age. Protruding structures were detected on the surface of the hair cells by 72 hr post-irradiation. The neutron-irradiation also caused the apoptotic cell death of epithelial cells at the nasal conchae, and subsequent acute otitis media continued until 10 weeks of age.

Noise-induced cell death in the mouse medial geniculate body and primary auditory cortex

Noise-induced effects within the inner ear have been well investigated for several years. However, this peripheral damage cannot fully explain the audiological symptoms in noise-induced hearing loss (NIHL), e.g. tinnitus, recruitment, reduced speech intelligibility, hyperacusis. There are few reports on central noise effects. Noise can induce an apoptosis of neuronal tissue within the lower auditory pathway. Higher auditory structures (e.g. medial geniculate body, auditory cortex) are characterized by metabolic changes after noise exposure. However, little is known about the microstructural changes of the higher auditory pathway after noise exposure. The present paper was therefore aimed at investigating the cell density in the medial geniculate body (MGB) and the primary auditory cortex (AI) after noise exposure. Normal hearing mice were exposed to noise (10 kHz center frequency at 115 dB SPL for 3 h) at the age of 21 days under anesthesia (Ketamin/Rompun, 10:1). After 1 week, auditory brainstem response recordings (ABR) were performed in noise exposed and normal hearing animals. After fixation, the brain was microdissected and stained (Kluever-Barrera). The cell density in the MGB subdivisions and the AI were determined by counting the cells within a grid. Noise-exposed animals showed a significant ABR threshold shift over the whole frequency range. Cell density was significantly reduced in all subdivisions of the MGB and in layers IV-VI of AI. The present findings demonstrate a significant noise-induced change of the neuronal cytoarchitecture in central key areas of auditory processing. These changes could contribute to the complex psychoacoustic symptoms after NIHL.

Effects of high linear energy transfer radiation on the cochlea of C3H/He mouse during postnatal developmental course

To investigate the biological effectiveness of neutrons at energies below 1MeV with regard to ear toxicity, we exposed mice to 1.0 Gy of monoenergetic neutrons (1.026 MeV) or 137Cs gamma rays at 7 days of age, and observed subsequent morphological changes in the inner ear with light and scanning electron microscopes. Monoenergetic neutrons, but not gamma rays, caused acute changes in the ear. The epithelium of the greater epithelial ridge in the organ of Corti showed degeneration around 6 hours and disappeared by 72 hours post-irradiation. The apoptotic cell death of the epithelium of the greater epithelial ridge was inducible by the radiation at 3 or 4 days of age. The hair cells formed the protrusion structures of the surface by 72 hours post-irradiation. Neutron-irradiation also caused acute otitis media until 10 weeks of age.

Vocal memory and learning in adult Bengalese Finches with regenerated hair cells

Critical learning periods are common in vertebrate development. In many birds, song learning is limited by a critical period; juveniles copy songs from adult birds by forming memories of those songs during a restricted developmental period and then using auditory feedback to practice their own vocalizations. Adult songs are stable over time regardless of exposure to other birds, but auditory feedback is required for the maintenance of stable adult song. A technique was developed to reversibly deafen Bengalese Finches by destruction and regeneration of inner ear auditory hair cells. With this approach, we asked two questions about the plasticity of song information stored in the adult brain. First, do adult birds store memories or "templates" of their songs that exist independent of auditory reinforcement? Such memories could be used to control vocal output by acting as fixed models of song to which ongoing vocalizations are matched. Second, can adult song learning, which does not normally occur in this species, be induced by removing and then restoring hearing? Studying changes in adult song behavior during hair cell loss and regeneration revealed two findings: (1) adult birds store memories or templates of their songs that exist independent of auditory input and can be used to restore normal vocal behavior when hearing is restored; (2) under experimental circumstances, adult birds can be induced to acquire song material from other birds. Results suggest that, in Bengalese Finches, the degree of behavioral and neural plasticity in juvenile and adult birds may be less distinct that previously thought.

Avian brainstem neurogenesis is stimulated during cochlear hair cell regeneration

Unlike mammals, adult avians are able to regenerate cochlear sensory hair cells following injury. Brainstem auditory neurons in chicken nucleus magnocellularis (NM), which receive their sole excitatory afferent input from the cochlea, were examined for evidence of mitosis during ototoxin-induced loss and regeneration of cochlear hair cells. Using tritiated thymidine as a mitotic marker in tissue processed for autoradiography and counterstained with thionin, labeled NM neurons and glia were counted from chickens killed 16 days after gentamicin or saline injections. Newly generated NM neurons were observed during cochlear hair cell regeneration. More labeled neurons were observed in the experimental chickens, but a few were also seen in the control chickens. We predicted labeled NM neurons would be found solely in the rostral high frequency region, given the gentamicin-induced high frequency cochlear hair cell loss and regeneration. However, the labeled NM neurons were located throughout the tonotopic axis of the nucleus. The total number of labeled neurons was lower than predicted. Many labeled NM glia were observed in experimental and control chickens. Labeled cells were also observed throughout the chicken brainstem and cerebellum in both experimental and control chickens, indicating great potential for CNS plasticity. Results in NM indicate the avian auditory system is capable of regenerating brainstem auditory neurons in addition to the previously well-established capability of regenerating cochlear hair cells in response to ototoxic injury. Recovery of both central and peripheral auditory components will be necessary to restore hearing damaged by noise or ototoxic drugs.

Time course and quantification of changes in cochlear integrity observed in commercially raised broiler chickens

Extensive cochlear hair cell damage and loss occurs in aged broiler chickens. We describe the time course and several characteristics of this decline in cochlear integrity in 19-, 30-, 38- and 66-week-old commercially raised broiler chickens. The 19-week-old group is normal and serves as a baseline for comparison. Generally, cochlear damage increases in severity and percent length of the cochlea with age. Hair cell density increases from the base to the apex. Density is similar across the groups in regions of the cochlea that sustained little or no damage, and decreases in regions of extreme damage. Counts of normal and abnormal hair cells are inversely related. A subset of 66-week-old birds has higher density measurements and increased hair cell counts in the apical region of the cochlea. The progressive damage found in these commercially raised birds is described in the context of both the effects of age and noise exposure on the auditory system. Two additional groups of birds were raised at the University of Kansas Medical Center in a quieter environment to determine the cause of the damage seen in age-matched commercially raised birds. These cochleae are largely normal; a small number displayed damage. This suggests that noise exposure exacerbates naturally occurring cochlear degradation.

Breed differences in cochlear integrity in adult, commercially raised chickens

Two types of chickens are commercially available. Broiler birds are bred to develop quickly for meat production, while egg layers are bred to attain a smaller adult size. Because we have observed breed differences in the response of central auditory neurons to cochlear ablation in adult birds [Edmonds et al. (1999) Hear. Res. 127, 62-76], we examined cochleae from the two breeds for differences in integrity. We evaluated cochlear hair cell structure using scanning electron microscopy and cochlear hair cell function using distortion product otoacoustic emissions (DPOAEs) and the auditory brainstem response. We observed striking breed differences in cochlear integrity in adult but not hatchling birds. In adult broiler birds, all cochleae showed damage, encompassing at least the basal 29% of the cochlea. In 15 of 18 broiler ears, damage was observed throughout the basal 60% of the cochlea. In contrast, cochleae from egg layer adults were largely normal. Two thirds of egg layer ears showed no anatomical abnormalities, while in the remainder cochlear damage was seen within the basal 48% of the cochlea. DPOAEs recorded from egg layer birds showed loss of high frequency emissions in every ear for which the cochlea displayed anatomical damage. Average sound pressure levels in both commercial facilities were 90 dB, suggesting these two breeds may exhibit differential susceptibility to noise damage.