The role of a family history in King Kopetzky Syndrome (obscure auditory dysfunction)

Age-Dependent Auditory Processing Deficits after Cochlear Synaptopathy Depend on Auditory Nerve Latency and the Ability of the Brain to Recruit LTP/BDNF

Age-related decoupling of auditory nerve fibers from hair cells (cochlear synaptopathy) has been linked to temporal processing deficits and impaired speech recognition performance. The link between both is elusive. We have previously demonstrated that cochlear synaptopathy, if centrally compensated through enhanced input/output function (neural gain), can prevent age-dependent temporal discrimination loss. It was also found that central neural gain after acoustic trauma was linked to hippocampal long-term potentiation (LTP) and upregulation of brain-derived neurotrophic factor (BDNF). Using middle-aged and old BDNF-live-exon-visualization (BLEV) reporter mice we analyzed the specific recruitment of LTP and the activity-dependent usage of Bdnf exon-IV and -VI promoters relative to cochlear synaptopathy and central (temporal) processing. For both groups, specimens with higher or lower ability to centrally compensate diminished auditory nerve activity were found. Strikingly, low compensating mouse groups differed from high compensators by prolonged auditory nerve latency. Moreover, low compensators exhibited attenuated responses to amplitude-modulated tones, and a reduction of hippocampal LTP and Bdnf transcript levels in comparison to high compensators. These results suggest that latency of auditory nerve processing, recruitment of hippocampal LTP, and Bdnf transcription, are key factors for age-dependent auditory processing deficits, rather than cochlear synaptopathy or aging per se.

Age-Related Changes in the Auditory Brainstem Response and Suprathreshold Processing of Temporal and Spectral Modulation

The purpose of this study was to determine whether cochlear synaptopathy can be shown to be a viable basis for age-related hearing difficulties in humans and whether it manifests as deficient suprathreshold processing of temporal and spectral modulation. Three experiments were undertaken evaluating the effects of age on (a) the auditory brainstem response as a function of level, (b) temporal modulation detection as a function of level and background noise, and (c) spectral modulation as a function of level. Across the three experiments, a total of 21 older listeners with near-normal audiograms and 29 young listeners with audiometrically normal hearing participated. The auditory brainstem response experiment demonstrated reduced Wave I amplitudes and concomitant reductions in the amplitude ratios of Wave I to Wave V in the older listener group. These findings were interpreted as consistent with an electrophysiological profile of cochlear synaptopathy. The temporal and spectral modulation detection experiments, however, provided no support for the hypothesis of compromised suprathreshold processing in these domains. This pattern of results suggests that even if cochlear synaptopathy can be shown to be a viable basis for age-related hearing difficulties, then temporal and spectral modulation detection paradigms are not sensitive to its presence.

Loud Music Exposure and Cochlear Synaptopathy in Young Adults: Isolated Auditory Brainstem Response Effects but No Perceptual Consequences

The purpose of this study was to test the hypothesis that listeners with frequent exposure to loud music exhibit deficits in suprathreshold auditory performance consistent with cochlear synaptopathy. Young adults with normal audiograms were recruited who either did ( n = 31) or did not ( n = 30) have a history of frequent attendance at loud music venues where the typical sound levels could be expected to result in temporary threshold shifts. A test battery was administered that comprised three sets of procedures: (a) electrophysiological tests including distortion product otoacoustic emissions, auditory brainstem responses, envelope following responses, and the acoustic change complex evoked by an interaural phase inversion; (b) psychoacoustic tests including temporal modulation detection, spectral modulation detection, and sensitivity to interaural phase; and (c) speech tests including filtered phoneme recognition and speech-in-noise recognition. The results demonstrated that a history of loud music exposure can lead to a profile of peripheral auditory function that is consistent with an interpretation of cochlear synaptopathy in humans, namely, modestly abnormal auditory brainstem response Wave I/Wave V ratios in the presence of normal distortion product otoacoustic emissions and normal audiometric thresholds. However, there were no other electrophysiological, psychophysical, or speech perception effects. The absence of any behavioral effects in suprathreshold sound processing indicated that, even if cochlear synaptopathy is a valid pathophysiological condition in humans, its perceptual sequelae are either too diffuse or too inconsequential to permit a simple differential diagnosis of hidden hearing loss.

Normal hearing is not enough to guarantee robust encoding of suprathreshold features important in everyday communication

"Normal hearing" is typically defined by threshold audibility, even though everyday communication relies on extracting key features of easily audible sound, not on sound detection. Anecdotally, many normal-hearing listeners report difficulty communicating in settings where there are competing sound sources, but the reasons for such difficulties are debated: Do these difficulties originate from deficits in cognitive processing, or differences in peripheral, sensory encoding? Here we show that listeners with clinically normal thresholds exhibit very large individual differences on a task requiring them to focus spatial selective auditory attention to understand one speech stream when there are similar, competing speech streams coming from other directions. These individual differences in selective auditory attention ability are unrelated to age, reading span (a measure of cognitive function), and minor differences in absolute hearing threshold; however, selective attention ability correlates with the ability to detect simple frequency modulation in a clearly audible tone. Importantly, we also find that selective attention performance correlates with physiological measures of how well the periodic, temporal structure of sounds above the threshold of audibility are encoded in early, subcortical portions of the auditory pathway. These results suggest that the fidelity of early sensory encoding of the temporal structure in suprathreshold sounds influences the ability to communicate in challenging settings. Tests like these may help tease apart how peripheral and central deficits contribute to communication impairments, ultimately leading to new approaches to combat the social isolation that often ensues.

Auditory filter shapes and high-frequency hearing in adults who have impaired speech in noise performance despite clinically normal audiograms

Some individuals complain of hearing difficulties in the presence of background noise even in the absence of clinically significant hearing loss (obscure auditory dysfunction). Previous evidence suggests that these listeners have impaired frequency resolution, but there has been no thorough characterization of auditory filter shapes in this population. Here, the filter shapes of adults (n = 14) who self-reported speech recognition problems in noise and performed poorly on a sentence-in-noise perception test despite having clinically normal audiograms were compared to those of controls (n = 10). The filter shapes were evaluated using a 2-kHz probe with a fixed level of 30, 40, or 50 dB sound pressure level (SPL) and notched-noise simultaneous maskers that were varied in level to determine the masker level necessary to just mask the probe. The filters of the impaired group were significantly wider than those of controls at all probe levels owing to an unusual broadening of the upper slope of the filter. In addition, absolute thresholds were statistically indistinguishable between the groups at the standard audiometric frequencies, but were elevated in the impaired listeners at higher frequencies. These results strengthen the idea that this population has a variety of hearing deficits that go undetected by standard audiometry.

King-Kopetzky syndrome in the light of an ecological conceptual framework: El Síndrome de King-Kopetzky a la luz de un trabajo conceptual ecológico

The principal symptom of subjects suffering from King-Kopetzky syndrome is a perceived difficulty in recognizing and understanding speech in noisy backgrounds. For some patients, minor disturbances in auditory function, e.g. a deteriorated signal-to-noise ratio for speech, can be demonstrated; for others, all measurements of hearing are normal. A conceptual framework developed for the analysis of communication disorders is applied to King-Kopetzky syndrome in the present article. The usefulness of the framework is evaluated, and an extended system for the analysis of King-Kopetzky syndrome patients is suggested. It is emphasized that changes in demands resulting from external conditions and altered perception and evaluation of the conditions may generate the symptoms. A change in the subjects' desired self-image (preferendum) and a change in social role, new, unfamiliar vocabulary, as well as minor dysfunctions in peripheral and central auditory processing, might generate the characteristic features of the syndrome. The framework is related to the current literature, and arguments for the usefulness of the framework in the planning of support and rehabilitation are presented. Several new questions are generated for further analysis of King-Kopetzky syndrome.

The Audioscan: a high frequency resolution audiometric technique and its clinical applications

The Audioscan is a form of high definition audiometry based on iso-hearing level frequency sweeps, which was developed by Meyer-Bisch in 1990. Compared with traditional tone audiometry, it sweeps across the preset frequency range at a predetermined sweep rate and provides a continuous audiometric curve. Because the device has a maximum frequency range of 125-16 000 Hz with 64 frequencies per octave, the Audioscan method can, theoretically, give 64 times as many values as fixed-frequency audiometry, which may give greater accuracy and sensitivity. An advantage of this is its capacity to detect mild audiometric deficits such as narrow notches situated between the frequencies normally tested. These may represent very limited auditory lesions, at a stage when they cannot be detected by routine audiological methods. Thus, the Audioscan method can give not only a detailed audiometric curve, but also provide important indicators of mild auditory dysfunction. The Audioscan device (e.g. Essilor model) is commercially available for clinical purpose. It is a software-based system, which can also be used for pure tone audiometry and Békésy audiometry. This paper reviews the general aspects of the Audioscan technique and current applications for detecting auditory dysfunction. This would be valuable to provide some guidelines on the Audioscan assessment, and contribute to a clarification of the clinical application of Audioscan and facilitate further research.