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Bölükbaş K, Edwards L, Baguley DM, Fackrell K. Clinical experiences, current approaches, opinions and awareness of healthcare professionals regarding the audio-vestibular consequences of individuals with traumatic brain injury: a cross-sectional online survey study. BMJ Open 2024; 14:e078017. [PMID: 38977364 DOI: 10.1136/bmjopen-2023-078017] [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] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVE To explore the experiences, current approaches, opinions and awareness of healthcare professionals (HCPs) caring for adults with traumatic brain injury (TBI) regarding the audio-vestibular consequences. DESIGN/SETTING Cross-sectional online survey study. PARTICIPANTS HCPs with experience of caring for adults with TBI, who were not ENT (ear nose throat) specialists or audiologists. METHODS The study was conducted from May 2022 to December 2022. The online survey consisted of 16 closed and open-text questions in English and Turkish about clinical experience, current approaches and awareness of audio-vestibular consequences following TBI. Frequencies of responses to closed questions and associations between variables were analysed using SPSS V.28. Open-text responses were summarised in Microsoft Excel. RESULTS Seventy HCPs participated from 17 professions and 14 countries, with the majority from the UK (42.9%). HCPs stated that 'some' to 'all' of their patients had auditory problems such as 'inability to understand speech-in-noise' (66%), 'tinnitus' (64%), 'hyperacusis' (57%) and balance problems such as 'dizziness' (79%) and 'vertigo' (67%). Usually, HCPs asked about the balance status of patients at appointments and when they observed dizziness and/or balance disorder they used screening tests, most commonly finger-to-nose (53%). For auditory impairments, HCPs preferred referring patients with TBI to audiology/ENT services. However, 6% of HCPs felt that audio-vestibular conditions could be ignored on referral because patients with TBI struggled with many impairments. Additionally, 44% would suggest hearing aids to patients with TBI with hearing loss 'if they would like to use' rather than 'definitely'. CONCLUSIONS Many audio-vestibular impairments are observed by HCPs caring for patients with TBI. The assessment and intervention opinions and awareness of HCPs for these impairments vary. However, non-expert HCPs may not be aware of negative consequences of untreated audio-vestibular impairments following TBI. Therefore, developing a simple framework for screening and indications of audio-vestibular impairments for referral may be helpful for non-audiological specialists regularly seeing these patients.
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Affiliation(s)
- Kübra Bölükbaş
- Hearing Sciences, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute of Health and Social Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Laura Edwards
- Division of Rehabilitation Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - David M Baguley
- Hearing Sciences, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute of Health and Social Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Kathryn Fackrell
- Hearing Sciences, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute of Health and Social Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
- School of Healthcare Enterprise and Innovation, University of Southampton, Southampton, UK
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McFarlane KA, Sanchez JT. Effects of Temporal Processing on Speech-in-Noise Perception in Middle-Aged Adults. BIOLOGY 2024; 13:371. [PMID: 38927251 PMCID: PMC11200514 DOI: 10.3390/biology13060371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
Auditory temporal processing is a vital component of auditory stream segregation, or the process in which complex sounds are separated and organized into perceptually meaningful objects. Temporal processing can degrade prior to hearing loss, and is suggested to be a contributing factor to difficulties with speech-in-noise perception in normal-hearing listeners. The current study tested this hypothesis in middle-aged adults-an under-investigated cohort, despite being the age group where speech-in-noise difficulties are first reported. In 76 participants, three mechanisms of temporal processing were measured: peripheral auditory nerve function using electrocochleography, subcortical encoding of periodic speech cues (i.e., fundamental frequency; F0) using the frequency following response, and binaural sensitivity to temporal fine structure (TFS) using a dichotic frequency modulation detection task. Two measures of speech-in-noise perception were administered to explore how contributions of temporal processing may be mediated by different sensory demands present in the speech perception task. This study supported the hypothesis that temporal coding deficits contribute to speech-in-noise difficulties in middle-aged listeners. Poorer speech-in-noise perception was associated with weaker subcortical F0 encoding and binaural TFS sensitivity, but in different contexts, highlighting that diverse aspects of temporal processing are differentially utilized based on speech-in-noise task characteristics.
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Affiliation(s)
- Kailyn A. McFarlane
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL 60208, USA;
| | - Jason Tait Sanchez
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL 60208, USA;
- Knowles Hearing Center, Northwestern University, Evanston, IL 60208, USA
- Department of Neurobiology, Northwestern University, Evanston, IL 60208, USA
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Rizzi R, Bidelman GM. Functional benefits of continuous vs. categorical listening strategies on the neural encoding and perception of noise-degraded speech. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.15.594387. [PMID: 38798410 PMCID: PMC11118460 DOI: 10.1101/2024.05.15.594387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Acoustic information in speech changes continuously, yet listeners form discrete perceptual categories to ease the demands of perception. Being a more continuous/gradient as opposed to a discrete/categorical listener may be further advantageous for understanding speech in noise by increasing perceptual flexibility and resolving ambiguity. The degree to which a listener's responses to a continuum of speech sounds are categorical versus continuous can be quantified using visual analog scaling (VAS) during speech labeling tasks. Here, we recorded event-related brain potentials (ERPs) to vowels along an acoustic-phonetic continuum (/u/ to /a/) while listeners categorized phonemes in both clean and noise conditions. Behavior was assessed using standard two alternative forced choice (2AFC) and VAS paradigms to evaluate categorization under task structures that promote discrete (2AFC) vs. continuous (VAS) hearing, respectively. Behaviorally, identification curves were steeper under 2AFC vs. VAS categorization but were relatively immune to noise, suggesting robust access to abstract, phonetic categories even under signal degradation. Behavioral slopes were positively correlated with listeners' QuickSIN scores, suggesting a behavioral advantage for speech in noise comprehension conferred by gradient listening strategy. At the neural level, electrode level data revealed P2 peak amplitudes of the ERPs were modulated by task and noise; responses were larger under VAS vs. 2AFC categorization and showed larger noise-related delay in latency in the VAS vs. 2AFC condition. More gradient responders also had smaller shifts in ERP latency with noise, suggesting their neural encoding of speech was more resilient to noise degradation. Interestingly, source-resolved ERPs showed that more gradient listening was also correlated with stronger neural responses in left superior temporal gyrus. Our results demonstrate that listening strategy (i.e., being a discrete vs. continuous listener) modulates the categorical organization of speech and behavioral success, with continuous/gradient listening being more advantageous to speech in noise perception.
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Lander DM, Liu S, Roup CM. Associations Between Auditory Working Memory, Self-Perceived Listening Effort, and Hearing Difficulty in Adults With Mild Traumatic Brain Injury. Ear Hear 2024; 45:695-709. [PMID: 38229218 DOI: 10.1097/aud.0000000000001462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVES Mild traumatic brain injury (TBI) can have persistent effects in the auditory domain (e.g., difficulty listening in noise), despite individuals having normal pure-tone auditory sensitivity. Individuals with a history of mild TBI often perceive hearing difficulty and greater listening effort in complex listening situations. The purpose of the present study was to examine self-perceived hearing difficulty, listening effort, and performance on an auditory processing test battery in adults with a history of mild TBI compared with a control group. DESIGN Twenty adults ages 20 to 53 years old participated divided into a mild TBI (n = 10) and control group (n = 10). Perceived hearing difficulties were measured using the Adult Auditory Processing Scale and the Hearing Handicap Inventory for Adults. Listening effort was measured using the National Aeronautics and Space Administration-Task Load Index. Listening effort ratings were obtained at baseline, after each auditory processing test, and at the completion of the test battery. The auditory processing test battery included (1) dichotic word recognition, (2) the 500-Hz masking level difference, (3) the Listening in Spatialized Noise-Sentences test, and (4) the Word Auditory Recognition and Recall Measure (WARRM). RESULTS Results indicated that individuals with a history of mild TBI perceived significantly greater degrees of hearing difficulty and listening effort than the control group. There were no significant group differences on two of the auditory processing tasks (dichotic word recognition or Listening in Spatialized Noise-Sentences). The mild TBI group exhibited significantly poorer performance on the 500-Hz MLD and the WARRM, a measure of auditory working memory, than the control group. Greater degrees of self-perceived hearing difficulty were significantly associated with greater listening effort and poorer auditory working memory. Greater listening effort was also significantly associated with poorer auditory working memory. CONCLUSIONS Results demonstrate that adults with a history of mild TBI may experience subjective hearing difficulty and listening effort when listening in challenging acoustic environments. Poorer auditory working memory on the WARRM task was observed for the adults with mild TBI and was associated with greater hearing difficulty and listening effort. Taken together, the present study suggests that conventional clinical audiometric battery alone may not provide enough information about auditory processing deficits in individuals with a history of mild TBI. The results support the use of a multifaceted battery of auditory processing tasks and subjective measures when evaluating individuals with a history of mild TBI.
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Affiliation(s)
- Devan M Lander
- Department of Speech & Hearing Science, The Ohio State University, Columbus, Ohio, USA
| | - Shuang Liu
- Independent Statistical Consultant, Columbus, Ohio, USA
| | - Christina M Roup
- Department of Speech & Hearing Science, The Ohio State University, Columbus, Ohio, USA
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Buriti AKL, Luiz CBL, Oliveira LRDB, Suriano IC, Gil D. Central auditory processing and self-perception questionnaire after acoustically controlled auditory training in individuals with mild traumatic brain injury. Codas 2024; 36:e20230048. [PMID: 38695432 PMCID: PMC11086975 DOI: 10.1590/2317-1782/20232023048pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/31/2023] [Indexed: 05/14/2024] Open
Abstract
PURPOSE To correlate behavioral assessment results of central auditory processing and the self-perception questionnaire after acoustically controlled auditory training. METHODS The study assessed 10 individuals with a mean age of 44.5 years who had suffered mild traumatic brain injury. They underwent behavioral assessment of central auditory processing and answered the Formal Auditory Training self-perception questionnaire after the therapeutic intervention - whose questions address auditory perception, understanding orders, request to repeat statements, occurrence of misunderstandings, attention span, auditory performance in noisy environments, telephone communication, and self-esteem. Patients were asked to indicate the frequency with which the listed behaviors occurred. RESULTS Figure-ground, sequential memory for sounds, and temporal processing correlated with improvement in following instructions, fewer requests to repeat statements, increased attention span, improved communication, and understanding on the phone and when watching TV. CONCLUSION Auditory closure, figure-ground, and temporal processing had improved in the assessment after the acoustically controlled auditory training, and there were fewer auditory behavior complaints.
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Affiliation(s)
- Ana Karina Lima Buriti
- Departamento de Fonoaudiologia, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brasil.
| | | | | | - Italo Capraro Suriano
- Departamento de Fonoaudiologia, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brasil.
| | - Daniela Gil
- Departamento de Fonoaudiologia, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brasil.
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Davidson A, Souza P. Relationships Between Auditory Processing and Cognitive Abilities in Adults: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:296-345. [PMID: 38147487 DOI: 10.1044/2023_jslhr-22-00716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
PURPOSE The contributions from the central auditory and cognitive systems play a major role in communication. Understanding the relationship between auditory and cognitive abilities has implications for auditory rehabilitation for clinical patients. The purpose of this systematic review is to address the question, "In adults, what is the relationship between central auditory processing abilities and cognitive abilities?" METHOD Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to identify, screen, and determine eligibility for articles that addressed the research question of interest. Medical librarians and subject matter experts assisted in search strategy, keyword review, and structuring the systematic review process. To be included, articles needed to have an auditory measure (either behavioral or electrophysiologic), a cognitive measure that assessed individual ability, and the measures needed to be compared to one another. RESULTS Following two rounds of identification and screening, 126 articles were included for full analysis. Central auditory processing (CAP) measures were grouped into categories (behavioral: speech in noise, altered speech, temporal processing, binaural processing; electrophysiologic: mismatch negativity, P50, N200, P200, and P300). The most common CAP measures were sentence recognition in speech-shaped noise and the P300. Cognitive abilities were grouped into constructs, and the most common construct was working memory. The findings were mixed, encompassing both significant and nonsignificant relationships; therefore, the results do not conclusively establish a direct link between CAP and cognitive abilities. Nonetheless, several consistent relationships emerged across different domains. Distorted or noisy speech was related to working memory or processing speed. Auditory temporal order tasks showed significant relationships with working memory, fluid intelligence, or multidomain cognitive measures. For electrophysiology, relationships were observed between some cortical evoked potentials and working memory or executive/inhibitory processes. Significant results were consistent with the hypothesis that assessments of CAP and cognitive processing would be positively correlated. CONCLUSIONS Results from this systematic review summarize relationships between CAP and cognitive processing, but also underscore the complexity of these constructs, the importance of study design, and the need to select an appropriate measure. The relationship between auditory and cognitive abilities is complex but can provide informative context when creating clinical management plans. This review supports a need to develop guidelines and training for audiologists who wish to consider individual central auditory and cognitive abilities in patient care. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24855174.
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Grant KW, Phatak SA, Myers JR, Jenkins KA, Kubli LR, Brungart DS. Functional Hearing Difficulties in Blast-Exposed Service Members With Normal to Near-Normal Hearing Thresholds. Ear Hear 2024; 45:130-141. [PMID: 37599415 DOI: 10.1097/aud.0000000000001407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
OBJECTIVES Estimated prevalence of functional hearing and communication deficits (FHCDs), characterized by abnormally low speech recognition and binaural tone detection in noise or an abnormally high degree of self-perceived hearing difficulties, dramatically increases in active-duty service members (SMs) who have hearing thresholds slightly above the normal range and self-report to have been close to an explosive blast. Knowing the exact nature of the underlying auditory-processing deficits that contribute to FHCD would not only provide a better characterization of the effects of blast exposure on the human auditory system, but also allow clinicians to prescribe appropriate therapies to treat or manage patient complaints. DESIGN Two groups of SMs were initially recruited: (1) a control group (N = 78) with auditory thresholds ≤20 dB HL between 250 and 8000 Hz, no history of blast exposure, and who passed a short FHCD screener, and (2) a group of blast-exposed SMs (N = 26) with normal to near-normal auditory thresholds between 250 and 4000 Hz, and who failed the FHCD screener (cutoffs based on the study by Grant et al.). The two groups were then compared on a variety of audiometric, behavioral, cognitive, and electrophysiological measures. These tests were selected to characterize various aspects of auditory system processing from the cochlear to the cortex. A third, smaller group of blast-exposed SMs who performed within normal limits on the FHCD screener were also recruited (N = 11). This third subject group was unplanned at the onset of the study and was added to evaluate the effects of blast exposure on hearing and communication regardless of performance on the FHCD screener. RESULTS SMs in the blast-exposed group with FHCD performed significantly worse than control participants on several metrics that measured peripheral and mostly subcortical auditory processing. Cognitive processing was mostly unaffected by blast exposure with the exception of cognitive tests of language-processing speed and working memory. Blast-exposed SMs without FHCD performed similarly to the control group on tests of peripheral and brainstem processing, but performed similarly to blast-exposed SMs with FHCD on measures of cognitive processing. Measures derived from EEG recordings of the frequency-following response revealed that blast-exposed SMs who exhibited FHCD demonstrated increased spontaneous neural activity, reduced amplitude of the envelope-following response, poor internal signal to noise ratio, reduced response stability, and an absent or delayed onset response, compared with the other two participant groups. CONCLUSIONS Degradation in the neural encoding of acoustic stimuli is likely a major contributing factor leading to FHCD in blast-exposed SMs with normal to near-normal audiometric thresholds. Blast-exposed SMs, regardless of their performance on the FHCD screener, exhibited a deficit in language-processing speed and working memory, which could lead to difficulties in decoding rapid speech and in understanding speech in challenging speech communication settings. Further tests are needed to align these findings with clinical treatment protocols being used for patients with suspected auditory-processing disorders.
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Affiliation(s)
- Ken W Grant
- Walter Reed National Military Medical Center, Audiology and Speech Pathology Center, Bethesda, Maryland, USA
| | - Sandeep A Phatak
- Walter Reed National Military Medical Center, Audiology and Speech Pathology Center, Bethesda, Maryland, USA
| | - Jennifer R Myers
- Walter Reed National Military Medical Center, Audiology and Speech Pathology Center, Bethesda, Maryland, USA
| | - Kimberly A Jenkins
- Walter Reed National Military Medical Center, Audiology and Speech Pathology Center, Bethesda, Maryland, USA
| | - Lina R Kubli
- Walter Reed National Military Medical Center, Audiology and Speech Pathology Center, Bethesda, Maryland, USA
- U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Douglas S Brungart
- Walter Reed National Military Medical Center, Audiology and Speech Pathology Center, Bethesda, Maryland, USA
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Stahl AN, Racca JM, Kerley CI, Anderson A, Landman B, Hood LJ, Gifford RH, Rex TS. Comprehensive behavioral and physiologic assessment of peripheral and central auditory function in individuals with mild traumatic brain injury. Hear Res 2024; 441:108928. [PMID: 38086151 DOI: 10.1016/j.heares.2023.108928] [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: 08/28/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023]
Abstract
Auditory complaints are frequently reported by individuals with mild traumatic brain injury (mTBI) yet remain difficult to detect in the absence of clinically significant hearing loss. This highlights a growing need to identify sensitive indices of auditory-related mTBI pathophysiology beyond pure-tone thresholds for improved hearing healthcare diagnosis and treatment. Given the heterogeneity of mTBI etiology and the diverse peripheral and central processes required for normal auditory function, the present study sought to determine the audiologic assessments sensitive to mTBI pathophysiology at the group level using a well-rounded test battery of both peripheral and central auditory system function. This test battery included pure-tone detection thresholds, word understanding in quiet, sentence understanding in noise, distortion product otoacoustic emissions (DPOAEs), middle-ear muscle reflexes (MEMRs), and auditory evoked potentials (AEPs), including auditory brainstem responses (ABRs), middle latency responses (MLRs), and late latency responses (LLRs). Each participant also received magnetic resonance imaging (MRI). Compared to the control group, we found that individuals with mTBI had reduced DPOAE amplitudes that revealed a compound effect of age, elevated MEMR thresholds for an ipsilateral broadband noise elicitor, longer ABR Wave I latencies for click and 4 kHz tone burst elicitors, longer ABR Wave III latencies for 4 kHz tone bursts, larger MLR Na and Nb amplitudes, smaller MLR Pb amplitudes, longer MLR Pa latencies, and smaller LLR N1 amplitudes for older individuals with mTBI. Further, mTBI individuals with combined hearing difficulty and noise sensitivity had a greater number of deficits on thalamic and cortical AEP measures compared to those with only one/no self-reported auditory symptoms. This finding was corroborated with MRI, which revealed significant structural differences in the auditory cortical areas of mTBI participants who reported combined hearing difficulty and noise sensitivity, including an enlargement of left transverse temporal gyrus (TTG) and bilateral planum polare (PP). These findings highlight the need for continued investigations toward identifying individualized audiologic assessments and treatments that are sensitive to mTBI pathophysiology.
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Affiliation(s)
- Amy N Stahl
- Neuroscience Graduate Program, Vanderbilt University, Nashville, TN USA; Department of Ophthalmology & Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN USA
| | - Jordan M Racca
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN USA; Collaborative for STEM Education and Outreach, Vanderbilt Peabody College of Education, Vanderbilt University, Nashville, TN USA
| | - Cailey I Kerley
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Adam Anderson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Bennett Landman
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Linda J Hood
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN USA
| | - René H Gifford
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN USA
| | - Tonia S Rex
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
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van der Horn HJ, Dodd AB, Wick TV, Robertson‐Benta CR, McQuaid JR, Hittson AK, Ling JM, Zotev V, Ryman SG, Erhardt EB, Phillips JP, Campbell RA, Sapien RE, Mayer AR. Neural correlates of cognitive control deficits in pediatric mild traumatic brain injury. Hum Brain Mapp 2023; 44:6173-6184. [PMID: 37800467 PMCID: PMC10619369 DOI: 10.1002/hbm.26504] [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: 06/06/2023] [Revised: 08/18/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023] Open
Abstract
There is a growing body of research showing that cerebral pathophysiological processes triggered by pediatric mild traumatic brain injury (pmTBI) may extend beyond the usual clinical recovery timeline. It is paramount to further unravel these processes, because the possible long-term cognitive effects resulting from ongoing secondary injury in the developing brain are not known. In the current fMRI study, neural processes related to cognitive control were studied in 181 patients with pmTBI at sub-acute (SA; ~1 week) and early chronic (EC; ~4 months) stages post-injury. Additionally, a group of 162 age- and sex-matched healthy controls (HC) were recruited at equivalent time points. Proactive (post-cue) and reactive (post-probe) cognitive control were examined using a multimodal attention fMRI paradigm for either congruent or incongruent stimuli. To study brain network function, the triple-network model was used, consisting of the executive and salience networks (collectively known as the cognitive control network), and the default mode network. Additionally, whole-brain voxel-wise analyses were performed. Decreased deactivation was found within the default mode network at the EC stage following pmTBI during both proactive and reactive control. Voxel-wise analyses revealed sub-acute hypoactivation of a frontal area of the cognitive control network (left pre-supplementary motor area) during proactive control, with a reversed effect at the EC stage after pmTBI. Similar effects were observed in areas outside of the triple-network during reactive control. Group differences in activation during proactive control were limited to the visual domain, whereas for reactive control findings were more pronounced during the attendance of auditory stimuli. No significant correlations were present between task-related activations and (persistent) post-concussive symptoms. In aggregate, current results show alterations in neural functioning during cognitive control in pmTBI up to 4 months post-injury, regardless of clinical recovery. We propose that subacute decreases in activity reflect a general state of hypo-excitability due to the injury, while early chronic hyperactivation represents a compensatory mechanism to prevent default mode interference and to retain cognitive control.
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Affiliation(s)
| | | | | | | | | | | | - Josef M. Ling
- The Mind Research Network/LBERIAlbuquerqueNew MexicoUSA
| | - Vadim Zotev
- The Mind Research Network/LBERIAlbuquerqueNew MexicoUSA
| | | | - Erik B. Erhardt
- Department of Mathematics and StatisticsUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | | | - Richard A. Campbell
- Department of Psychiatry & Behavioral SciencesUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Robert E. Sapien
- Department of Emergency MedicineUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Andrew R. Mayer
- The Mind Research Network/LBERIAlbuquerqueNew MexicoUSA
- Department of Psychiatry & Behavioral SciencesUniversity of New MexicoAlbuquerqueNew MexicoUSA
- Department of PsychologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
- Department of NeurologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
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Roup CM, Lander D, Powell J, Hoffman J. The Impact of Traumatic Brain Injury on Binaural Processing in Young and Middle-Age Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4037-4051. [PMID: 37732825 DOI: 10.1044/2023_jslhr-22-00725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE This study examined the impact of traumatic brain injury (TBI) on self-perceived hearing and suprathreshold binaural processing in young and middle-age adults. METHOD Ninety-three adults with normal hearing (thresholds ≤ 25 dB HL, 250-4000 Hz) participated in one of four groups: 38 young adults, 23 young adults with TBI, 16 middle-age adults, and 16 middle-age adults with TBI. Self-perceived hearing difficulty was measured via questionnaires. Binaural processing was measured using dichotic word recognition, the Listening in Spatialized Noise-Sentences Test (LiSN-S), and the 500-Hz masking level difference (MLD). For each participant, a composite binaural processing (CBP) score was calculated to obtain a global metric of binaural processing performance. The CBP was composed of six measures from the three behavioral tests, including the S0N0 and SπN0 thresholds from the 500-Hz MLD, the low- and high-cue speech recognition thresholds from the LiSN-S, and the free and directed recall ear advantages from the dichotic word test. RESULTS The middle-age TBI group reported significantly greater degrees of self-perceived hearing difficulty than the other groups. On average, the middle-age TBI group performed poorer on the individual binaural processing tests; however, the differences were significant for the S0N0 and SπN0 MLD thresholds only. Results for the global metric of binaural processing revealed significantly poorer CBP scores for the middle-age TBI group compared to the other groups. CONCLUSIONS Results demonstrate that both age and a positive history of TBI contributed to deficits in suprathreshold binaural processing. Middle-age adults with a history of TBI are at risk for experiencing presenescent deficits in suprathreshold binaural processing deficits, despite having clinically normal hearing.
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Affiliation(s)
- Christina M Roup
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Devan Lander
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Julie Powell
- Debra B. Romas & Associates, Mount Vernon, OH
- OhioHealth, Columbus
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Koerner TK, Gallun FJ. Speech understanding and extended high-frequency hearing sensitivity in blast-exposed veteransa). THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 154:379-387. [PMID: 37462921 DOI: 10.1121/10.0020174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/29/2023] [Indexed: 07/21/2023]
Abstract
Auditory difficulties reported by normal-hearing Veterans with a history of blast exposure are primarily thought to stem from processing deficits in the central nervous system. However, previous work on speech understanding in noise difficulties in this patient population have only considered peripheral hearing thresholds in the standard audiometric range. Recent research suggests that variability in extended high-frequency (EHF; >8 kHz) hearing sensitivity may contribute to speech understanding deficits in normal-hearing individuals. Therefore, this work was designed to identify the effects of blast exposure on several common clinical speech understanding measures and EHF hearing sensitivity. This work also aimed to determine whether variability in EHF hearing sensitivity contributes to speech understanding difficulties in normal-hearing blast-exposed Veterans. Data from 41 normal- or near-normal-hearing Veterans with a history of blast exposure and 31 normal- or near-normal-hearing control participants with no history of head injury were employed in this study. Analysis identified an effect of blast exposure on several speech understanding measures but showed no statistically significant differences in EHF thresholds between participant groups. Data showed that variability in EHF hearing sensitivity did not contribute to group-related differences in speech understanding, although study limitations impact interpretation of these results.
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Affiliation(s)
- Tess K Koerner
- Department of Veterans Affairs (VA) Rehabilitation Research and Development (RR & D), National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon 97239, USA
| | - Frederick J Gallun
- Department of Veterans Affairs (VA) Rehabilitation Research and Development (RR & D), National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon 97239, USA
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Tepe V, Guillory L, Boudin-George A, Cantelmo T, Murphy S. Central Auditory Processing Dysfunction in Service Members and Veterans: Treatment Considerations and Strategies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-28. [PMID: 37379242 DOI: 10.1044/2023_jslhr-23-00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
PURPOSE Military risk factors such as blast exposure, noise exposure, head trauma, and neurotoxin exposure place Service members and Veterans at risk for deficits associated with auditory processing dysfunction. However, there is no clinical guidance specific to the treatment of auditory processing deficits in this unique population. We provide an overview of available treatments and their limited supporting evidence for use in adults, emphasizing the need for multidisciplinary case management and interdisciplinary research to support evidence-based solutions. METHOD We explored relevant literature to inform the treatment of auditory processing dysfunction in adults, with emphasis on findings involving active or former military personnel. We were able to identify a limited number of studies, pertaining primarily to the treatment of auditory processing deficits through the use of assistive technologies and training strategies. We assessed the current state of the science for knowledge gaps that warrant additional study. CONCLUSIONS Auditory processing deficits often co-occur with other military injuries and may pose significant risk in military operational and occupational settings. Research is needed to advance clinical diagnostic and rehabilitative capabilities, guide treatment planning, support effective multidisciplinary management, and inform fitness-for-duty standards. We emphasize the need for an inclusive approach to the assessment and treatment of auditory processing concerns in Service members and Veterans and for evidence-based solutions to address complex military risk factors and injuries.
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Affiliation(s)
- Victoria Tepe
- Department of Defense Hearing Center of Excellence, JBSA Lackland, TX
- The Geneva Foundation, Tacoma, WA
| | - Lisa Guillory
- Harry S. Truman Memorial Veterans' Hospital, Columbia, MO
| | - Amy Boudin-George
- Department of Defense Hearing Center of Excellence, JBSA Lackland, TX
| | - Tasha Cantelmo
- Alexander T. Augusta Military Medical Center, Fort Belvoir, VA
| | - Sara Murphy
- Department of Defense Hearing Center of Excellence, JBSA Lackland, TX
- The Geneva Foundation, Tacoma, WA
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13
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Davidson A, Eitel M, Lange RT, French LM, Lippa S, Brickell TA, Brungart D. Efficient Estimation of the Binaural Masking Level Difference Using a Technique Based on Manual Audiometry. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1378-1393. [PMID: 36898137 DOI: 10.1044/2022_jslhr-22-00519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The Masking Level Difference (MLD) has been used for decades to evaluate the binaural listening advantage. Although originally measured using Bekesy audiometry, the most common clinical use of the MLD is the CD-based Wilson 500-Hz technique with interleaved N0S0 and N0Sπ components. Here, we propose an alternative technique based on manual audiometry as a faster way of measuring the MLD. The article describes the advantages to this administration technique and evaluates if it is a viable alternative for the Wilson technique. METHOD Data were retrospectively analyzed on 264 service members (SMs). All SMs completed both the Wilson and Manual MLDs. Descriptive and correlational statistics were applied to evaluate the comparisons between the two techniques and highlight the differences. Equivalence measures were also completed to compare the tests using a standardized cutoff score. Analyses were also made to compare both techniques to subjective and objective measures of hearing performance. RESULTS Moderate to high positive correlations were determined between Wilson and Manual measures of each threshold (N0Sπ and N0S0). Although the Manual and Wilson MLD techniques produced significantly different thresholds, simple linear transformations can be used to obtain approximately equivalent scores on the two tests, and agreement was high for using these transformed scores to identify individuals with substantial MLD deficits. Both techniques had moderate test-retest reliability. The Manual MLD and components had stronger correlations to the subjective and objective hearing measures than the Wilson. CONCLUSIONS The Manual technique is a faster method for obtaining MLD scores that is just as reliable as the CD-based Wilson test. With the significant reduction in assessment time and comparable results, the Manual MLD is a viable alternative for direct use in the clinic.
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Affiliation(s)
| | - Megan Eitel
- Walter Reed National Military Medical Center, Bethesda, MD
| | - Rael T Lange
- Walter Reed National Military Medical Center, Bethesda, MD
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD
- National Intrepid Center of Excellence, Bethesda, MD
- University of British Columbia, Vancouver
| | - Louis M French
- Walter Reed National Military Medical Center, Bethesda, MD
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD
- National Intrepid Center of Excellence, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sara Lippa
- Walter Reed National Military Medical Center, Bethesda, MD
- National Intrepid Center of Excellence, Bethesda, MD
| | - Tracey A Brickell
- Walter Reed National Military Medical Center, Bethesda, MD
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD
- National Intrepid Center of Excellence, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
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Lunardelo PP, Fukuda MTH, Stefanelli ACGF, Zanchetta S. Behavioral assessment of auditory processing in adulthood: population of interest and tests - a systematic review. Codas 2023; 35:e20220044. [PMID: 37132698 PMCID: PMC10162648 DOI: 10.1590/2317-1782/20232022044pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/12/2022] [Indexed: 05/04/2023] Open
Abstract
PURPOSE To identify the behavioral tests used to assess auditory processing throughout adulthood, focusing on the characteristics of the target population as an interest group. RESEARCH STRATEGIES PubMed, CINAHL, Web of Science, and Scielo, databases were searched with descriptors: "auditory perception" or "auditory perception disorders" or "auditory processing" or "central auditory processing" or "auditory processing disorders" or "central auditory processing disorders" with adults OR aging. SELECTION CRITERIA Studies with humans included, the adult population from 18 to 64 years old, who performed at least one behavioral test to assess auditory processing in the absence of hearing loss. DATA ANALYSIS Data extraction was performed independently, using a protocol developed by the authors that included different topics, mainly the behavioral auditory tests performed and the results found. RESULTS Of the 867 records identified, 24 contained the information needed to answer the survey questions. CONCLUSION Almost all studies were conducted verify performance in one or two auditory processing tests. The target target population was heterogeneous, with the most frequent persons with diabetes, stuttering, auditory processing disorder, and noise exposure. There is little information regarding benchmarks for testing in the respective age groups.
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Affiliation(s)
- Pamela Papile Lunardelo
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto - FFCLRP, Universidade de São Paulo - USP - Ribeirão Preto (SP), Brasil
| | - Marisa Tomoe Hebihara Fukuda
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto - FFCLRP, Universidade de São Paulo - USP - Ribeirão Preto (SP), Brasil
- Faculdade de Medicina de Ribeirão Preto - FMRP, Universidade de São Paulo - USP - Ribeirão Preto (SP), Brasil
| | | | - Sthella Zanchetta
- Faculdade de Medicina de Ribeirão Preto - FMRP, Universidade de São Paulo - USP - Ribeirão Preto (SP), Brasil
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15
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Hwang PH, Nelson LD, Sharon JD, McCrea MA, Dikmen SS, Markowitz AJ, Manley GT, Temkin NR. Association Between TBI-Related Hearing Impairment and Cognition: A TRACK-TBI Study. J Head Trauma Rehabil 2022; 37:E327-E335. [PMID: 34698685 PMCID: PMC9035476 DOI: 10.1097/htr.0000000000000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the association between hearing impairment and cognitive function after traumatic brain injury (TBI). SETTING A total of 18 level I trauma centers throughout the United States in the T ransforming R esearch a nd C linical K nowledge in TBI (TRACK-TBI) study. PARTICIPANTS From February 2014 to June 2018, a total of 2697 participants with TBI were enrolled in TRACK-TBI. Key eligibility criteria included external force trauma to the head, presentation to a participating level I trauma center, and receipt of a clinically indicated head computed tomographic (CT) scan within 24 hours of injury. A total of 1267 participants were evaluated in the study, with 216 participants with hearing impairment and 1051 participants without hearing impairment. Those with missing or unknown hearing status or cognitive assessment were excluded from analysis. DESIGN Prospective, observational cohort study. MAIN MEASURES Hearing impairment at 2 weeks post-TBI was based on self-report. Participants who indicated worse hearing in one or both ears were defined as having hearing impairment, whereas those who denied worse hearing in either ear were defined as not having hearing impairment and served as the reference group. Cognitive outcomes at 6 months post-TBI included executive functioning and processing speed, as measured by the Trail Making Test (TMT) B/A and the Wechsler Adult Intelligence Scale, Fourth Edition, Processing Speed Index subscale (WAIS-IV PSI), respectively. RESULTS TBI-related hearing impairment had a small but significantly greater TMT B/A ratio than without TBI-related hearing impairment: mean difference ( B ) = 0.25; 95% CI, 0.07 to 0.43; P = .005. No significant mean differences on WAIS-IV PSI scores were found between participants with and without TBI-related hearing impairment: B = 0.36; 95% CI, -2.07 to 2.60; P = .825. CONCLUSION We conclude that TBI-related hearing impairment at 6 months postinjury was significantly associated with worse executive functioning but not cognitive processing speed.
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Affiliation(s)
- Phillip H Hwang
- Department of Anatomy & Neurobiology, Boston University, Boston, Massachusetts (Dr Hwang); Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee (Drs Nelson and McCrea); Departments of Otolaryngology (Dr Sharon) and Neurological Surgery (Dr Manley), University of California San Francisco; Departments of Rehabilitation Medicine (Dr Dikmen), Neurological Surgery (Dr Temkin), and Biostatistics (Dr Temkin), University of Washington, Seattle; and Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California (Ms Markowitz)
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16
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A Retrospective Study of the Effects of Traumatic Brain Injury on Auditory Function: From a Clinical Perspective. NEUROSCI 2022. [DOI: 10.3390/neurosci3010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: The main purpose of this retrospective study was to identify auditory dysfunctions related to traumatic brain injury (TBI) in individuals evaluated in an Audiology clinic. Method: Peripheral and central auditory evaluations were performed from March 2014 to June 2018 in 26 patients (14 males) with TBI. The age of the participants ranged from 9 to 59 years old (34.24 ± 15.21). Six participants had blast-related TBI and 20 had blunt force TBI. Sixteen experienced a single TBI event whereas ten experienced several. Correlation analyses were performed to verify the relationship, if any, between the number of auditory tests failed and the number, type, and severity of TBIs. Result: All participants failed at least one auditory test. Nearly 60% had abnormal results on degraded speech tests (compressed and echoed, filtered or in background noise) and 25% had a high frequency hearing loss. There was no statistically significant correlation between the number of auditory tests failed and the number, type, and severity of TBIs. Conclusion: Results indicated negative and heterogenous effects of TBI on peripheral and central auditory function and highlighted the need for a more extensive auditory assessment in individuals with TBI.
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17
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de Godoy CCF, de Andrade AN, Suriano I, Matas CG, Gil D. Central auditory processing in children after traumatic brain injury. Clinics (Sao Paulo) 2022; 77:100118. [PMID: 36202032 PMCID: PMC9535263 DOI: 10.1016/j.clinsp.2022.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/29/2022] [Accepted: 08/29/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Traumatic brain injury can impair the central auditory pathways and auditory cortex. Hence, individuals who suffered a traumatic brain injury may be at risk of central auditory processing disorders, which can be identified with behavioral tests that assess central auditory function. OBJECTIVE To characterize and compare the performance of children and adolescents with and without a history of traumatic brain injury in behavioral tests that assess central auditory processing. METHOD The sample comprised 8- to 18-year-old individuals of both sexes who suffered moderate or severe closed traumatic brain injury 3 to 24 months before their participation in the study and whose hearing thresholds were normal. These individuals were matched for sex and age with other subjects without a history of traumatic brain injury and submitted to behavioral assessment of the central auditory processing with special tests to assess hearing skills (namely, auditory closure, figure-ground, and temporal processing), selected according to their chronological age and response-ability. RESULTS The study group performed statistically worse than the comparison group in auditory closure, figure-ground in verbal dichotic listening, and temporal ordering. The central auditory processing tests with abnormal results in the comparison group were different from those in the study group. CONCLUSION Central auditory processing disorders were identified in all subjects of the study group, especially involving auditory closure and temporal processing skills, in comparison with subjects without a history of traumatic brain injury.
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Affiliation(s)
| | - Adriana Neves de Andrade
- Department of Speech-Language-Hearing Pathology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Italo Suriano
- Department of Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Carla Gentile Matas
- Department of Physiotherapy, Speech and Language Pathology and Audiology and Occupational Therapy - Universidade de São Paulo, São Paulo, SP, Brazil
| | - Daniela Gil
- Department of Speech-Language-Hearing Pathology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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18
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Estimated Prevalence of Functional Hearing Difficulties in Blast-Exposed Service Members With Normal to Near-Normal-Hearing Thresholds. Ear Hear 2021; 42:1615-1626. [PMID: 34108398 DOI: 10.1097/aud.0000000000001067] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Over the past decade, U.S. Department of Defense and Veterans Affairs audiologists have reported large numbers of relatively young adult patients who have normal to near-normal audiometric thresholds but who report difficulty understanding speech in noisy environments. Many of these service members also reported having experienced exposure to explosive blasts as part of their military service. Recent studies suggest that some blast-exposed patients with normal to near-normal-hearing thresholds not only have an awareness of increased hearing difficulties, but also poor performance on various auditory tasks (sound source localization, speech recognition in noise, binaural integration, gap detection in noise, etc.). The purpose of this study was to determine the prevalence of functional hearing and communication deficits (FHCD) among healthy Active-Duty service men and women with normal to near-normal audiometric thresholds. DESIGN To estimate the prevalence of such FHCD in the overall military population, performance of roughly 3400 Active-Duty service members with hearing thresholds mostly within the normal range were measured on 4 hearing tests and a brief 6-question survey to assess FHCD. Subjects were subdivided into 6 groups depending on the severity of the blast exposure (3 levels: none, far away, or close enough to feel heat or pressure) and hearing thresholds (2 levels: audiometric thresholds of 20 dB HL or better, slight elevation in 1 or more thresholds between 500 and 4000 Hz in either ear). RESULTS While the probability of having hearing difficulty was low (≈4.2%) for the overall population tested, that probability increased by 2 to 3 times if the service member was blast-exposed from a close distance or had slightly elevated hearing thresholds (>20 dB HL). Service members having both blast exposure and mildly elevated hearing thresholds exhibited up to 4 times higher risk for performing abnormally on auditory tasks and more than 5 times higher risk for reporting abnormally low ratings on the subjective questionnaire, compared with service members with no history of blast exposure and audiometric thresholds ≤20 dB HL. Blast-exposed listeners were roughly 2.5 times more likely to experience subjective or objective hearing deficits than those with no-blast history. CONCLUSIONS These elevated rates of abnormal performance suggest that roughly 33.6% of Active-Duty service members (or approximately 423,000) with normal to near-normal-hearing thresholds (i.e., H1 profile) are at some risk for FHCD, and about 5.7% (approximately 72,000) are at high risk, but are currently untested and undetected within the current fitness-for-duty standards. Service members identified as "at risk" for FHCD according to the metrics used in the present study, in spite of their excellent hearing thresholds, require further testing to determine whether they have sustained damage to peripheral and early-stage auditory processing (bottom-up processing), damage to cognitive processes for speech (top-down processing), or both. Understanding the extent of damage due to noise and blast exposures and the balance between bottom-up processing deficits and top-down deficits will likely lead to better therapeutic strategies.
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19
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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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20
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Vander Ghinst M, Bourguignon M, Wens V, Naeije G, Ducène C, Niesen M, Hassid S, Choufani G, Goldman S, De Tiège X. Inaccurate cortical tracking of speech in adults with impaired speech perception in noise. Brain Commun 2021; 3:fcab186. [PMID: 34541530 PMCID: PMC8445395 DOI: 10.1093/braincomms/fcab186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 01/17/2023] Open
Abstract
Impaired speech perception in noise despite normal peripheral auditory function is a common problem in young adults. Despite a growing body of research, the pathophysiology of this impairment remains unknown. This magnetoencephalography study characterizes the cortical tracking of speech in a multi-talker background in a group of highly selected adult subjects with impaired speech perception in noise without peripheral auditory dysfunction. Magnetoencephalographic signals were recorded from 13 subjects with impaired speech perception in noise (six females, mean age: 30 years) and matched healthy subjects while they were listening to 5 different recordings of stories merged with a multi-talker background at different signal to noise ratios (No Noise, +10, +5, 0 and −5 dB). The cortical tracking of speech was quantified with coherence between magnetoencephalographic signals and the temporal envelope of (i) the global auditory scene (i.e. the attended speech stream and the multi-talker background noise), (ii) the attended speech stream only and (iii) the multi-talker background noise. Functional connectivity was then estimated between brain areas showing altered cortical tracking of speech in noise in subjects with impaired speech perception in noise and the rest of the brain. All participants demonstrated a selective cortical representation of the attended speech stream in noisy conditions, but subjects with impaired speech perception in noise displayed reduced cortical tracking of speech at the syllable rate (i.e. 4–8 Hz) in all noisy conditions. Increased functional connectivity was observed in subjects with impaired speech perception in noise in Noiseless and speech in noise conditions between supratemporal auditory cortices and left-dominant brain areas involved in semantic and attention processes. The difficulty to understand speech in a multi-talker background in subjects with impaired speech perception in noise appears to be related to an inaccurate auditory cortex tracking of speech at the syllable rate. The increased functional connectivity between supratemporal auditory cortices and language/attention-related neocortical areas probably aims at supporting speech perception and subsequent recognition in adverse auditory scenes. Overall, this study argues for a central origin of impaired speech perception in noise in the absence of any peripheral auditory dysfunction.
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Affiliation(s)
- Marc Vander Ghinst
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI-ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium.,Service, d'ORL et de chirurgie cervico-faciale, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium
| | - Mathieu Bourguignon
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI-ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium.,Laboratory of Neurophysiology and Movement Biomechanics, UNI-ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium.,Basque Center on Cognition, Brain and Language (BCBL), Donostia/San Sebastian 20009, Spain
| | - Vincent Wens
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI-ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium.,Clinics of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium
| | - Gilles Naeije
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI-ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium.,Service de Neurologie, ULB-Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels 1070, Belgium
| | - Cecile Ducène
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI-ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium.,Service, d'ORL et de chirurgie cervico-faciale, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium
| | - Maxime Niesen
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI-ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium.,Service, d'ORL et de chirurgie cervico-faciale, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium
| | - Sergio Hassid
- Service, d'ORL et de chirurgie cervico-faciale, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium
| | - Georges Choufani
- Service, d'ORL et de chirurgie cervico-faciale, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium
| | - Serge Goldman
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI-ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium.,Clinics of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium
| | - Xavier De Tiège
- Laboratoire de Cartographie fonctionnelle du Cerveau, UNI-ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium.,Clinics of Functional Neuroimaging, Service of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels 1070, Belgium
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21
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de Larrea-Mancera ESL, Philipp MA, Stavropoulos T, Carrillo AA, Cheung S, Koerner TK, Molis MR, Gallun FJ, Seitz AR. Training with an auditory perceptual learning game transfers to speech in competition. JOURNAL OF COGNITIVE ENHANCEMENT 2021; 6:47-66. [PMID: 34568741 PMCID: PMC8453468 DOI: 10.1007/s41465-021-00224-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/24/2021] [Indexed: 12/23/2022]
Abstract
Understanding speech in the presence of acoustical competition is a major complaint of those with hearing difficulties. Here, a novel perceptual learning game was tested for its effectiveness in reducing difficulties with hearing speech in competition. The game was designed to train a mixture of auditory processing skills thought to underlie speech in competition, such as spectral-temporal processing, sound localization, and auditory working memory. Training on these skills occurred both in quiet and in competition with noise. Thirty college-aged participants without any known hearing difficulties were assigned either to this mixed-training condition or an active control consisting of frequency discrimination training within the same gamified setting. To assess training effectiveness, tests of speech in competition (primary outcome), as well as basic supra-threshold auditory processing and cognitive processing abilities (secondary outcomes) were administered before and after training. Results suggest modest improvements on speech in competition tests in the mixed-training compared to the frequency-discrimination control condition (Cohen’s d = 0.68). While the sample is small, and in normally hearing individuals, these data suggest promise of future study in populations with hearing difficulties.
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Affiliation(s)
- E Sebastian Lelo de Larrea-Mancera
- Psychology Department, University of California, Riverside, Riverside, CA USA.,Brain Game Center, University of California, Riverside, Riverside, CA USA
| | - Mark A Philipp
- Brain Game Center, University of California, Riverside, Riverside, CA USA
| | | | | | - Sierra Cheung
- Brain Game Center, University of California, Riverside, Riverside, CA USA
| | - Tess K Koerner
- Oregon Health and Science University, Portland, OR USA.,VA RR&D National Center for Rehabilitative Auditory Research, Portland, OR USA
| | - Michelle R Molis
- Oregon Health and Science University, Portland, OR USA.,VA RR&D National Center for Rehabilitative Auditory Research, Portland, OR USA
| | - Frederick J Gallun
- Oregon Health and Science University, Portland, OR USA.,VA RR&D National Center for Rehabilitative Auditory Research, Portland, OR USA
| | - Aaron R Seitz
- Psychology Department, University of California, Riverside, Riverside, CA USA.,Brain Game Center, University of California, Riverside, Riverside, CA USA
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Palandrani KN, Hoover EC, Stavropoulos T, Seitz AR, Isarangura S, Gallun FJ, Eddins DA. Temporal integration of monaural and dichotic frequency modulation. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 150:745. [PMID: 34470296 PMCID: PMC8337085 DOI: 10.1121/10.0005729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 06/17/2021] [Accepted: 07/02/2021] [Indexed: 05/06/2023]
Abstract
Frequency modulation (FM) detection at low modulation frequencies is commonly used as an index of temporal fine-structure processing. The present study evaluated the rate of improvement in monaural and dichotic FM across a range of test parameters. In experiment I, dichotic and monaural FM detection was measured as a function of duration and modulator starting phase. Dichotic FM thresholds were lower than monaural FM thresholds and the modulator starting phase had no effect on detection. Experiment II measured monaural FM detection for signals that differed in modulation rate and duration such that the improvement with duration in seconds (carrier) or cycles (modulator) was compared. Monaural FM detection improved monotonically with the number of modulation cycles, suggesting that the modulator is extracted prior to detection. Experiment III measured dichotic FM detection for shorter signal durations to test the hypothesis that dichotic FM relies primarily on the signal onset. The rate of improvement decreased as duration increased, which is consistent with the use of primarily onset cues for the detection of dichotic FM. These results establish that improvement with duration occurs as a function of the modulation cycles at a rate consistent with the independent-samples model for monaural FM, but later cycles contribute less to detection in dichotic FM.
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Affiliation(s)
- Katherine N Palandrani
- Department of Communication Sciences and Disorders, University of Maryland, College Park, Maryland 20742, USA
| | - Eric C Hoover
- Department of Communication Sciences and Disorders, University of Maryland, College Park, Maryland 20742, USA
| | - Trevor Stavropoulos
- Brain Game Center, University of California Riverside, Riverside, California 92521, USA
| | - Aaron R Seitz
- Department of Psychology, University of California Riverside, Riverside, California 92521, USA
| | - Sittiprapa Isarangura
- Department of Communication Sciences and Disorders, Mahidol University, Phaya Thai, Bangkok 10400, Thailand
| | - Frederick J Gallun
- Oregon Hearing Research Center, Oregon Health and Science University, Portland, Oregon 97239, USA
| | - David A Eddins
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida 33620, USA
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23
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Chong CD, Zhang J, Li J, Wu T, Dumkrieger G, Nikolova S, Ross K, Stegmann G, Liss J, Schwedt TJ, Jayasuriya S, Berisha V. Altered speech patterns in subjects with post-traumatic headache due to mild traumatic brain injury. J Headache Pain 2021; 22:82. [PMID: 34301180 PMCID: PMC8305503 DOI: 10.1186/s10194-021-01296-6] [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: 06/08/2021] [Accepted: 07/12/2021] [Indexed: 01/03/2023] Open
Abstract
Background/objective Changes in speech can be detected objectively before and during migraine attacks. The goal of this study was to interrogate whether speech changes can be detected in subjects with post-traumatic headache (PTH) attributed to mild traumatic brain injury (mTBI) and whether there are within-subject changes in speech during headaches compared to the headache-free state. Methods Using a series of speech elicitation tasks uploaded via a mobile application, PTH subjects and healthy controls (HC) provided speech samples once every 3 days, over a period of 12 weeks. The following speech parameters were assessed: vowel space area, vowel articulation precision, consonant articulation precision, average pitch, pitch variance, speaking rate and pause rate. Speech samples of subjects with PTH were compared to HC. To assess speech changes associated with PTH, speech samples of subjects during headache were compared to speech samples when subjects were headache-free. All analyses were conducted using a mixed-effect model design. Results Longitudinal speech samples were collected from nineteen subjects with PTH (mean age = 42.5, SD = 13.7) who were an average of 14 days (SD = 32.2) from their mTBI at the time of enrollment and thirty-one HC (mean age = 38.7, SD = 12.5). Regardless of headache presence or absence, PTH subjects had longer pause rates and reductions in vowel and consonant articulation precision relative to HC. On days when speech was collected during a headache, there were longer pause rates, slower sentence speaking rates and less precise consonant articulation compared to the speech production of HC. During headache, PTH subjects had slower speaking rates yet more precise vowel articulation compared to when they were headache-free. Conclusions Compared to HC, subjects with acute PTH demonstrate altered speech as measured by objective features of speech production. For individuals with PTH, speech production may have been more effortful resulting in slower speaking rates and more precise vowel articulation during headache vs. when they were headache-free, suggesting that speech alterations were related to PTH and not solely due to the underlying mTBI.
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Affiliation(s)
- Catherine D Chong
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA. .,ASU-Mayo Center for Innovative Imaging, Phoenix, AZ, USA.
| | - Jianwei Zhang
- School of Electrical, Computer and Energy Engineering and College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Jing Li
- School of Industrial and Systems Engineering, Georgia Tech, Atlanta, GA, USA
| | - Teresa Wu
- ASU-Mayo Center for Innovative Imaging, Phoenix, AZ, USA.,School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe, AZ, USA
| | | | | | | | - Gabriela Stegmann
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Julie Liss
- School of Electrical, Computer and Energy Engineering and College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Todd J Schwedt
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA.,ASU-Mayo Center for Innovative Imaging, Phoenix, AZ, USA
| | - Suren Jayasuriya
- School of Electrical, Computer and Energy Engineering and College of Health Solutions, Arizona State University, Tempe, AZ, USA.,School of Arts, Media and Engineering, Arizona State University, Tempe, AZ, USA
| | - Visar Berisha
- School of Electrical, Computer and Energy Engineering and College of Health Solutions, Arizona State University, Tempe, AZ, USA.,College of Health Solutions, Arizona State University, Tempe, AZ, USA
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24
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Sajja V, Long JB, Tenn CC. Editorial: Neurosensory Alterations From Blast Exposure and Blunt Impact. Front Neurol 2021; 12:674626. [PMID: 33897614 PMCID: PMC8060435 DOI: 10.3389/fneur.2021.674626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Venkatasivasaisujith Sajja
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States.,The Geneva Foundation, Tacoma, WA, United States
| | - Joseph B Long
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Catherine C Tenn
- Casualty Management Section, Defence Research and Development Canada, Suffield Research Centre, Medicine Hat, AB, Canada
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25
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Jiang J, Benhamou E, Waters S, Johnson JCS, Volkmer A, Weil RS, Marshall CR, Warren JD, Hardy CJD. Processing of Degraded Speech in Brain Disorders. Brain Sci 2021; 11:394. [PMID: 33804653 PMCID: PMC8003678 DOI: 10.3390/brainsci11030394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022] Open
Abstract
The speech we hear every day is typically "degraded" by competing sounds and the idiosyncratic vocal characteristics of individual speakers. While the comprehension of "degraded" speech is normally automatic, it depends on dynamic and adaptive processing across distributed neural networks. This presents the brain with an immense computational challenge, making degraded speech processing vulnerable to a range of brain disorders. Therefore, it is likely to be a sensitive marker of neural circuit dysfunction and an index of retained neural plasticity. Considering experimental methods for studying degraded speech and factors that affect its processing in healthy individuals, we review the evidence for altered degraded speech processing in major neurodegenerative diseases, traumatic brain injury and stroke. We develop a predictive coding framework for understanding deficits of degraded speech processing in these disorders, focussing on the "language-led dementias"-the primary progressive aphasias. We conclude by considering prospects for using degraded speech as a probe of language network pathophysiology, a diagnostic tool and a target for therapeutic intervention.
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Affiliation(s)
- Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Elia Benhamou
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Sheena Waters
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Jeremy C. S. Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London WC1H 0AP, UK;
| | - Rimona S. Weil
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Charles R. Marshall
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Jason D. Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Chris J. D. Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
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26
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Gallun FJ. Impaired Binaural Hearing in Adults: A Selected Review of the Literature. Front Neurosci 2021; 15:610957. [PMID: 33815037 PMCID: PMC8017161 DOI: 10.3389/fnins.2021.610957] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/19/2021] [Indexed: 11/17/2022] Open
Abstract
Despite over 100 years of study, there are still many fundamental questions about binaural hearing that remain unanswered, including how impairments of binaural function are related to the mechanisms of binaural hearing. This review focuses on a number of studies that are fundamental to understanding what is known about the effects of peripheral hearing loss, aging, traumatic brain injury, strokes, brain tumors, and multiple sclerosis (MS) on binaural function. The literature reviewed makes clear that while each of these conditions has the potential to impair the binaural system, the specific abilities of a given patient cannot be known without performing multiple behavioral and/or neurophysiological measurements of binaural sensitivity. Future work in this area has the potential to bring awareness of binaural dysfunction to patients and clinicians as well as a deeper understanding of the mechanisms of binaural hearing, but it will require the integration of clinical research with animal and computational modeling approaches.
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Affiliation(s)
- Frederick J. Gallun
- Oregon Hearing Research Center, Oregon Health and Science University, Portland, OR, United States
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27
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Kornguth S, Rylander HG, Smith S, Campbell J, Steffensen S, Arnold D, Athey A, Rutledge JN. Approaches for Monitoring Warfighter Blast-related Exposures in Training to Develop Effective Safety Standards. Mil Med 2021; 186:515-522. [PMID: 33499537 PMCID: PMC7980484 DOI: 10.1093/milmed/usaa426] [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: 03/25/2020] [Revised: 08/04/2020] [Accepted: 11/01/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Traumatic brain injuries are of concern to the sports and military communities because of the age of the participants and costly burden to society. To markedly reduce the impact of traumatic brain injury and its sequela (TBI-S), it is necessary to determine the initial vulnerability of individuals as well as identify new technologies that indicate early signs of TBI-S. MATERIALS AND METHODS Currently, diverse methods have been used by the authors and others in laboratory settings to reveal early signs of persistent TBI-S including simulation modeling of the effect of rapid deceleration on the deviatoric strain (shear force) imposed on specific brain regions, auditory evoked potential (AEP) measurements to determine injury to the auditory cortex optokinetic nystagmus (OKN) measures sensitive to vestibular trauma, and optical coherence tomography (OCT) measures that reveal changes in central visual function obtained noninvasively by examination of the retina. RESULTS Simulation studies provided technical information on maximal deviatoric strain at the base of the sulci and interface of gray and white matter consistent with results from neuropathology and from magnetic resonance imaging. The AEP and OKN reveal measurable injury to similar regions below the Sylvian fissure including auditory cortex and midbrain, and the OCT reveals changes to the retina consistent with forceful deceleration effects. CONCLUSIONS The studies and results are consistent with prior work demonstrating that noninvasive tests may be sensitive to the presence of TBI-S, potentially in the training field as advances in the portability of test instruments are underway. When combined with baseline data gathered from individuals in quantitative form, key variances can emerge. Therefore, it is hypothesized that AEP, OKN, and OCT, taken together, may yield faster objective and quantitative neurophysiological measures serving as a "signature" of neural injury and more indicative of potentially persistent TBI-S-recommending larger scale longitudinal studies.
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Affiliation(s)
- Steven Kornguth
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - Henry G Rylander
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Spencer Smith
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - Julia Campbell
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - Steve Steffensen
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - David Arnold
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - Alex Athey
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - J Neal Rutledge
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
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28
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Rauterkus G, Moncrieff D, Stewart G, Skoe E. Baseline, retest, and post-injury profiles of auditory neural function in collegiate football players. Int J Audiol 2021; 60:650-662. [PMID: 33439060 DOI: 10.1080/14992027.2020.1860261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Recent retrospective studies report differences in auditory neurophysiology between concussed athletes and uninjured controls using the frequency-following response (FFR). Adopting a prospective design in college football players, we compared FFRs before and after a concussion and evaluated test-retest reliability in non-concussed teammates. DESIGN Testing took place in a locker room. We analysed the FFR to the fundamental frequency (F0) (FFR-F0) of a speech stimulus, previously identified as a potential concussion biomarker. Baseline FFRs were obtained during the football pre-season. In athletes diagnosed with concussions during the season, FFRs were measured days after injury and compared to pre-season baseline. In uninjured controls, comparisons were made between pre- and post-season. STUDY SAMPLE Participants were Tulane University football athletes (n = 65). RESULTS In concussed athletes, there was a significant group-level decrease in FFR-F0 from baseline (26% decrease on average). By contrast, the control group's change from baseline was not statistically significant, and comparisons of pre- and post-season had good repeatability (intraclass correlation coefficient = 0.75). CONCLUSIONS Results converge with previous work to evince suppressed neural function to the FFR-F0 following concussion. This preliminary study paves the way for larger-scale clinical evaluation of the specificity and reliability of the FFR as a concussion diagnostic.HighlightsThis prospective study reveals suppressed neural responses to sound in concussed athletes compared to baseline.Neural responses to sound show good repeatability in uninjured athletes tested in a locker-room setting.Results support the feasibility of recording frequency-following responses in non-laboratory conditions.
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Affiliation(s)
- Grant Rauterkus
- Center for Sport, Tulane University School of Medicine, New Orleans, LA, USA
| | - Deborah Moncrieff
- School of Communication Sciences and Disorders, University of Memphis, Memphis, TN, USA
| | - Gregory Stewart
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Erika Skoe
- Department of Speech, Language, and Hearing Sciences, Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, USA
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29
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Koerner TK, A. Papesh M, Gallun FJ. A Questionnaire Survey of Current Rehabilitation Practices for Adults With Normal Hearing Sensitivity Who Experience Auditory Difficulties. Am J Audiol 2020; 29:738-761. [PMID: 32966118 DOI: 10.1044/2020_aja-20-00027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose A questionnaire survey was conducted to collect information from clinical audiologists about rehabilitation options for adult patients who report significant auditory difficulties despite having normal or near-normal hearing sensitivity. This work aimed to provide more information about what audiologists are currently doing in the clinic to manage auditory difficulties in this patient population and their views on the efficacy of recommended rehabilitation methods. Method A questionnaire survey containing multiple-choice and open-ended questions was developed and disseminated online. Invitations to participate were delivered via e-mail listservs and through business cards provided at annual audiology conferences. All responses were anonymous at the time of data collection. Results Responses were collected from 209 participants. The majority of participants reported seeing at least one normal-hearing patient per month who reported significant communication difficulties. However, few respondents indicated that their location had specific protocols for the treatment of these patients. Counseling was reported as the most frequent rehabilitation method, but results revealed that audiologists across various work settings are also successfully starting to fit patients with mild-gain hearing aids. Responses indicated that patient compliance with computer-based auditory training methods was regarded as low, with patients generally preferring device-based rehabilitation options. Conclusions Results from this questionnaire survey strongly suggest that audiologists frequently see normal-hearing patients who report auditory difficulties, but that few clinicians are equipped with established protocols for diagnosis and management. While many feel that mild-gain hearing aids provide considerable benefit for these patients, very little research has been conducted to date to support the use of hearing aids or other rehabilitation options for this unique patient population. This study reveals the critical need for additional research to establish evidence-based practice guidelines that will empower clinicians to provide a high level of clinical care and effective rehabilitation strategies to these patients.
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Affiliation(s)
- Tess K. Koerner
- VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
| | - Melissa A. Papesh
- VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Frederick J. Gallun
- VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland
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30
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Kidd G, Jennings TR, Byrne AJ. Enhancing the perceptual segregation and localization of sound sources with a triple beamformer. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2020; 148:3598. [PMID: 33379918 PMCID: PMC8097713 DOI: 10.1121/10.0002779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 06/01/2023]
Abstract
A triple beamformer was developed to exploit the capabilities of the binaural auditory system. The goal was to enhance the perceptual segregation of spatially separated sound sources while preserving source localization. The triple beamformer comprised a variant of a standard single-channel beamformer that routes the primary beam output focused on the target source location to both ears. The triple beam algorithm adds two supplementary beams with the left-focused beam routed only to the left ear and the right-focused beam routed only to the right ear. The rationale for the approach is that the triple beam processing exploits sound source segregation in high informational masking (IM) conditions. Furthermore, the exaggerated interaural level differences produced by the triple beam are well-suited for categories of listeners (e.g., bilateral cochlear implant users) who receive limited benefit from interaural time differences. The performance with the triple beamformer was compared to normal binaural hearing (simulated using a Knowles Electronic Manikin for Auditory Research, G.R.A.S. Sound and Vibration, Holte, DK) and to that obtained from a single-channel beamformer. Source localization in azimuth and masked speech identification for multiple masker locations were measured for all three algorithms. Taking both localization and speech intelligibility into account, the triple beam algorithm was considered to be advantageous under high IM listening conditions.
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Affiliation(s)
- Gerald Kidd
- Department of Speech, Language and Hearing Sciences and Hearing Research Center, Boston University, 635 Commonwealth Avenue, Boston, Massachusetts 02215, USA
| | - Todd R Jennings
- Department of Speech, Language and Hearing Sciences and Hearing Research Center, Boston University, 635 Commonwealth Avenue, Boston, Massachusetts 02215, USA
| | - Andrew J Byrne
- Department of Speech, Language and Hearing Sciences and Hearing Research Center, Boston University, 635 Commonwealth Avenue, Boston, Massachusetts 02215, USA
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31
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Lelo de Larrea-Mancera ES, Stavropoulos T, Hoover EC, Eddins DA, Gallun FJ, Seitz AR. Portable Automated Rapid Testing (PART) for auditory assessment: Validation in a young adult normal-hearing population. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2020; 148:1831. [PMID: 33138479 PMCID: PMC7541091 DOI: 10.1121/10.0002108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 05/23/2023]
Abstract
This study aims to determine the degree to which Portable Automated Rapid Testing (PART), a freely available program running on a tablet computer, is capable of reproducing standard laboratory results. Undergraduate students were assigned to one of three within-subject conditions that examined repeatability of performance on a battery of psychoacoustical tests of temporal fine structure processing, spectro-temporal amplitude modulation, and targets in competition. The repeatability condition examined test/retest with the same system, the headphones condition examined the effects of varying headphones (passive and active noise-attenuating), and the noise condition examined repeatability in the presence of recorded cafeteria noise. In general, performance on the test battery showed high repeatability, even across manipulated conditions, and was similar to that reported in the literature. These data serve as validation that suprathreshold psychoacoustical tests can be made accessible to run on consumer-grade hardware and perform in less controlled settings. This dataset also provides a distribution of thresholds that can be used as a normative baseline against which auditory dysfunction can be identified in future work.
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Affiliation(s)
| | - Trevor Stavropoulos
- Brain Game Center, University of California Riverside, 1201 University Avenue, Riverside California 92521, USA
| | - Eric C Hoover
- University of Maryland, College Park, Maryland 20742, USA
| | | | | | - Aaron R Seitz
- Psychology Department, University of California, Riverside, 900 University Avenue, Riverside, California 92521, USA
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32
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Kuchinsky SE, Eitel MM, Lange RT, French LM, Brickell TA, Lippa SM, Brungart DS. Objective and Subjective Auditory Effects of Traumatic Brain Injury and Blast Exposure in Service Members and Veterans. Front Neurol 2020; 11:613. [PMID: 32719649 PMCID: PMC7350851 DOI: 10.3389/fneur.2020.00613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022] Open
Abstract
Service members and veterans (SMVs) with a history of traumatic brain injury (TBI) or blast-related injury often report difficulties understanding speech in complex environments that are not captured by clinical tests of auditory function. Little is currently known about the relative contribution of other auditory, cognitive, and symptomological factors to these communication challenges. This study evaluated the influence of these factors on subjective and objective measures of hearing difficulties in SMVs with and without a history of TBI or blast exposure. Analyses included 212 U.S. SMVs who completed auditory and cognitive batteries and surveys of hearing and other symptoms as part of a larger longitudinal study of TBI. Objective speech recognition performance was predicted by TBI status, while subjective hearing complaints were predicted by blast exposure. Bothersome tinnitus was associated with a history of more severe TBI. Speech recognition performance deficits and tinnitus complaints were also associated with poorer cognitive function. Hearing complaints were predicted by high frequency hearing loss and reports of more severe PTSD symptoms. These results suggest that SMVs with a history of blast exposure and/or TBI experience communication deficits that go beyond what would be expected based on standard audiometric assessments of their injuries.
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Affiliation(s)
| | - Megan M Eitel
- Walter Reed National Military Medical Center, Bethesda, MD, United States.,Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Rael T Lange
- Walter Reed National Military Medical Center, Bethesda, MD, United States.,Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,National Intrepid Center of Excellence, Bethesda, MD, United States.,Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,General Dynamics Information Technology, Falls Church, VA, United States
| | - Louis M French
- Walter Reed National Military Medical Center, Bethesda, MD, United States.,Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,National Intrepid Center of Excellence, Bethesda, MD, United States.,Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Tracey A Brickell
- Walter Reed National Military Medical Center, Bethesda, MD, United States.,Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,National Intrepid Center of Excellence, Bethesda, MD, United States.,General Dynamics Information Technology, Falls Church, VA, United States.,Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Sara M Lippa
- Walter Reed National Military Medical Center, Bethesda, MD, United States.,Defense and Veterans Brain Injury Center, Silver Spring, MD, United States.,National Intrepid Center of Excellence, Bethesda, MD, United States
| | - Douglas S Brungart
- Walter Reed National Military Medical Center, Bethesda, MD, United States
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33
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Tepe V, Papesh M, Russell S, Lewis MS, Pryor N, Guillory L. Acquired Central Auditory Processing Disorder in Service Members and Veterans. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:834-857. [PMID: 32163310 DOI: 10.1044/2019_jslhr-19-00293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose A growing body of evidence suggests that military service members and military veterans are at risk for deficits in central auditory processing. Risk factors include exposure to blast, neurotrauma, hazardous noise, and ototoxicants. We overview these risk factors and comorbidities, address implications for clinical assessment and care of central auditory processing deficits in service members and veterans, and specify knowledge gaps that warrant research. Method We reviewed the literature to identify studies of risk factors, assessment, and care of central auditory processing deficits in service members and veterans. We also assessed the current state of the science for knowledge gaps that warrant additional study. This literature review describes key findings relating to military risk factors and clinical considerations for the assessment and care of those exposed. Conclusions Central auditory processing deficits are associated with exposure to known military risk factors. Research is needed to characterize mechanisms, sources of variance, and differential diagnosis in this population. Existing best practices do not explicitly consider confounds faced by military personnel. Assessment and rehabilitation strategies that account for these challenges are needed. Finally, investment is critical to ensure that Veterans Affairs and Department of Defense clinical staff are informed, trained, and equipped to implement effective patient care.
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Affiliation(s)
- Victoria Tepe
- Department of Defense Hearing Center of Excellence, JBSA Lackland, TX
- The Geneva Foundation, Tacoma, WA
| | - Melissa Papesh
- VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Shoshannah Russell
- Walter Reed National Military Medical Center, Bethesda, MD
- Henry Jackson Foundation, Bethesda, MD
| | - M Samantha Lewis
- VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
- School of Audiology, Pacific University, Hillsboro, OR
| | - Nina Pryor
- Department of Defense Hearing Center of Excellence, JBSA Lackland, TX
- Air Force Research Laboratory, Wright-Patterson Air Force Base, OH
| | - Lisa Guillory
- Harry S. Truman Memorial Veterans' Hospital, Columbia, MO
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Missouri, Columbia
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Souza P, Gallun F, Wright R. Contributions to Speech-Cue Weighting in Older Adults With Impaired Hearing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:334-344. [PMID: 31940258 PMCID: PMC7213489 DOI: 10.1044/2019_jslhr-19-00176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Purpose In a previous paper (Souza, Wright, Blackburn, Tatman, & Gallun, 2015), we explored the extent to which individuals with sensorineural hearing loss used different cues for speech identification when multiple cues were available. Specifically, some listeners placed the greatest weight on spectral cues (spectral shape and/or formant transition), whereas others relied on the temporal envelope. In the current study, we aimed to determine whether listeners who relied on temporal envelope did so because they were unable to discriminate the formant information at a level sufficient to use it for identification and the extent to which a brief discrimination test could predict cue weighting patterns. Method Participants were 30 older adults with bilateral sensorineural hearing loss. The first task was to label synthetic speech tokens based on the combined percept of temporal envelope rise time and formant transitions. An individual profile was derived from linear discriminant analysis of the identification responses. The second task was to discriminate differences in either temporal envelope rise time or formant transitions. The third task was to discriminate spectrotemporal modulation in a nonspeech stimulus. Results All listeners were able to discriminate temporal envelope rise time at levels sufficient for the identification task. There was wide variability in the ability to discriminate formant transitions, and that ability predicted approximately one third of the variance in the identification task. There was no relationship between performance in the identification task and either amount of hearing loss or ability to discriminate nonspeech spectrotemporal modulation. Conclusions The data suggest that listeners who rely to a greater extent on temporal cues lack the ability to discriminate fine-grained spectral information. The fact that the amount of hearing loss was not associated with the cue profile underscores the need to characterize individual abilities in a more nuanced way than can be captured by the pure-tone audiogram.
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Affiliation(s)
- Pamela Souza
- Department of Communication Sciences and Disorders and Knowles Hearing Center, Northwestern University, Evanston, IL
| | - Frederick Gallun
- Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, VA Portland Health Care System and Oregon Health and Sciences University
| | - Richard Wright
- Department of Linguistics, University of Washington, Seattle
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Neurosensory Deficits Associated with Concussion (Auditory, Vestibular, and Visual Dysfunction). Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00009-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Stockbridge MD, Newman R. Enduring Cognitive and Linguistic Deficits in Individuals With a History of Concussion. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1554-1570. [PMID: 31487473 DOI: 10.1044/2019_ajslp-18-0196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The purpose of this research is to determine whether individuals with a history of concussion retain enduring differences in narrative writing tasks, which necessitate rapid and complex integration of both cognitive and linguistic faculties. Method Participants aged 12-40 years old, who did or did not have a remote history of concussion, were recruited to take an online survey that included writing both a familiar and a novel narrative. They also were asked to complete multiple tasks targeting word-level and domain general cognitive skills, so that their performance could be interpreted across these dimensions. Results Participants with a concussion history were largely similar to participants with no history of brain injury across tasks that targeted a single skill in isolation. However, participants with prior concussions demonstrated difficulty in providing both key content and details when presented with a novel video and asked to provide a summary of what they had just seen. Number of lifetime concussions predicted the inclusion of key content when summarizing the video. Thus, differences in cognitive and linguistic skills required for written narrative language may continue to be present far after concussion, despite average normative levels of performance on tasks targeting these skills in isolation. Conclusions These findings suggest that individuals with a concussion history, particularly a history of multiple concussions, may continue to experience difficulties for a long period after injury and are likely to benefit from more complex and ecologically valid assessment prior to discharge. Individuals with a concussion history who return to full participation in work, school, and recreational activities may continue to benefit from assistance when asked to rapidly acquire and distill novel information, as is often required in academic and professional environments.
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Affiliation(s)
| | - Rochelle Newman
- Department of Hearing and Speech Sciences, University of Maryland, College Park
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Discrepancies in Hearing Thresholds between Pure-Tone Audiometry and Auditory Steady-State Response in Non-Malingerers. Ear Hear 2019; 41:663-668. [PMID: 31567521 DOI: 10.1097/aud.0000000000000791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate discrepancies between pure-tone audiometry (PTA) and auditory steady state response (ASSR) tests in non-malingerers and investigate brain lesions that may explain the discrepancies, especially in cases where the PTA threshold was worse than the estimated ASSR threshold. DESIGN PTA, speech audiometry, auditory brainstem response, ASSR, and neuroimaging tests were carried out on individuals selected from 995 cases of hearing impairment. Among these, medical records of 25 subjects (19 males, 6 females; mean age = 46.5 ± 16.0 years) with significant discrepancy between PTA and estimated ASSR thresholds were analyzed retrospectively. To define acceptable levels of discrepancy in PTA and ASSR hearing thresholds, 56 patients (27 males, 29 females; mean age = 53.0 ± 13.6 years) were selected for the control group. Magnetic resonance images, magnetic resonance angiograms, and positron emission tomograms were reviewed to identify any neurologic abnormalities. RESULTS Pathologic brain lesions were found in 20 cases (80%) in the study group, all of which showed a significant discrepancy in hearing threshold between PTA and ASSR. Temporal lobe lesions were found in 14 cases (70%), frontal lobe lesions in 12 (60%), and thalamic lesions without the frontal or temporal lobe in 2 cases (10%). On repeated PTA and ASSR tests a few months later, the discrepancy between ASSR and behavioral hearing thresholds was reduced or resolved in 6 cases (85.7%). Temporal lobe lesions were found in all 3 cases in which the estimated ASSR threshold worsened with unchanged PTA threshold, and frontal lobe lesions were found in all 3 cases in which the PTA threshold improved but the estimated ASSR threshold was unchanged. No neurological lesions were found in 5 cases (20%) of patients with a discrepancy between ASSR and behavioral hearing thresholds. CONCLUSIONS Clinicians should not rely exclusively on ASSR, especially in cases of central nervous system including temporal, frontal lobe, or thalamus lesions. If no lesions are found in a neuroimaging study of a patient with a discrepancy between PTA thresholds and estimated ASSR thresholds, further functional studies of the brain may be needed. If clinicians encounter patients with a discrepancy between PTA thresholds and estimated ASSR thresholds, an evaluation of brain lesions and repeat audiologic tests are recommended in lieu of relying solely on ASSR.
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Vander Werff KR, Rieger B. Impaired auditory processing and neural representation of speech in noise among symptomatic post-concussion adults. Brain Inj 2019; 33:1320-1331. [PMID: 31317775 PMCID: PMC6731965 DOI: 10.1080/02699052.2019.1641624] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
Background: The purpose of the study was to examine auditory event-related potential (AERP) evidence of changes in earlier and later stages of auditory processing in individuals with long-term post-concussion problems compared to healthy controls, with a secondary aim of comparing AERPs by functional auditory behavioral outcomes. Methods: P1-N1-P2 complex and P300 components recorded to speech in quiet and background noise conditions were completed in individuals with ongoing post-concussion symptoms following mTBI and healthy controls. AERPs were also examined between sub-groups with normal or impaired auditory processing by behavioral tests. Results: Group differences were present for later stages of auditory processing (P300). Earlier components did not significantly differ by group overall but were more affected by noise in the mTBI group. P2 amplitude in noise differed between mTBI sub-groups with normal or impaired auditory processing. Conclusion: AERPs revealed differences between healthy controls and those with chronic post-concussion symptoms following mTBI at a later stage of auditory processing (P300). Neural processing at the earlier stage (P1-N1-P2) was more affected by noise in the mTBI group. Preliminary evidence suggested that it may be only the proportion of individuals with functional evidence of central auditory dysfunction with changes in AERPs at earlier stages of processing.
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Affiliation(s)
- Kathy R. Vander Werff
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse NY
| | - Brian Rieger
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY
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Vander Werff KR, Rieger B. Auditory and Cognitive Behavioral Performance Deficits and Symptom Reporting in Postconcussion Syndrome Following Mild Traumatic Brain Injury. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2501-2518. [PMID: 31260387 PMCID: PMC6808357 DOI: 10.1044/2019_jslhr-h-18-0281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/13/2018] [Accepted: 02/15/2019] [Indexed: 05/07/2023]
Abstract
Purpose This study examined auditory deficits and symptom reporting in individuals with long-term postconcussion symptoms following a single mild traumatic brain injury (mTBI) compared to age- and gender-matched controls without a history of mTBI. Method Case history interviews, symptom questionnaires, and a battery of central auditory and neuropsychological tests were administered to 2 groups. The mTBI group was a civilian population recruited from a local concussion management program who were seeking rehabilitation for postconcussion-related problems in a postacute period between 3 and 18 months following injury. Symptom validity testing was included to assess the rate of possible insufficient test effort and its influence on scores for all outcome measures. Analyses of group differences in test scores were performed both with and without the participants who showed insufficient test effort. Rates of symptom reporting, correlations among symptoms and behavioral test outcomes, and the relationships between auditory and cognitive test performance were analyzed. Results The mTBI group reported a high rate of auditory symptoms and general postconcussion symptoms. Performance on neuropsychological tests of cognitive function showed some differences in raw scores between groups, but when effort was considered, there were no significant differences in the rate of abnormal performance between groups. In contrast, there were significant differences in both raw scores and the rate of abnormal performance between groups for some auditory tests when only considering participants with sufficient effort. Auditory symptoms were strongly correlated with other general postconcussion symptoms. Conclusions Significant auditory symptoms and evidence of long-term central auditory dysfunction were found in a subset of individuals who had chronic postconcussion symptoms after a single mTBI unrelated to blast trauma. The rate of abnormal performance on auditory behavioral tests exceeded the rate of abnormal performance on tests of cognitive function. Supplemental Material https://doi.org/10.23641/asha.8329955.
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Affiliation(s)
| | - Brian Rieger
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, NY
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Hoover EC, Kinney BN, Bell KL, Gallun FJ, Eddins DA. A Comparison of Behavioral Methods for Indexing the Auditory Processing of Temporal Fine Structure Cues. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2018-2034. [PMID: 31145649 PMCID: PMC6808371 DOI: 10.1044/2019_jslhr-h-18-0217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 12/20/2018] [Accepted: 02/13/2019] [Indexed: 05/12/2023]
Abstract
Purpose Growing evidence supports the inclusion of perceptual tests that quantify the processing of temporal fine structure (TFS) in clinical hearing assessment. Many tasks have been used to evaluate TFS in the laboratory that vary greatly in the stimuli used and whether the judgments require monaural or binaural comparisons of TFS. The purpose of this study was to compare laboratory measures of TFS for inclusion in a battery of suprathreshold auditory tests. A subset of available TFS tasks were selected on the basis of potential clinical utility and were evaluated using metrics that focus on characteristics important for clinical use. Method TFS measures were implemented in replication of studies that demonstrated clinical utility. Monaural, diotic, and dichotic measures were evaluated in 11 young listeners with normal hearing. Measures included frequency modulation (FM) tasks, harmonic frequency shift detection, interaural phase difference (TFS-low frequency), interaural time difference (ITD), monaural gap duration discrimination, and tone detection in noise with and without a difference in interaural phase (N0S0, N0Sπ). Data were compared with published results and evaluated with metrics of consistency and efficiency. Results Thresholds obtained were consistent with published data. There was no evidence of predictive relationships among the measures consistent with a homogenous group. The most stable tasks across repeated testing were TFS-low frequency, diotic and dichotic FM, and N0Sπ. Monaural and diotic FM had the lowest normalized variance and were the most efficient accounting for differences in total test duration, followed by ITD. Conclusions Despite a long stimulus duration, FM tasks dominated comparisons of consistency and efficiency. Small differences separated the dichotic tasks FM, ITD, and N0Sπ. Future comparisons following procedural optimization of the tasks will evaluate clinical efficiency in populations with impairment.
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Affiliation(s)
- Eric C. Hoover
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Brianna N. Kinney
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Karen L. Bell
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Frederick J. Gallun
- National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Oregon
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland
| | - David A. Eddins
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
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Papesh MA, Elliott JE, Callahan ML, Storzbach D, Lim MM, Gallun FJ. Blast Exposure Impairs Sensory Gating: Evidence from Measures of Acoustic Startle and Auditory Event-Related Potentials. J Neurotrauma 2019; 36:702-712. [PMID: 30113267 PMCID: PMC6387566 DOI: 10.1089/neu.2018.5801] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Many military service members and veterans who have been exposed to high-intensity blast waves experience traumatic brain injury (TBI), resulting in chronic auditory deficits despite normal hearing sensitivity. The current study sought to examine the neurological cause of this chronic dysfunction by testing the hypothesis that blast exposure leads to impaired filtering of sensory information at brainstem and early cortical levels. Groups of blast-exposed and non-blast-exposed participants completed self-report measures of auditory and neurobehavioral status, auditory perceptual tasks involving degraded and competing speech stimuli, and physiological measures of sensory gating, including pre-pulse inhibition and habituation of the acoustic startle reflex and electrophysiological assessment of a paired-click sensory gating paradigm. Blast-exposed participants showed significantly reduced habituation to acoustic startle stimuli and impaired filtering of redundant sensory information at the level the auditory cortex. Multiple linear regression analyses revealed that poorer sensory gating at the cortical level was primarily influenced by a diagnosis of TBI, whereas reduced habituation was primarily influenced by a diagnosis of post-traumatic stress disorder. A statistical model was created including cortical sensory gating and habituation to acoustic startle, which strongly predicted performance on a degraded speech task. These results support the hypothesis that blast exposure impairs central auditory processing via impairment of neural mechanisms underlying habituation and sensory gating.
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Affiliation(s)
- Melissa A. Papesh
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
- Department of Otolaryngology Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
| | - Jonathan E. Elliott
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
| | - Megan L. Callahan
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Daniel Storzbach
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Miranda M. Lim
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
- Department of Neurology, Oregon Health & Science University, Portland, Oregon
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon
- Department of Behavioral Neuroscience and Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon
| | - Frederick J. Gallun
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
- Department of Otolaryngology Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
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Jakien KM, Gallun FJ. Normative Data for a Rapid, Automated Test of Spatial Release From Masking. Am J Audiol 2018; 27:529-538. [PMID: 30458523 PMCID: PMC6436452 DOI: 10.1044/2018_aja-17-0069] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/20/2018] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of this study is to report normative data and predict thresholds for a rapid test of spatial release from masking for speech perception. The test is easily administered and has good repeatability, with the potential to be used in clinics and laboratories. Normative functions were generated for adults varying in age and amounts of hearing loss. Method The test of spatial release presents a virtual auditory scene over headphones with 2 conditions: colocated (with target and maskers at 0°) and spatially separated (with target at 0° and maskers at ± 45°). Listener thresholds are determined as target-to-masker ratios, and spatial release from masking (SRM) is determined as the difference between the colocated condition and spatially separated condition. Multiple linear regression was used to fit the data from 82 adults 18–80 years of age with normal to moderate hearing loss (0–40 dB HL pure-tone average [PTA]). The regression equations were then used to generate normative functions that relate age (in years) and hearing thresholds (as PTA) to target-to-masker ratios and SRM. Results Normative functions were able to predict thresholds with an error of less than 3.5 dB in all conditions. In the colocated condition, the function included only age as a predictive parameter, whereas in the spatially separated condition, both age and PTA were included as parameters. For SRM, PTA was the only significant predictor. Different functions were generated for the 1st run, the 2nd run, and the average of the 2 runs. All 3 functions were largely similar in form, with the smallest error being associated with the function on the basis of the average of 2 runs. Conclusion With the normative functions generated from this data set, it would be possible for a researcher or clinician to interpret data from a small number of participants or even a single patient without having to first collect data from a control group, substantially reducing the time and resources needed. Supplemental Material https://doi.org/10.23641/asha.7080878
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Affiliation(s)
- Kasey M. Jakien
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Department of Veterans Affairs, OR
- Department of Otolaryngology–Head & Neck Surgery, Oregon Health and Science University, Portland
| | - Frederick J. Gallun
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Department of Veterans Affairs, OR
- Department of Otolaryngology–Head & Neck Surgery, Oregon Health and Science University, Portland
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Abstract
It has been shown that there is an increased risk for impaired auditory function following traumatic brain injury (TBI) in Veterans. Evidence is strongest in the area of self-report, but behavioural and electro-physiological data have been obtained that are consistent with these complaints. Peripheral and central dysfunction have both been observed. Historically, studies have focused on penetrating head injuries where central injury is more easily documented than in mild closed head injuries, but several recent reports have expanded the literature to include closed head injuries as well. The lack of imaging technology that can identify which closed head injuries are likely to impact auditory function is a significant barrier to accurate diagnosis and rehabilitation. Current behavioural and electrophysiological measures are effective in substantiating the auditory complaints of these patients but leave many questions unanswered. One significant limitation of current approaches is the lack of clear data regarding the potential influence of those mental health comorbidities that are very likely to be present in the Veteran population. In the area of rehabilitation, there are indications that hearing aids and other assistive listening devices may provide benefit, as can auditory training programmes, yet more research needs to be done.
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Affiliation(s)
- Frederick J Gallun
- a VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System , Portland , OR , USA.,b Department of Otolaryngology/H&NS , Oregon Health and Science University , Portland , OR , USA.,c Neuroscience Graduate Program , Oregon Health and Science University , Portland , OR , USA
| | - Melissa A Papesh
- a VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System , Portland , OR , USA
| | - M Samantha Lewis
- a VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System , Portland , OR , USA.,b Department of Otolaryngology/H&NS , Oregon Health and Science University , Portland , OR , USA
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Thompson EC, Krizman J, White-Schwoch T, Nicol T, LaBella CR, Kraus N. Difficulty hearing in noise: a sequela of concussion in children. Brain Inj 2018. [DOI: 10.1080/02699052.2018.1447686] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Elaine C Thompson
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Jennifer Krizman
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Travis White-Schwoch
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Trent Nicol
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Cynthia R LaBella
- Division of Pediatric Orthopaedics & Sports Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nina Kraus
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
- Institute for Neuroscience, Northwestern University, Evanston, IL, USA
- Department of Neurobiology, Northwestern University, Evanston, IL, USA
- Department of Otolaryngology, Northwestern University, Evanston, IL, USA
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