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Niemczak CE, Montagnese B, Levy J, Fellows AM, Gui J, Leigh SM, Magohe A, Massawe ER, Buckey JC. Machine learning for predicting cognitive deficits using auditory and demographic factors. PLoS One 2024; 19:e0302902. [PMID: 38743715 PMCID: PMC11093307 DOI: 10.1371/journal.pone.0302902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
IMPORTANCE Predicting neurocognitive deficits using complex auditory assessments could change how cognitive dysfunction is identified, and monitored over time. Detecting cognitive impairment in people living with HIV (PLWH) is important for early intervention, especially in low- to middle-income countries where most cases exist. Auditory tests relate to neurocognitive test results, but the incremental predictive capability beyond demographic factors is unknown. OBJECTIVE Use machine learning to predict neurocognitive deficits, using auditory tests and demographic factors. SETTING The Infectious Disease Center in Dar es Salaam, Tanzania. PARTICIPANTS Participants were 939 Tanzanian individuals from Dar es Salaam living with and without HIV who were part of a longitudinal study. Patients who had only one visit, a positive history of ear drainage, concussion, significant noise or chemical exposure, neurological disease, mental illness, or exposure to ototoxic antibiotics (e.g., gentamycin), or chemotherapy were excluded. This provided 478 participants (349 PLWH, 129 HIV-negative). Participant data were randomized to training and test sets for machine learning. MAIN OUTCOME(S) AND MEASURE(S) The main outcome was whether auditory variables combined with relevant demographic variables could predict neurocognitive dysfunction (defined as a score of <26 on the Kiswahili Montreal Cognitive Assessment) better than demographic factors alone. The performance of predictive machine learning algorithms was primarily evaluated using the area under the receiver operational characteristic curve. Secondary metrics for evaluation included F1 scores, accuracies, and the Youden's indices for the algorithms. RESULTS The percentage of individuals with cognitive deficits was 36.2% (139 PLWH and 34 HIV-negative). The Gaussian and kernel naïve Bayes classifiers were the most predictive algorithms for neurocognitive impairment. Algorithms trained with auditory variables had average area under the curve values of 0.91 and 0.87, F1 scores (metric for precision and recall) of 0.81 and 0.76, and average accuracies of 86.3% and 81.9% respectively. Algorithms trained without auditory variables as features were statistically worse (p < .001) in both the primary measure of area under the curve (0.82/0.78) and the secondary measure of accuracy (72.3%/74.5%) for the Gaussian and kernel algorithms respectively. CONCLUSIONS AND RELEVANCE Auditory variables improved the prediction of cognitive function. Since auditory tests are easy-to-administer and often naturalistic tasks, they may offer objective measures or predictors of neurocognitive performance suitable for many global settings. Further research and development into using machine learning algorithms for predicting cognitive outcomes should be pursued.
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Affiliation(s)
- Christopher E. Niemczak
- Geisel School of Medicine at Dartmouth, Space Medicine Innovations Laboratory, Lebanon, NH, United States of America
- Dartmouth Health, Department of Medicine, Division of Hyperbaric Medicine, Lebanon, NH, United States of America
| | - Basile Montagnese
- Geisel School of Medicine at Dartmouth, Space Medicine Innovations Laboratory, Lebanon, NH, United States of America
| | - Joshua Levy
- Dartmouth Health, Department of Pathology and Laboratory Medicine, Lebanon, NH, United States of America
- Dartmouth Health, Department of Dermatology, Lebanon, NH, United States of America
- Geisel School of Medicine at Dartmouth, Epidemiology, Lebanon, NH, United States of America
- Geisel School of Medicine at Dartmouth, Program in Quantitative Biomedical Sciences, Lebanon, NH, United States of America
| | - Abigail M. Fellows
- Dartmouth Health, Department of Medicine, Division of Hyperbaric Medicine, Lebanon, NH, United States of America
| | - Jiang Gui
- Geisel School of Medicine at Dartmouth, Program in Quantitative Biomedical Sciences, Lebanon, NH, United States of America
- Geisel School of Medicine at Dartmouth, Biomedical Data Science, Lebanon, NH, United States of America
| | - Samantha M. Leigh
- Dartmouth Health, Department of Medicine, Division of Hyperbaric Medicine, Lebanon, NH, United States of America
| | - Albert Magohe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Enica R. Massawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jay C. Buckey
- Geisel School of Medicine at Dartmouth, Space Medicine Innovations Laboratory, Lebanon, NH, United States of America
- Dartmouth Health, Department of Medicine, Division of Hyperbaric Medicine, Lebanon, NH, United States of America
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Niemczak CE, Zhan Y, Ren J, Song F, Lu H, Chen G, Fellows AM, Gui J, Soli SD, Buckey JC, Shi Y. A Central Auditory Test reveals differences between drug treatment regimens in adults living with HIV. Int J Audiol 2024; 63:207-212. [PMID: 36662150 PMCID: PMC10356905 DOI: 10.1080/14992027.2023.2168217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This exploratory study examined whether central auditory tests show differences between people living with HIV (PLWH) treated with two predominant antiretroviral drug therapy (ART) regimens. DESIGN Cross-sectional. STUDY SAMPLE 253 PLWH (mean age 39.8 years) from the Shanghai Public Health Clinical Centre, China. METHODS The Hearing in Noise Test speech reception threshold (SRT) assessed central auditory function and the Montreal Cognitive Assessment (MoCA) assessed cognition. The relationship between ART regimen and SRT was evaluated with multivariable linear regression incorporating age, HIV duration, and peripheral hearing ability. Multivariable logistic regression was used to ascertain if SRT and ART regimen predicted MoCA impairment. RESULTS The two predominant ART regimens differed by one drug (zidovudine or tenofovir). Participants taking the zidovudine-containing regimen had poorer SRT performance (p=.012) independent of age and hearing thresholds. MoCA scores did not differ between drug regimens, but a negative relationship was found between SRT and MoCA impairment (p=.048). CONCLUSIONS ART regimens differed in their association with central auditory test performance likely reflecting neurocognitive changes in PLWH taking the zidovudine-containing regimen. Central auditory test performance also marginally predicted cognitive impairment, supporting further assessment of central auditory tests to detect neurocognitive deficits in PLWH.
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Affiliation(s)
- Christopher E Niemczak
- Department of Medicine, Dartmouth Health, Lebanon, NH, USA
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Yi Zhan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Junkun Ren
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Fengxiang Song
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Guochao Chen
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Abigail M Fellows
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jiang Gui
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Sigfrid D Soli
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Jay C Buckey
- Department of Medicine, Dartmouth Health, Lebanon, NH, USA
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Lee T, Rieke C, Niemczak C, Kobrina A, Clavier O, Gonzalez J, Fuente A, Alvarez KM, Gonzalez-Quiroz M, Buckey J, Saunders J. Assessment of Central Auditory Processing in Children Using a Novel Tablet-Based Platform: Application for Low- and Middle-Income Countries. Otol Neurotol 2024; 45:176-183. [PMID: 38206066 PMCID: PMC10783812 DOI: 10.1097/mao.0000000000004085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Evaluate whether a portable, tablet-based central auditory processing (CAP) test system using native language training videos and administered by minimally trained community health workers can produce CAP results comparable to previously published norms. Our secondary aim was to determine subject parameters that influence test results. STUDY DESIGN Cross-sectional study. SETTING Community-based settings in Chontales, Nicaragua, New Hampshire, and Florida. PATIENTS English- and/or Spanish-speaking children and adolescents (n = 245; average age, 12.20 yr; range, 6-18 yr). MAIN OUTCOME MEASURES Completion of the following tests with responses comparable to published norms: Pure-tone average (PTA), gap detection threshold (GDT), fixed-level frequency threshold, masking level difference (MLD), Hearing in Noise Test (HINT), Dichotic Digits Test (DDT), and Frequency Pattern Recognition (FPR) test. RESULTS GDT, HINT, and DDT had comparable results to previously published normative values. MLD and FPR results differed compared with previously published normative values. Most CAP tests (MLD, GDT, HINT) results were independent of age and PTA (p = 0.1-0.9). However, DDT was associated with age and PTA (p < 0.0001). CONCLUSIONS Pediatric CAP testing can be successfully completed in remote low- and middle- income country environments using a tablet-based platform without the presence of an audiologist. Performance on DDT improved with age but deteriorated with hearing loss. Further investigation is warranted to assess the variability of FPR.
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Affiliation(s)
- Torri Lee
- Geisel School of Medicine at Dartmouth
| | | | | | | | | | | | | | - Karen Mojica Alvarez
- Vivian Pellas Hospital, Medical Director, Mayflower Medical Outreach, Managua, Nicaragua
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Bolzenius JD, Goodkin K. Variability in the relationships between auditory processing and neurocognitive status among older adults with HIV. AIDS 2023; 37:2091-2093. [PMID: 37755426 DOI: 10.1097/qad.0000000000003668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
| | - Karl Goodkin
- Department of Psychiatry
- Institute of Neuroscience, The University of Texas Rio Grande Valley, Harlingen, TX, USA
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Torre P, Sundermann EE, Brandino A, Heaton A, Devore J, Anderson AM, Moore RC. Auditory and cognitive function in older adults living with and without HIV. AIDS 2023; 37:1971-1978. [PMID: 37289579 PMCID: PMC10538433 DOI: 10.1097/qad.0000000000003618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the peripheral hearing sensitivity and central auditory processing in persons with HIV (PWH) and persons without HIV (PWoH); and the association between cognitive function and central auditory processing in PWH and PWoH. DESIGN Cross-sectional, observational study. METHODS Participants included 67 PWH {70.2% men; mean age = 66.6 years [standard deviation (SD) = 4.7 years]} and 35 PWoH [51.4% men; mean age = 72.9 years (SD = 7.0 years)]. Participants completed a hearing assessment and a central auditory processing assessment that included dichotic digits testing (DDT). Pure-tone air-conduction thresholds were obtained at octave frequencies from 0.25 through 8 kHz. A pure-tone average (PTA) was calculated from 0.5, 1, 2, and 4 kHz thresholds for each ear. Participants also completed a neuropsychological battery assessing cognition in seven domains. RESULTS PWH had slightly lower (i.e. better) PTAs compared with PWoH, but this was not statistically significant. Conversely, PWH and PWoH had similar DDT results for both ears. Poorer verbal fluency, learning, and working memory performance was significantly related to lower DDT scores, and those defined as having verbal fluency, learning, and working memory impairment had significantly poorer DDT scores (8-18% lower) in both ears. CONCLUSION Hearing and DDT results were similar in PWH and PWoH. The relationship between verbal fluency, learning, and working memory impairment and poorer DDT results did not differ by HIV serostatus. Clinicians, particularly audiologists, should be mindful of cognitive functioning abilities when evaluating central auditory processing.
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Affiliation(s)
- Peter Torre
- San Diego State University, School of Speech, Language, and Hearing Sciences, San Diego
| | - Erin E Sundermann
- University of California San Diego, Department of Psychiatry, La Jolla, California
| | | | - Anne Heaton
- University of California San Diego, Department of Psychiatry, La Jolla, California
| | - Julia Devore
- San Diego State University, School of Speech, Language, and Hearing Sciences, San Diego
| | | | - Raeanne C Moore
- University of California San Diego, Department of Psychiatry, La Jolla, California
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Niemczak CE, Cox C, Grigoryan G, Springer G, Fellows AM, Torre P, Hoffman HJ, Buckey JC, Plankey MW. Gap detection responses modelled using the Hill equation in adults with well-controlled HIV. Int J Audiol 2023; 62:383-392. [PMID: 35521916 PMCID: PMC9683355 DOI: 10.1080/14992027.2022.2068083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study's objective was determining whether gap detection deficits are present in a longstanding cohort of people living with HIV (PLWH) compared to those living without HIV (PLWOH) using a new gap detection modelling technique (i.e. fitting gap responses using the Hill equation and analysing the individual gap detection resulting curves with non-linear statistics). This approach provides a measure of both gap threshold and the steepness of the gap length/correct detection relationship. DESIGN The relationship between the correct identification rate at each gap length was modelled using the Hill equation. Results were analysed using a nonlinear mixed-effect regression model. STUDY SAMPLE 45 PLWH (age range 41-78) and 39 PLWOH (age range 38-79) were enrolled and completed gap detection testing. RESULTS The likelihood ratio statistic comparing the full regression model with the HIV effects to the null model, assuming one population curve for both groups, was highly significant (p < 0.001), suggesting a less precise relationship between gap length and correct detection in PLWH. CONCLUSIONS PLWH showed degraded gap detection ability compared to PLWOH, likely due to central nervous system effects of HIV infection or treatment. The Hill equation provided a new approach for modelling gap detection ability.
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Affiliation(s)
| | - Christopher Cox
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Gayle Springer
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Peter Torre
- San Diego State University, San Diego, California, USA
| | - Howard J. Hoffman
- National Institute on Deafness and Other Communication Disorders, Bethesda, Maryland, USA
| | - Jay C. Buckey
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Torre P, Zhang ZJ, Hoffman HJ, Frederick T, Purswani M, Williams PL, Yao TJ. Auditory Function in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol Up Young Adults: A Pilot Study. J Acquir Immune Defic Syndr 2023; 92:340-347. [PMID: 36729663 PMCID: PMC9974905 DOI: 10.1097/qai.0000000000003145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/05/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND To collect and compare selected hearing measures in a pilot study of young adults with perinatally acquired HIV (YAPHIV) and those with perinatal HIV exposure who are uninfected young adults with PHEU (YAPHEU). SETTING Cross-sectional hearing measures in YAPHIV and YAPHEU enrolled in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol (AMP) for Participants 18 Years of Age and Older (AMP Up). METHODS Pure-tone air conduction audiometry and distortion product otoacoustic emission (DPOAE) data were collected in 1 visit. A low-frequency pure-tone average (PTA) (LFPTA, at 0.25, 0.5, 1, and 2 kHz), a speech-frequency PTA (SFPTA, at 0.5, 1, 2, and 4 kHz), and a high-frequency PTA (HFPTA, at 3, 4, 6, and 8 kHz) were calculated. Hearing loss was defined as worse ear SFPTA of ≥20 dB HL. Separate linear regression models were fit for worse ear LFPTA, SFPTA, and HFPTA to assess associations with PHIV status. DPOAE signal-to-noise ratios (SNRs) were obtained at 3 frequencies in each ear. RESULTS Forty-seven YAPHIV and 9 YAPHEU completed hearing testing. All adjusted mean PTAs were similar between YAPHIV and YAPHEU. Hearing loss occurred more in YAPHIV (7/47, 15.2%; 95% CI: 6.3%-28.9%), compared with YAPHEU (0/9, 0%). No associations were detected between HIV disease severity measures and worse ear SFPTA. DPOAE SNRs were similar between YAPHIV and YAPHEU. CONCLUSIONS In this pilot study, peripheral hearing (ie, PTAs) and cochlear function (ie, DPOAEs) were similar between YAPHIV and YAPHEU. A larger study is warranted to confirm these findings.
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Affiliation(s)
- Peter Torre
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA
| | - Zhongli J. Zhang
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Howard J. Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, MD
| | - Toni Frederick
- Department of Pediatrics, Maternal, Child & Adolescent Center for Infectious Diseases and Virology, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Murli Purswani
- Department of Pediatrics, Division of Pediatric Infectious Disease, BronxCare Health System, Bronx, NY
| | - Paige L. Williams
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
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Niemczak CE, Ealer C, Fellows A, Magohe A, Gui J, Rieke C, Nicol T, Massawe ER, Kraus N, Buckey JC. Peripheral Auditory Function in Tanzanian Children Living With HIV With Clinically Normal Hearing. JAMA Netw Open 2023; 6:e233061. [PMID: 36920392 PMCID: PMC10018326 DOI: 10.1001/jamanetworkopen.2023.3061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
IMPORTANCE Despite normal audiometry, adults living with HIV have lower distortion product otoacoustic emissions (DPOAEs) compared with HIV-negative controls, but the degree of these differences in children living with HIV is unknown. If subclinical auditory deficits are present, results could affect developmental outcomes in children living with HIV (CLWH). OBJECTIVE To compare DPOAEs and auditory brainstem responses (ABR) between 2 age- and sex-matched groups of younger children with normal audiometry, 1 infected with HIV and the other uninfected. DESIGN, SETTING, AND PARTICIPANTS Cohort study in an infectious disease center in Dar es Salaam, Tanzania. Participants included 340 Tanzanian children aged 3 to 9 years with clinically normal hearing, type A tympanograms bilaterally, and air-conduction thresholds of 20 dB HL or less from 0.5 to 8 kHz. Participants in the cohort repeated testing approximately every 6 months (approximately 2.2 sessions per participant) for a total of 744 total observations. Data were analyzed from March 2020 to January 2022. MAIN OUTCOMES AND MEASURES DPOAE amplitudes from 1.5 to 8 kHz using an f2 to f1 ratio of 1.2 and L1/L2 values of 65/55 dB sound pressure level and click-evoked ABR using a slow (21.1/s) and fast (61.1/s) click rate. RESULTS A total of 141 CLWH (70 female participants [49.3%]; mean [SD] age, 7.24 [1.67] years) and 199 HIV-negative individuals (99 female participants [49.7%]; mean [SD] age, 7.26 [1.44] years) participated in the study. The groups did not differ significantly in age, static immittance, or air-conduction thresholds. HIV status was independently associated with approximately 1.4 dB (95% CI, -3.28 to 0.30 dB) to 3.8 dB (95% CI, 6.03 to -1.99 dB) lower DPOAE amplitudes at 6 and 8 kHz bilaterally and 0.28 μV (95% CI, 0.01 to 0.33 μV) lower ABR wave V amplitudes in the right ear. CONCLUSIONS AND RELEVANCE Consistent with previous findings in young adults, CLWH had slightly, but reliably, lower DPOAEs and ABR wave V amplitudes than HIV-negative controls. The magnitude of these differences was small, but results suggest an early and consistent association between HIV infection or treatment and outer hair cell and auditory brainstem responses in children as young as 3 years. These subclinical changes suggest tracking both auditory function and development outcomes in CLWH is warranted.
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Affiliation(s)
- Christopher E. Niemczak
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Christin Ealer
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Abigail Fellows
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Albert Magohe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jiang Gui
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Catherine Rieke
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Trent Nicol
- Auditory Neuroscience Laboratory, Department of Communication Sciences, Northwestern University, Evanston, Illinois
| | - Enica R. Massawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nina Kraus
- Auditory Neuroscience Laboratory, Department of Communication Sciences, Northwestern University, Evanston, Illinois
- Auditory Neuroscience Laboratory, Departments of Communication Sciences, Neurobiology and Otolaryngology, Northwestern University, Evanston, Illinois
| | - Jay C. Buckey
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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The Resting State Central Auditory Network: a Potential Marker of HIV-Related Central Nervous System Alterations. Ear Hear 2022; 43:1222-1227. [PMID: 35044995 PMCID: PMC9232992 DOI: 10.1097/aud.0000000000001186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE HIV positive (HIV+) individuals with otherwise normal hearing ability show central auditory processing deficits as evidenced by worse performance in speech-in-noise perception compared with HIV negative (HIV-) controls. HIV infection and treatment are also associated with lower neurocognitive screening test scores, suggesting underlying central nervous system damage. To determine how central auditory processing deficits in HIV+ individuals relate to brain alterations in the cortex involved with auditory processing, we compared auditory network (AN) functional connectivity between HIV+ adults with or without speech-in-noise perception difficulties and age-matched HIV- controls using resting-state fMRI. DESIGN Based on the speech recognition threshold of the hearing-in-noise test, twenty-seven HIV+ individuals were divided into a group with speech-in-noise perception abnormalities (HIV+SPabnl, 38.2 ± 6.8 years; 11 males and 2 females) and one without (HIV+SPnl 34.4 ± 8.8 years; 14 males). An HIV- group with normal speech-in-noise perception (HIV-, 31.3 ± 5.2 years; 9 males and 3 females) was also enrolled. All of these younger and middle-aged adults had normal peripheral hearing determined by audiometry. Participants were studied using resting-state fMRI. Independent component analysis was applied to identify the AN. Group differences in the AN were identified using statistical parametric mapping. RESULTS Both HIV+ groups had increased functional connectivity (FC) in parts of the AN including the superior temporal gyrus, middle temporal gyrus, supramarginal gyrus, and Rolandic operculum compared to the HIV- group. Compared with the HIV+SPnl group, the HIV+SPabnl group showed greater FC in parts of the AN including the middle frontal and inferior frontal gyri. CONCLUSIONS The classical auditory areas in the temporal lobe are affected by HIV regardless of speech perception ability. Increased temporal FC in HIV+ individuals might reflect functional compensation to achieve normal primary auditory perception. Furthermore, increased frontal FC in the HIV+SPabnl group compared with the HIV+SPnl group suggest that speech-in-noise perception difficulties in HIV-infected adults also affect areas involved in higher-level cognition, providing imaging evidence consistent with the hypothesis that HIV-related neurocognitive deficits can include central auditory processing deficits.
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Niemczak CE, Lichtenstein JD, Magohe A, Amato JT, Fellows AM, Gui J, Huang M, Rieke CC, Massawe ER, Boivin MJ, Moshi N, Buckey JC. The Relationship Between Central Auditory Tests and Neurocognitive Domains in Adults Living With HIV. Front Neurosci 2021; 15:696513. [PMID: 34658754 PMCID: PMC8517794 DOI: 10.3389/fnins.2021.696513] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/07/2021] [Indexed: 12/21/2022] Open
Abstract
Objective: Tests requiring central auditory processing, such as speech perception-in-noise, are simple, time efficient, and correlate with cognitive processing. These tests may be useful for tracking brain function. Doing this effectively requires information on which tests correlate with overall cognitive function and specific cognitive domains. This study evaluated the relationship between selected central auditory focused tests and cognitive domains in a cohort of normal hearing adults living with HIV and HIV- controls. The long-term aim is determining the relationships between auditory processing and neurocognitive domains and applying this to analyzing cognitive function in HIV and other neurocognitive disorders longitudinally. Method: Subjects were recruited from an ongoing study in Dar es Salaam, Tanzania. Central auditory measures included the Gap Detection Test (Gap), Hearing in Noise Test (HINT), and Triple Digit Test (TDT). Cognitive measures included variables from the Test of Variables of Attention (TOVA), Cogstate neurocognitive battery, and Kiswahili Montreal Cognitive Assessment (MoCA). The measures represented three cognitive domains: processing speed, learning, and working memory. Bootstrap resampling was used to calculate the mean and standard deviation of the proportion of variance explained by the individual central auditory tests for each cognitive measure. The association of cognitive measures with central auditory variables taking HIV status and age into account was determined using regression models. Results: Hearing in Noise Tests and TDT were significantly associated with Cogstate learning and working memory tests. Gap was not significantly associated with any cognitive measure with age in the model. TDT explained the largest mean proportion of variance and had the strongest relationship to the MoCA and Cogstate tasks. With age in the model, HIV status did not affect the relationship between central auditory tests and cognitive measures. Age was strongly associated with multiple cognitive tests. Conclusion: Central auditory tests were associated with measures of learning and working memory. Compared to the other central auditory tests, TDT was most strongly related to cognitive function. These findings expand on the association between auditory processing and cognitive domains seen in other studies and support evaluating these tests for tracking brain health in HIV and other neurocognitive disorders.
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Affiliation(s)
- Christopher E. Niemczak
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Jonathan D. Lichtenstein
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Albert Magohe
- Department of Otorhinolaryngology, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jennifer T. Amato
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Abigail M. Fellows
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Jiang Gui
- Department of Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Michael Huang
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Catherine C. Rieke
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Enica R. Massawe
- Department of Otorhinolaryngology, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Michael J. Boivin
- Department of Psychiatry, Michigan State University, East Lansing, MI, United States
| | - Ndeserua Moshi
- Department of Otorhinolaryngology, Muhimibili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jay C. Buckey
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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11
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Niemczak CE, White-Schwoch T, Fellows A, Magohe A, Gui J, Rieke C, Nicol T, Massawe ER, Moshi N, Kraus N, Buckey JC. Peripheral Auditory Function in Young HIV-Positive Adults With Clinically Normal Hearing. Otolaryngol Head Neck Surg 2021; 167:155-162. [PMID: 34546820 DOI: 10.1177/01945998211047147] [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: 11/15/2022]
Abstract
OBJECTIVE Little is known about peripheral auditory function in young adults with HIV, who might be expected to show early evidence of hearing loss if HIV infection or treatment does affect peripheral function. The goal of this study was to compare peripheral auditory function in 2 age- and gender-matched groups of young adults with clinically normal hearing with and without HIV. STUDY DESIGN Matched cohort study with repeated measures. SETTING Infectious disease center in Dar es Salaam, Tanzania. METHODS Participants included HIV-positive (n = 38) and HIV-negative (n = 38) adults aged 20 to 30 years who had clinically normal hearing, defined as type A tympanograms, air conduction thresholds ≤25 dB HL bilaterally from 0.5 to 8 kHz, and distortion product otoacoustic emissions (DPOAEs) >6 dB above the noise floor bilaterally from 1.5 to 8 kHz. Participants were tested multiple times over 6-month intervals (average, 2.7 sessions/participant) for a total of 208 observations. Primary outcome measures included tympanograms, air conduction audiograms, DPOAEs, and click-evoked auditory brainstem responses. RESULTS HIV groups did not significantly differ in age, static immittance, or air conduction thresholds. HIV-positive status was independently associated with approximately 3.7-dB lower DPOAE amplitudes from 2 to 8 kHz (95% CI, 1.01-6.82) in both ears and 0.04-µV lower (95% CI, 0.003-0.076) auditory brainstem response wave I amplitudes in the right ear. CONCLUSION Young adults living with HIV have slightly but reliably smaller DPOAEs and auditory brainstem response wave I amplitudes than matched HIV-negative controls. The magnitude of these differences is small, but these results support measuring peripheral auditory function in HIV-positive individuals as they age.
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Affiliation(s)
- Christopher E Niemczak
- Space Medicine Innovations Lab, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Travis White-Schwoch
- Auditory Neuroscience Laboratory, Department of Communication Sciences, Northwestern University, Evanston, Illinois, USA
| | - Abigail Fellows
- Space Medicine Innovations Lab, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Albert Magohe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jiang Gui
- Department of Data Science, Dartmouth College, Hanover, New Hampshire, USA
| | - Catherine Rieke
- Space Medicine Innovations Lab, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Trent Nicol
- Auditory Neuroscience Laboratory, Department of Communication Sciences, Northwestern University, Evanston, Illinois, USA
| | - Enica R Massawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ndeserua Moshi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nina Kraus
- Auditory Neuroscience Laboratory, Department of Communication Sciences, Northwestern University, Evanston, Illinois, USA.,Departments of Neurobiology and Otolaryngology, Northwestern University, Evanston, Illinois, USA
| | - Jay C Buckey
- Space Medicine Innovations Lab, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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12
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Brooks CA, Clavier OH, Fellows AM, Rieke CC, Niemczak CE, Gui J, Pryor NJ, Gallagher HL, Murphy SA, Wise SR, Healy-Leavitt C, Allen LV, Buckey JC. Distortion product otoacoustic mapping measured pre- and post-loud sound exposures. Int J Audiol 2021; 61:187-196. [PMID: 34107827 DOI: 10.1080/14992027.2021.1928303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Sampling distortion product otoacoustic emissions (DPOAEs) at multiple f2/f1 ratios and f2 frequency values produces a DPOAE "map." This study examined the efficacy of DPOAE mapping compared with pure tone audiometry and standard DPOAEs for detecting noise effects in subjects exposed to loud sound. DESIGN A map significance score was developed as a single measure of map change. Significance scores were evaluated before and after exposure to: loud music (LM), controlled noise (CN), and firing range noise (FR) in three separate sets of subjects. Scores were compared to audiometry and standard DPOAE results in the LM study. STUDY SAMPLE The LM and CN exposure studies involved 22, and 20 healthy young subjects respectively with normal hearing. Eight Marines were studied before and after FR exposure. RESULTS After LM exposure, audiometry showed significant changes at 1, 2, 4, and 6 kHz. Standard DPOAE measures were also significantly different at several frequencies. Map significance scores detected changes more effectively and showed the distribution of DPOAE alterations. CONCLUSIONS Map significance scores detected changes after noise exposure more reliably than audiometry and standard DPOAEs. Additionally, maps showed a diffuse response to sound exposure perhaps explaining why individual DP-grams appear less sensitive.
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Affiliation(s)
| | | | | | | | | | - Jiang Gui
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Nina J Pryor
- Air Force Research Laboratory, Wright Patterson Air Force Base, Dayton, OH, USA.,Department of Defense, Hearing Center of Excellence, San Antonio, TX, USA.,zCore Business Solutions, Inc, Round Rock, TX, USA
| | - Hilary L Gallagher
- Air Force Research Laboratory, Wright Patterson Air Force Base, Dayton, OH, USA
| | - Sara A Murphy
- Department of Defense, Hearing Center of Excellence, San Antonio, TX, USA.,Naval Medical Center San Diego, San Diego, CA, USA.,The Geneva Foundation, Tacoma, WA, USA
| | - Sean R Wise
- Creare LLC, Hanover, NH, USA.,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | - Jay C Buckey
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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13
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Massawe ER, Moshi N, Ren J, Rieke CC, Magohe AK, Fellows AM, Arega EA, Niemczak CE, Jackson BP, Karagas MR, Buckey JC. Unexplained multi-sensory neuropathy syndrome in young Tanzanian adults. JOURNAL OF GLOBAL HEALTH REPORTS 2021; 5. [PMID: 34084947 DOI: 10.29392/001c.21360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background A unique syndrome affecting young adults of unexplained hearing loss often associated with uncorrectable poor visual acuity and lower extremity numbness is endemic in Dar es Salaam. This study characterized the hearing loss, associated it with other symptoms, and gathered information on potential causes. Methods Forty-seven patients (23 men, 24 women) <40 years old with a symptom consistent with the syndrome, negative syphilis test, and no head injury history were recruited from Muhimbili National Hospital. 18 controls (10 men, 8 women) were recruited from the same neighborhoods as patients. Hearing ability and cochlear outer hair cell function (distortion-product otoacoustic emissions (DPOAEs)) were assessed, as were visual acuity and color vision. Peripheral neuropathy was evaluated using the Michigan Neuropathy Screening Instrument (MNSI), and physical examination. Blood C-reactive protein levels and toenail trace metal concentrations were measured. Environmental exposures were elicited using a questionnaire. Patients with at least two of the following signs were defined as having the syndrome: poor hearing with normal DPOAEs, vision not correctable to better than 20/30, or a MNSI score greater than 4. Results 29 participants met the case definition. CRP levels did not differ between groups but manganese, cobalt and tin levels were each greater in the cases than controls. No other environmental exposure differences were noted. Conclusions Toenail manganese, cobalt, and tin levels were higher in those with the syndrome. These metals are potential neurotoxins suggesting a possible environmental origin for this unique and debilitating syndrome.
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Affiliation(s)
- Enica R Massawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ndeserua Moshi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Junkun Ren
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Catherine C Rieke
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Albert K Magohe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Enat A Arega
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | | | | | - Jay C Buckey
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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14
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Niemczak C, Fellows A, Lichtenstein J, White-Schwoch T, Magohe A, Gui J, Wilbur J, Clavier O, Massawe E, Moshi N, Boivin M, Kraus N, Buckey J. Central Auditory Tests to Track Cognitive Function in People With HIV: Longitudinal Cohort Study. JMIR Form Res 2021; 5:e26406. [PMID: 33470933 PMCID: PMC7902183 DOI: 10.2196/26406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/06/2021] [Accepted: 01/17/2021] [Indexed: 12/20/2022] Open
Abstract
Background The development of neurocognitive deficits in people infected with HIV is a significant public health problem. Previous cross-sectional studies have shown that performance on central auditory tests (CATs) correlates with cognitive test results in those with HIV, but no longitudinal data exist for confirmation. We have been performing longitudinal assessments of central auditory and cognitive function on a cohort of HIV-positive and HIV-negative individuals in Dar es Salaam, Tanzania to understand how the central auditory system could be used to study and track the progress of central nervous system dysfunction. Objective The goal of the project was to determine if CATs can track the trajectory of cognitive function over time in people diagnosed with HIV. Methods Tests of peripheral and central auditory function as well as cognitive performance were performed on 382 individuals over the course of 3.5 years. Visits were scheduled every 6 months. CATs included tests of auditory temporal processing (gap detection) and speech perception in noise (Hearing in Noise Test and Triple Digit Test). Cognitive tests included the Montreal Cognitive Assessment (MoCA), Test of Variables of Attention (TOVA), and subtests from the Cogstate battery. HIV-positive subjects were divided into groups based on their CAT results at their final visit (bottom 20%, top 20%, middle 60%). Primary analyses focused on the comparison between HIV-positive individuals that performed worse on CATs (bottom 20%) and the overall HIV-positive group (middle 60%). Data were analyzed using linear mixed-effect models with time as the main fixed effect. Results The group with the worst (bottom 20%) CAT performance showed a difference in trajectory for the MoCA (P=.003), TOVA (P<.048), and Cogstate (P<.046) over the course of the study period compared to the overall HIV-positive group. A battery of three CATs showed a significant difference in cognitive trajectory over a relatively short study period of 3.5 years independent of age (bottom 20% vs HIV-positive group). Conclusions The results of this study support the ability for CATs to track cognitive function over time, suggesting that central auditory processing can provide a window into central nervous system performance. CATs can be simple to perform, and are relatively insensitive to education and socioeconomic status because they only require repeating sentences, numbers, or detecting gaps in noise. These tests could potentially provide a time-efficient, low-cost method to screen for and monitor cognitive decline in patients with HIV, making them a useful surveillance tool for this major public health problem.
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Affiliation(s)
- Christopher Niemczak
- Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Abigail Fellows
- Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Jonathan Lichtenstein
- Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States.,Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Travis White-Schwoch
- Department of Communication Sciences and Disorders, Northwestern University, Chicago, IL, United States
| | - Albert Magohe
- Dar Dar Programs, Dar es Salaam, United Republic of Tanzania
| | - Jiang Gui
- Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | | | | | - Enica Massawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Ndeserua Moshi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Michael Boivin
- Department of Psychiatry, Michigan State University, East Lansing, MI, United States
| | - Nina Kraus
- Department of Communication Sciences and Disorders, Northwestern University, Chicago, IL, United States
| | - Jay Buckey
- Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
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15
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Dawood G, Klop D, Olivier E, Elliott H, Pillay M, Grimmer K. Nature and extent of hearing loss in HIV-infected children: A scoping review. Int J Pediatr Otorhinolaryngol 2020; 134:110036. [PMID: 32335463 DOI: 10.1016/j.ijporl.2020.110036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Antiretroviral therapy (ART) has had a major impact on life expectancy from HIV as many people now live with it as a chronic disease. Chronic HIV has been associated with a range of comorbid disabilities and health conditions, one of which is hearing loss. Undiagnosed and untreated hearing loss, particularly in children, has been linked to poorer spoken language skills, with subsequent effects on academic performance. METHODS This systematic scoping review aimed to summarize the available peer-reviewed literature on hearing loss in HIV-infected children, specifically to describe its extent and nature. The review followed the framework proposed by Arksey and O'Malley. Key search terms included hearing loss (and synonyms), child (and synonyms), and HIV. Electronic databases (EBSCOhost Research Platform, PubMed, Web of Science and Scopus databases) were searched for any relevant articles published from January 1, 2000 to June 30, 2019. Reference lists of included articles were pearled for additional relevant articles not already identified. Each stage of the selection process was conducted independently by two authors. The results were then collated by a third author who also resolved any discrepancies. Extracted data included sample descriptors, audiologic tests, hearing loss prevalence, hearing loss descripts, and factors associated with hearing loss. RESULTS Seventeen articles were included; 10 from Africa, four from South America, two from North America and the remaining article from Asia. Although most of the articles reported on pure tone audiometry, the samples as well as the cut-off criteria for normal hearing were heterogenous. Prevalence of hearing loss varied across articles (from 6% to 84%). Conductive hearing loss occurred more frequently than sensorineural or mixed hearing loss. ART use and ear infection were reported as significant in three of five articles that reported on significant associates of HIV-related hearing loss. CONCLUSION There was a modest volume of research from a limited number of countries. Heterogeneity in sampling and audiometric methods precluded a clear understanding of potential associations between chronic HIV-related hearing loss and contributing factors.
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Affiliation(s)
- Gouwa Dawood
- Division of Speech-Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, T Ygerberg, Cape Town, South Africa.
| | - Daleen Klop
- Division of Speech-Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, T Ygerberg, Cape Town, South Africa
| | - Elrietha Olivier
- Division of Speech-Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, T Ygerberg, Cape Town, South Africa
| | - Haley Elliott
- Division of Speech-Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, T Ygerberg, Cape Town, South Africa
| | - Mershen Pillay
- Discipline of Speech-Language Pathology, University of KwaZulu-Natal, Westville, South Africa
| | - Karen Grimmer
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
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16
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White-Schwoch T, Magohe AK, Fellows AM, Rieke CC, Vilarello B, Nicol T, Massawe ER, Moshi N, Kraus N, Buckey JC. Auditory neurophysiology reveals central nervous system dysfunction in HIV-infected individuals. Clin Neurophysiol 2020; 131:1827-1832. [PMID: 32554244 DOI: 10.1016/j.clinph.2020.04.165] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To test the hypothesis that human immunodeficiency virus (HIV) affects auditory-neurophysiological functions. METHODS A convenience sample of 68 HIV+ and 59 HIV- normal-hearing adults was selected from a study set in Dar es Salaam, Tanzania. The speech-evoked frequency-following response (FFR), an objective measure of auditory function, was collected. Outcome measures were FFRs to the fundamental frequency (F0) and to harmonics corresponding to the first formant (F1), two behaviorally relevant cues for understanding speech. RESULTS The HIV+ group had weaker responses to the F1 than the HIV- group; this effect generalized across multiple stimuli (d = 0.59). Responses to the F0 were similar between groups. CONCLUSIONS Auditory-neurophysiological responses differ between HIV+ and HIV- adults despite normal hearing thresholds. SIGNIFICANCE The FFR may reflect HIV-associated central nervous system dysfunction that manifests as disrupted auditory processing of speech harmonics corresponding to the first formant.
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Affiliation(s)
- Travis White-Schwoch
- Auditory Neuroscience Laboratory, Department of Communication Sciences, Northwestern University, Evanston, IL, United States
| | - Albert K Magohe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Abigail M Fellows
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Catherine C Rieke
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Brandon Vilarello
- Auditory Neuroscience Laboratory, Department of Communication Sciences, Northwestern University, Evanston, IL, United States
| | - Trent Nicol
- Auditory Neuroscience Laboratory, Department of Communication Sciences, Northwestern University, Evanston, IL, United States
| | - Enica R Massawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ndeserua Moshi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nina Kraus
- Auditory Neuroscience Laboratory, Department of Communication Sciences, Northwestern University, Evanston, IL, United States.
| | - Jay C Buckey
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
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17
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Torre P, Russell JS, Smith R, Hoffman HJ, Lee S, Williams PL, Yao TJ. Words-in-Noise Test Performance in Young Adults Perinatally HIV Infected and Exposed, Uninfected. Am J Audiol 2020; 29:68-78. [PMID: 32004075 DOI: 10.1044/2019_aja-19-00042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The purpose of this study was to compare Words-in-Noise (WIN) data between young adults with perinatal HIV (PHIV) infection and those with PHIV exposure but uninfected (PHEU) and to evaluate associations between antiretroviral therapy (ART) exposures and WIN data. Method The WIN test and cognitive function were assessed in participants of the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol Up. Impaired WIN (IWIN) performance was defined as a signal-to-babble ratio of > +10 dB. Cognitive function was determined based on fluid cognition composite scores (FCCSs) and crystallized cognition composite scores, and < 70 was considered a fluid or crystallized cognitive impairment. Log binomial models were used to calculate the relative risks of IWIN between PHIV and PHEU. Results PHIV (n = 334) and PHEU (n = 52) participants had similar WIN thresholds and IWIN percentages. For young adults with FCCS ≥ 70, participants with PHIV were less likely to have IWIN for the better ear and worse ear as compared to participants with PHEU. For young adults with FCCS < 70, there was no association between HIV status and risk of IWIN for the better ear or worse ear. For those adults with crystallized cognition composite score of ≥ 70, young adults with PHIV were less likely to have IWIN for the better ear than young adults with PHEU; there was no association between HIV status and IWIN for the worse ear. For young adults with PHIV without a Centers for Disease Control and Prevention Class C diagnosis, a longer combination ART duration was associated with a higher risk of IWIN for the better ear. Conclusions For those without cognitive impairment, young adults with PHEU had poorer WIN thresholds than those young adults with PHIV. In young adults with PHIV who had no prior Centers for Disease Control and Prevention Class C diagnosis, a longer combination ART duration was associated with IWIN only in the better ear.
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Affiliation(s)
- Peter Torre
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
| | - Jonathan S. Russell
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Renee Smith
- Department of Pediatrics, University of Illinois at Chicago Children's Hospital
| | - Howard J. Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders,National Institutes of Health, Bethesda, MD
| | - Sonia Lee
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development,National Institutes of Health, Bethesda, MD
| | - Paige L. Williams
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
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18
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Sebothoma B, Khoza-Shangase K. Middle ear Pathologies in Adults Living with Human Immunodeficiency Virus: A Systematic Review. Ann Otol Rhinol Laryngol 2020; 129:821-828. [PMID: 32126822 DOI: 10.1177/0003489420909847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Middle ear pathologies have been linked with HIV. The onset and development of these pathologies in individuals with HIV have not been categorized; and clarity has not been gained regarding whether their presentation is any different in this population when compared to HIV negative control group. PURPOSE The aim of this study was to explore and document published evidence reflecting trends in middle ear pathologies in adults living with HIV. METHODS A systematic review of literature from January 1982 to December 2018 was conducted using Medline, CINAHL, PubMed, and Psych Info. Studies that reported the occurrence rate of middle ear pathologies in adults with HIV and published in English were included. RESULTS Twelve articles met the inclusion criteria. Evidence suggests that the reported occurrence rates of middle ear pathologies ranges from 2.5% to 58% in this population. The variability in assessment measures as well as the different cut-off criteria used in studies seem to have an influence in the findings, with pure tone audiometry identifying more middle ear pathologies in the current review than tympanometry with 226 Hz probe tone and clinical examination. Otitis media, conductive hearing loss, and type B tympanogram were common findings reported in this study. No evidence of an association between the use of antiretroviral therapy (ART) and the rates of middle ear pathologies was found. CONCLUSION Although there are very few studies that have reported on middle ear pathologies in adults living with HIV, the available studies have sufficiently established a link between HIV and middle ear disease in this population, and have revealed that the rate of occurrence is influenced by a number of factors. Key amongst these is the type of assessment measure used. Careful analysis of middle ear pathologies in this population through well controlled research designs that include different assessment measures. The use of case-control and longitudinal designs to determine differences between groups and to establish the time of onset and development of middle ear pathologies is required.
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Affiliation(s)
- Ben Sebothoma
- Department of Speech pathology and Audiology, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Katijah Khoza-Shangase
- Department of Speech pathology and Audiology, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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19
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Matas CG, Padilha FYOMM, Angrisani RMG, Samelli AG. Oxidative Stress as a Risk Factor for Hearing Changes in HIV-positive Normal Listeners. Clinics (Sao Paulo) 2020; 75:e1845. [PMID: 33263619 PMCID: PMC7654961 DOI: 10.6061/clinics/2020/e1845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/24/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Human immunodeficiency virus-positive (HIV+) individuals can experience a decrease in antioxidants. Such deficiency can make inner ear cells and synapses more vulnerable to oxidative stress, resulting in auditory alterations, even in the presence of normal thresholds. This study aims to compare the audiological findings of HIV+ patients (with and without exposure to anti-retroviral treatment) to those of healthy individuals. METHODS This was a cross-sectional observational study, comprising 42 normal-hearing adults divided into the Control Group (CG), without HIV; Group I (GI), HIV+, without exposure to the highly active anti-retroviral therapy (HAART); Group II (GII), HIV+, with exposure to HAART. All participants underwent conventional audiometry (0.25-8 kHz), high-frequency audiometry (9-20 kHz), transient evoked otoacoustic emissions (TEOAEs), efferent auditory pathway's inhibitory effect assessment, brainstem auditory evoked potentials (BAEPs), and cognitive potential (P300). RESULTS In the comparison of the hearing thresholds between the groups, there was a statistically significant difference for most of the frequencies assessed (GII presented hearing thresholds significantly poor when compared with other groups). The presence of TEOAE and the inhibitory effect was also verified in a significantly higher number of individuals in the CG than in the other groups. As for the BAEP, there was a statistically significant difference for the interpeak intervals I-V (GII showed higher values when compared with CG). For P300, there were no statistically significant differences. CONCLUSION Normal-hearing HIV+ individuals (with and without exposure to HAART) presented with poor performance in the audiological procedures, suggesting the presence of auditory alterations even in the presence of normal-hearing thresholds.
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Affiliation(s)
- Carla G. Matas
- Curso de Fonoaudiologia, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding Author. E-mail:
| | | | - Rosanna MG Angrisani
- Curso de Fonoaudiologia, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alessandra G. Samelli
- Curso de Fonoaudiologia, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
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20
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Dawood G, Klop D, Olivier E, Elliott H, Pillay M. Children with HIV: A scoping review of auditory processing skills. PLoS One 2019; 14:e0221573. [PMID: 31513582 PMCID: PMC6742466 DOI: 10.1371/journal.pone.0221573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/10/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Auditory processing disorders can negatively affect academic performance in children. They can result from a number of aetiologies, including the human immunodeficiency virus (HIV). Although studies in paediatrics are limited, research suggests that HIV-infected children display poorer auditory processing skills than uninfected children. Methods The aims of this study were to scan the peer-reviewed literature on auditory processing skills in HIV-infected children, to describe how auditory processing was tested, how auditory processing skills were reported, and to identify gaps in current evidence. This systematic scoping review was conducted using a modified version of Arksey and O’Malley’s framework. Key words comprised ‘HIV’, ‘auditory processing’, ‘hearing’ and ‘child’. Electronic databases were searched for relevant articles published from 1 January 2000 to 30 April 2018, and reference lists of included studies were pearled. Two researchers reviewed the articles and extracted data on sample descriptors, auditory processing testing procedures, and auditory processing skills. A third author collated the results and resolved discrepancies. The American Speech-Language-Hearing Association description of auditory processing skills framed the analysis. Results Five articles were included in this review (three from Brazil, one each from Mexico and Tanzania). Samples, and methods of testing were heterogeneous. Three studies reported on localization abilities, while gap detection thresholds, performance on dichotic tasks and speech discrimination scores were reported in one article each. No one study tested all areas of auditory processing skills and there was limited information about the auditory processing skills required for learning. Conclusion This review highlighted the current sparse evidence-base for auditory processing in HIV-infected children. It identified the need to standardise testing procedures, measures of auditory processing skills, and sample selection.
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Affiliation(s)
- Gouwa Dawood
- Division of Speech, Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
- * E-mail:
| | - Daleen Klop
- Division of Speech, Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Elrietha Olivier
- Division of Speech, Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Haley Elliott
- Division of Speech, Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Mershen Pillay
- Discipline of Speech-Language Pathology, School of Health Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
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de Jong MA, Luder A, Gross M. Main Aspects of Peripheral and Central Hearing System Involvement in Unexplained HIV-Related Hearing Complaints. Front Neurol 2019; 10:845. [PMID: 31447765 PMCID: PMC6691119 DOI: 10.3389/fneur.2019.00845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/22/2019] [Indexed: 12/28/2022] Open
Abstract
Objective: Hearing abnormalities frequently occur in Human Immunodeficiency Virus (HIV) infected individuals. Both conductive and uni- or bilateral sensorineural hearing loss (SNHL) have been described along with other audiological and vestibular symptoms such as tinnitus, vertigo and balance disturbances. While frequent middle ear infections may explain impairment of peripheral hearing abilities, the exact etiology of cochlear, and central auditory processing deficits still remains unclear. Direct effects of HIV, opportunistic infections, ototoxic side effects of antiretroviral therapy (ART), and immunologic responses to the central nervous system involving the auditory pathway have been proposed. We aim to review the audiological profile in HIV infected adults related to the effects of HIV and HAART on the inner ear structures. Methods: We present a review of the literature on cases of HIV related SNHL in adult patients and studies conducted to investigate audiometric changes in such patients. Data on presentation, diagnosis and pathophysiology were reviewed. Results: Sensorineural hearing loss in the higher frequencies is a common form of hearing loss in HIV infected individuals throughout disease progression, along with decreased otoacoustic emission (OAE) responses, increased PTA hearing thresholds and prolonged latencies for auditory brainstem responses (ABR). Conclusion: HIV affects all stages of auditory perception in a way similar to accelerated aging of the auditory system. And we postulate that synaptic loss may be the first step, followed by cochlear damage and central pathology as the virus remains present in all the structures of the auditory pathway causing local inflammation and degeneration. Evaluation of hearing function among all patients diagnosed with HIV infection seems to be an accepted approach; it should include OAE testing, pure tone and speech audiometry, speech-in-noise tests and ABR measurements.
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Affiliation(s)
- Marrigje Aagje de Jong
- Department of Otolaryngology-Head and Neck Surgery, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
| | - Ari Luder
- Department of Otolaryngology-Head and Neck Surgery, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
| | - Menachem Gross
- Department of Otolaryngology-Head and Neck Surgery, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
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Abstract
OBJECTIVE Evidence suggests damage to brain auditory pathways, rather than inner ear damage, underlies the hearing difficulties HIV+ individuals report. But, antiretroviral therapy (ART) may affect the hearing system and also lead to hearing complaints. DESIGN Longitudinal study of HIV+ and HIV- individuals in Dar es Salaam Tanzania. A subset of this cohort started ART while in the study allowing the effects of ART to be studied directly. METHODS The ability to hear quiet sounds (pure-tone audiometry), cochlear outer hair cell function [distortion-product otoacoustic emissions (DPOAEs)], and gaps-in-noise detection thresholds (a central auditory processing test) were assessed at each visit. Visits were scheduled for 6-month intervals, but the number and spacing of visits varied. In the group that started ART while in the study, 107 HIV+ individuals had audiometric thresholds, 98 had DPOAEs, and 98 had gap measurements suitable for analysis. Data were analyzed using a linear mixed model with time and starting ART as fixed effects and individual participant repeated measures as random effects. RESULTS Starting ART did not affect audiometric or gap detection thresholds. The slope of the DPOAE amplitude vs. time relationship was more negative after starting ART but did not differ from the HIV- group. Gap thresholds were higher in the HIV+ group. CONCLUSION ART did not affect audiometric thresholds significantly suggesting common ART drugs are not major ototoxins. The gap detection results from the study show effects on central auditory processing in HIV+ individuals, supporting the origin of HIV-related hearing complaints in the central auditory system.
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Abstract
OBJECTIVES Human immunodeficiency virus positive (HIV+) individuals report hearing difficulties, but standard audiological tests show no, or small, changes in peripheral hearing ability. The hearing complaints may reflect central nervous system (CNS) auditory processing deficits, rather than middle or inner ear problems, and may result from CNS damage due to HIV infection or treatment. If central auditory task performance and cognitive deficits in HIV+ individuals are shown to be related, then central auditory tests might serve as a "window" into CNS function in these patients. DESIGN We measured cognitive performance (Mandarin Montreal Cognitive Assessment [MoCA]) and speech in noise perception (Mandarin hearing-in-noise test [HINT]) in 166 normal-hearing HIV+ individuals (158 men, 8 women, average age 36 years) at the Shanghai Public Health Clinical Center in Shanghai, China. Data collection included audiometry, tympanometry, and the Amsterdam Inventory of Auditory Handicap (AIAH), which assesses the subjective ability to understand speech and localize sound. RESULTS Subjects had no middle ear disease and met criteria for normal-hearing sensitivity (all thresholds 20 dB HL or less). A significant negative relationship between speech reception thresholds (SRT) and MoCA scores (r = 0.15, F = 28.2, p < 0.001) existed. Stepwise linear regression showed that when the factors of age, MoCA scores, hearing thresholds, and education level were considered, only age and MoCA scores contributed independently to the SRT results (overall model r = 0.30, F = 38.8, p < 0.001). Subjective hearing complaints from the AIAH supported the HINT results. AIAH and MoCA scores were also related (r = 0.05, F = 8.5, p = 0.004), with those with worse MoCA scores having more problems on the AIAH. When the cohort was divided into those with normal and abnormal performance on the MoCA, those with abnormal performance on the MoCA had significantly higher average SRTs (p < 0.001). CONCLUSIONS Understanding speech in noise measured both objectively with the HINT and subjectively with the AIAH was inversely related to cognitive abilities despite a normal ability to hear soft sounds determined by audiometry. Although age was also an important independent factor affecting speech perception, the age relationship within the speech findings in this study may represent more than just age-related declines in speech in noise understanding. Although reliable data on disease duration are not available, the older members of this cohort likely had HIV longer and probably had more severe symptoms at presentation than the younger members because early detection and treatment of HIV in Shanghai has improved over time. Therefore, the age relationship may also include elements of disease duration and severity. Speech perception, especially in challenging listening conditions, involves cortical and subcortical centers and is a demanding neurological task. The problems interpreting speech in noise HIV+ individuals have may reflect HIV-related or HIV treatment-related, central nervous damage, suggesting that CNS complications in HIV+ individuals could potentially be diagnosed and monitored using central auditory tests.
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Minhas RS, Iyengar DA, Thakur JS, Azad RK. Effect of HIV and Antiretroviral Treatment on Auditory Functions. Int Arch Otorhinolaryngol 2018; 22:378-381. [PMID: 30357077 PMCID: PMC6197983 DOI: 10.1055/s-0038-1639594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/19/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Numerous studies have evaluated auditory functions in human immunodeficiency virus (HIV) patients; however, these studies had a few major limitations in terms of methodology as they used mainly evoked audiometry although this method is expensive, time consuming and not widely available. Therefore, we conducted a study in naïve HIV subjects with routine audiometry. Objective To determine the effect of HIV and of the drugs used to treat it on the auditory functions. Methods A prospective observational study was conducted in a medical college with 25 naive HIV-seropositive patients for over a year. Pure tone audiometry (250-8,000 Hz) and CD4 T-lymphocyte count were performed at the time of enrollment and 6 months after commencement of highly active antiretroviral treatment. Results The subjects had increased hearing thresholds at high frequencies (4 KHz and 8KHz) in both ears at the time of enrollment that persisted at the same level (p > 0.05) on follow-up at 6 months. None of the subjects had any other otological symptom during the 6 months of observation. Seven subjects had sensorineural hearing loss in one or both ears at 0 and 6 months. These observations did not show any significant difference on Wilcoxon-signed-rank test. Spearman correlation did not find a significant correlation (p > 0.05) between CD4 T-lymphocyte counts and pure tone audiometry during the study. Conclusion We found high-frequency hearing loss in all subjects with no relation with highly active antiretroviral therapy (HAART) and severity of the disease. This study advocates hearing assessment with pure tone audiometry in HIV subjects so that intervention can be initiated in a timely manner.
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Affiliation(s)
- Ravinder S. Minhas
- Department of ENT, Indira Gandhi Medical College (IGMC), Shimla, HP, India
| | | | - Jagdeep S. Thakur
- Department of ENT, Indira Gandhi Medical College (IGMC), Shimla, HP, India
| | - Ramesh K. Azad
- Department of ENT, Indira Gandhi Medical College (IGMC), Shimla, HP, India
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Saunders JE, Rankin Z, Noonan KY. Otolaryngology and the Global Burden of Disease. Otolaryngol Clin North Am 2018; 51:515-534. [DOI: 10.1016/j.otc.2018.01.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVES In a cross-sectional study of human immunodeficiency virus (HIV)-infected adults, the authors showed lower distortion product otoacoustic emissions (DPOAEs) in HIV+ individuals compared with controls as well as findings consistent with a central auditory processing deficit in HIV+ adults on antiretroviral therapy. The authors hypothesized that HIV+ children would also have a higher prevalence of abnormal central and peripheral hearing test results compared with HIV- controls. DESIGN Pure-tone thresholds, DPOAEs, and tympanometry were performed on 244 subjects (131 HIV+ and 113 HIV- subjects). Thirty-five of the HIV+, and 3 of the HIV- subjects had a history of tuberculosis treatment. Gap detection results were available for 18 HIV- and 44 HIV+ children. Auditory brainstem response results were available for 72 HIV- and 72 HIV+ children. Data from ears with abnormal tympanograms were excluded. RESULTS HIV+ subjects were significantly more likely to have abnormal tympanograms, histories of ear drainage, tuberculosis, or dizziness. All audiometric results were compared between groups using a two-way ANOVA with HIV status and ear drainage history as grouping variables. Mean audiometric thresholds, gap detection thresholds, and auditory brainstem response latencies did not differ between groups, although the HIV+ group had a higher proportion of individuals with a hearing loss >25 dB HL in the better ear. The HIV+ group had reduced DPOAE levels (p < 0.05) at multiple frequencies compared with HIV- subjects. No relationships were found between treatment regimens or delay in starting treatment and audiological parameters. CONCLUSIONS As expected, children with HIV+ were more likely to have a history of ear drainage, and to have abnormal tympanograms. Similar to the adult findings, the HIV+ group did not show significantly reduced audiometric thresholds, but did have significantly lower DPOAE magnitudes. These data suggest that (1) HIV+ children often have middle ear damage which complicates understanding the direct effects of HIV on the hearing system, and (2) even when corrected for confounders DPOAEs were lower in the HIV+ group. Previous studies suggest ototoxicity from antiretroviral drugs is an unlikely cause of the reduced DPOAE magnitudes. Other possibilities include effects on efferent pathways connecting to outer hair cells or a direct effect of HIV on the cochlea.
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Ensink RJH, Kuper H. Is hearing impairment associated with HIV? A systematic review of data from low- and middle-income countries. Trop Med Int Health 2017; 22:1493-1504. [PMID: 29078020 DOI: 10.1111/tmi.12993] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To systematically review evidence on the prevalence and characteristics of hearing impairment among children and adults living with HIV in low- and middle-income countries (LMIC). METHODS Articles were identified up to January 2016 through searching four electronic databases. Epidemiological studies conducted in LMIC that explored the association between HIV status and hearing loss, with or without an HIV-uninfected comparison group, were eligible for inclusion. Results were screened and assessed for eligibility, and data were extracted by two reviewers, with discussion in the case of disagreement. Findings were narratively synthesised. RESULTS The search identified 638 unique references, of which 21 studies were included in the review, including 3491 people with HIV from 13 LMIC. There was lack of consistency in the definition used for hearing loss, making comparability across studies difficult. Among children with HIV, across the three studies that used a cut-off of >15 dB in either ear, the prevalence of hearing loss ranged from 22 to 37%. Among the three studies that used >25 dB in either ear, the prevalence ranged from 32 to 39%. Among adults with HIV, for the five studies that used a threshold of >25 dB for either ear, the prevalence ranged from 10 to 43%. The prevalence of hearing impairment was significantly higher among people with HIV than in controls in eight of the ten studies that assessed this comparison. Conductive hearing loss was the most common type of hearing loss in children with HIV, while sensorineural hearing loss was more common in adults with HIV. There was a lack of evidence for an association between ART use and hearing loss, although there was some suggestion that late stage of HIV disease or low CD4 count was related to hearing loss. There were concerns about the quality of the studies included in the review. CONCLUSIONS The current evidence is suggestive of a high prevalence of hearing loss among people living with HIV compared to people without HIV, or to WHO estimates for the general population. More research is needed to better understand the aetiology of hearing loss in relation to HIV, and whether screening for and treatment of hearing loss can be effectively integrated into HIV treatment services needs further research.
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Affiliation(s)
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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28
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Matas CG, Samelli AG, Magliaro FCL, Segurado A. Audiological and electrophysiological alterations in HIV-infected individuals subjected or not to antiretroviral therapy. Braz J Otorhinolaryngol 2017; 84:574-582. [PMID: 28823692 PMCID: PMC9452257 DOI: 10.1016/j.bjorl.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/22/2017] [Accepted: 07/03/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction The Human Immunodeficiency Virus (HIV) and infections related to it can affect multiple sites in the hearing system. The use of High Activity Anti-Retroviral Therapy (HAART) can cause side effects such as ototoxicity. Thus, no consistent patterns of hearing impairment in adults with Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome have been established, and the problems that affect the hearing system of this population warrant further research. Objectives This study aimed to compare the audiological and electrophysiological data of Human Immunodeficiency Virus-positive patients with and without Acquired Immune Deficiency Syndrome, who were receiving High Activity Anti-Retroviral Therapy, to healthy individuals. Methods It was a cross-sectional study conducted with 71 subjects (30–48 years old), divided into groups: Research Group I: 16 Human Immunodeficiency Virus-positive individuals without Acquired Immunodeficiency Syndrome (not receiving antiretroviral treatment); Research Group II: 25 Human Immunodeficiency Virus-positive individuals with Acquired Immunodeficiency Syndrome (receiving antiretroviral treatment); Control Group: 30 healthy subjects. All individuals were tested by pure-tone air conduction thresholds at 0.25–8 kHz, extended high frequencies at 9–20 kHz, electrophysiological tests (Auditory Brainstem Response, Middle Latency Responses, Cognitive Potential). Results Research Group I and Research Group II had higher hearing thresholds in both conventional and high frequency audiometry when compared to the control group, prolonged latency of waves I, III, V and interpeak I–V in Auditory Brainstem Response and prolonged latency of P300 Cognitive Potential. Regarding Middle Latency Responses, there was a decrease in the amplitude of the Pa wave of Research Group II compared to the Research Group I. Conclusions Both groups with Human Immunodeficiency Virus had higher hearing thresholds when compared to healthy individuals (group exposed to antiretroviral treatment showed the worst hearing threshold) and seemed to have lower neuroelectric transmission speed along the auditory pathway in the brainstem, subcortical and cortical regions.
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Affiliation(s)
- Carla Gentile Matas
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil.
| | - Alessandra Giannella Samelli
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Fernanda Cristina Leite Magliaro
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Aluisio Segurado
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, SP, Brazil
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Sogebi OA, Fadeyi MO, Adefuye BO, Soyinka FO. Hearing thresholds in patients with drug-resistant tuberculosis: baseline audiogram configurations and associations. J Bras Pneumol 2017; 43:195-201. [PMID: 28746530 PMCID: PMC5687950 DOI: 10.1590/s1806-37562016000000165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/31/2016] [Indexed: 12/02/2022] Open
Abstract
Objective: To use baseline audiogram parameters in order to ascertain whether drug-resistant tuberculosis (DR-TB) has effects on hearing, as well as to describe the configurations of the audiograms and to determine whether there are parameters that can be associated with those configurations. Methods: This was a prospective study involving patients diagnosed with DR-TB at a tuberculosis treatment center in the state of Ogun, in Nigeria. The patients included in the study were submitted to pure tone audiometry at baseline (within two weeks after treatment initiation). For comparative analyses, data regarding demographic and clinical characteristics were collected from the medical records of the patients. Results: The final sample comprised 132 patients. The mean age of the patients was 34.5 ± 12.6 years (range, 8-82 years), and the male:female ratio was 2:1. Of the 132 patients, 103 (78.0%) resided in neighboring states, 125 (94.7%) had previously experienced antituberculosis treatment failure, and 18 (13.6%) were retroviral-positive. Normal audiograms were found in 12 patients (9.1%), whereas sensorineural hearing loss was identified in 104 (78.8%), the two most common configurations being ascending, in 54 (40.9%), and sloping, in 26 (19.7%). Pure-tone averages at low frequencies (0.25-1.0 kHz) and high frequencies (2.0-8.0 kHz) were 33.0 dB and 40.0 dB, respectively. Regarding the degree of hearing loss in the better ear, 36 patients (27.3%) were classified as having normal hearing and 67 (50.8%) were classified as having mild hearing loss (26-40 dB), whereas 29 (21.9%) showed moderate or severe hearing loss. Among the variables studied (age, gender, retroviral status, previous treatment outcome, and weight at admission), only male gender was associated with audiometric configurations. Conclusions: In this sample of patients with DR-TB, most presented with bilateral, mild, suboptimal sensorineural hearing loss, and ascending/sloping audiometric configurations were associated with male gender.
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Affiliation(s)
- Olusola Ayodele Sogebi
- . ENT Unit, Department of Surgery, College of Health Sciences, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Muse Olatunbosun Fadeyi
- . Drug Resistant Tuberculosis Treatment Centre, Sacred Heart Hospital (Special), Lantoro, Abeokuta, Nigeria
| | - Bolanle Olufunlola Adefuye
- . Respiratory Unit, Department of Medicine, College of Health Sciences, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Festus Olukayode Soyinka
- . Ogun State Tuberculosis, Leprosy and Buruli Ulcer Control Program, Ministry of Health, Ogun State, Nigeria
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Zhan Y, Buckey JC, Fellows AM, Shi Y. Magnetic Resonance Imaging Evidence for Human Immunodeficiency Virus Effects on Central Auditory Processing: A Review. ACTA ACUST UNITED AC 2017; 8. [PMID: 28890843 PMCID: PMC5589342 DOI: 10.4172/2155-6113.1000708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
New research suggests that individuals with human immunodeficiency virus (HIV) have central auditory processing deficits. To review the evidence for HIV affecting parts of the central nervous system involved in central auditory processing, we performed a systematic review of the literature. The objective was to determine whether existing studies show evidence for damage to structures associated with central auditory pathways in HIV. We searched PubMed for papers that used structural magnetic resonance imaging (MRI), diffusion tensor imaging, magnetic resonance spectroscopy or functional MRI in individuals infected with HIV. The review showed that HIV affects several areas involved in central auditory processing particularly the thalamus, internal capsule and temporal cortex. These findings support the idea that HIV can affect central auditory pathways and support the potential use of central auditory tests as a way to assess central nervous system effects of HIV.
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Affiliation(s)
- Yi Zhan
- Department of Radiology, Shanghai Public Health Clinic Center, Fudan University, Shanghai, China
| | - Jay C Buckey
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinic Center, Fudan University, Shanghai, China
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Kraus N, Lindley T, Colegrove D, Krizman J, Otto-Meyer S, Thompson EC, White-Schwoch T. The neural legacy of a single concussion. Neurosci Lett 2017; 646:21-23. [DOI: 10.1016/j.neulet.2017.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/03/2017] [Accepted: 03/05/2017] [Indexed: 12/14/2022]
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Kraus N, Thompson EC, Krizman J, Cook K, White-Schwoch T, LaBella CR. Auditory biological marker of concussion in children. Sci Rep 2016; 6:39009. [PMID: 28005070 PMCID: PMC5178332 DOI: 10.1038/srep39009] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/14/2016] [Indexed: 01/16/2023] Open
Abstract
Concussions carry devastating potential for cognitive, neurologic, and socio-emotional disease, but no objective test reliably identifies a concussion and its severity. A variety of neurological insults compromise sound processing, particularly in complex listening environments that place high demands on brain processing. The frequency-following response captures the high computational demands of sound processing with extreme granularity and reliably reveals individual differences. We hypothesize that concussions disrupt these auditory processes, and that the frequency-following response indicates concussion occurrence and severity. Specifically, we hypothesize that concussions disrupt the processing of the fundamental frequency, a key acoustic cue for identifying and tracking sounds and talkers, and, consequently, understanding speech in noise. Here we show that children who sustained a concussion exhibit a signature neural profile. They have worse representation of the fundamental frequency, and smaller and more sluggish neural responses. Neurophysiological responses to the fundamental frequency partially recover to control levels as concussion symptoms abate, suggesting a gain in biological processing following partial recovery. Neural processing of sound correctly identifies 90% of concussion cases and clears 95% of control cases, suggesting this approach has practical potential as a scalable biological marker for sports-related concussion and other types of mild traumatic brain injuries.
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Affiliation(s)
- Nina Kraus
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, United States.,Department of Communication Sciences, Northwestern University, Evanston, IL, United States.,Department of Neurobiology &Physiology, Northwestern University, Evanston, IL, United States.,Department of Otolaryngology, Northwestern University's Feinberg School of Medicine, Chicago, IL, United States
| | - Elaine C Thompson
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, United States.,Department of Communication Sciences, Northwestern University, Evanston, IL, United States
| | - Jennifer Krizman
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, United States.,Department of Communication Sciences, Northwestern University, Evanston, IL, United States
| | - Katherine Cook
- Division of Pediatric Orthopaedic Surgery &Sports Medicine, Ann &Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Northwestern University's Feinberg School of Medicine, Chicago, IL, United States
| | - Travis White-Schwoch
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, United States.,Department of Communication Sciences, Northwestern University, Evanston, IL, United States
| | - Cynthia R LaBella
- Division of Pediatric Orthopaedic Surgery &Sports Medicine, Ann &Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Northwestern University's Feinberg School of Medicine, Chicago, IL, United States
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Duong N, Torre P, Springer G, Cox C, Plankey MW. Hearing Loss and Quality of Life (QOL) among Human Immunodeficiency Virus (HIV)-Infected and Uninfected Adults. ACTA ACUST UNITED AC 2016; 7. [PMID: 28217403 PMCID: PMC5313124 DOI: 10.4172/2155-6113.1000645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Research has established that human immunodeficiency virus (HIV) causes hearing loss. Studies have yet to evaluate the impact on quality of life (QOL). This project evaluates the effect of hearing loss on QOL by HIV status. METHODS The study participants were from the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV study (WIHS). A total of 248 men and 127 women participated. Pure-tone air conduction thresholds were collected for each ear at frequencies from 250 through 8000 Hz. Pure-tone averages (PTAs) for each ear were calculated as the mean of air conduction thresholds in low frequencies (i.e., 250, 500, 1000 and 2000 Hz) and high frequencies (i.e., 3000, 4000, 6000 and 8000 Hz). QOL data were gathered with the Short Form 36 Health Survey and Medical Outcome Study (MOS)-HIV instrument in the MACS and WIHS, respectively. A median regression analysis was performed to test the association of PTAs with QOL by HIV status. RESULTS There was no significant association between hearing loss and QOL scores at low and high pure tone averages in HIV positive and negative individuals. HIV status, HIV biomarkers and treatment did not change the lack of association of low and high pure tone averages with poorer QOL. CONCLUSION Although we did not find a statistically significant association of hearing loss with QOL by HIV status, testing for hearing loss with aging and recommending treatment may offset any presumed later life decline in QOL.
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Affiliation(s)
- N Duong
- School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
| | - P Torre
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, California, USA
| | - G Springer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - C Cox
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - M W Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA
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Torre P, Hoffman HJ, Springer G, Cox C, Young MA, Margolick JB, Plankey M. Speech audiometry findings from HIV+ and HIV- adults in the MACS and WIHS longitudinal cohort studies. JOURNAL OF COMMUNICATION DISORDERS 2016; 64:103-109. [PMID: 27477593 PMCID: PMC5125885 DOI: 10.1016/j.jcomdis.2016.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/18/2016] [Accepted: 07/18/2016] [Indexed: 06/06/2023]
Abstract
The purpose of this study was to compare various speech audiometry measures between HIV+ and HIV- adults and to further evaluate the association between speech audiometry and HIV disease variables in HIV+ adults only. Three hundred ninety-six adults from the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS) completed speech audiometry testing. There were 262 men, of whom 117 (44.7%) were HIV+, and 134 women, of whom 105 (78.4%) were HIV+. Speech audiometry was conducted as part of the standard clinical audiological evaluation that included otoscopy, tympanometry, and pure-tone air- and bone-conduction thresholds. Specific speech audiometry measures included speech recognition thresholds (SRT) and word recognition scores in quiet presented at 40dB sensation level (SL) in reference to the SRT. SRT data were categorized in 5-dB steps from 0 to 25dB hearing level (HL) with one category as ≥30dB HL while word recognition scores were categorized as <90%, 90-99%, and 100%. A generalized estimating equations model was used to evaluate the association between HIV status and both ordinal outcomes. The SRT distributions across HIV+ and HIV- adults were similar. HIV+ and HIV- adults had a similar percentages of word recognition scores <90%, a lower percentage of HIV- adults had 90-99%, but HIV- adults had a higher percentage of 100%. After adjusting for covariables, HIV+ adults were borderline significantly more likely to have a higher SRT than HIV- adults (odds ratio [OR]=1.45, p=0.06). Among HIV+ adults, HIV-related variables (i.e., CD4+ T-cell counts, HIV viral load, and ever history of clinical AIDS) were not significantly associated with either SRT or word recognition score data. There was, however, a ceiling effect for word recognition scores, probably the result of obtaining this measure in quiet with a relatively high presentation level. A more complex listening task, such as speech-in-noise testing, may be a more clinically informative test to evaluate the effects of HIV on speech communication.
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Affiliation(s)
- Peter Torre
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, United States.
| | - Howard J Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Gayle Springer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mary A Young
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, D.C., United States
| | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, D.C., United States
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