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Khakzand S, Maarefvand M, Ruzbahani M, Tajdini A. Assessment of Peripheral and Central Auditory Processing after Treatment for Idiopathic Sudden Sensorineural Hearing Loss. Int Arch Otorhinolaryngol 2024; 28:e415-e423. [PMID: 38974630 PMCID: PMC11226256 DOI: 10.1055/s-0043-1776728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/09/2023] [Indexed: 07/09/2024] Open
Abstract
Introduction When cases of idiopathic sudden sensorineural hearing loss (SSNHL) are treated successfully, most clinicians assume the normality and symmetry of the auditory processing. This assumption is based on the recovery of the detection ability on the part of the patients, but the auditory processing involves much more than detection alone. Since certain studies have suggested a possible involvement of the central auditory system during the acute phase of sudden hearing loss, the present study hypothesized that auditory processing would be asymmetric in people who have experienced sudden hearing loss. Objective To assess the physiologic and electrophysiological conditions of the cochlea and central auditory system, as well as behavioral discrimination, of three primary aspects of sound (intensity, frequency, and time) in subjects with normal ears and ears treated successfully for SSNHL. Methods The study included 19 SSNHL patients whose normal and treated ears were assessed for otoacoustic emissions, speech auditory brainstem response, intensity and pitch discrimination, and temporal resolution in a within-subject design. Results The otoacoustic emissions were poorer in the treated ears compared to the normal ears. Ear- and sex-dependent differences were observed regarding otoacoustic emissions and pitch discrimination. Conclusion The asymmetrical processing observed in the present study was not consistent with the hearing threshold values, which might suggest that the central auditory system would be affected regardless of the status of the peripheral hearing. Further experiments with larger samples, different recovery scenarios after treatment, and other assessments are required.
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Affiliation(s)
- Soheila Khakzand
- Audiology Department, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Maarefvand
- Audiology Department, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Ruzbahani
- Audiology Department, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Ardavan Tajdini
- Ear, Nose and Throat Department, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Vasilkov V, Caswell-Midwinter B, Zhao Y, de Gruttola V, Jung DH, Liberman MC, Maison SF. Evidence of cochlear neural degeneration in normal-hearing subjects with tinnitus. Sci Rep 2023; 13:19870. [PMID: 38036538 PMCID: PMC10689483 DOI: 10.1038/s41598-023-46741-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023] Open
Abstract
Tinnitus, reduced sound-level tolerance, and difficulties hearing in noisy environments are the most common complaints associated with sensorineural hearing loss in adult populations. This study aims to clarify if cochlear neural degeneration estimated in a large pool of participants with normal audiograms is associated with self-report of tinnitus using a test battery probing the different stages of the auditory processing from hair cell responses to the auditory reflexes of the brainstem. Self-report of chronic tinnitus was significantly associated with (1) reduced cochlear nerve responses, (2) weaker middle-ear muscle reflexes, (3) stronger medial olivocochlear efferent reflexes and (4) hyperactivity in the central auditory pathways. These results support the model of tinnitus generation whereby decreased neural activity from a damaged cochlea can elicit hyperactivity from decreased inhibition in the central nervous system.
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Affiliation(s)
- Viacheslav Vasilkov
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | - Benjamin Caswell-Midwinter
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | - Yan Zhao
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
| | - Victor de Gruttola
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02114, USA
| | - David H Jung
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | - M Charles Liberman
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | - Stéphane F Maison
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA.
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA.
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Cancel VE, McHaney JR, Milne V, Palmer C, Parthasarathy A. A data-driven approach to identify a rapid screener for auditory processing disorder testing referrals in adults. Sci Rep 2023; 13:13636. [PMID: 37604867 PMCID: PMC10442397 DOI: 10.1038/s41598-023-40645-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023] Open
Abstract
Hearing thresholds form the gold standard assessment in Audiology clinics. However, ~ 10% of adult patients seeking audiological care for self-perceived hearing deficits have thresholds that are normal. Currently, a diagnostic assessment for auditory processing disorder (APD) remains one of the few viable avenues of further care for this patient population, yet there are no standard guidelines for referrals. Here, we identified tests within the APD testing battery that could provide a rapid screener to inform APD referrals in adults. We first analyzed records from the University of Pittsburgh Medical Center (UPMC) Audiology database to identify adult patients with self-perceived hearing difficulties despite normal audiometric thresholds. We then looked at the patients who were referred for APD testing. We examined test performances, correlational relationships, and classification accuracies. Patients experienced most difficulties within the dichotic domain of testing. Additionally, accuracies calculated from sensitivities and specificities revealed the words-in-noise (WIN), the Random Dichotic Digits Task (RDDT) and Quick Speech in Noise (QuickSIN) tests had the highest classification accuracies. The addition of these tests have the greatest promise as a quick screener during routine audiological assessments to help identify adult patients who may be referred for APD assessment and resulting treatment plans.
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Affiliation(s)
- Victoria E Cancel
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 5060A Forbes Tower, Pittsburgh, PA, 15260, USA
| | - Jacie R McHaney
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 5060A Forbes Tower, Pittsburgh, PA, 15260, USA
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - Virginia Milne
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 5060A Forbes Tower, Pittsburgh, PA, 15260, USA
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine Palmer
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 5060A Forbes Tower, Pittsburgh, PA, 15260, USA
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Aravindakshan Parthasarathy
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 5060A Forbes Tower, Pittsburgh, PA, 15260, USA.
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of BioEngineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
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4
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Grant KJ, Parthasarathy A, Vasilkov V, Caswell-Midwinter B, Freitas ME, de Gruttola V, Polley DB, Liberman MC, Maison SF. Predicting neural deficits in sensorineural hearing loss from word recognition scores. Sci Rep 2022; 12:8929. [PMID: 35739134 PMCID: PMC9226113 DOI: 10.1038/s41598-022-13023-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/19/2022] [Indexed: 12/28/2022] Open
Abstract
The current gold standard of clinical hearing assessment includes a pure-tone audiogram combined with a word recognition task. This retrospective study tests the hypothesis that deficits in word recognition that cannot be explained by loss in audibility or cognition may reflect underlying cochlear nerve degeneration (CND). We collected the audiological data of nearly 96,000 ears from patients with normal hearing, conductive hearing loss (CHL) and a variety of sensorineural etiologies including (1) age-related hearing loss (ARHL); (2) neuropathy related to vestibular schwannoma or neurofibromatosis of type 2; (3) Ménière’s disease; (4) sudden sensorineural hearing loss (SSNHL), (5) exposure to ototoxic drugs (carboplatin and/or cisplatin, vancomycin or gentamicin) or (6) noise damage including those with a 4-kHz “noise notch” or reporting occupational or recreational noise exposure. Word recognition was scored using CID W-22 monosyllabic word lists. The Articulation Index was used to predict the speech intelligibility curve using a transfer function for CID W-22. The level at which maximal intelligibility was predicted was used as presentation level (70 dB HL minimum). Word scores decreased dramatically with age and thresholds in all groups with SNHL etiologies, but relatively little in the conductive hearing loss group. Discrepancies between measured and predicted word scores were largest in patients with neuropathy, Ménière’s disease and SSNHL, intermediate in the noise-damage and ototoxic drug groups, and smallest in the ARHL group. In the CHL group, the measured and predicted word scores were very similar. Since word-score predictions assume that audiometric losses can be compensated by increasing stimulus level, their accuracy in predicting word score for CHL patients is unsurprising. The lack of a strong age effect on word scores in CHL shows that cognitive decline is not a major factor in this test. Amongst the possible contributions to word score discrepancies, CND is a prime candidate: it should worsen intelligibility without affecting thresholds and has been documented in human temporal bones with SNHL. Comparing the audiological trends observed here with the existing histopathological literature supports the notion that word score discrepancies may be a useful CND metric.
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Affiliation(s)
- Kelsie J Grant
- Eaton-Peabody Laboratories, Massachusetts Eye & Ear, 243 Charles Street, Boston, MA, 02114-3096, USA
| | - Aravindakshan Parthasarathy
- Eaton-Peabody Laboratories, Massachusetts Eye & Ear, 243 Charles Street, Boston, MA, 02114-3096, USA.,Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.,Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA
| | - Viacheslav Vasilkov
- Eaton-Peabody Laboratories, Massachusetts Eye & Ear, 243 Charles Street, Boston, MA, 02114-3096, USA.,Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Benjamin Caswell-Midwinter
- Eaton-Peabody Laboratories, Massachusetts Eye & Ear, 243 Charles Street, Boston, MA, 02114-3096, USA.,Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Maria E Freitas
- Eaton-Peabody Laboratories, Massachusetts Eye & Ear, 243 Charles Street, Boston, MA, 02114-3096, USA
| | - Victor de Gruttola
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Daniel B Polley
- Eaton-Peabody Laboratories, Massachusetts Eye & Ear, 243 Charles Street, Boston, MA, 02114-3096, USA.,Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - M Charles Liberman
- Eaton-Peabody Laboratories, Massachusetts Eye & Ear, 243 Charles Street, Boston, MA, 02114-3096, USA.,Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Stéphane F Maison
- Eaton-Peabody Laboratories, Massachusetts Eye & Ear, 243 Charles Street, Boston, MA, 02114-3096, USA. .,Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.
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5
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Diao T, Duan M, Ma X, Liu J, Yu L, Jing Y, Wang M. The impairment of speech perception in noise following pure tone hearing recovery in patients with sudden sensorineural hearing loss. Sci Rep 2022; 12:866. [PMID: 35039548 PMCID: PMC8763940 DOI: 10.1038/s41598-021-03847-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023] Open
Abstract
To explore whether patients with unilateral idiopathic sudden sensorineural hearing loss (uISSNHL) have normal speech in noise (SIN) perception under different masking conditions after complete recovery of pure tone audiometry. Eight completely recovered uISSNHL patients were enrolled in ISSNHL group, while 8 normal-hearing adults matched with age, gender, and education experience were selected as the control group. Each group was tested SIN under four masking conditions, including noise and speech maskings with and without spatial separation cues. For both ISSNHL and control groups a two-way ANOVA showed a statistically significant effect of masking type (p = 0.007 vs p = 0.012). A significant effect of perceived spatial separation (p < 0.001 vs p < 0.001). A significant interaction between masking type and perceived spatial separation was found (p < 0.001 vs p < 0.001). A paired sample T-test showed that the SIN perception of the control group was statistically significant lower than that of ISSNHL patients only under speech masking without spatial separation cues (p = 0.011). There were still abnormalities in the auditory center shortly after complete recovery in the ISSNHL group (within 2 weeks). However, the auditory periphery and higher-level ability to use spatial cues was normal.
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Affiliation(s)
- Tongxiang Diao
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Maoli Duan
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.,Department of Otolaryngology Head and Neck Surgery & Audiology and Neurotology, Karolinska University Hospital, Karolinska Institute, 171 76, Stockholm, Sweden
| | - Xin Ma
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Jinjun Liu
- School of Psychology, Beijing Normal University, Beijing, 100875, China
| | - Lisheng Yu
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Yuanyuan Jing
- Department of Otolaryngology, Head and Neck Surgery, People's Hospital, Peking University, Beijing, China
| | - Mengyuan Wang
- School of Psychology, Beijing Normal University, Beijing, 100875, China.
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Asp F, Stokroos RJ, Agterberg MJH. Toward Optimal Care for Children With Congenital Unilateral Aural Atresia. Front Neurol 2021; 12:687070. [PMID: 34305795 PMCID: PMC8298319 DOI: 10.3389/fneur.2021.687070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Filip Asp
- Scientific Center for Advanced Pediatric Audiology, Division of Ear, Nose, and Throat Diseases, Department of Clinical Science, Intervention and Technology Karolinska Institute, Stockholm, Sweden
| | - Robert J Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,University Medical Center (UMC) Utrecht Brain Center, Utrecht, Netherlands
| | - Martijn J H Agterberg
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre Nijmegen, Nijmegen, Netherlands.,Department of Biophysics, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
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Mepani AM, Verhulst S, Hancock KE, Garrett M, Vasilkov V, Bennett K, de Gruttola V, Liberman MC, Maison SF. Envelope following responses predict speech-in-noise performance in normal-hearing listeners. J Neurophysiol 2021; 125:1213-1222. [PMID: 33656936 DOI: 10.1152/jn.00620.2020] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Permanent threshold elevation after noise exposure or aging is caused by loss of sensory cells; however, animal studies show that hair cell loss is often preceded by degeneration of the synapses between sensory cells and auditory nerve fibers. Silencing these neurons is likely to degrade auditory processing and may contribute to difficulties understanding speech in noisy backgrounds. Reduction of suprathreshold ABR amplitudes can be used to quantify synaptopathy in inbred mice. However, ABR amplitudes are highly variable in humans, and thus more challenging to use. Since noise-induced neuropathy preferentially targets fibers with high thresholds and low spontaneous rate and because phase locking to temporal envelopes is particularly strong in these fibers, measuring envelope following responses (EFRs) might be a more robust measure of cochlear synaptopathy. A recent auditory model further suggests that modulation of carrier tones with rectangular envelopes should be less sensitive to cochlear amplifier dysfunction and, therefore, a better metric of cochlear neural damage than sinusoidal amplitude modulation. In this study, we measure performance scores on a variety of difficult word-recognition tasks among listeners with normal audiograms and assess correlations with EFR magnitudes to rectangular versus sinusoidal modulation. Higher harmonics of EFR magnitudes evoked by a rectangular-envelope stimulus were significantly correlated with word scores, whereas those evoked by sinusoidally modulated tones did not. These results support previous reports that individual differences in synaptopathy may be a source of speech recognition variability despite the presence of normal thresholds at standard audiometric frequencies.NEW & NOTEWORTHY Recent studies suggest that millions of people may be at risk of permanent impairment from cochlear synaptopathy, the age-related and noise-induced degeneration of neural connections in the inner ear. This study examines electrophysiological responses to stimuli designed to improve detection of neural damage in subjects with normal hearing sensitivity. The resultant correlations with word recognition performance are consistent with a contribution of cochlear neural damage to deficits in hearing in noise abilities.
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Affiliation(s)
- Anita M Mepani
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Sarah Verhulst
- Department of Information Technology, Ghent University, Ghent, Belgium
| | - Kenneth E Hancock
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Markus Garrett
- Department of Information Technology, Ghent University, Ghent, Belgium.,Department of Medical Physics and Acoustics, University of Oldenburg, Oldenburg, Germany
| | | | - Kara Bennett
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Victor de Gruttola
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - M Charles Liberman
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Harvard Program in Speech and Hearing Bioscience and Technology, Harvard University, Boston, Massachusetts
| | - Stéphane F Maison
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, Massachusetts.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Harvard Program in Speech and Hearing Bioscience and Technology, Harvard University, Boston, Massachusetts
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