Older adults' perceptions of current and future hearing healthcare services in Australia, England, US and Canada.

OBJECTIVE: A high prevalence of hearing loss in older adults contrasts with a small proportion of people who seek help. Emerging developments in hearing healthcare (HHC) could reduce costs but may not increase access. This study evaluated older adults' perceptions of current and future HHC services in Australia, England, US and Canada to explore potential levers and system improvements. METHODS: Semi-structured focus groups (n = 47) were conducted, and data were analysed using a directed content analysis. Participants were adults 60 years and older with a) no hearing problems; b) hearing problems and hearing aid use; and c) hearing problems and no hearing aid use. RESULTS: Perceived barriers, facilitators and preferences were largely consistent across countries, with stigma and trust in HHC being the barriers most often discussed. CONCLUSION: Although cost and access were consistently deemed important, there may be limited change in help-seeking and HHC uptake unless the key barriers of trust and stigma are addressed. When seeking to undertake transformative change to healthcare it is important to engage recipients of care to understand existing barriers and coproduce a user-centered solution.

Simultaneous EEG and MEG recordings reveal vocal pitch elicited cortical gamma oscillations in young and older adults.

The frequency-following response with origin in the auditory brainstem represents the pitch contour of voice and can be recorded with electrodes from the scalp. MEG studies also revealed a cortical contribution to the high gamma oscillations at the fundamental frequency (f0) of a vowel stimulus. Therefore, studying the cortical component of the frequency-following response could provide insights into how pitch information is encoded at the cortical level. Comparing how aging affects the different responses may help to uncover the neural mechanisms underlying speech understanding deficits in older age. We simultaneously recorded EEG and MEG responses to the syllable /ba/. MEG beamformer analysis localized sources in bilateral auditory cortices and the midbrain. Time-frequency analysis showed a faithful representation of the pitch contour between 106 Hz and 138 Hz in the cortical activity. A cross-correlation revealed a latency of 20 ms. Furthermore, stimulus onsets elicited cortical 40-Hz responses. Both the 40-Hz and the f0 response amplitudes increased in older age and were larger in the right hemisphere. The effects of aging and laterality of the f0 response were evident in the MEG only, suggesting that both effects were characteristics of the cortical response. After comparing f0 and N1 responses in EEG and MEG, we estimated that approximately one-third of the scalp-recorded f0 response could be cortical in origin. We attributed the significance of the cortical f0 response to the precise timing of cortical neurons that serve as a time-sensitive code for pitch.

Auditory Evoked Responses in Older Adults With Normal Hearing, Untreated, and Treated Age-Related Hearing Loss.

OBJECTIVES: The goal of this study was to identify the effects of auditory deprivation (age-related hearing loss) and auditory stimulation (history of hearing aid use) on the neural registration of sound across two stimulus presentation conditions: (1) equal sound pressure level and (2) equal sensation level. DESIGN: We used a between-groups design, involving three groups of 14 older adults (n = 42; 62 to 84 years): (1) clinically defined normal hearing (≤25 dB from 250 to 8000 Hz, bilaterally), (2) bilateral mild-moderate/moderately severe sensorineural hearing loss who have never used hearing aids, and (3) bilateral mild-moderate/moderately severe sensorineural hearing loss who have worn bilateral hearing aids for at least the past 2 years. RESULTS: There were significant delays in the auditory P1-N1-P2 complex in older adults with hearing loss compared with their normal hearing peers when using equal sound pressure levels for all participants. However, when the degree and configuration of hearing loss were accounted for through the presentation of equal sensation level stimuli, no latency delays were observed. These results suggest that stimulus audibility modulates P1-N1-P2 morphology and should be controlled for when defining deprivation and stimulus-related neuroplasticity in people with hearing loss. Moreover, a history of auditory stimulation, in the form of hearing aid use, does not appreciably alter the neural registration of unaided auditory evoked brain activity when quantified by the P1-N1-P2. CONCLUSIONS: When comparing auditory cortical responses in older adults with and without hearing loss, stimulus audibility, and not hearing loss-related neurophysiological changes, results in delayed response latency for those with age-related hearing loss. Future studies should carefully consider stimulus presentation levels when drawing conclusions about deprivation- and stimulation-related neuroplasticity. Additionally, auditory stimulation, in the form of a history of hearing aid use, does not significantly affect the neural registration of sound when quantified using the P1-N1-P2-evoked response.

Reliability of the Home Hearing Test: Implications for Public Health.

BACKGROUND: The projected increase in the aging population raises concerns about how to manage the health-care needs in a cost-effective way. Within hearing health care, there are presently too few audiologists to meet the expected demand, and training more professionals may not be a feasible way of addressing this problem. For this reason, there is a need to develop different ways of assessing hearing sensitivity that can be conducted accurately and inexpensively when a certified audiologist and/or sound-attenuated booth is unavailable. More specifically, there is a need to determine if the Etymotic Home Hearing Test (HHT) can yield accurate and reliable data from older adults with varying degrees of hearing loss. PURPOSE: To compare audiometric thresholds obtained using the HHT, an automated pure-tone air-conduction test, to those obtained using manual audiometry (MA), among older adults with varying degrees of hearing loss. STUDY SAMPLE: Participants were 112 English-speaking adults (58% Female), aged 60 yr and older. Participants were excluded from this study if otoscopy revealed cerumen impaction and/or suspected ear pathology. INTERVENTION: All participants completed the HHT on tablet computers in a carpeted classroom and MA in a double-walled sound-attenuated booth using insert earphones for both measures. Both measures were completed in the same test session, and the order of testing (MA versus HHT) was counterbalanced. DATA COLLECTION AND ANALYSIS: Absolute differences in threshold measurements (in dB HL) were calculated across all ears (n = 224 ears) and for all frequencies (octave frequencies from 0.5 to 8 kHz). Correlation and multiple linear regression analyses were conducted to determine if thresholds obtained using the HHT significantly correlated with thresholds using MA. Mean thresholds for each method (HHT and MA) were compared using correlation analyses for each test frequency. Multiple linear regression analysis was used to examine the relationship between the four-frequency pure-tone average (PTA) (average threshold at 0.5, 1, 2, and 4 kHz) in the better-hearing ear measured using the HHT and a set of seven independent factors: four-frequency PTA in the better-hearing ear measured via MA, treatment group (HHT versus MA), age, gender, and degree of hearing loss (mild, moderate, and >moderate). RESULTS: Correlation analyses revealed significant frequency-specific correlations, ranging from 0.91 to 0.97 (p < 0.001), for air-conduction thresholds obtained using the HHT and MA. Mean HHT thresholds were significantly correlated with mean MA thresholds in both ears across the frequency range. This relationship held true across different degrees of hearing loss. The regression model accounted for a significant amount of variance in the HHT better-ear PTA, with MA better-ear PTA being the only significant predictor in our final model, with no effect of degree of loss, age, or gender. CONCLUSIONS: The HHT is an accurate and cost-effective method of establishing pure-tone air-conduction thresholds, when compared with MA. Therefore, the HHT can be used as a tool to acquire accurate air-conduction hearing thresholds from older adults, in-group settings, without the use of a sound-attenuated booth or a certified audiologist.

Listening and Learning: Cognitive Contributions to the Rehabilitation of Older Adults With and Without Audiometrically Defined Hearing Loss.

Here, we describe some of the ways in which aging negatively affects the way sensory input is transduced and processed within the aging brain and how cognitive work is involved when listening to a less-than-perfect signal. We also describe how audiologic rehabilitation, including hearing aid amplification and listening training, is used to reduce the amount of cognitive resources required for effective auditory communication and conclude with an example of how listening effort is being studied in research laboratories for the purpose(s) of informing clinical practice.

Hearing Impairment and Cognitive Energy: The Framework for Understanding Effortful Listening (FUEL).

The Fifth Eriksholm Workshop on "Hearing Impairment and Cognitive Energy" was convened to develop a consensus among interdisciplinary experts about what is known on the topic, gaps in knowledge, the use of terminology, priorities for future research, and implications for practice. The general term cognitive energy was chosen to facilitate the broadest possible discussion of the topic. It goes back to who described the effects of attention on perception; he used the term psychic energy for the notion that limited mental resources can be flexibly allocated among perceptual and mental activities. The workshop focused on three main areas: (1) theories, models, concepts, definitions, and frameworks; (2) methods and measures; and (3) knowledge translation. We defined effort as the deliberate allocation of mental resources to overcome obstacles in goal pursuit when carrying out a task, with listening effort applying more specifically when tasks involve listening. We adapted Kahneman's seminal (1973) Capacity Model of Attention to listening and proposed a heuristically useful Framework for Understanding Effortful Listening (FUEL). Our FUEL incorporates the well-known relationship between cognitive demand and the supply of cognitive capacity that is the foundation of cognitive theories of attention. Our FUEL also incorporates a motivation dimension based on complementary theories of motivational intensity, adaptive gain control, and optimal performance, fatigue, and pleasure. Using a three-dimensional illustration, we highlight how listening effort depends not only on hearing difficulties and task demands but also on the listener's motivation to expend mental effort in the challenging situations of everyday life.

How Can Public Health Approaches and Perspectives Advance Hearing Health Care?

This commentary explores the role of public health programs and themes on hearing health care. Ongoing engagement within the hearing professional community is needed to determine how to change the landscape and identify important features in the evolution of population hearing health care. Why and how to leverage existing public health programs and develop new programs to improve hearing health in older individuals is an important topic. Hearing professionals are encouraged to reflect on these themes and recommendations and join the discussion about the future of hearing science on a population level.

Aging and Hearing Health: The Life-course Approach.

Sensory abilities decline with age. More than 5% of the world's population, approximately 360 million people, have disabling hearing loss. In adults, disabling hearing loss is defined by thresholds greater than 40 dBHL in the better hearing ear.Hearing disability is an important issue in geriatric medicine because it is associated with numerous health issues, including accelerated cognitive decline, depression, increased risk of dementia, poorer balance, falls, hospitalizations, and early mortality. There are also social implications, such as reduced communication function, social isolation, loss of autonomy, impaired driving ability, and financial decline. Furthermore, the onset of hearing loss is gradual and subtle, first affecting the detection of high-pitched sounds and with difficulty understanding speech in noisy but not in quiet environments. Consequently, delays in recognizing and seeking help for hearing difficulties are common. Age-related hearing loss has no known cure, and technologies (hearing aids, cochlear implants, and assistive devices) improve thresholds but do not restore hearing to normal. Therefore, health care for persons with hearing loss and people within their communication circles requires education and counseling (e.g., increasing knowledge, changing attitudes, and reducing stigma), behavior change (e.g., adapting communication strategies), and environmental modifications (e.g., reducing noise). In this article, we consider the causes, consequences, and magnitude of hearing loss from a life-course perspective. We examine the concept of "hearing health," how to achieve it, and implications for policy and practice.

Aided Electrophysiology Using Direct Audio Input: Effects of Amplification and Absolute Signal Level.

PURPOSE: This study investigated (a) the effect of amplification on cortical auditory evoked potentials (CAEPs) at different signal levels when signal-to-noise ratios (SNRs) were equated between unaided and aided conditions, and (b) the effect of absolute signal level on aided CAEPs when SNR was held constant. METHOD: CAEPs were recorded from 13 young adults with normal hearing. A 1000-Hz pure tone was presented in unaided and aided conditions with a linear analog hearing aid. Direct audio input was used, allowing recorded hearing aid noise floor to be added to unaided conditions to equate SNRs between conditions. An additional stimulus was created through scaling the noise floor to study the effect of signal level. RESULTS: Amplification resulted in delayed N1 and P2 peak latencies relative to the unaided condition. An effect of absolute signal level (when SNR was constant) was present for aided CAEP area measures, such that larger area measures were found at higher levels. CONCLUSION: Results of this study further demonstrate that factors in addition to SNR must also be considered before CAEPs can be used to clinically to measure aided thresholds.

Self-Reported Hearing Difficulties Among Adults With Normal Audiograms: The Beaver Dam Offspring Study.

OBJECTIVE: Clinicians encounter patients who report experiencing hearing difficulty (HD) even when audiometric thresholds fall within normal limits. When there is no evidence of audiometric hearing loss, it generates debate over possible biomedical and psychosocial etiologies. It is possible that self-reported HDs relate to variables within and/or outside the scope of audiology. The purpose of this study is to identify how often, on a population basis, people with normal audiometric thresholds self-report HD and to identify factors associated with such HDs. DESIGN: This was a cross-sectional investigation of participants in the Beaver Dam Offspring Study. HD was defined as a self-reported HD on a four-item scale despite having pure-tone audiometric thresholds within normal limits (<20 dB HL0.5, 1, 2, 3, 4, 6, 8 kHz bilaterally, at each frequency). Distortion product otoacoustic emissions and word-recognition performance in quiet and with competing messages were also analyzed. In addition to hearing assessments, relevant factors such as sociodemographic and lifestyle factors, environmental exposures, medical history, health-related quality of life, and symptoms of neurological disorders were also examined as possible risk factors. The Center for Epidemiological Studies-Depression was used to probe symptoms associated with depression, and the Medical Outcomes Study Short-Form 36 mental score was used to quantify psychological stress and social and role disability due to emotional problems. The Visual Function Questionnaire-25 and contrast sensitivity test were used to query vision difficulties. RESULTS: Of the 2783 participants, 686 participants had normal audiometric thresholds. An additional grouping variable was created based on the available scores of HD (four self-report questions), which reduced the total dataset to n = 682 (age range, 21-67 years). The percentage of individuals with normal audiometric thresholds who self-reported HD was 12.0% (82 of 682). The prevalence in the entire cohort was therefore 2.9% (82 of 2783). Performance on audiological tests (distortion product otoacoustic emissions and word-recognition tests) did not differ between the group self-reporting HD and the group reporting no HD. A multivariable model controlling for age and sex identified the following risk factors for HD: lower incomes (odds ratio [OR] $50,000+ = 0.55, 95% confidence interval [CI] = 0.30-1.00), noise exposure through loud hobbies (OR = 1.48, 95% CI = 1.15-1.90), or firearms (OR = 2.07, 95% CI = 1.04-4.16). People reporting HD were more likely to have seen a doctor for hearing loss (OR = 12.93, 95% CI = 3.86-43.33) and report symptoms associated with depression (Center for Epidemiological Studies-Depression [OR = 2.39, 95% CI = 1.03-5.54]), vision difficulties (Visual Function Questionnaire-25 [OR = 0.93, 95% CI = 0.89-0.97]), and neuropathy (e.g., numbness, tingling, and loss of sensation [OR = 1.98, 95% CI = 1.14-3.44]). CONCLUSIONS: The authors used a population approach to identify the prevalence and risk factors associated with self-reported HD among people who perform within normal limits on common clinical tests of auditory function. The percentage of individuals with normal audiometric thresholds who self-reported HD was 12.0%, resulting in an overall prevalence of 2.9%. Auditory and nonauditory risk factors were identified, therefore suggesting that future directions aimed at assessing, preventing, and managing these types of HDs might benefit from information outside the traditional scope of audiology.

The Ear-Brain Connection: Older Ears and Older Brains.

PURPOSE: The purpose of this article is to review recent research from our laboratory on the topic of aging, and the ear-brain system, as it relates to hearing aid use and auditory rehabilitation. The material described here was presented as part of the forum on the brain and hearing aids, at the 2014 HEaling Across the Lifespan (HEAL) conference. METHOD: The method involves a narrative review of previously reported electroencephalography (EEG) and magnetoencephalography (MEG) data from our laboratory as they relate to the (a) neural detection of amplified sound and (b) ability to learn new sound contrasts. CONCLUSIONS: Results from our studies add to the mounting evidence that there are central effects of biological aging as well as peripheral pathology that affect a person's neural detection and use of sound. What is more, these biological effects can be seen as early as middle age. The accruing evidence has implications for hearing aid use because effective communication relies not only on sufficient detection of sound but also on the individual's ability to learn to make use of these sounds in ever-changing listening environments.

Is the auditory evoked P2 response a biomarker of learning?

Even though auditory training exercises for humans have been shown to improve certain perceptual skills of individuals with and without hearing loss, there is a lack of knowledge pertaining to which aspects of training are responsible for the perceptual gains, and which aspects of perception are changed. To better define how auditory training impacts brain and behavior, electroencephalography (EEG) and magnetoencephalography (MEG) have been used to determine the time course and coincidence of cortical modulations associated with different types of training. Here we focus on P1-N1-P2 auditory evoked responses (AEP), as there are consistent reports of gains in P2 amplitude following various types of auditory training experiences; including music and speech-sound training. The purpose of this experiment was to determine if the auditory evoked P2 response is a biomarker of learning. To do this, we taught native English speakers to identify a new pre-voiced temporal cue that is not used phonemically in the English language so that coinciding changes in evoked neural activity could be characterized. To differentiate possible effects of repeated stimulus exposure and a button-pushing task from learning itself, we examined modulations in brain activity in a group of participants who learned to identify the pre-voicing contrast and compared it to participants, matched in time, and stimulus exposure, that did not. The main finding was that the amplitude of the P2 auditory evoked response increased across repeated EEG sessions for all groups, regardless of any change in perceptual performance. What's more, these effects are retained for months. Changes in P2 amplitude were attributed to changes in neural activity associated with the acquisition process and not the learned outcome itself. A further finding was the expression of a late negativity (LN) wave 600-900 ms post-stimulus onset, post-training exclusively for the group that learned to identify the pre-voiced contrast.

Plasticity in neuromagnetic cortical responses suggests enhanced auditory object representation.

BACKGROUND: Auditory perceptual learning persistently modifies neural networks in the central nervous system. Central auditory processing comprises a hierarchy of sound analysis and integration, which transforms an acoustical signal into a meaningful object for perception. Based on latencies and source locations of auditory evoked responses, we investigated which stage of central processing undergoes neuroplastic changes when gaining auditory experience during passive listening and active perceptual training. Young healthy volunteers participated in a five-day training program to identify two pre-voiced versions of the stop-consonant syllable 'ba', which is an unusual speech sound to English listeners. Magnetoencephalographic (MEG) brain responses were recorded during two pre-training and one post-training sessions. Underlying cortical sources were localized, and the temporal dynamics of auditory evoked responses were analyzed. RESULTS: After both passive listening and active training, the amplitude of the P2m wave with latency of 200 ms increased considerably. By this latency, the integration of stimulus features into an auditory object for further conscious perception is considered to be complete. Therefore the P2m changes were discussed in the light of auditory object representation. Moreover, P2m sources were localized in anterior auditory association cortex, which is part of the antero-ventral pathway for object identification. The amplitude of the earlier N1m wave, which is related to processing of sensory information, did not change over the time course of the study. CONCLUSION: The P2m amplitude increase and its persistence over time constitute a neuroplastic change. The P2m gain likely reflects enhanced object representation after stimulus experience and training, which enables listeners to improve their ability for scrutinizing fine differences in pre-voicing time. Different trajectories of brain and behaviour changes suggest that the preceding effect of a P2m increase relates to brain processes, which are necessary precursors of perceptual learning. Cautious discussion is required when interpreting the finding of a P2 amplitude increase between recordings before and after training and learning.

Aging degrades the neural encoding of simple and complex sounds in the human brainstem.

BACKGROUND: Older adults, with or without normal peripheral hearing sensitivity, have difficulty understanding speech. This impaired speech perception may, in part, be due to desynchronization affecting the neural representation of acoustic features. Here we determine if phase-locked neural activity generating the brainstem frequency-following response (FFR) exhibits age-related desynchronization and how this degradation affects the neural representation of simple and complex sounds. PURPOSE: The objectives of this study were to (1) characterize the effects of age on the neural representation of simple tones and complex consonant-vowel stimuli, (2) determine if sustained and transient components of the FFR are differentially affected by age, and (3) determine if the inability to encode a simple signal predicts degradation in representation for complex speech signals. RESEARCH DESIGN: Correlational. STUDY SAMPLE: Thirty four adults (aged 22-77 yr) with hearing thresholds falling within normal limits. DATA COLLECTION AND ANALYSIS: Stimuli used to evoke FFRs were 1000 Hz tone bursts as well as a consonant-vowel /da/ sound. RESULTS: The neural representation of simple (tone) and complex (/da/) stimuli declines with advancing age. Tone-FFR phase coherence decreased as chronological age increased. For the consonant-vowel FFRs, transient onset and offset response amplitudes were smaller, and offset responses were delayed with age. Sustained responses at the onset of vowel periodicity were prolonged in latency and smaller in amplitude as age increased. FFT amplitude of the consonant-vowel FFR fundamental frequency did not significantly decline with increasing age. The ability to encode a simple signal was related to degradation in the neural representation of a complex, speechlike sound. Tone-FFR phase coherence was significantly related to the later vowel response components but not the earlier vowel components. CONCLUSIONS: FFR components representing the tone and consonant-vowel /da/ stimulus were negatively affected by age, showing age-related reductions in response synchrony and amplitude, as well as prolonged latencies. These aging effects were evident in middle age, even in the absence of significant hearing loss.

Aided cortical auditory evoked potentials in response to changes in hearing aid gain.

OBJECTIVE: There is interest in using cortical auditory evoked potentials (CAEPs) to evaluate hearing aid fittings and experience-related plasticity associated with amplification; however, little is known about hearing aid signal processing effects on these responses. The purpose of this study was to determine the effect of clinically relevant hearing aid gain settings, and the resulting in-the-canal signal-to-noise ratios (SNRs), on the latency and amplitude of P1, N1, and P2 waves. DESIGN & SAMPLE: Evoked potentials and in-the-canal acoustic measures were recorded in nine normal-hearing adults in unaided and aided conditions. In the aided condition, a 40-dB signal was delivered to a hearing aid programmed to provide four levels of gain (0, 10, 20, and 30 dB). As a control, unaided stimulus levels were matched to aided condition outputs (i.e. 40, 50, 60, and 70 dB) for comparison purposes. RESULTS: When signal levels are defined in terms of output level, aided CAEPs were surprisingly smaller and delayed relative to unaided CAEPs, probably resulting from increases to noise levels caused by the hearing aid. DISCUSSION: These results reinforce the notion that hearing aids modify stimulus characteristics such as SNR, which in turn affects the CAEP in a way that does not reliably reflect hearing aid gain.

Relationship between behavioral and physiological spectral-ripple discrimination.

Previous studies have found a significant correlation between spectral-ripple discrimination and speech and music perception in cochlear implant (CI) users. This relationship could be of use to clinicians and scientists who are interested in using spectral-ripple stimuli in the assessment and habilitation of CI users. However, previous psychoacoustic tasks used to assess spectral discrimination are not suitable for all populations, and it would be beneficial to develop methods that could be used to test all age ranges, including pediatric implant users. Additionally, it is important to understand how ripple stimuli are processed in the central auditory system and how their neural representation contributes to behavioral performance. For this reason, we developed a single-interval, yes/no paradigm that could potentially be used both behaviorally and electrophysiologically to estimate spectral-ripple threshold. In experiment 1, behavioral thresholds obtained using the single-interval method were compared to thresholds obtained using a previously established three-alternative forced-choice method. A significant correlation was found (r = 0.84, p = 0.0002) in 14 adult CI users. The spectral-ripple threshold obtained using the new method also correlated with speech perception in quiet and noise. In experiment 2, the effect of the number of vocoder-processing channels on the behavioral and physiological threshold in normal-hearing listeners was determined. Behavioral thresholds, using the new single-interval method, as well as cortical P1-N1-P2 responses changed as a function of the number of channels. Better behavioral and physiological performance (i.e., better discrimination ability at higher ripple densities) was observed as more channels added. In experiment 3, the relationship between behavioral and physiological data was examined. Amplitudes of the P1-N1-P2 "change" responses were significantly correlated with d' values from the single-interval behavioral procedure. Results suggest that the single-interval procedure with spectral-ripple phase inversion in ongoing stimuli is a valid approach for measuring behavioral or physiological spectral resolution.

Identifying cochlear implant channels with poor electrode-neuron interfaces: electrically evoked auditory brain stem responses measured with the partial tripolar configuration.

OBJECTIVES: The goal of this study was to compare cochlear implant behavioral measures and electrically evoked auditory brain stem responses (EABRs) obtained with a spatially focused electrode configuration. It has been shown previously that channels with high thresholds, when measured with the tripolar configuration, exhibit relatively broad psychophysical tuning curves. The elevated threshold and degraded spatial/spectral selectivity of such channels are consistent with a poor electrode-neuron interface, defined as suboptimal electrode placement or reduced nerve survival. However, the psychophysical methods required to obtain these data are time intensive and may not be practical during a clinical mapping session, especially for young children. Here, we have extended the previous investigation to determine whether a physiological approach could provide a similar assessment of channel functionality. We hypothesized that, in accordance with the perceptual measures, higher EABR thresholds would correlate with steeper EABR amplitude growth functions, reflecting a degraded electrode-neuron interface. DESIGN: Data were collected from six cochlear implant listeners implanted with the HiRes 90k cochlear implant (Advanced Bionics). Single-channel thresholds and most comfortable listening levels were obtained for stimuli that varied in presumed electrical field size by using the partial tripolar configuration, for which a fraction of current (σ) from a center active electrode returns through two neighboring electrodes and the remainder through a distant indifferent electrode. EABRs were obtained in each subject for the two channels having the highest and lowest tripolar (σ = 1 or 0.9) behavioral threshold. Evoked potentials were measured with both the monopolar (σ = 0) and a more focused partial tripolar (σ ≥ 0.50) configuration. RESULTS: Consistent with previous studies, EABR thresholds were highly and positively correlated with behavioral thresholds obtained with both the monopolar and partial tripolar configurations. The Wave V amplitude growth functions with increasing stimulus level showed the predicted effect of shallower growth for the partial tripolar than for the monopolar configuration, but this was observed only for the low-threshold channels. In contrast, high-threshold channels showed the opposite effect; steeper growth functions were seen for the partial tripolar configuration. CONCLUSIONS: These results suggest that behavioral thresholds or EABRs measured with a restricted stimulus can be used to identify potentially impaired cochlear implant channels. Channels having high thresholds and steep growth functions would likely not activate the appropriate spatially restricted region of the cochlea, leading to suboptimal perception. As a clinical tool, quick identification of impaired channels could lead to patient-specific mapping strategies and result in improved speech and music perception.

Auditory evoked potentials dissociate rapid perceptual learning from task repetition without learning.

Performance improvement during an hour of auditory perceptual training is accompanied by rapid physiological changes. These changes may reflect learning or simply task repetition independent of learning. We assessed the contribution of learning and task repetition to changes in auditory evoked potentials during a difficult speech identification task and an easy tone identification task. We posited that only task repetition effects would occur in the tone task but that task repetition and learning would interact in the speech task. Speech identification improved with practice (increased sensitivity d' with a constant response bias ß). This behavioral improvement coincided with a decrease in the amplitude of sensory evoked responses (N1, P2) and a decrease in the amplitude of a slow wave (peak=320 ms after onset) over the left frontal and parietal sites. Results show rapid physiological changes associated with learning, distinct from changes related to task repetition.

Repeated stimulus exposure alters the way sound is encoded in the human brain.

Auditory training programs are being developed to remediate various types of communication disorders. Biological changes have been shown to coincide with improved perception following auditory training so there is interest in determining if these changes represent biologic markers of auditory learning. Here we examine the role of stimulus exposure and listening tasks, in the absence of training, on the modulation of evoked brain activity. Twenty adults were divided into two groups and exposed to two similar sounding speech syllables during four electrophysiological recording sessions (24 hours, one week, and up to one year later). In between each session, members of one group were asked to identify each stimulus. Both groups showed enhanced neural activity from session-to-session, in the same P2 latency range previously identified as being responsive to auditory training. The enhancement effect was most pronounced over temporal-occipital scalp regions and largest for the group who participated in the identification task. The effects were rapid and long-lasting with enhanced synchronous activity persisting months after the last auditory experience. Physiological changes did not coincide with perceptual changes so results are interpreted to mean stimulus exposure, with and without being paired with an identification task, alters the way sound is processed in the brain. The cumulative effect likely involves auditory memory; however, in the absence of training, the observed physiological changes are insufficient to result in changes in learned behavior.

Aging alters the perception and physiological representation of frequency: evidence from human frequency-following response recordings.

Older adults, even with clinically normal hearing sensitivity, have auditory perceptual deficits relative to their younger counterparts. This difficulty may in part, be related to a decline in the neural representation of frequency. The purpose of this study was to examine the effect of age on behavioral and physiological measures of frequency representation. Thirty two adults (ages 22-77), with hearing thresholds 25 dB HL at octave frequencies 0.25-8.0 kHz, participated in this experiment. Frequency discrimination difference limens (FDLs) were obtained at 500 and 1000 Hz using a two-interval, two-alternative forced choice procedure. Linear regression analyses showed significant declines in FDLs at both frequencies as age increased. Frequency-following responses (FFRs) were elicited by 500 and 1000 Hz tonebursts, as well as at frequencies within and outside those FDLs. Linear regression of FFR phase coherence and FFR amplitude at frequencies at and slightly below 1000 Hz showed significant decreases as age increased. Therefore, pitch discrimination, as measured by FDLs, and neural representation of frequency, as reflected by FFR, declined as age increased. Although perception and neural representation concurrently declined, one was not predictive of the other.