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Meehan S, Adank ML, van der Schroeff MP, Vroegop JL. A systematic review of acoustic change complex (ACC) measurements and applicability in children for the assessment of the neural capacity for sound and speech discrimination. Hear Res 2024; 451:109090. [PMID: 39047579 DOI: 10.1016/j.heares.2024.109090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE The acoustic change complex (ACC) is a cortical auditory evoked potential (CAEP) and can be elicited by a change in an otherwise continuous sound. The ACC has been highlighted as a promising tool in the assessment of sound and speech discrimination capacity, and particularly for difficult-to-test populations such as infants with hearing loss, due to the objective nature of ACC measurements. Indeed, there is a pressing need to develop further means to accurately and thoroughly establish the hearing status of children with hearing loss, to help guide hearing interventions in a timely manner. Despite the potential of the ACC method, ACC measurements remain relatively rare in a standard clinical settings. The objective of this study was to perform an up-to-date systematic review on ACC measurements in children, to provide greater clarity and consensus on the possible methodologies, applications, and performance of this technique, and to facilitate its uptake in relevant clinical settings. DESIGN Original peer-reviewed articles conducting ACC measurements in children (< 18 years). Data were extracted and summarised for: (1) participant characteristics; (2) ACC methods and auditory stimuli; (3) information related to the performance of the ACC technique; (4) ACC measurement outcomes, advantages, and challenges. The systematic review was conducted using PRISMA guidelines for reporting and the methodological quality of included articles was assessed. RESULTS A total of 28 studies were identified (9 infant studies). Review results show that ACC responses can be measured in infants (from < 3 months), and there is evidence of age-dependency, including increased robustness of the ACC response with increasing childhood age. Clinical applications include the measurement of the neural capacity for speech and non-speech sound discrimination in children with hearing loss, auditory neuropathy spectrum disorder (ANSD) and central auditory processing disorder (CAPD). Additionally, ACCs can be recorded in children with hearing aids, auditory brainstem implants, and cochlear implants, and ACC results may guide hearing intervention/rehabilitation strategies. The review identified that the time taken to perform ACC measurements was often lengthy; the development of more efficient ACC test procedures for children would be beneficial. Comparisons between objective ACC measurements and behavioural measures of sound discrimination showed significant correlations for some, but not all, included studies. CONCLUSIONS ACC measurements of the neural capacity to discriminate between speech and non-speech sounds are feasible in infants and children, and a wide range of possible clinical applications exist, although more time-efficient procedures would be advantageous for clinical uptake. A consideration of age and maturational effects is recommended, and further research is required to investigate the relationship between objective ACC measures and behavioural measures of sound and speech perception for effective clinical implementation.
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Affiliation(s)
- Sarah Meehan
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Marloes L Adank
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marc P van der Schroeff
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jantien L Vroegop
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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Desai MJ, Salmon J, Verrills P, Mitchell B, Du Toit N, Bates D, Vajramani G, Williams A, Love-Jones S, Patel N, Nikolic S, Mehta V, Ahmad A, Yu J, Christellis N, Harkin S, Baranidharan G, Levy R, Staats P, Malinowski MN, Makous J, Sullivan N, Kottalgi S, Hartley M, Mishra LN. A Novel Pulsed Stimulation Pattern in Spinal Cord Stimulation: Clinical Results and Postulated Mechanisms of Action in the Treatment of Chronic Low Back and Leg Pain. Neuromodulation 2023; 26:182-191. [PMID: 36503999 DOI: 10.1016/j.neurom.2022.10.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/04/2022] [Accepted: 10/23/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this article is to discuss the possible mechanisms of action (MOAs) and results of a pilot study of a novel, anatomically placed, and paresthesia-independent, neurostimulation waveform for the management of chronic intractable pain. MATERIALS AND METHODS A novel, multilayered pulsed stimulation pattern (PSP) that comprises three temporal layers, a Pulse Pattern layer, Train layer, and Dosage layer, was developed for the treatment of chronic intractable pain. During preliminary development, the utility was evaluated of anatomical PSP (aPSP) in human subjects with chronic intractable pain of the leg(s) and/or low back, compared with that of traditional spinal cord stimulation (T-SCS) and physiological PSP. The scientific theory and testing presented in this article provide the preliminary justification for the potential MOAs by which PSP may operate. RESULTS During the pilot study, aPSP (n = 31) yielded a greater decrease in both back and leg pain than did T-SCS (back: -60% vs -46%; legs: -63% vs -43%). In addition, aPSP yielded higher responder rates for both back and leg pain than did T-SCS (61% vs 48% and 78% vs 50%, respectively). DISCUSSION The novel, multilayered approach of PSP may provide multimechanistic therapeutic relief through preferential fiber activation in the dorsal column, optimization of the neural onset response, and use of both the medial and lateral pathway through the thalamic nuclei. The results of the pilot study presented here suggest a robust responder rate, with several subjects (five subjects with back pain and three subjects with leg pain) achieving complete relief from PSP during the acute follow-up period. These clinical findings suggest PSP may provide a multimechanistic, anatomical, and clinically effective management for intractable chronic pain. Because of the limited sample size of clinical data, further testing and long-term clinical assessments are warranted to confirm these preliminary findings.
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Affiliation(s)
- Mehul J Desai
- International Spine, Pain & Performance Center, Washington, DC, USA; School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
| | - John Salmon
- Department of Pain Management, Pain Care Perth and Western Australia, Perth, Western Australia, Australia
| | - Paul Verrills
- Department of Pain Management, Metro Pain, Melbourne, Victoria, Australia
| | - Bruce Mitchell
- Department of Pain Management, Metro Pain, Melbourne, Victoria, Australia
| | - Neels Du Toit
- Department of Pain Management, Metro Pain, Melbourne, Victoria, Australia
| | - Dan Bates
- Department of Pain Management, Metro Pain, Melbourne, Victoria, Australia
| | - Girish Vajramani
- Department of Neurosurgery, University Hospital Southampton, Southampton, UK
| | - Adam Williams
- Department of Neurosurgery, University of Bristol, Bristol, UK
| | - Sarah Love-Jones
- Department of Pain Management, North Bristol National Health Service Trust, Bristol, UK
| | - Nikunj Patel
- Department of Neurosurgery, North Bristol National Health Service Trust, Bristol, UK
| | - Serge Nikolic
- Department of Pain Management, St Bartholomew's Hospital, London, UK
| | - Vivek Mehta
- Department of Pain Management, St Bartholomew's Hospital, London, UK
| | - Alia Ahmad
- Department of Pain Management, St Bartholomew's Hospital, London, UK
| | - James Yu
- Department of Pain Management, Sydney Spine and Pain, Sydney, New South Wales, Australia
| | - Nick Christellis
- Department of Pain Management, Pain Specialists Australia, Richmond, New South Wales, Australia
| | - Sam Harkin
- Department of Pain Management, Pain Specialists Australia, Richmond, New South Wales, Australia
| | - Ganesan Baranidharan
- Department of Pain Management, Leeds Teaching Hospital National Health Service Trust, Leeds, UK
| | - Robert Levy
- Department of Neurosurgery, Institute for Neuromodulation, Boca Raton, FL, USA
| | - Peter Staats
- Department of Pain Management, Premier Pain Centers, Shrewsbury, NJ, USA
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Xie D, Luo J, Chao X, Li J, Liu X, Fan Z, Wang H, Xu L. Relationship Between the Ability to Detect Frequency Changes or Temporal Gaps and Speech Perception Performance in Post-lingual Cochlear Implant Users. Front Neurosci 2022; 16:904724. [PMID: 35757528 PMCID: PMC9213807 DOI: 10.3389/fnins.2022.904724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/17/2022] [Indexed: 12/03/2022] Open
Abstract
Previous studies, using modulation stimuli, on the relative effects of frequency resolution and time resolution on CI users’ speech perception failed to reach a consistent conclusion. In this study, frequency change detection and temporal gap detection were used to investigate the frequency resolution and time resolution of CI users, respectively. Psychophysical and neurophysiological methods were used to simultaneously investigate the effects of frequency and time resolution on speech perception in post-lingual cochlear implant (CI) users. We investigated the effects of psychophysical results [frequency change detection threshold (FCDT), gap detection threshold (GDT)], and acoustic change complex (ACC) responses (evoked threshold, latency, or amplitude of ACC induced by frequency change or temporal gap) on speech perception [recognition rate of monosyllabic words, disyllabic words, sentences in quiet, and sentence recognition threshold (SRT) in noise]. Thirty-one adult post-lingual CI users of Mandarin Chinese were enrolled in the study. The stimuli used to induce ACCs to frequency changes were 800-ms pure tones (fundamental frequency was 1,000 Hz); the frequency change occurred at the midpoint of the tones, with six percentages of frequency changes (0, 2, 5, 10, 20, and 50%). Temporal silences with different durations (0, 5, 10, 20, 50, and 100 ms) were inserted in the middle of the 800-ms white noise to induce ACCs evoked by temporal gaps. The FCDT and GDT were obtained by two 2-alternative forced-choice procedures. The results showed no significant correlation between the CI hearing threshold and speech perception in the study participants. In the multiple regression analysis of the influence of simultaneous psychophysical measures and ACC responses on speech perception, GDT significantly predicted every speech perception index, and the ACC amplitude evoked by the temporal gap significantly predicted the recognition of disyllabic words in quiet and SRT in noise. We conclude that when the ability to detect frequency changes and the temporal gap is considered simultaneously, the ability to detect frequency changes may have no significant effect on speech perception, but the ability to detect temporal gaps could significantly predict speech perception.
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Affiliation(s)
- Dianzhao Xie
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jianfen Luo
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiuhua Chao
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jinming Li
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xianqi Liu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhaomin Fan
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Haibo Wang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lei Xu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Han JH, Dimitrijevic A. Acoustic Change Responses to Amplitude Modulation in Cochlear Implant Users: Relationships to Speech Perception. Front Neurosci 2020; 14:124. [PMID: 32132897 PMCID: PMC7040081 DOI: 10.3389/fnins.2020.00124] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/31/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives The ability to understand speech is highly variable in people with cochlear implants (CIs) and to date, there are no objective measures that identify the root of this discrepancy. However, behavioral measures of temporal processing such as the temporal modulation transfer function (TMTF) has previously found to be related to vowel and consonant identification in CI users. The acoustic change complex (ACC) is a cortical auditory-evoked potential response that can be elicited by a “change” in an ongoing stimulus. In this study, the ACC elicited by amplitude modulation (AM) change was related to measures of speech perception as well as the amplitude detection threshold in CI users. Methods Ten CI users (mean age: 50 years old) participated in this study. All subjects participated in behavioral tests that included both speech and amplitude modulation detection to obtain a TMTF. CI users were categorized as “good” (n = 6) or “poor” (n = 4) based on their speech-in noise score (<50%). 64-channel electroencephalographic recordings were conducted while CI users passively listened to AM change sounds that were presented in a free field setting. The AM change stimulus was white noise with four different AM rates (4, 40, 100, and 300 Hz). Results Behavioral results show that AM detection thresholds in CI users were higher compared to the normal-hearing (NH) group for all AM rates. The electrophysiological data suggest that N1 responses were significantly decreased in amplitude and their latencies were increased in CI users compared to NH controls. In addition, the N1 latencies for the poor CI performers were delayed compared to the good CI performers. The N1 latency for 40 Hz AM was correlated with various speech perception measures. Conclusion Our data suggest that the ACC to AM change provides an objective index of speech perception abilities that can be used to explain some of the variation in speech perception observed among CI users.
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Affiliation(s)
- Ji-Hye Han
- Communication Sciences Research Center, Cincinnati Childs Hospital Medical Center, Cincinnati, OH, United States.,Laboratory of Brain & Cognitive Sciences for Convergence Medicine, College of Medicine, Hallym University, Chuncheon, South Korea
| | - Andrew Dimitrijevic
- Communication Sciences Research Center, Cincinnati Childs Hospital Medical Center, Cincinnati, OH, United States.,Department Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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