Are the non-classical auditory pathways involved in autism and PDD?

Contributions of dysfunctional plasticity mechanisms to the development of atypical perceptual processing

Experimental studies of sensory plasticity during development in birds and mammals have highlighted the importance of sensory experiences for the construction and refinement of functional neural circuits. We discuss how dysregulation of experience-dependent brain plasticity can lead to abnormal perceptual representations that may contribute to heterogeneous deficits symptomatic of several neurodevelopmental disorders. We focus on alterations of somatosensory processing and the dynamic reorganization of cortical synaptic networks that occurs during early perceptual development. We also discuss the idea that the heterogeneity of strengths and weaknesses observed in children with neurodevelopmental disorders may be a direct consequence of altered plasticity mechanisms during early development. Treating the heterogeneity of perceptual developmental trajectories as a phenomenon worthy of study rather than as an experimental confound that should be overcome may be key to developing interventions that better account for the complex developmental trajectories experienced by modern humans.

Counseling Protocol for a Transitional Intervention for Debilitating Hyperacusis

INTRODUCTION

This clinical focus article describes a structured counseling protocol for use with protected sound management and therapeutic sound in a transitional intervention for debilitating hyperacusis. The counseling protocol and its associated visual aids are crafted as a teaching tool to educate affected individuals about hyperacusis and encourage their acceptance of a transitional intervention.

DESCRIPTION OF COUNSELING COMPONENTS

The counseling protocol includes five components. First, the patient's audiometric results are reviewed with the patient, and the transitional intervention is introduced. An overview of peripheral auditory structures and central neural pathways and the concept of central gain are covered in the second and third components. Maladaptive hyper-gain processes within the auditory neural pathways, which underlie the hyperacusis condition, and associated connections with nonauditory processes responsible for negative reactions to hyperacusis are covered in the fourth component. Detrimental effects from misused hearing protection devices (HPDs) and the necessity to wean the patient from overuse of HPDs are also discussed. In the fifth component, the importance of therapeutic sound is introduced as a tool to downregulate hyper-gain activity within the auditory pathways; its implementation in uncontrolled and controlled sound environments is described. It is explained that, over the course of the transitional intervention, recalibration of the hyper-gain processes will be ongoing, leading to restoration of normal homeostasis within the auditory pathways. In turn, associated activation of reactive nonauditory processes, which contribute to hyperacusis-related distress, will be reduced or eliminated. As recalibration progresses, there will be less need for protected sound management and sound therapy. Sound tolerance will improve, hyperacusis will subside, and daily activities in typical healthy sound environments will again become routine.

RESULTS AND CONCLUSION

The combination of counseling with protected sound management and therapeutic sound is highlighted in companion reports, including a summary of the outcomes of a successful trial of the transitional intervention.

Auditory symptoms and autistic spectrum disorder: A scoping review and recommendations for future research

Introduction

Auditory symptoms in individuals with Autistic Spectrum Disorder (ASD) are well described within the neurodevelopmental literature, yet there is minimal mention of ASD in Otolaryngology literature. This is surprising considering the potential clinical and diagnostic implications of this link, and the potential for ASD to present to Otolaryngologists in the form of unexplained auditory symptoms. The aims of this literature review were to explore the intersection of auditory symptoms and ASD from the perspective of clinical Otolaryngology, and to outline a clinically focused research agenda based on emerging themes relevant to Otolaryngology.

Methods

We searched Pubmed, Embase, Ovid and Cochrane library for studies until November 2021. Four authors independently reviewed 227 publications identified. 39 were filtered into the final analysis. The PRISMA 2020 guidelines were followed. The heterogeneity of literature meant that a Systematic Review was not feasible. Included studies were therefore classified thematically, forming the basis of the scoping review.

Results

Diagnostic theories for auditory symptoms in ASD include the entire auditory pathway and brain. There is a growing body of literature on auditory symptoms in ASD, suggesting that a primary diagnosis of ASD should be considered in patients presenting with otherwise unexplained auditory symptoms, and indicating a learning need for Otolaryngologists and audiologists, to whom these patients may present.

Conclusion

We recommend a research agenda focusing on multidisciplinary collaboration, stakeholder engagement, responsible clinical screening, and clarification of pathophysiological mechanisms and terminology.

Brain mapping of auditory steady-state responses: A broad view of cortical and subcortical sources

Auditory steady-state responses (ASSRs) are evoked brain responses to modulated or repetitive acoustic stimuli. Investigating the underlying neural generators of ASSRs is important to gain in-depth insight into the mechanisms of auditory temporal processing. The aim of this study is to reconstruct an extensive range of neural generators, that is, cortical and subcortical, as well as primary and non-primary ones. This extensive overview of neural generators provides an appropriate basis for studying functional connectivity. To this end, a minimum-norm imaging (MNI) technique is employed. We also present a novel extension to MNI which facilitates source analysis by quantifying the ASSR for each dipole. Results demonstrate that the proposed MNI approach is successful in reconstructing sources located both within (primary) and outside (non-primary) of the auditory cortex (AC). Primary sources are detected in different stimulation conditions (four modulation frequencies and two sides of stimulation), thereby demonstrating the robustness of the approach. This study is one of the first investigations to identify non-primary sources. Moreover, we show that the MNI approach is also capable of reconstructing the subcortical activities of ASSRs. Finally, the results obtained using the MNI approach outperform the group-independent component analysis method on the same data, in terms of detection of sources in the AC, reconstructing the subcortical activities and reducing computational load.

Contributions of non-primary cortical sources to auditory temporal processing

Temporal processing is essential for speech perception and directional hearing. However, the number and locations of cortical sources involved in auditory temporal processing are still a matter of debate. Using source reconstruction of human EEG responses, we show that, in addition to primary sources in the auditory cortices, sources outside the auditory cortex, designated as non-primary sources, are involved in auditory temporal processing. Non-primary sources within the left and right motor areas, the superior parietal lobe and the right occipital lobe were activated by amplitude-modulated stimuli, and were involved in the functional network. The robustness of these findings was checked for different stimulation conditions. The non-primary sources showed weaker phase-locking and lower activity than primary sources. These findings suggest that the non-primary sources belong to the non-primary auditory pathway. This pathway and non-primary sources detected in motor area explain how, in temporal prediction of upcoming stimuli and motor theory of speech perception, the motor area receives auditory inputs.

Insights from the third international conference on hyperacusis: causes, evaluation, diagnosis, and treatment

BACKGROUND

Hyperacusis is intolerance of certain everyday sounds that causes significant distress and impairment in social, occupational, recreational, and other day-to-day activities.

OBJECTIVE

The aim of this report is to summarize the key findings and conclusions from the Third International Conference on Hyperacusis.

TOPICS COVERED

The main topics discussed comprise (1) diagnosis of hyperacusis and audiological evaluations, (2) neurobiological aspect of hyperacusis, (3) misophonia, (4) hyperacusis in autism spectrum disorder, (5) noise sensitivity, (6) hyperacusis-related distress and comorbid psychiatric illness, and (7) audiologist-delivered cognitive behavioral therapy for hyperacusis.

CONCLUSIONS

Implications for research and clinical practice are summarised.

Misophonia and Potential Underlying Mechanisms: A Perspective

There is a growing research interest in the diagnosis rate of misophonia, a condition characterized by a negative emotional/autonomic reaction to specific everyday sounds. Diagnosis of misophonia requires a thorough case history and audiological test procedures. Associative and non-associative learning models for understanding the underlying mechanisms of misophonia have been presented. Currently, there is no cure or pharmaceutical agent for misophonia; however, therapy programs addressing misophonia and its characteristics do exist. Investigation of comorbid conditions and other psychological therapy strategies might help to reveal more about the underlying mechanisms and potentially lead to a successful treatment method.

Neural Mechanisms Involved in Hypersensitive Hearing: Helping Children with ASD Who Are Overly Sensitive to Sounds

Professionals working with children diagnosed with autism spectrum disorder (ASD) may find that these children are overly sensitive to sounds. These professionals are often concerned as to why children may have auditory hypersensitivities. This review article discusses the neural mechanisms identified underlying hypersensitive hearing in people. The authors focus on brain research to support the idea of the nonclassical auditory pathways being involved in connecting the auditory system with the emotional system of the brain. The authors also discuss brain mechanisms felt to be involved in auditory hypersensitivity. The authors conclude with a discussion of some treatments for hypersensitive hearing. These treatments include desensitization training and the use of listening therapies such as The Listening Program.

Tinnitus and hyperacusis in autism spectrum disorders with emphasis on high functioning individuals diagnosed with Asperger's Syndrome

OBJECTIVES

To evaluate the prevalence of tinnitus and hyperacusis in individuals with Asperger's Syndrome (AS).

METHODS

A home-developed case-history survey and three item-weighted questionnaires: Tinnitus Reaction Questionnaire (TRQ), Tinnitus Handicap Inventory (THI), and the Hyperacusis Questionnaire (HQ) were employed. These tools categorize the subjective response to tinnitus and hyperacusis. The research tools were mailed to a mailing list of individuals with Asperger's Syndrome.

RESULTS

A total of 55 subjects diagnosed with AS were included in the analysis (15.5% response rate). Sixty-nine percent of all respondents (38/55) reported hyperacusis with an average HQ score of 20.7. Furthermore, 35% (19/55) reported perceiving tinnitus with average scores of 27 for the TRQ and 23 for the THI. Thirty-one percent (17/55) reported both hyperacusis and tinnitus. The prevalence of hyperacusis in the AS respondents remained relatively constant across age groups.

CONCLUSIONS

Hyperacusis and tinnitus are more prevalent in the ASD population subgroup diagnosed with AS under DSM-IV criteria than in the general public. Hyperacusis also appears to be more prevalent in the AS population than in the ASD population at large. Future research is warranted to provide insight into the possible correlation between tinnitus and hyperacusis symptoms and the abnormal social interactions observed in this group.

A neural model to study sensory abnormalities and multisensory effects in autism

Computational modeling plays an increasingly prominent role in complementing critical research in the genetics, neuroscience, and psychology of autism. This paper presents a model that supports the notion that weak central coherence, a processing bias for features and local information, may be responsible for perception abnormalities by failing to "control" sensory issues in autism. The model has a biologically plausible architecture based on a self-organizing map. It incorporates temporal information in input stimuli, with emphasis on real auditory signals, and provides a mechanism to model multisensory effects. Through comprehensive simulations the paper studies the effect of a control mechanism (akin to central coherence) in compensating the effects of temporal information in the presentation of stimuli, sensory abnormalities, and crosstalk between domains. The mechanism is successful in balancing out timing effects, basic hypersensitivities and, to a lesser degree, multisensory effects. An analysis of the effect of the control mechanism's onset time on performance suggests that most of the potential benefits are still attainable even when started rather late in the learning process. This high level of adaptability shown by the neural network highlights the importance of appropriate teaching and intervention throughout the lifetime of persons with autism and other neurological disorders.

Degraded auditory processing in a rat model of autism limits the speech representation in non-primary auditory cortex

Although individuals with autism are known to have significant communication problems, the cellular mechanisms responsible for impaired communication are poorly understood. Valproic acid (VPA) is an anticonvulsant that is a known risk factor for autism in prenatally exposed children. Prenatal VPA exposure in rats causes numerous neural and behavioral abnormalities that mimic autism. We predicted that VPA exposure may lead to auditory processing impairments which may contribute to the deficits in communication observed in individuals with autism. In this study, we document auditory cortex responses in rats prenatally exposed to VPA. We recorded local field potentials and multiunit responses to speech sounds in primary auditory cortex, anterior auditory field, ventral auditory field. and posterior auditory field in VPA exposed and control rats. Prenatal VPA exposure severely degrades the precise spatiotemporal patterns evoked by speech sounds in secondary, but not primary auditory cortex. This result parallels findings in humans and suggests that secondary auditory fields may be more sensitive to environmental disturbances and may provide insight into possible mechanisms related to auditory deficits in individuals with autism.

The otological manifestations associated with autistic spectrum disorders

OBJECTIVES

To elucidate the otological manifestations found in this increasingly commonly diagnosed condition. This paper will discuss the diagnosis, aetiology, pathogenesis, management and the outcomes of treatment.

STUDY DESIGN

Systematic literature review.

MATERIALS AND METHODS

The following databases were searched for articles pertaining to the otological manifestations of autistic spectrum disorders: MEDLINE, EMBASE, CURRENT CONTENTS, PSYCHLIT, CINAHL and HEALTHSTAR. Articles from 1965 to June 2012 were extracted. Relevant articles from the literature were selected and reviewed by two independent authors. Each paper was assessed as to its level of evidence and validity. The relevant results are presented and discussed in order to present a practical approach to the management of these patients.

RESULTS

Patients with ASD have an increased incidence of peripheral and central otological pathology. This pathology plays a key role in the behavioural, communication, and social aspects of the disease. ASD patients have a higher incidence of profound sensorineural hearing loss, middle ear infections, and abnormalities of the cochlear nerve and brainstem auditory pathways. There are cortical and brainstem neurodevelopmental abnormalities in the way auditory information is interpreted and processed in the ASD patient.

CONCLUSIONS

The otolaryngologist plays a key role in the multidisciplinary management of individuals with ASD due to the high prevalence of otological pathology amongst these patients. Early diagnosis and expedient treatment focusing on normalisation of auditory input and development can maximise developmental outcomes.

Changing perspectives on Landau-Kleffner syndrome

Landau-Kleffner syndrome (LKS) is a childhood disorder characterized by an acquired aphasia that emerges in association with epileptiform electroencephalographic abnormalities. The language loss is often characterized by a severe disturbance of auditory language comprehension (verbal auditory agnosia) combined with a substantial disruption of expressive language. Comorbid behavioral disturbances commonly involve hyperactivity and attentional problems but sometimes encompass a more pervasive pattern of difficulties resembling an autism spectrum disorder. Now one the most frequently described forms of acquired aphasia in children, LKS has had a profound influence on both neurological practice and cognitive neuroscience. Here, we review current conceptualizations of LKS, consider its pleomorphic manifestations and discuss existing and future diagnostic issues and dilemmas. The potential relevance of LKS to understanding other disorders, including autistic regression, is considered.

A neural model for compensation of sensory abnormalities in autism through feedback from a measure of global perception

Sensory abnormalities and weak central coherence (WCC), a processing bias for features and local information, are important characteristics associated with autism. This paper introduces a self-organizing map (SOM)-based computational model of sensory abnormalities in autism, and of a feedback system to compensate for them. Feedback relies on a measure of balance of coverage over four (sensory) domains. Different methods to compute this measure are discussed, as is the flexibility to configure the system using different control mechanisms. Statistically significant improvements throughout training are demonstrated for compensation of a simple (i.e., monotonically decreasing) hypersensitivity in one of the domains. Fine-tuning control parameters can lead to further gains, but a standard setup results in good performance. Significant improvements are also shown for complex hypersensitivities (i.e., increasing and decreasing through time) in two domains. Although naturally best suited to compensate hypersensitivities--stimuli filtering may mitigate neuron migration to a hypersensitive domain--the system is also shown to perform effectively when compensating hyposensitivities. With poor coverage balance in the model akin to poor global perception, WCC would be consistent with inadequate feedback, resulting in uncontrolled hyper- and/or hyposensitivities characteristic of autism, as seen in the topologies of the resulting SOMs.

Sensory correlations in autism

This study examined the relationship between auditory, visual, touch, and oral sensory dysfunction in autism and their relationship to multisensory dysfunction and severity of autism. The Sensory Profile was completed on 104 persons with a diagnosis of autism, 3 to 56 years of age. Analysis showed a significant correlation between the different processing modalities using total scores. Analysis also showed a significant correlation between processing modalities for both high and low thresholds, with the exception that auditory high threshold processing did not correlate with oral low threshold or touch low threshold processing. Examination of the different age groups suggests that sensory disturbance correlates with severity of autism in children, but not in adolescents and adults. Evidence from this study suggests that: all the main modalities and multisensory processing appear to be affected; sensory processing dysfunction in autism is global in nature; and sensory processing problems need to be considered part of the disorder.

Brief report: can you see what is not there? low-level auditory-visual integration in autism spectrum disorder

Patients diagnosed with Autism Spectrum Disorder, show impaired integration of information across different senses. The processing-level from which this impairment originates, however, remains unclear. We investigated low-level integration of auditory and visual stimuli in subjects with Autism Spectrum Disorder. High-functioning adult subjects with Autism Spectrum Disorder as well as age- and IQ-matched adults were tested using a task that evokes illusory visual stimuli, by presenting sounds concurrently with visual flashes. In both groups the number of sounds presented significantly affected the number of flashes perceived, yet there was no difference between groups. This finding implicates that any problems arising from integrating auditory and visual information must stem from higher processing stages in high-functioning adults with Autism Spectrum Disorder.

The role of neural plasticity in tinnitus

There is considerable evidence that expression of neural plasticity plays a central role in the development of the abnormalities that cause many forms of tinnitus. Expression of neural plasticity can change the balance between excitation and inhibition, promote hyperactivity, and cause re-organization of specific parts of the nervous system or redirection of information to parts of the nervous system not normally involved in processing of sounds (such as the non-classical, or extralemniscal pathways). The strongest promoter of expression of neural plasticity is deprivation of input, which explains why tinnitus often occurs together with hearing loss or injury to the auditory nerve.

Neural plasticity in tinnitus

Two distinctly different kinds of tinnitus occur: objective and subjective tinnitus. Objective tinnitus is caused by sounds generated in the body while subjective tinnitus is caused by abnormal neural activity that is not evoked by sound. This chapter discusses subjective tinnitus. Subjective tinnitus has many forms. In most forms of tinnitus the anatomical location of the physiological abnormality is in the central nervous system, although the sensation is often referred to one ear or both ears. The cause of most forms of subjective tinnitus is the changes that have occurred as a result of expression of neural plasticity, thus a form of reprogramming of the brain that is not to the benefit of the individual person. Tinnitus often occurs together with hearing loss, indicating that the expression of neural plasticity has been evoked by deprivation of input. Tinnitus is often accompanied by hyperacusis, and sometimes phonophobia and depression, indicating altered processing of auditory information or rerouting of information. Several studies have brought evidence that some forms of tinnitus are associated with an abnormal involvement of the nonclassical (extralemniscal, diffuse, or polysensory) auditory pathways that bypass the primary auditory cerebral cortex and provide subcortical connections to limbic structures among others. There is no general treatment for tinnitus, but there are several treatments that can alleviate or reduce the tinnitus in some patients.