Investigation of the effectiveness of sound enrichment in the treatment of tinnitus due to hearing loss.

OBJECTIVE: In previous animal studies, sound enhancement reduced tinnitus perception in cases associated with hearing loss. The aim of this study was to investigate the efficacy of sound enrichment therapy in tinnitus treatment by developing a protocol that includes criteria for psychoacoustic characteristics of tinnitus to determine whether the etiology is related to hearing loss. METHODS: A total of 96 patients with chronic tinnitus were included in the study. Fifty-two patients in the study group and 44 patients in the placebo group considered residual inhibition (RI) outcomes and tinnitus pitches. Both groups received sound enrichment treatment with different spectrum contents. The tinnitus handicap inventory (THI), visual analog scale (VAS), minimum masking level (MML), and tinnitus loudness level (TLL) results were compared before and at 1, 3, and 6 months after treatment. RESULTS: There was a statistically significant difference between the groups in THI, VAS, MML, and TLL scores from the first month to all months after treatment (p < .01). For the study group, there was a statistically significant decrease in THI, VAS, MML, and TLL scores in the first month (p < .01). This decrease continued at a statistically significant level in the third month of posttreatment for THI (p < .05) and at all months for VAS-1 (tinnitus severity) (p < .05) and VAS-2 (tinnitus discomfort) (p < .05). CONCLUSION: In clinical practice, after excluding other factors related to the tinnitus etiology, sound enrichment treatment can be effective in tinnitus cases where RI is positive and the tinnitus pitch is matched with a hearing loss between 45 and 55 dB HL in a relatively short period of 1 month.

Auditory processing in normally hearing individuals with and without tinnitus: assessment with four psychoacoustic tests.

PURPOSE: In most cases, tinnitus co-exists with hearing loss, suggesting that poorer speech understanding is simply due to a lack of acoustic information reaching the central nervous system (CNS). However, it also happens that patients with tinnitus who have normal hearing also report problems with speech understanding, and it is possible to suppose that tinnitus is to blame for difficulties in perceptual processing of auditory information. The purpose of the study was to evaluate the auditory processing abilities of normally hearing subjects with and without tinnitus. METHODS: The study group comprised 97 adults, 54 of whom had normal hearing and chronic tinnitus (the study group) and 43 who had normal hearing and no tinnitus (the control group). The audiological assessment comprised pure-tone audiometry and high-frequency pure-tone audiometry, impedance audiometry, and distortion product oto-acoustic emission assessment. To evaluate possible auditory processing deficits, the Frequency Pattern Test (FPT), Duration Pattern Test (DPT), Dichotic Listening Test (DLT), and Gap Detection Threshold (GDT) tests were performed. RESULTS: The tinnitus subjects had significantly lower scores than the controls in the gap detection test (p < 0.01) and in the dichotic listening test (p < 0.001), but only for the right ear. The results for both groups were similar in the temporal ordering tests (FPT and DPT). Right-ear advantage (REA) was found for the controls, but not for the tinnitus subjects. CONCLUSION: In normally hearing patients, the presence of tinnitus may be accompanied with auditory processing difficulties.

Auditory perceptual discomfort and low-hearing tolerance in the first episode psychosis

Awareness of perceptual and sensory changes that might occur in visual, auditory, proprioception, and other senses, in the early stages towards the First Episode Psychosis (FEP), and their subsequent sensorial evolution as the disturb progresses deeper into an acute episode, might be a key element for interrupting the process. In the present study, we investigated hearing discomfort/tolerance to 16 given sound streams. Sixteen people diagnosed with FEP, participated in the experiment. Sixteen frequency sweeps varying in modulation envelopes (sawtooth, sine), order (ascending, descending), duration (4s, 8s), and range (50­8000 Hz, 2­8 kHz) were presented randomly, but always in the same sequence, to FEP and healthy controls (HC). The level of discomfort was estimated by the participant by making a mark across a continuous line whose extremes read "nothing bad" (left) and "too bad" (right). Results showed that ascending sine pure frequency sweeps (p < 0.01) and descending sine pure frequencies sweeps (p < 0.01) caused the maximum discomfort in FEP. Other variables also showed differences between FEP and HC, and FEP were always more intolerant to such pure frequency sweeps than HC. We conclude that this might be useful for very early assessment of people at risk, people with FEP, and people with schizophrenia. (AU)

Ergonomic Auditory Alarm Signals for the Oil and Chemical Processing Industry.

OCCUPATIONAL APPLICATIONSAuditory alarm signals are a safety measure that would benefit from improvement across many industries. There is a considerable research base that can be applied to the development and testing of audible alarms, though this is rarely done in practice. We describe a process that can be adopted in any area where audible alarm signals are widespread. A comprehensive approach to updating and improving auditory alarms requires consideration not only of individual alarm sounds but also of how the alarm signals will work together. We show the development and design of alarm signal sets following best practices from acoustic, psychoacoustic, and psychological knowledge to ensure that the resultant alarms are localizable, audible, easy to learn, appropriately urgency-mapped, and differentiable. We also describe benchmarking tests, and a protocol for thinking about how auditory alarm signals might be implemented in control rooms of different sizes.

Auditory attention in individuals with tinnitus / Auditory attention in individuals with tinnitus

Abstract Introduction Tinnitus is characterized by the presence of a sound in the absence of external sound stimulus. In individuals with normal audiometry, it may be associated with auditory attention difficulty, especially in those who report high tinnitus annoyance. Objective To investigate auditory attention ability in individuals with tinnitus complaint. Methods Cross-sectional analytical observational study. We evaluated 30 volunteers with normal hearing (up to 25 dBHL): 15 with tinnitus (test group) and 15 with no complaints (control group), aged between 18-40 years. The volunteers answered the tinnitus handicap inventory questionnaire and a visual analogue scale. Subsequently, a basic audiological evaluation (meatoscopy, tonal and vocal audiometry, and imittanciometry) and psychoacoustic measures of tinnitus (loudness and pitch) were performed. To evaluate auditory attention, the following tests were performed: auditory cognitive evoked potential (P300), central auditory processing tests (dichotic digits test and speech-in-noise test) and sustained auditory attention ability test. Results In the tinnitus handicap inventory, individuals with tinnitus had a mean score of 37.78 (±27.05), characterized as moderate degree. In the dichotic digits test (binaural separation), a difference was observed between the groups in both ears. Moreover, there was a difference in the speech-in-noise test in both ears (RE: p = 0.044; LE: p = 0.019), in P300 (p = 0.049) and in total sustained auditory attention ability test (p = 0.032). Also, there is a negative correlation between sustained auditory attention ability test, decrease in attentiveness and binaural integration (RE: p = 0.044; LE: p = 0.048). Conclusions Individuals with tinnitus had a poorer performance compared to the control group regarding auditory attention ability. Therefore, it is inferred that tinnitus is associated with poor performance in selective and sustained auditory attention in the assessed volunteers. These aspects should be considered for the management of patients with tinnitus.

Resumo Introdução O zumbido caracteriza-se pela presença de som na ausência de estímulo sonoro externo. Em indivíduos com audiometria normal pode estar associado à dificuldade na atenção auditiva, principalmente naqueles que referem alto incômodo do zumbido. Objetivo Investigar a habilidade de atenção auditiva em indivíduos com queixa de zumbido. Método Pesquisa do tipo observacional analítica de caráter transversal. Foram avaliados 30 voluntários com audição normal (até 25 dBNA): 15 com zumbido (grupo teste) e 15 sem a queixa (grupo controle), entre 18 e 40 anos. Os voluntários responderam o questionário do handicap do zumbido - Tinnitus Handicap Inventory - e a escala visual analógica. Em seguida, fez-se a avaliação audiológica básica (meatoscopia, audiometria tonal, vocal e imitanciometria) e medidas psicoacústicas do zumbido (loudness e pitch). Para avaliar a atenção auditiva, foram usados os testes: potencial evocado auditivo cognitivo (P300), processamento auditivo central (dicótico de dígitos e de fala no ruído) e o de atenção auditiva sustentada. Resultados No Tinnitus Handicap Inventory, indivíduos com zumbido apresentaram escore médio de 37,78 (± 27,05); caracterizado por grau moderado. No teste dicótico de dígitos (separação binaural) percebeu-se diferença entre os grupos, nas duas orelhas. Além disso, houve diferença no teste de fala no ruído, em ambas as orelhas (OD: p = 0,044; OE: p = 0,019), no P300 (p = 0,049) e no teste de atenção auditiva sustentada total (p = 0,032). Além de correlação negativa entre o teste de atenção auditiva sustentada, decréscimo de vigilância e integração binaural (OD: p = 0,044; OE: p = 0,048). Conclusão Os indivíduos com zumbido apresentaram desempenho inferior ao grupo controle na habilidade de atenção auditiva. Portanto, infere-se que o zumbido está associado ao baixo desempenho na atenção auditiva seletiva e sustentada nos voluntários pesquisados. Tais aspectos devem ser considerados para o manejo do paciente com zumbido.

Snoring: is a reliable assessment possible?

PURPOSE: It is not easy to assess how severe and annoying a patient's snoring is. Solid parameters are lacking; snorers cannot deliver a reliable self-assessment and it is uncertain whether bed partners' statements can be relied upon. The purpose of the present study was therefore to investigate whether and how well snoring assessment based on acoustic parameters and bed partners' reporting agree. METHODS: In a double-blind, placebo-controlled study on snoring treatment, several acoustic parameters [snoring index (SI), percentage snoring time (ST), sound pressure level, sound energy, loudness, psychoacoustic annoyance and psychoacoustic snore score (PSS)] were measured in 18 subjects during 24 polysomnographies. Bed partners also assessed snoring annoyance and loudness as well as treatment outcome. RESULTS: No correlation was found between the subjective annoyance caused by snoring and the acoustic parameters. Regarding perceived loudness, there was a moderate, significant correlation with loudness (N5) and PSS over the hour with the highest SI. SI, ST, LAeq and maximum sound pressure level dB(A)max showed no significant correlation. After the intervention only mean sound energy LAeq over the entire night showed a significant correlation (rs = 0.782; p = 0.022) with bed partners' assessments. However, this result was not confirmed in the second control night. CONCLUSIONS: The non-existent or only weak correlation between bed partners' ratings and objective parameters indicate that snoring severity should be evaluated with caution. Neither acoustic parameters, at least for one measurement over just one night, nor bed partners' ratings should be used as the sole basis for snoring assessment.

Comparison of Amplitude Modulated Sounds and Pure Tones at the Tinnitus Frequency: Residual Tinnitus Suppression and Stimulus Evaluation.

Recent studies have compared tinnitus suppression, or residual inhibition, between amplitude- and frequency-modulated (AM) sounds and noises or pure tones (PT). Results are indicative, yet inconclusive, of stronger tinnitus suppression of modulated sounds especially near the tinnitus frequency. Systematic comparison of AM sounds at the tinnitus frequency has not yet been studied in depth. The current study therefore aims at further advancing this line of research by contrasting tinnitus suppression profiles of AM and PT sounds at the matched tinnitus frequency (i.e., 10 and 40 Hz AM vs. PT). Participants with chronic, tonal tinnitus (n = 29) underwent comprehensive psychometric, audiometric, tinnitus matching, and acoustic stimulation procedures. Stimuli were presented for 3 minutes in two loudness regimes (60 dB sensation level [SL], minimum masking level [MML] + 6 dB, control sound: SL -6 dB) and amplitude modulated with 0, 10, or 40 Hz. Tinnitus loudness suppression was measured after the stimulation every 30 seconds. In addition, stimuli were rated regarding their valence and arousal. Results demonstrate only trends for better tinnitus suppression for the 10 Hz modulation and presentation level of 60 dB SL compared with PT, whereas nonsignificant results are reported for 40 Hz and MML + 6 dB, respectively. Furthermore, the 10 Hz AM at 60 dB SL and the 40 Hz AM at MML + 6 dB (trend) stimuli were better tolerated as elicited by valence ratings. We conclude that 10 Hz AM sounds at the tinnitus frequency may be useful to further elucidate the phenomenon of residual inhibition.

Perfil clínico e implicações do zumbido em indivíduos com e sem perda auditiva / Clinical profile and implications of tinnitus in individuals with and without hearing loss

RESUMO Objetivo comparar as características clínicas do zumbido e interferência na qualidade de vida em indivíduos com e sem perda auditiva associada, bem como discutir a associação de mensurações quantitativas e instrumentos qualitativos de avaliação. Método estudo quantitativo, descritivo e de corte transversal aprovado pelo Comitê de Ética em pesquisa (nº 973.314/2016 CAEE: 41634815.3.0000.0106). Foram comparadas as respostas da avaliação psicoacústica do zumbido (pesquisa de intensidade, frequência, nível mínimo de mascaramento e limiar de desconforto para tom puro e fala), bem como questionário Tinnitus Handicap Inventory (THI) e escala visual analógica (EVA) de 15 sujeitos portadores de zumbido e perda auditiva periférica (grupo GI) e 16 indivíduos normo-ouvintes (grupo GII). Resultados O escore médio na EVA e THI no GI foi, respectivamente, de 5,1(+1,5) e 42,3(+18) e no GII de 5,7(+2.6) e 32,7(+25), sugerindo incômodo moderado no GI e moderado/leve no GII (p>0,005). Verificou-se correlação moderada entre o THI e EVA apenas no GII. Na avaliação psicoacústica, observaram-se diferenças significantes entre os grupos referentes à medida da loudness (*p=0,013) e ao nível mínimo de mascaramento (*p=0,001). Conclusão a perda auditiva parece não se constituir em um fator determinante para o maior ou menor impacto do zumbido na qualidade de vida do sujeito. Já as diferenças encontradas entre os grupos, referentes às medidas psicoacústicas, podem ser justificadas pela presença do dano coclear em si. A mensuração objetiva do zumbido, independentemente da presença ou não da perda auditiva periférica, caracteriza-se como um importante instrumento complementar às medidas de auto avaliação.

ABSTRACT Purpose To compare clinical characteristics of tinnitus and interference in quality of life in individuals with and without associated hearing loss, as well as to discuss the association of quantitative measurements and qualitative instruments. Methods A quantitative, cross-sectional and comparative study approved by the Research Ethics Committee (No. 973.314/CAEE: 41634815.3.0000.0106) was carried out. The responses of the psychoacoustic assessment of tinnitus (intensity, frequency, minimum masking level and loudness discomfort level for pure tone and speech), as well as the Tinnitus Handicap Inventory (THI) questionnaire, and the visual analogue scale (VAS) were compared between 15 patients with tinnitus and peripheral hearing loss (group I) and 16 adults with normal hearing (group II). Results The mean VAS and THI scores obtained in GI were 5.1 (+1.5) and 42.3 (+18), and in GII, 5.7 (+2.6) and 32.7 (+25), respectively. This result suggests moderate GI annoyance and moderate/mild GII annoyance (p>0.005). There was a positive and moderate correlation between THI and VAS only in GII. In the psychoacoustic evaluation, significant differences were observed between the groups regarding the measurement of loudness (*p=0.013) and the minimum masking level (*p=0.001). Conclusion There was no direct influence of the presence of hearing loss in relation to the impact of tinnitus. The differences found between the groups regarding the psychoacoustics measures can be justified by the presence of cochlear damage. The objective measurement of tinnitus, regardless of the presence or absence of peripheral hearing loss, is an important instrument to be used along with self-evaluation measures.

Psychoacoustic classification of persistent tinnitus / Classificação psicoacústica do zumbido persistente

Abstract Introduction: Tinnitus is a difficult to treat symptom, with different responses in patients. It is classified in different ways, according to its origin and associated diseases. Objective: to propose a single and measurable classification of persistent tinnitus, through its perception as sounds of nature or of daily life and its comparison with pure tone or noise, of high or low pitch, presented to the patient by audiometer sound. Methods: A total of 110 adult patients, of both genders, treated at the Tinnitus Outpatient Clinic, were enrolled according to the inclusion and exclusion criteria. Otorhinolaryngologic and Audiological, Pitch Matching and Loudness, Visual Analog Scale, Tinnitus Handicap Inventory and Minimum Masking Level assessments were performed. Results: In these 110 patients, 181 tinnitus complaints were identified accordingly to type and ear, with 93 (51%) Pure Tone, and 88 (49%) Noise type; 19 at low and 162 at high frequency; with a mean in the Pure Tone of 5.4.07 in the Visual Analog Scale and 12.31 decibel in the Loudness and a mean in the Noise of 6.66 and 10.51 decibel. For Tinnitus Handicap Inventory and Minimum Masking Level, the 110 patients were separated into three groups with tinnitus, Pure Tone, Noise and multiple. Tinnitus Handicap Inventory higher in the group with multiple tinnitus, of 61.38. Masking noises such as White Noise and Narrow Band were used for the Minimum Masking Level at the frequencies of 500 and 6000 Hz. There was a similarity between the Pure Tone and Multiple groups. In the Noise group, different responses were found when Narrow Band was used at low frequency. Conclusion: Classifying persistent tinnitus as pure tone or noise, present in high or low frequency and establishing its different characteristics allow us to know its peculiarities and the effects of this symptom in patients' lives.

Resumo Introdução: O zumbido é um sintoma de difícil tratamento, com respostas diferentes nos pacientes. É classificado de formas diversas, de acordo com a origem ou doenças associadas. Objetivo: Propor uma classificação única e mensurável do zumbido persistente, por meio da sua percepção como sons da natureza ou da vida cotidiana e da sua comparação com o tom puro ou o ruído, de pitch alto ou baixo, apresentado ao paciente pelos sons do audiômetro. Método: Participaram 110 pacientes adultos, de ambos os sexos, atendidos no Ambulatório de Zumbido, tendo sido observados os critérios de inclusão e exclusão. Realizada avaliação otorrinolaringológica, audiológica, Pitch Matching e Loudness, Visual Analog Scale, Tinnitus Handicap Inventory e Minimum Masking Level. Resultados: Nesses 110 pacientes foram identificadas 181 queixas de zumbido separadas por tipo e orelha, 93 (51%) tipo tom puro e 88 (49%) tipo ruído 19 de baixa frequência e 162 de alta frequência; com média do Visual Analog Scale no tom puro de 5,47 e ruído de 6,66; média do Loudness do tom puro de 12,31 dBNS e ruído de 10,51 dBNS. Para o Tinnitus Handicap Inventory e o Minimum Masking Level os 110 pacientes foram separados em três grupos com zumbido, tom puro, ruído e múltiplo, com a média do Tinnitus Handicap Inventory maior no grupo com zumbido múltiplo com 61,38. Para o Minimum Masking Level foram usados os ruídos mascaradores tipo White Noise e Narrow Band nas frequências de 500 Hz e 6000 Hz. Houve semelhança entre os grupos com tom puro e múltiplo. No grupo de ruído foram encontradas respostas diferentes quando usado o Narrow Band em frequência baixa. Conclusão: Classificar o zumbido persistente em tom puro ou ruído, presentes em frequência alta ou baixa e estabelecer suas diferentes características nos permitem conhecer suas particularidades e a repercussão desse sintoma na vida dos pacientes.

[Clinical value of psychoacoustic characteristics in patients with idiopathic tinnitus].

Objective:To analyze the relationship between psychological parameters and clinical severity score in patients with idiopathic tinnitus, and clarify the value of psychoacoustic testing in the severity of tinnitus and evaluation of curative effect.Method:A total of 165 patients with idiopathic tinnitus were collected. All patients received conventional audiological and psychoacoustic tests. Psychoacoustic tests include pitch matching (PM), loudness matching(LM), minimal masking levels (MMLs) and residual suppression(RI). Tinnitus handicap inventory (THI) and tinnitus evaluation questionnaire(TEQ) were used to evaluate the severity of tinnitus. SPSS 18.0 was used to analyze the relationship between the severity of tinnitus and psychosocial parameters by univariate analysis and multivariate Logistic regression analysis. Changes of patients psychological parameters were analyzed after five weeks of tinnitustherapy.Result:①Results of univariate analysis showed that there were significant difference with THI score: types of sound and loudness matching sensory level(LMSL) (P<0.05). There were also a significant correlations with TEQ score: the duration of tinnitus, tinnitus pitch matching(PM2) and loudness matching hearing level(LMHL)(P<0.05).②Multivariate analysis showed that PM2 and LMSL had significant correlation with THI(P<0.05), while patients with a single sound were less severe: with the increasing of LMSL, the severity of tinnitus was aggravated. There was also a significant correlation between LMHL and TEQ scores(P<0.05), and the greater the LMHL value, the more severe the tinnitus.③The statistically significant indicators are: LMSL, MMLs, MMLs difference, Feldman curve(P<0.05).Conclusion:The clinical severity of tinnitus is correlated with some psychological parameters of tinnitus. Tinnitus psychoacoustic tests help to assess the clinical severity of tinnitus.

Modular auditory decision-making behavioral task designed for intraoperative use in humans.

BACKGROUND: Neurosurgical interventions that require active patient feedback, such as deep brain stimulation surgery, create an opportunity to conduct cognitive or behavioral experiments during the acquisition of invasive neurophysiology. Optimal design and implementation of intraoperative behavioral experiments require consideration of stimulus presentation, time and surgical constraints. We describe the use of a modular, inexpensive system that implements a decision-making paradigm, designed to overcome challenges associated with the operative environment. NEW METHOD: We have created an auditory, two-alternative forced choice (2AFC) task for intraoperative use. Behavioral responses were acquired using an Arduino based single-hand held joystick controller equipped with a 3-axis accelerometer, and two button presses, capable of sampling at 2 kHz. We include designs for all task relevant code, 3D printed components, and Arduino pin-out diagram. RESULTS: We demonstrate feasibility both in and out of the operating room with behavioral results represented by three healthy control subjects and two Parkinson's disease subjects undergoing deep brain stimulator implantation. Psychometric assessment of performance indicated that the subjects could detect, interpret and respond accurately to the task stimuli using the joystick controller. We also demonstrate, using intraoperative neurophysiology recorded during the task, that the behavioral system described here allows us to examine neural correlates of human behavior. COMPARISON WITH EXISTING METHODS: For low cost and minimal effort, any clinical neural recording system can be adapted for intraoperative behavioral testing with our experimental setup. CONCLUSION: Our system will enable clinicians and basic scientists to conduct intraoperative awake and behaving electrophysiologic studies in humans.

Mismatch negativity reflects asymmetric pre-attentive harmonic interval discrimination.

OBJECTIVE: Western music is based on intervals; thus, interval discrimination is important for distinguishing the character of melodies or tracking melodies in polyphonic music. In this study the encoding of intervals in simultaneously presented sound is studied. STUDY DESIGN: In an electrophysiological experiment in 15 normal-hearing non-musicians, major thirds or fifths were presented in a controlled oddball paradigm. Harmonic intervals were created by simultaneously presented sinusoidals with randomized root frequency. Mismatch negativity (MMN) responses were measured with an EEG recording. The discrimination index was calculated in a psychoacoustic experiment. RESULTS: A clear MMN response was found for the major third but not for the fifth. The neural generators were located within the auditory cortices. Psychoacoustically, no evidence was found that the subjects were able to detect the deviants. CONCLUSIONS: We conclude that pre-attentive discrimination of harmonic interval size is, in principle, possible in listeners without musical training although simultaneous presentation makes it harder to distinguish compared to non-overlapping intervals. Furthermore we see a difference in the response to infrequent dissonant stimuli in consonant standard stimuli compared to the opposite, rare consonant stimuli in dissonant standard stimuli.

Imaging evaluation of electrode placement and effect on electrode discrimination on different cochlear implant electrode arrays.

OBJECTIVE: The aim of the present study is to evaluate the effect of electrode discrimination based on electrode to modiolus distance in different cochlear implant models, using image information to estimate the outcomes after an implantation on electrode discrimination METHODS: A descriptive prospective randomized study performed during 16 months. A psychoacoustic platform was used to evaluate patients' electrode discrimination capabilities of patients. For the acquisition of the images, a cone beam computed tomography was used to assess postcochlear implantation of electrodes' position. We considered two other new measurements: the intracochlear position index, which indicates how far is the electrode from the modiolar wall, and the homogeneity factor (HF), which provides us with information about the distance between the electrodes and the modiolus RESULTS: 21 postlingually deaf adults showing different CI models [CI522 (n = 7), CI512 (n = 7), and CI532 (n = 7)] that corresponded to the lateral and perimodiolar array electrodes. The average success rate of the CI522 group was 47%, of the CI512 group was 48%, and of the CI532 group was 77%. There is statistically significant difference between groups CI532-CI522 (p = 0.0033) and CI532-CI512 (p = 0.0027) CONCLUSION: The Nucleus CI532 offers a better perimodiolar placement. HF and IPI measurements provide information about the electrodes location inside the cochlea, being related to electrode discrimination.

Physiologic effects of voice stimuli in conscious and unconscious palliative patients-a pilot study.

BACKGROUND: Sounds and acoustic stimuli can have an effect on human beings. In medical care, sounds are often used as parts of therapies, e. g., in different types of music therapies. Also, human speech greatly affects the mental status. Although calming sounds and music are widely established in the medical field, clear evidence for the effect of sounds in palliative care is scare, and data about effects of the human voice in general are still missing. Thus, the aim of this study was to evaluate the effects of different voice stimuli on palliative patients. METHODS: Two different voice stimuli (one calm, the other turbulent) were presented in a randomized sequence, and physiological parameters (blood pressure, heart frequency, oxygen saturation, respiratory rate) were recorded. RESULTS: Twenty patients (14 conscious and 6 unconscious) participated in this study. There was a decrease of heart frequency as well as an increase of oxygen saturation in the group of conscious patients, whereas no significant change of blood pressure or respiratory rate were detected in either group, conscious and unconscious patients. CONCLUSIONS: Although our dataset is heterogeneous, it can be concluded that voice stimuli can influence conscious patients. However, in this setting, no effect on unconscious patients was demonstrated. More clinical research on this topic with larger groups and a broader spectrum of parameters is needed.

Spontaneous Otoacoustic Emissions in TectaY1870C/+ Mice Reflect Changes in Cochlear Amplification and How It Is Controlled by the Tectorial Membrane.

Spontaneous otoacoustic emissions (SOAEs) recorded from the ear canal in the absence of sound reflect cochlear amplification, an outer hair cell (OHC) process required for the extraordinary sensitivity and frequency selectivity of mammalian hearing. Although wild-type mice rarely emit, those with mutations that influence the tectorial membrane (TM) show an incidence of SOAEs similar to that in humans. In this report, we characterized mice with a missense mutation in Tecta, a gene required for the formation of the striated-sheet matrix within the core of the TM. Mice heterozygous for the Y1870C mutation (TectaY1870C/+ ) are prolific emitters, despite a moderate hearing loss. Additionally, Kimura's membrane, into which the OHC stereocilia insert, separates from the main body of the TM, except at apical cochlear locations. Multimodal SOAEs are also observed in TectaY1870C/+ mice where energy is present at frequencies that are integer multiples of a lower-frequency SOAE (the primary). Second-harmonic SOAEs, at twice the frequency of a lower-frequency primary, are the most frequently observed. These secondary SOAEs are found in spatial regions where stimulus-evoked OAEs are small or in the noise floor. Introduction of high-level suppressors just above the primary SOAE frequency reduce or eliminate both primary and second-harmonic SOAEs. In contrast, second-harmonic SOAEs are not affected by suppressors, either above or below the second-harmonic SOAE frequency, even when they are much larger in amplitude. Hence, second-harmonic SOAEs do not appear to be spatially separated from their primaries, a finding that has implications for cochlear mechanics and the consequences of changes to TM structure.

Repeated shock stress facilitates basolateral amygdala synaptic plasticity through decreased cAMP-specific phosphodiesterase type IV (PDE4) expression.

Previous studies have shown that exposure to stressful events can enhance fear memory and anxiety-like behavior as well as increase synaptic plasticity in the rat basolateral amygdala (BLA). We have evidence that repeated unpredictable shock stress (USS) elicits a long-lasting increase in anxiety-like behavior in rats, but the cellular mechanisms mediating this response remain unclear. Evidence from recent morphological studies suggests that alterations in the dendritic arbor or spine density of BLA principal neurons may underlie stress-induced anxiety behavior. Recently, we have shown that the induction of long-term potentiation (LTP) in BLA principal neurons is dependent on activation of postsynaptic D1 dopamine receptors and the subsequent activation of the cyclic adenosine 5'-monophosphate (cAMP)-protein kinase A (PKA) signaling cascade. Here, we have used in vitro whole-cell patch-clamp recording from BLA principal neurons to investigate the long-term consequences of USS on their morphological properties and synaptic plasticity. We provided evidence that the enhanced anxiety-like behavior in response to USS was not associated with any significant change in the morphological properties of BLA principal neurons, but was associated with a changed frequency dependence of synaptic plasticity, lowered LTP induction threshold, and reduced expression of phosphodiesterase type 4 enzymes (PDE4s). Furthermore, pharmacological inhibition of PDE4 activity with rolipram mimics the effects of chronic stress on LTP induction threshold and baseline startle. Our results provide the first evidence that stress both enhances anxiety-like behavior and facilitates synaptic plasticity in the amygdala through a common mechanism of PDE4-mediated disinhibition of cAMP-PKA signaling.

Resposta auditiva de estado estável e avaliação comportamental em crianças de 6 a 48 meses / Auditory steady-state response and behavioral avaluation in children between 6 to 48 monhts of age

RESUMO Objetivo Verificar como os limiares obtidos pelas respostas auditivas de estado estável (RAEE) podem estimar os limiares obtidos pela audiometria com reforço visual (VRA), em crianças com audição normal e perda auditiva de diversos graus. Métodos Foram avaliadas 41 crianças de ambos os sexos (28 crianças do sexo masculino e 13 do sexo feminino), com faixa etária de 18 a 48 meses. Foram pesquisadas as frequências de 500, 1000, 2000 e 4000 Hz, em ambos os métodos de avaliação, e avaliadas as orelhas separadamente, totalizando 82 orelhas, sendo 20 com audição normal e 62 com perda auditiva. Os limiares foram analisados para calcular suas correlações e outras variáveis. Resultados Os limiares não variaram significativamente, nem com a idade, nem com o sexo. Em média, foram observados limiares eletrofisiológicos maiores que os limiares comportamentais. Conclusão A técnica da RAEE possibilita a determinação dos limiares auditivos objetivamente, com uma considerável correlação com os limiares psicoacústicos, concordando com a literatura. Recomenda-se, entretanto, a realização de novos estudos brasileiros, que visem ao estabelecimento de critérios mínimos necessários para o planejamento e aplicação de protocolos, com fins de padronização, contribuindo com a validação diagnóstica.

ABSTRACT Purpose The objective of the following study was to verify how the thresholds obtained by ASSR can estimate the thresholds obtained by the VRA in children with normal hearing and hearing loss of different degrees. Methods Were evaluated 41 children of both sex (28 boys and 13 girls), on ages between 18 and 48 months. The thresholds were obtained with ASSR with multiple and simultaneous stimulation on frequencies of 500, 1000, 2000 and 4000Hz. The thresholds were obtained with VRA on each ear separately on frequencies of 500, 1000, 2000 and 4000Hz. Were evaluated 82 ears, 20 with normal hearing and 62 with hearing loss. The correlation between the thresholds was calculated. Results The findings of this study demonstrate that the thresholds didn't have a statistic relevant relation with variables of age and sex. Considering the mean, the eletrophysiological thresholds were higher than the behavioral. These findings suggest ASSR can determinate hearing thresholds objectively and with a high correlation with psychoacoustic thresholds obtained by the behavioral method. Conclusion We recommend, however that another Brazilian studies be made, so it can be established a minimum criteria necessary for the planning and application of pattern protocols, contributing with diagnostic validation of ASSR technique.

Importance of Perimodiolar Electrode Position for Psychoacoustic Discrimination in Cochlear Implantation.

HYPOTHESIS: Modiolar proximity of the cochlear implant electrodes and low impedance values have a positive effect on electrical pitch discrimination. BACKGROUND: The proximity of the cochlear electrode to the modiolar wall can determine changes in tissue and fluid environment. With the onset of soft-surgery techniques, the trauma caused during surgery has been reduced, minimizing fibrous growth. METHODS: Computed tomography-scan measurements of electrode-inner wall distance and psychoacoustic electrode discrimination tests were done. Neural Response Telemery and impedance data were used in the study. RESULTS: It was found that patients fitted with perimodiolar arrays have lower impedance values and smaller electrode-inner wall distances than those fitted with straight arrays. These variables were significantly correlated to electrode discrimination. It was found that a closer distance to the modiolus also results in better electrode discrimination. CONCLUSION: Perimodiolar electrodes could be a better solution in terms of pitch discrimination both because they are closer to the modiolus and because their impedance is lower.

Perception of Iterated Rippled Noise Periodicity in Cochlear Implant Users.

Pitch perception is more challenging for individuals with cochlear implants (CIs) than normal-hearing subjects because the signal processing by CIs is restricted. Processing and perceiving the periodicity of signals may contribute to pitch perception. Whether individuals with CIs can discern pitch within an iterated rippled noise (IRN) signal is still unclear. In a prospective controlled psychoacoustic study with 34 CI users and 15 normal-hearing control subjects, the difference limen between IRN signals with different numbers of iterations was measured. In 7 CI users and 15 normal-hearing control listeners with single-sided deafness, pitch matching between IRN and harmonic complex tones was measured. The pitch onset response (POR) following signal changes from white noise to IRN was measured electrophysiologically. The CI users could discriminate different numbers of iteration in IRN signals, but worse than normal-hearing listeners. A POR was measured for both normal-hearing subjects and CI users increasing with the pitch salience of the IRN. This indicates that the POR could serve as an objective measure to monitor progress during audioverbal therapy after CI surgery.