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Crum R, Chowsilpa S, Kaski D, Giunti P, Bamiou DE, Koohi N. Hearing rehabilitation of adults with auditory processing disorder: a systematic review and meta-analysis of current evidence-based interventions. Front Hum Neurosci 2024; 18:1406916. [PMID: 38974481 PMCID: PMC11224551 DOI: 10.3389/fnhum.2024.1406916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/31/2024] [Indexed: 07/09/2024] Open
Abstract
Background For adults with auditory processing disorder (APD), listening and communicating can be difficult, potentially leading to social isolation, depression, employment difficulties and certainly reducing the quality of life. Despite existing practice guidelines suggesting treatments, the efficacy of these interventions remains uncertain due to a lack of comprehensive reviews. This systematic review and meta-analysis aim to establish current evidence on the effectiveness of interventions for APD in adults, addressing the urgent need for clarity in the field. Methods Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search across MEDLINE (Ovid), Embase (Ovid), Web of Science and Scopus, focusing on intervention studies involving adults with APD. Studies that met the inclusion criteria were grouped according to intervention with a meta-analysis only conducted where intervention, study design and outcome measure were comparable. Results Out of 1,618 screened records, 13 studies were included, covering auditory training (AT), low-gain hearing aids (LGHA), and personal remote microphone systems (PRMS). Our analysis revealed: AT, Mixed results with some improvements in speech intelligibility and listening ability, indicating potential benefits but highlighting the need for standardized protocols; LGHA, The included studies demonstrated significant improvements in monaural low redundancy speech testing (p < 0.05), suggesting LGHA could enhance speech perception in noisy environments. However, limitations include small sample sizes and potential biases in study design. PRMS, Demonstrated the most consistent evidence of benefit, significantly improving speech testing results, with no additional benefit from combining PRMS with other interventions. Discussion PRMS presents the most evidence-supported intervention for adults with APD, although further high-quality research is crucial for all intervention types. The establishment and implementation of standardized intervention protocols alongside rigorously validated outcome measures will enable a more evidence-based approach to managing APD in adults.
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Affiliation(s)
- Rachel Crum
- The Ear Institute, University College London, London, United Kingdom
| | - Sanathorn Chowsilpa
- The Ear Institute, University College London, London, United Kingdom
- Otology Neurotology and Communication Disorder Unit, Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Diego Kaski
- The Ear Institute, University College London, London, United Kingdom
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, United Kingdom
- Neuro-otology Department, University College London Hospitals, London, United Kingdom
- Ataxia Centre, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Paola Giunti
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, United Kingdom
- Ataxia Centre, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Doris-Eva Bamiou
- The Ear Institute, University College London, London, United Kingdom
- Neuro-otology Department, University College London Hospitals, London, United Kingdom
- Biomedical Research Centre, National Institute for Health Research, London, United Kingdom
| | - Nehzat Koohi
- The Ear Institute, University College London, London, United Kingdom
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, United Kingdom
- Ataxia Centre, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
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Lander DM, Liu S, Roup CM. Associations Between Auditory Working Memory, Self-Perceived Listening Effort, and Hearing Difficulty in Adults With Mild Traumatic Brain Injury. Ear Hear 2024; 45:695-709. [PMID: 38229218 DOI: 10.1097/aud.0000000000001462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVES Mild traumatic brain injury (TBI) can have persistent effects in the auditory domain (e.g., difficulty listening in noise), despite individuals having normal pure-tone auditory sensitivity. Individuals with a history of mild TBI often perceive hearing difficulty and greater listening effort in complex listening situations. The purpose of the present study was to examine self-perceived hearing difficulty, listening effort, and performance on an auditory processing test battery in adults with a history of mild TBI compared with a control group. DESIGN Twenty adults ages 20 to 53 years old participated divided into a mild TBI (n = 10) and control group (n = 10). Perceived hearing difficulties were measured using the Adult Auditory Processing Scale and the Hearing Handicap Inventory for Adults. Listening effort was measured using the National Aeronautics and Space Administration-Task Load Index. Listening effort ratings were obtained at baseline, after each auditory processing test, and at the completion of the test battery. The auditory processing test battery included (1) dichotic word recognition, (2) the 500-Hz masking level difference, (3) the Listening in Spatialized Noise-Sentences test, and (4) the Word Auditory Recognition and Recall Measure (WARRM). RESULTS Results indicated that individuals with a history of mild TBI perceived significantly greater degrees of hearing difficulty and listening effort than the control group. There were no significant group differences on two of the auditory processing tasks (dichotic word recognition or Listening in Spatialized Noise-Sentences). The mild TBI group exhibited significantly poorer performance on the 500-Hz MLD and the WARRM, a measure of auditory working memory, than the control group. Greater degrees of self-perceived hearing difficulty were significantly associated with greater listening effort and poorer auditory working memory. Greater listening effort was also significantly associated with poorer auditory working memory. CONCLUSIONS Results demonstrate that adults with a history of mild TBI may experience subjective hearing difficulty and listening effort when listening in challenging acoustic environments. Poorer auditory working memory on the WARRM task was observed for the adults with mild TBI and was associated with greater hearing difficulty and listening effort. Taken together, the present study suggests that conventional clinical audiometric battery alone may not provide enough information about auditory processing deficits in individuals with a history of mild TBI. The results support the use of a multifaceted battery of auditory processing tasks and subjective measures when evaluating individuals with a history of mild TBI.
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Affiliation(s)
- Devan M Lander
- Department of Speech & Hearing Science, The Ohio State University, Columbus, Ohio, USA
| | - Shuang Liu
- Independent Statistical Consultant, Columbus, Ohio, USA
| | - Christina M Roup
- Department of Speech & Hearing Science, The Ohio State University, Columbus, Ohio, USA
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Papesh MA, Koerner T. Clinical Gaps-in-Noise Measures in Blast-Exposed Veterans: Associations with Electrophysiological and Behavioral Responses. Semin Hear 2024; 45:83-100. [PMID: 38370515 PMCID: PMC10872670 DOI: 10.1055/s-0043-1770139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
It has been established that blast exposure and brain injury can result in self-reported and measured auditory processing deficits in individuals with normal or near-normal hearing sensitivity. However, the impaired sensory and/or cognitive mechanisms underlying these auditory difficulties are largely unknown. This work used a combination of behavioral and electrophysiological measures to explore how neural stimulus discrimination and processing speed contribute to impaired temporal processing in blast-exposed Veterans measured using the behavioral Gaps-in-Noise (GIN) Test. Results confirm previous findings that blast exposure can impact performance on the GIN and effect neural auditory discrimination, as measured using the P3 auditory event-related potential. Furthermore, analyses revealed correlations between GIN thresholds, P3 responses, and a measure of behavioral reaction time. Overall, this work illustrates that behavioral responses to the GIN are dependent on both auditory-specific bottom-up processing beginning with the neural activation of the cochlea and auditory brainstem as well as contributions from complex neural networks involved in processing speed and task-dependent target detection.
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Affiliation(s)
- Melissa A. Papesh
- VA National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, Oregon
- Department of Otolaryngology Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Tess Koerner
- VA National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, Oregon
- Department of Otolaryngology Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
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Davidson A, Souza P. Relationships Between Auditory Processing and Cognitive Abilities in Adults: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:296-345. [PMID: 38147487 DOI: 10.1044/2023_jslhr-22-00716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
PURPOSE The contributions from the central auditory and cognitive systems play a major role in communication. Understanding the relationship between auditory and cognitive abilities has implications for auditory rehabilitation for clinical patients. The purpose of this systematic review is to address the question, "In adults, what is the relationship between central auditory processing abilities and cognitive abilities?" METHOD Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to identify, screen, and determine eligibility for articles that addressed the research question of interest. Medical librarians and subject matter experts assisted in search strategy, keyword review, and structuring the systematic review process. To be included, articles needed to have an auditory measure (either behavioral or electrophysiologic), a cognitive measure that assessed individual ability, and the measures needed to be compared to one another. RESULTS Following two rounds of identification and screening, 126 articles were included for full analysis. Central auditory processing (CAP) measures were grouped into categories (behavioral: speech in noise, altered speech, temporal processing, binaural processing; electrophysiologic: mismatch negativity, P50, N200, P200, and P300). The most common CAP measures were sentence recognition in speech-shaped noise and the P300. Cognitive abilities were grouped into constructs, and the most common construct was working memory. The findings were mixed, encompassing both significant and nonsignificant relationships; therefore, the results do not conclusively establish a direct link between CAP and cognitive abilities. Nonetheless, several consistent relationships emerged across different domains. Distorted or noisy speech was related to working memory or processing speed. Auditory temporal order tasks showed significant relationships with working memory, fluid intelligence, or multidomain cognitive measures. For electrophysiology, relationships were observed between some cortical evoked potentials and working memory or executive/inhibitory processes. Significant results were consistent with the hypothesis that assessments of CAP and cognitive processing would be positively correlated. CONCLUSIONS Results from this systematic review summarize relationships between CAP and cognitive processing, but also underscore the complexity of these constructs, the importance of study design, and the need to select an appropriate measure. The relationship between auditory and cognitive abilities is complex but can provide informative context when creating clinical management plans. This review supports a need to develop guidelines and training for audiologists who wish to consider individual central auditory and cognitive abilities in patient care. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24855174.
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Roup CM, Lander D, Powell J, Hoffman J. The Impact of Traumatic Brain Injury on Binaural Processing in Young and Middle-Age Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4037-4051. [PMID: 37732825 DOI: 10.1044/2023_jslhr-22-00725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE This study examined the impact of traumatic brain injury (TBI) on self-perceived hearing and suprathreshold binaural processing in young and middle-age adults. METHOD Ninety-three adults with normal hearing (thresholds ≤ 25 dB HL, 250-4000 Hz) participated in one of four groups: 38 young adults, 23 young adults with TBI, 16 middle-age adults, and 16 middle-age adults with TBI. Self-perceived hearing difficulty was measured via questionnaires. Binaural processing was measured using dichotic word recognition, the Listening in Spatialized Noise-Sentences Test (LiSN-S), and the 500-Hz masking level difference (MLD). For each participant, a composite binaural processing (CBP) score was calculated to obtain a global metric of binaural processing performance. The CBP was composed of six measures from the three behavioral tests, including the S0N0 and SπN0 thresholds from the 500-Hz MLD, the low- and high-cue speech recognition thresholds from the LiSN-S, and the free and directed recall ear advantages from the dichotic word test. RESULTS The middle-age TBI group reported significantly greater degrees of self-perceived hearing difficulty than the other groups. On average, the middle-age TBI group performed poorer on the individual binaural processing tests; however, the differences were significant for the S0N0 and SπN0 MLD thresholds only. Results for the global metric of binaural processing revealed significantly poorer CBP scores for the middle-age TBI group compared to the other groups. CONCLUSIONS Results demonstrate that both age and a positive history of TBI contributed to deficits in suprathreshold binaural processing. Middle-age adults with a history of TBI are at risk for experiencing presenescent deficits in suprathreshold binaural processing deficits, despite having clinically normal hearing.
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Affiliation(s)
- Christina M Roup
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Devan Lander
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Julie Powell
- Debra B. Romas & Associates, Mount Vernon, OH
- OhioHealth, Columbus
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Graham AS, Ben-Azu B, Tremblay MÈ, Torre P, Senekal M, Laughton B, van der Kouwe A, Jankiewicz M, Kaba M, Holmes MJ. A review of the auditory-gut-brain axis. Front Neurosci 2023; 17:1183694. [PMID: 37600010 PMCID: PMC10435389 DOI: 10.3389/fnins.2023.1183694] [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: 03/10/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Hearing loss places a substantial burden on medical resources across the world and impacts quality of life for those affected. Further, it can occur peripherally and/or centrally. With many possible causes of hearing loss, there is scope for investigating the underlying mechanisms involved. Various signaling pathways connecting gut microbes and the brain (the gut-brain axis) have been identified and well established in a variety of diseases and disorders. However, the role of these pathways in providing links to other parts of the body has not been explored in much depth. Therefore, the aim of this review is to explore potential underlying mechanisms that connect the auditory system to the gut-brain axis. Using select keywords in PubMed, and additional hand-searching in google scholar, relevant studies were identified. In this review we summarize the key players in the auditory-gut-brain axis under four subheadings: anatomical, extracellular, immune and dietary. Firstly, we identify important anatomical structures in the auditory-gut-brain axis, particularly highlighting a direct connection provided by the vagus nerve. Leading on from this we discuss several extracellular signaling pathways which might connect the ear, gut and brain. A link is established between inflammatory responses in the ear and gut microbiome-altering interventions, highlighting a contribution of the immune system. Finally, we discuss the contribution of diet to the auditory-gut-brain axis. Based on the reviewed literature, we propose numerous possible key players connecting the auditory system to the gut-brain axis. In the future, a more thorough investigation of these key players in animal models and human research may provide insight and assist in developing effective interventions for treating hearing loss.
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Affiliation(s)
- Amy S. Graham
- Imaging Sciences, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| | - Benneth Ben-Azu
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Department of Pharmacology, Faculty of Basic Medical Sciences, College of Health Sciences, Delta State University, Abraka, Delta State, Nigeria
| | - Marie-Ève Tremblay
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Département de Médecine Moléculaire, Université Laval, Québec City, QC, Canada
- Axe Neurosciences, Centre de Recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
- Neurology and Neurosurgery Department, McGill University, Montreal, QC, Canada
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
- Centre for Advanced Materials and Related Technology (CAMTEC), University of Victoria, Victoria, BC, Canada
- Institute for Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | - Peter Torre
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, United States
| | - Marjanne Senekal
- Department of Human Biology, Division of Physiological Sciences, University of Cape Town, Cape Town, South Africa
| | - Barbara Laughton
- Family Clinical Research Unit, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Andre van der Kouwe
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Marcin Jankiewicz
- Imaging Sciences, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| | - Mamadou Kaba
- Department of Pathology, Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Martha J. Holmes
- Imaging Sciences, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- ImageTech, Simon Fraser University, Surrey, BC, Canada
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Kraus N, Colegrove D, Otto-Meyer R, Bonacina S, Nicol T, Cunningham J, Krizman J. Subconcussion revealed by sound processing in the brain. EXERCISE, SPORT, & MOVEMENT 2023; 1:1-4. [PMID: 38130893 PMCID: PMC10735248 DOI: 10.1249/esm.0000000000000011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Introduction/Purpose We tested the hypothesis that an objective measure of auditory processing reveals a history of head trauma that does not meet the clinical definition of concussion. Methods Division I collegiate student-athletes (n = 709) across 19 sports were divided into groups, based on their sport, using prevailing classifications of "contact" (317 males, 212 females) and "noncontact" (58 males, 122 females). Participants were evaluated using the frequency-following response (FFR) to speech. The amplitude of FFR activity in a frequency band corresponding to the fundamental frequency (F0)-the voice pitch-of the speech stimulus, an outcome reduced in individuals with concussions, was critically examined. Results We found main effects of contact level and sex. The FFR-F0 was smaller in contact athletes than noncontact athletes and larger in females than males. There was a contact by sex interaction, with the FFR-F0 of males in the contact group being smaller than the three other groups. Secondary analyses found a correlation between FFR-F0 and length of participation in contact sports in male athletes. Conclusion These findings suggest that the disruption of sensory processing in the brain can be observed in individuals without a concussion but whose sport features regular physical contact. This evidence identifies sound processing in the brain as an objective marker of subconcussion in athletes.
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Affiliation(s)
- Nina Kraus
- Department of Communication Science and Disorders, Northwestern University, Evanston, IL, USA
- Department of Neurobiology, Northwestern University, Evanston, IL, USA
- Department of Otolaryngology, Northwestern University, Chicago, IL, USA
| | - Danielle Colegrove
- Department of Sports Medicine, Northwestern University, Evanston, IL, USA
| | - Rembrandt Otto-Meyer
- Department of Communication Science and Disorders, Northwestern University, Evanston, IL, USA
| | - Silvia Bonacina
- Department of Communication Science and Disorders, Northwestern University, Evanston, IL, USA
| | - Trent Nicol
- Department of Communication Science and Disorders, Northwestern University, Evanston, IL, USA
| | - Jenna Cunningham
- Department of Communication Science and Disorders, Northwestern University, Evanston, IL, USA
| | - Jennifer Krizman
- Department of Communication Science and Disorders, Northwestern University, Evanston, IL, USA
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Tepe V, Guillory L, Boudin-George A, Cantelmo T, Murphy S. Central Auditory Processing Dysfunction in Service Members and Veterans: Treatment Considerations and Strategies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-28. [PMID: 37379242 DOI: 10.1044/2023_jslhr-23-00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
PURPOSE Military risk factors such as blast exposure, noise exposure, head trauma, and neurotoxin exposure place Service members and Veterans at risk for deficits associated with auditory processing dysfunction. However, there is no clinical guidance specific to the treatment of auditory processing deficits in this unique population. We provide an overview of available treatments and their limited supporting evidence for use in adults, emphasizing the need for multidisciplinary case management and interdisciplinary research to support evidence-based solutions. METHOD We explored relevant literature to inform the treatment of auditory processing dysfunction in adults, with emphasis on findings involving active or former military personnel. We were able to identify a limited number of studies, pertaining primarily to the treatment of auditory processing deficits through the use of assistive technologies and training strategies. We assessed the current state of the science for knowledge gaps that warrant additional study. CONCLUSIONS Auditory processing deficits often co-occur with other military injuries and may pose significant risk in military operational and occupational settings. Research is needed to advance clinical diagnostic and rehabilitative capabilities, guide treatment planning, support effective multidisciplinary management, and inform fitness-for-duty standards. We emphasize the need for an inclusive approach to the assessment and treatment of auditory processing concerns in Service members and Veterans and for evidence-based solutions to address complex military risk factors and injuries.
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Affiliation(s)
- Victoria Tepe
- Department of Defense Hearing Center of Excellence, JBSA Lackland, TX
- The Geneva Foundation, Tacoma, WA
| | - Lisa Guillory
- Harry S. Truman Memorial Veterans' Hospital, Columbia, MO
| | - Amy Boudin-George
- Department of Defense Hearing Center of Excellence, JBSA Lackland, TX
| | - Tasha Cantelmo
- Alexander T. Augusta Military Medical Center, Fort Belvoir, VA
| | - Sara Murphy
- Department of Defense Hearing Center of Excellence, JBSA Lackland, TX
- The Geneva Foundation, Tacoma, WA
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Hwang PH, Nelson LD, Sharon JD, McCrea MA, Dikmen SS, Markowitz AJ, Manley GT, Temkin NR. Association Between TBI-Related Hearing Impairment and Cognition: A TRACK-TBI Study. J Head Trauma Rehabil 2022; 37:E327-E335. [PMID: 34698685 PMCID: PMC9035476 DOI: 10.1097/htr.0000000000000735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the association between hearing impairment and cognitive function after traumatic brain injury (TBI). SETTING A total of 18 level I trauma centers throughout the United States in the T ransforming R esearch a nd C linical K nowledge in TBI (TRACK-TBI) study. PARTICIPANTS From February 2014 to June 2018, a total of 2697 participants with TBI were enrolled in TRACK-TBI. Key eligibility criteria included external force trauma to the head, presentation to a participating level I trauma center, and receipt of a clinically indicated head computed tomographic (CT) scan within 24 hours of injury. A total of 1267 participants were evaluated in the study, with 216 participants with hearing impairment and 1051 participants without hearing impairment. Those with missing or unknown hearing status or cognitive assessment were excluded from analysis. DESIGN Prospective, observational cohort study. MAIN MEASURES Hearing impairment at 2 weeks post-TBI was based on self-report. Participants who indicated worse hearing in one or both ears were defined as having hearing impairment, whereas those who denied worse hearing in either ear were defined as not having hearing impairment and served as the reference group. Cognitive outcomes at 6 months post-TBI included executive functioning and processing speed, as measured by the Trail Making Test (TMT) B/A and the Wechsler Adult Intelligence Scale, Fourth Edition, Processing Speed Index subscale (WAIS-IV PSI), respectively. RESULTS TBI-related hearing impairment had a small but significantly greater TMT B/A ratio than without TBI-related hearing impairment: mean difference ( B ) = 0.25; 95% CI, 0.07 to 0.43; P = .005. No significant mean differences on WAIS-IV PSI scores were found between participants with and without TBI-related hearing impairment: B = 0.36; 95% CI, -2.07 to 2.60; P = .825. CONCLUSION We conclude that TBI-related hearing impairment at 6 months postinjury was significantly associated with worse executive functioning but not cognitive processing speed.
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Affiliation(s)
- Phillip H Hwang
- Department of Anatomy & Neurobiology, Boston University, Boston, Massachusetts (Dr Hwang); Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee (Drs Nelson and McCrea); Departments of Otolaryngology (Dr Sharon) and Neurological Surgery (Dr Manley), University of California San Francisco; Departments of Rehabilitation Medicine (Dr Dikmen), Neurological Surgery (Dr Temkin), and Biostatistics (Dr Temkin), University of Washington, Seattle; and Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California (Ms Markowitz)
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Parker A, Skoe E, Tecoulesco L, Naigles L. A Home-Based Approach to Auditory Brainstem Response Measurement: Proof-of-Concept and Practical Guidelines. Semin Hear 2022; 43:177-196. [PMID: 36313050 PMCID: PMC9605808 DOI: 10.1055/s-0042-1756163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Broad-scale neuroscientific investigations of diverse human populations are difficult to implement. This is because the primary neuroimaging methods (magnetic resonance imaging, electroencephalography [EEG]) historically have not been portable, and participants may be unable or unwilling to travel to test sites. Miniaturization of EEG technologies has now opened the door to neuroscientific fieldwork, allowing for easier access to under-represented populations. Recent efforts to conduct auditory neuroscience outside a laboratory setting are reviewed and then an in-home technique for recording auditory brainstem responses (ABRs) and frequency-following responses (FFRs) in a home setting is introduced. As a proof of concept, we have conducted two in-home electrophysiological studies: one in 27 children aged 6 to 16 years (13 with autism spectrum disorder) and another in 12 young adults aged 18 to 27 years, using portable electrophysiological equipment to record ABRs and FFRs to click and speech stimuli, spanning rural and urban and multiple homes and testers. We validate our fieldwork approach by presenting waveforms and data on latencies and signal-to-noise ratio. Our findings demonstrate the feasibility and utility of home-based ABR/FFR techniques, paving the course for larger fieldwork investigations of populations that are difficult to test or recruit. We conclude this tutorial with practical tips and guidelines for recording ABRs and FFRs in the field and discuss possible clinical and research applications of this approach.
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Affiliation(s)
- Ashley Parker
- Department of Speech, Language, and Hearing Sciences, University of Connecticut, Storrs, Connecticut
- Connecticut Institute for Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut
- Department of Communication Sciences and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Erika Skoe
- Department of Speech, Language, and Hearing Sciences, University of Connecticut, Storrs, Connecticut
- Connecticut Institute for Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut
- Cognitive Sciences Program, University of Connecticut, Storrs, Connecticut
| | - Lee Tecoulesco
- Cognitive Sciences Program, University of Connecticut, Storrs, Connecticut
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
| | - Letitia Naigles
- Connecticut Institute for Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut
- Cognitive Sciences Program, University of Connecticut, Storrs, Connecticut
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut
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Validating a Short Conners CPT 3 as a Screener: Predicting Self-reported CDC Concussion Symptoms in Children, Adolescents, and Adults. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2021. [DOI: 10.1007/s40817-021-00107-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rauterkus G, Moncrieff D, Stewart G, Skoe E. Baseline, retest, and post-injury profiles of auditory neural function in collegiate football players. Int J Audiol 2021; 60:650-662. [PMID: 33439060 DOI: 10.1080/14992027.2020.1860261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Recent retrospective studies report differences in auditory neurophysiology between concussed athletes and uninjured controls using the frequency-following response (FFR). Adopting a prospective design in college football players, we compared FFRs before and after a concussion and evaluated test-retest reliability in non-concussed teammates. DESIGN Testing took place in a locker room. We analysed the FFR to the fundamental frequency (F0) (FFR-F0) of a speech stimulus, previously identified as a potential concussion biomarker. Baseline FFRs were obtained during the football pre-season. In athletes diagnosed with concussions during the season, FFRs were measured days after injury and compared to pre-season baseline. In uninjured controls, comparisons were made between pre- and post-season. STUDY SAMPLE Participants were Tulane University football athletes (n = 65). RESULTS In concussed athletes, there was a significant group-level decrease in FFR-F0 from baseline (26% decrease on average). By contrast, the control group's change from baseline was not statistically significant, and comparisons of pre- and post-season had good repeatability (intraclass correlation coefficient = 0.75). CONCLUSIONS Results converge with previous work to evince suppressed neural function to the FFR-F0 following concussion. This preliminary study paves the way for larger-scale clinical evaluation of the specificity and reliability of the FFR as a concussion diagnostic.HighlightsThis prospective study reveals suppressed neural responses to sound in concussed athletes compared to baseline.Neural responses to sound show good repeatability in uninjured athletes tested in a locker-room setting.Results support the feasibility of recording frequency-following responses in non-laboratory conditions.
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Affiliation(s)
- Grant Rauterkus
- Center for Sport, Tulane University School of Medicine, New Orleans, LA, USA
| | - Deborah Moncrieff
- School of Communication Sciences and Disorders, University of Memphis, Memphis, TN, USA
| | - Gregory Stewart
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Erika Skoe
- Department of Speech, Language, and Hearing Sciences, Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, USA
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13
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Koerner TK, A. Papesh M, Gallun FJ. A Questionnaire Survey of Current Rehabilitation Practices for Adults With Normal Hearing Sensitivity Who Experience Auditory Difficulties. Am J Audiol 2020; 29:738-761. [PMID: 32966118 DOI: 10.1044/2020_aja-20-00027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose A questionnaire survey was conducted to collect information from clinical audiologists about rehabilitation options for adult patients who report significant auditory difficulties despite having normal or near-normal hearing sensitivity. This work aimed to provide more information about what audiologists are currently doing in the clinic to manage auditory difficulties in this patient population and their views on the efficacy of recommended rehabilitation methods. Method A questionnaire survey containing multiple-choice and open-ended questions was developed and disseminated online. Invitations to participate were delivered via e-mail listservs and through business cards provided at annual audiology conferences. All responses were anonymous at the time of data collection. Results Responses were collected from 209 participants. The majority of participants reported seeing at least one normal-hearing patient per month who reported significant communication difficulties. However, few respondents indicated that their location had specific protocols for the treatment of these patients. Counseling was reported as the most frequent rehabilitation method, but results revealed that audiologists across various work settings are also successfully starting to fit patients with mild-gain hearing aids. Responses indicated that patient compliance with computer-based auditory training methods was regarded as low, with patients generally preferring device-based rehabilitation options. Conclusions Results from this questionnaire survey strongly suggest that audiologists frequently see normal-hearing patients who report auditory difficulties, but that few clinicians are equipped with established protocols for diagnosis and management. While many feel that mild-gain hearing aids provide considerable benefit for these patients, very little research has been conducted to date to support the use of hearing aids or other rehabilitation options for this unique patient population. This study reveals the critical need for additional research to establish evidence-based practice guidelines that will empower clinicians to provide a high level of clinical care and effective rehabilitation strategies to these patients.
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Affiliation(s)
- Tess K. Koerner
- VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
| | - Melissa A. Papesh
- VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Frederick J. Gallun
- VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland
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14
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Kuchinsky SE, Eitel MM, Lange RT, French LM, Brickell TA, Lippa SM, Brungart DS. Objective and Subjective Auditory Effects of Traumatic Brain Injury and Blast Exposure in Service Members and Veterans. Front Neurol 2020; 11:613. [PMID: 32719649 PMCID: PMC7350851 DOI: 10.3389/fneur.2020.00613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022] Open
Abstract
Service members and veterans (SMVs) with a history of traumatic brain injury (TBI) or blast-related injury often report difficulties understanding speech in complex environments that are not captured by clinical tests of auditory function. Little is currently known about the relative contribution of other auditory, cognitive, and symptomological factors to these communication challenges. This study evaluated the influence of these factors on subjective and objective measures of hearing difficulties in SMVs with and without a history of TBI or blast exposure. Analyses included 212 U.S. SMVs who completed auditory and cognitive batteries and surveys of hearing and other symptoms as part of a larger longitudinal study of TBI. Objective speech recognition performance was predicted by TBI status, while subjective hearing complaints were predicted by blast exposure. Bothersome tinnitus was associated with a history of more severe TBI. Speech recognition performance deficits and tinnitus complaints were also associated with poorer cognitive function. Hearing complaints were predicted by high frequency hearing loss and reports of more severe PTSD symptoms. These results suggest that SMVs with a history of blast exposure and/or TBI experience communication deficits that go beyond what would be expected based on standard audiometric assessments of their injuries.
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Affiliation(s)
| | - Megan M Eitel
- Walter Reed National Military Medical Center, Bethesda, MD, United States.,Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Rael T Lange
- Walter Reed National Military Medical Center, Bethesda, MD, United States.,Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,National Intrepid Center of Excellence, Bethesda, MD, United States.,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,General Dynamics Information Technology, Falls Church, VA, United States
| | - Louis M French
- Walter Reed National Military Medical Center, Bethesda, MD, United States.,Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,National Intrepid Center of Excellence, Bethesda, MD, United States.,Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Tracey A Brickell
- Walter Reed National Military Medical Center, Bethesda, MD, United States.,Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,National Intrepid Center of Excellence, Bethesda, MD, United States.,General Dynamics Information Technology, Falls Church, VA, United States.,Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Sara M Lippa
- Walter Reed National Military Medical Center, Bethesda, MD, United States.,Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,National Intrepid Center of Excellence, Bethesda, MD, United States
| | - Douglas S Brungart
- Walter Reed National Military Medical Center, Bethesda, MD, United States
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15
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Knoll RM, Lubner RJ, Brodsky JR, Wong K, Jung DH, Remenschneider AK, Herman SD, Kozin ED. Auditory Quality-of-Life Measures in Patients With Traumatic Brain Injury and Normal Pure Tone Audiometry. Otolaryngol Head Neck Surg 2020; 163:1250-1254. [PMID: 32600124 DOI: 10.1177/0194599820933886] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Auditory complaints are commonly reported following traumatic brain injury (TBI). However, few studies have examined patient-reported auditory symptomatology and quality-of-life metrics in individuals with TBI. We hypothesize that following TBI, individuals can experience auditory symptoms even with hearing thresholds in the normal range. Adult patients with normal auditory thresholds and a history of TBI were evaluated for subjective hearing loss, tinnitus, aural fullness, hyperacusis, and autophony. Hearing Handicap Inventory for Adults, Tinnitus Handicap Inventory, and Hyperacusis Questionnaire were administered. Thirty-one patients were prospectively recruited. Twenty-eight TBI participants (90%) reported ≥1 auditory symptoms at the time of survey intake. Mild to severe handicap in the Hearing Handicap Inventory for Adults and Tinnitus Handicap Inventory was reported in 71.4% and 40% of the participants with hearing loss and tinnitus, respectively. Hyperacusis handicap was considered significant in 41.1% of the participants who complained of hyperacusis and completed the survey. Despite normal hearing thresholds, individuals with TBI experience decrements in auditory quality-of-life metrics. Level of evidence: 3.
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Affiliation(s)
- Renata M Knoll
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Rory J Lubner
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob R Brodsky
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kevin Wong
- Department of Otolaryngology, The Mount Sinai Hospital, New York, New York, USA
| | - David H Jung
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron K Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Seth D Herman
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Elliott D Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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16
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Tepe V, Papesh M, Russell S, Lewis MS, Pryor N, Guillory L. Acquired Central Auditory Processing Disorder in Service Members and Veterans. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:834-857. [PMID: 32163310 DOI: 10.1044/2019_jslhr-19-00293] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose A growing body of evidence suggests that military service members and military veterans are at risk for deficits in central auditory processing. Risk factors include exposure to blast, neurotrauma, hazardous noise, and ototoxicants. We overview these risk factors and comorbidities, address implications for clinical assessment and care of central auditory processing deficits in service members and veterans, and specify knowledge gaps that warrant research. Method We reviewed the literature to identify studies of risk factors, assessment, and care of central auditory processing deficits in service members and veterans. We also assessed the current state of the science for knowledge gaps that warrant additional study. This literature review describes key findings relating to military risk factors and clinical considerations for the assessment and care of those exposed. Conclusions Central auditory processing deficits are associated with exposure to known military risk factors. Research is needed to characterize mechanisms, sources of variance, and differential diagnosis in this population. Existing best practices do not explicitly consider confounds faced by military personnel. Assessment and rehabilitation strategies that account for these challenges are needed. Finally, investment is critical to ensure that Veterans Affairs and Department of Defense clinical staff are informed, trained, and equipped to implement effective patient care.
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Affiliation(s)
- Victoria Tepe
- Department of Defense Hearing Center of Excellence, JBSA Lackland, TX
- The Geneva Foundation, Tacoma, WA
| | - Melissa Papesh
- VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Shoshannah Russell
- Walter Reed National Military Medical Center, Bethesda, MD
- Henry Jackson Foundation, Bethesda, MD
| | - M Samantha Lewis
- VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
- School of Audiology, Pacific University, Hillsboro, OR
| | - Nina Pryor
- Department of Defense Hearing Center of Excellence, JBSA Lackland, TX
- Air Force Research Laboratory, Wright-Patterson Air Force Base, OH
| | - Lisa Guillory
- Harry S. Truman Memorial Veterans' Hospital, Columbia, MO
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia
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17
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Stockbridge MD, Newman RS, Zukowski A, Slawson KK, Doran A, Ratner NB. Language profiles in children with concussion. Brain Inj 2020; 34:567-574. [DOI: 10.1080/02699052.2020.1725836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Melissa D. Stockbridge
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland, USA
| | - Rochelle S. Newman
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland, USA
| | - Andrea Zukowski
- Department of Linguistics, University of Maryland, College Park, Maryland, USA
| | - Kristin K. Slawson
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland, USA
| | - Anthony Doran
- Head First Sports Injury and Concussion Care, Waugh Chapel, Maryland, USA
| | - Nan Bernstein Ratner
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland, USA
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18
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Vander Werff KR, Rieger B. Auditory and Cognitive Behavioral Performance Deficits and Symptom Reporting in Postconcussion Syndrome Following Mild Traumatic Brain Injury. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2501-2518. [PMID: 31260387 PMCID: PMC6808357 DOI: 10.1044/2019_jslhr-h-18-0281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/13/2018] [Accepted: 02/15/2019] [Indexed: 05/07/2023]
Abstract
Purpose This study examined auditory deficits and symptom reporting in individuals with long-term postconcussion symptoms following a single mild traumatic brain injury (mTBI) compared to age- and gender-matched controls without a history of mTBI. Method Case history interviews, symptom questionnaires, and a battery of central auditory and neuropsychological tests were administered to 2 groups. The mTBI group was a civilian population recruited from a local concussion management program who were seeking rehabilitation for postconcussion-related problems in a postacute period between 3 and 18 months following injury. Symptom validity testing was included to assess the rate of possible insufficient test effort and its influence on scores for all outcome measures. Analyses of group differences in test scores were performed both with and without the participants who showed insufficient test effort. Rates of symptom reporting, correlations among symptoms and behavioral test outcomes, and the relationships between auditory and cognitive test performance were analyzed. Results The mTBI group reported a high rate of auditory symptoms and general postconcussion symptoms. Performance on neuropsychological tests of cognitive function showed some differences in raw scores between groups, but when effort was considered, there were no significant differences in the rate of abnormal performance between groups. In contrast, there were significant differences in both raw scores and the rate of abnormal performance between groups for some auditory tests when only considering participants with sufficient effort. Auditory symptoms were strongly correlated with other general postconcussion symptoms. Conclusions Significant auditory symptoms and evidence of long-term central auditory dysfunction were found in a subset of individuals who had chronic postconcussion symptoms after a single mTBI unrelated to blast trauma. The rate of abnormal performance on auditory behavioral tests exceeded the rate of abnormal performance on tests of cognitive function. Supplemental Material https://doi.org/10.23641/asha.8329955.
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Affiliation(s)
| | - Brian Rieger
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY
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19
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Papesh MA, Elliott JE, Callahan ML, Storzbach D, Lim MM, Gallun FJ. Blast Exposure Impairs Sensory Gating: Evidence from Measures of Acoustic Startle and Auditory Event-Related Potentials. J Neurotrauma 2019; 36:702-712. [PMID: 30113267 PMCID: PMC6387566 DOI: 10.1089/neu.2018.5801] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Many military service members and veterans who have been exposed to high-intensity blast waves experience traumatic brain injury (TBI), resulting in chronic auditory deficits despite normal hearing sensitivity. The current study sought to examine the neurological cause of this chronic dysfunction by testing the hypothesis that blast exposure leads to impaired filtering of sensory information at brainstem and early cortical levels. Groups of blast-exposed and non-blast-exposed participants completed self-report measures of auditory and neurobehavioral status, auditory perceptual tasks involving degraded and competing speech stimuli, and physiological measures of sensory gating, including pre-pulse inhibition and habituation of the acoustic startle reflex and electrophysiological assessment of a paired-click sensory gating paradigm. Blast-exposed participants showed significantly reduced habituation to acoustic startle stimuli and impaired filtering of redundant sensory information at the level the auditory cortex. Multiple linear regression analyses revealed that poorer sensory gating at the cortical level was primarily influenced by a diagnosis of TBI, whereas reduced habituation was primarily influenced by a diagnosis of post-traumatic stress disorder. A statistical model was created including cortical sensory gating and habituation to acoustic startle, which strongly predicted performance on a degraded speech task. These results support the hypothesis that blast exposure impairs central auditory processing via impairment of neural mechanisms underlying habituation and sensory gating.
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Affiliation(s)
- Melissa A. Papesh
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
- Department of Otolaryngology Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
| | - Jonathan E. Elliott
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Megan L. Callahan
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Daniel Storzbach
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Miranda M. Lim
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon
- Department of Behavioral Neuroscience and Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon
| | - Frederick J. Gallun
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
- Department of Otolaryngology Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
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20
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Šarkić B, Douglas JM, Simpson A. Peripheral auditory dysfunction secondary to traumatic brain injury: a systematic review of literature. Brain Inj 2018; 33:111-128. [DOI: 10.1080/02699052.2018.1539868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Bojana Šarkić
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Jacinta. M. Douglas
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
- Summer Foundation, Victoria, Australia
| | - Andrea Simpson
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
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21
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Abstract
It has been shown that there is an increased risk for impaired auditory function following traumatic brain injury (TBI) in Veterans. Evidence is strongest in the area of self-report, but behavioural and electro-physiological data have been obtained that are consistent with these complaints. Peripheral and central dysfunction have both been observed. Historically, studies have focused on penetrating head injuries where central injury is more easily documented than in mild closed head injuries, but several recent reports have expanded the literature to include closed head injuries as well. The lack of imaging technology that can identify which closed head injuries are likely to impact auditory function is a significant barrier to accurate diagnosis and rehabilitation. Current behavioural and electrophysiological measures are effective in substantiating the auditory complaints of these patients but leave many questions unanswered. One significant limitation of current approaches is the lack of clear data regarding the potential influence of those mental health comorbidities that are very likely to be present in the Veteran population. In the area of rehabilitation, there are indications that hearing aids and other assistive listening devices may provide benefit, as can auditory training programmes, yet more research needs to be done.
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Affiliation(s)
- Frederick J Gallun
- a VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System , Portland , OR , USA.,b Department of Otolaryngology/H&NS , Oregon Health and Science University , Portland , OR , USA.,c Neuroscience Graduate Program , Oregon Health and Science University , Portland , OR , USA
| | - Melissa A Papesh
- a VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System , Portland , OR , USA
| | - M Samantha Lewis
- a VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System , Portland , OR , USA.,b Department of Otolaryngology/H&NS , Oregon Health and Science University , Portland , OR , USA
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22
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Brainstem Evoked Potential Indices of Subcortical Auditory Processing After Mild Traumatic Brain Injury. Ear Hear 2018; 38:e200-e214. [PMID: 28319479 DOI: 10.1097/aud.0000000000000411] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The primary aim of this study was to assess subcortical auditory processing in individuals with chronic symptoms after mild traumatic brain injury (mTBI) by measuring auditory brainstem responses (ABRs) to standard click and complex speech stimuli. Consistent with reports in the literature of auditory problems after mTBI (despite normal-hearing thresholds), it was hypothesized that individuals with mTBI would have evidence of impaired neural encoding in the auditory brainstem compared to noninjured controls, as evidenced by delayed latencies and reduced amplitudes of ABR components. We further hypothesized that the speech-evoked ABR would be more sensitive than the click-evoked ABR to group differences because of its complex nature, particularly when recorded in a background noise condition. DESIGN Click- and speech-ABRs were collected in 32 individuals diagnosed with mTBI in the past 3 to 18 months. All mTBI participants were experiencing ongoing injury symptoms for which they were seeking rehabilitation through a brain injury rehabilitation management program. The same data were collected in a group of 32 age- and gender-matched controls with no history of head injury. ABRs were recorded in both left and right ears for all participants in all conditions. Speech-ABRs were collected in both quiet and in a background of continuous 20-talker babble ipsilateral noise. Peak latencies and amplitudes were compared between groups and across subgroups of mTBI participants categorized by their behavioral auditory test performance. RESULTS Click-ABR results were not significantly different between the mTBI and control groups. However, when comparing the control group to only those mTBI subjects with measurably decreased performance on auditory behavioral tests, small differences emerged, including delayed latencies for waves I, III, and V. Similarly, few significant group differences were observed for peak amplitudes and latencies of the speech-ABR when comparing at the whole group level but were again observed between controls and those mTBI subjects with abnormal behavioral auditory test performance. These differences were seen for the onset portions of the speech-ABR waveforms in quiet and were close to significant for the onset wave. Across groups, quiet versus noise comparisons were significant for most speech-ABR measures but the noise condition did not reveal more group differences than speech-ABR in quiet, likely because of variability and overall small amplitudes in this condition for both groups. CONCLUSIONS The outcomes of this study indicate that subcortical neural encoding of auditory information is affected in a significant portion of individuals with long-term problems after mTBI. These subcortical differences appear to relate to performance on tests of auditory processing and perception, even in the absence of significant hearing loss on the audiogram. While confounds of age and slight differences in audiometric thresholds cannot be ruled out, these preliminary results are consistent with the idea that mTBI can result in neuronal changes within the subcortical auditory pathway that appear to relate to functional auditory outcomes. Although further research is needed, clinical audiological evaluation of individuals with ongoing post-mTBI symptoms is warranted for identification of individuals who may benefit from auditory rehabilitation as part of their overall treatment plan.
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23
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Chen JX, Lindeborg M, Herman SD, Ishai R, Knoll RM, Remenschneider A, Jung DH, Kozin ED. Systematic review of hearing loss after traumatic brain injury without associated temporal bone fracture. Am J Otolaryngol 2018; 39:338-344. [PMID: 29506762 DOI: 10.1016/j.amjoto.2018.01.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 01/31/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE While hearing loss following temporal bone fracture is a well-described phenomenon, few data exist on auditory dysfunction in patients with traumatic brain injury (TBI) without temporal bone fracture. Herein, we aim to systematically review hearing loss after TBI without bony fracture and describe its etiologies. DATA SOURCES Pubmed, Embase, Cochrane databases. REVIEW METHODS A systematic review of the literature from 1966 to January 2017 was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses recommendations. Data were obtained from studies that investigated hearing loss in TBI without skull fracture according to an a priori protocol with inclusion and exclusion criteria. Variables included type and severity of hearing loss, as well as pathophysiology of hearing loss. RESULTS There were 13 studies with 773 patients that met study criteria. Overall, there was one prospective cohort study, four retrospective cohort studies, two case-control studies, and six case reports. The studies with the highest level of evidence report a change in hearing of at least 10-15 dB across a range of frequencies in as many as 58% percent of TBI patients without bony fracture, which was transient or chronic. The mechanism/severity of injury may impact the rate of hearing loss. CONCLUSIONS Hearing loss after TBI in the absence of bony injury appears to be a clinically significant but poorly characterized phenomenon.
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24
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Thompson EC, Krizman J, White-Schwoch T, Nicol T, LaBella CR, Kraus N. Difficulty hearing in noise: a sequela of concussion in children. Brain Inj 2018. [DOI: 10.1080/02699052.2018.1447686] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Elaine C Thompson
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Jennifer Krizman
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Travis White-Schwoch
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Trent Nicol
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Cynthia R LaBella
- Division of Pediatric Orthopaedics & Sports Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nina Kraus
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
- Institute for Neuroscience, Northwestern University, Evanston, IL, USA
- Department of Neurobiology, Northwestern University, Evanston, IL, USA
- Department of Otolaryngology, Northwestern University, Evanston, IL, USA
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25
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Dresang HC, Turkstra LS. Implicit causality bias in adults with traumatic brain injury. JOURNAL OF COMMUNICATION DISORDERS 2018; 71:1-10. [PMID: 29223490 PMCID: PMC5801097 DOI: 10.1016/j.jcomdis.2017.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 11/15/2017] [Accepted: 12/03/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Individuals with moderate or severe traumatic brain injury often experience impairments in pragmatic language functions. Pragmatic language has been studied primarily in connected language genres such as narratives. It may be, however, that individuals with traumatic brain injury also miss microscopic cues, such as social cues embedded in single word meanings or sentence structure. The current study examined one type of sentence-level pragmatic language cue: implicit causality bias. Implicit causality bias is the attribution of an interpersonal transitive verb action to either the subject noun phrase or object noun phrase of a sentence, and is an inherent property of English-language verbs. METHOD In this study, 19 adults with traumatic brain injury and 18 typical adults were asked to provide sensible and spontaneous completions to 96 sentence fragments. Each fragment contained one interpersonal transitive verb and two noun phrases to which the cause of the verb could be attributed. RESULTS Adults with traumatic brain injury showed significantly less implicit causality bias than typical adults, and also made more errors in assigning the causality of a clause. CONCLUSIONS These results challenge assumptions regarding intact implicit processing in adults with traumatic brain injury, and reveal mechanisms by which communication could fail in everyday social interactions.
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Affiliation(s)
- Haley C Dresang
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Goodnight Hall 1975 Willow Drive, Madison, WI, 53706, USA.
| | - Lyn S Turkstra
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Goodnight Hall 1975 Willow Drive, Madison, WI, 53706, USA; Department of Surgery/Division of Trauma Surgery, Neuroscience Training Program, University of Wisconsin-Madison, USA
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Abstract
OBJECTIVE The aim of this study was to analyze the concussion incidence rate ratios across 29 seasons in a Swedish Hockey League team. DESIGN Cohort study over 29 seasons within one Swedish elite series ice hockey team. PARTICIPANTS All players who were part of one Swedish elite ice hockey team during the research period gave consent for participation in the study. INDEPENDENT VARIABLES Exposure to top-level Swedish ice hockey. MAIN OUTCOME MEASURES Incidence rate ratio for concussion and rehabilitation periods due to concussion were calculated and analyzed. RESULTS During the research period, 267 players in total were part of the team. A total of 1638 traumatic injuries were registered, of which 162 were concussions. Incidence rates (IRs) ranged from 0/1000 games during the first season to 118/1000 games for the final recorded season. The incidence rate ratio was 1.06 (confidence interval, 1.03-1.10) for the entire research period. A shift toward longer rehabilitation periods was discovered. CONCLUSIONS This study showed a significant increase of concussion IR and a trend toward longer rehabilitation periods due to concussion. Possible risk factors were discussed. Risk behavior and rehabilitation protocols should be prioritized areas in the research of concussion in ice hockey.
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Hoover EC, Souza PE, Gallun FJ. Auditory and Cognitive Factors Associated with Speech-in-Noise Complaints following Mild Traumatic Brain Injury. J Am Acad Audiol 2017; 28:325-339. [PMID: 28418327 PMCID: PMC5600820 DOI: 10.3766/jaaa.16051] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Auditory complaints following mild traumatic brain injury (MTBI) are common, but few studies have addressed the role of auditory temporal processing in speech recognition complaints. PURPOSE In this study, deficits understanding speech in a background of speech noise following MTBI were evaluated with the goal of comparing the relative contributions of auditory and nonauditory factors. RESEARCH DESIGN A matched-groups design was used in which a group of listeners with a history of MTBI were compared to a group matched in age and pure-tone thresholds, as well as a control group of young listeners with normal hearing (YNH). STUDY SAMPLE Of the 33 listeners who participated in the study, 13 were included in the MTBI group (mean age = 46.7 yr), 11 in the Matched group (mean age = 49 yr), and 9 in the YNH group (mean age = 20.8 yr). DATA COLLECTION AND ANALYSIS Speech-in-noise deficits were evaluated using subjective measures as well as monaural word (Words-in-Noise test) and sentence (Quick Speech-in-Noise test) tasks, and a binaural spatial release task. Performance on these measures was compared to psychophysical tasks that evaluate monaural and binaural temporal fine-structure tasks and spectral resolution. Cognitive measures of attention, processing speed, and working memory were evaluated as possible causes of differences between MTBI and Matched groups that might contribute to speech-in-noise perception deficits. RESULTS A high proportion of listeners in the MTBI group reported difficulty understanding speech in noise (84%) compared to the Matched group (9.1%), and listeners who reported difficulty were more likely to have abnormal results on objective measures of speech in noise. No significant group differences were found between the MTBI and Matched listeners on any of the measures reported, but the number of abnormal tests differed across groups. Regression analysis revealed that a combination of auditory and auditory processing factors contributed to monaural speech-in-noise scores, but the benefit of spatial separation was related to a combination of working memory and peripheral auditory factors across all listeners in the study. CONCLUSIONS The results of this study are consistent with previous findings that a subset of listeners with MTBI has objective auditory deficits. Speech-in-noise performance was related to a combination of auditory and nonauditory factors, confirming the important role of audiology in MTBI rehabilitation. Further research is needed to evaluate the prevalence and causal relationship of auditory deficits following MTBI.
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Affiliation(s)
- Eric C Hoover
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL
| | - Pamela E Souza
- Department of Communication Sciences and Disorders and Knowles Hearing Center, Northwestern University, Evanston, IL
| | - Frederick J Gallun
- National Center for Rehabilitative Auditory Research, Portland VA Medical Center and Otolaryngology and Head and Neck Surgery Department, Oregon Health and Science University, Portland, OR
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Marangoni AT, Suriano ÍC, Buriti AKL, Gil D. Formal Auditory Training with Individuals after Traumatic Brain Injury. Health (London) 2017. [DOI: 10.4236/health.2017.96070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Does time heal all wounds? Experimental diffuse traumatic brain injury results in persisting histopathology in the thalamus. Behav Brain Res 2016; 340:137-146. [PMID: 28042008 DOI: 10.1016/j.bbr.2016.12.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/30/2016] [Accepted: 12/28/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Thalamic dysfunction has been implicated in overall chronic neurological dysfunction after traumatic brain injury (TBI), however little is known about the underlying histopathology. In experimental diffuse TBI (dTBI), we hypothesize that persisting histopathological changes in the ventral posteromedial (VPM) nucleus of the thalamus is indicative of progressive circuit reorganization. Since circuit reorganization in the VPM impacts the whisker sensory system, the histopathology could explain the development of hypersensitivity to whisker stimulation by 28days post-injury; similar to light and sound hypersensitivity in human TBI survivors. METHODS Adult, male Sprague-Dawley rats underwent craniotomy and midline fluid percussion injury (FPI) (moderate severity; 1.8-2.0atm) or sham surgery. At 1d, 7d, and 28days post-FPI (d FPI) separate experiments confirmed the cytoarchitecture (Giemsa stain) and evaluated neuropathology (silver stain), activated astrocytes (GFAP), neuron morphology (Golgi stain) and microglial morphology (Iba-1) in the VPM. RESULTS Cytoarchitecture was unchanged throughout the time course, similar to previously published data; however, neuropathology and astrocyte activation were significantly increased at 7d and 28d and activated microglia were present at all time points. Neuron morphology was dynamic over the time course with decreased dendritic complexity (fewer branch points; decreased length of processes) at 7d FPI and return to sham values by 28d FPI. CONCLUSIONS These data indicate that dTBI results in persisting thalamic histopathology out to a chronic time point. While these changes can be indicative of either adaptive (recovery) or maladaptive (neurological dysfunction) circuit reorganization, they also provide a potential mechanism by which maladaptive circuit reorganization could contribute to the development of chronic neurological dysfunction. Understanding the processes that mediate circuit reorganization is critical to the development of future therapies for TBI patients.
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Bressler S, Goldberg H, Shinn-Cunningham B. Sensory coding and cognitive processing of sound in Veterans with blast exposure. Hear Res 2016; 349:98-110. [PMID: 27815131 DOI: 10.1016/j.heares.2016.10.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 11/17/2022]
Abstract
Recent anecdotal reports from VA audiology clinics as well as a few published studies have identified a sub-population of Service Members seeking treatment for problems communicating in everyday, noisy listening environments despite having normal to near-normal hearing thresholds. Because of their increased risk of exposure to dangerous levels of prolonged noise and transient explosive blast events, communication problems in these soldiers could be due to either hearing loss (traditional or "hidden") in the auditory sensory periphery or from blast-induced injury to cortical networks associated with attention. We found that out of the 14 blast-exposed Service Members recruited for this study, 12 had hearing thresholds in the normal to near-normal range. A majority of these participants reported having problems specifically related to failures with selective attention. Envelope following responses (EFRs) measuring neural coding fidelity of the auditory brainstem to suprathreshold sounds were similar between blast-exposed and non-blast controls. Blast-exposed subjects performed substantially worse than non-blast controls in an auditory selective attention task in which listeners classified the melodic contour (rising, falling, or "zig-zagging") of one of three simultaneous, competing tone sequences. Salient pitch and spatial differences made for easy segregation of the three concurrent melodies. Poor performance in the blast-exposed subjects was associated with weaker evoked response potentials (ERPs) in frontal EEG channels, as well as a failure of attention to enhance the neural responses evoked by a sequence when it was the target compared to when it was a distractor. These results suggest that communication problems in these listeners cannot be explained by compromised sensory representations in the auditory periphery, but rather point to lingering blast-induced damage to cortical networks implicated in the control of attention. Because all study participants also suffered from post-traumatic disorder (PTSD), follow-up studies are required to tease apart the contributions of PTSD and blast-induced injury on cognitive performance.
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Affiliation(s)
- Scott Bressler
- Center for Computational Neuroscience and Neural Technologies (CompNet), Boston University, Boston, MA 02215, USA
| | - Hannah Goldberg
- Center for Computational Neuroscience and Neural Technologies (CompNet), Boston University, Boston, MA 02215, USA
| | - Barbara Shinn-Cunningham
- Center for Computational Neuroscience and Neural Technologies (CompNet), Boston University, Boston, MA 02215, USA; Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA.
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Vander Werff Kathy R. The Application of the International Classification of Functioning, Disability and Health to Functional Auditory Consequences of Mild Traumatic Brain Injury. Semin Hear 2016; 37:216-32. [PMID: 27489400 DOI: 10.1055/s-0036-1584409] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This article reviews the auditory consequences of mild traumatic brain injury (mTBI) within the context of the International Classification of Functioning, Disability and Health (ICF). Because of growing awareness of mTBI as a public health concern and the diverse and heterogeneous nature of the individual consequences, it is important to provide audiologists and other health care providers with a better understanding of potential implications in the assessment of levels of function and disability for individual interdisciplinary remediation planning. In consideration of body structures and function, the mechanisms of injury that may result in peripheral or central auditory dysfunction in mTBI are reviewed, along with a broader scope of effects of injury to the brain. The activity limitations and participation restrictions that may affect assessment and management in the context of an individual's personal factors and their environment are considered. Finally, a review of management strategies for mTBI from an audiological perspective as part of a multidisciplinary team is included.
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Abstract
The relationship between the pure-tone audiogram and the categorization of normal hearing or a mild hearing loss fails to account for other important non-audiometric factors that impact hearing ability for approximately one-third of adults. In order to obtain a complete hearing profile of our patients who present with normal hearing or a mild hearing loss, it is necessary to consider more than simply the results of the pure-tone audiogram. Both subjective hearing handicap via questionnaire and suprathreshold auditory measures (especially in background noise) have been shown to be sensitive to deficits not captured by the pure-tone audiogram. Viable treatment options with demonstrated benefit, such as mild-gain amplification, should be considered for this population.
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Affiliation(s)
- Christina M. Roup
- Department of Speech and Hearing Science, The Ohio State University
Columbus, OH
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Abaji JP, Curnier D, Moore RD, Ellemberg D. Persisting Effects of Concussion on Heart Rate Variability during Physical Exertion. J Neurotrauma 2015; 33:811-7. [PMID: 26159461 DOI: 10.1089/neu.2015.3989] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of this study was to evaluate cardiac autonomic modulation in university athletes during the post-acute to late phase (mean, 95 days ±63) of injury at rest and during physical exertion. We also sought to evaluate the effect of time since injury and number of injuries on heart rate variability (HRV). We hypothesized that physical exertion would reveal persisting modifications in HRV following a concussion. We included, in a cross-sectional design, athletes who sustained a concussion and matched controls. Concussions were identified by a medical doctor using established criteria. Twelve male concussed and 12 control athletes took part in the study. Control participants were teammates who were chosen to match the concussed athletes with regard to their height, weight, education, and age. The beat-to-beat electrocardiogram intervals of the participants were measured at rest and during physical exertion (isometric hand grip contraction; IHGC), which was sustained for 3 minutes at 30% of the participants' maximum. Linear and nonlinear parameters of HRV were calculated. The ratio between low and high frequency (LF/HF) bands was calculated to assess the sympathovagal balance. During the IHGC, but not at rest, concussed athletes presented significantly lower power in HF bands, leading to a significantly higher LF/HF ratio (p ≤ 0.05). Thus, asymptomatic athletes still may exhibit modifications in cardiac autonomic modulation weeks to months following injury. These modifications may only become apparent during physical exertion. Monitoring HRV may aid diagnosis and provide insight about safe return to play.
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Affiliation(s)
| | - Daniel Curnier
- 1 Department of Kinesiology, Université de Montréal , Montreal, Quebec, Canada .,2 Research Center, CHU Sainte-Justine, Université de Montréal , Montreal, Quebec, Canada
| | - Robert Davis Moore
- 1 Department of Kinesiology, Université de Montréal , Montreal, Quebec, Canada
| | - Dave Ellemberg
- 1 Department of Kinesiology, Université de Montréal , Montreal, Quebec, Canada .,2 Research Center, CHU Sainte-Justine, Université de Montréal , Montreal, Quebec, Canada
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Johnson JE, Turkstra LS. Inference in conversation of adults with traumatic brain injury. Brain Inj 2012; 26:1118-26. [DOI: 10.3109/02699052.2012.666370] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Marangoni AT, Santos RBF, Suriano ÍC, Ortiz KZ, Gil D. Avaliação eletrofisiológica da audição em indivíduos após traumatismo cranioencefálico. REVISTA CEFAC 2011. [DOI: 10.1590/s1516-18462011005000138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: caracterizar o potencial evocado auditivo de tronco encefálico e de longa latência em pacientes pós traumatismo cranioencefálico, comparando-os com indivíduos normais. MÉTODO: estudo clínico transversal realizado com 20 indivíduos audiologicamente normais divididos em dois grupos pareados por idade e sexo: a) 10 indivíduos que sofreram traumatismo cranioencefálico (grupo pesquisa); b) 10 indivíduos sem qualquer tipo de alteração neurológica (grupo controle). Foram submetidos à avaliação audiológica básica, ao potencial evocado auditivo de tronco encefálico e ao potencial evocado auditivo de longa latência (P300). RESULTADOS: observou-se no potencial evocado auditivo de tronco encefálico, latências absolutas das ondas I, III e V e intervalo interpico I-III mais prolongados no grupo pesquisa do que no grupo controle, sendo estatisticamente significante para as latências absolutas das ondas I e III à direita e para a onda III e intervalo interpico I-III à esquerda. A amplitude das ondas I, III e V na orelha direita e das ondas III e V na orelha esquerda foram maiores no grupo controle. Em relação ao P300, o grupo pesquisa apresentou maior latência e menor amplitude em ambas as orelhas, sem significância estatística, quando comparado ao grupo controle. CONCLUSÃO: indivíduos que sofreram traumatismo cranioencefálico apresentam alterações no potencial evocado auditivo de tronco encefálico e não apresentam diferenças significantes no potencial evocado auditivo de longa latência (P300) quando comparados a indivíduos sem lesões cerebrais.
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Abstract
The purpose of this study was to assess the results of a hearing evaluation protocol among 130 pediatric patients with a head injury. Sixteen of these patients failed an audiology evaluation. Ten were thought to have failed based on congestion/middle ear dysfunction, while 6 patients had temporary or permanent hearing loss thought to be related to their injury. The majority who failed because of their injury had temporal bone fractures and abnormal visual ear examination results. More research on trauma-related hearing loss following various types of head injuries and skull fractures in pediatric patients of varying ages is needed.
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Bergemalm PO, Hennerdal S, Persson B, Lyxell B, Borg E. Perception of the acoustic environment and neuroimaging findings: a report of six cases with a history of closed head injury. Acta Otolaryngol 2009; 129:801-8. [PMID: 18836964 DOI: 10.1080/00016480802419099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION The main finding was the relation between difficulty in determining the direction of movement of a sound source and frontal lesions and poor working memory. Poor correspondence in some cases between functional findings and imaging findings can be due to the possibility of axonal degeneration as well as plastic reorganization. OBJECTIVE The purpose of the present investigation of six cases was to identify auditory, cognitive and neuroimaging long-term sequelae of closed head injury (CHI) with particular focus on environmental sound recognition and moving sound sources. SUBJECTS AND METHODS Six subjects who had experienced CHI were investigated with auditory tests. Four subjects also completed cognitive testing. CT and MRI were performed. RESULTS There was a large individual variability of the test results with respect to morphological findings. In five cases with central auditory processing disorders morphological brain damage was demonstrated. Two cases with shortcomings on cognitive testing and with frontal brain lesions demonstrated problems in determining the direction of movement of a sound source. The results may indicate that basal frontal lobe structures play a role in following and determining the direction of movement of a sound source. Two cases had problems with environmental sound recognition; in one left temporal brain lesions were demonstrated.
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Neuropsychology and clinical neuroscience of persistent post-concussive syndrome. J Int Neuropsychol Soc 2008; 14:1-22. [PMID: 18078527 DOI: 10.1017/s135561770808017x] [Citation(s) in RCA: 262] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 08/16/2007] [Accepted: 08/16/2007] [Indexed: 01/17/2023]
Abstract
On the mild end of the acquired brain injury spectrum, the terms concussion and mild traumatic brain injury (mTBI) have been used interchangeably, where persistent post-concussive syndrome (PPCS) has been a label given when symptoms persist for more than three months post-concussion. Whereas a brief history of concussion research is overviewed, the focus of this review is on the current status of PPCS as a clinical entity from the perspective of recent advances in the biomechanical modeling of concussion in human and animal studies, particularly directed at a better understanding of the neuropathology associated with concussion. These studies implicate common regions of injury, including the upper brainstem, base of the frontal lobe, hypothalamic-pituitary axis, medial temporal lobe, fornix, and corpus callosum. Limitations of current neuropsychological techniques for the clinical assessment of memory and executive function are explored and recommendations for improved research designs offered, that may enhance the study of long-term neuropsychological sequelae of concussion.
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Vannemreddy P, Ray AK, Patnaik R, Patnaik S, Mohanty S, Sharma HS. Zinc protoporphyrin IX attenuates closed head injury-induced edema formation, blood-brain barrier disruption, and serotonin levels in the rat. ACTA NEUROCHIRURGICA. SUPPLEMENT 2006; 96:151-6. [PMID: 16671445 DOI: 10.1007/3-211-30714-1_34] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The role of heme oxygenase (HO) in closed head injury (CHI) was examined using a potent HO and guanylyl cyclase inhibitor, zinc protoporphyrin (Zn-PP) in the rat. Blood-brain barrier (BBB) permeability to Evans blue and radioiodine, edema formation, and plasma and brain levels of serotonin were measured in control, CHI, and Zn-PP-treated CHI rats. CHI was produced by an impact of 0.224 N on the right parietal bone by dropping 114.6 g weight from a height of 20 cm in anesthetized rats. This concussive injury resulted in edema formation and brain swelling 5 hours after insult that was most pronounced in the contralateral hemisphere. The whole brain was edematous and remained in a semi-fluid state. Microvascular permeability disturbances to protein tracers were prominent in both cerebral hemispheres and the underlying cerebral structures. Plasma and brain serotonin showed pronounced increases and correlated with edema formation. Pretreatment with Zn-PP (10 mg/ kg, i.p) 30 minutes before or after CHI attenuated edema formation, brain swelling, plasma and brain serotonin levels, and microvascular permeability at 5 hours. Brain edema, BBB permeability, and serotonin levels were not attenuated when the compound was administered 60 minutes post-CHI suggesting that HO is involved in cellular and molecular mechanisms of edema formation and BBB breakdown early after CHI.
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Affiliation(s)
- P Vannemreddy
- Laboratory of Neuroanatomy, Department of Medical Cell Biology, Biomedical Center, Uppsala University, Uppsala, Sweden
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