Effects of conductive hearing loss on auditory nerve activity in gerbil

The Feasibility and Reliability of a Digits-in-Noise Test in the Clinical Follow-Up of Children With Mild to Profound Hearing Loss

OBJECTIVES

Speech perception in noise is an important aspect of the rehabilitation of children with hearing loss. We aimed to evaluate the feasibility and reliability of the Dutch digits-in-noise (DIN) test in the clinical follow-up of children with hearing aids (HAs) and/or cochlear implants (CIs). A second aim of the study was to gain insight in the speech perception in noise performance of children with different degrees of hearing loss.

DESIGN

We retrospectively analyzed DIN test data of Dutch-speaking children with hearing loss (N = 188; 5 to 18 years old). A free-field version of the DIN-test was used. Children with open-set phoneme recognition in quiet of >70% at 65 dB SPL (best aided condition) were included. Ages ranged from 5 to 18 years old. All were experienced HA or CI users and had used their device(s) for at least 1 year before the measurement in the study. The DIN-test was performed in the framework of a clinical rehabilitation program. During testing, children wore their own devices with normal daily programs.

RESULTS

The average speech reception threshold (SRT) was -3.6 dB (SD 3.6) for the first list and significantly improved to -4.0 dB (SD 3.1) for the second list. HA users had a 4-dB better SRT compared with CI users. The larger the child's hearing loss, the worse the SRT is. However, 15% of the children who completed a first list of 24 trials were unable to complete a second list. Mean adaptive staircase trajectories across trials suggested that learning occurred throughout the first list, and that loss of sustained attention contributed to response variability during the second list.

CONCLUSION

The DIN test can be used to assess speech perception in noise abilities for children with different degrees of hearing loss and using HAs or CIs. The children with hearing loss required a higher signal-to-noise ratio (SNR) than did normal-hearing children and the required SNR is larger as the hearing loss increases. However, the current measurement procedure should be optimized for use in standard pediatric audiological care, as 15% of the children were unable to conduct a second list after the first list to reach a more stable SNR.

Conductive Hearing Loss Has Long-Lasting Structural and Molecular Effects on Presynaptic and Postsynaptic Structures of Auditory Nerve Synapses in the Cochlear Nucleus

Sound deprivation by conductive hearing loss increases hearing thresholds, but little is known about the response of the auditory brainstem during and after conductive hearing loss. Here, we show in young adult rats that 10 d of monaural conductive hearing loss (i.e., earplugging) leads to hearing deficits that persist after sound levels are restored. Hearing thresholds in response to clicks and frequencies higher than 8 kHz remain increased after a 10 d recovery period. Neural output from the cochlear nucleus measured at 10 dB above threshold is reduced and followed by an overcompensation at the level of the lateral lemniscus. We assessed whether structural and molecular substrates at auditory nerve (endbulb of Held) synapses in the cochlear nucleus could explain these long-lasting changes in hearing processing. During earplugging, vGluT1 expression in the presynaptic terminal decreased and synaptic vesicles were smaller. Together, there was an increase in postsynaptic density (PSD) thickness and an upregulation of GluA3 AMPA receptor subunits on bushy cells. After earplug removal and a 10 d recovery period, the density of synaptic vesicles increased, vesicles were also larger, and the PSD of endbulb synapses was larger and thicker. The upregulation of the GluA3 AMPAR subunit observed during earplugging was maintained after the recovery period. This suggests that GluA3 plays a role in plasticity in the cochlear nucleus. Our study demonstrates that sound deprivation has long-lasting alterations on structural and molecular presynaptic and postsynaptic components at the level of the first auditory nerve synapse in the auditory brainstem.

SIGNIFICANCE STATEMENT

Despite being the second most prevalent form of hearing loss, conductive hearing loss and its effects on central synapses have received relatively little attention. Here, we show that 10 d of monaural conductive hearing loss leads to an increase in hearing thresholds, to an increased central gain upstream of the cochlear nucleus at the level of the lateral lemniscus, and to long-lasting presynaptic and postsynaptic structural and molecular effects at the endbulb of the Held synapse. Knowledge of the structural and molecular changes associated with decreased sensory experience, along with their potential reversibility, is important for the treatment of hearing deficits, such as hyperacusis and chronic otitis media with effusion, which is prevalent in young children with language acquisition or educational disabilities.

Hearing loss differentially affects thalamic drive to two cortical interneuron subtypes

Sensory deprivation, such as developmental hearing loss, leads to an adjustment of synaptic and membrane properties throughout the central nervous system. These changes are thought to compensate for diminished sound-evoked activity. This model predicts that compensatory changes should be synergistic with one another along each functional pathway. To test this idea, we examined the excitatory thalamic drive to two types of cortical inhibitory interneurons that display differential effects in response to developmental hearing loss. The inhibitory synapses made by fast-spiking (FS) cells are weakened by hearing loss, whereas those made by low threshold-spiking (LTS) cells remain strong but display greater short-term depression (Takesian et al. 2010). Whole-cell recordings were made from FS or LTS interneurons in a thalamocortical brain slice, and medial geniculate (MG)-evoked postsynaptic potentials were analyzed. Following hearing loss, MG-evoked net excitatory potentials were smaller than normal at FS cells but larger than normal at LTS cells. Furthermore, MG-evoked excitatory potentials displayed less short-term depression at FS cells and greater short-term depression at LTS cells. Thus deprivation-induced adjustments of excitatory synapses onto inhibitory interneurons are cell-type specific and parallel the changes made by the inhibitory afferents.

The conductive hearing loss due to an experimentally induced middle ear effusion alters the interaural level and time difference cues to sound location

Otitis media with effusion (OME) is a pathologic condition of the middle ear that leads to a mild to moderate conductive hearing loss as a result of fluid in the middle ear. Recurring OME in children during the first few years of life has been shown to be associated with poor detection and recognition of sounds in noisy environments, hypothesized to result due to altered sound localization cues. To explore this hypothesis, we simulated a middle ear effusion by filling the middle ear space of chinchillas with different viscosities and volumes of silicone oil to simulate varying degrees of OME. While the effects of middle ear effusions on the interaural level difference (ILD) cue to location are known, little is known about whether and how middle ear effusions affect interaural time differences (ITDs). Cochlear microphonic amplitudes and phases were measured in response to sounds delivered from several locations in azimuth before and after filling the middle ear with fluid. Significant attenuations (20-40 dB) of sound were observed when the middle ear was filled with at least 1.0 ml of fluid with a viscosity of 3.5 Poise (P) or greater. As expected, ILDs were altered by ~30 dB. Additionally, ITDs were shifted by ~600 μs for low frequency stimuli (<4 kHz) due to a delay in the transmission of sound to the inner ear. The data show that in an experimental model of OME, ILDs and ITDs are shifted in the spatial direction of the ear without the experimental effusion.

Resting neural activity patterns in auditory brainstem and midbrain in conductive hearing loss

CONCLUSIONS

Conductive hearing loss (CHL) lowers resting neural activity patterns in the auditory periphery. Such reductions of peripheral auditory activity may influence the developing central brain during early postnatal years when the system is still highly plastic.

OBJECTIVES

A common cause of CHL in young children is otitis media; if chronic and/or episodic there may be a risk to speech and language development. In this clinical context we have investigated changes in neural activity patterns in the brainstem and midbrain in an animal model of CHL.

METHODS

In a mouse model, a 50-60 dB CHL was produced by blocking the ear canals. We quantified resting neural activity patterns in the cochlear nucleus and inferior colliculus using c-fos immuno-labelling. This experimental group was compared with normal-hearing controls and with animals with bilateral cochlear ablation.

RESULTS

Subjects with CHL had a statistically significant reduction in c-fos-labelled cells in the cochlear nucleus and central nucleus of the inferior colliculus compared with normal controls. This decreased c-fos expression suggests a change in resting neural activity generated at the inner hair cell synapse, leading to a reduction in activity levels in the ascending auditory pathways.

Developmental plasticity of auditory cortical inhibitory synapses

Functional inhibitory synapses form in auditory cortex well before the onset of normal hearing. However, their properties change dramatically during normal development, and many of these maturational events are delayed by hearing loss. Here, we review recent findings on the developmental plasticity of inhibitory synapse strength, kinetics, and GABAA receptor localization in auditory cortex. Although hearing loss generally leads to a reduction of inhibitory strength, this depends on the type of presynaptic interneuron. Furthermore, plasticity of inhibitory synapses also depends on the postsynaptic target. Hearing loss leads reduced GABAA receptor localization to the membrane of excitatory, but not inhibitory neurons. A reduction in normal activity in development can also affect the use-dependent plasticity of inhibitory synapses. Even moderate hearing loss can disrupt inhibitory short- and long-term synaptic plasticity. Thus, the cortex did not compensate for the loss of inhibition in the brainstem, but rather exacerbated the response to hearing loss by further reducing inhibitory drive. Together, these results demonstrate that inhibitory synapses are exceptionally dynamic during development, and deafness-induced perturbation of inhibitory properties may have a profound impact on auditory processing.

Suppression of spontaneous firing in inferior colliculus neurons during sound processing

Spontaneous activity is a well-known neural phenomenon that occurs throughout the brain and is essential for normal development of auditory circuits and for processing of sounds. Spontaneous activity could interfere with sound processing by reducing the signal-to-noise ratio. Multiple studies have reported that spontaneous activity in auditory neurons can be suppressed by sound stimuli. The goal of this study was to determine the stimulus conditions that cause this suppression and to identify possible underlying mechanisms. Experiments were conducted in the inferior colliculus (IC) of awake little brown bats using extracellular and intracellular recording techniques. The majority of IC neurons (82%) fired spontaneously, with a median spontaneous firing rate of 6 spikes/s. After offset of a 4 ms sound, more than half of these neurons exhibited suppression of spontaneous firing that lasted hundreds of milliseconds. The duration of suppression increased with sound level. Intracellular recordings showed that a short (<50 ms) membrane hyperpolarization was often present during the beginning of suppression, but it was never observed during the remainder of the suppression. Beyond the initial 50 ms period, the absence of significant changes in input resistance during suppression suggests that suppression is presynaptic in origin. Namely, it may occur on presynaptic terminals and/or elsewhere on presynaptic neurons. Suppression of spontaneous firing may serve as a mechanism for enhancing signal-to-noise ratios during signal processing.

Ventral cochlear nucleus responses to contralateral sound are mediated by commissural and olivocochlear pathways

In the normal guinea pig, contralateral sound inhibits more than a third of ventral cochlear nucleus (VCN) neurons but excites <4% of these neurons. However, unilateral conductive hearing loss (CHL) and cochlear ablation (CA) result in a major enhancement of contralateral excitation. The response properties of the contralateral excitation produced by CHL and CA are similar, suggesting similar pathways are involved for both types of hearing loss. Here we used the neurotoxin melittin to test the hypothesis that this "compensatory" contralateral excitation is mediated either by direct glutamatergic CN-commissural projections or by cholinergic neurons of the olivocochlear bundle (OCB) that send collaterals to the VCN. Unit responses were recorded from the left VCN of anesthetized, unilaterally deafened guinea pigs (CHL via ossicular disruption, or CA via mechanical destruction). Neural responses were obtained with 16-channel electrodes to enable simultaneous data collection from a large number of single- and multiunits in response to ipsi- and contralateral tone burst and noise stimuli. Lesions of each pathway had differential effects on the contralateral excitation. We conclude that contralateral excitation has a fast and a slow component. The fast excitation is likely mediated by glutamatergic neurons located in medial regions of VCN that send their commissural axons to the other CN via the dorsal/intermediate acoustic striae. The slow component is likely mediated by the OCB collateral projections to the CN. Commissural neurons that leave the CN via the trapezoid body are an additional source of fast, contralateral excitation.

Hearing loss prevents the maturation of GABAergic transmission in the auditory cortex

Inhibitory neurotransmission is a critical determinant of neuronal network gain and dynamic range, suggesting that network properties are shaped by activity during development. A previous study demonstrated that sensorineural hearing loss (SNHL) in gerbils leads to smaller inhibitory potentials in L2/3 pyramidal neurons in the thalamorecipient auditory cortex, ACx. Here, we explored the mechanisms that account for proper maturation of γ-amino butyric acid (GABA)ergic transmission. SNHL was induced at postnatal day (P) 10, and whole-cell voltage-clamp recordings were obtained from layer 2/3 pyramidal neurons in thalamocortical slices at P16–19. SNHL led to an increase in the frequency of GABAzine-sensitive (antagonist) spontaneous (s) and miniature (m) inhibitory postsynaptic currents (IPSCs), accompanied by diminished amplitudes and longer durations. Consistent with this, the amplitudes of minimum-evoked IPSCs were also reduced while their durations were longer. The α1- and β2/3 subunit–specific agonists zolpidem and loreclezole increased control but not SNHL sIPSC durations. To test whether SNHL affected the maturation of GABAergic transmission, sIPSCs were recorded at P10. These sIPSCs resembled the long SNHL sIPSCs. Furthermore, zolpidem and loreclezole were ineffective in increasing their durations. Together, these data strongly suggest that the presynaptic release properties and expression of key postsynaptic GABA_A receptor subunits are coregulated by hearing.

Responses of ventral cochlear nucleus neurons to contralateral sound after conductive hearing loss

Conductive hearing loss (CHL) is an attenuation of signals stimulating the cochlea, without damage to the auditory end organ. It can cause central auditory processing deficits that outlast the CHL itself. Measures of oxidative metabolism show a decrease in activity of nuclei receiving input originating at the affected ear but, surprisingly, an increase in the activity of second-order neurons of the opposite ear. In normal hearing animals, contralateral sound produces an inhibitory response to broadband noise in approximately one third of ventral cochlear nucleus (VCN) neurons. Excitatory responses also occur but are very rare. We looked for changes in the binaural properties of neurons in the VCN of guinea pigs at intervals immediately, 1 day, 1 wk, and 2 wk after the induction of a unilateral CHL by ossicular disruption. CHL was always induced in the ear ipsilateral to the VCN from which recordings were made. The main observations were as follows: 1) ipsilateral excitatory thresholds were raised by at least 40 dB; 2) contralateral inhibitory responses showed a small but statistically significant immediate decrease followed by an increase, returning to normal by 14 days; and 3) there was a large increase in the proportion of units with excitatory responses to contralateral BBN. The increase was immediate and lasting. The latencies of the excitatory responses were at least 6 ms, consistent with activation by a path involving several synapses and inconsistent with cross talk. The latencies and rate-level functions of contralateral excitation were similar to those seen occasionally in normal hearing animals, suggesting an upregulation of an existing pathway. In conclusion, contralateral excitatory inputs to the VCN exist, which are not normally effective, and can compensate rapidly for large changes in afferent input.

Tinnitus as a plastic phenomenon and its possible neural underpinnings in the dorsal cochlear nucleus

Tinnitus displays many features suggestive of plastic changes in the nervous system. These can be categorized based on the types of manipulations that induce them. We have categorized the various forms of plasticity that characterize tinnitus and searched for their neural underpinnings in the dorsal cochlear nucleus (DCN). This structure has been implicated as a possible site for the generation of tinnitus-producing signals owing to its tendency to become hyperactive following exposure to tinnitus inducing agents such as intense sound and cisplatin. In this paper, we review the many forms of plasticity that have been uncovered in anatomical, physiological and neurochemical studies of the DCN. Some of these plastic changes have been observed as consequences of peripheral injury or as fluctuations in the behavior and chemical activities of DCN neurons, while others can be induced by stimulation of auditory or even non-auditory structures. We show that many parallels can be drawn between the various forms of plasticity displayed by tinnitus and the various forms of neural plasticity which have been defined in the DCN. These parallels lend further support to the hypothesis that the DCN is an important site for the generation and modulation of tinnitus-producing signals.

The effect of silence on tinnitus perception

OBJECTIVE

The effect of sustained silence was studied on the emergence of tinnitus perception in 120 normal hearing young adult Caucasians and African Americans.

STUDY DESIGN AND SETTING

After sitting in a sound booth for a period of 20 minutes, participants were asked to complete a questionnaire documenting whether they perceived sounds in the silent setting and descriptions of the sounds they heard.

RESULTS

Tinnitus-like sounds were perceived in 64% of listeners overall. No significant differences in tinnitus perception were observed between males and females. However, there was a significant difference in tinnitus perception between Caucasian and African American subjects, with tinnitus sounds emerging in sustained silence less frequently in African American listeners. Tinnitus emerged quickly in a majority of subjects (less than 4 minutes) and African American subjects who perceived tinnitus heard a greater number of individual tinnitus-like sounds than did Caucasian subjects. Ring (57%), buzz (21%), pulse (22%), heartbeat (21%), and hum (14%) were the most common sounds heard, with ring being the most common overall tinnitus perception.

CONCLUSIONS AND SIGNIFICANCE

Few investigators have documented at the emergence of tinnitus in normal hearing subjects. Results of the current study found significant differences in tinnitus perception between Caucasian and African American subjects, but found no significant differences when comparing males and female subjects.

EBM RATING

C.

Unilateral cochlear ablation produces greater loss of inhibition in the contralateral inferior colliculus

Bilateral cochlear ablation leads to a profound weakening of synaptic inhibition within the inferior colliculus (IC) of gerbils [Vale & Sanes (2000) J. Neurosci., 20, 1912-1921]. To examine whether unilateral deafening leads to similar functional alterations, we studied the effect of unilateral cochlear ablation on inhibitory synaptic properties both ipsilateral and contralateral to the deafened ear. Lateral lemniscal and commissure of the IC-evoked inhibitory postsynaptic currents (IPSCs) were recorded in an IC brain slice preparation using whole-cell and gramicidin perforated-patch electrodes in the presence of kynurenic acid. Unilateral cochlear ablation led to a 23 mV depolarizing shift in the IPSC equilibrium potential for IC neurons contralateral to the deafened ear, but only a 10 mV depolarization in the ipsilateral IC. Lateral lemniscal-evoked inhibitory synaptic conductance declined significantly in the ipsilateral and contralateral IC, whereas commissural-evoked inhibitory synaptic conductance declined only contralateral to the ablated cochlea. An analysis of paired-pulse facilitation showed that inhibitory transmitter release was more affected ipsilateral to the ablated cochlea. Thus, unilateral cochlear ablation modifies inhibitory synapses in the inferior colliculus, but these changes appear to be dominated by postsynaptic alterations in the contralateral IC, and by presynaptic changes in the ipsilateral IC.

Impaired binaural hearing in children produced by a threshold level of middle ear disease

Otitis media with effusion (OME), a form of middle ear disease, is the most common reason for young children both to visit their family doctor and to have surgery. Almost all children have at least a single episode of OME before their first birthday and annual incidence rates exceed 50% in each of the first five years. For most children, OME occurs infrequently, but about 10-15% of children have OME during more than half of their first six years. Middle ear effusions attenuate and delay sound, causing conductive sound distortion during the crucial years for language acquisition. The many studies of OME effects on language and other indices of development have produced mixed results. However, a consensus is emerging of mild language impairment in the preschool years, with subsequent performance, emotional, and behavioral difficulties. In addition to the peripheral hearing loss produced directly by the disease, binaural and other central auditory deficits can outlive the OME. It has been unclear which children are at risk of central impairment following OME, since the children studied have generally been recruited from otolaryngology clinics. Consequently, a detailed prospective history of the middle ear status of participants has not been available. By studying six-year-old children with a lifetime known history of OME, we show in this study that only those children with a cumulative OME experience of more than about half the time during the first five years consistently have residual impaired binaural hearing.