Congenital Cytomegalovirus-Associated Sensorineural Hearing Loss in Children: Identification Following Universal Newborn Hearing Screening, Effect of Antiviral Treatment, and Long-Term Hearing Outcomes.

OBJECTIVES: Congenital cytomegalovirus (cCMV) is the most common cause of nongenetic sensorineural hearing loss (SNHL) in children. We examined the longitudinal hearing outcomes of children with cCMV in relation to their newborn hearing screening findings, and their use of antiviral therapy. DESIGN: The study was based on a retrospective chart review using a database of pediatric patients (N = 445) seen at the University of Minnesota Lions clinic. Chart review identified infants with cCMV, and records were reviewed for information about universal newborn hearing screen (UNHS) results, the clinical course of SNHL, and the use of antiviral therapy. RESULTS: A total of 44 children were identified with cCMV. In this group, 33 (75%) had SNHL of varying degree and age at onset. Notably, 17 (39%) children passed UNHS bilaterally. Of those children, 6 (35%) ultimately acquired bilateral or unilateral SNHL, detected at a mean age of 20 months (median age, 12 months). Five out of 10 children (50%) that did not pass UNHS in one ear acquired late-onset hearing loss in the contralateral ear, identified at a mean age of 24 months (median age, 4 months). Eleven (25%) children passed UNHS bilaterally and continued to demonstrate normal hearing in both ears at their most recent follow-up visit at a mean age of 19 months (SD, 18 months). Of the 33 children with cCMV and SNHL, 18 (55%) received antiviral medication (ganciclovir and/or valganciclovir). While, on average, both treated and untreated ears experienced a progression of hearing loss over time, the group that received antiviral treatment experienced less overall hearing change compared with the untreated group (baseline-adjusted expected mean difference, -10.5 dB; 95% confidence interval, -28.1 to 7.2 dB). CONCLUSIONS: Among children with cCMV included in this study who passed UNHS in both ears, 35% demonstrated delayed-onset SNHL. Notably, of those children who referred unilaterally, 50% later demonstrated SNHL in the contralateral ear. These findings have implications for audiological monitoring, and potentially antiviral therapy, of children with cCMV. As implementation of universal cCMV screening moves forward, a key aspect of follow-up will be appropriate long-term audiologic monitoring.

Dual Sensory Impairment: Impact of Central Vision Loss and Hearing Loss on Visual and Auditory Localization.

Purpose: In the United States, AMD is a leading cause of low vision that leads to central vision loss and has a high co-occurrence with hearing loss. The impact of central vision loss on the daily functioning of older individuals cannot be fully addressed without considering their hearing status. We investigated the impact of combined central vision loss and hearing loss on spatial localization, an ability critical for social interactions and navigation. Methods: Sixteen older adults with central vision loss primarily due to AMD, with or without co-occurring hearing loss, completed a spatial perimetry task in which they verbally reported the directions of visual or auditory targets. Auditory testing was done with eyes open in a dimly lit room or with a blindfold. Twenty-three normally sighted, age-matched, and hearing-matched control subjects also completed the task. Results: Subjects with central vision loss missed visual targets more often. They showed increased deviations in visual biases from control subjects as the scotoma size increased. However, these deficits did not generalize to sound localization. As hearing loss became more severe, the sound localization variability increased, and this relationship was not altered by coexisting central vision loss. For both control and central vision loss subjects, sound localization was less reliable when subjects wore blindfolds, possibly due to the absence of visual contextual cues. Conclusions: Although central vision loss impairs visual localization, it does not impair sound localization and does not prevent vision from providing useful contextual cues for sound localization.

Amplitude-modulation forward masking for listeners with and without hearing loss.

Amplitude-modulation (AM) forward masking was measured for listeners with normal hearing and sensorineural hearing loss at 4000 and 1000 Hz, using continuous and noncontinuous masker and signal carriers, respectively. A low-fluctuation noise (LFN) carrier was used for the "continuous carrier" conditions. An unmodulated low-fluctuation noise (U-LFN), an unmodulated Gaussian noise (U-GN), and an amplitude-modulation low-fluctuation noise (AM-LFN) were maskers for the "noncontinuous carrier" conditions. As predicted, U-GN yielded more masking than U-LFN and similar masking to AM-LFN, suggesting that U-GN resulted in AM forward masking. Contrary to predictions, no differences in masked thresholds were observed between listener groups.

Visual and Auditory Spatial Localization in Younger and Older Adults.

Visual and auditory localization abilities are crucial in real-life tasks such as navigation and social interaction. Aging is frequently accompanied by vision and hearing loss, affecting spatial localization. The purpose of the current study is to elucidate the effect of typical aging on spatial localization and to establish a baseline for older individuals with pathological sensory impairment. Using a verbal report paradigm, we investigated how typical aging affects visual and auditory localization performance, the reliance on vision during sound localization, and sensory integration strategies when localizing audiovisual targets. Fifteen younger adults (N = 15, mean age = 26 years) and thirteen older adults (N = 13, mean age = 68 years) participated in this study, all with age-adjusted normal vision and hearing based on clinical standards. There were significant localization differences between younger and older adults, with the older group missing peripheral visual stimuli at significantly higher rates, localizing central stimuli as more peripheral, and being less precise in localizing sounds from central locations when compared to younger subjects. Both groups localized auditory targets better when the test space was visible compared to auditory localization when blindfolded. The two groups also exhibited similar patterns of audiovisual integration, showing optimal integration in central locations that was consistent with a Maximum-Likelihood Estimation model, but non-optimal integration in peripheral locations. These findings suggest that, despite the age-related changes in auditory and visual localization, the interactions between vision and hearing are largely preserved in older individuals without pathological sensory impairments.

Adults With Hearing Loss Demonstrate Resilience During COVID-19 Pandemic: Applications for Postpandemic Services.

BACKGROUND: The COVID-19 pandemic has produced unique challenges for persons with hearing loss. There is a unique concern that adults with hearing loss may be more susceptible to isolation than adults with normal hearing. PURPOSE: This study explored the impact of the COVID-19 pandemic on the well-being of older adults with and without hearing loss. RESEARCH DESIGN: This was a longitudinal study with pre-COVID-19 and six mid-COVID-19 interviews, spanning from March 1, 2020, to October 31, 2020. STUDY SAMPLE: The study enrolled 12 participants with hearing aids and 12 with cochlear implants aged 55-80 years that were compared to 18 age-matched adults with hearing within normal limits. DATA COLLECTION AND ANALYSIS: Surveys were completed to evaluate the impact of time alone and loneliness, social contact, depression, and the impact of masks on hearing. A mixed-effects statistical model was used to analyze each question. RESULTS: Participants commonly reported stress and anxiety during monthly video calls. Adults with varying degrees of hearing loss reported decreased social interaction and increased stress during the pandemic, similar to the rates observed by participants with healthy hearing. Face coverings were commonly reported to affect the intelligibility of conversational speech. Participants with hearing loss found satisfactory methods for maintaining social connection during the pandemic that they hope will continue once restrictions ease fully. CONCLUSIONS: Participants from the hearing loss groups in this study were frustrated by challenges posed by facial masks and were resilient in their ability to cope with COVID-19 and found the use of technology to be helpful. Audiologists are encouraged to use these successful electronic means of connecting with their patients even after restrictions are fully lifted.

Self-Adjustment of Hearing Aid Amplification for Lower Speech Levels: Independent Ratings, Paired Comparisons, and Speech Recognition.

PURPOSE: Self-adjustment of hearing aid amplification enables wearers to customize the hearing aid output to match their preferences and could become an important tool for programming direct-to-consumer devices for people with mild-to-moderate hearing loss. One risk is that user-selected settings may provide inadequate audibility. This study assessed that risk by quantifying relationships between self-adjusted settings, subjective preferences, and speech recognition performance using speech at low levels in quiet, where achieving high speech audibility requires sufficient amplification. METHOD: Fifteen people with symmetric, mild-to-moderate sensorineural hearing loss self-adjusted hearing aid amplification while listening to speech in quiet at 45, 55, and 65 dBA. After self-adjustment, 11 participants made blinded ratings of their self-adjusted fit, their NAL-NL2 prescriptive fit, and experimenter-created fits with reduced gain. Participants completed blinded paired comparisons and sentence recognition assessments using these settings. RESULTS: The gain of self-adjusted fits showed a large range of variability between participants. On average, self-adjusted gain was similar to NAL-NL2 prescribed gain for input signals of 55 dBA and slightly greater than prescribed gain for 45-dBA signals. Speech recognition scores for NAL-NL2 fits were consistently high, and differences in speech recognition results were strongly correlated with the overall preferences obtained from paired comparisons. CONCLUSIONS: Self-adjusted fits are highly variable between individuals for low-audibility conditions. Nonetheless, self-adjusted fits are at least as satisfactory as NAL-NL2 fits, and listeners tend to disfavor settings that result in poorer speech recognition. The findings argue against concerns that self-adjustment will result in inadequate audibility compared to prescribed settings.

No Benefit of Deriving Cochlear-Implant Maps From Binaural Temporal-Envelope Sensitivity for Speech Perception or Spatial Hearing Under Single-Sided Deafness.

OBJECTIVES: This study tested whether speech perception and spatial acuity improved in people with single-sided deafness and a cochlear implant (SSD+CI) when the frequency allocation table (FAT) of the CI was adjusted to optimize frequency-dependent sensitivity to binaural disparities. DESIGN: Nine SSD+CI listeners with at least 6 months of CI listening experience participated. Individual experimental FATs were created to best match the frequency-to-place mapping across ears using either sensitivity to binaural temporal-envelope disparities or estimated insertion depth. Spatial localization ability was measured, along with speech perception in spatially collocated or separated noise, first with the clinical FATs and then with the experimental FATs acutely and at 2-month intervals for 6 months. Listeners then returned to the clinical FATs and were retested acutely and after 1 month to control for long-term learning effects. RESULTS: The experimental FAT varied between listeners, differing by an average of 0.15 octaves from the clinical FAT. No significant differences in performance were observed in any of the measures between the experimental FAT after 6 months and the clinical FAT one month later, and no clear relationship was found between the size of the frequency-allocation shift and perceptual changes. CONCLUSION: Adjusting the FAT to optimize sensitivity to interaural temporal-envelope disparities did not improve localization or speech perception. The clinical frequency-to-place alignment may already be sufficient, given the inherently poor spectral resolution of CIs. Alternatively, other factors, such as temporal misalignment between the two ears, may need to be addressed before any benefits of spectral alignment can be observed.

Individual Hearing Outcomes in Cochlear Implant Users Influence Social Engagement and Listening Behavior in Everyday Life.

PURPOSE: The goal of this study was to assess the listening behavior and social engagement of cochlear implant (CI) users and normal-hearing (NH) adults in daily life and relate these actions to objective hearing outcomes. METHOD: Ecological momentary assessments (EMAs) collected using a smartphone app were used to probe patterns of listening behavior in CI users and age-matched NH adults to detect differences in social engagement and listening behavior in daily life. Participants completed very short surveys every 2 hr to provide snapshots of typical, everyday listening and socializing, as well as longer, reflective surveys at the end of the day to assess listening strategies and coping behavior. Speech perception testing, with accompanying ratings of task difficulty, was also performed in a lab setting to uncover possible correlations between objective and subjective listening behavior. RESULTS: Comparisons between speech intelligibility testing and EMA responses showed poorer performing CI users spending more time at home and less time conversing with others than higher performing CI users and their NH peers. Perception of listening difficulty was also very different for CI users and NH listeners, with CI users reporting little difficulty despite poor speech perception performance. However, both CI users and NH listeners spent most of their time in listening environments they considered "not difficult." CI users also reported using several compensatory listening strategies, such as visual cues, whereas NH listeners did not. CONCLUSION: Overall, the data indicate systematic differences between how individual CI users and NH adults navigate and manipulate listening and social environments in everyday life.

Sensitivity to binaural temporal-envelope beats with single-sided deafness and a cochlear implant as a measure of tonotopic match (L).

For cochlear-implant users with near-normal contralateral hearing, a mismatch between the frequency-to-place mapping in the two ears could produce a suboptimal performance. This study assesses tonotopic matches via binaural interactions. Dynamic interaural time-difference sensitivity was measured using bandpass-filtered pulse trains at different rates in the acoustic and implanted ear, creating binaural envelope beats. Sensitivity to beats should peak when the same tonotopic region is stimulated in both ears. All nine participants detected dynamic interaural timing differences and demonstrated some frequency selectivity. This method provides a guide to frequency-to-place mapping without compensation for inherent latency differences between the acoustic and implanted ears.

Auditory performance in bald eagles and red-tailed hawks: a comparative study of hearing in diurnal raptors.

Collision with wind turbines is a conservation concern for eagles with population abundance implications. The development of acoustic alerting technologies to deter eagles from entering hazardous air spaces is a potentially significant mitigation strategy to diminish associated morbidity and mortality risks. As a prelude to the engineering of deterrence technologies, auditory function was assessed in bald eagles (Haliaeetus leucocephalus), as well as in red-tailed hawks (Buteo jamaicensis). Auditory brainstem responses (ABRs) to a comprehensive battery of clicks and tone bursts varying in level and frequency were acquired to evaluate response thresholds, as well as suprathreshold response characteristics of wave I of the ABR, which represents the compound potential of the VIII cranial nerve. Sensitivity curves exhibited an asymmetric convex shape similar to those of other avian species, response latencies decreased exponentially with increasing stimulus level and response amplitudes grew with level in an orderly manner. Both species were responsive to a frequency band at least four octaves wide, with a most sensitive frequency of 2 kHz, and a high-frequency limit of approximately 5.7 kHz in bald eagles and 8 kHz in red-tailed hawks. Findings reported here provide a framework within which acoustic alerting signals might be developed.

Listener Factors Explain Little Variability in Self-Adjusted Hearing Aid Gain.

Self-adjustment of hearing aid gain can provide valuable information about the gain preferences of individual listeners, but these preferences are not well understood. Listeners with mild-to-moderate hearing loss used self-adjustment to select amplification gain and compression parameters in real time on a portable touch screen device while listening in quiet and noisy backgrounds. Adjustments to gain prescribed by the National Acoustics Laboratories' non-linear fitting procedure (NAL-NL2) showed large between-subject variability. Known listener characteristics (age, gender, hearing thresholds, hearing aid experience, acceptable noise level, and external ear characteristics) and listener engagement with the self-adjustment software were examined as potential predictors of this variability. Neither listener characteristics nor time spent adjusting gain were robust predictors of gain change from NAL-NL2. Listeners with less than 2 years of hearing aid experience and who also had better hearing thresholds tended to select less gain, relative to NAL-NL2, than experienced hearing aid users who had poorer thresholds. Listener factors explained no more than 10% of the between-subject variance in deviation from NAL-NL2, suggesting that modifying prescriptive fitting formulae based on the factors examined here would be unlikely to result in amplification parameters that are similar to user-customized settings. Self-adjustment typically took less than 3 min, indicating that listeners could use comparable technology without a substantial time commitment.

Mechanisms of Localization and Speech Perception with Colocated and Spatially Separated Noise and Speech Maskers Under Single-Sided Deafness with a Cochlear Implant.

OBJECTIVES: This study tested listeners with a cochlear implant (CI) in one ear and acoustic hearing in the other ear, to assess their ability to localize sound and to understand speech in collocated or spatially separated noise or speech maskers. DESIGN: Eight CI listeners with contralateral acoustic hearing ranging from normal hearing to moderate sensorineural hearing loss were tested. Localization accuracy was measured in five of the listeners using stimuli that emphasized the separate contributions of interaural level differences (ILDs) and interaural time differences (ITD) in the temporal envelope and/or fine structure. Sentence recognition was tested in all eight CI listeners, using collocated and spatially separated speech-shaped Gaussian noise and two-talker babble. Performance was compared with that of age-matched normal-hearing listeners via loudspeakers or via headphones with vocoder simulations of CI processing. RESULTS: Localization improved with the CI but only when high-frequency ILDs were available. Listeners experienced no additional benefit via ITDs in the stimulus envelope or fine structure using real or vocoder-simulated CIs. Speech recognition in two-talker babble improved with a CI in seven of the eight listeners when the target was located at the front and the babble was presented on the side of the acoustic-hearing ear, but otherwise showed little or no benefit of a CI. CONCLUSION: Sound localization can be improved with a CI in cases of significant residual hearing in the contralateral ear, but only for sounds with high-frequency content, and only based on ILDs. In speech understanding, the CI contributed most when it was in the ear with the better signal to noise ratio with a speech masker.

Self-Adjusted Amplification Parameters Produce Large Between-Subject Variability and Preserve Speech Intelligibility.

The current study used the self-fitting algorithm to allow listeners to self-adjust hearing-aid gain or compression parameters to select gain for speech understanding in a variety of quiet and noise conditions. Thirty listeners with mild to moderate sensorineural hearing loss adjusted gain parameters in quiet and in several types of noise. Outcomes from self-adjusted gain and audiologist-fit gain indicated consistent within-subject performance but a great deal of between-subject variability. Gain selection did not strongly affect intelligibility within the range of signal-to-noise ratios tested. Implications from the findings are that individual listeners have consistent preferences for gain and may prefer gain configurations that differ greatly from National Acoustic Laboratories-based prescriptions in quiet and in noise.

Primary Blast Causes Delayed Effects without Cell Death in Shell-Encased Brain Cell Aggregates.

Previous work in this laboratory used underwater explosive exposures to isolate the effects of shock-induced principle stress without shear on rat brain aggregate cultures. The current study has utilized simulated air blast to expose aggregates in suspension and enclosed within a spherical shell, enabling the examination of a much more complex biomechanical insult. Culture medium-filled spheres were exposed to single pulse overpressures of 15-30 psi (∼6-7 msec duration) and measurements within the sphere at defined sites showed complex and spatially dependent pressure changes. When brain aggregates were exposed to similar conditions, no cell death was observed and no changes in several commonly used biomarkers of traumatic brain injury (TBI) were noted. However, similarly to underwater blast, immediate and transient increases in the protein kinase B signaling pathway were observed at early time-points (3 days). In contrast, the oligodendrocyte marker 2',3'-cyclic nucleotide 3'-phosphodiesterase, as well as vascular endothelial growth factor, both displayed markedly delayed (14-28 days) and pressure-dependent responses. The imposition of a spherical shell between the single pulse shock wave and the target brain tissue introduces greatly increased complexity to the insult. This work shows that brain tissue can not only discriminate the nature of the pressure changes it experiences, but that a portion of its response is significantly delayed. These results have mechanistic implications for the study of primary blast-induced TBI and also highlight the importance of rigorously characterizing the actual pressure variations experienced by target tissue in primary blast studies.

Primary Blast-Induced Changes in Akt and GSK3ß Phosphorylation in Rat Hippocampus.

Traumatic brain injury (TBI) due to blast from improvised explosive devices has been a leading cause of morbidity and mortality in recent conflicts in Iraq and Afghanistan. However, the mechanisms of primary blast-induced TBI are not well understood. The Akt signal transduction pathway has been implicated in various brain pathologies including TBI. In the present study, the effects of simulated primary blast waves on the phosphorylation status of Akt and its downstream effector kinase, glycogen synthase kinase 3ß (GSK3ß), in rat hippocampus, were investigated. Male Sprague-Dawley (SD) rats (350-400 g) were exposed to a single pulse shock wave (25 psi; ~7 ms duration) and sacrificed 1 day, 1 week, or 6 weeks after exposure. Total and phosphorylated Akt, as well as phosphorylation of its downstream effector kinase GSK3ß (at serine 9), were detected with western blot analysis and immunohistochemistry. Results showed that Akt phosphorylation at both serine 473 and threonine 308 was increased 1 day after blast on the ipsilateral side of the hippocampus, and this elevation persisted until at least 6 weeks postexposure. Similarly, phosphorylation of GSK3ß at serine 9, which inhibits GSK3ß activity, was also increased starting at 1 day and persisted until at least 6 weeks after primary blast on the ipsilateral side. In contrast, p-Akt was increased at 1 and 6 weeks on the contralateral side, while p-GSK3ß was increased 1 day and 1 week after primary blast exposure. No significant changes in total protein levels of Akt and GSK were observed on either side of the hippocampus at any time points. Immunohistochemical results showed that increased p-Akt was mainly of neuronal origin in the CA1 region of the hippocampus and once phosphorylated, the majority was translocated to the dendritic and plasma membranes. Finally, electrophysiological data showed that evoked synaptic N-methyl-d-aspartate (NMDA) receptor activity was significantly increased 6 weeks after primary blast, suggesting that increased Akt phosphorylation may enhance synaptic NMDA receptor activation, or that enhanced synaptic NMDA receptor activation may increase Akt phosphorylation.

Neural indices of phonemic discrimination and sentence-level speech intelligibility in quiet and noise: A P3 study.

This study examined how speech babble noise differentially affected the auditory P3 responses and the associated neural oscillatory activities for consonant and vowel discrimination in relation to segmental- and sentence-level speech perception in noise. The data were collected from 16 normal-hearing participants in a double-oddball paradigm that contained a consonant (/ba/ to /da/) and vowel (/ba/ to /bu/) change in quiet and noise (speech-babble background at a -3 dB signal-to-noise ratio) conditions. Time-frequency analysis was applied to obtain inter-trial phase coherence (ITPC) and event-related spectral perturbation (ERSP) measures in delta, theta, and alpha frequency bands for the P3 response. Behavioral measures included percent correct phoneme detection and reaction time as well as percent correct IEEE sentence recognition in quiet and in noise. Linear mixed-effects models were applied to determine possible brain-behavior correlates. A significant noise-induced reduction in P3 amplitude was found, accompanied by significantly longer P3 latency and decreases in ITPC across all frequency bands of interest. There was a differential effect of noise on consonant discrimination and vowel discrimination in both ERP and behavioral measures, such that noise impacted the detection of the consonant change more than the vowel change. The P3 amplitude and some of the ITPC and ERSP measures were significant predictors of speech perception at segmental- and sentence-levels across listening conditions and stimuli. These data demonstrate that the P3 response with its associated cortical oscillations represents a potential neurophysiological marker for speech perception in noise.

The Effect of Underwater Blast on Aggregating Brain Cell Cultures.

Although the deleterious effects of primary blast on gas-filled organs are well accepted, the effect of blast-induced shock waves on the brain is less clear because of factors that complicate the interpretation of clinical and experimental data. Brain cell aggregate cultures are comprised of multiple differentiated brain cell types and were used to examine the effects of underwater blast. Suspensions of these cultures encased in dialysis tubing were exposed to explosive-generated underwater blasts of low (∼300 kPa), medium (∼2,700 kPa), or high (∼14,000 kPa) intensities and harvested at 1-28 days post-exposure. No changes in gross morphology were noted immediately or weeks after blast wave exposure, and no increases in either apoptotic (caspase-3) or necrotic (lactate dehydrogenase) cell death were observed. Changes in neuronal (neurofilament H, acetylcholinesterase, and choline acetyltransferase) and glial (glial fibrillary acidic protein, glutamine synthetase) endpoints did not occur. However, significant time- and pressure-related increases in Akt (protein kinase B) phosphorylation were noted, as well as declines in vascular endothelial growth factor levels, implicating pathways involved in cellular survival mechanisms. The free-floating nature of the aggregates during blast wave exposure, coupled with their highly hydrolyzed dialysis tubing containment, results in minimized boundary effects, thus enabling accurate assessment of brain cell response to a simplified shock-induced stress wave. This work shows that, at its simplest, blast-induced shock waves produce subtle changes in brain tissue. This study has mechanistic implications for the study of primary blast-induced traumatic brain injury and supports the thesis that underwater blast may cause subtle changes in the brains of submerged individuals.

Neural indices of phonemic discrimination and sentence-level speech intelligibility in quiet and noise: A mismatch negativity study.

Successful speech communication requires the extraction of important acoustic cues from irrelevant background noise. In order to better understand this process, this study examined the effects of background noise on mismatch negativity (MMN) latency, amplitude, and spectral power measures as well as behavioral speech intelligibility tasks. Auditory event-related potentials (AERPs) were obtained from 15 normal-hearing participants to determine whether pre-attentive MMN measures recorded in response to a consonant (from /ba/ to /bu/) and vowel change (from /ba/ to /da/) in a double-oddball paradigm can predict sentence-level speech perception. The results showed that background noise increased MMN latencies and decreased MMN amplitudes with a reduction in the theta frequency band power. Differential noise-induced effects were observed for the pre-attentive processing of consonant and vowel changes due to different degrees of signal degradation by noise. Linear mixed-effects models further revealed significant correlations between the MMN measures and speech intelligibility scores across conditions and stimuli. These results confirm the utility of MMN as an objective neural marker for understanding noise-induced variations as well as individual differences in speech perception, which has important implications for potential clinical applications.

Inherent envelope fluctuations in forward maskers: Effects of masker-probe delay for listeners with normal and impaired hearing.

Forward-masked thresholds increase as the magnitude of inherent masker envelope fluctuations increase for both normal-hearing (NH) and hearing-impaired (HI) adults for a short masker-probe delay (25 ms). The slope of the recovery from forward masking is shallower for HI than for NH listeners due to reduced cochlear nonlinearities. However, effects of hearing loss on additional masking due to inherent envelope fluctuations across masker-probe delays remain unknown. The current study assessed effects of hearing loss on the slope and amount of recovery from forward maskers that varied in inherent envelope fluctuations. Forward-masked thresholds were measured at 2000 and 4000 Hz, for masker-probe delays of 25, 50, and 75 ms, for NH and HI adults. Four maskers at each center frequency varied in inherent envelope fluctuations: Gaussian noise (GN) or low-fluctuation noise (LFN), with 1 or 1/3 equivalent rectangular bandwidths (ERBs). Results suggested that slopes of recovery from forward masking were shallower for HI than for NH listeners regardless of masker fluctuations. Additional masking due to inherent envelope fluctuations was greater for HI than for NH listeners at longer masker-probe delays, suggesting that inherent envelope fluctuations are more disruptive for HI than for NH listeners for a longer time course.

Neural Correlates of Phonetic Learning in Postlingually Deafened Cochlear Implant Listeners.

OBJECTIVE: The present training study aimed to examine the fine-scale behavioral and neural correlates of phonetic learning in adult postlingually deafened cochlear implant (CI) listeners. The study investigated whether high variability identification training improved phonetic categorization of the /ba/-/da/ and /wa/-/ja/ speech contrasts and whether any training-related improvements in phonetic perception were correlated with neural markers associated with phonetic learning. It was hypothesized that training would sharpen phonetic boundaries for the speech contrasts and that changes in behavioral sensitivity would be associated with enhanced mismatch negativity (MMN) responses to stimuli that cross a phonetic boundary relative to MMN responses evoked using stimuli from the same phonetic category. DESIGN: A computer-based training program was developed that featured multitalker variability and adaptive listening. The program was designed to help CI listeners attend to the important second formant transition cue that categorizes the /ba/-/da/ and /wa/-/ja/ contrasts. Nine adult CI listeners completed the training and 4 additional CI listeners that did not undergo training were included to assess effects of procedural learning. Behavioral pre-post tests consisted of identification and discrimination of the synthetic /ba/-/da/ and /wa/-/ja/ speech continua. The electrophysiologic MMN response elicited by an across phoneme category pair and a within phoneme category pair that differed by an acoustically equivalent amount was derived at pre-post test intervals for each speech contrast as well. RESULTS: Training significantly enhanced behavioral sensitivity across the phonetic boundary and significantly altered labeling of the stimuli along the /ba/-/da/ continuum. While training only slightly altered identification and discrimination of the /wa/-/ja/ continuum, trained CI listeners categorized the /wa/-/ja/ contrast more efficiently than the /ba/-/da/ contrast across pre-post test sessions. Consistent with behavioral results, pre-post EEG measures showed the MMN amplitude to the across phoneme category pair significantly increased with training for both the /ba/-/da/ and /wa/-/ja/ contrasts, but the MMN was unchanged with training for the corresponding within phoneme category pairs. Significant brain-behavior correlations were observed between changes in the MMN amplitude evoked by across category phoneme stimuli and changes in the slope of identification functions for the trained listeners for both speech contrasts. CONCLUSIONS: The brain and behavior data of the present study provide evidence that substantial neural plasticity for phonetic learning in adult postlingually deafened CI listeners can be induced by high variability identification training. These findings have potential clinical implications related to the aural rehabilitation process following receipt of a CI device.